Thrombus aspiration ineffective for STEMI patients

Thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) does not seem to improve outcomes in patients with ST-elevation myocardial infarction (STEMI), a recent study has found.

The study included 563 STEMI patients (mean age, 62.3±12.8 years; 79.6 percent male), of whom 291 underwent PPCI alone while the remaining 272 received TA. The primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as a composite of cardiovascular death, cardiogenic shock, recurrent myocardial infarction or heart failure hospitalization.

At the 5-year follow-up, 42 patients in the PPCI alone group developed MACEs, as opposed to only 26 in the TA group. The corresponding rates were 3.13 percent and 2.02 percent, which did not correspond to a significant risk estimate according to Cox proportional hazards regression (adjusted hazard ratio [HR], 0.70, 95 percent confidence interval [CI], 0.42–1.17; p=0.171).

Analysis by the individual components showed that there was no particular driver of the principal findings. Recurrent myocardial infarction (adjusted HR, 0.79, 97 percent CI, 0.36–1.74; p=0.564), cardiogenic shock (adjusted HR, 0.72, 95 percent CI, 0.32–1.65; p=0.437) and heart failure hospitalization (adjusted HR, 0.57, 95 percent CI, 0.27–1.20; p=0.139) were all similarly likely to occur in the PPCI alone and TA arms.

The same was true for cardiovascular (adjusted HR, 0.91, 95 percent CI, 0.45–1.87; p=0.805) and all-cause (adjusted HR, 1.08, 95 percent CI, 0.61–1.89; p=0.799) deaths.

Moreover, this lack of efficacy was compounded by a significant safety concern. Stroke occurred in 0.70 percent of the TA group, as opposed to only 0.14 percent of the PPCA alone arm. This corresponded to a significant risk estimate (adjusted HR, 7.32, 95 percent CI, 1.33–40.31; p=0.022).