An international survey of clinical practice during primary percutaneous coronary intervention for ST-elevation myocardial infarction with a focus on aspiration thrombectomy Academic Article uri icon

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abstract

  • AIMS: Data suggest that there is a variable use of thrombectomy during primary percutaneous coronary interventions (PPCI). We sought to evaluate practices during PPCI for ST-elevation myocardial infarction (STEMI), including the use of aspiration thrombectomy, and to determine the feasibility of conducting a definitive aspiration thrombectomy trial. METHODS AND RESULTS: A 27-item online survey was distributed to 1,607 interventional cardiologists internationally. A total of 461 responses were received. During PPCI, aspiration thrombectomy is used routinely by 36% of respondents, and selectively by 60%. Twenty-five percent of respondents reported experiencing a complication related to thrombectomy including: vessel dissection (13%), bringing thrombus back into left main coronary artery from target vessel (5%), stroke or transient ischaemic attack (2%), and coronary artery perforation (1%). The vast majority of respondents (89%) believe that a confirmatory aspiration thrombectomy trial is needed and 85% would be willing to randomise patients in such a trial. CONCLUSIONS: The majority of interventional cardiologists surveyed are not using thrombectomy routinely during PPCI. The survey results suggest that a large, confirmatory thrombectomy trial is needed and feasible in the current era. The survey also highlights a significant level of variability and underutilisation of other evidence-based therapies during PPCI.

authors

  • Russo, Juan J
  • Dzavík, Vladimír
  • Cairns, John A
  • Rao, Sunil V
  • Niemelä, Kari O
  • Natarajan, Madhu
  • Bertrand, Olivier F
  • Eskola, Markku
  • Welsh, Robert
  • Maciejewski, Pawel
  • Cheema, Asim N
  • Fung, Anthony
  • Cantor, Warren J
  • Lavi, Shahar
  • Widimsky, Petr
  • Jolly, Sanjit

publication date

  • February 2013