title: Effect of intracoronary thrombectomy on 30-day mortality in patients with acute myocardial infarction.
abstract: Insertion of intracoronary thrombectomy (ICT) devices, as a precedent to percutaneous coronary intervention (PCI), theoretically could have a beneficial effect on the outcome in patients with acute myocardial infarction. To examine whether ICT was associated with a lower 30-day mortality rate in patients with acute myocardial infarction, we studied 3,913 patients who underwent PCI within 24 hours after onset. A total of 990 patients (25.3%) were treated with ICT before PCI. The 30-day mortality rate was lower in the patients receiving ICT than in those without (3.7% vs 6.2%, p = 0.004), but this beneficial effect disappeared after adjustment for baseline characteristics (hazard ratio [HR] 0.658, p = 0.166). We also divided the patients into tertiles according to the Thrombolysis In Myocardial Infarction (TIMI) risk score. After adjustment for baseline characteristics, ICT was associated with a lower 30-day mortality rate in patients from the highest TIMI risk score tertile (HR 0.407, p = 0.029), but not in patients from the lower 2 tertiles. ICT was also an independent predictor of a lower 30-day mortality risk in patients aged > or =70 years (HR 0.239, p = 0.007), patients with diabetes mellitus (HR 0.275, p = 0.039), and those with stent implantation (HR 0.437, p = 0.034). In conclusion, in selected patients with high TIMI risk scores, an age > or =70 years, diabetes mellitus, or stenting, ICT is associated with a lower 30-day mortality rate.
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nakatani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.forename: Hiroya
authors.initials: H
authors.lastname: Mizuno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shimizu
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Suna
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D016019:Survival Analysis; D017131:Thrombectomy