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Importance of Thrombus Aspiration in intrahospital outcomes from Primary Angioplasty

Introduction

Distal emboli are one of the most feared angiographic complications of Primary Angioplasty (PA). In the optimization of acute myocardial infarction (MI) treatment, thrombus aspiration (T) has been appointed as one of the most potentially promising techniques.

Objectives

To analyze safety and effectiveness of thrombus aspiration with catheter export in primary angioplasty.

Materials and Methods

A consecutive, not selected population of 51 patients (pts) with myocardial infarction treated with primary angioplasty and thrombus aspiration with catheter export device was evaluated retrospectively, average age 60 years old (37-80), male 43 (84,3%). All patients were follow at one year. Thrombus load was measured according to length (L) relation of the radiolucent vessel area in relation to its reference diameter (D). Little: L = D, medium-sized: L = 2 times D, large: L = 3 times D, extended: L > 3 times D. Optimal Myocardial reperfusion was evaluated with the resolution ST > 50%, Timi flow III and myocardial Blush III.

Demographics

Localization

Evolution Time

killip class

Contrapulsation balon

Inotropic drug

Results

Success of device (catheter): 48 ptes. (94,1%), success of procedure: 45 ptes. (89%), mortality: 4 pts (7.8%), reinfarct: 3 (5.9%), cardiac insufficiency: 8 (15.7%). No reflow: 1 pts (2%) + slow flow: 5 (9%) = 11%, occlusion collateral branch: 8 pts (15.7%). Export device reduced a significant amount of trombus in 42 pts (82.4%).

TIMI flow

  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%)

ST Resolution

    Timi III M.blush III
STR > 50% 40 (78,4%) 40 (88%) 34 (94%)
STR < 50% 11 (21,6%) 5 (12%) 2 (6%)

Trombus

Small 6 (11,8%)
Middle 15 (29,4%)
Large 12 (23,5%)
Extensive 20 (39,2%)

Technique pos-export

MACE: Folow up to one year

  Intrahospital 1 month 6 month 1 year
Death 3 (5,9%) 0 0 1 (2%)
AMI 3 (5,9%) 0 1 (2%) 0
Angina 0 2 (3,9%) 2 (3,9%) 0
Cardiac insuff 8 (15,7%) 0 0 0
Reinternation 0 0 2 (3,9%) 0
Revascularization 3 (5,9%) 1 (2%) 0 0
ACV 0 0 0 0
Acute trombosis 2 (3,9%) 0 0 0
Subacute trombosis   1 (2%) 0 0

Conclusions

Thrombus aspiration was safe and effective using catheter export, improving coronary flow in a high percentage, an acceptable success rate of the procedure and mainly of the myocardial reperfusion. Nevertheless, it did not reduce distal embolization significantly, may be this is due to the fact that it was a complex population characterized by a high incidence of initial Timi 0 and a great load of thrombus.

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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