title: Manual Thrombus Aspiration Is Not Associated With Reduced Mortality in Patients Treated With Primary Percutaneous Coronary Intervention: An Observational Study of 10,929 Patients With ST-Segment Elevation Myocardial Infarction From the London Heart Attack Group.
abstract: OBJECTIVE
  This study aimed to assess the impact of thrombus aspiration on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The clinical effect of routine intracoronary thrombus aspiration before primary PCI in patients with ST-segment elevation myocardial infarction is uncertain.
  
  
  METHODS
  We undertook an observational cohort study of 10,929 ST-segment elevation myocardial infarction patients from January 2005 to July 2011 at 8 centers across London, United Kingdom. Patients' details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society PCI dataset. Primary outcome was all-cause mortality at a median follow-up of 3.0 years (interquartile range: 1.2 to 4.6 years).
  
  
  RESULTS
  In our cohort, 3,572 patients (32.7%) underwent thrombus aspiration during primary PCI. Patients who had thrombus aspiration were younger, had lower rates of previous myocardial infarction but were more likely to have poor left ventricular function. Procedural success rates were higher (90.9% vs. 89.2%; p=0.005) and in-hospital major adverse cardiac event rates were lower (4.4% vs. 5.5%; p=0.012) in patients undergoing thrombus aspiration. However, Kaplan-Meier analysis demonstrated no significant difference in mortality rates between patients with and without thrombus aspiration (14.8% aspiration vs. 15.3% PCI only; p=0.737) during the follow-up period. After multivariate Cox analysis (hazard ratio [HR]: 0.89, 95% confidence interval [CI]: 0.65 to 1.23) and the addition of propensity matching (HR: 0.85 95% CI: 0.60 to 1.20) thrombus aspiration was still not associated with decreased mortality.
  
  
  CONCLUSIONS
  In this cohort of nearly 11,000 patients, routine thrombus aspiration was not associated with a reduction in long-term mortality in patients undergoing primary PCI, although procedural success and in-hospital major adverse cardiac event rates were improved.
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Krishnaraj S
authors.initials: KS
authors.lastname: Rathod
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Gallagher
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Department of Cardiology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Kalra
authors.affiliation: Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom.
authors.forename: Pitt
authors.initials: P
authors.lastname: Lim
authors.affiliation: Department of Cardiology, University College London Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Crake
authors.affiliation: Department of Cardiology, University College London Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom.
authors.forename: Mick
authors.initials: M
authors.lastname: Ozkor
authors.affiliation: Department of Cardiology, University College London Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom.
authors.forename: Roby
authors.initials: R
authors.lastname: Rakhit
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.affiliation: Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex.
authors.forename: M Bilal
authors.initials: MB
authors.lastname: Iqbal
authors.affiliation: Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex.
authors.forename: Miles C
authors.initials: MC
authors.lastname: Dalby
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom.
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.affiliation: Department of Cardiology, London Ambulance Service NHS Trust, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Whitbread
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Department of Cardiology, St. Thomas' NHS Foundation Trust, Guys and St. Thomas Hospital, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: Department of Cardiology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Philip A
authors.initials: PA
authors.lastname: MacCarthy
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
authors.forename: Roshan
authors.initials: R
authors.lastname: Weerackody
authors.affiliation: Department of Cardiology, Barts Health National Health Service (NHS) Trust, London, United Kingdom. Electronic address: andrew.wragg@bartshealth.nhs.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012955:Societies, Medical; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: mortality; myocardial infarction; primary percutaneous coronary intervention; thrombectomy; thrombus aspiration