In the Journals

Aspiration thrombectomy use declined over time with small excess risk

The use of aspiration thrombectomy during primary PCI in patients with STEMI declined by more than 50% since 2011, and since then, there was small excess risk for in-hospital stroke associated with selective aspiration thrombectomy use, according to a study published in JAMA Cardiology.

Eric A. Secemsky, MD, interventional cardiologist, director of vascular intervention and outcomes researcher at the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center, and colleagues analyzed data from 683,584 patients (mean age, 62 years; 72% women) from the National Cardiovascular Data Registry CathPCI registry who underwent primary PCI from July 2009 to June 2016. Linked data between the CathPCI registry and CMS were examined for longitudinal outcomes. Information that was analyzed included procedural and patient characteristics, operator characteristics, race/ethnicity and institutional characteristics.

The primary outcomes of interest were in-hospital stroke and in-hospital mortality. Secondary outcomes of interest, which were analyzed at 30 and 180 days, were defined as in-hospital and out-of-hospital stroke, in-hospital and out-of-hospital mortality, all-cause readmission and HF hospitalizations after discharge.

The use of aspiration thrombectomy during primary PCI increased from 2009 to 2011 with a peak of 13.8%. This then declined by more than 9 percentage points for a rate of 4.7% by mid-2016. The overall use of aspiration thrombectomy was 10.8%, with a lowest operator group median of 0% and the highest operator group median of 33.8%.

The association between the use of aspiration thrombectomy and in-hospital death remained nonsignificant after instrumental variable analysis (adjusted risk difference = –0.18%; 95% CI, –0.53 to 0.16). The use of aspiration thrombectomy was associated with a small increase in in-hospital stroke (adjusted risk difference = 0.14%; 95% CI, 0.01-0.3).

Differences in HF, death, rehospitalization or stroke at 180 days were not seen in patients who were linked to CMS.

“Our findings have two important implications,” Secemsky and colleagues wrote. “First, 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. Second, our comparative analysis helps fill a gap in the data regarding the effectiveness of selective [aspiration thrombectomy] use during [primary] PCI for STEMI.”

In a related editorial, Patrick O’Gara, MD, director of strategic planning in the division of cardiovascular medicine at Brigham and Women’s Hospital, wrote: “Justification for the use of [aspiration thrombectomy] is not forthcoming from this study. Whether an adequately powered randomized clinical trial of the use of [aspiration thrombectomy] either as a bailout strategy or in a preselected group of patients with high thrombus burden can be executed is uncertain.” – by Darlene Dobkowski

Disclosures: Secemsky and O’Gara report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

The use of aspiration thrombectomy during primary PCI in patients with STEMI declined by more than 50% since 2011, and since then, there was small excess risk for in-hospital stroke associated with selective aspiration thrombectomy use, according to a study published in JAMA Cardiology.

Eric A. Secemsky, MD, interventional cardiologist, director of vascular intervention and outcomes researcher at the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center, and colleagues analyzed data from 683,584 patients (mean age, 62 years; 72% women) from the National Cardiovascular Data Registry CathPCI registry who underwent primary PCI from July 2009 to June 2016. Linked data between the CathPCI registry and CMS were examined for longitudinal outcomes. Information that was analyzed included procedural and patient characteristics, operator characteristics, race/ethnicity and institutional characteristics.

The primary outcomes of interest were in-hospital stroke and in-hospital mortality. Secondary outcomes of interest, which were analyzed at 30 and 180 days, were defined as in-hospital and out-of-hospital stroke, in-hospital and out-of-hospital mortality, all-cause readmission and HF hospitalizations after discharge.

The use of aspiration thrombectomy during primary PCI increased from 2009 to 2011 with a peak of 13.8%. This then declined by more than 9 percentage points for a rate of 4.7% by mid-2016. The overall use of aspiration thrombectomy was 10.8%, with a lowest operator group median of 0% and the highest operator group median of 33.8%.

The association between the use of aspiration thrombectomy and in-hospital death remained nonsignificant after instrumental variable analysis (adjusted risk difference = –0.18%; 95% CI, –0.53 to 0.16). The use of aspiration thrombectomy was associated with a small increase in in-hospital stroke (adjusted risk difference = 0.14%; 95% CI, 0.01-0.3).

Differences in HF, death, rehospitalization or stroke at 180 days were not seen in patients who were linked to CMS.

“Our findings have two important implications,” Secemsky and colleagues wrote. “First, 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. Second, our comparative analysis helps fill a gap in the data regarding the effectiveness of selective [aspiration thrombectomy] use during [primary] PCI for STEMI.”

In a related editorial, Patrick O’Gara, MD, director of strategic planning in the division of cardiovascular medicine at Brigham and Women’s Hospital, wrote: “Justification for the use of [aspiration thrombectomy] is not forthcoming from this study. Whether an adequately powered randomized clinical trial of the use of [aspiration thrombectomy] either as a bailout strategy or in a preselected group of patients with high thrombus burden can be executed is uncertain.” – by Darlene Dobkowski

Disclosures: Secemsky and O’Gara report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.