Thrombectomy Shows Long-term, but no Short-term, Benefit in STEMI Patients

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While failing to lower 30-day major adverse cardiac events (MACE) compared with primary percutaneous coronary intervention (PCI) alone, aspiration thrombectomy reduces mortality at 1 year in patients with ST-segment elevation myocardial infarction (STEMI), according to an Israeli registry study published online December 13, 2013, ahead of print in the American Journal of Cardiology.

Researchers led by Mady Moriel, MD, of Shaare Zedek Medical Center (Jerusalem, Israel), looked at 517 consecutive patients hospitalized in 23 intensive coronary care units included in a prospective observational nationwide Acute Coronary Syndrome Israeli Survey registry conducted March-April 2010.

Forty-two percent of patients (n = 217) received aspiration thrombectomy and primary PCI, while over half (58%, n = 300) received PCI alone. The decision to perform aspiration thrombectomy was at the discretion of each participating center and operating physician. Characteristics of patients in both groups were similar, although thrombectomy patients had lower systolic BP on admission and more frequently presented with Killip class II-IV compared with patients receiving primary PCI alone.

At 30 days, incidence of MACE (death, hospitalization for unstable angina, MI, stent thrombosis, urgent revascularization, stroke) was similar between the 2 groups, as were rates of several individual outcomes (table 1).

Table 1. Thirty-Day Outcomes

 

With Aspiration Thrombectomy
(n = 217)

Without Aspiration Thrombectomy
(n = 300)

P Value

MACE

10.6%

9.7%

0.73

Mortality

3.2%

4.0%

0.64

Nonfatal MI

1%

2%

0.48


In Cox regression analysis, at 1 year, use of aspiration thrombectomy was an independent predictor of decreased mortality (adjusted HR 0.31; 95% CI 0.10-0.96; P = 0.042). Similar results were obtained in a model adjusting for propensity score alone (HR 0.37; 95% CI 0.14-0.98; P = 0.047), although unadjusted rates were similar (3.7% with thrombectomy vs. 6.7% with primary PCI alone; P = 0.13).

Use of glycoprotein IIb/IIIa inhibitors (GPIs) was not associated with 1-year mortality, nor was the interaction between the use of aspiration thrombectomy and GPIs (P = 0.83 for interaction).

The authors note that similar to the TASTE trial, the current study did not reveal better outcomes at 30 days with thrombectomy.However a lower 1-year mortality rate was found, “possibly related to lower reinfarction rates during the follow-up,” they propose.

The authors note that the registry was apparently subject to selection bias, with sicker patients chosen for aspiration thrombectomy. “The observation that there was a trend of reduced crude 1-year mortality that turned out to be significant after covariate adjustments may be related to the relatively small sample size and low event rate in our study,” they assert. “Nonetheless, this prospective multicenter observational survey of unselected STEMI patients represents the ‘real world’ clinical practice and its associated outcome.”

Study Details

Different manual thrombectomy devices were used at different centers, including:

  • Pronto extraction catheter (Vascular Solutions)
  • Export aspiration catheter (Medtronic)
  • Eliminate aspiration catheter (Terumo)
  • QuickCat extraction catheter (Spectranetics)
  • QXT extraction catheter (Vascular Solutions)
  • ASAP aspiration catheter kit (Merit Medical Systems)

 


Source:
Moriel M, Matetzky S, Segev A, et al. Aspiration thrombectomy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention – (from the Acute Coronary Syndrome Israeli Survey 2010). Am J Cardiol. 2013; Epub ahead of print.

 

Disclosures:

  • Dr. Moriel makes no statement regarding conflicts of interest.

 

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