Data from randomized trials evaluating thrombus aspiration (TA) in patients with ST-Elevation Myocardial Infarction (STEMI) are conflicting. Therefore, we assessed one-year survival in STEMI patients participating in the FAST-MI (French Registry of ST-elevation and non-ST-elevation Myocardial Infarction) 2010 according to TA during primary percutaneous coronary intervention (PCI), such as used in the real world.

FAST-MI 2010 is a nationwide French registry that included 4,169 patients with acute myocardial infarction (AMI) at the end of 2010 in 213 centres. Of those, 2,087 patients had STEMI or left bundle branch block (LBBB), of whom 1,538 had primary PCI, with TA used in 671 (44%).

Patients with TA were younger (61±13.5 vs. 63±14 years), with a similar GRACE (Global Registry of Acute Coronary Events) risk score (140±31 vs. 143±34), and a shorter median time from symptom onset (245 vs. 285 min); location of AMI, history of MI, PCI or coronary artery bypass surgery did not differ significantly. Thirty-day mortality was 2.1% vs. 2.1% (adjusted p=0.18) and one-year survival was 95.5% vs. 94.8%. Using fully adjusted Cox multivariate analysis, hazard ratio for one-year death was 1.14 (95% confidence interval [CI], 0.63 to 2.07). After propensity score matching (480 patients per group), one-year survival was also similar with both strategies.

In a real-world setting of patients admitted with STEMI, the use of TA during primary PCI was not associated with improved one-year survival.

Clinicaltrials.gov identifier: NCT01237418