Outcomes From Selective Use of Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

• Published in: JACC. Cardiovascular interventions Vol. 9; no. 2; pp. 126 - 134
• Main Authors: Sirker, Alex, MB BChir, Mamas, Mamas, BM BChir, Kwok, Chun Shing, MB BS, Kontopantelis, Evangelos, PhD, Ludman, Peter, MD, Hildick-Smith, David, MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2016
• Subjects: aspiration; Cardiovascular; mortality; myocardial infarction; thrombectomy; RCT; PPCI; thrombectomy; NICOR; myocardial infarction; primary percutaneous coronary intervention; Thrombolysis In Myocardial Infarction; British Cardiovascular Intervention Society; randomized controlled trial; percutaneous coronary intervention; BCIS; TIMI; aspiration; PCI; mortality; National Institute of Cardiovascular Outcomes Research; STEMI; ST-segment elevation myocardial infarction; CABG; coronary artery bypass grafting
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2015.10.047

Abstract Objectives This study used a large national cohort to examine patterns of thrombectomy use in ST-segment elevation myocardial infarction (STEMI) and the relationship to mortality. Background The impact of coronary thrombectomy on mortality in STEMI has not been definitively established. Published trial data have been insufficiently powered to address this. Methods The U.K. national registry was used to study 98,176 patients treated with primary percutaneous coronary intervention (PCI), between January 1, 2006, and December 31, 2013. Patients were grouped on the basis of whether they received thrombectomy or not; subgroups of simple (manual aspiration) and complex (mechanical) thrombectomy were also evaluated. The primary endpoint was 30-day mortality. The principal adjusted analysis used propensity score matching (PSM). A sensitivity analysis was performed using logistic regression controlled for the propensity score. Results Thrombectomy use markedly increased in the United Kingdom between 2008 and 2010 but plateaued thereafter at slightly below 50% of all primary PCI cases. No significant mortality difference was seen, in adjusted analyses, between the overall thrombectomy group and the no thrombectomy group, at 30 days or 1 year (at 30 days, PSM average treatment effect [ATE] coefficient 0.0028, 95% confidence interval: −0.0048 to 0.0104; p = 0.47). Likewise, no difference was seen between the simple (manual) thrombectomy versus no thrombectomy, at either time point (at 30 days, PSM ATE coefficient 0.0007, 95% confidence interval: −0.0049 to 0.0063; p = 0.80). By contrast, the complex (mechanical) thrombectomy group demonstrated a significantly higher mortality than the no thrombectomy group at 1-year follow-up (PSM ATE coefficient 0.0434, 95% confidence interval: 0.0081 to 0.0786; p = 0.017). Conclusions Coronary thrombectomy was not associated with lower mortality in primary PCI for STEMI when used in our large all-comer cohort in a selective manner on the basis of physician judgment. These findings are consistent with other negative clinical outcomes in recent large randomized controlled trials studying routine manual thrombectomy in primary PCI.