Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: findings from the HORIZONS-AMI trial.
OBJECTIVE
To assess the quality of coronary reperfusion and long-term clinical outcomes of patients enrolled in the HORIZONS-AMI trial according to the use of thrombus aspiration (TA).


BACKGROUND
The impact of manual TA on microvascular perfusion and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unsettled.


METHODS
In this retrospective, nonrandomized, subgroup analysis, the authors evaluated thrombolysis in myocardial infarction (TIMI) flow, tissue myocardial perfusion grade (TMPG), ST-segment resolution (STR), net adverse clinical events (NACE), and major adverse cardiac events (MACE) in patients undergoing pPCI with or without manual TA.


RESULTS
A total of 318 patients had pPCI with upfront TA, and 2,917 patients had pPCI without TA. Patients who had TA were more likely to have TIMI 0/1 flow at baseline (75.1% vs. 63.7%, P < 0.0001). There was no difference in the rates of final TIMI 3 flow (90.2% vs. 92.3%, P = 0.19) or dynamic TMPG 2-3 (77.4% vs. 76.4%, P = 0.68). STR ≥70% was similar in both groups at 60 minutes but higher in the TA group at discharge (71.8% vs. 64.6%, P = 0.02). After multivariable adjustment, TA did not predict MACE at 30 days (HR 0.96 [0.51-1.80], P = 0.90), 1 year (HR 1.03 [0.68-1.55], P = 0.89), or 3 years (HR 1.13 [0.86-1.48], P = 0.39). Stent thrombosis did not differ at 1 year or 3 years.


CONCLUSIONS
In STEMI patients undergoing pPCI, the use of manual TA was associated with improved STR at discharge, but not with any difference in final TIMI flow, TMPG, or MACE.
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Dennis W T
DW
Nilsen
Roxana
R
Mehran
Roland S
RS
Wu
Jennifer
J
Yu
Jan E
JE
Nordrehaug
Bruce R
BR
Brodie
Bernhard
B
Witzenbichler
Eugenia
E
Nikolsky
Martin
M
Fahy
Gregg W
GW
Stone
D000368:Aged; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome