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Published on: January 18, 2018
Improved outcome with AngioJet thrombectomy during primary stenting in acute myocardial infarction patients with
Samin K Sharma1, Frank Tamburrino, Angelica M Mares
1Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6574, USA. samin.sharma@msnyuhealth.org
Insights
AngioJet thrombectomy before primary stenting in acute myocardial infarction (MI) with high-grade thrombus improves blood flow. This intervention shows a trend toward better short- and long-term outcomes, reducing major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Primary stenting in acute myocardial infarction (MI) can be complicated by slow-flow/no-reflow phenomena.
- Distal embolization of intracoronary thrombus is a primary cause of these complications.
- The AngioJet thrombectomy catheter is used to mitigate distal embolization and enhance flow.
Purpose of the Study:
- To evaluate the effect of AngioJet thrombectomy during primary stenting in acute MI patients with high-grade thrombus (Thrombolysis In Myocardial Infarction [TIMI] grade ≥3).
- To assess the impact on epicardial and microvascular flow, and clinical outcomes.
Main Methods:
- A retrospective analysis of 95 acute MI patients with TIMI thrombus grade ≥3 who underwent primary stenting.
- Patients were divided into two groups: those treated with AngioJet thrombectomy (n=52) and those without (n=43).
- Epicardial and microvascular flow were assessed using TIMI flow rates, corrected TIMI frame count (CTFC), and TIMI myocardial perfusion grade (TMPG). 30-day major adverse cardiac events (MACE) and 1-year survival were followed.
Main Results:
- Baseline characteristics were comparable between the AngioJet and no-AngioJet groups.
- AngioJet use was associated with improved TIMI flow, TMP grade, and CTFC.
- A trend towards lower 30-day and 1-year MACE was observed in the AngioJet group.
Conclusions:
- AngioJet thrombectomy prior to stenting in acute MI patients with high-grade thrombus significantly improves both epicardial and microvascular flow.
- The procedure demonstrates a trend towards better short-term and long-term clinical outcomes, including reduced MACE.
- AngioJet is a valuable tool for managing thrombus burden in acute MI, potentially improving procedural success and patient prognosis.
Background:
Primary stenting during acute myocardial infarction (MI) is often complicated by slow-flow/no-reflow due to distal embolization of intracoronary thrombus. The AngioJet thrombectomy catheter has been utilized in this setting in order to limit distal embolization and improve flow. The effect of AngioJet during primary stenting in acute MI with high-grade thrombus (greater than or equal to grade 3, as per thrombolysis in MI [TIMI] classification) is not known.
Methods:
We analyzed 95 consecutive acute MI patients with thrombus grade > or = 3 who underwent primary stenting with AngioJet (n = 52) and without AngioJet (n = 43) for epicardial and microvascular flow, and followed for 30-day major adverse cardiac events (MACE) and 1-year survival. Baseline characteristics and in-hospital events were obtained from the interventional database. Two independent operators analyzed pre- and post-procedure TIMI flow rates, corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG).
Results:
Baseline clinical and angiographic characteristics were comparable between the two groups. AngioJet use was associated with better TIMI flow, TMP grade, CTFC and a trend towards lower 30-day and 1-year MACE. Use of AngioJet thrombectomy prior to stenting of acute MI patients with high-grade thrombus improves epicardial and microvascular flow, with a trend toward better short- and long-term outcome.
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