title: No long-term clinical benefit from manual aspiration thrombectomy in ST-elevation myocardial infarction patients. Data from NRDES registry.
abstract: BACKGROUND
  Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all-cause mortality. Our aim was to analyze long-term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry.
  
  
  METHODS
  There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry. Patients were divided into two groups: those that were treated with manual thrombectomy for their primary PCI vs. those who were not.
  
  
  RESULTS
  There were altogether 2,686 patients enrolled in the NRDES Registry of whom 1,763 were diagnosed with STEMI (66%). Aspiration thrombectomy was used in 673 of these cases (38%) and 1,090 (62%) patients were treated without thrombectomy during the index primary PCI. Overall mortality at 1 year was 11.03% in thrombectomy and 7.46% in no thrombectomy group respectively (P = 0.0292 which became insignificant after propensity score matching adjustment P = 0.613). Specific subgroup analyses revealed that there was no benefit from aspiration thrombectomy in neither subgroup.
  
  
  CONCLUSIONS
  Manual aspiration thrombectomy in patients undergoing primary PCI for STEMI was not associated with improved long-term 1-year clinical outcome. Subgroup analysis did not reveal any specific setting in which thrombectomy would be clinically superior. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Siudak
authors.forename: Waldemar
authors.initials: W
authors.lastname: Mielecki
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Jacek
authors.initials: J
authors.lastname: Legutko
authors.forename: Stanisław
authors.initials: S
authors.lastname: Bartuś
authors.forename: Krzysztof L
authors.initials: KL
authors.lastname: Bryniarski
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Partyka
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011044:Poland; D057216:Propensity Score; D012042:Registries; D012307:Risk Factors; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: myocardial infarction; registry; thrombectomy