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Published on: January 18, 2018
Trends and Outcomes of Uilization of Thrombectomy During Primary Percutaneous Coronary Intervention
Michael Megaly1, Ramy Sedhom2, Ayman Elbadawi3
1Division of Cardiology, Banner University Medical Center, UA college of Medicine, Phoenix, AZ, United States of America.
Insights
Thrombectomy use during primary percutaneous coronary intervention (PCI) remained stable from 2016-2018. While associated with increased stroke risk, thrombectomy was not linked to higher in-hospital mortality in patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Primary percutaneous coronary intervention (PCI) is a key treatment for acute myocardial infarction.
- Thrombectomy, a procedure to remove blood clots, is sometimes used during primary PCI.
- Understanding national trends and outcomes of thrombectomy use is crucial for optimizing patient care.
Purpose of the Study:
- To describe national trends in thrombectomy utilization during primary PCI between 2016 and 2018.
- To evaluate the association between thrombectomy use and in-hospital mortality and stroke.
- To identify factors influencing thrombectomy use in contemporary practice.
Main Methods:
- Utilized the Nationwide Readmission Database (NRD) from 2016-2018.
- Identified patients undergoing primary PCI and thrombectomy.
- Performed multivariate regression analysis to assess outcomes, adjusting for high-risk features.
Main Results:
- Thrombectomy was used in 15.2% of primary PCI cases, with stable utilization trends.
- Patients undergoing thrombectomy had higher rates of in-hospital mortality and stroke.
- Multivariable analysis revealed thrombectomy was not independently associated with mortality but was linked to a higher stroke risk.
Conclusions:
- Thrombectomy use during primary PCI has remained consistent from 2016-2018.
- The procedure is associated with an increased risk of stroke, but not in-hospital mortality, after adjusting for confounders.
- These findings highlight the need for careful consideration of thrombectomy in primary PCI settings.
Background:
To describe the national trends and outcomes of contemporary thrombectomy use for primary percutaneous coronary intervention (PCI) from 2016 to 2018.
Methods:
We queried the Nationwide Readmission Database (NRD) from January 2016 to December 2018 to identify patients who underwent primary PCI and thrombectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality and stroke in patients undergoing primary PCI and those who underwent thrombectomy.
Results:
We identified 409,910 total hospitalizations who underwent primary PCI. Thrombectomy was used in 62,446 records (15.2%) with no change in the trend over the study period (p trend = 0.52). Thrombectomy was more utilized in patients who had more cardiogenic shock and use of mechanical circulatory devices. The overall incidence of in-hospital mortality and stroke were 5.6% and 1.1%, respectively. The incidence of in-hospital mortality (6.7% vs. 5.4%, p < 0.001) and strokes (1.3% vs. 1.0%, p < 0.001) were higher in the thrombectomy group. On multivariable regression analysis adjusting for high-risk features, thrombectomy was not independently associated with in-hospital mortality [1.036, 95% CI (0.993-1.080), p = 0.100], but was associated with a higher risk of stroke [OR 1.186, 95% CI (1.097-1.283), p < 0.001].
Conclusion:
During primary PCI, thrombectomy was used in 1 of 6 cases, and its use has been stable over 2016-2018. The use of thrombectomy was associated with a higher risk of stroke, but not in-hospital death.
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