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Previous studies mainly focused on the effect of thrombus aspiration on short-term prognosis, and has not been proved to reduce the clinical events 30 days or 1 year. The aim of this analysis was to assess the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) on the long-term clinical outcomes for patients with ST-elevation myocardial infarction (STEMI), compared with patients did not receive thrombus aspiration during PPCI.
A total of 1033 consecutive patients diagnosed with STEMI and multivessel disease and underwent primary PCI between January 2005 to January 2015 were included in this study. Propensity matching score was calculated on the basis of several baseline and procedural characteristics in order to predict the probability for each patient of having been treated with thrombus aspiration. The characteristics including age, sex, smoking, family history of coronary artery disease, hypertension, diabetes, dyslipidemia, previous myocardial infarction, previous PCI, Killip class, site of myocardial infarction, culprit vessels, number of diseased vessels, the time from onset of symptoms to PCI. We considered a composite primary end point of MACE, including all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. The median follow-up was 4.0 years.
Twenty-nine patients were lost to follow-up. After propensity score matching, 418 patients underwent thrombus aspiration during PPCI and 418 patients without thrombus aspiration were selected. During the follow-up, 271 MACE were identified in 200 STEMI patients. The first MACE occurred in 24.0% patients underwent thrombus aspiration and 25.5% without thrombus aspiration (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.77 to 1.34, p =0.901). All-cause death occurred in 6.2% and 6.2% of the patients with or without thrombus aspiration, respectively (HR 1.14, 95% CI 0.65 to 2.00, p =0.651), non-fatal re-infarction in 5.9% and 7.2% (HR 0.92, 95% CI 0.53 to 1.58, p=0.756), repeat revascularization in 16.3% and 20.3% (HR 0.88, 95% CI 0.63 to 1.22, p =0.435), and stroke in 2.5% and 2.5% (HR 1.10, 95% CI 0.46 to 2.66, p =0.825).
In a real-world setting of patients admitted with STEMI and multivessel disease, the use of thrombus aspiration during primary PCI did not reduce the rate of MACE, nor the composite of MACE.