title: Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  To assess the impact of thrombus aspiration during primary percutaneous coronary intervention (PPCI) on the mortality of patients with ST-elevation myocardial infarction (STEMI) patients.
  
  
  RESULTS
  Retrospective analysis of prospectively collected data on 2567 consecutive PPCI-treated STEMI patients between 2008 and 2011. Cox proportional hazard models and multiple logistic regression analysis were used to adjust for known covariates. Thrombectomy was performed in 1095 patients (42.7%). Post-PPCI thrombolysis in myocardial infarction 3 flow was more frequently achieved in the thrombectomy group [adjusted odds ratio (OR); 1.92, 95% confidence interval (CI): 1.34-2.76, P = 0.0004]. Overall in-hospital and longer term (mean follow-up 9.9 months) mortality rates were 4.5 and 9.0%, respectively. Thrombectomy was associated with a significant reduction in in-hospital (adjusted OR: 0.51, 95% CI: 0.29-0.93, P = 0.027) and longer term mortality [adjusted hazard ratio (HR): 0.69, 95% CI: 0.48-0.96, P = 0.028]. With propensity weighting, the adjusted HR for longer term mortality for thrombectomy was 0.43 (95% CI: 0.19-0.97; P = 0.042). The association between thrombectomy and reduced longer term mortality was only significant in those with a total ischaemic time ≤180min (P = 0.001) but not in patients with a total ischaemic time >180min (P = 0.99).
  
  
  CONCLUSIONS
  This study of real-world, unselected STEMI patients demonstrates that thrombus aspiration during PPCI is associated with a significant reduction in mortality, especially in those with a short total ischaemic time. These findings support the use of thrombectomy during PPCI in this group of patients.
authors.affiliation: Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN,  UK.
authors.forename: Awsan
authors.initials: A
authors.lastname: Noman
authors.forename: Mohaned
authors.initials: M
authors.lastname: Egred
authors.forename: Alan
authors.initials: A
authors.lastname: Bagnall
authors.forename: Ioakim
authors.initials: I
authors.lastname: Spyridopoulos
authors.forename: Sheila
authors.initials: S
authors.lastname: Jamieson
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmed
mesh_terms: D003328:Coronary Thrombosis / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D013396:Suction; D017131:Thrombectomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome