Chonnam Med J.  2020 Jan;56(1):36-43. 10.4068/cmj.2020.56.1.36.

Impact of Thrombus Aspiration on Clinical Outcomes in Korean Patients with ST Elevation Myocardial Infarction

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea. jojeong@cnu.ac.kr
  • 2Chungbuk Regional Cardiovascular Disease Center, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 3Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju, Korea.

Abstract

We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.

Keyword

Myocardial Infarction; Percutaneous Coronary Intervention; Thrombectomy

MeSH Terms

Coronary Angiography
Follow-Up Studies
Humans
Korea
Mortality
Myocardial Infarction*
Percutaneous Coronary Intervention
Propensity Score
Stroke
Thrombectomy
Thrombosis*

Figure

  • FIG. 1 Study population flow chart. From the Korean Acute Myocardial Infarction Registry - National Institute of Health (KAMIR-NIH), we analyzed a total of 13516 patients with acute myocardial infarction undergoing primary PCI. Inclusion criteria for the current study are the patients with STEMI who underwent coronary angiography and PCI within 12 hours of the onset of symptoms, pre-procedural TIMI flow 0, 1 and follow-up for 1-year. As a result, 2119 patients of PCI alone group and 1630 patients of PCI with TA group were enrolled, respectively. NSTEMI: non ST-segment elevation myocardial infarction, STEMI: ST-segment elevation myocardial infarction, PCI: percutaneous coronary intervention, TIMI: Thrombolysis In Myocardial Infarction, TA: thrombus aspiration.

  • FIG. 2 Kaplan-Meier curve of MACE at 1-year between PCI alone and PCI with TA in propensity-matched cohort. The rate of MACE at 1-year follow-up was no significant difference between the two groups. MACE: major adverse cardiac events, PCI: percutaneous coronary intervention, TA: thrombus aspiration.

  • FIG. 3 Subgroup analysis: unadjusted hazard ratio (HR) for 1-year MACE in propensity score matched patients. HR of various subgroup were analyzed in propensity score matched patients during 1-year follow up. MACE was not reduced in PCI with TA group in any subgroups. HR of overall patients was adjusted result. MACE was not also reduced in PCI with TA group in overall patients. PCI: percutaneous coronary intervention, TA: thrombus aspiration, CVD: cardiovascular death, MI: myocardial infarction, MACE: major adverse cardiovascular event, HR: hazard ratio, TIMI: Thrombolysis in Myocardial infarction.


Reference

1. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008; 358:557–567.
Article
2. Costopoulos C, Gorog DA, Di Mario C, Kukreja N. Use of thrombectomy devices in primary percutaneous coronary intervention: a systematic review and meta-analysis. Int J Cardiol. 2013; 163:229–241.
Article
3. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, et al. Cardiac death and reinfarction after 1 year in the thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS): a 1-year follow-up study. Lancet. 2008; 371:1915–1920.
Article
4. Sardella G, Mancone M, Bucciarelli-Ducci C, Agati L, Scardala R, Carbone I, et al. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial. J Am Coll Cardiol. 2009; 53:309–315.
Article
5. De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J. 2008; 29:3002–3010.
Article
6. Burzotta F, De Vita M, Gu YL, Isshiki T, Lefèvre T, Kaltoft A, et al. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J. 2009; 30:2193–2203.
Article
7. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. TOTAL Investigators. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015; 372:1389–1398.
Article
8. Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. TASTE Trial. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013; 369:1587–1597.
Article
9. Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, et al. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med. 2014; 371:1111–1120.
Article
10. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39:119–177.
11. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2016; 133:1135–1147.
12. Ryan TJ, Bauman WB, Kennedy JW, Kereiakes DJ, King SB 3rd, McCallister BD, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1993; 88:2987–3007.
Article
13. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999; 33:1756–1824.
Article
14. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 writing group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 writing committee. Circulation. 2008; 117:296–329.
Article
15. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, Jacobs AK, Morrison DA, Williams DO, et al. 2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines: 2007 writing group to review new evidence and update the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention, writing on behalf of the 2005 writing committee. Circulation. 2008; 117:261–295.
Article
16. Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J. 2008; 29:2989–3001.
Article
17. Elgendy IY, Huo T, Bhatt DL, Bavry AA. Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials. Circ Cardiovasc Interv. 2015; 8:e002258.
Article
18. Hachinohe D, Jeong MH, Saito S, Kim MC, Cho KH, Ahmed K, et al. Korea Acute Myocardial Infarction Registry Investigators. Clinical impact of thrombus aspiration during primary percutaneous coronary intervention: results from Korea Acute Myocardial Infarction Registry. J Cardiol. 2012; 59:249–257.
Article
19. Sim DS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, et al. other Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Manual thrombus aspiration during primary percutaneous coronary intervention: impact of total ischemic time. J Cardiol. 2017; 69:428–435.
Article
20. Bajaj NS, Ather S, Gaba S, Aggarwal H, Arora P, Ghimire G, et al. Glycoprotein IIb/IIIa inhibitors improve mortality after aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Int J Cardiol. 2015; 187:206–207.
Article
21. Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, et al. INFUSE-AMI Investigators. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012; 307:1817–1826.
Article
22. Sim DS, Ahn Y, Kim YH, Lee D, Seon HJ, Park KH, et al. Effect of manual thrombus aspiration during primary percutaneous coronary intervention on infarct size: evaluation with cardiac computed tomography. Int J Cardiol. 2013; 168:4328–4330.
Article
23. Quadros AS, Cambruzzi E, Sebben J, David RB, Abelin A, Welter D, et al. Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: clinical and angiographic outcomes. Am Heart J. 2012; 164:553–560.
Article
24. van 't Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998; 97:2302–2306.
25. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93:879–888.
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