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dc.contributor.authorLagerqvist, Bo
dc.contributor.authorFröbert, Ole
dc.contributor.authorOlivecrona, Göran K
dc.contributor.authorGudnason, Thórarinn
dc.contributor.authorMaeng, Michael
dc.contributor.authorAlström, Patrik
dc.contributor.authorAndersson, Jonas
dc.contributor.authorCalais, Fredrik
dc.contributor.authorCarlsson, Jörg
dc.contributor.authorCollste, Olov
dc.contributor.authorGötberg, Matthias
dc.contributor.authorHårdhammar, Peter
dc.contributor.authorIoanes, Dan
dc.contributor.authorKallryd, Anders
dc.contributor.authorLinder, Rickard
dc.contributor.authorLundin, Anders
dc.contributor.authorOdenstedt, Jacob
dc.contributor.authorOmerovic, Elmir
dc.contributor.authorPuskar, Verner
dc.contributor.authorTödt, Tim
dc.contributor.authorZelleroth, Eva
dc.contributor.authorOstlund, Ollie
dc.contributor.authorJames, Stefan K
dc.date.accessioned2014-09-24T16:48:38Z
dc.date.available2014-09-24T16:48:38Z
dc.date.issued2014-09-18
dc.date.submitted2014
dc.identifier.citationN. Engl. J. Med. 2014, 371 (12):1111-20en
dc.identifier.issn1533-4406
dc.identifier.pmid25176395
dc.identifier.doi10.1056/NEJMoa1405707
dc.identifier.urihttp://hdl.handle.net/2336/331837
dc.descriptionTo access publisher's full text version of this article click on the hyperlink at the bottom of the pageen
dc.description.abstractBackground Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. Methods We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial. Results No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P=0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P=0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P=0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P=0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI. Conclusions Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year. (Funded by the Swedish Research Council and others; TASTE ClinicalTrials.gov number, NCT01093404 .).
dc.description.sponsorshipSwedish Research Council, the Swedish Association of Local Authorities and Regions, Terumo Medical, Medtronic, and Vascular Solutions, by grants from the Swedish Heart–Lung Foundation (20100178, to Dr. Fröbert; and B0010401, to Dr. James), and by the Landspitali University Hospital Research Fund (to Dr. Gudnason).en
dc.language.isoenen
dc.publisherNEJM, Massachusetts Medical Societyen
dc.relation.urlhttp://dx.doi.org/10.1056/NEJMoa1405707en
dc.relation.urlhttp://www.nejm.org/doi/pdf/10.1056/NEJMoa1405707en
dc.rightsArchived with thanks to The New England journal of medicineen
dc.subjectHjartasjúkdómaren
dc.subject.meshMyocardial Infarction/therapy*en
dc.subject.meshMyocardial Infarction/mortalityen
dc.subject.meshAgeden
dc.subject.meshCause of Deathen
dc.subject.meshCombined Modality Therapyen
dc.subject.meshCoronary Restenosisen
dc.subject.meshCoronary Thrombosis/therapy*en
dc.subject.meshElectrocardiographyen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshKaplan-Meier Estimateen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPatient Readmissionen
dc.subject.meshPercutaneous Coronary Intervention*en
dc.subject.meshSuction*en
dc.subject.meshMyocardial Infarction/mortalityen
dc.subject.meshMyocardial Infarction/therapy*en
dc.titleOutcomes 1 year after thrombus aspiration for myocardial infarction.en
dc.typeArticleen
dc.contributor.department1From the Department of Medical Sciences, Cardiology Section, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Coronary Heart Disease, Skane University Hospital, Clinical Sciences Section, Lund University, Lund (G.K.O., M.G., A.L.), Department of Cardiology, Karolinska Institutet, Södersjukhuset (P.A., O.C.), and Department of Cardiology, Karolinska Institutet, Danderyd (R.L.), Stockholm, Department of Cardiology, Umeå University Hospital, Umeå (J.A.), Section of Cardiology, Kalmar County Hospital and Linnaeus University, Kalmar (J.C.), Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., J.O., E.O.), Department of Cardiology, Skaraborgs Hospital, Skövde (A.K.), Department of Radiology, Ryhov Hospital, Jönköping (V.P.), Department of Cardiology, Linköping University Hospital, Linköping (T.T.), and Department of Radiology, Mälarsjukhuset, Eskilstuna (E.Z.) - all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital, Reykjavik, Iceland (T.G.); and the Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmarken
dc.identifier.journalThe New England journal of medicineen
dc.rights.accessLandspitali Access - LSH-aðganguren
html.description.abstractBackground Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. Methods We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial. Results No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P=0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P=0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P=0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P=0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI. Conclusions Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year. (Funded by the Swedish Research Council and others; TASTE ClinicalTrials.gov number, NCT01093404 .).


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