Key result
Manual thrombus aspiration significantly reduced the 4-week rate of major adverse cardiac events (2.7% vs 11.8%) compared to conventional PCI in STEMI patients with heavy thrombus burden.
Why the study?
Although routine thrombus aspiration during primary PCI is not recommended, uncertainty remained regarding its role and benefit in STEMI patients with a large thrombus burden on initial coronary angiography.
Does manual thrombus aspiration improve clinical and angiographic outcomes in STEMI patients with heavy thrombus burden undergoing primary PCI?
Observational (n=209)
No
Does manual thrombus aspiration improve clinical and angiographic outcomes in STEMI patients with heavy thrombus burden undergoing primary PCI?
Absolute Event Rate: 2.7% vs 11.8%
p-value: p=0.02
In STEMI patients with high thrombus burden, manual thrombus aspiration during primary PCI significantly improved 1-month mortality, myocardial perfusion, and LV systolic function compared to conventional PCI.
Should not yet change STEMI PCI practice; leaves open selective benefit pending randomized confirmation.
BACKGROUND: Routine thrombus aspiration during primary PCI does not improve clinical outcomes. Although recent guidelines for management of patient presented by ST-elevation myocardial infarction treated by primary PCI does not recommend routine use of thrombus aspiration and ranking it as class III recommendation. However, there is remaining uncertainty about rule of TA in group of patients presented by STEMI and their initial coronary angiogram shows large thrombus burden as there is a logical rationale for greater benefit, and still, there are no clear guidelines for management of this group of patients; the aim of this study is to evaluate the in-hospital and short-term outcome of using manual thrombus aspiration in STEMI patients undergoing primary PCI and showing large thrombus burden. RESULTS: The study was prospective observational study included 209 patients referred to coronary care unit (CCU) with diagnosis of STEMI who had undergone primary PCI; their initial coronary angiography show totally occluded infarct-related artery with heavy thrombus burden. Patients were divided into 2 groups: group (B) which included 73 patients, who had undergone PTCA and manual thrombus aspiration followed by stent to culprit lesion, and group (A) which included 136 patients, who had undergone conventional PTCA and stent of culprit lesion within the period from November 2016 till July 2018. Patients had a pre-discharge echo and were followed up for 4 weeks for major adverse cardiac events (MACE) and echo repeated after 1 month of discharge. It was found that thrombus aspiration in heavy thrombus burden cases had improved in-hospital mortality and in-hospital secondary endpoints (TIMI flow, MBG, ST-segment resolution), as well as 30-day MACE and LV systolic function. CONCLUSION: In patients presented with STEMI and heavy thrombus burden culprit artery, manual thrombus aspiration has great value in reducing index hospitalization and 1 month mortality and improve TIMI flow, MBG, ST-segment resolution, and left ventricular systolic function.
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Elfekky et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) with heavy thrombus burden (n=209). Manual thrombus aspiration vs. Conventional percutaneous coronary intervention was evaluated on Major adverse cardiac events (MACE) at 4 weeks (p=0.02). Manual thrombus aspiration significantly reduced the 4-week rate of major adverse cardiac events (2.7% vs 11.8%) compared to conventional PCI in STEMI patients with heavy thrombus burden.
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