Manual thrombus aspiration during primary percutaneous coronary intervention

Impact of total ischemic time

Doo Sun Sim, Myung Ho Jeong, Youngkeun Ahn, Young Jo Kim, Shung Chull Chae, Taek Jong Hong, In Whan Seong, Jei Keon Chae, Chong Jin Kim, Myeong Chan Cho, Seung-Woon Rha, Jang Ho Bae, Ki Bae Seung, Seung Jung Park

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - 2015 Sep 12

Fingerprint

Percutaneous Coronary Intervention
Thrombosis
Confidence Intervals
Cohort Effect
Mortality
Coronary Artery Bypass
Myocardial Infarction

Keywords

  • Myocardial infarction
  • Percutaneous coronary intervention
  • Thrombectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sim, D. S., Jeong, M. H., Ahn, Y., Kim, Y. J., Chae, S. C., Hong, T. J., ... Park, S. J. (Accepted/In press). Manual thrombus aspiration during primary percutaneous coronary intervention: Impact of total ischemic time. Journal of Cardiology. https://doi.org/10.1016/j.jjcc.2016.01.003

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 journalArticle

Sim, DS, Jeong, MH, Ahn, Y, Kim, YJ, Chae, SC, Hong, TJ, Seong, IW, Chae, JK, Kim, CJ, Cho, MC, Rha, S-W, Bae, JH, Seung, KB & Park, SJ 2015, 'Manual thrombus aspiration during primary percutaneous coronary intervention: Impact of total ischemic time', Journal of Cardiology. https://doi.org/10.1016/j.jjcc.2016.01.003
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. / Manual thrombus aspiration during primary percutaneous coronary intervention : Impact of total ischemic time. In: Journal of Cardiology. 2015.
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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

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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.

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KW - Myocardial infarction

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