Aspiration Thrombectomy in PCI for STEMI On Decline

The use of aspiration thrombectomy (AT) during percutaneous coronary intervention (PCI) has declined in recent years, according to a new retrospective analysis.  

The authors, publishing online in JAMA Cardiology, preformed a retrospective cohort study of 683,584 patients who underwent PCI for ST-elevation myocardial infarction (STEMI) from the National Cardiovascular Data Registry (NCDR) Cath PCI Registry from 2009 to 2016. The primary study outcomes were in-hospital stroke and death, with an array of secondary outcomes that included heart failure, stroke, all-cause rehospitalization, and death through 180 days of follow-up. Most of the patients in the study sample were male (71.6%) and white (87.2%).  

It should be emphasized that this study analyzed “selective” use of #AT, which is still supported by many colleagues after TASTE & TOTAL trials, and the consequent change in practice guidelines. This piece of evidence shall be seriously taken into account to enrich the discussion https://t.co/SxRYcaPooO

— Sergio R. de Leiras (@srdeleiras) January 13, 2019

1/What are the real-world outcomes of aspiration thrombectomy (AT) use in PCI for STEMI? Our team at @SmithBIDMC, led by @EricSecemskyMD found no clinical benefit from AT use vs PCI alone, & a small but significant risk of in-hospital stroke. @JAMACardio https://t.co/FYR29BNs5Y

— Enrico Ferro, MD (@enricoferroMD) January 13, 2019

According to the analysis results, AT use increased between 2009 and 2011, then declined through 2016. During the period where the use of AT increased, it attained a peak use of 13.8%. It then dropped by 9%, reaching 4.7% by mid-2016. The overall use of AT was 10.8%. The researchers reported that the use of AT did not have an association with in-hospital death but was associated with a small increase in in-hospital (P=0.03). No differences were reported in cumulative events at 180 days. 

See this great thread by @EricSecemskyMD on study he led examining how rates of aspiration thrombectomy have changed after publication of trial data.

Exploited variation in use between MDs as instrumental variable to examine effectiveness of more selective use of the device. https://t.co/sLqHZW1Sbw

— Robert W. Yeh (@rwyeh) January 10, 2019

“Aspiration thrombectomy use is declining nationwide, with trends in use corresponding with evolving trial data,” the authors wrote. “There was no clinical benefit of selective aspiration thrombectomy use during primary percutaneous coronary intervention for STEMI.” 

No benefits in SELECTIVE…🤔😥 “Operator Variation in Aspiration Thrombectomy” @shci_sec @SCAI https://t.co/rM2eAXWXq8

— Lucia Vera Pernasetti (@LPernasett) January 10, 2019

The added that “these data demonstrate an association of physician practice patterns with evolving trial data and support the use of registry data for evaluating postapproval physician behavior.” 

Interesting & important study!! In US, aspiration thrombectomy (AT) use for STEMI showed rise (peak 14% in '11) & fall (nadir 4.7% in '16) pattern. In my home country (JAPAN), AT is still widely used (54.2% in '16 from Cardiovasc Interv Ther. 2018;33:178-203)…Significant Gap!! https://t.co/LAnsP9jfe4

— ROM (@taku_inohara) January 9, 2019

Source: JAMA Cardiology