Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Jan 2018)

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

  • Oskar Angerås,
  • Inger Haraldsson,
  • Björn Redfors,
  • Ole Fröbert,
  • Petur Petursson,
  • Per Albertsson,
  • Dan Ioanes,
  • Jacob Odenstedt,
  • Hans Olsson,
  • Nils Witt,
  • Andreas Rück,
  • Jonas Millgård,
  • Johan Nilsson,
  • Jonas Persson,
  • Måns Söderbom,
  • Hans Wedel,
  • David Erlinge,
  • Stefan James,
  • Truls Råmunddal,
  • Elmir Omerovic

DOI
https://doi.org/10.1161/JAHA.117.007680
Journal volume & issue
Vol. 7, no. 1

Abstract

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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.

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