SOLACI | Latin American Society of Interventional Cardiology

Aspiration thrombectomy (AT) in patients with high thrombotic burden could pathophysiologically reduce thrombus burden, decrease distal embolization, reduce no-reflow phenomenon, and improve microvascular perfusion. However, its usefulness has not been shown in the large, randomized trials (TASTE and TOTAL) that compared routine use of AT in primary angioplasty in patients with ST-segment elevation acute coronary syndrome (STEACS).

Both European and American guidelines contraindicate its routine use in Class III acute coronary syndromes (ACS), which differs from Japanese guidelines, where elective or bailout AT is recommended in Class IIB patients.

Based on this, researchers presented data from the Japanese PCI (percutaneous coronary intervention) registry, with the aim of assessing temporal trends in the use of AT in the treatment of ACS, and the association between its use and in-hospital clinical outcomes.

This registry included 282,606 patients with ACS who underwent PCI, out of which 83,422 underwent AT (29.5%) in various clinical scenarios (52.9% STEACS, 23.5% non-ST-segment elevation acute coronary syndrome, 5.2% unstable angina). AT use frequency slowly decreased, from 54.3% of STEACS patients at baseline to 50.9% in 2018.

Comparing baseline characteristics, patients treated with AT were younger, mostly male and smokers, and the right coronary artery was the main culprit.

Treatment with AT improved PCI success rates compared with patients who did not undergo AT (98.7% vs. 97.8%, p < 0.001). The incidence of death in patients with STEACS who underwent AT was lower (2.5% vs. 3%, p < 0.001). When analyzing procedure-related complications (overall), no significant differences were observed between scenarios. However, when studying the different events, AT patients showed greater prevalence of stent thrombosis and inotropes requirements.

An analysis of AT was performed on the basis of door-to-balloon time, with a higher rate of complications observed in longer times, namely 75 to 90 min and 90 to 120 min.

Conclusions

In Japan, aspiration thrombectomy is still a common alternative to treat acute coronary syndrome, considering that there are no IIB/IIIA inhibitors commercially available there. In this retrospective study, it was observed that patients treated with AT had improved success in angioplasty, with a non-significant decrease in mortality in patients with STEACS.

The difference in guideline recommendations is mainly due to the fact that Japan based its recommendations on the results of the VAMPIRE study, which showed a decrease in slow or no reflow in STEACS patients treated with AT.

This study with many patients constitutes a hypothesis to continue the search for the ideal scenario in which AT can be useful without its well-known adverse effects.

Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.

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

Font: Inohara, Taku et al. “Use of Thrombus Aspiration for Patients With Acute Coronary Syndrome: Insights From the Nationwide J-PCI Registry.” Journal of the American Heart Association vol. 11,16 (2022): e025728. doi:10.1161/JAHA.122.025728.