054 Predictors of failure of EXPORT® thrombectomy in patients with myocardial infarction treated by percutaneous coronary intervention with an aspiration device: data from the RICO Survey

Background Thrombus aspiration is applicable in a large majority of patients with ST-segment elevation myocardial infarction (STEMI), and it results in better reperfusion and clinical outcomes than conventional PCI. However, some aspiration procedures remain none productive. Then, the aim of the present study was to determine the baseline clinical and/or angiographic characteristics of a none effective thrombectomy. Methods Consecutive patients who benefited from thrombus aspiration and primary or rescue angioplasty, were included. The end point was effective or none effective aspiration defined by the presence of atherothrombotic material in the aspirate samples. Results Among the 180 patients included, material was collected in 155 patients (86%). The baseline characteristics are presented in table 1. Table 1 . Baseline characteristics Thrombectomy Not effective Effective p Men (%) 80% 69% NS Age (years, mean ± SD) 70 ± 15 62 ± 14 Heart Rate (mean ± SD) 81 ± 23 74 ± 21 NS Systolic Blood pressure (mm Hg, mean ± SD) 150 ± 32 134 ± 27 Delay symptoms-reperfusion (min, mean ± SD) 504 ± 572 641 ± 1064 NS Culprit lesion (%) Left anterior artery 48% 35% NS Circumflex artery 8% 9% NS Right artery 36% 52% NS AHA classification AHA A 0% 3% NS AHA B1 24% 27% NS AHA B2 76% 70% NS AHA C 0% 1% NS Visible thrombus (%) 28% 61% 0.005 Length (mm) 0% 3% NS 10 – 20 mm 48% 47% NS > 10 mm 52% 50% N Calcification (%) 60% 37% 0.048 In multivariate analysis, the ability to remove the clot is negatively influenced by: a) age>70 years [OR(95%CI): 5.459 (1.943–15.339); p = 0.001 b) admission systolic blood pressure [OR(95%CI): 1.028 (1.010–1.048); p = 0.003] and c) no thrombus seen on the angiography [OR(95%CI): 0.220 (0.074–0.651), p = 0.006] Conclusion The present study demonstrated that manual thrombus aspiration is effective in a majority but not in all the patients. Others studies are then needed to develop more efficient aspiration techniques and other aspiration devices to improve the results of such procedures.