Rheolytic thrombectomy during percutaneous coronary intervention improves long-term outcome in high-risk patients with acute myocardial infarction

Abstract

Objectives: Aim of the present study was to compare the immediate and long-term effects of AngioJet rheolytic thrombectomy performed in the setting of a percutaneous coronary angioplasty (PTCA) with those of conventional PTCA in patients with acute myocardial infarction (AMI) and angiographic evidence of high intracoronary thrombus burden.

Background: Plaque rupture, with subsequent exposure to the flowing bloodstream of high thrombotic materials often leads to intravascular thrombosis, representing the main pathophysiological event of acute coronary syndromes. PTCA is the first-choice treatment for these patients in hospitals with cardiac catheterization facilities. However, distal embolization of thrombotic material, fibrin, and other fragments from atherosclerotic plaques might lead to procedural failure.

Methods: Immediate and 1-year follow-up results of a group of 30 consecutive patients, presenting with AMI and angiographic evidence of high thrombus burden, who underwent rheolytic thrombectomy and PTCA were compared with those of 30 consecutive patients with similar clinical presentation, risk profile, and angiographic picture, and treated with standard PTCA procedure.

Results: After the procedure, angiographic analysis showed a higher incidence of final thrombolysis in myocardial infarction (TIMI) flow grade 3 in the AngioJet group (93.3% vs 83.3%, P = 0.034). In addition, mean corrected TIMI frame count (cTFC) was significantly lower in the AngioJet group (22.4 vs 32.4, P = 0,0004). At 1-year follow-up, patients treated with AngioJet showed a significantly lower incidence of death (3.33% vs 13.33%,P < 0.001), major adverse cardiac events (MACE: 10% vs 30%, P = 0.026), and need of revascularization (6.67% vs 20%, P = 0.013).

Conclusions: Data of the present study highlight that AngioJet thrombectomy in selected AMI patients at high risk for distal thrombotic embolization results not only in immediately improved angiographic results as compared to conventional PTCA but, indeed, seems to be associated with a significantly better long-term clinical outcome.