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Clinical and Angiographic Predictors and Prognostic Value of Failed Thrombus Aspiration in Primary Percutaneous Coronary Intervention
Study Questions:
What are the predictors and implications of failed thrombus aspiration in patients undergoing primary percutaneous coronary intervention (PCI)?
Methods:
The authors evaluated the outcome of 1,399 patients who underwent attempted thrombus aspiration for primary PCI. Failure of thrombus aspiration was defined as the inability to reach and/or cross the occlusion with the aspiration catheter for effective thrombus removal. Further, they analyzed patients in which no aspiration material could be obtained.
Results:
Thrombus aspiration was unsuccessful in 10.3% of the patients. The independent predictors of failure of thrombectomy catheter to cross the lesion were proximal tortuosity (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.92-4.31; p < 0.001), lesion calcification (OR, 2.70; 95% CI, 1.77-4.13; p < 0.001), and bifurcation lesion (OR, 1.97; 95% CI, 1.15-3.37; p < 0.013). Independent predictors of lack of detectable aspirate were age over 60 years and circumflex artery lesion. There was no difference in the 1-year mortality of those with successful versus failed thrombus aspiration (6.4% vs. 6.2%; HR, 0.98; 95% CI, 0.49-1.95; p = 0.95).
Conclusions:
The authors concluded that tortuosity of the proximal vessel, lesion calcification, and bifurcation lesion were independent predictors of failed thrombus aspiration in patients undergoing primary PCI.
Perspective:
Manual thrombus aspiration has been demonstrated to improve angiographic outcome and appears to be associated with a survival benefit in meta-analysis. Only a third of patients are currently treated with thrombus aspiration (Menees et al., SCAI 2011), and there is lack of consensus on whether thrombus aspiration should be performed routinely or selectively. This study suggests that the procedure is successful in ~90% of patients undergoing primary PCI, and thrombus aspiration should be routinely performed unless the presence of the high-risk anatomic features identified in this study makes procedural success unlikely.
Keywords: Thrombosis, Thrombectomy, Coronary Vessels, Consensus, Percutaneous Coronary Intervention
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