Age-Related Utilization of Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction: Findings From the Improving Care for Cardiovascular Disease in China Project

Yang-Yang Qu; Xiao-Guo Zhang; Cheng-Wei Ju; Ya-Min Su; Rui Zhang; Wen-Jie Zuo; Zhen-Jun Ji; Li-Juan Chen; Gen-Shan Ma

doi:10.3389/fcvm.2022.791007

Age-Related Utilization of Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction: Findings From the Improving Care for Cardiovascular Disease in China Project

Front Cardiovasc Med. 2022 Feb 21:9:791007. doi: 10.3389/fcvm.2022.791007. eCollection 2022.

Authors

Yang-Yang Qu¹, Xiao-Guo Zhang¹, Cheng-Wei Ju¹, Ya-Min Su¹, Rui Zhang¹, Wen-Jie Zuo¹, Zhen-Jun Ji¹, Li-Juan Chen¹, Gen-Shan Ma¹

Affiliation

¹ Department of Cardiology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.

Abstract

Background: There are some controversies on the utilization and benefits of thrombus aspiration in patients with ST-segment elevation myocardial infarction (STEMI). However, a few studies investigated this issue and the age-associated effects among the large population in China. Hence, we aimed to figure out the age-associated utilization and in-hospital outcomes of thrombus aspiration to improve therapeutic decisions in clinical routine.

Methods: We retrospectively recruited 13,655 eligible STEMI patients from the database of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. These subjects were allocated into primary percutaneous coronary intervention (PPCI)-only group and thrombus aspiration group after being subdivided into three age groups (G_21-50, G_51-75, and G_76-95). After 1:1 propensity score matching for PPCI-only and thrombus aspiration groups, a total of 8,815 matched patients were enrolled for the subsequent analysis. The primary outcome was in-hospital cardiovascular death, and the key safety outcome was in-hospital stroke.

Results: We observed that the ratio of STEMI patients undergoing thrombus aspiration to PPCI-only reduced with aging. For patients ≤ 75 years, the culprit lesion suffered from thrombus aspiration was mainly located in the left anterior descending branch, and left-ventricular ejection fraction (LVEF) was lower (G_21-50: 54.9 ± 8.9 vs. 56.0 ± 8.7%, P = 0.01; G_51-75: 53.9 ± 9.6 vs. 54.8 ± 9.0%, P = 0.001) and the rate of regional wall motion abnormality was higher (G_21-50: 75.7 vs. 66.5%, P < 0.001; G_51-75: 75.4 vs. 69.1%, P < 0.001) in the thrombus aspiration group. By contrast, for patients > 75 years, the right coronary artery was the predominant culprit lesion undergoing thrombus aspiration, LVEF (63.1 ± 10.5 vs. 53.1 ± 9.5%, P = 0.985) and the regional wall motion abnormality (79.2 vs. 74.2%, P = 0.089) were comparable between the two treatment groups. Thrombus aspiration neither reduced the in-hospital risk of cardiovascular death, all-cause death, recurrent myocardial infarction, acute stent thrombosis, heart failure, cardiogenic shock, and sudden cardiac arrest nor increased stroke risk compared with the PPCI-only group. However, after adjustment for age, thrombus aspiration presented the tendency to reduce the incidence of sudden cardiac arrest (4.9 vs. 2.5%, P = 0.06) and in-hospital cardiovascular death at 3 days (hazard ratio 0.46; 95% CI, 0.20-1.06; log-rank P = 0.08) in G_76-95 group and tended to increase the incidence of heart failure in G_51-75 (5.7 vs. 6.9%, P = 0.07).

Conclusion: The thrombus aspiration neither significantly reduced the in-hospital incidence of major adverse cardiac events nor increased stroke risk. However, it might play a protective role in reducing in-hospital sudden cardiac arrest and increasing survival from cardiovascular death at 3 days for the elderly.

Keywords: ST-segment elevation myocardial infarction; adverse cardiac events; age; primary percutaneous coronary intervention; stroke; thrombus aspiration.