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Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

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Abstract

Background

The clinical benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. This study assessed the impact of circadian rhythms on the effectiveness of manual TA.

Methods and results

We conducted an observational study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing PPCI with (TA group) or without (PCI-alone group) manual TA were divided based on time-of-day symptom onset: group 1 (00:00–05:59), group 2 (06:00–11:59), group 3 (12:00–17:59) and group 4 (18:00–23:59). The primary endpoint was circadian variation of myocardial infarction (MI) size. The secondary endpoint was in-hospital all-cause mortality. Between 2009 and 2014, 3648 patients underwent PPCI (TA, 49%). After propensity-score matching, 2860 patients were included. Minimal myocardial Injury was observed in groups 2 and 3 (peak creatine kinase level group 1, 2723 ± 148 U/l; group 2, 2493 ± 105 U/l; group 3, 2550 ± 106 U/l; group 4, 2952 ± 144 U/l; p = 0.044) in the TA group, whereas no time-of-day dependence was found in PCI-alone group. After periodic sinusoidal regression analysis, a circadian relationship between time-of-day symptom onset and MI size was demonstrated in the TA group (p < 0.001). In-hospital all-cause mortality was 3.4% in the TA group and 4.3% in the PCI-alone group (p = 0.20).

Conclusions

In this large registry of STEMI patients, manual TA did not reduce in-hospital all-cause mortality. Nonetheless, there was a circadian dependence of TA effectiveness with greatest myocardial salvage for patients with symptom onset between 06:00 and 17:59.

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Abbreviations

ACS:

Acute coronary syndrome

AMIS:

Acute myocardial infarction in Switzerland

CK:

Creatine kinase

I/R:

Ischemia/reperfusion

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

PPCI:

Primary percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

TA:

Thrombus aspiration

TIMI:

Thrombolysis In myocardial infarction

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Author information

Authors and Affiliations

  1. Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Stephane Fournier, Olivier Muller, Rachel Fesselet, Andrea Zuffi, Sophie Degrauwe, PierGiorgio Masci, Eric Eeckhout & Juan F. Iglesias

  2. Bristol Heart Institute, University of Bristol, Bristol, UK

    Umberto Benedetto

  3. Division of Cardiology, University Hospital, Geneva, Switzerland

    Marco Roffi & Stéphane Noble

  4. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Thomas Pilgrim & Stephan Windecker

  5. Department of Cardiology, Triemli Hospital, Zurich, Switzerland

    Franz R. Eberli

  6. Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Hans Rickli

  7. AMIS Plus Data Center, University of Zurich, Zurich, Switzerland

    Dragana Radovanovic

  8. Laboratory of Signal Transduction, Department of Biomedicine, Basel University Hospital, Basel, Switzerland

    Paul Erne

  9. Department of Cardiology, University Hospital, Fribourg, Switzerland

    Stéphane Cook

Authors
  1. Stephane Fournier
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  2. Olivier Muller
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  3. Umberto Benedetto
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  8. Dragana Radovanovic
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  11. Stéphane Noble
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  12. Rachel Fesselet
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  13. Andrea Zuffi
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  15. PierGiorgio Masci
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  16. Stephan Windecker
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  17. Eric Eeckhout
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  18. Juan F. Iglesias
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on behalf on the AMIS Plus Investigators

Corresponding author

Correspondence to Juan F. Iglesias.

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Fournier, S., Muller, O., Benedetto, U. et al. Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Res Cardiol 107, 338–346 (2018). https://doi.org/10.1007/s00392-017-1189-8

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  • DOI: https://doi.org/10.1007/s00392-017-1189-8

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