Abstract 14990: A Propensity Score Analysis of Five-Year Outcomes After Coronary Thrombus Aspiration in Acute Myocardial Infarction: Insights From the FAST-MI Real-Life Registry

Abstract

Introduction: Though previous trials and registries have shown no short-term benefit of thrombectomy in acute myocardial infarction (AMI), data on long-term outcomes are lacking. Hypothesis: Use of coronary thrombectomy in real-life conditions does not affect 5-year outcome. Methods: FAST-MI program consists of 3 nationwide French surveys (2005, 2010, 2015), including consecutive AMI patients over a 1-month period. This analysis focused on patients undergoing percutaneous coronary intervention (PCI, N=9,731). Five-year follow-up is >96%. Results: Thrombectomy was used in 1,781 patients (18%; 2005: 7%, 2010: 27%, 2015: 18%), 87% of them had STEMI. They were younger (61±13 vs 65±14 yo), mostly men (81% vs 74%, p<0.001), with less multivessel coronary artery disease (47% vs 55%, P<0.001) and a culprit lesion mostly on the right coronary artery (40% vs 31%, P<0.001). Crude in-hospital death was higher with thrombectomy (3.1% vs 2.0%, P=0.005) but 5-year death lower (13% vs 17%, P<0.001; crude HR 0.74 [95%CI 0.66-0.82]). After adjustment on the propensity score (PS) for getting thrombectomy, OR for in-hospital death was 1.24[95%CI 0.82-1.87] and HR for 5-year death: 0.95 [95%CI 0.79-1.14], P=0.58. In hospital survivors, Cox multivariate adjustment including discharge medications yielded similar results (HR 0.96, 95%CI 0.76-1.21, P=0.73). After PS matching, the two cohorts (N=1,430 each) had even distributions for all baseline characteristics and medications. In-hospital death was similar (2.7% vs 2.6%, P=0.91) but stroke was numerically higher (0.8% vs 0.3%, P=0.13) with thrombectomy. Five-year survival was similar in the 2 cohorts: HR 0.93, 95%CI 0.75-1.14, P=0.46. (Figure) Conclusions: These real-world data show that the use of thrombectomy has increased until 2010 and declined thereafter, in keeping with international guidelines, and suggest that thrombectomy has no beneficial nor detrimental effect on long-term survival compared to PCI alone.