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Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study

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Abstract

The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P = 0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405–959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P = 0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90–0.71; P = 0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge (P = 0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 (P = 0.14), left ventricular ejection fraction (P = 0.47), and non-fatal reinfarction during follow-up (P = 0.17). Rehospitalization rate (1.82 vs. 10.3%; P < 0.0001) and Canadian Cardiovascular Society (CCS) grading (P = 0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients.

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Abbreviations

ATT:

Average treatment effect of the treated

AMI:

Acute myocardial infarction

CABG:

Coronary artery bypass graft

CCS:

Canadian Cardiovascular Society

CI:

Confidence interval

CK:

Creatine kinase

ECG:

12-Lead electrocardiogram

FMC:

First medical contact

GP:

Glycoprotein

HR:

Hazard ratio

ICU:

Intensive care unit

IPTW:

Inverse probability treatment weighting

IQR:

Inter quartile range

LBBB:

Left bundle branch block

LVEF:

Left ventricular ejection fraction

OR:

Odds ratio

PPCI:

Primary percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

TA:

Thrombus aspiration

TIMI flow-grade:

Thrombolysis in myocardial infarction flow-grade

Twang:

Toolkit for Weighting and Analysis of Nonequivalent Groups

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Acknowledgements

We thank Elizabeth Martinson, PhD, from the KHFI Editorial Office for her editorial assistance.

Author contributions

JB: data management, first draft of the manuscript; SK: data management, first draft of the manuscript; JL: treatment and follow-up of patients, data interpretation, proofreading the manuscript; AM: statistic, interpretation of data, proofreading of the manuscript; W-KK: treatment of patients, proofreading of the manuscript; JSW: follow up of patients, proofreading of the manuscript; MA: follow up of patients, data management, proofreading of the manuscript; KW: follow up of patients, data management, proofreading of the manuscript; MB: treatment and follow up of patients, proofreading of the manuscript; OD: treatment and follow up of patients, proofreading of the manuscript; CW: treatment of patients, proofreading of the manuscript; CH: treatment of patients, proofreading of the manuscript; HN: treatment of patients, proofreading of the manuscript; HM: conception of the study, treatment of patients, proofreading of the manuscript and CL: conception of the study, treatment of patients, proofreading of the manuscript.

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

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Author notes

  1. Johannes Blumenstein, Steffen Kriechbaum, Christoph Liebetrau and Helge Möllmann have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Johannes Blumenstein, Steffen Daniel Kriechbaum, Jürgen Leick, Won-Keun Kim, Jan Sebastian Wolter, Claudia Walther, Christian W. Hamm, Holger Nef, Christoph Liebetrau & Helge Möllmann

  2. Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Benekestraße 2-8, 61231, Bad Nauheim, Germany

    Alexander Meyer

  3. Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany

    Won-Keun Kim, Maisun Abu-Samra, Kay Weipert, Matthias Bayer, Oliver Dörr, Christian W. Hamm, Holger Nef & Christoph Liebetrau

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  1. Johannes Blumenstein
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Corresponding author

Correspondence to Steffen Daniel Kriechbaum.

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The authors declare that they have no competing interest.

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The local ethics committee of the Justus Liebig University of Giessen Medical School approved this study, and the study was performed according to the principles of the Declaration of Helsinki.

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Blumenstein, J., Kriechbaum, S.D., Leick, J. et al. Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study. J Thromb Thrombolysis 45, 240–249 (2018). https://doi.org/10.1007/s11239-017-1601-2

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