Initial thrombosuction with subsequent angioplasty in primary coronary intervention--comparison with conventional strategy.
BACKGROUND
Large thrombus burden remains challenging in the setting of acute myocardial infarct. Initial thrombosuction (IT) followed by actual angioplasty may be advantageous over conventional strategy in primary percutaneous coronary intervention (PCI).


METHODS
With a case-control design, 22 consecutive patients receiving primary PCI with IT were designated as group 1. Another 22 well-matched patients undergoing primary PCI with conventional strategy in the same period were enrolled as group 2. Clinical and angiographic outcomes, procedural parameters and resource usage were compared.


RESULTS
Baseline characteristics were comparable, including the symptom onset-to-needle time (250+/-101 vs. 261+/-149 min, p = NS). Total procedure time (33+/-14 vs. 47+/-20 min, p = 0.011), fluoroscopy time (10+/-6 vs. 16+/-10 min, p = 0.014) and contrast medium consumption (140+/-40 vs. 170+/-50 ml, p = 0.024) were all significantly reduced with group 1. No-reflow occurred less frequently with group 1 (5% vs. 32%, p = 0.046) during intervention, and TIMI 3 flow was established more quickly (19+/-10 vs. 30+/-20 min, p = 0.024). Final TIMI 3 flow rates and stent rates were similar. The time to myocardial enzyme peak was shorter with group 1 (9.7+/-3.1 vs. 12.8+/-6.3 h, p = 0.048), but no difference was found in 3 months cumulative major cardiac adverse event rates.


CONCLUSIONS
Primary PCI with IT achieves earlier reperfusion and is more efficient in terms of time and resource, comparing to conventional strategy.
Yang
Chi-Tung
CT
Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, No. 7, Chung-Shan South Road, Taipei, Taiwan.
Hwang
Juey-Jen
JJ
Lin
Lung-Chun
LC
Kao
Hsien-Li
HL
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012449:Safety; D015607:Stents; D013396:Suction / Q000295:instrumentation; D017131:Thrombectomy / Q000295:instrumentation*; D016896:Treatment Outcome