Kilic S, et al. - This trial investigated the potential benefit of thrombus aspiration (TA) and pre-hospital (pre-H) ticagrelor treatment in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Findings revealed that when left to physicians discretion, use of TA in high-risk patients was related to bail-out use of glycoprotein IIb/IIIa inhibitors (GPI) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding and did not alter 30-day clinical outcomes. In other words, pre-H ticagrelor treatment predicted lower 30-day rates of stent thrombosis (ST) or new myocardial infarction (MI) without interaction with TA.

Methods

• Researchers performed this study on 1630 patients who underwent primary PCI.
• They used multivariate analysis to investigate the potential association of TA and pre-H treatment with clinical outcomes.
• They also explored potential interactions between TA and pre-H ticagrelor.

Results

• Data reported that overall 941 (57.7%) patients underwent TA.
• Researchers found that adjusted multivariate logistic model revealed a significant association of pre-H ticagrelor treatment with less frequent new MI or definite stent thrombosis (ST) (OR 0.43, 95% CI 0.20–0.92, P = .031), or definite ST (OR 0.26, 95% CI 0.07–0.91, P = .036) at 30 days.
• Compared with no-TA group, patients treated with TA had higher frequency of TIMI flow 0–1 (80.7% vs 51.9%, P < .0001).
• Findings also demonstrated that TA when also adjusted for TIMI flow 0–1 showed significant association only for higher bail-out use of GPI (OR 1.72, 95% CI 1.18–2.50, P = .004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.10–7.76, P = .032).
• Furthermore, results revealed that no significant interactions between TA and pre-H ticagrelor were present for the explored endpoints.