Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction

Background The previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited. Methods and Results We investigated th...

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Autores principales:	Yohei Sotomi, Yasunori Ueda, Shungo Hikoso, Daisaku Nakatani, Shinichiro Suna, Tomoharu Dohi, Hiroya Mizuno, Katsuki Okada, Hirota Kida, Bolrathanak Oeun, Akihiro Sunaga, Taiki Sato, Tetsuhisa Kitamura, Yasuhiko Sakata, Hiroshi Sato, Masatsugu Hori, Issei Komuro, Yasushi Sakata
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	acute myocardial infarction percutaneous coronary intervention stroke thrombus aspiration Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/e7611c61ef644669bf22fb97a219fb13
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spelling	oai:doaj.org-article:e7611c61ef644669bf22fb97a219fb132021-11-16T10:22:44ZManual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction10.1161/JAHA.121.0222582047-9980https://doaj.org/article/e7611c61ef644669bf22fb97a219fb132021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022258https://doaj.org/toc/2047-9980Background The previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited. Methods and Results We investigated the association between manual TA and stroke risk during primary PCI in the OACIS (Osaka Acute Coronary Insufficiency Study) database (N=12 093). The OACIS is a prospective, multicenter registry of myocardial infarction. The primary end point of the present study is stroke at 7 days. A total of 9147 patients who underwent primary PCI within 24 hours of hospitalization were finally analyzed (TA group, n=4448, versus non‐TA group, n=4699 patients). TA was independently associated with risk of stroke at 7 days (odds ratio [OR], 1.92 [95% CI, 1.19‒3.12]; P=0.008) in the simple logistic regression model, while the multilevel random effects logistic regression model with hospital treated as a random effect showed that manual TA was not associated with incremental risk of stroke at 7 days (OR, 0.91 [95% CI, 0.71‒1.16]; P=0.435). The 7‐day stroke risk of manual TA was significantly heterogeneous in different institutions (P for interaction=0.007). Conclusions Manual TA during primary PCI for patients with acute myocardial infarction was independently associated with the overall increased risk of periprocedural stroke. However, this result was substantially skewed because of institution specific risk variation, suggesting that the periprocedural stroke may be preventable by prudent PCI procedure or appropriate periprocedural management. Registration URL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000005464. Unique identifier: UMIN000004575.Yohei SotomiYasunori UedaShungo HikosoDaisaku NakataniShinichiro SunaTomoharu DohiHiroya MizunoKatsuki OkadaHirota KidaBolrathanak OeunAkihiro SunagaTaiki SatoTetsuhisa KitamuraYasuhiko SakataHiroshi SatoMasatsugu HoriIssei KomuroYasushi SakataWileyarticleacute myocardial infarctionpercutaneous coronary interventionstrokethrombus aspirationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute myocardial infarction percutaneous coronary intervention stroke thrombus aspiration Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	acute myocardial infarction percutaneous coronary intervention stroke thrombus aspiration Diseases of the circulatory (Cardiovascular) system RC666-701 Yohei Sotomi Yasunori Ueda Shungo Hikoso Daisaku Nakatani Shinichiro Suna Tomoharu Dohi Hiroya Mizuno Katsuki Okada Hirota Kida Bolrathanak Oeun Akihiro Sunaga Taiki Sato Tetsuhisa Kitamura Yasuhiko Sakata Hiroshi Sato Masatsugu Hori Issei Komuro Yasushi Sakata Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
description	Background The previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited. Methods and Results We investigated the association between manual TA and stroke risk during primary PCI in the OACIS (Osaka Acute Coronary Insufficiency Study) database (N=12 093). The OACIS is a prospective, multicenter registry of myocardial infarction. The primary end point of the present study is stroke at 7 days. A total of 9147 patients who underwent primary PCI within 24 hours of hospitalization were finally analyzed (TA group, n=4448, versus non‐TA group, n=4699 patients). TA was independently associated with risk of stroke at 7 days (odds ratio [OR], 1.92 [95% CI, 1.19‒3.12]; P=0.008) in the simple logistic regression model, while the multilevel random effects logistic regression model with hospital treated as a random effect showed that manual TA was not associated with incremental risk of stroke at 7 days (OR, 0.91 [95% CI, 0.71‒1.16]; P=0.435). The 7‐day stroke risk of manual TA was significantly heterogeneous in different institutions (P for interaction=0.007). Conclusions Manual TA during primary PCI for patients with acute myocardial infarction was independently associated with the overall increased risk of periprocedural stroke. However, this result was substantially skewed because of institution specific risk variation, suggesting that the periprocedural stroke may be preventable by prudent PCI procedure or appropriate periprocedural management. Registration URL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000005464. Unique identifier: UMIN000004575.
format	article
author	Yohei Sotomi Yasunori Ueda Shungo Hikoso Daisaku Nakatani Shinichiro Suna Tomoharu Dohi Hiroya Mizuno Katsuki Okada Hirota Kida Bolrathanak Oeun Akihiro Sunaga Taiki Sato Tetsuhisa Kitamura Yasuhiko Sakata Hiroshi Sato Masatsugu Hori Issei Komuro Yasushi Sakata
author_facet	Yohei Sotomi Yasunori Ueda Shungo Hikoso Daisaku Nakatani Shinichiro Suna Tomoharu Dohi Hiroya Mizuno Katsuki Okada Hirota Kida Bolrathanak Oeun Akihiro Sunaga Taiki Sato Tetsuhisa Kitamura Yasuhiko Sakata Hiroshi Sato Masatsugu Hori Issei Komuro Yasushi Sakata
author_sort	Yohei Sotomi
title	Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
title_short	Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
title_full	Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
title_fullStr	Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
title_full_unstemmed	Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction
title_sort	manual thrombus aspiration and its procedural stroke risk in myocardial infarction
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/e7611c61ef644669bf22fb97a219fb13
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Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction

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