Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in “real-world” settings.Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke.Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556–1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164–0.949; p = 0.038].Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA.

A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score

“…It also has a serious importance on the prognosis after MI (in-hospital death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass surgery and stroke). [18][19][20] MPV elevation, which is a marker of platelet function, is associated with an increased risk of cardiovascular diseases such as myocardial infarction, stroke and transient ischemic attack. In their study, Han et al showed that the incidence of stroke and coronary artery disease was higher in the group with MPV>8 fL.…”

Validation of plasma D-dimer in Chinese patients with acute non-ST segment elevation myocardial infarction

“…Compared with the complex calculation of ACCI based on medical history, D-dimer could be identified only by a blood test, which might be more suitable for patients with critical illnesses or speech disorders. In a real-world retrospective study, Li et al ( 10 ) observed that patients with STEMI who had a higher plasma D-dimer might benefit from the use of thrombus aspiration during primary PCI. In addition, we used joint indicators to predict MACEs and all-cause deaths.…”

“…Several studies have suggested that increased D-dimer levels are associated with the presence and severity of coronary disease (6)(7)(8) and indicate an unfavorable prognosis for stable coronary disease (9). Therefore, D-dimer may be a valuable marker for predicting ischemic events (10). However, to our knowledge, the role of D-dimer in predicting the incidence of adverse events in Chinese patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been thoroughly studied.…”