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Aspiration thrombectomy fails to demonstrate benefit in primary PCI
Although primary percutaneous coronary intervention (PPCI) restores epicardial coronary flow in the majority of patients with ST-segment myocardial infarction, this approach can lead to microvascular obstruction resulting from distal embolization of thrombus. Manual thrombectomy (i.e. aspiration thrombectomy) prior to PPCI has been proposed as a method to reduce thrombus burden and resultant distal embolization with PPCI. Although results from early studies of aspiration thrombectomy suggested improvements in patient outcomes, subsequent trials have failed to demonstrate a clinical benefit of aspiration thrombectomy prior to PPCI. This large, multi-centre, international trial furthers the evidence that aspiration does not offer benefit in the routine care of patients undergoing PPCI. This study randomized 10,732 patients with ST elevation myocardial infarction to routine manual thrombectomy prior to PCI or standard PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days with a primary safety end-point of stroke within 30 days. Crossover rates between groups were low and the primary analysis was by intention-to-treat. Compared to standard PPCI, treatment with aspiration thrombectomy did not reduce rates of the primary outcome (6.9% vs. …
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