Effect of Adjunctive Thrombus Aspiration on In-Hospital and 3-Year Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and Large Native Coronary Artery Thrombus Burden

Initial experience with a continuous mechanical aspiration system for thrombus removal before percutaneous coronary intervention

OBJECTIVES

Here we investigate the safety and efficacy of a continuous mechanical aspiration system when used before percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).

BACKGROUND

Historically, trials of routine manual aspiration thrombectomy in ACS patients have reported mixed results. This may be due to the technical limitations of manual aspiration, which suffers from decreasing vacuum power as aspiration is performed.

METHODS

This is a retrospective case series of all patients treated with continuous mechanical aspiration (Indigo CAT RX Aspiration System; Penumbra Inc.) before PCI between August 2017 and July 2020 at five centers in the United States. Data regarding angiographic assessments, procedure, and safety were examined.

RESULTS

Seventy-two patients (mean age 60 ± 12.5 years, 34.7% female) with ST Elevation Myocardial Infarction (STEMI) (80.6%) or Non-ST Elevation Myocardial Infarction (NSTEMI) (19.4%) were included. Target vessels were the right coronary (43.1%), left anterior descending (33.3%), and left circumflex (23.6%). Preprocedure, 94.4% had a high thrombus burden (thrombolysis in myocardial infarction [TIMI] thrombus grade ≥ 3). Median aspiration time was 35 s and median access-to-reperfusion time was 10 min. After CAT RX alone, 86.1% had complete perfusion (TIMI flow grade 3). After the procedure, 94.4% had TIMI thrombus grade <3% and 97.2% had TIMI flow grade 3. There were no cases of ischemic stroke. Cardiovascular mortality at 30 days was 1.4%.

CONCLUSIONS

In our initial experience, aspirating thrombus from ACS patients using the Indigo CAT RX Aspiration System before PCI was safe and effective for reducing thrombus burden and restoring flow.

Thrombus aspiration during primary percutaneous coronary intervention improved outcome in patients with STEMI and a large thrombus burden

Background

The benefit of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) to patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to assess TA's impact on the outcome and prognosis for patients with STEMI and a large thrombus burden during PPCI.

Methods

This retrospective study evaluated consecutive patients with STEMI and a large thrombus burden (thrombolysis in myocardial infraction [TIMI] thrombus grade ≥4) who underwent conventional PPCI (n = 126) or PPCI + TA (n = 208) between February 2017 and January 2019. The procedure outcome and clinical prognosis were compared.

Results

Postprocedural vessel diameter was larger, and corrected TIMI frame count (cTFC) was lower in the PPCI + TA compared with the PPCI group. The proportion of postprocedural TIMI 3 flow was 83.3% in the PPC group and 94.2% in the PPCI+TA group. During the 12-month follow-up, no significant differences existed in the incidence of cardiac death, reinfarction, stent thrombosis, target vessel revascularization, or stroke.

Conclusion

Application of TA in patients with STEMI and a large thrombus burden during PPCI may improve the procedural outcome, but it showed no benefit on the clinical prognosis in the 12-month follow-up. Longer follow-up studies are needed to confirm TA's clinical implications in patients with STEMI.

Long-term Impact of Thrombus Aspiration in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) is reported to improve myocardial reperfusion. However, the long-term prognostic implication of TA remains unclear. We aimed to investigate the influence of adjunctive TA on long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing PPCI. All STEMI patients from China that included in the TOTAL trial who were ≥18 years old and referred for PPCI within the 12 hours after symptom onset between January 2011 and November 2012 were retrospectively analyzed. Patients were divided into 2 groups based on the use of TA or not. The primary efficacy outcomes were 5-year major adverse cardiac events, a composite of cardiovascular death, recurrent MI, cardiogenic shock, or heart failure hospitalization. The primary safety outcome was a 5-year stroke. A total of 563 patients were included. The incidence rate of major adverse cardiac events at 5 years in the TA group was similar to that in the PCI group (hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.42 to 1.17). In addition, TA was significantly associated with a nearly sevenfold increased risk of stroke at 5 years compared with PCI alone (HR 7.32, 95% CI 1.33 to 40.31). Our propensity scoring match analyses suggested that patients with an occluded lesion might benefit from the TA (HR 0.24, 95% CI 0.08 to 0.70). In conclusion, TA is not associated with improved outcomes in patients with STEMI but may have an adverse impact on stroke. Patients with an occluded infarct-related artery could benefit from the TA.