title: Clinical and angiographic predictors and prognostic value of failed thrombus aspiration in primary percutaneous coronary intervention.
abstract: OBJECTIVE
  This study sought to investigate which factors are associated with failure of thrombus aspiration (TA) and if this has prognostic implications.
  
  
  BACKGROUND
  The pathophysiological mechanism and clinical benefit of TA during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction is still in debate.
  
  
  METHODS
  Between August 2001 and October 2007, TA was attempted in 1,399 patients. Failure of TA was defined as the inability to reach and/or cross the occlusion with the aspiration catheter for effective thrombus removal. In addition, we analyzed patients in which no material could be obtained. We examined baseline clinical and angiographic variables related to failure of TA or to the lack of aspirate. Follow-up on vital status was obtained at 1 year.
  
  
  RESULTS
  In 144 (10.3%) patients, the aspiration catheter failed to cross the lesion. After multivariable adjustment, marked proximal tortuosity (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.92 to 4.31, p < 0.001), the presence of a calcified lesion (OR: 2.70, 95% CI: 1.77 to 4.13, p < 0.001), and a bifurcation lesion (OR: 1.97, 95% CI: 1.15 to 3.37, p = 0.013) were independent predictors of failed TA. Age over 60 years and the circumflex as infarct-related artery were associated with the lack of aspirate. Mortality rates at 1 year were 6.2% in patients with failed TA and 6.4% with successful TA (hazard ratio: 0.98, 95% CI: 0.49 to 1.95, p = 0.95).
  
  
  CONCLUSIONS
  The presence of marked proximal tortuosity of the infarct-related artery, a calcified lesion, and a bifurcation lesion are independent predictors of failure of thrombus aspiration. We found that unsuccessful TA did not affect 1-year mortality.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maarten A
authors.initials: MA
authors.lastname: Vink
authors.forename: Miranda C
authors.initials: MC
authors.lastname: Kramer
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Li
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Saskia Z
authors.initials: SZ
authors.lastname: Rittersma
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Allard C
authors.initials: AC
authors.lastname: van der Wal
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015425:Myocardial Reperfusion; D016017:Odds Ratio; D011379:Prognosis; D013223:Statistics as Topic; D013396:Suction; D017131:Thrombectomy; D017211:Treatment Failure
chemical_list: D005343:Fibrinolytic Agents