Skip to main content
SpringerLink
Log in

Use and outcome of thrombus aspiration in patients with primary PCI for acute ST-elevation myocardial infarction: results from the multinational Euro Heart Survey PCI Registry

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The clinical benefit of thrombus aspiration (TA) in patients presenting with acute ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI) is not well defined. Furthermore, there is a large variation in the use of TA in real-world registries. Between 2005 and 2008, a total of 7146 consecutive patients with acute STEMI undergoing primary PCI were prospectively enrolled into the PCI Registry of the Euro Heart Survey Programme. For the present analysis, patients treated additionally with TA (n = 897, 12.6 %) were compared with those without TA (n = 6249, 87.4 %). Patients with hemodynamic instability at initial presentation (15.1 vs. 11.0 %; p < 0.001) and resuscitation prior to PCI (10.4 vs. 7.4 %; p = 0.002) were more frequently treated with TA. TIMI flow grade 0/1 before PCI was more often found among those with TA (73.5 vs. 58.6 %; p < 0.001). After adjustment for confounding factors in the propensity score analysis, TA was not associated with improved in-hospital survival (risk difference −1.1 %, 95 % confidence interval −2.7 to 0.6 %). In this European real-world registry, the rate of TA use was low. Hemodynamically unstable patients were more likely to be treated with TA. Consistent with the results of the TASTE study and the TOTAL trial, TA was not associated with a significant reduction in short-term mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bauer T, Mollmann H, Weidinger F, Zeymer U, Seabra-Gomes R, Eberli F, Serruys P, Vahanian A, Silber S, Wijns W, Hochadel M, Nef HM, Hamm CW, Marco J, Gitt AK (2011) Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol 151:164–169

    Article  PubMed  Google Scholar 

  2. Bavry AA, Kumbhani DJ, Bhatt DL (2008) Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials. Eur Heart J 29:2989–3001

    Article  PubMed  Google Scholar 

  3. Block PC, Elmer D, Fallon JT (1982) Release of atherosclerotic debris after transluminal angioplasty. Circulation 65:950–952

    Article  CAS  PubMed  Google Scholar 

  4. Brener SJ, Witzenbichler B, Maehara A, Dizon J, Fahy M, El-Omar M, Dambrink JH, Genereux P, Mehran R, Oldroyd K, Parise H, Gibson CM, Stone GW (2013) Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion: the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction (INFUSE-AMI) trial. Am Heart J 166:64–70

    Article  PubMed  Google Scholar 

  5. Burzotta F, De Vita M, Gu YL, Isshiki T, Lefevre T, Kaltoft A, Dudek D, Sardella G, Orrego PS, Antoniucci D, De Luca L, Biondi-Zoccai GG, Crea F, Zijlstra F (2009) Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J 30:2193–2203

    Article  PubMed  Google Scholar 

  6. Colavita PG, Ideker RE, Reimer KA, Hackel DB, Stack RS (1986) The spectrum of pathology associated with percutaneous transluminal coronary angioplasty during acute myocardial infarction. J Am Coll Cardiol 8:855–860

    Article  CAS  PubMed  Google Scholar 

  7. De Luca G, Navarese EP, Suryapranata H (2013) A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol 166:606–612

    Article  PubMed  Google Scholar 

  8. De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann FJ, Van de Werf F, Antman EM, Topol EJ (2005) Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. JAMA 293:1759–1765

    Article  PubMed  Google Scholar 

  9. Fernandez-Rodriguez D, Alvarez-Contreras L, Martin-Yuste V, Brugaletta S, Ferreira I, De Antonio M, Cardona M, Marti V, Garcia-Picart J, Sabate M (2014) Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction? World J Cardiol 6:1030–1037

    Article  PubMed  PubMed Central  Google Scholar 

  10. Frobert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, Aasa M, Angeras O, Calais F, Danielewicz M, Erlinge D, Hellsten L, Jensen U, Johansson AC, Karegren A, Nilsson J, Robertson L, Sandhall L, Sjogren I, Ostlund O, Harnek J, James SK (2013) Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 369:1587–1597

