Abstract 10994: Use of Aspiration Thrombectomy and Practice Patterns During Primary PCI for STEMI – Results of an International Survey
Background: Small randomized trials and meta-analyses of aspiration thrombectomy (AT) for STEMI demonstrate improved angiographic outcomes and suggest a possible reduction in mortality but an increase in stroke. We conducted an international survey of the extent and patterns of use of AT and assessed the feasibility of performing a definitive, large randomized trial.
Methods: A 27-item survey was distributed to 1616 interventional cardiologists (IC) internationally through various national organizations and investigator networks.
Results: A total of 425 surveys were completed (response rate 26%). AT is used routinely by 33% and selectively by 62% of IC during primary PCI. Overall, respondents use AT in 51% (standard deviation (SD) 31%) of their cases of primary PCI for STEMI. Common utilization criteria include: large thrombus (84%), TIMI 0 or 1 flow (55%), and proximal coronary artery occlusion (33%). Regarding technique, i) 79% turn on suction prior to advancing the catheter through the target lesion and ii) 81% remove the catheter from the target vessel under continuous suction. One-fifth (20%) of IC report having experienced at least one serious complication from aspiration thrombectomy, including: thrombus brought back from target vessel into left main (5%), left main dissection (<1%), vessel dissection other than left main (14%), and stroke or TIA (2%). During primary PCI for STEMI, GP IIb/IIIa inhibitors are used routinely and selectively by 36% and 55% of IC respectively and bivalirudin by 10% and 18% respectively. Direct stenting is used routinely by 27%, selectively by 54%, and rarely or never by 18%. With regards to catheter size during primary PCI, 6 Fr is used by 90%, 7 Fr by 8%, and 5 Fr by 2%. Eighty-seven percent of IC believe that a definitive, large randomized trial of AT is needed and 90% would randomize patients in such a trial.
Conclusions: This is the first international survey of AT and it shows that it is used routinely by less than one-third of IC. In “real world” practice, complications related to AT are not infrequent. The data suggests that a definitive trial is needed and that there is sufficient equipoise and interest among IC such that a trial is feasible in the current era.
- © 2010 by American Heart Association, Inc.