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Clin Res Cardiol. 2019 Mar 11. doi: 10.1007/s00392-019-01452-8. [Epub ahead of print]

Thrombus aspiration in patients with ST-elevation myocardial infarction presenting late after symptom onset: long-term clinical outcome of a randomized trial.

Author information

1
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. anne.freund@medizin.uni-leipzig.de.
2
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. anne.freund@medizin.uni-leipzig.de.
3
Leipzig Heart Institute, Leipzig, Germany. anne.freund@medizin.uni-leipzig.de.
4
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
5
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
6
University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
7
Leipzig Heart Institute, Leipzig, Germany.

Abstract

BACKGROUND:

In the largest randomized trial so far, thrombus aspiration failed to reduce the primary endpoint of microvascular obstruction (MVO) in patients with ST-elevation myocardial infarction (STEMI) presenting late after symptom onset. Long-term clinical outcome data of this trial have not been reported yet.

METHODS AND RESULTS:

A total of 144 patients with STEMI presenting ≥ 12 and ≤ 48 h after symptom onset were randomized to primary percutaneous coronary intervention (PCI) with or without manual thrombus aspiration in a 1:1 fashion. The primary efficacy endpoint was the extent of MVO assessed by cardiac magnetic resonance imaging and showed no significant difference between groups. Long-term clinical follow-up was performed at 4 years. Overall mortality at 4 years reached 18%. There was no significant difference between groups with respect to mortality and major adverse cardiac events defined as the composite of death, myocardial reinfarction and target vessel revascularization. In a multivariate Cox regression model glomerular filtration rate on admission, left ventricular ejection fraction, and cardiogenic shock were independently associated with time-dependent occurrence of death.

CONCLUSION:

Routine thrombus aspiration in STEMI patients presenting late after symptom onset showed no significant difference with respect to long-term clinical endpoints compared to conventional PCI only.

KEYWORDS:

Clinical outcome; Late presenting; ST-elevation myocardial infarction; Thrombus aspiration

PMID:
30859380
DOI:
10.1007/s00392-019-01452-8

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