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Safety of AngioJet thrombectomy in acute ST-segment elevation myocardial infarction: a large, single-center
Kavitha M Chinnaiyan1, Cindy L Grines, William W O'Neill
1Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Insights
AngioJet thrombectomy (AT) during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) did not increase adverse outcomes in this study. AT can be safely used in selected STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction
Background:
- Thrombus and plaque embolization can impair reperfusion in STEMI.
- Previous studies suggested potential risks with AngioJet thrombectomy (AT).
Purpose of the Study:
- To evaluate clinical outcomes of AT use during PCI for STEMI.
- To assess the safety and efficacy of AT in STEMI management.
Main Methods:
- Retrospective analysis of 1,260 STEMI patients undergoing PCI (2000-2005).
- Comparison of outcomes between patients treated with and without AT.
- Analysis included angiographic, procedural, and in-hospital events.
Main Results:
- 19% of STEMI patients received adjunctive AT.
- Lower TIMI 3 flow post-PCI in the AT group (86% vs 90%, p=0.04).
- No significant difference in major adverse cardiac events (7.5% vs 9.0%, p=NS).
Conclusions:
- AT use in STEMI PCI was not linked to increased adverse outcomes.
- Data suggest AT is safe for selected STEMI patients.
- Further research may clarify optimal patient selection for AT.
Objectives:
To determine the clinical outcomes associated with use of AngioJet thrombectomy (AT) during percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).
Background:
Embolization of thrombus and atherosclerotic plaque is thought to contribute to sub-optimal myocardial reperfusion and worse clinical outcomes in STEMI. However, in a recent randomized trial, a higher mortality and infarct size was observed in patients treated with AT.
Methods:
We performed a retrospective analysis of all patients who underwent primary or rescue PCI for STEMI between January 2000 and December 2005. Angiographic, procedural and in-hospital outcomes were compared between patients treated with or without AT.
Results:
1,260 STEMI patients underwent primary or rescue PCI at our hospital during the study period. Of these, 239 (19%) underwent adjunctive treatment with AT. Patients treated with AT were more likely to be female, smokers and have a right coronary artery culprit. A slightly lower incidence of thrombolysis in myocardial infarction (TIMI) 3 grade flow was observed in the AT group after PCI (86% vs. 90%, p = 0.04). There was no significant difference in the incidence of in-lab ventricular tachycardia/ventricular fibrillation, vascular complications or transfusion between the study groups. The peak creatine kinase was higher in patients treated with AT. The incidence of in-hospital major adverse cardiac events was 7.5% in the AT group and 9.0% in the control group (p = NS).
Conclusions:
In this large, single-center experience, use of AT during mechanical reperfusion for STEMI was not associated with an increased risk of adverse outcomes. Our data suggest that AT may be performed safely in selected patients with STEMI.
