Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Table 1 Baseline clinical and angiographic features n (%)

Characteristics	Thrombus aspiration	Conventional PCI	P value
	n = 156	n = 300
Age, mean ± SD	63.2 ± 12.8	64.3 ± 12.8	0.410
Female sex	38 (24.4)	62 (20.7)	0.370
Previous or current smoker	94 (60.3)	205 (68.3)	0.085
Hypertension	82 (52.6)	166 (55.3)	0.570
Dyslipidemia	30 (19.2)	92 (30.7)	0.009
Peripheral vasculopathy	9 (5.8)	19 (6.3)	0.800
Previous MI	10 (6.7)	36 (12.3)	0.065
Previous PCI	8 (5.1)	29 (9.7)	0.092
Previous CABG	2 (1.3)	10 (3.3)	0.190
Indication			0.013
Primary	114 (73.1)	206 (68.7)
Rescue	42 (26.9)	94 (31.3)
Classification			0.650
Anterolateral	69 (44.2)	133 (44.3)
Inferoposterior	83 (53.2)	152 (50.7)
Non-Q MI	3 (1.9)	12 (4)
LBBB	1 (0.6)	3 (1)
Killip			0.058
I	182 (86.3)	228 (76.5)
II	13 (8.5)	35 (11.7)
III	1 (0.7)	7 (2.3)
IV	7 (4.6)	28 (9.4)
Number of diseased vessels			0.003
1	94 (60.3)	136 (45.3)
2	43 (27.6)	95 (31.7)
3	19 (12.2)	69 (23)
Infarct related artery			0.650
LAD	68 (43.6)	137 (45.7)
LCx	15 (9.6)	35 (11.7)
RCA	69 (44.2)	116 (38.7)
LM	4 (2.6)	8 (2.75)
Bypass	0	1 (0.3)
GP IIb/IIIa inhibitors	100 (65.3)	150 (50.6)	0.012
IABP	7 (4.5)	25 (8.4)	0.120

PCI: Percutaneous coronary intervention; MI: Myocardial infarction; CABG: Coronary artery by-pass graft; LBBB: Left bundle branch block; LAD: Left anterior descending; LCx: Left circumflex; RCA: Right coronary artery; LM: Left-main; IABP: Intra-aortic balloon pump; GP: Glycoprotein.

Table 2 Procedural data and angiographic results n (%)

Characteristics	Thrombus aspiration	Conventional PCI	P value
	n = 156	n =300
Time to treatment, median (IQR)	273 (170-477)	300 (180-480)	0.610
Initial TIMI flow			< 0.001
0	111 (71.2)	143 (48.8)
1	9 (5.8)	16 (5.5)
2	16 (10.3)	38 (13)
3	20 (12.8)	96 (32.8)
Initial TIMI flow < 3	136 (87.2)	204 (67.2)	< 0.001
Final TIMI flow			0.140
0	2 (1.3)	9 (3.1)
1	1 (0.6)	6 (2.1)
2	19 (12.3)	50 (17.1)
3	133 (85.8)	227 (77.7)
Final TIMI flow < 3	22 (14.1)	65 (21.7)	0.040
Angiographic complication			0.450
Non-reflow	6 (3.8)	16 (5.4)
Thrombus embolization	7 (4.5)	22 (7.4)
Coronary dissection	2 (1.3)	7 (2.4)
Angiographic success	123 (78.8)	200 (68)	0.015
Direct stenting	88 (58.7)	131 (45.5)	0.009
Type of stent			0.008
BMS	133 (88.7)	238 (79.3)
DES	17 (11.3)	62 (20.7)
Length of stented segment (mm), mean ± SD	24.1 ± 11.8	26.9 ± 15.7	0.038
Diameter of stented segment (mm), mean ± SD	3.17 ± 0.43	2.93 ± 0.44	< 0.001
Number of stents, mean ± SD	1.3 ± 0.67	1.5 ± 0.84	0.009
LVEF, mean ± SD	49.6 ± 9.8	49 ± 10.4	0.610

PCI: Percutaneous coronary intervention; IQR: Interquartile range; TIMI: Thrombolysis in myocardial infarction; BMS: Bare metal stents; DES: Drug-eluting stents; LVEF: Left ventricle ejection fraction.

Table 3 Multivariate analysis of angiographic success

	HR (95%CI)	P
Thrombus aspiration	2.3 (1.2-4.3)	0.007
Primary PCI	4.4 (2.1-9)	< 0.001
Active smoking	1.76 (0.9-3.4)	0.093
Age	1.031 (1.001-1.063)	0.044
Initial TIMI flow = 0	0.46 (0.25-0.84)	0.012

PCI: Percutaneous coronary intervention; TIMI: Thrombolysis in Myocardial Infarction.

Table 4 In-hospital and long-term outcomes n (%)

	Thrombus aspiration	Conventional PCI	P value
	n = 156	n = 300
In-hospital
CK peak UI/L, median (IQR)	2563 (1284-4542)	1517 (744-3816)	0.020
ST resolution at 30 min	75 (71.4)	174 (74)	0.610
Intra-procedural death	2 (1.3)	5 (1.7)	1.000
In-hospital cardiac death	15 (9.6)	22 (7.3)	0.400
Non-target vessel PCI revascularization	12 (7.7)	41 (13.8)	0.059
CABG	0 (0)	1 (0.3)	1.000
Follow-up
MACE	25 (17.0)	61 (21.6)	0.250
All-cause death	26 (17.0)	57 (19.6)	0.500
Cardiac death	13 (8.3)	23 (7.9)	0.830
MI	10 (6.8)	28 (10)	0.270
CABG	2 (1.4)	10 (3.5)	0.390
Target vessel PCI revascularization	8 (5.4)	25 (8.9)	0.200
Non-target vessel PCI revascularization	7 (4.8)	16 (5.7)	0.680
Definitive stent thrombosis	2 (1.4)	12 (4.4)	0.150
Probable stent thrombosis	1 (0.7)	2 (0.7)	1.000
Possible stent thrombosis	2 (1.4)	6 (2.2)	0.720

PCI: Percutaneous coronary intervention; CABG: Coronary artery by-pass graft; MACE: Major adverse cardiac events; MI: Myocardial infarction; IQR: Interquartile range; ST: Stent thrombosis.