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Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction.

Fröbert, Ole; Lagerqvist, Bo; Olivecrona, Göran LU ; Omerovic, Elmir; Gudnason, Thorarinn; Maeng, Michael; Aasa, Mikael; Angerås, Oskar; Calais, Fredrik and Danielewicz, Mikael, et al. (2013) In New England Journal of Medicine 369(17). p.1587-1597
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... (More)
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 .). (Less)
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New England Journal of Medicine
volume
369
issue
17
pages
1587 - 1597
publisher
Massachusetts Medical Society
external identifiers
  • wos:000326031100008
  • pmid:23991656
  • scopus:84886258945
ISSN
0028-4793
DOI
10.1056/NEJMoa1308789
language
English
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yes
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107d7206-3472-4662-b91c-b6318907f292 (old id 4066405)
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http://www.ncbi.nlm.nih.gov/pubmed/23991656?dopt=Abstract
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2013-10-01 09:51:36
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2019-09-22 03:13:50
@article{107d7206-3472-4662-b91c-b6318907f292,
  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 .).},
  author       = {Fröbert, Ole and Lagerqvist, Bo and Olivecrona, Göran and Omerovic, Elmir and Gudnason, Thorarinn and Maeng, Michael and Aasa, Mikael and Angerås, Oskar and Calais, Fredrik and Danielewicz, Mikael and Erlinge, David and Hellsten, Lars and Jensen, Ulf and Johansson, Agneta C and Kåregren, Amra and Nilsson, Johan and Robertson, Lotta and Sandhall, Lennart and Sjögren, Iwar and Ostlund, Ollie and Harnek, Jan and James, Stefan K},
  issn         = {0028-4793},
  language     = {eng},
  number       = {17},
  pages        = {1587--1597},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction.},
  url          = {http://dx.doi.org/10.1056/NEJMoa1308789},
  volume       = {369},
  year         = {2013},
}