Document Type : Original Article(s)
Authors
1 Cardiologist, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Cardiologist, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Nurse, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
4 Nurse, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: The applicability of manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction (STEMI) has been a challenging issue. This study aimed to compare the impact of additive manual thrombectomy on patients with myocardial infarction (MI) and total cutoff vessel with standard primary percutaneous coronary intervention (PPCI) with bailout thrombectomy. METHODS: In this case-control study, 181 patients with acute STEMI were enrolled who referred to Chamran Hospital (Isfahan, Iran) between August to December 2014. The culprit lesion was treated with routine PPCI with bailout thrombectomy (111 patients) and routine primary thrombectomy then percutaneous coronary intervention [(PCI), 70 patients] during hospitalization and one month after discharge. Patients in the case group received manual thrombectomy before PPCI and patients in the control group received standard PPCI with bailout thrombectomy. Patients were followed during the study procedure, post-hospitalization and one month later for cardiovascular outcomes including death, recurrent MI, stroke, major bleeding, post PCI arrhythmia, no reflow, thrombolysis in myocardial infarction (TIMI)-flow and TIMI myocardial blush grade (TMBG), which were assessed and recorded. RESULTS: Myocardial perfusion and angiographic outcomes had no significant differences in the two groups (P = 0.730). There was also no significant difference in no reflow prevalence between the two groups (P > 0.990). There were no significant differences for primary outcomes such as death, stroke, major bleeding and arrhythmia between the two groups (P < 0.050). In particular, outcomes were the same for both groups during hospitalization period and one month after discharge. Mortality rate during hospitalization was 5.7% for the control group and 4.5% for the case group (P = 0.730). However, one-month mortality rate was quite similar in both groups. CONCLUSION: This study showed there is no significant difference in cardiovascular outcomes such as death, stroke, bleeding, arrhythmia, target vessel revascularization, and distal embolization during hospitalization and one month after discharge in patients with acute MI and total cutoff of the involved vessel, who underwent PPCI with and without primary Export® aspiration catheter direct thrombosuction.
Keywords
- Costopoulos C, Gorog DA, Di Mari C, Kukreja N. Use of thrombectomy devices in primary percutaneous coronary intervention: A systematic review and meta-analysis. Int J Cardiol 2013; 163(3): 229-41.
- Navarese EP, Tarantini G, Musumeci G, Napodano M, Rossini R, Kowalewski M, et al. Manual vs mechanical thrombectomy during PCI for STEMI: A comprehensive direct and adjusted indirect meta-analysis of randomized trials. Am J Cardiovasc Dis 2013; 3(3): 146-57.
- De Carlo M, Aquaro GD, Palmieri C, Guerra E, Misuraca L, Giannini C, et al. A prospective randomized trial of thrombectomy versus no thrombectomy in patients with ST-segment elevation myocardial infarction and thrombus-rich lesions: MUSTELA (MUltidevice Thrombectomy in Acute ST-Segment ELevation Acute Myocardial Infarction) trial. JACC Cardiovasc Interv 2012; 5(12): 1223-30.
- De Luca G, Navarese EP, Suryapranata H. A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol 2013; 166(3): 606-12.
- De Luca G, Verdoia M, Cassetti E. Thrombectomy during primary angioplasty: Methods, devices, and clinical trial data. Curr Cardiol Rep 2010; 12(5): 422-8.
- Jolly SS, Cairns J, Yusuf S, Meeks B, Shestakovska O, Thabane L, et al. Design and rationale of the TOTAL trial: A randomized trial of routine aspiration ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI. Am Heart J 2014; 167(3): 315-21.
- Frobert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013; 369(17): 1587-97.
- Dudek D, Mielecki W, Burzotta F, Gasior M, Witkowski A, Horvath IG, et al. Thrombus aspiration followed by direct stenting: A novel strategy of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial). Am Heart J 2010; 160(5): 966-72.
- Kumbhani DJ, Bavry AA, Bhatt DL. Role of Aspiration and Mechanical Thrombectomy in Patients with Acute Myocardial Infarction Undergoing Primary Angioplasty: An Updated Meta-Analysis of Randomized Trials. Circulation 2012; 126(21 Supplement): A17864.
- Nilsen DW, Mehran R, Wu RS, Yu J, Nordrehaug JE, Brodie BR, et al. Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: findings from the HORIZONS-AMI trial. Catheter Cardiovasc Interv 2013; 82(4): 594-601.
