Rheolytic thrombectomy in patients with ST-elevation myocardial infarction and large thrombus burden: the Thoraxcenter experience.
OBJECTIVE
To determine the impact of Rheolytic thrombectomy (RT) on the clinical and angiographic outcome of patients with ST-elevation myocardial infarction (STEMI) and large thrombus burden (LTB).


METHODS
Two hundred sixty-six consecutive patients who presented from April 2002 until December 2004 with STEMI and LTB were retrospectively analyzed. LTB was defined as definite presence of thrombus with the greatest dimension greater > or = 2 vessel diameters by visual assessment. RT, as well as the interventional procedure and the peri-procedural pharmacological therapy, was at the discretion of the operator. All patients were followed for major adverse cardiac events (MACE) defined as death, non-fatal myocardial infarction (MI) and infarct-related artery revascularization. Pre- and post-procedural thrombolysis in myocardial infarction (TIMI) flow and thrombus burden as well as myocardial blush, distal embolization and no reflow were also determined.


RESULTS
Complete follow-up was available in all patients; mean duration was 17 +/- 8.7 months. RT was used in 75 patients (28.2%). Stents were implanted in 251 (94.4%) patients; drug-eluting stents in 210 (84.6%) patients (15.5% sirolimus-eluting stents and 69.1% paclitaxel-eluting stents). The 2-year cumulative survival and MACE-free survival were higher in the RT compared to the non-RT group (92% vs. 82.7%, p = 0.051 and 87.7% vs. 69.9%, p = 0.004, respectively). Post-procedure indices (TIMI 3 flow, absence of thrombus and myocardial blush grade 3) of angiographic outcome were significantly better in the RT group. RT was an independent predictor of MACE (HR: 0.45, 95% CI: 0.22-0.93, p = 0.03).


CONCLUSIONS
RT significantly improves the clinical and angiographic outcome of patients with STEMI and large thrombus burden.
Sianos
Georgios
G
Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands. g.sianos@erasmusmc.nl
Papafaklis
Michail I
MI
Vaina
Sofia
S
Daemen
Joost
J
van Mieghem
Carlos A
CA
Van Domburg
Ron T
RT
Michalis
Lampros K
LK
de Jaegere
Peter
P
Serruys
Patrick W
PW
D000368:Aged; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016503:Drug Delivery Systems; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome