Abstract
Introduction: Aspiration thrombectomy (AT) during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been widely used. Recent large multicenter trials have created uncertainty about the benefit of thrombus aspiration and suggested possible harm from increased stroke risk. There is lack of real world data regarding outcomes with AT when performed in addition to PCI of the culprit artery for STEMI. Hypothesis: We sought to investigate the effect of AT on in-hospital mortality when performed in addition to culprit artery PCI for STEMI. Methods: Using the U.S. National Inpatient Sample (NIS) database from 2007-14, we identified all discharge records with a primary diagnosis of STEMI (ICD-9-CM diagnosis codes 410.XX) undergoing PCI (ICD-9-CM procedure codes 00.66, and 36.0X). Patients receiving AT in addition to PCI during the hospitalization were identified using ICD-9-CM procedure code 36.09, and in-hospital mortality was compared in patients with and without AT. Statistical analyses were performed using R (Vienna, Austria). To account for the single cluster stratified random sampling design of NIS, R survey package was used to obtain national estimates. Proportions were compared with Chi-Square test, and p trend computed using Mann-Kendall test. Results: Of 951,322 PCIs for STEMI, 4299 (0.4%) had AT in addition to PCI. Use of AT remained consistent over the study period (0.53% vs. 0.70%; p trend = 0.896). We observed no statistically significant difference in the age adjusted in-hospital mortality in patients with and without AT (3.8% vs. 4.4 %; p = 0.06). Conclusion: In this nationally representative study population, aspiration thrombectomy is not associated with improvement in in-hospital mortality when performed in addition to PCI of the culprit artery for STEMI.
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