Thrombus containing lesions strategies during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction: insights from ORPKI National Registry

Abstract

In the era of potent P2Y₁₂ inhibitors, according to current guidelines, treatment with glycoprotein IIb/IIIa inhibitors (GPIs) should be limited to bail-out and/or highly thrombotic situations. Similarly, the recommendation for aspiration thrombectomy (AT) is downgraded to very selective use. We examine the prevalence, and predictors of GPI and AT use in STEMI patients referred to primary percutaneous coronary intervention (PCI). Data on 116,873 consecutive STEMI patients referred to primary PCI in Poland between 2015 and 2020 were analyzed. GPIs were administered in 29.3%, AT was used in 11.6%, and combined treatment with both in 6.1%. There was a mild trend toward a decrease in GPI and AT usage during the analyzed years. On the contrary, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5 to 48.1%. Occluded infarct-related artery at baseline and no-reflow during PCI were the strongest predictors of GPI administration (OR 2.3; 95% CI 2.22-2.38 and OR 3.47; 95% CI 3.13-3.84, respectively) and combined usage of GPI and AT (OR 4.4; 95% CI 4.08-4.8 and OR 3.49; 95% CI 3.08-3.95 respectively) in a multivariate logistic regression model. Similarly, the administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies. In STEMI patients in Poland, GPIs are selectively used in one in four patients during primary PCI, and the combined usage of GPI and AT is marginal. Despite the rapid growth in potent P2Y₁₂ inhibitors usage in recent years, GPIs are selectively used at a stable rate during PCI in highly thrombotic lesions.

Keywords: Antiplatelet therapy; Aspiration thrombectomy; Glycoprotein IIb/IIIa inhibitors; Myocardial infarction; Percutaneous coronary intervention; Registries.

Fig. 1

Temporal trends in glycoprotein (GP) IIb/IIIa inhibitors administration (black), aspiration thrombectomy (white) and ticagrelor or prasugrel administration (grey) in consecutive ST-segment elevation myocardial infarction patients referred to primary PCI in Poland between 2015 and 2020 (p < 0.0001 for all three trends)

Fig. 2

Glycoprotein (GP) IIb/IIIa inhibitors administration (black) and combined strategy (GP IIb/IIIa inhibitors administration and aspiration thrombectomy) (grey) according to site ST-segment elevation myocardial infarction volume (quartiles)