Conflict of interest: Dennis W.T. Nilsen, MD, PhD: None; Roxana Mehran, MD: Research Grants (institutional)—BMS/Sanofi, The Medicines Co., Lilly/Daiichi Sankyo. Advisory Board—Regado. Consultant—AstraZeneca, Abbott, Johnson & Johnson, Merck Sharp & Dohme, Maya Medical; Roland Wu, MD: None; Jan E. Nordrehaug, MD, PhD: None; Bruce B. Brodie, MD: None; Bernhard Witzenbichler, MD: Lecture Fees (modest) from Boston Scientific and the Medicines Company; Jennifer Yu, MBBS: None; Eugenia Nikolsky, MD: None; Martin Fahy, MSc: None; Gregg W. Stone, MD: Consultant to Medtronic, Boston Scientific, Abbott Vascular and the Medicines Company.
Coronary Artery Disease
Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: Findings from the HORIZONS-AMI trial
Article first published online: 26 JUN 2013
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 82, Issue 4, pages 594–601, 1 October 2013
How to Cite
Nilsen, D. W.T., Mehran, R., Wu, R. S., Yu, J., Nordrehaug, J. E., Brodie, B. R., Witzenbichler, B., Nikolsky, E., Fahy, M. and Stone, G. W. (2013), Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: Findings from the HORIZONS-AMI trial. Cathet. Cardiovasc. Intervent., 82: 594–601. doi: 10.1002/ccd.24705
- Issue published online: 23 SEP 2013
- Article first published online: 26 JUN 2013
- Accepted manuscript online: 16 OCT 2012 10:47AM EST
- Manuscript Accepted: 7 OCT 2012
- Manuscript Received: 11 SEP 2012
- thrombus aspiration;
- primary PCI;
To assess the quality of coronary reperfusion and long-term clinical outcomes of patients enrolled in the HORIZONS-AMI trial according to the use of thrombus aspiration (TA).
The impact of manual TA on microvascular perfusion and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unsettled.
In this retrospective, nonrandomized, subgroup analysis, the authors evaluated thrombolysis in myocardial infarction (TIMI) flow, tissue myocardial perfusion grade (TMPG), ST-segment resolution (STR), net adverse clinical events (NACE), and major adverse cardiac events (MACE) in patients undergoing pPCI with or without manual TA.
A total of 318 patients had pPCI with upfront TA, and 2,917 patients had pPCI without TA. Patients who had TA were more likely to have TIMI 0/1 flow at baseline (75.1% vs. 63.7%, P < 0.0001). There was no difference in the rates of final TIMI 3 flow (90.2% vs. 92.3%, P = 0.19) or dynamic TMPG 2-3 (77.4% vs. 76.4%, P = 0.68). STR ≥70% was similar in both groups at 60 minutes but higher in the TA group at discharge (71.8% vs. 64.6%, P = 0.02). After multivariable adjustment, TA did not predict MACE at 30 days (HR 0.96 [0.51–1.80], P = 0.90), 1 year (HR 1.03 [0.68–1.55], P = 0.89), or 3 years (HR 1.13 [0.86–1.48], P = 0.39). Stent thrombosis did not differ at 1 year or 3 years.
In STEMI patients undergoing pPCI, the use of manual TA was associated with improved STR at discharge, but not with any difference in final TIMI flow, TMPG, or MACE. © 2012 Wiley Periodicals, Inc.