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.