TY - JOUR
T1 - Use of Thrombus Aspiration for Patients With Acute Coronary Syndrome
T2 - Insights From the Nationwide J-PCI Registry
AU - Inohara, Taku
AU - Kohsaka, Shun
AU - Yamaji, Kyohei
AU - Iida, Osamu
AU - Shinke, Toshiro
AU - Sakakura, Kenichi
AU - Ishii, Hideki
AU - Amano, Tetsuya
AU - Ikari, Yuji
N1 - Funding Information:
The J-PCI (Japanese Percutaneous Coronary Intervention) registry is a registry led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics.
Funding Information:
Dr Kohsaka reports investigator-initiated grant from Novartis and Daiichi Sankyo, and personal fees from Bristol-Myers Squibb. Dr Sakakura receives lecture fees from Kaneka and Nipro. Dr Amano receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. Dr Nakamura receives remuneration for lecture from Daiichi Sankyo, Sanofi, Bayer, Nippon Boehringer Ingelheim, Bristol-Myers Squibb, Terumo, Japan Lifeline, Abbott, Boston Scientific, Medtronic, and Nipro, and investigator-initiated grant funding from Sanofi and Daiichi Sankyo. Dr Ishii receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Mochida Pharma, Novartis Pharma, and Otsuka Pharma.The remaining authors have no disclosures to report.
Publisher Copyright:
© 2022, American Heart Association Inc. All rights reserved.
PY - 2022/8/16
Y1 - 2022/8/16
N2 - BACKGROUND: There is significant regional or institutional variation in the use of thrombus aspiration (TA) in patients undergoing percutaneous coronary intervention (PCI). We investigated the temporal trend in TA use and its association with clinical outcomes in acute coronary syndrome using the nationwide J-PCI (Japanese PCI) registry. METHODS AND RESULTS: Between 2016 and 2018, patients with acute coronary syndrome undergoing PCI (n=282 606; median age, 71.0 years; interquartile range, 62.0–79.0 years; women, 24.7%) at 1124 hospitals were stratified on the basis of whether TA was performed (TA and non-TA). The patients were subdivided according to clinical presentation (ST-segment– elevation myocardial infarction, non– ST-segment– elevation myocardial infarction, and unstable angina). Successful PCI, defined as the achievement of TIMI (Thrombolysis in Myocardial Infarction) 3 flow, and in-hospital mortality were assessed. During the study pe-riod, 83 422 patients (29.5%) underwent TA (52.9%, 23.5%, and 5.2% for ST-segment– elevation myocardial infarction, non– ST-segment– elevation myocardial infarction, and unstable angina, respectively), and the TA implementation rate remained relatively stable throughout. Patients treated with TA had higher rate of successful PCI than non-TA (98.7% versus 97.8%; P<0.001). TA was not associated with in-hospital death among patients with ST-segment– elevation myocardial infarction (adjusted odds ratio [aOR], 1.02 [95% CI, 0.94–1.12]). However, TA use was associated with higher rates of in-hospital death in patients with non– ST-segment– elevation myocardial infarction (aOR, 1.51 [95% CI, 1.23–1.86]) or unstable angina (aOR, 1.95 [95% CI, 1.37–2.79]). CONCLUSIONS: In our retrospective analysis of the nationwide PCI registry, TA use was associated with a higher achievement of successful PCI without impairing in-hospital mortality among patients with ST-segment– elevation myocardial infarction. Nevertheless, its use should be cautioned in less-established indications (eg, non– ST-segment– elevation myocardial infarction and unstable angina).
AB - BACKGROUND: There is significant regional or institutional variation in the use of thrombus aspiration (TA) in patients undergoing percutaneous coronary intervention (PCI). We investigated the temporal trend in TA use and its association with clinical outcomes in acute coronary syndrome using the nationwide J-PCI (Japanese PCI) registry. METHODS AND RESULTS: Between 2016 and 2018, patients with acute coronary syndrome undergoing PCI (n=282 606; median age, 71.0 years; interquartile range, 62.0–79.0 years; women, 24.7%) at 1124 hospitals were stratified on the basis of whether TA was performed (TA and non-TA). The patients were subdivided according to clinical presentation (ST-segment– elevation myocardial infarction, non– ST-segment– elevation myocardial infarction, and unstable angina). Successful PCI, defined as the achievement of TIMI (Thrombolysis in Myocardial Infarction) 3 flow, and in-hospital mortality were assessed. During the study pe-riod, 83 422 patients (29.5%) underwent TA (52.9%, 23.5%, and 5.2% for ST-segment– elevation myocardial infarction, non– ST-segment– elevation myocardial infarction, and unstable angina, respectively), and the TA implementation rate remained relatively stable throughout. Patients treated with TA had higher rate of successful PCI than non-TA (98.7% versus 97.8%; P<0.001). TA was not associated with in-hospital death among patients with ST-segment– elevation myocardial infarction (adjusted odds ratio [aOR], 1.02 [95% CI, 0.94–1.12]). However, TA use was associated with higher rates of in-hospital death in patients with non– ST-segment– elevation myocardial infarction (aOR, 1.51 [95% CI, 1.23–1.86]) or unstable angina (aOR, 1.95 [95% CI, 1.37–2.79]). CONCLUSIONS: In our retrospective analysis of the nationwide PCI registry, TA use was associated with a higher achievement of successful PCI without impairing in-hospital mortality among patients with ST-segment– elevation myocardial infarction. Nevertheless, its use should be cautioned in less-established indications (eg, non– ST-segment– elevation myocardial infarction and unstable angina).
KW - acute coronary syndrome
KW - myocardial infarction
KW - percutaneous coronary intervention
KW - thrombus aspiration
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U2 - 10.1161/JAHA.122.025728
DO - 10.1161/JAHA.122.025728
M3 - Article
C2 - 35946472
AN - SCOPUS:85136128589
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 16
M1 - e025728
ER -