Comparison of the X-SIZER thrombectomy device with adjunct abciximab during primary angioplasty and stenting for ST-segment elevation myocardial infarction.
OBJECTIVE
To evaluate the safety and efficacy of the X-SIZER thrombectomy device versus the use of abciximab during primary angioplasty for acute ST-elevation myocardial infarction (STEMI).


METHODS
Retrospective analysis of patients undergoing primary angioplasty for STEMI from October 2000 to December 2002 using the X-SIZER thrombectomy device versus abciximab.


METHODS
National University Hospital, Singapore.


METHODS
Out of 79 patients, 44 underwent X-SIZER use, while 35 received adjunct abciximab. Both groups were similarly represented with regards to age, gender, risk factors, target vessel site/diameter, cardiogenic shock, and onset of chest pain to procedure time. The infarct-related artery was occluded in 88.6% in both groups.


METHODS
A 2-mm X-SIZER was used in 34/44 (77.3%), while a 1.5-mm device was used in the remainder. Final TIMI 3 flow was obtained in 38/44 (86.4%) in the X-SIZER group compared to 26/35 (74.3%) in the abciximab group (P = 0.175).


METHODS
Coronary TIMI flow rate, electrocardiogram (ECG) resolution, slow flow/no reflow phenomenon, and patient outcome (death, cardiac failure, or repeat revascularization) at 1 month.


RESULTS
ECG resolution and slow flow/no reflow were better in the X-SIZER group (77.3% vs 54.3%, P = 0.031; 9.1% vs 25.7%, P = 0.047, respectively). Patient outcome at 1 month was, however, not significantly different (18.2% vs 17.1%, P = 0.904, respectively, for X-SIZER and abciximab).


CONCLUSIONS
X-SIZER thrombectomy during primary percutaneous coronary intervention for thrombus-laden STEMI is a safe and effective strategy. When compared to patients receiving abciximab, it was associated with improved ECG resolution, less slow flow/no reflow and a trend to better TIMI 3 flow.
Low
Adrian F
AF
From the Cardiac Department, National University Hospital, Singapore. mdclowa@nus.edu.sg
Lim
Yean-Teng
YT
Teo
Swee-Guan
SG
Budiono
Bambang
B
Sutandar
Antono
A
Tan
Huay-Cheem
HC
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation*
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab