Clinical impact of direct stenting and interaction with thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: Thrombectomy Trialists Collaboration

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Clinical impact of direct stenting and interaction with thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention : Thrombectomy Trialists Collaboration

Mahmoud, Karim D. (författare): Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands,St Franciscus Gasthuis, Dept Cardiol, Kleiweg 500,POB 10900, NL-3004 BA Rotterdam, Netherlands;Erasmus MC, Thorax Ctr, Dept Cardiol, Rotterdam, Netherlands,Erasmus University Medical Center,Franciscus Gasthuis & Vlietland

Jolly, Sanjit S. (författare): Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada,McMaster Univ, Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

James, Stefan K, 1964- (författare): Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi

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Dzavik, Vladimir (författare): Peter Munk Cardiac Centre, University Health Network, Toronto Ontario, Canada,Univ Hlth Network, Peter Munk Cardiac Ctr, Toronto, ON, Canada,University Health Network University of Toronto

Cairns, John A. (författare): University of British Columbia, Vancouver British Columbia, Canada,Univ British Columbia, Vancouver, BC, Canada,McMaster Univ, Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada,Population Health Research Institute, Ontario,McMaster University

Olivecrona, Goran K. (författare): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital

Renlund, Henrik, 1979- (författare): Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Institutionen för medicinska vetenskaper

Gao, Peggy (författare): Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada,McMaster Univ, Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

Lagerqvist, Bo, 1952- (författare): Uppsala University,Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)

Alazzoni, Ashraf (författare): Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada

Kedev, Sasko (författare): University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia,Sts Cyril & Methodius Univ, Univ Clin Cardiol, Skopje, Macedonia,The Saints Cyril and Methodius University of Skopje

Stankovic, Goran (författare): Department of Cardiology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Univ Belgrade, Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia;Univ Belgrade, Fac Med, Belgrade, Serbia

Meeks, Brandi (författare): Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada,McMaster Univ, Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

Fröbert, Ole, 1964- (författare): Örebro University,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiology,Orebro Univ, Fac Hlth, Sodra Grev Rosengatan, Dept Cardiol, Orebro, Sweden

Zijlstra, Felix (författare): Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands,Erasmus MC, Thorax Ctr, Dept Cardiol, Rotterdam, Netherlands,Erasmus University Medical Center

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2018-04-21
2018
Engelska.
Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39:26, s. 2472-2479

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Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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Aims: Preliminary studies suggest that direct stenting (DS) during percutaneous coronary intervention (PCI) may reduce microvascular obstruction and improve clinical outcome. Thrombus aspiration may facilitate DS. We assessed the impact of DS on clinical outcome and myocardial reperfusion and its interaction with thrombus aspiration among ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI.Methods and results: Patient-level data from the three largest randomized trials on routine manual thrombus aspiration vs. PCI only were merged. A 1:1 propensity matched population was created to compare DS and conventional stenting. Synergy between DS and thrombus aspiration was assessed with interaction P-values in the final models. In the unmatched population (n= 17329), 32% underwent DS and 68% underwent conventional stenting. Direct stenting rates were higher in patients randomized to thrombus aspiration as compared with PCI only (41% vs. 22%; P < 0.001). Patients undergoing DS required less contrast (162 mL vs. 172 mL; P < 0.001) and had shorter fluoroscopy time (11.1 min vs. 13.3 min; P < 0.001). After propensity matching (n = 10944), no significant differences were seen between DS and conventional stenting with respect to 30-day cardiovascular death [1.7% vs. 1.9%; hazard ratio 0.88, 95% confidence interval (CI) 0.55-1.41; P=0.60; P-interaction = 0.96) and 30-day stroke or transient ischaemic attack (0.6% vs. 0.4%; odds ratio 1.02; 95% CI 0.14-7.54; P= 0.99; P-interaction = 0.81). One-year results were similar. No significant differences were seen in electrocardiographic and angiographic myocardial reperfusion measures.Conclusion: Direct stenting rates were higher in patients randomized to thrombus aspiration. Clinical outcomes and myocardial reperfusion measures did not differ significantly between DS and conventional stenting and there was no interaction with thrombus aspiration.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Myocardial infarction
Myocardial reperfusion
Percutaneous coronary intervention
Thrombectomy
Stents
Myocardial infarction
Myocardial reperfusion
Percutaneous coronary intervention
Stents
Thrombectomy

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Av författaren/redakt...: Mahmoud, Karim D ...; Jolly, Sanjit S.; James, Stefan K, ...; Dzavik, Vladimir; Cairns, John A.; Olivecrona, Gora ...; visa fler...; Renlund, Henrik, ...; Gao, Peggy; Lagerqvist, Bo, ...; Alazzoni, Ashraf; Kedev, Sasko; Stankovic, Goran; Meeks, Brandi; Fröbert, Ole, 19 ...; Zijlstra, Felix; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Örebro universitet; Uppsala universitet; Lunds universitet

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