Observational Study
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World J Cardiol. Sep 26, 2014; 6(9): 1030-1037
Published online Sep 26, 2014. doi: 10.4330/wjc.v6.i9.1030
Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?
Diego Fernández-Rodríguez, Luis Alvarez-Contreras, Victoria Martín-Yuste, Salvatore Brugaletta, Ignacio Ferreira, Marta De Antonio, Montserrat Cardona, Vicens Martí, Juan García-Picart, Manel Sabaté
Diego Fernández-Rodríguez, Luis Alvarez-Contreras, Victoria Martín-Yuste, Salvatore Brugaletta, Montserrat Cardona, Manel Sabaté, Department of Cardiology, Hospital Clinic, 08036 Barcelona, Spain
Ignacio Ferreira, Department of Cardiology, Hospital Vall d’Hebrón, 08035 Barcelona, Spain
Marta De Antonio, Department of Cardiology, Hospital Germans Trias i Pujol, 08740 Bdalona, Spain
Vicens Martí, Juan García-Picart, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08026 Barcelona, Spain
Author contributions: Fernández-Rodríguez D and Alvarez-Contreras L equally contributed to this work; all the authors contributed to this paper.
Correspondence to: Victoria Martín-Yuste, MD, PhD, Department of Cardiology, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. vmartiny@clinic.ub.es
Telephone: +34-93-2275519 Fax: +34-93-2275751
Received: April 27, 2014
Revised: August 19, 2014
Accepted: September 4, 2014
Published online: September 26, 2014
Abstract

AIM: To evaluate the impact of thrombus aspiration (TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction (STEMI) registry.

METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.

RESULTS: A total of 456 patients were analyzable and categorized in TA group (156 patients; 34.2%) and non-TA (NTA) group (300 patients; 65.8%). Patients treated with TA had less prevalence of multivessel disease (39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow < 3 (P < 0.001) than NTA group. There was a higher rate of direct stenting (58.7% vs 45.5%, P = 0.009), with shorter (24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents (3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P < 0.001) in the TA group as compared to NTA group. The number of implanted stents (1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group.

CONCLUSION: In an “all-comers” STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Manual thrombus aspiration, Stent, Thrombolysis in myocardial infarction flow

Core tip: Thrombus embolization is highly detected in ST-segment elevation myocardial infarction (STEMI) leading to unfavorable clinical outcomes. To prevent thrombus embolization, manual thrombus aspiration (TA) receives a high recommendation during primary percutaneous coronary intervention (PCI) by clinical practice guidelines. However, the TASTE trial, recently published, showing no impact of manual TA on short-term mortality, has reopened the debate about the role of this technique in STEMI. This study is one the first showing that manual TA optimizes stent implantation during primary PCI resulted in more efficient procedures, leading to the implantation of fewer, shorter and larger stents.