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Does thrombus aspiration with catheter export device provide benefits to the intrahospital outcomes of primary angioplasty?

Introduction

Does thrombus aspiration with catheter export device provide benefits to the intrahospital outcomes of primary angioplasty?

Introduction

The thrombus load and /or the distal embolization during Primary Angioplasty (PA) can be a major cause of microcirculatory dysfunction and can be reduced by the removal of clots before stenting.

Objective

To evaluate whether thrombus aspiration (T) with catheter export device reduces distal embolization and potentially increases the incidence of Timi III flow and improves myocardial microcirculatory dysfunction, affecting favorably the clinical and angiographic outcomes of PA.

Materials and methods

A population of 196 consecutive patients with acute ST segment elevation myocardial infarction (STEMI) treated by primary angioplasty was analyzed retrospectively. Two groups were identified: one trated with tromboaspiration before angioplasty: 51 pts (Group I) and the other was treated with conventional treatment (balloon plus stent or direct stenting) 145 pts (Group II). Both populations were identical, except multivessel disease: GI 13 pts (25%) vs. GII 59 pts (40%) P= 0,05, Basal Timi flow 0: GI 48 pts (94%) vs. GII 112 pts (77%) P= 0,05. Optimal Myocardial reperfusion in both populations was evaluated and compared with segment resolution ST> 50% (RST), TIMI flow III and myocardial Blush III (BMIII). We also analyzed the angiographic embolization rate and the relationship between thrombus extraction and direct stent, Timi post wire, post export and post stent.

Results

There were no statistically significant differences in the success of the procedure: GI 88.2% vs. GII 86.2 % , respectively ST resolution > 70%: 17 pts (33%) vs. 52 pts (35%), resolution ST> 50%: 40 pts (78.4%) vs. 110 pts (75.8%), BM III: 36 pts (70,5%) vs. 93 pts (64%), slow flow + no reflow: 11.8% vs. 13,8%, Timi flow 0 pre: 48 pts (94%) vs. 112 pts (77%) P= 0,05, Timi I pre: 1 pts (1,9%) vs. 5 pts (3,9%) P= 0,05, Timi II pre: 1 pts (1,9%) vs. 12 pts (8,1%) P= 0,05. There were no significant differences in Timi flow post aspiration with export. Mortality: 3 pts. (5.8%) vs.16 pts (11%) P= 0,2; Cardiac insufficiency: 8 pts (15,6%) vs. 20pts (3,7%) P=NS; Reinfarct: 3 pts (5,8%) vs. 1 pt (0,6%) P=0,02 respectively. GI direct stenting : 38 pts (74,5%) vs. 55 pts (37,9%) P=0,001.

ST Resolution

  RST> 50% Total
  no si  
Coventional 35 (24%) 110 (76%) 145
Aspiration 11 (21%) 40 (79%) 51
Total 46 150 196
P=NS

Group I (tromboaspiration)

  0 I II III
Baseline 48 (94,1%) 1 (2%) 1 (2%) 1 (2%)
Post-wire 19 (37,3%) 17 (33,3%) 13 (25,5%) 2 (3,9%)
Post-export 6 (11,8%) 6 (11,8%) 21 (41,2%) 18 (35,3%)
Final 1 (2%) 0 5(9,8%) 45 (89%)
M. Blush 1 (2%) 2 (3,9%) 12(23,5%) 36 (70,6%)

Group II (convencional treatment)

  0 I II III
Baseline 112 (77,2%) 5 (3,4%) 23(15,8%) 16(11,3%)
Post-wire 66(45,5%) 20(13,7%) 43(29,6%) 15(10,3%)
Final 4(2,7%) 0 16(11%) 125(86,2%)
M. Blush 93(64,1%)
P=NS

Procedure succes

  SUCCES Total
  no si  
Coventional 14 (23,8%) 125 (86,2%) 145
Aspiration 6 (11%) 45 (89%) 51
Total 21 175 196
P=NS

Colaterall oclusion

  SUCCES Total
  no si  
Coventional 126 19 (13,1%) 145
Aspiration 43 8 (15,6%) 51
Total 169 27 196
P=NS

Intrahospital and long term outcomes

  Intrahospital One month
  Aspiration Conventional Aspiration Conventional
Total death 3 (5,8%) 16 (11,3%)    
Cardiac death 3 (5,8%) 16 (11,3%)    
AMI 3 (5,8%) 1 (0,6%) 0 1 (0,6%)
Cardiac insuff. 8 (15,6%) 20 (0,6%) 0 2 (1,3%)
ACV 0 1 (0,6%)    
angina 0 0 2 (3,9%) 3 (2%)
Rehospitalization 0 0 1 (1,9% 3 (2%)
P=NS

Conclusions

In our experience T with catheter Export was a safe and effective procedure, with a high degree of success and minor complications, with an important immediate improvement of the coronary flow that allowed the performance of direct stenting to a high percentage of patients with a statistically significant difference between the latter and conventional treatment. Nevertheless, these encouraging results did not achieve a statistically significant difference in relation to the conventional treatment in the intrahospital angiographic and clinical results.

Autor: Dr. Carlos Alejandro Alvarez, Dr. Fernando Ordoñez, Dr. Alberto Cristino, Dr. Carlos J. Alvarez Iorio

Ultima actualizacion: 23 DE JUNIO DE 2008

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