Comparative efficacy analysis of an aspiration device before primary angioplasty in patients with acute myocardial infarction: a single-center experience.
BACKGROUND
ST-elevation myocardial infarction is caused by occlusive coronary thrombosis where antecedent plaque disruption occurs. When treating STEMI the main goal is to achieve prompt reperfusion of the infarction area. Several studies have demonstrated the efficacy of an aspiration device before percutaneous coronary intervention in patients with acute myocardial infarction.


OBJECTIVE
To determine the added value of thrombus aspiration prior to primary PCI by comparing AMI patients with totally occluded infarct-related artery treated with routine primary PCI to those treated with extraction device prior to primary PCI.


METHODS
The study group comprised 122 consecutive patients with AMI and a totally occluded infarct artery (TIMI flow 0) who underwent primary PCI. The patients were divided into two groups: 68 who underwent primary PCI only (control group) and 54 who underwent primary thrombus extraction with an extraction device before PCI (extraction group). Baseline clinical and lesion characteristics were similar in both groups. Final TIMI grade flow and myocardial blush as well as 1 year mortality, target lesion revascularization, recurrent myocardial infarction, unstable angina and stroke were compared between the two groups.


RESULTS
Primary angiographic results were better for the extraction group versus the control group: final grade 3 TIMI flow was 100% vs. 95.6% (P= 0.03) and final grade 3 myocardial blush grade 50% vs. 41.18% (although Pwas not significant). Long-term follow-up total MACE showed a nonsignificant positive trend in the extraction group (12.96% vs. 24.71%, P= 0.26).


CONCLUSIONS
The use of extraction devices for intracoronary thrombectomy during primary PCI in patients with totally occluded infarct artery significantly improved epicardial reperfusion in the infarct-related vessel and showed a trend for more favorable long-term outcome.
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Ariel
A
Finkelstein
Shmuel
S
Schwartzenberg
Limor
L
Bar
Yehuda
Y
Levy
Amir
A
Halkin
Itzhak
I
Herz
Samuel
S
Bazan
Rafael
R
Massachi
Shmuel
S
Banal
Gad
G
Keren
Jacob
J
George
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003328:Coronary Thrombosis / Q000150:complications / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D013396:Suction / Q000295:instrumentation; D016019:Survival Analysis; D016896:Treatment Outcome