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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impact of thrombus aspiration during primary percutaneous coronary intervention in cardiogenic shock complicating
Francesco Tomassini1, Andrea Gagnor, Nicolò Montali
1Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Insights
Thrombus aspiration during primary PCI for STEMI with CS showed lower mortality but wasn't an independent survival predictor. Procedural success was the key factor for better outcomes in these critically ill patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS) has high mortality.
- Primary percutaneous coronary intervention (PPCI) is the standard reperfusion therapy.
- The role of adjunctive thrombus aspiration (TA) in STEMI complicated by CS remains debated.
Purpose of the Study:
- To evaluate the impact of thrombus aspiration (TA) during primary PCI on survival in STEMI patients with CS.
- To identify predictors of in-hospital and long-term survival in this high-risk population.
Main Methods:
- Retrospective analysis of 155 STEMI patients with CS undergoing PPCI.
- Comparison between patients who underwent TA (n=70) and those who did not (conventional PCI, n=85).
- Multivariate analysis to determine independent predictors of survival.
Main Results:
- The TA group had higher rates of right ventricular infarction and better left ventricular ejection fraction.
- Thrombus aspiration was associated with reduced in-hospital (31.4% vs 48.2%) and long-term mortality (42.8% vs 64.7%).
- Procedural success, not TA, was the sole independent predictor of improved survival.
Conclusions:
- Thrombus aspiration during PPCI for STEMI with CS did not independently predict survival.
- Procedural success is the critical determinant for better outcomes in STEMI patients with CS undergoing PPCI.
Aim:
To assess the impact on in-hospital and long-term survival of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).
Methods And Results:
From September 2001 to May 2010 we collected data from 155 patients affected with STEMI complicated by CS undergoing PPCI (12.4% of all PPCI) including 70 patients (45.2%) in TA group and 85 patients (54.8%) in conventional PCI group. Patients in TA group were more likely to have right ventricular infarction (24.3% vs 5.9%, p=0.002), higher mean left ventricular ejection fraction (40% ± 9% vs 35% ± 7%, p<0.0001) and lower left main coronary artery occlusion (2.8% vs 21.2%, p=0.002). TA was associated with a lower rate of in-hospital and long-term mortality (31.4% vs 48.2%, p=0.05 and 42.8% vs 64.7%, p=0.01 respectively) at a mean follow-up time of 6.1 ± 2.1 years. At multivariate analysis the only independent predictor of in-hospital and long-term survival was the procedural success (HR 0.18 95% CI 0.025-0.31, p=0.03 and HR 0.46 95% CI 0.09-0.74, p=0.034 respectively).
Conclusions:
In this retrospective study TA, performed during PPCI for STEMI complicated by CS, was not an independent predictor of in-hospital and long-term survival.
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