title: Rheolytic Thrombectomy for Acute Myocardial Infarction Complicated by Cardiogenic Shock.
abstract: OBJECTIVE
  We sought to investigate the prognostic impact of rheolytic thrombectomy (RT) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).
  
  
  BACKGROUND
  Very few data exist on thrombus removal before stenting in patients with AMI and CS treated with primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  Of 4023 patients who underwent PCI for AMI between 1995 and 2012, we focused on 371 patients presenting with CS at admission and separated them into two groups: the first included 63 patients treated with RT (RT group), and the remaining 308 underwent standard PCI (non-RT group). The primary endpoint was the composite of cardiac death, reinfarction, stroke, and target-vessel revascularization (TVR) at 2-year follow-up (MACE).
  
  
  RESULTS
  The primary endpoint rate was lower in the RT-group (57.1% RT vs 70.8% non-RT; P=.04). The difference between groups was driven by a lower TVR rate (9.5% RT vs 23.4% non-RT; P=.02) and reinfarction (1.6% RT vs 9.1% non-RT; P=.04), while no difference between groups was revealed in mortality (46.0% RT vs 49.4% non-RT; P=.68) or stroke rate (1.6% RT vs 3.2% non-RT; P=.70). At multivariable analysis, the variables related to the risk of the primary endpoint were age (hazard ratio [HR], 1.036; 95% confidence interval [CI], 1.022-1.048; P<.001), three-vessel disease (HR, 1.504; 95% CI, 1.163-1.946; P=.01), RT (HR, 0.689; 95% CI, 0.476-0.998; P=.049), and successful primary PCI (HR, 0.367; 95% CI, 0.266-0.505; P<.001).
  
  
  CONCLUSIONS
  RT reduces 2-year MACE rate in patients with large thrombus burden and AMI complicated by CS.
authors.forename: Ruben
authors.initials: R
authors.lastname: Vergara
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Letizia
authors.initials: L
authors.lastname: Giurlani
authors.forename: Marco
authors.initials: M
authors.lastname: Marrani
authors.forename: Giulia
authors.initials: G
authors.lastname: Cantini
authors.affiliation: Division of Cardiology, Careggi Hospital, Viale Morgagni I-50139, Florence, Italy. david.antoniucci@virgilio.it.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery
chemical_list: D005343:Fibrinolytic Agents