title: Routine aspiration thrombectomy improves the diagnosis and management of embolic myocardial infarction.
abstract: OBJECTIVE
  Assess the effect of aspiration thrombectomy on diagnosis and management of embolic acute myocardial infarction.
  
  
  BACKGROUND
  Discrimination of embolic acute myocardial infarction from atherosclerotic plaque rupture/erosion prompts oral anticoagulation treatment of source of embolus, as well as avoiding unnecessary stenting and dual antiplatelet therapy. However, detection is difficult without aspiration.
  
  
  METHODS
  We compared rates of diagnosis of embolic infarction for 2.5 years prior to (pre-RAT) and 2.5 years post routine aspiration thrombectomy (post-RAT). Baseline demographics, outcomes, and treatment strategies were also compared between the embolic infarction and atherosclerotic infarction.
  
  
  RESULTS
  Diagnosed embolic infarction rose from 1.2% in the pre-RAT era to 2.8% in the post-RAT period (P < 0.05). In addition, more successful removal of thrombus by aspiration led to less stenting (20% vs. 55% P < 0.05) in the post-RAT period thus avoiding the hazards of "triple therapy." Embolic infarction was more frequently associated with atrial fibrillation (55% vs. 8%), had higher mortality (17% vs. 4%), and had higher rates of embolic stroke (13% vs. 0.3%) when compared with atherosclerotic MI (all P < 0.05).
  
  
  CONCLUSIONS
  Routine aspiration thrombectomy more readily identifies embolic infarction allowing more specific therapy and avoidance of stenting and triple anticoagulant therapy.
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Alex L
authors.initials: AL
authors.lastname: Huang
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: J Conleth
authors.initials: JC
authors.lastname: Murphy
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kozor
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Warren
authors.initials: W
authors.lastname: Yan
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Loxton
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.
authors.forename: Soon Y
authors.initials: SY
authors.lastname: Soo Hoo
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Gemma A
authors.initials: GA
authors.lastname: Figtree
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Helge H
authors.initials: HH
authors.lastname: Rasmussen
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hansen
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Gregory I C
authors.initials: GI
authors.lastname: Nelson
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
authors.affiliation: Royal North Shore Hospital, St Leonards, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Ward
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D004617:Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012307:Risk Factors; D012422:Rupture, Spontaneous; D017131:Thrombectomy / Q000009:adverse effects; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: embolism; myocardial infarction; thrombectomy