Aspiration Thrombectomy in Patients with Acute Myocardial Infarction-5-Year Analysis Based on a Large National Registry (ORPKI).

Rafał Januszek,Piotr Mika,Andrzej Surdacki,Wojciech Wańha,Stanisław Bartuś,Roman Wojdyła,Krzysztof P Malinowski,Jacek Legutko,Zbigniew Siudak,Tomasz Kameczura,Wojciech Wojakowski

doi:10.3390/jcm9113610

Abstract

Blood flow restoration after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction (AMI) may not always be achieved and could be complicated by the no-reflow phenomenon (NRP). The aim of the current study was to assess the frequency of thrombus aspirations (TAs) and NRPs in patients with AMI and treated with pPCI based on the data collected during a 5-year period in the national ORPKI registry, as well as the frequency of periprocedural strokes and predictors of TA and NRP. This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2018, and included 200,991 patients treated due to AMI out of 535,857 patients treated using PCI. Among them, 16,777 patients underwent TA. TA was mainly used in the STEMI subgroup of 14,207 patients (84.8%). The frequency of NRP among AMI patients in the thrombectomy group was 2.75% and in the non-thrombectomy group 0.82%. Predictors of TA and NRP were also assessed using multivariate analysis. The percentage of patients treated with pPCI and with PCI alone increased significantly in all of the three selected groups of patients from 88.7% to 94.3% in the AMI group (p < 0.001), from 82.3% to 90.3% in the STEMI subgroup (p < 0.001), and from 96.3% to 98.2% in the NSTEMI subgroup (p < 0.001) during the analysed period. NRP occurred more often in the thrombectomy group for the NSTEMI (0.58% vs. 3.07%, p < 0.05) and STEMI (1.06% vs. 2.69%, p < 0.05) subgroups. Periprocedural stroke occurred more often in the thrombectomy group in comparison to the non-thrombectomy group with AMI (0.03% vs. 0.01%, p < 0.05) and the NSTEMI (0.16% vs. 0.02%, p < 0.05). In conclusion, the frequency of TA has been experiencing a steady decline in recent years, regardless of AMI type, among patients treated with pPCI.

Highlights

Despite the ability of primary percutaneous coronary interventions to restore patency of infarct-related arteries (IRAs), satisfactory myocardial reperfusion may not always be achieved in patients with a high thrombus burden [1]
Considering the period between 2014 and 2018, the percentage of patients treated with primary percutaneous coronary intervention (pPCI), without the use of thrombus aspirations (TAs), significantly increased in all of the three selected groups of patients, from 88.7% to 94.3% in the overall acute myocardial infarction (AMI) group (p < 0.001), from 82.3% to 90.3% in STEMI subgroup (p < 0.001), and from 96.3% to 98.2% in non-ST-segment elevation myocardial infarction (NSTEMI) subgroup (p < 0.001; Figure 1A)
This was accompanied by a significant increase in the percentage of pPCI without TA in all of the three selected groups of patients and was related in both cases to the change in treatment guidelines

Summary

Introduction

Despite the ability of primary percutaneous coronary interventions (pPCIs) to restore patency of infarct-related arteries (IRAs), satisfactory myocardial reperfusion may not always be achieved in patients with a high thrombus burden [1]. The results of the TAPAS trial (Thrombus Aspiration during PCI in Acute Myocardial Infarction Study) allowed the report that thrombus aspiration (TA) decreased all-cause and cardiovascular mortality rates at 1 year, and tended to reduce the risk of stent thrombosis (ST) compared to PCI alone [3]. In two larger randomised control trials, the TASTE (Thrombus Aspiration in STEMI (ST-segment elevation myocardial infarction) in Scandinavia) and TOTAL (Trial of Routine Aspiration Thrombectomy with PCI versus PCI-alone in Patients with STEMI) studies, no benefits of TA were found in reducing the risk of all-cause or cardiovascular mortality, recurrent MI, or ST [4,5]. Actual guidelines have demonstrated the role of TA during pPCI by giving class III to routine TA in STEMI patients instead of an IIb recommendation for the use of selective or bail-out TA in previous guidelines [7]. While treatment with TA has not been mentioned in the previous non-ST-segment elevation myocardial infarction (NSTEMI) guidelines, routine TA has not been proven beneficial in this setting and in the actual one is not advised routinely [8,9]

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