Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: Findings from the HORIZONS-AMI trial

Authors

  • Dennis W.T. Nilsen MD, PhD,

    Corresponding author
    1. Institute of Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
    • Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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  • Roxana Mehran MD,

    1. Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
    2. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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    • 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.

  • Roland S. Wu MD,

    1. Division of Cardiology, Columbia University Medical Center, New York, New York
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    • 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.

  • Jennifer Yu MBBS,

    1. Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
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  • Jan E. Nordrehaug MD, PhD,

    1. Institute of Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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    • 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.

  • Bruce R. Brodie MD,

    1. LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina
    2. Cone Health Heart & Vascular Center, Moses Cone Hospital, Greensboro, North Carolina
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    • 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.

  • Bernhard Witzenbichler MD,

    1. Department of Cardiology and Pulmonology, Charité–University Medicine, Berlin, Germany
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    • 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.

  • Eugenia Nikolsky MD, PhD,

    1. Department of Cardiology, Rambam Health Care Campus and the Technion—Israel Institute of Technology, Haifa, Israel
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    • 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.

  • Martin Fahy MSC,

    1. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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    • 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.

  • Gregg W. Stone MD

    1. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
    2. Division of Cardiology, Columbia University Medical Center, New York, New York
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    • 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.


Correspondence to: Dennis W.T. Nilsen, MD, PhD, FESC, FACC, FAHA, Prof. of Medicine, University of Bergen, Director Div. of Interventional Cardiology and Pacemaker Clinic, Stavanger University Hospital, PO 8100, 4068 Stavanger, Norway. E-mail: dnilsen1@getmail.no

Abstract

Objectives

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).

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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