Rheolytic thrombectomy in acute myocardial infarction: the Florence experience and objectives of the multicenter randomized JETSTENT trial.
The Florence-AngioJet randomized trial was the first study that assessed the efficacy of Rheolytic thrombectomy before direct infarct artery stent implantation in patients who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). This study was based on a sample of 100 patients with a first acute MI and the endpoints of the study were early ST-segment resolution, corrected thrombolysis in myocardial infarction (TIMI) frame count, and infarct size as assessed by technetium-99m sestamibi scintigraphy at 1 month. All 3 endpoints were reached. Patients randomized to thrombectomy before direct stenting had a higher incidence of early ST-segment elevation resolution (90% vs. 72%, p = 0.022), lower corrected TIMI frame counts (18.2 +/- 7.7 vs. 22.5 +/- 11.0, p = 0.032), and smaller infarcts (13.0 +/- 11.6% vs. 21.2 +/- 18.0%, p = 0.010) as compared to patients randomized to direct stenting alone. The AngioJET Thrombectomy and STENTing for Treatment of Acute Myocardial Infarction (JETSTENT) trial is a multi-center international randomized trial based on a sample of 500 patients with acute MI, the aim of which is the confirmation of the results of the Florence trial. Patients with a history of previous MI will be enrolled. No restriction based on clinical status on presentation or high-risk coronary anatomy will be used. Thus, patients with cardiogenic shock will be included. To be eligible, patients must have visible thrombus or a persisting total occlusion, and all use of AngioJet must follow the specific technique used in the Florence experience. The primary hypothesis of the study is that rheolytic thrombectomy before infarct artery stenting provides a better reperfusion as revealed by electrocardiogram and scintigraphy. The subsequent increase in myocardial salvage could result in a decreased incidence of death and heart congestive failure due to left ventricle remodeling at a mid-term follow up.
Antoniucci
David
D
Careggi Hospital Viale Morgagni, Florence, Italy. david.antoniucci@virgilio.it
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003328:Coronary Thrombosis / Q000150:complications / Q000628:therapy*; D006801:Humans; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D017131:Thrombectomy / Q000379:methods*