Doo Sun Sim1, Myung Ho Jeong2, Youngkeun Ahn1, Young Jo Kim3, Shung Chull Chae4, Taek Jong Hong5, In Whan Seong6, Jei Keon Chae7, Chong Jin Kim8, Myeong Chan Cho9, Seung-Woon Rha10, Jang Ho Bae11, Ki Bae Seung12, Seung Jung Park13. 1. Chonnam National University Hospital, Gwangju, Republic of Korea. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 3. Yeungnam University Hospital, Daegu, Republic of Korea. 4. Kyungpuk National University Hospital, Daegu, Republic of Korea. 5. Busan National University Hospital, Busan, Republic of Korea. 6. Chungnam National University Hospital, Daejon, Republic of Korea. 7. Chunbuk National University Hospital, Jeonju, Republic of Korea. 8. Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea. 9. Chungbuk National University Hospital, Cheongju, Republic of Korea. 10. Korea University Guro Hospital, Seoul, Republic of Korea. 11. Konyang University Hospital, Daejon, Republic of Korea. 12. Catholic University Seoul St. Mary's Hospital, Seoul, Republic of Korea. 13. Asan Medical Center, Seoul, Republic of Korea.
Abstract
BACKGROUND: The benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) remains uncertain, and the effect of TA in relation to total ischemic time has not been evaluated. METHODS: We analyzed 5641 patients with ST-elevation myocardial infarction (STEMI) (<12h) from the Korea Acute Myocardial Infarction Registry undergoing primary PCI. Patients were divided into 2 groups: TA (n=1245) and PCI only (n=4396). Propensity-matched 12-month clinical outcome was compared between the groups according to different total ischemic times (≤2h, 2-4h, 4-6h, >6h). RESULTS: Twelve-month rates of death and major adverse cardiac events (MACE: composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass grafting) were not different between TA and PCI only. After propensity matching (n=1162 for each group), there were no differences in the 12-month outcome between TA and PCI only, which was consistent across subgroups. In the propensity-matched cohort, the effect of TA on 12-month outcome showed a U-shaped relationship with longer total ischemic time: TA in patients with total ischemic time between 4 and 6h was associated with lower rates of death [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.24-1.19, p for interaction=0.01] and MACE (HR: 0.28, 95% CI: 0.12-0.66, p for interaction=0.01). CONCLUSIONS: Manual TA during primary PCI was not associated with improved clinical outcome at 12 months. The impact of TA may become clinically relevant with longer total ischemic time, forming a U-shaped relationship.
BACKGROUND: The benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) remains uncertain, and the effect of TA in relation to total ischemic time has not been evaluated. METHODS: We analyzed 5641 patients with ST-elevation myocardial infarction (STEMI) (<12h) from the Korea Acute Myocardial Infarction Registry undergoing primary PCI. Patients were divided into 2 groups: TA (n=1245) and PCI only (n=4396). Propensity-matched 12-month clinical outcome was compared between the groups according to different total ischemic times (≤2h, 2-4h, 4-6h, >6h). RESULTS: Twelve-month rates of death and major adverse cardiac events (MACE: composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass grafting) were not different between TA and PCI only. After propensity matching (n=1162 for each group), there were no differences in the 12-month outcome between TA and PCI only, which was consistent across subgroups. In the propensity-matched cohort, the effect of TA on 12-month outcome showed a U-shaped relationship with longer total ischemic time: TA in patients with total ischemic time between 4 and 6h was associated with lower rates of death [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.24-1.19, p for interaction=0.01] and MACE (HR: 0.28, 95% CI: 0.12-0.66, p for interaction=0.01). CONCLUSIONS: Manual TA during primary PCI was not associated with improved clinical outcome at 12 months. The impact of TA may become clinically relevant with longer total ischemic time, forming a U-shaped relationship.
Authors: Rafał Januszek; Zbigniew Siudak; Krzysztof P Malinowski; Roman Wojdyła; Piotr Mika; Wojciech Wańha; Tomasz Kameczura; Andrzej Surdacki; Wojciech Wojakowski; Jacek Legutko; Stanisław Bartuś Journal: J Clin Med Date: 2020-11-09 Impact factor: 4.241