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Published on: January 18, 2018
Percutaneous thrombectomy with the RESCUE system in acute myocardial infarction
Dariusz Dudek1, Waldemar Mielecki, Jacek Legutko
12nd Department of Cardiology, Institute of Cardiology, Collegium Medicum, Jagiellonian University, Cracow, Poland.
Insights
Percutaneous thrombectomy before stenting in ST-elevation myocardial infarction (STEMI) is safe and improves myocardial perfusion. This intervention better restores infarct artery patency compared to standard percutaneous coronary intervention alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI) can lead to distal coronary embolization.
- Percutaneous thrombectomy prior to stent implantation may mitigate this risk and improve microcirculation.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous thrombectomy in STEMI patients.
- To compare outcomes of thrombectomy followed by PCI versus PCI alone.
Main Methods:
- Seventy-two STEMI patients were randomized to PCI with stenting alone (n=32) or thrombectomy (RESCUE system) followed by PCI (n=40).
- Coronary flow (TIMI scale, cTFC), myocardial perfusion (tMPG), ST-segment resolution, and left ventricular ejection fraction (LVEF) were assessed.
Main Results:
- Thrombectomy was effective in 87% of patients.
- While initial flow and perfusion grades were similar, thrombectomy patients showed significantly greater ST-segment resolution (68% vs 25%, p=0.005).
- Peak CK-MB occurred earlier with thrombectomy, and LVEF tended to be higher at 3-month follow-up.
Conclusions:
- Thrombectomy with the RESCUE system is a safe and effective adjunctive therapy for STEMI.
- Thrombectomy improves myocardial perfusion and infarct-related artery patency more effectively than standard PCI.
Background:
Percutaneous coronary interventions (PCI) in acute myocardial infarction with ST segment elevation (STEMI) are associated with distal coronary embolisation. It may be speculated that percutaneous thrombectomy preceding stent implantation may prevent coronary microcirculation from embolisation.
Aim:
To assess safety and efficacy of percutaneous thrombectomy in patients with STEMI.
Methods:
Seventy two patients with STEMI were randomised to PCI with stent implantation alone (n=32) or percutaneous thrombectomy with the RESCUE system, followed by stent implantation (n=40). Coronary flow in infarct related artery before and after the procedure was assessed using TIMI scale and corrected TIMI frame count - cTFC. Myocardial blood flow was measured using TIMI myocardial perfusion grade - tMPG. The degree of ST segment resolution 60 min after PCI was also assessed. Left ventricular ejection fraction (LVEF) was measured in hospital and three months later.
Results:
The two groups did not differ with respect to the time from the onset of symptoms to the procedure (236+/-162 min vs 258+/-198 min, NS) or the baseline TIMI, cTFC and tMPG values. An effective thrombectomy procedure was performed in 35 (87%) patients from group B. After the procedure, the number of patients with TIMI 3 grade as well as cTFC values and the proportion of patients with tMPG 3 were similar in both groups (86% vs 85%, NS; 19 vs 21, NS; and 38% vs 54%, NS). The sum of ST segment elevations after the procedure was significantly greater in patients who underwent PCI only compared with patients who had thrombectomy and PCI (6.8+/-5.2 mm vs 3.6+/-2.9 mm, p=0.004). Complete normalisation of ST segment was achieved in 68% of patients treated with thrombectomy and PCI compared with 25% of patients who had PCI only (p=0.005). CK-MB peak values occurred significantly earlier in patients treated with thrombectomy (92.1% vs 66.7% up to 360 min, p=0.01). After 3 months of follow-up, LVEF tended to be greater in patients treated with thrombectomy and PCI than in those who underwent PCI only (55.3+/-14.7% vs 60.3+/-9.2%, NS).
Conclusions:
Thrombectomy with the RESCUE system in patients with STEMI is safe and effectively restores patency of infarct related artery. Thrombectomy better improves myocardial perfusion than standard PCI.
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