title: Manual versus nonmanual thrombectomy in primary and rescue percutaneous coronary angioplasty.
abstract: Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing primary or rescue percutaneous coronary intervention in a tertiary care center. We identified 232 consecutive patients with STEMI and time from symptom onset to emergency room contact of < or = 12 h undergoing percutaneous coronary intervention with coronary thrombectomy devices. Primary end point was ST-segment resolution of > or = 70%. Several angiographic, procedural and clinical secondary end points were also evaluated. The manual thrombectomy group included 110 patients and the nonmanual group 122 patients. Both groups were similar in their clinical characteristics. The primary end point occurred with similar frequency in patients treated with manual versus nonmanual thrombectomy (67.9% vs 60.0%, P = 0.216). No significant differences were found in the two groups with regard to procedural complications, angiographic reperfusion parameters, in-hospital major adverse cardiac events, or infarct size, whereas manual thrombectomy was associated with a better left ventricle ejection fraction at discharge. Furthermore, treatment with a manual thrombectomy device was associated with significantly shorter procedural times (69 min vs 95 min, P < 0.001) and lower procedural costs (2981 euros vs 7505 euros, P < 0.001). The use of manual thrombus-aspiration catheters appeared equivalent to nonmanual thrombectomy devices in the setting of primary or rescue percutaneous intervention in terms of clinical efficacy, and led to shorter procedures and cost savings.
authors.affiliation: Heart Department, San Carlo Hospital, Potenza, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Tarsia
authors.forename: Mario
authors.initials: M
authors.lastname: De Michele
authors.forename: Domenico
authors.initials: D
authors.lastname: Polosa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Fabio
authors.initials: F
authors.lastname: Costantino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Del Prete
authors.forename: Rocco Aldo
authors.initials: RA
authors.lastname: Osanna
authors.forename: Pasquale
authors.initials: P
authors.lastname: Innelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Sisto
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lisanti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D057216:Propensity Score; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013318:Stroke Volume; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left