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Impact of thrombus aspiration on mortality, stent thrombosis, and stroke in patients with ST-segment-elevation myocardial infarction : A report from the Swedish coronary angiography and angioplasty registry

Angerås, Oskar; Haraldsson, Inger; Redfors, Björn; Fröbert, Ole; Petursson, Petur; Albertsson, Per; Ioanes, Dan; Odenstedt, Jacob; Olsson, Hans and Witt, Nils, et al. (2018) In Journal of the American Heart Association 7(1).
Abstract

Background--Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with STsegment- elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Methods and Results--We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction.... (More)

Background--Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with STsegment- elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Methods and Results--We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatmentpreference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: -1.2; 95% confidence interval [CI], -5.4 to 3.0; P=0.57) and 1 year (risk reduction: -2.4; 95% CI, -7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: -2.7; 95% CI, -4.1 to -1.4; P < 0.001) and 1 year (risk reduction: -3.5; 95% CI, -5.3 to -1.7; P < 0.001). In-hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, -0.8 to 1.1; P=0.76). Conclusions--Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.

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published
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keywords
Myocardial infarction, Primary percutaneous coronary intervention, Thrombectomy
in
Journal of the American Heart Association
volume
7
issue
1
publisher
Wiley-Blackwell
external identifiers
  • scopus:85040508696
  • pmid:29317403
ISSN
2047-9980
DOI
10.1161/JAHA.117.007680
language
English
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yes
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9076777e-bfbe-4e11-9171-94d8b885d5bc
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2018-02-05 12:58:49
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2018-02-06 03:00:09
@article{9076777e-bfbe-4e11-9171-94d8b885d5bc,
  abstract     = {<p>Background--Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with STsegment- elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Methods and Results--We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatmentpreference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: -1.2; 95% confidence interval [CI], -5.4 to 3.0; P=0.57) and 1 year (risk reduction: -2.4; 95% CI, -7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: -2.7; 95% CI, -4.1 to -1.4; P &lt; 0.001) and 1 year (risk reduction: -3.5; 95% CI, -5.3 to -1.7; P &lt; 0.001). In-hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, -0.8 to 1.1; P=0.76). Conclusions--Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.</p>},
  articleno    = {e007680},
  author       = {Angerås, Oskar and Haraldsson, Inger and Redfors, Björn and Fröbert, Ole and Petursson, Petur and Albertsson, Per and Ioanes, Dan and Odenstedt, Jacob and Olsson, Hans and Witt, Nils and Rück, Andreas and Millgård, Jonas and Nilsson, Johan and Persson, Jonas and Söderbom, Måns and Wedel, Hans and Erlinge, David and James, Stefan and Råmunddal, Truls and Omerovic, Elmir},
  issn         = {2047-9980},
  keyword      = {Myocardial infarction,Primary percutaneous coronary intervention,Thrombectomy},
  language     = {eng},
  month        = {01},
  number       = {1},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of the American Heart Association},
  title        = {Impact of thrombus aspiration on mortality, stent thrombosis, and stroke in patients with ST-segment-elevation myocardial infarction : A report from the Swedish coronary angiography and angioplasty registry},
  url          = {http://dx.doi.org/10.1161/JAHA.117.007680},
  volume       = {7},
  year         = {2018},
}