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Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction
Uppsala Univ, Dept Med Sci, Cardiol Sect, S-75185 Uppsala, Sweden.;Uppsala Univ, Uppsala Clin Res Ctr, S-75185 Uppsala, Sweden..
Orebro University Hospital. Department of Cardiology.
Lund Univ, Dept Coronary Heart Dis, Skane Univ Hosp, Clin Sci Sect, Lund, Sweden..
Landspitali Univ Hosp, Dept Cardiol, Reykjavik, Iceland.;Landspitali Univ Hosp, Cardiovasc Res Ctr, Reykjavik, Iceland..
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2014 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 12, 1111-1120 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration.

METHODS: We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial.

RESULTS: No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P = 0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P = 0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P = 0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P = 0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI.

CONCLUSIONS: Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year.

Place, publisher, year, edition, pages
Massachusetts Medical Society , 2014. Vol. 371, no 12, 1111-1120 p.
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-56540DOI: 10.1056/NEJMoa1405707ISI: 000341687300006PubMedID: 25176395Scopus ID: 2-s2.0-84907424166OAI: oai:DiVA.org:oru-56540DiVA: diva2:1082684
Available from: 2017-03-17 Created: 2017-03-17 Last updated: 2017-03-27Bibliographically approved

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Fröbert, OleCalais, FredrikLundin, Anders
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