Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction.

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Abstract

Background The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality. Methods We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days. Results No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI. Conclusions Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404 .).

Details

Authors
  • Ole Fröbert
  • Bo Lagerqvist
  • Göran Olivecrona
  • Elmir Omerovic
  • Thorarinn Gudnason
  • Michael Maeng
  • Mikael Aasa
  • Oskar Angerås
  • Fredrik Calais
  • Mikael Danielewicz
  • Lars Hellsten
  • Agneta C Johansson
  • Amra Kåregren
  • Johan Nilsson
  • Lotta Robertson
  • Lennart Sandhall
  • Iwar Sjögren
  • Ollie Ostlund
  • Stefan K James
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)1587-1597
JournalNew England Journal of Medicine
Volume369
Issue number17
Publication statusPublished - 2013
Publication categoryResearch
Peer-reviewedYes

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