Open AccessImpact 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
Author(s) -
Angerås Oskar,
Haraldsson Inger,
Redfors Björn,
Fröbert Ole,
Petursson Petur,
Albertsson Per,
Ioanes Dan,
Odenstedt Jacob,
Olsson Hans,
Witt Nils,
Rück Andreas,
Millgård Jonas,
Nilsson Johan,
Persson Jonas,
Söderbom Måns,
Wedel Hans,
Erlinge David,
James Stefan,
Råmunddal Truls,
Omerovic Elmir
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007680
Subject(s) - medicine , myocardial infarction , stroke (engine) , percutaneous coronary intervention , cardiology , thrombus , thrombosis , angioplasty , coronary thrombosis , relative risk , stent , surgery , confidence interval , mechanical engineering , engineering
Background Thrombus 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 Results We 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). Conclusions Mortality 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.