Journal of cardiology · 2012
Clinical impact of thrombus aspiration during primary percutaneous coronary intervention: results from Korea Acute Myocardial Infarction Registry.
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Hachinohe Daisuke, Jeong Myung Ho, Saito Shigeru, Kim Min Chol, Cho Kyung Hoon, Ahmed Khurshid, Hwang Seung Hwan, Lee Min Goo, Sim Doo Sun, Park Keun-Ho, Kim Ju Han, Hong Young Joon, Ahn Youngkeun, Kang Jung Chaee, Kim Jong Hyun, Chae Shung Chull, Kim Young Jo, Hur Seung Ho, Seong In Whan, Hong Taek Jong, Choi Donghoon, Cho Myeong Chan, Kim Chong Jin, Seung Ki Bae, Chung Wook Sung, Jang Yang Soo, Rha Seung Woon, Bae Jang Ho, Park Seung Jung, Korea Acute Myocardial Infarction Registry Investigators
Аннотация
BACKGROUND: The role of thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PPCI) remains a matter of controversy.
METHODS AND RESULTS: A total of 2105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry, a cohort of 745 (35.4%) patients who underwent TA during PPCI was compared with 1360 (64.6%) patients who underwent conventional PCI without TA. Clinical outcomes at 12-months of overall enrolled patients and subgroups according to key variables were assessed using Cox regression models adjusted by propensity score. Although there was no significant difference among overall patients, in subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitor during PPCI [adjusted hazard ratio (HR) 0.329, 95% confidence interval (CI) 0.126-0.860, p=0.023] and left anterior descending (LAD) as a culprit lesion (adjusted HR 0.516, 95% CI 0.275-0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA.
CONCLUSIONS: Although TA does not improve clinical outcomes in overall patients who underwent PPCI, TA for LAD occlusion improves 12-month MACE. Furthermore, use of GP IIb/IIIa inhibitor with TA has a synergistic effect on clinical outcomes.
METHODS AND RESULTS: A total of 2105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry, a cohort of 745 (35.4%) patients who underwent TA during PPCI was compared with 1360 (64.6%) patients who underwent conventional PCI without TA. Clinical outcomes at 12-months of overall enrolled patients and subgroups according to key variables were assessed using Cox regression models adjusted by propensity score. Although there was no significant difference among overall patients, in subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitor during PPCI [adjusted hazard ratio (HR) 0.329, 95% confidence interval (CI) 0.126-0.860, p=0.023] and left anterior descending (LAD) as a culprit lesion (adjusted HR 0.516, 95% CI 0.275-0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA.
CONCLUSIONS: Although TA does not improve clinical outcomes in overall patients who underwent PPCI, TA for LAD occlusion improves 12-month MACE. Furthermore, use of GP IIb/IIIa inhibitor with TA has a synergistic effect on clinical outcomes.