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Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit

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Abstract

Data regarding clinical efficacy of thrombectomy in patients with acute myocardial infarction (AMI) have been still limited in Japan. Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary percutaneous coronary intervention (PCI) results and in-hospital prognoses were retrospectively compared between AMI patients with totally occluded infarct-related artery (IRA) (TIMI flow grade 0) undergoing thrombus aspiration during primary PCI (with-aspiration patients, n = 568) and those without thrombus aspiration (without-aspiration patients, n = 266). The with-aspiration patients were more likely to have higher TIMI grade in the IRA immediately after primary PCI, and had a lower in-hospital mortality rate than the without-aspiration patients. According to a multivariate analysis, thrombectomy as well as stent usage was found to be independent predictor of final TIMI flow grade ≥2 in the IRA, and the final TIMI flow grade ≥2 in the IRA was found to be an independent factor for in-hospital survival. These results suggest that among real-world, unselected Japanese AMI patients with totally occluded IRA on initial coronary angiography, thrombus aspiration is an effective adjunctive therapy during primary PCI to improve final epicardial coronary flow in the IRA, which might lead to better in-hospital prognosis.

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Authors and Affiliations

  1. Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Jun Shiraishi, Yoshio Kohno, Takashi Yanagiuchi, Sho Hashimoto, Daisuke Ito, Masayoshi Kimura, Akihiro Matsui, Hirokazu Yokoi, Masayuki Hyogo, Takatomo Shima & Takahisa Sawada

  2. Department of Emergency Medicine, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Masayasu Arihara

  3. Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Takeshi Nakamura, Satoaki Matoba, Hiroyuki Yamada, Akiyoshi Matsumuro & Takeshi Shirayama

  4. Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan

    Makoto Kitamura

  5. Department of Cardiology, Tanabe Central Hospital, Kyotanabe, Japan

    Keizo Furukawa

Authors
  1. Jun Shiraishi
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  2. Yoshio Kohno
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  3. Takeshi Nakamura
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  4. Takashi Yanagiuchi
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  5. Sho Hashimoto
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  6. Daisuke Ito
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  7. Masayoshi Kimura
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  8. Akihiro Matsui
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  9. Hirokazu Yokoi
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  10. Masayasu Arihara
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  11. Masayuki Hyogo
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  12. Takatomo Shima
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  13. Takahisa Sawada
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  14. Satoaki Matoba
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  15. Hiroyuki Yamada
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  16. Akiyoshi Matsumuro
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  17. Takeshi Shirayama
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  18. Makoto Kitamura
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  19. Keizo Furukawa
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Corresponding author

Correspondence to Jun Shiraishi.

Additional information

On behalf of the AMI-Kyoto Multi-Center Risk Study Group, the members of the group are listed in “Appendix”.

Appendix

Appendix

The following institutions and principal investigators participated in the present study as the AMI-Kyoto Multi-Center Risk Study Group: Kyoto City Hospital: Okada T, Shima M, Kiyama M, Takamiya A, Nakajima N, Matsunaga S; Kyoto Kidugawa Hospital: Miyanaga H, Nakagawa T, Matsui H, Kunieda Y; Kyoto Second Red Cross Hospital: Fujita H, Inoue K, Matsuo A, Kimura S, Sakatani T, Isodono K, Tsubakimoto Y; Social Insurance Kyoto Hospital: Yamada C, Tanabe S, Yamahara Y, Katamura M; Tanabe Central Hospital: Kusuoka S, Nishio M, Nishizawa S; Nantan General Hospital: Tatsumi T, Keira N, Nomura T; Ayabe Municipal Hospital: Shiga K, Kohno Y, Adachi Y; Maizuru Medical Center: Harada Y, Hikosaka T, Nakagami T; Kyoto Saiseikai Hospital: Ishibashi K; Gakkentoshi Hospital: Sakai R; Kouseikai Takeda Hospital: Matsumoto K, Kinoshita N, Sawanishi T, Nakamura R; Kameoka Municipal Hospital: Matsuo R; Aiseikai Yamashina Hospital: Shirai H, Kosugi Y; Fukuchiyama Municipal Hospital: Sakamoto T; Yamashiro Public Hospital: Tomiyasu K; Saiseikai Shiga Hspital: Nakamura T, Nakahara Y, Kurata H, Hadase M; Omihachiman Community Medical Center: Maki K, Tatsukawa H, Zen K, Kambayashi D; Kyoto Prefectural Yosanoumi Hospital: Takada H; Kyoto Prefectural University School of Medicine: Shiraishi H, Yamano T.

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Shiraishi, J., Kohno, Y., Nakamura, T. et al. Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit. Cardiovasc Interv and Ther 30, 22–28 (2015). https://doi.org/10.1007/s12928-014-0282-4

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  • DOI: https://doi.org/10.1007/s12928-014-0282-4

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