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Clinical impact of direct stenting and interaction with thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention : Thrombectomy Trialists Collaboration

Mahmoud, Karim D.; Jolly, Sanjit S.; James, Stefan; Džavík, Vladimír; Cairns, John A.; Olivecrona, Goran K. LU ; Renlund, Henrik; Gao, Peggy; Lagerqvist, Bo and Alazzoni, Ashraf, et al. (2018) In European Heart Journal 39(26). p.2472-2479
Abstract

Aims Preliminary studies suggest that direct stenting (DS) during percutaneous coronary intervention (PCI) may reduce microvascular obstruction and improve clinical outcome. Thrombus aspiration may facilitate DS. We assessed the impact of DS on clinical outcome and myocardial reperfusion and its interaction with thrombus aspiration among ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI. Methods and results Patient-level data from the three largest randomized trials on routine manual thrombus aspiration vs. PCI only were merged. A 1:1 propensity matched population was created to compare DS and conventional stenting. Synergy between DS and thrombus aspiration was assessed with interaction P-values in the final... (More)

Aims Preliminary studies suggest that direct stenting (DS) during percutaneous coronary intervention (PCI) may reduce microvascular obstruction and improve clinical outcome. Thrombus aspiration may facilitate DS. We assessed the impact of DS on clinical outcome and myocardial reperfusion and its interaction with thrombus aspiration among ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI. Methods and results Patient-level data from the three largest randomized trials on routine manual thrombus aspiration vs. PCI only were merged. A 1:1 propensity matched population was created to compare DS and conventional stenting. Synergy between DS and thrombus aspiration was assessed with interaction P-values in the final models. In the unmatched population (n= 17 329), 32% underwent DS and 68% underwent conventional stenting. Direct stenting rates were higher in patients randomized to thrombus aspiration as compared with PCI only (41% vs. 22%; P < 0.001). Patients undergoing DS required less contrast (162mL vs. 172mL; P< 0.001) and had shorter fluoroscopy time (11.1min vs. 13.3 min; P< 0.001). After propensity matching (n= 10 944), no significant differences were seen between DS and conventional stenting with respect to 30-day cardiovascular death [1.7% vs. 1.9%; hazard ratio 0.88, 95% confidence interval (CI) 0.55-1.41; P=0.60; Pinteraction = 0.96) and 30-day stroke or transient ischaemic attack (0.6% vs. 0.4%; odds ratio 1.02; 95% CI 0.14-7.54; P=0.99; Pinteraction = 0.81). One-year results were similar. No significant differences were seen in electrocardiographic and angiographic myocardial reperfusion measures. Conclusion Direct stenting rates were higher in patients randomized to thrombus aspiration. Clinical outcomes and myocardial reperfusion measures did not differ significantly between DS and conventional stenting and there was no interaction with thrombus aspiration.

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published
subject
keywords
Myocardial infarction, Myocardial reperfusion, Percutaneous coronary intervention, Stents, Thrombectomy
in
European Heart Journal
volume
39
issue
26
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:85051373604
ISSN
0195-668X
DOI
10.1093/eurheartj/ehy219
language
English
LU publication?
yes
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6ff2a8d6-76e4-40d0-8b5b-1f53e7356150
date added to LUP
2018-09-11 14:17:52
date last changed
2019-11-20 05:25:13
@article{6ff2a8d6-76e4-40d0-8b5b-1f53e7356150,
  abstract     = {<p>Aims Preliminary studies suggest that direct stenting (DS) during percutaneous coronary intervention (PCI) may reduce microvascular obstruction and improve clinical outcome. Thrombus aspiration may facilitate DS. We assessed the impact of DS on clinical outcome and myocardial reperfusion and its interaction with thrombus aspiration among ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI. Methods and results Patient-level data from the three largest randomized trials on routine manual thrombus aspiration vs. PCI only were merged. A 1:1 propensity matched population was created to compare DS and conventional stenting. Synergy between DS and thrombus aspiration was assessed with interaction P-values in the final models. In the unmatched population (n= 17 329), 32% underwent DS and 68% underwent conventional stenting. Direct stenting rates were higher in patients randomized to thrombus aspiration as compared with PCI only (41% vs. 22%; P &lt; 0.001). Patients undergoing DS required less contrast (162mL vs. 172mL; P&lt; 0.001) and had shorter fluoroscopy time (11.1min vs. 13.3 min; P&lt; 0.001). After propensity matching (n= 10 944), no significant differences were seen between DS and conventional stenting with respect to 30-day cardiovascular death [1.7% vs. 1.9%; hazard ratio 0.88, 95% confidence interval (CI) 0.55-1.41; P=0.60; P<sub>interaction</sub> = 0.96) and 30-day stroke or transient ischaemic attack (0.6% vs. 0.4%; odds ratio 1.02; 95% CI 0.14-7.54; P=0.99; P<sub>interaction</sub> = 0.81). One-year results were similar. No significant differences were seen in electrocardiographic and angiographic myocardial reperfusion measures. Conclusion Direct stenting rates were higher in patients randomized to thrombus aspiration. Clinical outcomes and myocardial reperfusion measures did not differ significantly between DS and conventional stenting and there was no interaction with thrombus aspiration.</p>},
  author       = {Mahmoud, Karim D. and Jolly, Sanjit S. and James, Stefan and Džavík, Vladimír and Cairns, John A. and Olivecrona, Goran K. and Renlund, Henrik and Gao, Peggy and Lagerqvist, Bo and Alazzoni, Ashraf and Kedev, Sasko and Stankovic, Goran and Meeks, Brandi and Frøbert, Ole and Zijlstra, Felix},
  issn         = {0195-668X},
  keyword      = {Myocardial infarction,Myocardial reperfusion,Percutaneous coronary intervention,Stents,Thrombectomy},
  language     = {eng},
  month        = {07},
  number       = {26},
  pages        = {2472--2479},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Clinical impact of direct stenting and interaction with thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention : Thrombectomy Trialists Collaboration},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehy219},
  volume       = {39},
  year         = {2018},
}