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Vol. 76. Issue 9.
Pages 719-728 (September 2023)
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Vol. 76. Issue 9.
Pages 719-728 (September 2023)
Original article
Efficacy of thrombus aspiration in cardiogenic shock complicating acute myocardial infarction and high thrombus burden
Eficacia de la tromboaspiración en pacientes con shock cardiogénico secundario a infarto agudo de miocardio y alta carga trombótica
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Woochan Kwona,Ki Hong Choia,Jeong Hoon Yanga,
Corresponding author
jhysmc@gmail.com

Corresponding author:
Yu Jin ChungaTaek Kyu ParkaJoo Myung LeeaYoung Bin SongaJoo-Yong HahnaSeung-Hyuk ChoiaChul-Min AhnbCheol Woong YucIk Hyun ParkdWoo Jin JangeHyun-Joong KimfJang-Whan BaegSung Uk KwonhHyun-Jong LeeiWang Soo LeejJin-Ok JeongkSang-Don ParklHyeon-Cheol Gwona
a Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
b Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
c Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
d Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
e Department of Cardiology, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
f Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
g Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
h Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
i Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Republic of Korea
j Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
k Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
l Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Republic of Korea
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Tables (4)
Table 1. Baseline clinical characteristics and in-hospital management
Table 2. Baseline angiographic and procedural characteristics
Table 3. Comparison of in-hospital and 6-month clinical outcomes based on thrombus aspiration
Table 4. Subgroup analysis of 6-month clinical outcomes based on thrombus burden
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Additional material (1)
Abstract
Introduction and objectives

Current guidelines do not recommend routine thrombus aspiration in acute myocardial infarction (AMI) because no benefits were observed in previous randomized trials. However, there are limited data in cardiogenic shock (CS) complicating AMI.

Methods

We included 575 patients with AMI complicated by CS. The participants were stratified into the TA and no-TA groups based on use of TA. The primary outcome was a composite of 6-month all-cause death or heart failure rehospitalization. The efficacy of TA was additionally assessed based on thrombus burden (grade I-IV vs V).

Results

No significant difference was found in in-hospital death (28.9% vs 33.5%; P=.28), or 6-month death, or heart failure rehospitalization (32.4% vs 39.4%; HRadj: 0.80; 95%CI, 0.59-1.09; P=.16) between the TA and no-TA groups. However, in 368 patients with a higher thrombus burden (grade V), the TA group had a significantly lower risk of 6-month all-cause death or heart failure rehospitalization than the no-TA group (33.4% vs 46.3%; HRadj: 0.59; 95%CI, 0.41-0.85; P=.004), with significant interaction between thrombus burden and use of TA for primary outcome (adjusted Pint=.03).

Conclusions

Routine use of TA did not reduce short- and mid-term adverse clinical outcomes in patients with AMI complicated by CS. However, in select patients with a high thrombus burden, the use of TA might be associated with improved clinical outcomes. The study was registered at ClinicalTrials.gov (Identifier: NCT02985008).

Keywords:
Myocardial infarction
Cardiogenic shock
Coronary thrombosis
Thrombectomy
Abbreviations:
AMI
CS
PCI
STEMI
TA
TIMI
Resumen
Introducción y objetivos

Las guías actuales no recomiendan la aspiración sistemática de trombos (TA) en el infarto agudo de miocardio (IAM) debido a la falta de beneficio observada en ensayos aleatorizados previos. Sin embargo, los datos en el shock cardiogénico (SC) que complica un IAM son limitados.

Métodos

Se incluyó a 575 pacientes con IAM complicado por SC, que se estratificaron en 2 grupos según el uso o no uso de la tromboaspiración. El objetivo primario del estudio fue un combinado de muerte por cualquier causa o rehospitalización por insuficiencia cardiaca a los 6 meses. La eficacia de la tromboaspiración se evaluó en función de la carga de trombo (grado I-IV frente a V).

Resultados

No se encontraron diferencias significativas en la muerte intrahospitalaria (28,9% frente a 33,5%; p=0,28), ni en la muerte o rehospitalización por insuficiencia cardiaca a los 6 meses (32,4 frente a 39,4%; HRadj: 0,80; IC95%, 0,59-1,09; p=0,16) entre los grupos con y sin tromboaspiración. Sin embargo, en 368 pacientes con mayor carga trombótica (grado V), el grupo de tromboaspiración tuvo un riesgo significativamente menor de muerte por todas las causas o rehospitalización por insuficiencia cardiaca a los 6 meses comparado con el grupo sin tromboaspiración (33,4 frente a 46,3%, HR ajustada: 0,59; IC95%, 0,41-0,85; p=0,004), con una interacción significativa entre la carga de trombo y el uso de tromboaspiración para el resultado primario (pint ajustado=0,03).

Conclusiones

El uso rutinario de TA no redujo los resultados clínicos adversos a corto y medio plazo en pacientes con IAM complicado con SC. Sin embargo, en pacientes seleccionados con una elevada carga trombótica, el uso de tromboaspiración podría asociarse a una mejora de los resultados clínicos. El estudio se registró en ClinicalTrials.gov (Identifier: NCT02985008).

Palabras clave:
Infarto de miocardio
Shock cardiogénico
Trombosis coronaria
Trombectomía

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