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J Am Coll Cardiol, 2003; 42:1395-1402, doi:10.1016/S0735-1097(03)01041-6
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction

Massimo Napodano, MD*, Giampaolo Pasquetto, MD*, Salvatore Saccà, MD*, Carlo Cernetti, MD*, Virginia Scarabeo, MD*, Pietro Pascotto, MD* and Bernhard Reimers, MD*,*

* Department of Cardiology, Mirano, Italy

Manuscript received February 11, 2003; revised manuscript received May 12, 2003, accepted May 21, 2003.

* Reprint requests and correspondence: Dr. Bernhard Reimers, Mirano Hospital, Department of Cardiology, Via Mariutto 13, 30035, Mirano (Venice), Italy.
ulss13mir.card{at}tin.it

OBJECTIVES: We sought to evaluate the effects of mechanical thrombectomy on myocardial reperfusion during direct angioplasty for acute myocardial infarction (AMI).

BACKGROUND: Embolization of thrombus and plaque debris may occur during direct angioplasty for AMI. This may lead to distal vessel or side branch occlusion and to obstructions in the microvascular system, resulting in impaired myocardial reperfusion. Mechanical thrombectomy is used to reduce distal embolization.

METHODS: Ninety-two patients with AMI and angiographic evidence of intraluminal thrombus were randomized to either intracoronary thrombectomy followed by stenting or to a conventional strategy of stenting. Thrombectomy was performed using the X-Sizer catheter (EndiCOR Inc., San Clemente, California). Myocardial reperfusion was assessed by myocardial blush and ST resolution.

RESULTS: Postprocedure Thrombolysis in Myocardial Infarction-3 flow was not different between groups (93.5% vs. 95.7%, p = 0.39). Myocardial blush-3 was observed in 71.7% of patients undergoing thrombectomy and in 36.9% of patients undergoing conventional strategy (p = 0.006). ST-segment resolution ≥50% occurred more often in patients undergoing thrombectomy (82.6% vs. 52.2%, p = 0.001). By multivariate analysis, adjunctive thrombectomy was an independent predictor of blush-3 (odds ratio, 3.27; 95% confidence interval, 1.06 to 10.05; p = 0.039).

CONCLUSIONS: Intracoronary thrombectomy as adjunct to stenting during direct angioplasty for AMI improves myocardial reperfusion as assessed by myocardial blush and ST resolution.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CK = creatine kinase
  DS = diameter stenosis
  IRA = infarct-related artery
  MBG = myocardial blush grade
  PTCA = percutaneous transluminal coronary angioplasty
  TIMI = Thrombolysis In Myocardial Infarction




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