title: Effect of Coronary Thrombectomy in Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction.
abstract: Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEMI (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEMI (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal coronary reflow. In conclusion, pre-PCI procedural coronary thrombectomy may have serious limitations on attempting optimal coronary reflow that indicates a necessity of promising strategies for this critical illness.
authors.affiliation: Department of Cardiovascular Medicine, Sakakibara Heart Institute, Tokyo, Japan; Tokyo CCU Network Scientific Council, Tokyo, Japan. Electronic address: msuzuki@shi.heart.or.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular Medicine, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyachi
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yamashita
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Department of Cardiovascular Medicine, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
authors.affiliation: Department of Cardiovascular Medicine, Sakakibara Heart Institute, Tokyo, Japan; Tokyo CCU Network Scientific Council, Tokyo, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D000368:Aged; D015897:Comorbidity; D003326:Coronary Circulation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome