Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Kawaguchi, Ren; Hara, Hiroshi; Hirathuji, Tomoya; Adachi, Hitoshi; Toyama, Takuji; Naitou, Shigeto; Taniguchi, Koichi

doi:10.1253/circj.67.951

Cited by 10 publications

(4 citation statements)

References 31 publications

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“…Although some previous studies have shown that the coronary aspiration improves myocardial reperfusion in patients with STEMI (11)(12)(13), the issue of mechanical liberation of plaque debris induced by stent deployment remains unresolved. Moreover, it is still unclear which characteristics of the plaque cause distal embolization after stent deployment.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction

Kawaguchi

Oshima

Jingu

et al. 2007

Journal of the American College of Cardiology

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Section: Discussionmentioning

confidence: 99%

Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction

Kawaguchi

Oshima

Jingu

et al. 2007

Journal of the American College of Cardiology

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100

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“…4 5 Adjunctive intracoronary thrombectomy used in conjunction with primary PCI has recently emerged as an attractive tool to prevent distal embolisation in the microvasculature. [6][7][8][9][10] Recent studies showed that thrombectomy devices can preserve myocardial salvage and microvascular function. [11][12][13] On the other hand, reliable data on the application of these mechanical devices in STEMI and their additional benefits in reducing long term complications and clinical events are limited.…”

mentioning

confidence: 99%

Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction

Luca

2006

Heart

136

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Objective: To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI). Methods: 76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement (n = 38) or to conventional stenting (n = 38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated. Results: After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of postprocedure myocardial blush grade 3 (36.8% v 13.1%, p = 0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p = 0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) > 20%: 15 in the conventional group and four in the thrombectomy group (p = 0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p , 0.0001) and EDV (152.5 (18.1) ml v 138.1 (10.7) ml, p , 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed (10.5% in the conventional group v 8.6% in the thrombectomy group, not significant). Conclusion: Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.

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“…Therefore, echocardiography at discharge improves the identification of those patients who will have benefit from pharmacological adjunctive treatment to attenuate microvascular dysfunction and augment myocardial blood flow in the reperfused myocardium. [16][17][18] …”

Section: Pathophysiology and Clinical Background Of Patients With Angmentioning

confidence: 99%

Echocardiographic Predictors of Remote Outcome in Patients With Angiographically Successful Reflow After Acute Myocardial Infarction

Liu

Tanaka

Murata

et al. 2004

Circ J

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ercutaneous coronary intervention (PCI) is now routine for patients with acute myocardial infarction (AMI), and is increasingly used to treat complex coronary lesions with good long-term outcome. However, in the multicenter Lescol Intervention Prevention Study, 1 the annual risk of a major adverse cardiac event, defined as cardiac death, nonfatal myocardial infarction (MI) or a reintervention procedure (eg, coronary artery bypass grafting (CABG), repeat PCI, or PCI for a new lesion) approached 7%.Early restoration of coronary antegrade flow limits the progression of myocardial necrosis and is thus expected to enhance the functional recovery of postischemic dysfunction of the myocardium in patients with AMI. [2][3][4] Previous studies have demonstrated that 'angiographic no-reflow' predicts poor left ventricular (LV) functional recovery and a higher risk of cardiac mortality during the early phase and long-term follow-up period in patients with AMI. 5,6 However, the long-term prognosis after AMI remains unexplored in patients with angiographically successful reflow (TIMI (Thrombolysis in Myocardial Infarction) flow grade 3) after PCI.Several recent studies have proved the clinical usefulness of echocardiography in predicting outcome in patients with congestive heart failure (CHF), 7 AMI 8 and CABG, 9 but its long-term prognostic value in patients with angiographically successful reflow after AMI is unknown. Thus, in the present study we analyzed the long-term prognostic value of echocardiography in a consecutive series of patients with complete coronary revascularization by primary PCI for an initial AMI. Methods Patient PopulationOf 168 consecutive patients with AMI who were treated at Yamaguchi University Hospital, Japan, between January 1995 and January 2000, 113 (82 men, 31 women; age 46-84 years) were enrolled in the study. Criteria for inclusion were: (1) initial AMI; (2) a single-culprit lesion; (3) the infarct-related artery was recanalized with direct or rescue-PCI within 6 h of onset or between 6 and 24 h if evidence showed continuing ischemia; (4) residual stenosis Background The angiographically no-reflow phenomenon after percutaneous coronary intervention (PCI) predicts poor left ventricular (LV) functional recovery and a high risk of cardiac events in patients with their first acute myocardial infarction (AMI). However, risk factors of long-term adverse outcome for patients with angiographically successful reflow (TIMI (Thrombolysis in Myocardial Infarction) flow grade 3) for the AMI remain unknown. Methods and ResultsOf 168 echocardiograms were performed before PCI and at discharge, 113 were suitable for analysis. Clinical, angiographic, and echocardiographic variables were submitted to statistical analysis to detect the risk factors of cardiac events. During the follow-up period of 46±20 months, 31 patients had cardiac events, though there were no cardiac deaths. The 2 most important risk factors for congestive heart failure (CHF) or total cardiac events were LV dilation (chi-square: 7.5 and 9.4; ...

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Effectiveness of Thrombectomy Before Stent Implantation in Acute Myocardial Infarction

Cited by 10 publications

References 31 publications

Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction

Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction

Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction

Echocardiographic Predictors of Remote Outcome in Patients With Angiographically Successful Reflow After Acute Myocardial Infarction

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