Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort.

Aghlmandi, Soheila; Schärer, Nadine; Heg, Dik; Räber, Lorenz; Zwahlen, Marcel; Gencer, Baris; Nanchen, David; Carballo, David; Carballo, Sebastian; Jüni, Peter; von Eckardstein, Arnold; Landmesser, Ulf; Rodondi, Nicolas; Mach, François; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Klingenberg, Roland (2018). Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort. European Heart Journal: Acute Cardiovascular Care, 7(6), pp. 522-531. Sage 10.1177/2048872617706480

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BACKGROUND Randomised controlled trials have provided conflicting results regarding procedural and clinical outcomes of thrombus aspiration combined with percutaneous coronary intervention, when compared with primary percutaneous coronary intervention alone in patients with acute coronary syndromes. METHODS Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM-ACS cohort. At the discretion of the interventional cardiologist, patients underwent thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Procedural success was defined as post-procedural thrombolysis in myocardial infarction III flow in the infarct-related artery. Serial changes in high-sensitivity troponin T (ΔhsTnT) and adjudicated 30 days (1 year) clinical events defined as the composite of cardiac death, recurrent myocardial infarction or clinically indicated coronary revascularisation were assessed. RESULTS Among 1641 patients, 777 (47.4%) had angiographic evidence of coronary thrombus. Patients were categorised into thrombus aspiration with percutaneous coronary intervention ( n=663) or percutaneous coronary intervention alone ( n=114). ST-segment elevation myocardial infarction (STEMI) patients more often received thrombus aspiration with percutaneous coronary intervention (87.8%) than non-STEMI patients (73.5%), P<0.001. Procedural success was not different in thrombus aspiration with percutaneous coronary intervention compared with percutaneous coronary intervention alone (93.8% vs. 90.7%, P=0.243). ΔhsTnT was similar in STEMI patients (3.09±4.52 vs. 2.19±4.92 µg/l, P=0.086) as was clinical outcome in the entire cohort at 30 days (2.9% vs. 3.6%, P=0.76) and 1 year (7.2% vs. 5.3%, P=0.55) regardless of whether thrombus aspiration was used during primary percutaneous coronary intervention or not. CONCLUSIONS In this real-world acute coronary syndrome cohort, patients treated by thrombus aspiration with percutaneous coronary intervention showed no difference in the restoration of coronary blood flow compared with percutaneous coronary intervention alone immediately after the procedure. Furthermore, ΔhsTnT and clinical outcomes at either 30 days or 1 year were similar between thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. CLINICAL TRIALS REGISTRATION SPUM-ACS cohort NCT01000701.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Aghlmandi, Soheila; Heg, Dierik Hans; Räber, Lorenz; Zwahlen, Marcel; Rodondi, Nicolas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2048-8734

Publisher:

Sage

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

25 Apr 2017 11:21

Last Modified:

29 Nov 2018 12:51

Publisher DOI:

10.1177/2048872617706480

PubMed ID:

28425755

Uncontrolled Keywords:

Acute coronary syndromes TIMI flow biomarkers clinical outcome percutaneous coronary intervention thrombus aspiration

BORIS DOI:

10.7892/boris.99489

URI:

https://boris.unibe.ch/id/eprint/99489

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