Directional coronary atherectomy in acute myocardial infarction

Catheter-based intervention with directional coronary atherectomy (DCA) involving the surgical removal of obstructive plaque has been extensively studied in patients exhibiting stable and unstable angina. However, since no studies to date have evaluated the effectiveness of stand alone DCA as a primary treatment in the acute myocardial infarction (MI) setting, we conducted a five-year retrospective study of the early clinical and in-hospital outcomes of patients who underwent DCA within the 72-hour interval following acute MI. Our study included data obtained from a total of 30 acute MI patients treated between 1993 and 1998. Twenty-six of these patients (86%) met the criteria for angiographic success, while 11 (36%) showed less than 50% residual stenosis without the need for supplemental percutaneous transluminal coronary angioplasty (PTCA) or additional treatment for other major complications. Four (13%) of the patients exhibited negative outcomes including post-procedural MI, emergency coronary artery bypass grafting, abrupt vessel closure, hemorrhage necessitating vessel repair and transfusion, and death. Although stand alone DCA is not presently a common treatment, our results suggest it to be an effective and relatively safe procedure for acute MI. However, further studies involving a larger number of patients and a longer follow-up evaluation are needed for comparison of the relative effectiveness of this procedure with other treatments of acute MI.