    Article  CAS  PubMed  Google Scholar 

  11. Hachinohe D, Jeong MH, Saito S, Kim MC, Cho KH, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ (2012) Clinical impact of thrombus aspiration during primary percutaneous coronary intervention: results from Korea Acute Myocardial Infarction Registry. J Cardiol 59:249–257

    Article  PubMed  Google Scholar 

  12. Henriques JP, Zijlstra F, Ottervanger JP, de Boer MJ, van ‘t Hof AW, Hoorntje JC, Suryapranata H (2002) Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction. Eur Heart J 23:1112–1117

    Article  CAS  PubMed  Google Scholar 

  13. Jinnouchi H, Sakakura K, Wada H, Arao K, Kubo N, Sugawara Y, Funayama H, Momomura S, Ako J (2014) Transient no reflow following primary percutaneous coronary intervention. Heart Vessels 29:429–436

    Article  PubMed  Google Scholar 

  14. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemela K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Dzavik V (2015) Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 372:1389–1398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kelbaek H, Terkelsen CJ, Helqvist S, Lassen JF, Clemmensen P, Klovgaard L, Kaltoft A, Engstrom T, Botker HE, Saunamaki K, Krusell LR, Jorgensen E, Hansen HH, Christiansen EH, Ravkilde J, Kober L, Kofoed KF, Thuesen L (2008) Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial. J Am Coll Cardiol 51:899–905

    Article  PubMed  Google Scholar 

  16. Kilic S, Ottervanger JP, Dambrink JH, Hoorntje JC, Koopmans PC, Gosselink AT, Suryapranata H, van ‘t Hof AW (2014) The effect of thrombus aspiration during primary percutaneous coronary intervention on clinical outcome in daily clinical practice. Thromb Haemost 111:165–171

    Article  CAS  PubMed  Google Scholar 

  17. Lagerqvist B, Frobert O, Olivecrona GK, Gudnason T, Maeng M, Alstrom P, Andersson J, Calais F, Carlsson J, Collste O, Gotberg M, Hardhammar P, Ioanes D, Kallryd A, Linder R, Lundin A, Odenstedt J, Omerovic E, Puskar V, Todt T, Zelleroth E, Ostlund O, James SK (2014) Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 371:1111–1120

    Article  CAS  PubMed  Google Scholar 

  18. Lin TH, Lai WT, Kuo CT, Hwang JJ, Chiang FT, Chang SC, Chang CJ (2014) Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome: data from Taiwan Acute Coronary Syndrome Full Spectrum Registry. Heart Vessels 30(4):441–450

    Article  PubMed Central  Google Scholar 

  19. MacDonald RG, Feldman RL, Conti CR, Pepine CJ (1984) Thromboembolic complications of coronary angioplasty. Am J Cardiol 54:916–917

    Article  CAS  PubMed  Google Scholar 

  20. Mangiacapra F, Wijns W, De Luca G, Muller O, Trana C, Ntalianis A, Heyndrickx G, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E (2010) Thrombus aspiration in primary percutaneous coronary intervention in high-risk patients with ST-elevation myocardial infarction: a real-world registry. Catheter Cardiovasc Interv 76:70–76

    Article  PubMed  Google Scholar 

  21. Messas N, Hess S, Adraa AE, Ristorto J, Goiorani F, Brocchi J, Radulsecu B, Jesel L, Zupan M, Ohlmann P, Morel O (2014) Impact of manual thrombectomy on myocardial reperfusion as assessed by ST-segment resolution in STEMI patients treated by primary PCI. Arch Cardiovasc Dis 107:672–680

    Article  PubMed  Google Scholar 

  22. Minha S, Kornowski R, Vaknin-Assa H, Dvir D, Rechavia E, Teplitsky I, Brosh D, Bental T, Shor N, Battler A, Lev E, Assali A (2012) The impact of intracoronary thrombus aspiration on STEMI outcomes. Cardiovasc Revasc Med 13:167–171

    Article  PubMed  Google Scholar 

  23. Mongeon FP, Belisle P, Joseph L, Eisenberg MJ, Rinfret S (2010) Adjunctive thrombectomy for acute myocardial infarction: a bayesian meta-analysis. Circ Cardiovasc Interv 3:6–16

    Article  PubMed  Google Scholar 

  24. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, Matsui H, Toki Y, Ito T, Hayakawa T (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36:1202–1209

