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

Abstract

BackgroundThrombus 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 ST‐segment–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 ResultsWe 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 treatment‐preference 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).ConclusionsMortality 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.

Impact of manual thrombectomy on microvascular obstruction in STEMI patients

“…4 However, recent randomized controlled trials and large observational cohorts failed to find any benefits to MT with, even a signal of harm, mediated by a possible increase of stroke risk. [5][6][7][8] These results were confirmed in meta-analysis 9,10 and led to European guidelines recommending against the routine use of MT. 11 While the theoretical concept of MT seems straightforward, the mechanisms explaining its lack of efficacy remain unclear.…”

Vascular response and intrastent thrombus in the early phase after drug‐eluting versus bare‐metal stent implantation in patients with ST‐segment elevation myocardial infarction: An observational, single‐center study

“…The causes of thrombus formation and subsequent clinical events after coronary stent implantation are considered to be the accumulation of unfavorable factors in patient (eg, diabetes and hereditary drug withdrawal), procedural (eg, suboptimal stenting), device (eg, metal and polymer), lesion (eg, residual thrombus and lipid‐rich plaque), and pharmacological responses to antiplatelet drugs . Renewed technologies in G2‐DES such as biocompatible polymers, improved drug‐eluting kinetics, thinner struts, and a well‐designed platform with better conformability may contribute to the reduction of thrombus formation and clinical events compared with first‐generation DES and BMS .…”

“…The causes of thrombus formation and subsequent clinical events after coronary stent implantation are considered to be the accumulation of unfavorable factors in patient (eg, diabetes and hereditary drug withdrawal), procedural (eg, suboptimal stenting), device (eg, metal and polymer), lesion (eg, residual thrombus and lipid-rich plaque), and pharmacological responses to antiplatelet drugs. [24][25][26][27][28] Renewed technologies in G2-DES such as biocompatible polymers, improved drugeluting kinetics, thinner struts, and a well-designed platform with better conformability may contribute to the reduction of thrombus formation and clinical events compared with first-generation DES and BMS. [1][2][3][4] Although the exact mechanism of smaller thrombus burden in G2-DES compared with BMS in the present study still remains unclear, the presence of biocompatible polymer in G2-DES might play an important role as a protective factor for thrombus formation, among several differences between them.…”

Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART

“…Of note, a similar discrepancy in outcomes between IV-analysis and traditional regression analysis has previously been observed and published by our group in the context of thrombus aspiration in patients undergoing primary PCI. 24 The presented observational data is a valuable complement to the most recent RCTs in the field. 9,10 While the After Eighty study demonstrated the superiority of invasive strategy in the treatment of NSTE-ACS in the very elderly, the Italian Elderly ACS Study did not reproduce this result.…”