Effect of intracoronary thrombectomy on 30-day mortality in patients with acute myocardial infarction.
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.
Nakatani
Daisaku
D
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Sato
Hiroshi
H
Sakata
Yasuhiko
Y
Mizuno
Hiroya
H
Shimizu
Masahiko
M
Suna
Shinichiro
S
Nanto
Shinsuke
S
Hirayama
Atsushi
A
Ito
Hiroshi
H
Fujii
Kenshi
K
Hori
Masatsugu
M
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