Journal Club 2 October 2013


Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction





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.


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.


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.


Routine thrombus aspiration before PCI as compared with PCI alone did not reduce
30-day mortality among patients with STEMI.

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