Thrombus Aspiration during STEMI: A Propensity Analysis in a Large Real World Cohort

Abid Assali Hana Vaknin-Assa Eli Lev Gabi Greenberg Eldad Rechavia Tamir Bental Ran Kornowski

Cardiology, Rabin Medical Center, Petach-Tikva, Israel

Background: The clinical effect of intracoronary thrombus aspiration (TA) before primary PCI in patients with STEMI is debated.

Aims: evaluate whether TA improve one year clinical outcomes.

Methods and Materials: We analyzed the outcome of STEMI patients who underwent primary PCI comparing patients who underwent aspiration (TA) to those who had standard (STD) therapy. A propensity analysis was carried out for TA versus STD based on their baseline clinical and pre-procedural angiographic characteristics. The score was then incorporated into subsequent multi variate regression analysis as a covariate.

Results: 1987 consecutive patients were included: 537 (27%) with TA and 1450 (73%) with STD.

	STD [n=1450]	TA [n=537]	P-value
Age (year)	61±12	59±12	0.01
Male	81%	85%	0.1
Ant MI	45%	45%	0.99
Killip>1	14%	12%	0.6
DM	27%	23%	0.06
Renal failure	13%	9.5%	0.02
Cadillac score	4.05±3.5	4.2±3.4	0.5
Final TIMI3	95%	98%	0.02
12 month Death	5.5%	3.8%	0.1
12 month MI	4.8%	4.1%	0.5
12 month Definite Stent thrombosis	2.5%	1.6%	0.2
12 month TVR	11.4%	9.2%	0.2
12 month MACE	18.8%	14.3%	0.03

We used a non-conditional logistic regression model to determine independent significance of TA as a predictor of one year outcomes. Models were adjusted for the Cadillac score and the propensity score by introducing it as a covariate in each model. TA was not significant while Cadillac score was a significant predictor for one year MACE [OR1.17; 95% CI=1.17-1.2; P=0..001]

Conclusions: In this large cohort of real-world, TA did not reduce one year clinical outcomes among patients with STEMI

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