In-Hospital Outcomes of Manual Thrombus Aspiration Versus Pre-Balloon Dilatation During Primary Pci for Total Occlusion

Abstract

Objectives: This study was designed to compare the in-hospital outcomes of primary PCI with export vs. primary PCI with the balloon in patients with total occlusion. Methodology: Consecutive patients with STEMI undergoing primary PCI with TA and pre-balloon dilatation were recruited in 1:1 ratio and post-procedure in-hospital mortality and complication rate (slow flow/no-reflow, contrast-induced nephropathy (CIN), and arrhythmias) were compared. Patients in the TA group were further stratified based on export time (time from onset of chest pain to the use of export) as ≤ 6 hours or > 6 hours. Results: A total of 200:199 patients were recruited in export and balloon group. Overall complications were significantly higher in balloon group, 39.7% (79/199) vs. 23.0% (46/200); p<0.001, which included slow flow/no-reflow (24.6% vs. 14.5%; p=0.005), CIN (10.1% vs. 4.5%; p=0.022), and arrhythmias (14.6% vs. 5.5%; p=0.006) with in-hospital mortality rate of 3.0% (6/200) vs. 6.0% (12/199); p=0.153. Upon stratifications, outcomes were more favorable when export time was ≤ 6 hours as compared to > 6 hours with mortality rate of 0% vs. 6.3%; p=0.010 and complication rate of 19.2% vs. 27.1%; p=0.187. Conclusion: TA in patients with total occlusion was associated with lesser complications and relatively better mortality benefits. The benefits of TA were directly associated with export time. Therefore, timely use of export can be considered in patients with total occlusion.

Comparison of Angiographic and in Hospital Outcomes of Thrombuster Versus Pre Ballooning in Primary Percutaneous Coronary Intervention

“…20 According to the research protocol, thrombus aspiration may have advantages and enhance primary outcomes in patients who had primary PCI and had TIMI 0 flow after a coronary wire had crossed the lesion. Similar to the findings of Kumar et al 19 the results of this investigation support thrombus aspiration over pre dilatation using a balloon catheter. In compared to the balloon pre dilatation arm, manual thrombus aspiration significantly reduced inhospital mortality and comorbidities such slow/no reflow, contrastinduced nephropathy, and arrhythmias.…”

“…This was in response to the publishing of unfavorable studies about the regular use of thrombus aspiration. 19 Although the study found no therapeutic advantage of regular thrombus aspiration in terms of improving objective clinical endpoints, some positive results were shown in subgroup analyses of patients with significant thrombus load. 20 According to the research protocol, thrombus aspiration may have advantages and enhance primary outcomes in patients who had primary PCI and had TIMI 0 flow after a coronary wire had crossed the lesion.…”

“…Patients who attained TIMI flow I [5 (2.65%) vs 6 (3.19%)], II [29 (15.42%) vs 14 (7.44%)], and III [62 (32.97%) vs 72 (38.29%)] had significantly lower rates of overall mortality during the index hospitalisation, with a p-value of P0.001. A study by Kumar et al 19 using TIMI 0 flow thrombectomy (7.3%) and a balloon (7.5%) of patients demonstrated a superior result in the thrombectomy group. In terms of 30-day mortality, adjunctive manual thrombectomy devices were significantly linked with benefits [1.7 vs. 3.1%, OR (95% CI).…”