Improved outcome with AngioJet thrombectomy during primary stenting in acute myocardial infarction patients with high-grade thrombus.
BACKGROUND
Primary stenting during acute myocardial infarction (MI) is often complicated by slow-flow/no-reflow due to distal embolization of intracoronary thrombus. The AngioJet thrombectomy catheter has been utilized in this setting in order to limit distal embolization and improve flow. The effect of AngioJet during primary stenting in acute MI with high-grade thrombus (greater than or equal to grade 3, as per thrombolysis in MI [TIMI] classification) is not known.


METHODS
We analyzed 95 consecutive acute MI patients with thrombus grade > or = 3 who underwent primary stenting with AngioJet (n = 52) and without AngioJet (n = 43) for epicardial and microvascular flow, and followed for 30-day major adverse cardiac events (MACE) and 1-year survival. Baseline characteristics and in-hospital events were obtained from the interventional database. Two independent operators analyzed pre- and post-procedure TIMI flow rates, corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG).


RESULTS
Baseline clinical and angiographic characteristics were comparable between the two groups. AngioJet use was associated with better TIMI flow, TMP grade, CTFC and a trend towards lower 30-day and 1-year MACE. Use of AngioJet thrombectomy prior to stenting of acute MI patients with high-grade thrombus improves epicardial and microvascular flow, with a trend toward better short- and long-term outcome.
Sharma
Samin K
SK
Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6574, USA. samin.sharma@msnyuhealth.org
Tamburrino
Frank
F
Mares
Angelica M
AM
Kini
Annapoorna S
AS
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000592:standards; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D015607:Stents; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome