Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in “real-world” settings.Materials and Methods:...
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| Format: | Article |
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.706979/full |
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| author | Jun-feng Li Zhi-wei Lin Chang-xi Chen Shi-qi Liang Lei-lei Du Xiang Qu Zhan Gao Yu-heng Huang Shu-ting Kong Jin-xin Chen Ling-yue Sun Hao Zhou |
| author_facet | Jun-feng Li Zhi-wei Lin Chang-xi Chen Shi-qi Liang Lei-lei Du Xiang Qu Zhan Gao Yu-heng Huang Shu-ting Kong Jin-xin Chen Ling-yue Sun Hao Zhou |
| author_sort | Jun-feng Li |
| collection | DOAJ |
| description | Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in “real-world” settings.Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke.Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556–1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164–0.949; p = 0.038].Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA. |
| first_indexed | 2024-12-13T19:37:36Z |
| format | Article |
| id | doaj.art-2100d40e58c9440b9cb10c201906b579 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-13T19:37:36Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-2100d40e58c9440b9cb10c201906b5792022-12-21T23:33:46ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-08-01810.3389/fcvm.2021.706979706979Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary InterventionJun-feng Li0Zhi-wei Lin1Chang-xi Chen2Shi-qi Liang3Lei-lei Du4Xiang Qu5Zhan Gao6Yu-heng Huang7Shu-ting Kong8Jin-xin Chen9Ling-yue Sun10Hao Zhou11Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaDepartment of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, ChinaObjectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in “real-world” settings.Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke.Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556–1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164–0.949; p = 0.038].Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA.https://www.frontiersin.org/articles/10.3389/fcvm.2021.706979/fullthrombus aspirationD-Dpercutaneous coronary interventionSTEMIcoronary artery disease |
| spellingShingle | Jun-feng Li Zhi-wei Lin Chang-xi Chen Shi-qi Liang Lei-lei Du Xiang Qu Zhan Gao Yu-heng Huang Shu-ting Kong Jin-xin Chen Ling-yue Sun Hao Zhou Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Frontiers in Cardiovascular Medicine thrombus aspiration D-D percutaneous coronary intervention STEMI coronary artery disease |
| title | Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| title_full | Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| title_fullStr | Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| title_full_unstemmed | Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| title_short | Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention |
| title_sort | clinical impact of thrombus aspiration and interaction with d dimer levels in patients with st segment elevation myocardial infarction undergoing primary percutaneous coronary intervention |
| topic | thrombus aspiration D-D percutaneous coronary intervention STEMI coronary artery disease |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.706979/full |
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