title: Manual thrombus aspiration during primary percutaneous coronary intervention: Impact of total ischemic time.
abstract: The benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) remains uncertain, and the effect of TA in relation to total ischemic time has not been evaluated.
  
  
  
  We analyzed 5641 patients with ST-elevation myocardial infarction (STEMI) (<12h) from the Korea Acute Myocardial Infarction Registry undergoing primary PCI. Patients were divided into 2 groups: TA (n=1245) and PCI only (n=4396). Propensity-matched 12-month clinical outcome was compared between the groups according to different total ischemic times (≤2h, 2-4h, 4-6h, >6h).
  
  
  
  Twelve-month rates of death and major adverse cardiac events (MACE: composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass grafting) were not different between TA and PCI only. After propensity matching (n=1162 for each group), there were no differences in the 12-month outcome between TA and PCI only, which was consistent across subgroups. In the propensity-matched cohort, the effect of TA on 12-month outcome showed a U-shaped relationship with longer total ischemic time: TA in patients with total ischemic time between 4 and 6h was associated with lower rates of death [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.24-1.19, p for interaction=0.01] and MACE (HR: 0.28, 95% CI: 0.12-0.66, p for interaction=0.01).
  
  
  
  Manual TA during primary PCI was not associated with improved clinical outcome at 12 months. The impact of TA may become clinically relevant with longer total ischemic time, forming a U-shaped relationship.
authors: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Doo Sun
authors: DS
authors: Sim
authors: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors: Myung Ho
authors: MH
authors: Jeong
authors: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Youngkeun
authors: Y
authors: Ahn
authors: Yeungnam University Hospital, Daegu, Republic of Korea.
authors: Young Jo
authors: YJ
authors: Kim
authors: Kyungpuk National University Hospital, Daegu, Republic of Korea.
authors: Shung Chull
authors: SC
authors: Chae
authors: Busan National University Hospital, Busan, Republic of Korea.
authors: Taek Jong
authors: TJ
authors: Hong
authors: Chungnam National University Hospital, Daejon, Republic of Korea.
authors: In Whan
authors: IW
authors: Seong
authors: Chunbuk National University Hospital, Jeonju, Republic of Korea.
authors: Jei Keon
authors: JK
authors: Chae
authors: Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
authors: Chong Jin
authors: CJ
authors: Kim
authors: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors: Myeong Chan
authors: MC
authors: Cho
authors: Korea University Guro Hospital, Seoul, Republic of Korea.
authors: Seung-Woon
authors: SW
authors: Rha
authors: Konyang University Hospital, Daejon, Republic of Korea.
authors: Jang Ho
authors: JH
authors: Bae
authors: Catholic University Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors: Ki Bae
authors: KB
authors: Seung
authors: Asan Medical Center, Seoul, Republic of Korea.
authors: Seung Jung
authors: SJ
authors: Park
mesh_terms: D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy; D061665:Time-to-Treatment
keywords: Myocardial infarction; Percutaneous coronary intervention; Thrombectomy