Propensity score analysis of very long-term outcome after coronary thrombus aspiration in acute myocardial infarction - 16/04/25

Doi : 10.1016/j.acvd.2025.02.008

Orianne Weizman ^a,^b, Marie Hauguel-Moreau ^a, Edouard Gerbaud ^c, Guillaume Cayla ^d, Gilles Lemesle ^e,^f, Jean Ferrières ^g, François Schiele ^h, Etienne Puymirat ^b, Tabassome Simon ^f,^i,^j,^k,^l, Nicolas Danchin ^m,⁎
on behalf of the FAST-MI investigators
^a Cardiology Department, Ambroise-Paré University Hospital, AP–HP, 92100 Boulogne-Billancourt, France
^b Cardiology Department, Georges-Pompidou European Hospital, AP–HP, 75015 Paris, France
^c Inserm U1045, Intensive Care Unit, Centre de Recherche Cardio-Thoracique de Bordeaux (CRTCB), 33600 Pessac, France
^d Cardiology Department, University Hospital of Nîmes, University of Montpellier, 30900 Nîmes, France
^e Heart and Lung Institute, Inserm U1011-EGID, Institut Pasteur de Lille, University Hospital of Lille, Lille, University of Lille, 59000 Lille, France
^f French Alliance for Cardiovascular Trials (FACT), 75000 Paris, France
^g Cardiology Department, University Hospital of Toulouse, 31300 Toulouse, France
^h Cardiology Department, University Hospital Jean-Minjoz, 25000 Besançon, France
ⁱ Department of Clinical Pharmacology, Saint-Antoine Hospital, AP–HP, 75012 Paris, France
^j Unité de recherche clinique (URCEST), 75651 Paris, France
^k Sorbonne université, 75005 Paris, France
^l Inserm U-698, 75877 Paris, France
^m Cardiology Department, hôpital Paris Saint-Joseph, 75014 Paris, France

^⁎Corresponding author.

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Graphical abstract

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Highlights

•	Coronary TA used in a fifth of percutaneous revascularization procedures during MI.
•	TA use increased until 2010 and declined after publication of European guidelines.
•	Patients treated with TA had a specific profile.
•	They were young men, with a culprit lesion often in the right coronary artery.
•	Long-term survival was similar in patients with STEMI/NSTEMI treated or not with TA.
•	In those with significant thrombus burden, long-term survival was better with TA.

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Abstract

Background

The long-term prognostic impact of thrombus aspiration (TA) in acute myocardial infarction (AMI) is unclear.

Aim

To assess the long-term prognostic impact of TA in AMI.

Methods

Data were obtained from three nationwide French surveys (FAST-MI 2005, 2010 and 2015) including consecutive patients with AMI. Long-term death rate (up to 10 years) was assessed according to use of TA in patients with AMI treated with percutaneous coronary intervention (PCI).

Results

TA was used in 1781/9654 patients (18%; 2005, 7%; 2010, 27%; 2015, 18%), including 1546 (86.8%) with ST-segment elevation myocardial infarction. Patients who had TA were younger (61 vs. 65 years; P<0.001), mostly men (81 vs. 74%; P<0.001) and their culprit lesion was more often on the right coronary artery (40 vs. 31%; P<0.001). Crude very long-term mortality was lower with TA (25.0 vs. 32.5%; crude hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.68–0.82; P<0.001). Adjusting on a propensity score (PS) for getting TA, very long-term mortality did not differ (HR 1.03, 95% CI 0.89–1.20; P=0.67). In-hospital stroke was more frequent with TA (0.7 vs. 0.4%; P=0.04). After PS matching (two cohorts, 1430 patients in each), very long-term mortality was similar in the two PS-matched cohorts (HR 1.02, 95% CI 0.87–1.19; P=0.84). In patients with a high thrombus burden, the adjusted HR for very long-term mortality was 0.76 (95% CI 0.59–0.98; P=0.03) in favour of TA.

Conclusions

These routine-practice data show that TA use increased until 2010 and declined thereafter, in keeping with international guidelines. In the overall population of patients with AMI who underwent PCI, TA had no effect on long-term survival. In those with a high thrombus burden, TA was associated with improved long-term survival.

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Keywords : Myocardial infarction, STEMI, Coronary thrombus aspiration, Coronary thrombectomy