Key result
Thrombus aspiration during primary PCI for STEMI with large thrombus burden improved postprocedural TIMI 3 flow (94.2% vs 83.3%) but did not improve 12-month clinical prognosis.
Why the study?
The benefit of thrombus aspiration during PPCI in STEMI patients remains controversial, particularly in those with a large thrombus burden.
Does thrombus aspiration during primary PCI improve procedural outcomes and clinical prognosis in patients with STEMI and a large thrombus burden?
Cohort (n=334)
Does thrombus aspiration during primary PCI improve procedural outcomes and clinical prognosis in patients with STEMI and a large thrombus burden?
Absolute Event Rate: 94.2% vs 83.3%
Thrombus aspiration during primary PCI for STEMI with large thrombus burden improves procedural flow but does not significantly improve 12-month hard clinical outcomes.
TA may improve procedural success in STEMI with large thrombus burden; leaves open any clinical benefit pending randomized trials.
BACKGROUND: The benefit of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) to patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to assess TA's impact on the outcome and prognosis for patients with STEMI and a large thrombus burden during PPCI. METHODS: This retrospective study evaluated consecutive patients with STEMI and a large thrombus burden (thrombolysis in myocardial infraction [TIMI] thrombus grade ≥4) who underwent conventional PPCI (n = 126) or PPCI + TA (n = 208) between February 2017 and January 2019. The procedure outcome and clinical prognosis were compared. RESULTS: Postprocedural vessel diameter was larger, and corrected TIMI frame count (cTFC) was lower in the PPCI + TA compared with the PPCI group. The proportion of postprocedural TIMI 3 flow was 83.3% in the PPC group and 94.2% in the PPCI+TA group. During the 12-month follow-up, no significant differences existed in the incidence of cardiac death, reinfarction, stent thrombosis, target vessel revascularization, or stroke. CONCLUSION: Application of TA in patients with STEMI and a large thrombus burden during PPCI may improve the procedural outcome, but it showed no benefit on the clinical prognosis in the 12-month follow-up. Longer follow-up studies are needed to confirm TA's clinical implications in patients with STEMI.
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Zhang et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) with a large thrombus burden (n=334). Thrombus aspiration during primary percutaneous coronary intervention vs. Conventional primary percutaneous coronary intervention was evaluated on Postprocedural TIMI 3 flow. Thrombus aspiration during primary PCI for STEMI with large thrombus burden improved postprocedural TIMI 3 flow (94.2% vs 83.3%) but did not improve 12-month clinical prognosis.
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