title: Routine thrombectomy in percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: a randomized, controlled trial.
abstract: 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.
authors.affiliation: Department of Cardiology B, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Morten
authors.initials: M
authors.lastname: Bøttcher
authors.forename: Søren Steen
authors.initials: SS
authors.lastname: Nielsen
authors.forename: Hans-Henrik Tilsted
authors.initials: HH
authors.lastname: Hansen
authors.forename: Christian
authors.initials: C
authors.lastname: Terkelsen
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
authors.forename: Jens
authors.initials: J
authors.lastname: Kristensen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Lars Romer
authors.initials: LR
authors.lastname: Krusell
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.forename: Henning Rud
authors.initials: HR
authors.lastname: Andersen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Klaus
authors.initials: K
authors.lastname: Rasmussen
authors.forename: Michael
authors.initials: M
authors.lastname: Rehling
authors.forename: Torsten Toftegaard
authors.initials: TT
authors.lastname: Nielsen
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi