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Prospective study of extraction atherectomy in patients with acute myocardial infarction
B M Kaplan1, T Larkin, R D Safian
1Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Insights
Extraction atherectomy effectively treats high-risk acute myocardial infarction patients, achieving high procedural success and vessel patency. While in-hospital complications are low, restenosis remains a concern for these patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) poses high risks for acute myocardial infarction (AMI) patients with thrombolytic ineligibility, failure, cardiogenic shock, or vein graft occlusion.
- Transluminal extraction catheters offer a potential solution by enabling thrombus aspiration in high-risk AMI patients.
Purpose of the Study:
- To prospectively evaluate the efficacy and safety of extraction atherectomy in high-risk AMI patients.
- To assess procedural success, in-hospital complications, and long-term outcomes including vessel patency and restenosis.
Main Methods:
- A prospective study at 2 clinical centers involving 100 high-risk AMI patients.
- Extraction atherectomy was performed, with procedural success defined by residual stenosis <50% and TIMI 2/3 flow.
- In-hospital events and 6-month angiographic follow-up were analyzed.
Main Results:
- Procedural success was achieved in 94% of patients.
- In-hospital complications included 5% mortality and 4% bypass surgery.
- Six-month follow-up showed 90% vessel patency but 68% angiographic restenosis.
Conclusions:
- Extraction atherectomy is a safe and effective treatment for high-risk AMI patients, demonstrating high technical success and good vessel patency.
- Despite excellent short- and long-term patency, significant angiographic restenosis remains a challenge.
- Thrombus extraction in this population is associated with low in-hospital mortality and favorable 6-month patency rates.
Abstract:
Although percutaneous transluminal coronary angioplasty (PTCA) has been an effective treatment for primary reperfusion in acute myocardial infarction, patients with thrombolytic ineligibility, thrombolytic failure, cardiogenic shock, and vein graft occlusion remain at high risk for complications with PTCA treatment. The transluminal extraction catheter may be useful for treatment for such patients owing to its ability to aspirate thrombus. At 2 clinical centers, extraction atherectomy was prospectively evaluated in 100 patients (age 62 +/- 10 years). High-risk features included thrombolytic failure in 40%, postinfarct angina in 28%, presence of angiographic thrombus in 66%, presence of cardiogenic shock in 11%, and a saphenous vein graft occlusion in 29%. Procedural success, defined as a final residual stenosis <50% and Thrombolysis in Myocardial Infarction 2 or 3 grade flow, was seen in 94%. Events during the hospitalization included death in 5%, bypass surgery in 4%, and blood transfusion in 18%. In a substudy, patients enrolled at William Beaumont Hospital (n = 65) underwent elective predischarge angiography, which revealed a patent infarct-related vessel in 95%. These patients were also followed for 6 months with angiographic follow-up in 60%. Target vessel revascularization was necessary in 38%, and 6-month mortality was 10%. Although long-term vessel patency was 90%, angiographic restenosis occurred in 68%. Acute myocardial infarction patients can be treated with extraction atherectomy with a high technical success rate and a low incidence of complication. Infarct artery patency at 1 week and 6 months was excellent; however, angiographic restenosis remains a problem. Extraction of thrombus in this high-risk group of patients is associated with low in-hospital mortality and a high rate of vessel patency at 6 months.