Abstract 17966: Circadian Variation of Intracoronary Thrombus Aspiration Efficacy in Patients With St-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Introduction: The clinical benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) in patients with STEMI remains controversial. Different studies have suggested a circadian variation of myocardial infarction size (IS) among patients with STEMI depending on the time of the day at symptom onset.
Hypothesis: Clinical efficacy of manual TA varies according to circadian rhythms.
Methods: We analyzed data from a large, nationwide, prospective, multicenter registry of patients admitted with ACS in Switzerland (AMIS). Patients undergoing primary PCI for STEMI with (TA+) or without (TA-) manual TA within 12 hours of symptom onset were included. We divided 24 hours into 4 time groups based on the time of symptom onset: group 1 (00:00-05:59), group 2 (06:00-11:59), group 3 (12:00-17:59) and group 4 (18:00-23:59). The primary endpoint was in-hospital all-cause mortality.
Results: Between 2008 and 2014, a total of 3,648 patients (TA+, n=1,800; TA-, n=1,848) were included. In-hospital death of any cause occurred in 3.8% of the patients in the TA+ group, as compared with 3.7% in the TA- group (p=0.44). In-hospital mortality was not statistically different between the 4 time groups in TA+ and TA- patients (2.1%, 4.6%, 2.9% and 5.1% respectively in TA+ group, p=0.082 and 3.1%, 3.0%, 5.6% and 2.9% respectively in TA- group, p=0.098). We observed a circadian variation of myocardial IS in patients undergoing TA with larger myocardial IS occurring during the night period (group 1: 2,833±2,304 U/l; group 2: 2,449±2,336 U/l; group 3: 2,542±2,114 U/l; group 4: 2,995±2,424 U/l, p=0.001). Of note, there was a statistically significant net benefit of manual TA in terms of myocardial salvage in patients with symptom onset between 06:00 and 18:00 (groups 1 vs. 2: p<0.001; groups 1 vs. 3: p<0.05; groups 4 vs. 2: p<0.001; groups 4 vs. 3: p <0.05).
Conclusion: In a real-world registry of patients with STEMI, intracoronary TA during primary PCI was not associated with improved in-hospital all-cause mortality, independently of the time of symptom onset. However, our results suggest a circadian variation of the efficacy of manual TA with a significant reduction of myocardial IS in patients with symptom onset between 06:00 and 18:00.
Author Disclosures: S. Fournier: None. S. Hugelshofer: None. S. Degrauwe: None. P. P. Marques-Vidal: None. D. Radovanovic: None. P. Erne: None. E. Eeckhout: None. O. Muller: None. J. Iglesias: None.
- © 2015 by American Heart Association, Inc.