Key result
Combined thrombus aspiration and abciximab during primary PCI was associated with lower 1-year major adverse cardiovascular events (13% vs 29%; HR 0.48; 95% CI 0.28-0.84; P=0.01).
Why the study?
Does the combination of thrombus aspiration and abciximab reduce major adverse cardiovascular events in STEMI patients undergoing primary PCI?
Cohort (n=644)
Does the combination of thrombus aspiration and abciximab reduce major adverse cardiovascular events in STEMI patients undergoing primary PCI?
The combined use of thrombus aspiration and abciximab during primary PCI for STEMI is associated with improved 1-year clinical outcomes compared to conventional PCI.
BACKGROUND: Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use. METHODS AND RESULTS: A total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting (P < 0.001 vs. group 1 for both), presented higher rate of end-procedural TIMI flow grade 3 (P < 0.001 vs. group 1 for both), and lower rate of no-reflow (P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end-procedural TIMI flow grade 3 (P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log-rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28-0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95-0.98, P < 0.001) were significantly associated with lower MACE rate. CONCLUSIONS: The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1-year clinical outcome.
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Pyxaras et al. (2013) conducted a cohort in ST-segment elevation myocardial infarction (n=644). Thrombus aspiration and abciximab vs. Conventional primary percutaneous coronary intervention was evaluated on Composite of major adverse cardiovascular events (overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year (HR 0.48, 95% CI 0.28-0.84, p=0.01). Combined thrombus aspiration and abciximab during primary PCI was associated with lower 1-year major adverse cardiovascular events (13% vs 29%; HR 0.48; 95% CI 0.28-0.84; P=0.01).
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