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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
Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada.
Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Uppsala, Sweden.
Peter Munk Cardiac Centre, University Health Network, Toronto Ontario, Canada.
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 26, p. 2472-2479Article in journal (Refereed) Published
Abstract [en]

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= 17329), 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 (162 mL vs. 172 mL; P < 0.001) and had shorter fluoroscopy time (11.1 min vs. 13.3 min; P < 0.001). After propensity matching (n = 10944), 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-interaction = 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-interaction = 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.

Place, publisher, year, edition, pages
Oxford University Press, 2018. Vol. 39, no 26, p. 2472-2479
Keywords [en]
Myocardial infarction, Myocardial reperfusion, Percutaneous coronary intervention, Thrombectomy, Stents
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-68242DOI: 10.1093/eurheartj/ehy219ISI: 000438554000008PubMedID: 29688419OAI: oai:DiVA.org:oru-68242DiVA, id: diva2:1235786
Note

Funding Agencies:

Medtronic  

Vascular Solutions  

Terumo Inc.  

Boston Scientific  

Abbot Vascular  

AstraZeneca  

Medicines Company 

Available from: 2018-07-27 Created: 2018-07-27 Last updated: 2018-08-30Bibliographically approved

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Fröbert, Ole

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