Abstract
Multiple clinical studies have failed to establish the role of routine use of thrombectomy
in ST-elevation myocardial infarction (STEMI) patients. There is a paucity of data
on the impact of thrombectomy in unselected STEMI patients outside clinical trials.
We sought to evaluate the clinical variables and outcomes associated with the performance
of thrombectomy in STEMI patients. We retrospectively examined the clinical outcomes
in all STEMI patients who underwent successful percutaneous intervention (PCI) at
our center. Patients were divided into two groups, one with patients who underwent
conventional PCI and another with patients who had thrombus aspiration in addition
to conventional PCI. We compared the baseline clinical characteristics, laboratory
investigations, re-infarction rates, and all-cause mortality. Total 477 consecutive
STEMI patients were identified. Overall, 29% (139) of the patients underwent conventional
PCI and 71% (338) of the patients were treated with aspiration thrombectomy and PCI.
In addition to the presence of thrombus, patients with nonanterior infarction, and
patients with hemodynamic instability requiring intra-aortic balloon pump support
were more likely to undergo thrombectomy. Thrombectomy was associated with higher
enzymatic infarction (creatine kinase: 2,796 [2,575] vs. 1,716 [1,662]; p < 0.0001; CK-MB: 210.6 [156.0] vs. 142.0 [121.9], p < 0.0001). However, thrombectomy was not associated with any difference in 30 day
reinfarction rate (3.3 vs. 2.9%, p = 0.83), mortality (5.0 vs. 7.2%, p = 0.35), or composite of death and 30 day reinfarction (7.7 vs. 9.4%, p = 0.55). We observed that STEMI patients with anterior infarction and hemodynamic
instability were more likely to undergo thrombectomy during primary PCI.
Keywords
acute myocardial infarction - angioplasty - atherosclerosis - infarction - myocardial
infarction - thrombectomy
