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Preliminary experience using directional coronary atherectomy for the treatment of acute myocardial infarction
1Hamot Medical Center, Erie, Pennsylvania, USA.
Insights
Directional coronary atherectomy (DCA) shows promise for treating acute myocardial infarction (MI). Early results indicate a high procedural success rate and favorable outcomes for most patients, suggesting DCA
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Directional coronary atherectomy (DCA) is established for coronary artery disease.
- Limited data exists on DCA's efficacy in acute myocardial infarction (MI).
Purpose of the Study:
- To review early clinical experience with DCA in treating acute MI.
- To assess the safety and efficacy of DCA for acute MI patients.
Main Methods:
- Retrospective review of 12 acute MI patients treated with DCA (April 1993-February 1994).
- Standard anticoagulation (aspirin, nitroglycerin, heparin) and DCA devices were used.
- Postprocedure stenosis assessed angiographically; tissue weight measured.
Main Results:
- 92% procedural success rate with a mean 15% post-DCA stenosis.
- Mean tissue removed was 16 mg.
- 83% clinical success; 10 patients had no ischemic events, heart failure, or arrhythmias post-procedure.
Conclusions:
- DCA is a feasible and effective treatment for acute myocardial infarction.
- The procedure demonstrated a high success rate and acceptable safety profile in this early cohort.
- Further investigation is warranted for DCA in acute MI management.
Abstract:
Directional coronary atherectomy (DCA) has proven to be an effective treatment for coronary artery disease, both in multiple anatomical locations and in various clinical settings. Little has been published, however, regarding efficacy of DCA for treatment of acute myocardial infarction (MI). This brief report reviews our early experience with DCA in this new role. Twelve patients presenting from April 1993 through February 1994 were identified by review of the DCA Registry at Hamot Medical Center. The group comprised six men and six women mean age 60 years (range 39-81 years). Patients were administered oral aspirin and intravenous nitroglycerin Heparin dose was titrated to maintain ACTs > 300 seconds. DCA was performed using 9.5-, 10-, and 11Fr guiding catheters. Seven Fr EX, 7Fr graft, 7Fr surlyn, and 6Fr EX devices were used. Predilation and/or postdilation with balloon angioplasty was performed when clinically indicated. Postprocedure stenoses were determined using comparable orthogonal angiographic views. Lesions were measured by manual caliper assessment and tissue weights were obtained from all specimens. The procedural success rate was 92% (11/12) and the mean postprocedural diameter stenosis was 15% (range -20% to 52%). The mean tissue weight from atherectomy specimens was 16 mg (range 7.6-35 mg). The mean time from onset of pain to reperfusion was 2.8 hours (range 40 min to 5.5 hours). Clinical success was achieved in 83% (10/12) of patients. Two deaths occurred in patients presenting with cardiogenic shock. Ten patients experienced no ischemic events, heart failure, or arryhthmias following their interventional procedure.(ABSTRACT TRUNCATED AT 250 WORDS)