{"id":1642,"date":"2015-04-16T21:15:42","date_gmt":"2015-04-16T20:15:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1642"},"modified":"2015-11-12T17:03:29","modified_gmt":"2015-11-12T16:03:29","slug":"aspiration-thrombectomy-fails-to-demonstrate-benefit-in-primary-pci","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2015\/04\/16\/aspiration-thrombectomy-fails-to-demonstrate-benefit-in-primary-pci\/","title":{"rendered":"Aspiration thrombectomy fails to demonstrate benefit in primary PCI \u00a0"},"content":{"rendered":"

Although primary percutaneous coronary intervention (PPCI) restores epicardial coronary flow in the majority of patients with ST-segment myocardial infarction, this approach can lead to microvascular obstruction resulting from distal embolization of thrombus.\u00a0 Manual thrombectomy (i.e. aspiration thrombectomy) prior to PPCI has been proposed as a method to reduce thrombus burden and resultant distal embolization with PPCI.\u00a0 Although results from early studies of aspiration thrombectomy suggested improvements in patient outcomes, subsequent trials have failed to demonstrate a clinical benefit of aspiration thrombectomy prior to PPCI.\u00a0 This large, multi-centre, international trial furthers the evidence that aspiration does not offer benefit in the routine care of patients undergoing PPCI.\u00a0 This study randomized 10,732 patients with ST elevation myocardial infarction to routine manual thrombectomy prior to PCI or standard PCI alone.\u00a0 The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days with a primary safety end-point of stroke within 30 days.\u00a0 Crossover rates between groups were low and the primary analysis was by intention-to-treat.\u00a0 Compared to standard PPCI, treatment with aspiration thrombectomy did not reduce rates of the primary outcome (6.9% vs. 7.0%, HR, 0.99; 95% CI, 0.85 to 1.15; P=0.86) or individual components of the primary outcome.\u00a0 In a pre-specified sub-group analysis, there was no difference in patient outcomes as a function of initial thrombus burden. Furthermore, there was a significant increase in stroke in the thrombectomy group (0.7% vs. 0.3%, HR, 2.06; 95% CI, 1.13 to 3.75; P=0.02) within the first 30 days.\u00a0<\/strong><\/p>\n

Conclusions: <\/strong>In this large randomised controlled trial, routine aspiration thrombectomy did not improve patient outcomes for patients presenting with acute ST-elevation myocardial infarction.\u00a0 Rates of stroke in patients undergoing thrombectomy were significantly elevated at 30 days.\u00a0 Aspiration thrombectomy should no longer be a part of routine PCI care.<\/p>\n

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Summarized by Hussain Contractor and Steven M. Bradley<\/p>\n

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