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Impact of total ischemic time on manual thrombus aspiration benefit during primary percutaneous coronary intervention.
Hugelshofer, Sarah; Roffi, Marco; Witassek, Fabienne; Eberli, Franz R; Pilgrim, Thomas; Pedrazzini, Giovanni; Rickli, Hans; Radovanovic, Dragana; Erne, Paul; Degrauwe, Sophie; Muller, Olivier; Masci, Pier Giorgio; Windecker, Stephan; Iglesias, Juan F.
Afiliación
  • Hugelshofer S; Department of Cardiology, Lausanne University Hospital, Switzerland.
  • Roffi M; Division of Cardiology, University Hospital, Geneva, Switzerland.
  • Witassek F; AMIS Plus Data Center, University of Zurich, Switzerland.
  • Eberli FR; Department of Cardiology, Triemli Hospital, Zurich, Switzerland.
  • Pilgrim T; Department of Cardiology, Bern University Hospital, Switzerland.
  • Pedrazzini G; Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
  • Rickli H; Division of Cardiology, Kantonsspital St. Gallen, Switzerland.
  • Radovanovic D; AMIS Plus Data Center, University of Zurich, Switzerland.
  • Erne P; Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Switzerland.
  • Degrauwe S; Division of Cardiology, University Hospital, Geneva, Switzerland.
  • Muller O; Department of Cardiology, Lausanne University Hospital, Switzerland.
  • Masci PG; Department of Cardiology, Lausanne University Hospital, Switzerland.
  • Windecker S; Department of Cardiology, Bern University Hospital, Switzerland.
  • Iglesias JF; Division of Cardiology, University Hospital, Geneva, Switzerland. Electronic address: JuanFernando.Iglesias@hcuge.ch.
Am Heart J ; 204: 34-42, 2018 10.
Article en En | MEDLINE | ID: mdl-30075324
BACKGROUND: The benefits of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) remain uncertain. We assessed the influence of total ischemic time (TIT) on clinical outcomes among STEMI patients undergoing manual TA during pPCI. METHODS AND RESULTS: We conducted a retrospective study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing pPCI with (TA group) or without (PCI-alone group) manual TA were stratified based on short (<3 hours), intermediate (3-6 hours), and long (>6 hours) TIT. The primary endpoint was in-hospital all-cause mortality. The secondary endpoint was in-hospital major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction and stroke. Between 2008 and 2014, 4'154 patients (TA 48%) were included. Risk-adjusted in-hospital all-cause mortality was not different between TA and PCI-alone groups (OR 1.29; 95%CI 0.83-1.98; p=0.26), whereas there was significantly increased risk of MACE (OR 1.52; 95%CI 1.05-2.19; p=0.03) in patients treated with manual TA compared with PCI-alone. There was no significant difference between manual TA and PCI-alone with respect to risk-adjusted all-cause mortality according to TIT groups, but risk-adjusted MACE rates were significantly higher in the group of patients with long TIT treated with manual TA compared with PCI-alone (OR 2.42; 95%CI 1.16-5.04; p=0.02). CONCLUSION: In a large registry of STEMI patients, manual TA was not associated with lower risk-adjusted in-hospital all-cause mortality compared with PCI-alone regardless of TIT but was associated with significantly greater risk of MACE. In patients with prolonged TIT, manual TA was associated with higher risk-adjusted MACE rates compared with PCI-alone.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Succión / Trombosis Coronaria / Trombectomía / Tiempo de Tratamiento / Intervención Coronaria Percutánea / Infarto del Miocardio con Elevación del ST Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Heart J Año: 2018 Tipo del documento: Article País de afiliación: Suiza

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Succión / Trombosis Coronaria / Trombectomía / Tiempo de Tratamiento / Intervención Coronaria Percutánea / Infarto del Miocardio con Elevación del ST Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Heart J Año: 2018 Tipo del documento: Article País de afiliación: Suiza