title: Manual Aspiration Thrombectomy in Acute Myocardial Infarction: A Clinical Experience.
abstract: Multiple clinical studies have failed to establish the role of routine use of thrombectomy in ST-elevation myocardial infarction (STEMI) patients. There is a paucity of data on the impact of thrombectomy in unselected STEMI patients outside clinical trials. We sought to evaluate the clinical variables and outcomes associated with the performance of thrombectomy in STEMI patients. We retrospectively examined the clinical outcomes in all STEMI patients who underwent successful percutaneous intervention (PCI) at our center. Patients were divided into two groups, one with patients who underwent conventional PCI and another with patients who had thrombus aspiration in addition to conventional PCI. We compared the baseline clinical characteristics, laboratory investigations, re-infarction rates, and all-cause mortality. Total 477 consecutive STEMI patients were identified. Overall, 29% (139) of the patients underwent conventional PCI and 71% (338) of the patients were treated with aspiration thrombectomy and PCI. In addition to the presence of thrombus, patients with nonanterior infarction, and patients with hemodynamic instability requiring intra-aortic balloon pump support were more likely to undergo thrombectomy. Thrombectomy was associated with higher enzymatic infarction (creatine kinase: 2,796 [2,575] vs. 1,716 [1,662]; p < 0.0001; CK-MB: 210.6 [156.0] vs. 142.0 [121.9], p < 0.0001). However, thrombectomy was not associated with any difference in 30 day reinfarction rate (3.3 vs. 2.9%, p = 0.83), mortality (5.0 vs. 7.2%, p = 0.35), or composite of death and 30 day reinfarction (7.7 vs. 9.4%, p = 0.55). We observed that STEMI patients with anterior infarction and hemodynamic instability were more likely to undergo thrombectomy during primary PCI.
authors.affiliation: Tulane University Heart and Vascular Institute, New Orleans, Louisiana.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Jaiswal
authors.affiliation: Department of Computer Information Systems and Decision Sciences, St. Johns University, New York.
authors.forename: Simcha
authors.initials: S
authors.lastname: Pollack
authors.affiliation: Department of Internal Medicine, Hofstra North Shore-LIJ Health System, Manhasset, New York.
authors.forename: Astha
authors.initials: A
authors.lastname: Chichra
authors.affiliation: Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, New York.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Moustakakis
authors.affiliation: Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, New York.
authors.forename: Chong
authors.initials: C
authors.lastname: Park
authors.affiliation: Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, New York.
authors.forename: Todd
authors.initials: T
authors.lastname: Kerwin
keywords: acute myocardial infarction; angioplasty; atherosclerosis; infarction; myocardial infarction; thrombectomy