Conflicts of interest: Nothing to report.
Coronary Artery Disease
Adjunctive thrombus aspiration versus conventional percutaneous coronary intervention in ST-elevation myocardial infarction
Article first published online: 3 OCT 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 6, pages 922–929, May 2013
How to Cite
Kikkert, W. J., Claessen, B. E., van Geloven, N., Baan, J., Vis, M. M., Koch, K. T., Piek, J. J., Tijssen, J. G.P. and Henriques, J. P.S. (2013), Adjunctive thrombus aspiration versus conventional percutaneous coronary intervention in ST-elevation myocardial infarction. Cathet. Cardiovasc. Intervent., 81: 922–929. doi: 10.1002/ccd.24592
- Issue published online: 19 APR 2013
- Article first published online: 3 OCT 2012
- Accepted manuscript online: 6 AUG 2012 05:29AM EST
- Manuscript Accepted: 30 JUL 2012
- Manuscript Received: 19 APR 2012
- thrombus aspiration;
- ST-segment elevation myocardial infarction
The objective of this analysis is to determine the effects on mortality of thrombus aspiration during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) compared with conventional PCI.
Adjunctive thrombus aspiration in STEMI improves markers of myocardial reperfusion but evidence for improved survival is limited to the TAPAS trial.
We used data of 3,750 consecutive STEMI patients treated with either conventional PCI or thrombus aspiration between August 1, 2001 and January 1, 2009. For each patient, a propensity score was calculated based on clinical and angiographic characteristics, predicting a patient's probability of having been treated with thrombus aspiration. This propensity score was used in several ways to account for differences between patients treated with and without thrombus aspiration. In our primary analysis, patients treated with thrombus aspiration were matched one-to-one with patients treated with conventional PCI on their propensity score (1,391 matched pairs). Kaplan Meier and Cox regression models were used to estimate the influence of treatment on one-year mortality.
In total, 1,502 patients (40.1%) were treated with thrombus aspiration. In the propensity matched cohort, after one year 7.2% of patients treated with thrombus aspiration had died compared with 9.3% of patients in the control group. The hazard ratio for one-year mortality in patients treated with thrombus aspiration was 0.76 (95% CI: 0.59–0.99; P = 0.043). The hazard ratio remained materially unaltered and statistically significant in secondary analyses, varying between 0.61 and 0.77.
The routine use of thrombus aspiration was associated with reduced one-year mortality in this large real-world patient cohort. These data support the observed survival benefit in the TAPAS trial. © 2012 Wiley Periodicals, Inc.