Effects of percutaneous coronary arterial thrombectomy during acute myocardial infarction on left ventricular remodeling.
The benefit of primary angioplasty for acute myocardial infarction (AMI) is limited by the no-reflow phenomenon, resulting in chronic left ventricular (LV) remodeling. The aim of this study was to evaluate the impact of thrombectomy with the Rescue percutaneous thrombectomy catheter on LV function after AMI. We performed a retrospective study comparing conventional angioplasty with the combination of angioplasty and thrombectomy using the Rescue catheter. The study population was comprised of 109 consecutive patients with AMI who underwent angioplasty and thrombectomy and 86 controls treated with conventional angioplasty. Baseline clinical and lesion characteristics were similar in the 2 groups. Postprocedural restoration of normal flow (Thrombolysis In Myocardial Infarction grade 3) was more frequent in the thrombectomy group (82% vs 69%, p = 0.03). No differences were observed in cardiac events, including death, reinfarction, and target vessel revascularization (thrombectomy vs controls, 27% vs 33%; p = 0.44) or changes in ejection fraction (p = 0.22) during 6-month follow-up. The incidence of LV remodeling, defined as an increase in LV end-diastolic volume index of >20%, was significantly lower in the thrombectomy group (22% vs 44%; p = 0.01). Multiple logistic regression analysis revealed that thrombectomy with the Rescue catheter contributed significantly to reduction of both no-reflow and LV remodeling. In the setting of primary angioplasty, adjunctive pretreatment with a rescue catheter reduces the no-reflow phenomenon and protects against LV remodeling.
Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. kondo-h@med.nagoya-cu.ac.jp
Hiroaki
H
Kondo
Takahiko
T
Suzuki
Tatsuya
T
Fukutomi
Shogo
S
Suzuki
Motoya
M
Hayase
Shigenori
S
Ito
Shinsuke
S
Ojio
Mariko
M
Ehara
Yutaka
Y
Takeda
Makoto
M
Itoh
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*