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) (6. h). 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 6. h 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.
| Original language | English |
|---|---|
| Journal | Journal of Cardiology |
| DOIs | |
| Publication status | Accepted/In press - 2015 Sep 12 |
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Keywords
- Myocardial infarction
- Percutaneous coronary intervention
- Thrombectomy
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Manual thrombus aspiration during primary percutaneous coronary intervention : Impact of total ischemic time. / Sim, Doo Sun; Jeong, Myung Ho; Ahn, Youngkeun; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Rha, Seung-Woon; Bae, Jang Ho; Seung, Ki Bae; Park, Seung Jung.
In: Journal of Cardiology, 12.09.2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Manual thrombus aspiration during primary percutaneous coronary intervention
T2 - Impact of total ischemic time
AU - Sim, Doo Sun
AU - Jeong, Myung Ho
AU - Ahn, Youngkeun
AU - Kim, Young Jo
AU - Chae, Shung Chull
AU - Hong, Taek Jong
AU - Seong, In Whan
AU - Chae, Jei Keon
AU - Kim, Chong Jin
AU - Cho, Myeong Chan
AU - Rha, Seung-Woon
AU - Bae, Jang Ho
AU - Seung, Ki Bae
AU - Park, Seung Jung
PY - 2015/9/12
Y1 - 2015/9/12
N2 - 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) (6. h). 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 6. h 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.
AB - 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) (6. h). 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 6. h 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.
KW - Myocardial infarction
KW - Percutaneous coronary intervention
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=84957895097&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84957895097&partnerID=8YFLogxK
U2 - 10.1016/j.jjcc.2016.01.003
DO - 10.1016/j.jjcc.2016.01.003
M3 - Article
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
ER -