Thrombus aspiration during ST-segment elevation myocardial infarction
Ole Fröbert, Bo Lagerqvist, Göran K Olivecrona, Elmir Omerovic, Thorarinn Gudnason, Michael Maeng, Mikael Aasa, Oskar Angerås, Fredrik Calais, Mikael Danielewicz, David Erlinge, Lars Hellsten, Ulf Jensen, Agneta C Johansson, Amra Kåregren, Johan Nilsson, Lotta Robertson, Lennart Sandhall, Iwar Sjögren, Ollie Ostlund, Jan Harnek, Stefan K James, TASTE Trial, Per Fransson, Eric Lodin, Lotta Robertson, Henrik Enhörning, Bo Jonsson, Mattias Törnerud, Majid Kalani, Rickard Linder, Habib Mir-Akbari, Nikolas Östlund, Georgos Papado, Jonas Persson, Bassem Samad, Mehmet Hamid, Finn Hjortevang, Per Hultman, Kamaran Mohammed, Eva Zelleroth, Gunnar Domeij, Åsa Drakesy, Lars Hagström, Kristina Hambraeus, Per Lundberg, Iwar Sjögren, Crister Zedigh, Espen Haugen, Lars-Eric Hellsten, Staffan Johansson, Robert Kastberg, Peter Hårdhammar, Ann-Charlotte Karlsson, Ali Tabandeh, Martin Adielsson, Sven-Erik Olsson, Lennart Sandhall, Henrik Wagner, Mustafa Ali, Jörg Lauerman, Werner Puskar, Berne Åsberg, Jörg Carlsson, Witold Dubaniewicz, Anja Heinen, Torsten Schwalm, Jan Johansson, Jan Medin, Kenneth Mier, Karim Mokhtar, Carl-Magnus Pripp, Mats Allared, Mikael Danielewicz, Tage Nilsson, Hans Olsson, Nikolai Fedchenko, Henareh Loghman, Ulf Jensen, Magnus Lindroos, Andreas Ruck, Nawsad Saleh, Shams Y-Hassan, Piotr Czech, Per Lindvall, Björn Thorvinger, Helena Wikström, Ragnar Danielsen, Kristjan Eyjolfsson, Thorbjorn Gudjonsson, Thorarinn Gudnasson, Torfi Fjalar Jonasson, Gudjon Karlsson, Sigurpall Scheving, Axel Sigurdsson, Ulf Berglund, Anders Björkholm, Waldemar Czekierda, Marcus Gjerde, Dario Hauer, Tim Tödt, Dimitrios Venetsanos, Per Albertsson, Oskar Angerås, Christian Dworeck, Marc Gomes, Inger Haraldsson, Dan Ioanes, Fotios Katsaros, Michalis Koutouzis, Berglind Libungan, Göran Matejka, Jacob Odenstedt, Elmir Omerovic, Petur Petursson, Truls Råmunddal, Wilhelm Ridderstråle, Lisa Brandin, Anders Kallryd, Azad Matikhan, Jason Stewart, Ryszard Syberyjski, Pallonji Bhiladvala, Per Bondesson, David Erlinge, C G Gustavsson, Matthias Götberg, Jan Harnek, Anders Lundin, Tomas Molund, Margareta Nilsson, Göran Olivecrona, Fredrik Scherstén, Jan Haupt, Agneta C Johansson, Jens Jensen, Bo Lindvall, Daniel Wadell, Mikael Aasa, Patrik Alström, Olov Collsten, Anders Jonsson, Risto Jussila, Thomas Olsson, Per Tornvall, Nils Witt, Henrik Fryklund, Jens Solem, Magnus Wahlin, Jonas Andersson, Peter Eriksson, Lars Lundgren, Johan Nilsson, Björn Pettersson, Olov Duvernoy, Per Hultman, Stefan James, Bo Lagerqvist, Bertil Larsson, Johan Thuren, Giovanna Sarno, Christoph Varenhorst, Erik Diderholm, Per Grimfjärd, Martin Lindholm, Amra Kåregren, Fredrik Calais, Stella Cizinsky, Ole Fröbert, Ortwin Herterich, Istvan Herzfeld, Thomas Kellerth, Martin Lindholm, Kristian Wachtell, Leszek Zagozdzon, Hans Erik Bøtker, Evald H Christiansen, Anne Kaltoft, Lars Romer Krusell, Jens Flensted Lassen, Michael Maeng, Christian J Terkelsen, Leif Thuesen, Karsten Veien, Ole Fröbert, Bo Lagerqvist, Göran K Olivecrona, Elmir Omerovic, Thorarinn Gudnason, Michael Maeng, Mikael Aasa, Oskar