title: Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry.
abstract: BACKGROUND
  Data about the impact of thrombectomy in primary percutaneous coronary intervention (PCI) are inconsistent. The aim of our study was an evaluation of both the real-world use of thrombectomy and the impact of thrombectomy on outcome in unselected patients treated with primary PCI for ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  We used the data of the prospective ALKK PCI-registry of 35 hospitals from January 2010 to December 2013. A total of 10,755 patients receiving single-vessel primary PCI for acute STEMI were included. In 2176 patients (20.2 %) thrombectomy was performed. There was a wide range of use of thrombectomy in the different ALKK hospitals from 1.1 to 61.7 % (median 18.6 %, quartiles 6.0 and 40.3 %) with a general increase of use over the first years of the study period. In patients with and without thrombectomy there was TIMI 0 flow present before PCI in 6010 patients, TIMI 1 in 1338, TIMI 2 in 2002, and TIMI 3 in 1405. Patients with acute heart failure or cardiogenic shock received significantly more often thrombectomy. Fluoroscopy time (8.1 vs. 7.3 min, p < 0.0001) and dose area product (5373 cGy × cm(2) vs. 4802 cGy × cm(2), p < 0.0001) were significantly higher in patients treated with thrombectomy. The subgroup of patients with TIMI 0 flow before PCI had significantly higher rates of TIMI 3 flow after PCI when treated with thrombectomy (87.1 vs. 84.1 %, p < 0.01), while there was no difference in post-PCI TIMI 3 flow in patients with TIMI 1, 2 or 3 flow before PCI. Rates of major adverse cardiac and cerebrovascular events were similar in both groups in general and in all subgroups of TIMI flow.
  
  
  CONCLUSIONS
  The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow.
authors: Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany. t.haerle@gmx.de.
authors: Tobias
authors: T
authors: Härle
authors: Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.|Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors: Uwe
authors: U
authors: Zeymer
authors: Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors: Matthias
authors: M
authors: Hochadel
authors: Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors: Karin
authors: K
authors: Schmidt
authors: Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors: Ralf
authors: R
authors: Zahn
authors: Klinik für Kardiologie, Angiologie und Intensivmedizin, Vivantes Klinikum Neukölln, Berlin, Germany.
authors: Harald
authors: H
authors: Darius
authors: Kardiologie, Pneumologie und konservative Intensivmedizin, Vivantes Klinikum Spandau, Berlin, Germany.
authors: Steffen
authors: S
authors: Behrens
authors: Klinik für Kardiologie, Zentralklinik Bad Berka, Bad Berka, Germany.
authors: Bernward
authors: B
authors: Lauer
authors: Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum München, Munich, Germany.
authors: Harald
authors: H
authors: Mudra
authors: Medizinische Klinik I, Klinikum Fulda, Fulda, Germany.
authors: Volker
authors: V
authors: Schächinger
authors: Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
authors: Albrecht
authors: A
authors: Elsässer
mesh_terms: D000208:Acute Disease; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012042:Registries; D018570:Risk Assessment; D015996:Survival Rate; D017131:Thrombectomy / Q000401:mortality*; D016896:Treatment Outcome
keywords: Germany; Myocardial infarction; STEMI; TIMI flow; Thrombectomy; Thrombus aspiration