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Thrombus aspiration in patients with ST-elevation myocardial infarction presenting late after symptom onset: long-term clinical outcome of a randomized trial

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Abstract

Background

In the largest randomized trial so far, thrombus aspiration failed to reduce the primary endpoint of microvascular obstruction (MVO) in patients with ST-elevation myocardial infarction (STEMI) presenting late after symptom onset. Long-term clinical outcome data of this trial have not been reported yet.

Methods and results

A total of 144 patients with STEMI presenting ≥ 12 and ≤ 48 h after symptom onset were randomized to primary percutaneous coronary intervention (PCI) with or without manual thrombus aspiration in a 1:1 fashion. The primary efficacy endpoint was the extent of MVO assessed by cardiac magnetic resonance imaging and showed no significant difference between groups. Long-term clinical follow-up was performed at 4 years. Overall mortality at 4 years reached 18%. There was no significant difference between groups with respect to mortality and major adverse cardiac events defined as the composite of death, myocardial reinfarction and target vessel revascularization. In a multivariate Cox regression model glomerular filtration rate on admission, left ventricular ejection fraction, and cardiogenic shock were independently associated with time-dependent occurrence of death.

Conclusion

Routine thrombus aspiration in STEMI patients presenting late after symptom onset showed no significant difference with respect to long-term clinical endpoints compared to conventional PCI only.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Anne Freund, Sandra Schock, Philipp Lurz, Holger Thiele & Steffen Desch

  2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

    Anne Freund, Thomas Stiermaier, Suzanne de Waha-Thiele, Ingo Eitel & Steffen Desch

  3. University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany

    Thomas Stiermaier, Suzanne de Waha-Thiele, Ingo Eitel & Steffen Desch

  4. Leipzig Heart Institute, Leipzig, Germany

    Anne Freund & Holger Thiele

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  1. Anne Freund
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  2. Sandra Schock
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Correspondence to Anne Freund.

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Freund, A., Schock, S., Stiermaier, T. et al. Thrombus aspiration in patients with ST-elevation myocardial infarction presenting late after symptom onset: long-term clinical outcome of a randomized trial. Clin Res Cardiol 108, 1208–1214 (2019). https://doi.org/10.1007/s00392-019-01452-8

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  • DOI: https://doi.org/10.1007/s00392-019-01452-8

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