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Efficacy of thrombus aspiration in cardiogenic shock complicating acute myocardial infarction and high thrombus burden

Title
Efficacy of thrombus aspiration in cardiogenic shock complicating acute myocardial infarction and high thrombus burden
Authors
Lee, Hyun-JongLee, Wang SooJeong, Jin-OkPark, Sang-DonGwon, Hyeon-CheolKwon, WoochanChoi, Ki HongYang, Jeong HoonChung, Yu JinPark, Taek KyuLee, Joo MyungSong, Young BinHahn, Joo-YongChoi, Seung-HyukAhn, Chul-MinYu, Cheol WoongPark, Ik HyunJang, Woo JinKim, Hyun-JoongBae, Jang-WhanKwon, Sung Uk
Ewha Authors
장우진
SCOPUS Author ID
장우진scopusscopus
Issue Date
2023
Journal Title
REVISTA ESPANOLA DE CARDIOLOGIA
ISSN
1885-5857JCR Link
Citation
REVISTA ESPANOLA DE CARDIOLOGIA vol. 76, no. 9, pp. 719 - 728
Keywords
Myocardial infarctionCardiogenic shockCoronary thrombosisThrombectomy
Publisher
EDICIONES DOYMA S A
Indexed
SCIE; SCOPUS WOS
Document Type
Article
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 P-int =.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).
DOI
10.1016/j.rec.2023.01.009|http://dx.doi.org/10.1016/j.rec.2023.01.009
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