Use of Thrombus Aspiration for Patients With Acute Coronary Syndrome: Insights From the Nationwide J-PCI Registry

Taku Inohara, Shun Kohsaka, Kyohei Yamaji, Osamu Iida, Toshiro Shinke, Kenichi Sakakura, Hideki Ishii, Tetsuya Amano, Yuji Ikari

研究成果: Article査読

1 被引用数 (Scopus)

抄録

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).

本文言語English
論文番号e025728
ジャーナルJournal of the American Heart Association
11
16
DOI
出版ステータスPublished - 2022 8月 16
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ASJC Scopus subject areas

  • 循環器および心血管医学

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