title: The impact of intracoronary thrombus aspiration on STEMI outcomes.
abstract: BACKGROUND
  Manual coronary thrombus aspiration was associated with improved outcomes of ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the outcome of aspiration in a "real-world" setting of primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  We analyzed the outcome of STEMI patients who underwent PPCI (initial Thrombolysis in Myocardial Infarction flow grade 0/1), comparing patients who underwent aspiration (ASP) to those who had standard (STD) therapy. Various subgroups outcomes were further analyzed. Clinical end points included mortality and major adverse cardiovascular events (MACE) at 30 days and at 1 year.
  
  
  RESULTS
  One thousand thirty-five consecutive patients were included: 189 (18.26%) with ASP and 846 (81.74%) with STD. ASP patients were younger (58±12 vs. 61±13, P<.05) and had higher incidence of direct stenting compared to STD patients (34% vs. 16.7%, P<.05). No significant differences were noted in the outcome of ASP vs. STD at 30 days (mortality rate 4.2% vs. 4.5%, P=.9; MACE 6.9% vs. 9.8%, P=.2) and at 1 year (mortality rate 8.0% vs. 8.3%, P=.9; MACE 20.0% vs. 22.3%, P=.5). A significant advantage in favor of ASP was evident in patients with proximal culprit lesions, anterior infarcts, and right ventricular involvement.
  
  
  CONCLUSIONS
  Although this was largely a negative study, when STEMI involved a large jeopardized myocardium, aspiration was associated with sustained improved clinical outcomes.
authors.affiliation: Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, and Sackler, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Nurit
authors.initials: N
authors.lastname: Shor
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome