Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort.
Détails
ID Serval
serval:BIB_396E9E38241A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort.
Périodique
European heart journal. Acute cardiovascular care
ISSN
2048-8734 (Electronic)
ISSN-L
2048-8726
Statut éditorial
Publié
Date de publication
09/2018
Peer-reviewed
Oui
Volume
7
Numéro
6
Pages
522-531
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
Randomised controlled trials have provided conflicting results regarding procedural and clinical outcomes of thrombus aspiration combined with percutaneous coronary intervention, when compared with primary percutaneous coronary intervention alone in patients with acute coronary syndromes.
Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM-ACS cohort. At the discretion of the interventional cardiologist, patients underwent thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Procedural success was defined as post-procedural thrombolysis in myocardial infarction III flow in the infarct-related artery. Serial changes in high-sensitivity troponin T (ΔhsTnT) and adjudicated 30 days (1 year) clinical events defined as the composite of cardiac death, recurrent myocardial infarction or clinically indicated coronary revascularisation were assessed.
Among 1641 patients, 777 (47.4%) had angiographic evidence of coronary thrombus. Patients were categorised into thrombus aspiration with percutaneous coronary intervention ( n=663) or percutaneous coronary intervention alone ( n=114). ST-segment elevation myocardial infarction (STEMI) patients more often received thrombus aspiration with percutaneous coronary intervention (87.8%) than non-STEMI patients (73.5%), P<0.001. Procedural success was not different in thrombus aspiration with percutaneous coronary intervention compared with percutaneous coronary intervention alone (93.8% vs. 90.7%, P=0.243). ΔhsTnT was similar in STEMI patients (3.09±4.52 vs. 2.19±4.92 µg/l, P=0.086) as was clinical outcome in the entire cohort at 30 days (2.9% vs. 3.6%, P=0.76) and 1 year (7.2% vs. 5.3%, P=0.55) regardless of whether thrombus aspiration was used during primary percutaneous coronary intervention or not.
In this real-world acute coronary syndrome cohort, patients treated by thrombus aspiration with percutaneous coronary intervention showed no difference in the restoration of coronary blood flow compared with percutaneous coronary intervention alone immediately after the procedure. Furthermore, ΔhsTnT and clinical outcomes at either 30 days or 1 year were similar between thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone.
SPUM-ACS cohort NCT01000701.
Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM-ACS cohort. At the discretion of the interventional cardiologist, patients underwent thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Procedural success was defined as post-procedural thrombolysis in myocardial infarction III flow in the infarct-related artery. Serial changes in high-sensitivity troponin T (ΔhsTnT) and adjudicated 30 days (1 year) clinical events defined as the composite of cardiac death, recurrent myocardial infarction or clinically indicated coronary revascularisation were assessed.
Among 1641 patients, 777 (47.4%) had angiographic evidence of coronary thrombus. Patients were categorised into thrombus aspiration with percutaneous coronary intervention ( n=663) or percutaneous coronary intervention alone ( n=114). ST-segment elevation myocardial infarction (STEMI) patients more often received thrombus aspiration with percutaneous coronary intervention (87.8%) than non-STEMI patients (73.5%), P<0.001. Procedural success was not different in thrombus aspiration with percutaneous coronary intervention compared with percutaneous coronary intervention alone (93.8% vs. 90.7%, P=0.243). ΔhsTnT was similar in STEMI patients (3.09±4.52 vs. 2.19±4.92 µg/l, P=0.086) as was clinical outcome in the entire cohort at 30 days (2.9% vs. 3.6%, P=0.76) and 1 year (7.2% vs. 5.3%, P=0.55) regardless of whether thrombus aspiration was used during primary percutaneous coronary intervention or not.
In this real-world acute coronary syndrome cohort, patients treated by thrombus aspiration with percutaneous coronary intervention showed no difference in the restoration of coronary blood flow compared with percutaneous coronary intervention alone immediately after the procedure. Furthermore, ΔhsTnT and clinical outcomes at either 30 days or 1 year were similar between thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone.
SPUM-ACS cohort NCT01000701.
Mots-clé
Acute Coronary Syndrome/blood, Acute Coronary Syndrome/diagnosis, Acute Coronary Syndrome/etiology, Acute Coronary Syndrome/surgery, Aged, Biomarkers/blood, Coronary Angiography, Coronary Thrombosis/blood, Coronary Thrombosis/complications, Coronary Thrombosis/diagnosis, Coronary Thrombosis/surgery, Disease Progression, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/methods, Postoperative Complications/epidemiology, Prevalence, Switzerland/epidemiology, Thrombectomy/methods, Time Factors, Treatment Outcome, Troponin T/blood, Acute coronary syndromes, TIMI flow, biomarkers, clinical outcome, percutaneous coronary intervention, thrombus aspiration
Pubmed
Web of science
Création de la notice
29/04/2017 16:24
Dernière modification de la notice
20/08/2019 13:29
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