    Article  CAS  PubMed  Google Scholar 

  25. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso JE, Tracy CM, Woo YJ, Zhao DX (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127:529–555

    Article  PubMed  Google Scholar 

  26. Puymirat E, Aissaoui N, Cottin Y, Vanzetto G, Carrie D, Isaaz K, Valy Y, Tchetche D, Schiele F, Steg PG, Simon T, Danchin N (2014) Effect of coronary thrombus aspiration during primary percutaneous coronary intervention on one-year survival (from the FAST-MI 2010 Registry). Am J Cardiol 114:1651–1657

    Article  PubMed  Google Scholar 

  27. Resnic FS, Wainstein M, Lee MK, Behrendt D, Wainstein RV, Ohno-Machado L, Kirshenbaum JM, Rogers CD, Popma JJ, Piana R (2003) No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J 145:42–46

    Article  PubMed  Google Scholar 

  28. Silva-Orrego P, Colombo P, Bigi R, Gregori D, Delgado A, Salvade P, Oreglia J, Orrico P, de Biase A, Piccalo G, Bossi I, Klugmann S (2006) Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study. J Am Coll Cardiol 48:1552–1559

    Article  PubMed  Google Scholar 

  29. Siudak Z, Mielecki W, Dziewierz A, Rakowski T, Legutko J, Bartus S, Bryniarski KL, Partyka L, Dudek D (2015) No long-term clinical benefit from manual aspiration thrombectomy in ST-elevation myocardial infarction patients. Data from NRDES registry. Catheter Cardiovasc Interv 85:E16–E22

    Article  PubMed  Google Scholar 

  30. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van ‘t Hof A, Widimsky P, Zahger D (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619

    Article  CAS  PubMed  Google Scholar 

  31. Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ (2002) Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 346:957–966

    Article  CAS  PubMed  Google Scholar 

  32. Valente S, Mattesini A, Lazzeri C, Chiostri M, Giglioli C, Meucci F, Baldereschi GJ, Cordopatri C, Gensini GF (2014) Thrombus aspiration in ST-elevation myocardial infarction: does it actually impact on long-term outcome? Cardiol J. doi:10.5603/CJ.a2014.0061

    Google Scholar 

  33. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F (2008) Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 371:1915–1920

    Article  Google Scholar 

  34. Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, Andrikopoulos G, Baz JA, Betriu A, Claeys M, Danchin N, Djambazov S, Erne P, Hartikainen J, Huber K, Kala P, Klinceva M, Kristensen SD, Ludman P, Ferre JM, Merkely B, Milicic D, Morais J, Noc M, Opolski G, Ostojic M, Radovanovic D, De Servi S, Stenestrand U, Studencan M, Tubaro M, Vasiljevic Z, Weidinger F, Witkowski A, Zeymer U (2010) Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 31:943–957

    Article  PubMed  Google Scholar 

  35. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany

      Kay F. Weipert, Timm Bauer, Holger M. Nef & Christian W. Hamm

    2. Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany

      Helge Möllmann & Christian W. Hamm

    3. Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany

      Matthias Hochadel, Uwe Zeymer & Anselm K. Gitt

    4. Cardio-Thoracic Center of Monaco, Monaco, Monaco

      Jean Marco

    5. Rudolfstiftung Hospital, Vienna, Austria

      Franz Weidinger

    6. Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen Am Rhein, Germany

      Uwe Zeymer & Anselm K. Gitt

    Authors
    1. Kay F. Weipert
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Timm Bauer
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Holger M. Nef
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Helge Möllmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Matthias Hochadel
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Jean Marco
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Franz Weidinger
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Uwe Zeymer
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Anselm K. Gitt
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Christian W. Hamm
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Timm Bauer.

    Ethics declarations

    Conflict of interest

    The authors declare they have no conflict of interest.

    Additional information

    K. F. Weipert, T. Bauer contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Weipert, K.F., Bauer, T., Nef, H.M. et al. Use and outcome of thrombus aspiration in patients with primary PCI for acute ST-elevation myocardial infarction: results from the multinational Euro Heart Survey PCI Registry. Heart Vessels 31, 1438–1445 (2016). https://doi.org/10.1007/s00380-015-0754-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00380-015-0754-1

    Keywords

    Search

    Navigation