Routine thrombectomy in percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: a randomized, controlled trial.
BACKGROUND
Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction may result in reduced myocardial perfusion, infarct extension, and impaired prognosis.


RESULTS
In a prospective randomized trial, we studied the effect of routine thrombectomy in 215 patients with ST-segment-elevation myocardial infarction lasting <12 hours undergoing primary PCI. Patients were randomized to thrombectomy pretreatment or standard PCI. The primary end point was myocardial salvage measured by sestamibi SPECT, calculated as the difference between area at risk and final infarct size determined after 30 days (percent). Secondary end points included final infarct size, ST-segment resolution, and troponin T release. Baseline variables, including ST-segment elevation and area at risk, were similar. Salvage was not statistically different in the thrombectomy and control groups (median, 13% [interquartile range, 9% to 21%] and 18% [interquartile range, 7% to 25%]; P=0.12), but 24 patients in the thrombectomy group and 12 patients in the control group did not have an early SPECT scan, mainly because of poor general or cardiac condition (P=0.04). In the thrombectomy group, final infarct size was increased (median, 15%; [interquartile range, 4% to 25%] versus 8% [interquartile range, 2% to 18%]; P=0.004).


CONCLUSIONS
Thrombectomy performed as routine therapy in primary PCI for ST-elevation myocardial infarction does not increase myocardial salvage. The study suggests a possible deleterious effect of thrombectomy, resulting in an increased final infarct size, and does not support the use of thrombectomy in unselected primary PCI patients.
Kaltoft
Anne
A
Department of Cardiology B, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
Bøttcher
Morten
M
Nielsen
Søren Steen
SS
Hansen
Hans-Henrik Tilsted
HH
Terkelsen
Christian
C
Maeng
Michael
M
Kristensen
Jens
J
Thuesen
Leif
L
Krusell
Lars Romer
LR
Kristensen
Steen Dalby
SD
Andersen
Henning Rud
HR
Lassen
Jens Flensted
JF
Rasmussen
Klaus
K
Rehling
Michael
M
Nielsen
Torsten Toftegaard
TT
Bøtker
Hans Erik
HE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012008:Recurrence; D015607:Stents; D017256:Technetium Tc 99m Sestamibi; D017131:Thrombectomy / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon
D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi