title: X-sizer for thrombectomy in acute myocardial infarction improves ST-segment resolution: results of the X-sizer in AMI for negligible embolization and optimal ST resolution (X AMINE ST) trial.
abstract: OBJECTIVE
  We sought to compare, in a prospective randomized multicenter study, the effect of adjunctive thrombectomy using X-Sizer (eV3, White Bear Lake, Minnesota) before percutaneous coronary intervention (PCI) versus conventional PCI in patients with acute myocardial infarction (AMI) for <12 h and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 to 1. The primary end point was the magnitude of ST-segment resolution after PCI.
  
  
  BACKGROUND
  Despite a high rate of TIMI flow grade 3 achieved by PCI in patients with AMI, myocardial reperfusion remains relatively low. Distal embolization of thrombotic materials may play a major role in this setting.
  
  
  METHODS
  We conducted a prospective, randomized, multicenter study in patients with AMI <12 h and initial TIMI flow grade 0 to 1 who were treated with primary PCI. The magnitude of ST-segment resolution 1 h after PCI was the primary end point.
  
  
  RESULTS
  A total of 201 patients were included. Treatment groups were comparable by age (61 +/- 13 years), diabetes (22%), previous MI (8%), anterior MI (52%), onset-to-angiogram (258 +/- 173 min), and glycoprotein IIb/IIIa inhibitor use (59%). The magnitude of ST-segment resolution was greater in the X-Sizer group compared with the conventional group (7.5 vs. 4.9 mm, respectively; p = 0.033) as ST-segment resolution >50% (68% vs. 53%; p = 0.037). The occurrence of distal embolization was reduced (2% vs. 10%; p = 0.033) and TIMI flow grade 3 was obtained in 96% vs. 89%, respectively (p = 0.105). Myocardial blush grade 3 was similar (30% vs. 31%; p = NS). Six-month clinical outcome was comparable (death, 6% vs. 4% and major adverse cardiac and cerebral events, 13% vs. 13%, respectively). By multivariate analysis, independent predictors of ST-segment resolution >50% were: younger age, non-anterior MI, use of the X-Sizer, and a short time interval from symptom onset.
  
  
  CONCLUSIONS
  Reducing thrombus burden with X-Sizer before stenting leads to better myocardial reperfusion, as illustrated by a reduced risk of distal embolization and better ST-segment resolution.
authors: Institut Cardiovasculaire Paris Sud, Massy, France. t.lefevre@icps.com.fr
authors: Thierry
authors: T
authors: Lefèvre
authors: Eulegio
authors: E
authors: Garcia
authors: Bernhard
authors: B
authors: Reimers
authors: Iréne
authors: I
authors: Lang
authors: Carlo
authors: C
authors: di Mario
authors: Antonio
authors: A
authors: Colombo
authors: Franz-Joseph
authors: FJ
authors: Neumann
authors: Mariano Valdés
authors: MV
authors: Chavarri
authors: Philippe
authors: P
authors: Brunel
authors: Eberhart
authors: E
authors: Grube
authors: Martin
authors: M
authors: Thomas
authors: Bernard
authors: B
authors: Glatt
authors: Joseph
authors: J
authors: Ludwig
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000295:instrumentation; D017023:Coronary Angiography; D003326:Coronary Circulation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000601:surgery*; D015425:Myocardial Reperfusion; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation*; D013997:Time Factors
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex