title: Optimization in stent implantation by manual thrombus aspiration in ST-segment-elevation myocardial infarction: findings from the EXAMINATION trial.
abstract: BACKGROUND
  Manual thrombus aspiration (TA) is effective to reduce the thrombus burden during primary percutaneous coronary intervention for ST-elevation myocardial infarction. The objective of this study is to assess the impact of manual TA on stent implantation during primary percutaneous coronary intervention.
  
  
  RESULTS
  Population of the EXAMINATION trial (n=1498) was divided into 2 groups according to the use of TA. Immediate angiographic results, primary patient-oriented end point (combination of all-cause death, myocardial infarction, and any revascularization) and secondary device-oriented end point (combination of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization), definite/probable stent thrombosis, and major/minor bleeding were evaluated at 2 years. A total of 976 (65.2%) patients were classified into TA group and 522 (34.8%) patients into nonthrombus aspiration group. Manual TA was most frequently used in patients with worse initial thrombolysis in myocardial infarction flow. The TA group received less number of stents implanted (1.35 ± 0.62 versus 1.45 ± 0.71, P = 0.005) with bigger size (3.25 ± 0.44 versus 3.11 ± 0.46 mm, P < 0.001) compared with the nonthrombus aspiration group. A higher rate of direct stenting (69.2% versus 43.3%, P < 0.001) with lower rate of postdilatation (13.0% versus 18.0%, P < 0.009) was also present in the TA group compared with the nonthrombus aspiration group. At 2-year follow-up, no differences in clinical end point were observed between groups.
  
  
  CONCLUSIONS
  Manual TA during primary percutaneous coronary intervention is associated with a higher rate of direct stenting, a lower rate of postdilatation, and larger and less stents in comparison with conventional primary percutaneous coronary intervention. Conversely, manual TA had no apparent impact on clinical outcomes at long-term follow-up.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00828087.
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Diego
authors.initials: D
authors.lastname: Fernández-Rodríguez
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín-Yuste
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñíguez
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Pieter
authors.initials: P
authors.lastname: den Heijer
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Armando
authors.initials: A
authors.lastname: Bethencourt
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.). masabate@clinic.ub.es.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D013396:Suction / Q000379:methods; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: drug-eluting stent; myocardial infarction; percutaneous coronary intervention; stent; thrombectomy