- Deng SB, Wang J, Xiao J, Wu L, Jing XD, Yan YL, et al. Adjunctive manual thrombus aspiration during ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials. PLoS One 2014; 9(11): e113481.
- Kumbhani DJ, Bavry AA, Desai MY, Bangalore S, Byrne RA, Jneid H, et al. Aspiration thrombectomy in patients undergoing primary angioplasty: Totality of data to 2013. Catheter Cardiovasc Interv 2014; 84(6): 973-7.
- Antoniucci D. JETSTENT trial results: impact on ST-segment elevation myocardial infarction interventions. J Invasive Cardiol 2010; 22(10 Suppl B): 23B-5B.
- Kern MJ, Moore JA, Aguirre FV, Bach RG, Caracciolo EA, Wolford T, et al. Determination of angiographic (TIMI grade) blood flow by intracoronary Doppler flow velocity during acute myocardial infarction. Circulation 1996; 94(7): 1545-52.
- Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, et al. Intracoronary abciximab and aspiration thrombectomy during primary pci for anterior stemi: One-year results from the randomized infuse-ami trial. J Am Coll Cardiol 2013; 61(10_S).
- Antoniucci D, Valenti R, Migliorini A, Parodi G, Memisha G, Santoro GM, et al. Comparison of rheolytic thrombectomy before direct infarct artery stenting versus direct stenting alone in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 2004; 93(8): 1033-5.
- Lefevre T, Garcia E, Reimers B, Lang I, Di Mario C, Colombo A, et al. X-sizer for thrombectomy in acute myocardial infarction improves ST-segment resolution: Results of the X-sizer in AMI for negligible embolization and optimal ST resolution (X AMINE ST) trial. J Am Coll Cardiol 2005; 46(2): 246-52.
- Burzotta F, Trani C, Romagnoli E, Mazzari MA, Rebuzzi AG, De Vita M, et al. Manual thrombus-aspiration improves myocardial reperfusion: The randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J Am Coll Cardiol 2005; 46(2): 371-6.
- Silva-Orrego P, Colombo P, Bigi R, Gregori D, Delgado A, Salvade P, et al. Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: The DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study. J Am Coll Cardiol 2006; 48(8): 1552-9.
- Ikari Y, Sakurada M, Kozuma K, Kawano S, Katsuki T, Kimura K, et al. Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: Report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial. JACC Cardiovasc Interv 2008; 1(4): 424-31.
- Chevalier B, Gilard M, Lang I, Commeau P, Roosen J, Hanssen M, et al. Systematic primary aspiration in acute myocardial percutaneous intervention: A multicentre randomised controlled trial of the export aspiration catheter. EuroIntervention 2008; 4(2): 222-8.
- Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 2008; 358(6): 557-67.
- Bulum J, Ernst A, Strozzi M. The impact of successful manual thrombus aspiration on in-stent restenosis after primary PCI: Angiographic and clinical follow-up. Coron Artery Dis 2012; 23(7): 487-91.
- Onuma Y, Thuesen L, van Geuns RJ, van der Ent M, Desch S, Fajadet J, et al. Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: An optical frequency domain imaging study-TROFI trial. Eur Heart J 2013; 34(14): 1050-60.
- Kikkert WJ, Claessen BE, van Geloven N, Baan J Jr, Vis MM, Koch KT, et al. Adjunctive thrombus aspiration versus conventional percutaneous coronary intervention in ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2013; 81(6): 922-9.
- Sim DS, Ahn Y, Kim YH, Lee D, Seon HJ, Park KH, et al. Effect of manual thrombus aspiration during primary percutaneous coronary intervention on infarct size: Evaluation with cardiac computed tomography. Int J Cardiol 2013; 168(4): 4328-30.
- Woo SI, Park SD, Kim DH, Kwan J, Shin SH, Park KS, et al. Thrombus aspiration during primary percutaneous coronary intervention for preserving the index of microcirculatory resistance: A randomised study. EuroIntervention 2014; 9(9): 1057-62.
- Lagerqvist B, Frobert O, Olivecrona GK, Gudnason T, Maeng M, Alstrom P, et al. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 2014; 371(12): 1111-20.
- Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: A comprehensive meta-analysis of randomized trials. Eur Heart J 2008; 29(24): 2989-3001.
- Tamhane UU, Chetcuti S, Hameed I, Grossman PM, Moscucci M, Gurm HS. Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: A meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2010;10: 10.
)