Angerås, Fredrik Calais, Mikael Danielewicz, David Erlinge, Lars Hellsten, Ulf Jensen, Agneta C Johansson, Amra Kåregren, Johan Nilsson, Lotta Robertson, Lennart Sandhall, Iwar Sjögren, Ollie Ostlund, Jan Harnek, Stefan K James, TASTE Trial, Per Fransson, Eric Lodin, Lotta Robertson, Henrik Enhörning, Bo Jonsson, Mattias Törnerud, Majid Kalani, Rickard Linder, Habib Mir-Akbari, Nikolas Östlund, Georgos Papado, Jonas Persson, Bassem Samad, Mehmet Hamid, Finn Hjortevang, Per Hultman, Kamaran Mohammed, Eva Zelleroth, Gunnar Domeij, Åsa Drakesy, Lars Hagström, Kristina Hambraeus, Per Lundberg, Iwar Sjögren, Crister Zedigh, Espen Haugen, Lars-Eric Hellsten, Staffan Johansson, Robert Kastberg, Peter Hårdhammar, Ann-Charlotte Karlsson, Ali Tabandeh, Martin Adielsson, Sven-Erik Olsson, Lennart Sandhall, Henrik Wagner, Mustafa Ali, Jörg Lauerman, Werner Puskar, Berne Åsberg, Jörg Carlsson, Witold Dubaniewicz, Anja Heinen, Torsten Schwalm, Jan Johansson, Jan Medin, Kenneth Mier, Karim Mokhtar, Carl-Magnus Pripp, Mats Allared, Mikael Danielewicz, Tage Nilsson, Hans Olsson, Nikolai Fedchenko, Henareh Loghman, Ulf Jensen, Magnus Lindroos, Andreas Ruck, Nawsad Saleh, Shams Y-Hassan, Piotr Czech, Per Lindvall, Björn Thorvinger, Helena Wikström, Ragnar Danielsen, Kristjan Eyjolfsson, Thorbjorn Gudjonsson, Thorarinn Gudnasson, Torfi Fjalar Jonasson, Gudjon Karlsson, Sigurpall Scheving, Axel Sigurdsson, Ulf Berglund, Anders Björkholm, Waldemar Czekierda, Marcus Gjerde, Dario Hauer, Tim Tödt, Dimitrios Venetsanos, Per Albertsson, Oskar Angerås, Christian Dworeck, Marc Gomes, Inger Haraldsson, Dan Ioanes, Fotios Katsaros, Michalis Koutouzis, Berglind Libungan, Göran Matejka, Jacob Odenstedt, Elmir Omerovic, Petur Petursson, Truls Råmunddal, Wilhelm Ridderstråle, Lisa Brandin, Anders Kallryd, Azad Matikhan, Jason Stewart, Ryszard Syberyjski, Pallonji Bhiladvala, Per Bondesson, David Erlinge, C G Gustavsson, Matthias Götberg, Jan Harnek, Anders Lundin, Tomas Molund, Margareta Nilsson, Göran Olivecrona, Fredrik Scherstén, Jan Haupt, Agneta C Johansson, Jens Jensen, Bo Lindvall, Daniel Wadell, Mikael Aasa, Patrik Alström, Olov Collsten, Anders Jonsson, Risto Jussila, Thomas Olsson, Per Tornvall, Nils Witt, Henrik Fryklund, Jens Solem, Magnus Wahlin, Jonas Andersson, Peter Eriksson, Lars Lundgren, Johan Nilsson, Björn Pettersson, Olov Duvernoy, Per Hultman, Stefan James, Bo Lagerqvist, Bertil Larsson, Johan Thuren, Giovanna Sarno, Christoph Varenhorst, Erik Diderholm, Per Grimfjärd, Martin Lindholm, Amra Kåregren, Fredrik Calais, Stella Cizinsky, Ole Fröbert, Ortwin Herterich, Istvan Herzfeld, Thomas Kellerth, Martin Lindholm, Kristian Wachtell, Leszek Zagozdzon, Hans Erik Bøtker, Evald H Christiansen, Anne Kaltoft, Lars Romer Krusell, Jens Flensted Lassen, Michael Maeng, Christian J Terkelsen, Leif Thuesen, Karsten Veien
Abstract
Background: The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality.
Methods: We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days.
Results: No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI.
Conclusions: Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404.).
Source: PubMed