Cardiovascular Diabetology (Nov 2018)

Thrombus aspiration in hyperglycemic ST-elevation myocardial infarction (STEMI) patients: clinical outcomes at 1-year follow-up

  • Celestino Sardu,
  • Michelangela Barbieri,
  • Maria Luisa Balestrieri,
  • Mario Siniscalchi,
  • Pasquale Paolisso,
  • Paolo Calabrò,
  • Fabio Minicucci,
  • Giuseppe Signoriello,
  • Michele Portoghese,
  • Pasquale Mone,
  • Davide D’Andrea,
  • Felice Gragnano,
  • Alessandro Bellis,
  • Ciro Mauro,
  • Giuseppe Paolisso,
  • Maria Rosaria Rizzo,
  • Raffaele Marfella

DOI
https://doi.org/10.1186/s12933-018-0795-8
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 16

Abstract

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Abstract Objectives We evaluate whether the thrombus aspiration (TA) before primary percutaneous coronary intervention (PPCI) may improve STEMI outcomes in hyperglycemic patients. Background The management of hyperglycemic patients during STEMI is unclear. Methods We undertook an observational cohort study of 3166 first STEMI. Patients were grouped on the basis of whether they received TA or not. Moreover, among these patients we selected a subgroup of STEMI patients with hyperglycemia during the event (glycaemia > 140 mg/dl). The endpoint at 1 year included all-cause mortality, cardiac mortality and re-hospitalization for coronary disease, heart failure and stroke. Results One-thousand STEMI patients undergoing PPCI to plus TA (TA-group) and 1504 STEMI patients treated with PPCI alone (no-TA group) completed the study. In overall study-population, Kaplan–Meier-analysis demonstrated no significant difference in mortality rates between patients with and without TA (P = 0.065). After multivariate Cox-analysis (HR: 0.94, 95% CI 0.641–1.383) and the addition of propensity matching (HR: 0.86 95% CI 0.412–1.798) TA was still not associated with decreased mortality. By contrast, in hyperglycemic subgroup STEMI patients (TA-group, n = 331; no-TA group, n = 566), Kaplan–Meier-analysis demonstrated a significantly lower mortality (P = 0.019) in TA-group than the no-TA group. After multivariate Cox-analysis (HR: 0.64, 95% CI 0.379–0.963) and the addition of propensity matching (HR: 0.54, 95% CI 0.294–0.984) TA was still associated with decreased mortality. Conclusions TA was not associated with lower mortality in PPCI for STEMI when used in our large all-comer cohort. Conversely, TA during PPCI for STEMI reduces clinical outcomes in hyperglycemic patients. Trial registration NCT02817542. 25th, June 2016

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