title: Thrombus aspiration for reperfusion in myocardial infarction: Predictors and clinical impact of ineffectiveness.
abstract: OBJECTIVE
  The benefit of manual thrombus aspiration (TA) in the reperfusion of patients with ST-elevation myocardial infarction (STEMI) has been hotly debated. In most series, failure of TA has been largely unreported. Our objectives were to assess the rate, predictors, and impact on cumulative mortality of failed TA during primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  This was a single-center, retrospective study of consecutive STEMI patients undergoing PPCI with TA. TA was considered ineffective if, before angioplasty, coronary flow was TIMI <2. Independent predictors of TA failure were assessed by logistic regression, and predictors of cumulative mortality were assessed by Cox regression analysis.
  
  
  RESULTS
  Of 574 patients, TA was used in 417 (72.6%), and was effective in 365 (87.5%) and ineffective in 52 (12.5%). On multivariate analysis, SYNTAX score (OR=1.049, 95% CI: 1.015-1.084, p=0.005) and total ischemic time (OR=1.001, 95% CI: 1.000-1.003, p=0.02) were independent predictors of TA failure. Moderate or severe left ventricular dysfunction (HR=6.256, 95% CI: 1.896-20.644, p=0.003), APPROACH score (HR=1.094, 95% CI: 1.016-1.177, p=0.017), Killip class III/IV (HR=2.953, 95% CI: 1.122-7.770, p=0.028) and creatinine clearance on admission (HR=0.973, 95% CI: 0.953-0.994, p=0.011) were independently related to cumulative mortality at 24 ± 0.82 months.
  
  
  CONCLUSIONS
  Total ischemic time and SYNTAX score were independent predictors of TA failure. However, in medium-term follow-up, ineffective manual TA was not independently related to cumulative mortality.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal. Electronic address: andrecoimbraluz@hotmail.com.
authors.forename: André
authors.initials: A
authors.lastname: Luz
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Rodrigues
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Sousa
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Silveira
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Anjo
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Brochado
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Santos
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Silveira
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Cyrne Carvalho
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal.
authors.forename: Severo
authors.initials: S
authors.lastname: Torres
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D017131:Thrombectomy; D016896:Treatment Outcome
keywords: Aspiração de trombo; Enfarte agudo de miocárdio; Reperfusion; Reperfusão; ST‐elevation myocardial infarction; Thrombectomy; Thrombus aspiration; Trombectomia