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. 2015 Jun 15;4(6):e001962.
doi: 10.1161/JAHA.115.001962.

Clinical efficacy of thrombus aspiration on 5-year clinical outcomes in patients with ST-segment elevation acute myocardial infarction undergoing percutaneous coronary intervention

Hiroki Watanabe  1 , Hiroki Shiomi  1 , Kenji Nakatsuma  1 , Takeshi Morimoto  2 , Tomohiko Taniguchi  1 , Yutaka Furukawa  3 , Yoshihisa Nakagawa  4 , Minoru Horie  5 , Takeshi Kimura  1 ; CREDO‐Kyoto AMI investigators; Takeshi Kimura  6 , Ryuzo Sakata  6 , Akira Marui  6 , Mitsuo Matsuda  6 , Hirokazu Mitsuoka  6 , Masahiko Onoe  6 , Yoshihisa Nakagawa  6 , Kazuo Yamanaka  6 , Hisayoshi Fujiwara  6 , Yoshiki Takatsu  6 , Nobuhisa Ohno  6 , Ryuji Nohara  6 , Tomoyuki Murakami  6 , Teruki Takeda  6 , Masakiyo Nobuyoshi  6 , Masashi Iwabuchi  6 , Michiya Hanyu  6 , Ryozo Tatami  6 , Tsutomu Matsushita  6 , Manabu Shirotani  6 , Noboru Nishiwaki  6 , Toru Kita  6 , Yutaka Furukawa  6 , Yukikatsu Okada  6 , Hiroshi Kato  6 , Hiroshi Eizawa  6 , Katsuhisa Is  6 , Masaru Tanaka  6 , Shogo Nakayama  6 , Jong-Dae Lee  6 , Akira Nakano  6 , Takaaki Koshiji  6 , Koichi Morioka  6 , Akinori Takizawa  6 , Mitsuomi Shimamoto  6 , Fumio Yamazaki  6 , Masaaki Takahashi  6 , Junichiro Nishizawa  6 , Minoru Horie  6 , Hiroyuki Takashima  6 , Takashi Tamura  6 , Masaki Aota  6 , Mamoru Takahashi  6 , Takafumi Tabata  6 , Chuwa Tei  6 , Shuichi Hamasaki  6 , Yutaka Imoto  6 , Hiroyuki Yamamoto  6 , Hirofumi Kambara  6 , Osamu Doi  6 , Katsuhiko Matsuda  6 , Masafumi Nara  6 , Kazuaki Mitsudo  6 , Kazushige Kadota  6 , Tatsuhiko Komiya  6 , Shinji Miki  6 , Tetsu Mizoguchi  6 , Hiroyuki Nakajima  6 , Hisao Ogawa  6 , Seigo Sugiyama  6 , Michio Kawasuji  6 , Syuji Moriyama  6 , Ryuichi Hattori  6 , Takeshi Aoyama  6 , Makoto Araki  6 , Satoru Suwa  6 , Keiichi Tanbara  6 , Kumiko Kitagawa  6 , Misato Yamauchi  6 , Naoko Okamoto  6 , Yumika Fujino  6 , Saori Tezuka  6 , Asuka Saeki  6 , Miya Hanazawa  6 , Yuki Sato  6 , Chikako Hibi  6 , Hitomi Sasae  6 , Emi Takinami  6 , Yuriko Uchida  6 , Yuko Yamamoto  6 , Satoko Nishida  6 , Mai Yoshimoto  6 , Sachiko Maeda  6 , Izumi Miki  6 , Saeko Minematsu  6 , Mitsuru Abe  6 , Hiroki Shiomi  6 , Tomohisa Tada  6 , Junichi Tazaki  6 , Yoshihiro Kato  6 , Mamoru Hayano  6 , Akihiro Tokushige  6 , Masahiro Natsuaki  6 , Tetsu Nakajima  6
Affiliations

Clinical efficacy of thrombus aspiration on 5-year clinical outcomes in patients with ST-segment elevation acute myocardial infarction undergoing percutaneous coronary intervention

Hiroki Watanabe et al. J Am Heart Assoc. .

Erratum in

Abstract

Background: Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.

Methods and results: The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005-2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups.

Conclusions: Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients.

Keywords: acute coronary syndrome; coronary artery disease; no reflow; percutaneous coronary intervention; thrombus aspiration.

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Figures

Figure 1
Figure 1
Study flow chart. AMI indicates acute myocardial infarction; CABG, coronary artery bypass grafting; CREDO-Kyoto AMI Registry, Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction Registry; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TA, thrombus aspiration.
Figure 2
Figure 2
Crude and adjusted Kaplan–Meier curves for cumulative incidence of all-cause death. TA indicates thrombus aspiration.
Figure 3
Figure 3
Subgroup analyses and forest plots of hazard ratio for all-cause death. LAD indicates left anterior descending; PCI, percutaneous coronary intervention; TA, thrombus aspiration; TIMI, thrombolysis in myocardial infarction.
See this image and copyright information in PMC

Comment in

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