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

Hpertension: 21 (41.2%)
Diabetic: 4 (7.8%)
Dislypemia: 20 (39.2%)
Smokers 20 (39.2%)
Previous MI: 5 (9.8%)
Previous ACTP: 5 (9.8%)
Glicoprotein IIb/IIIa inhibitors: 1 pt (2%)
Multivessel disease: 13 pts (25,5%)

Localization

AMI anterior: 26 (51%)
AMI no anterior: 25 (49%)

Evolution Time

< 3 hours: 17 pts (33,3%)
> 3 hours: 34 pts (66,6%)

killip class

Killip I: 42 pts (82,4%)
Killip II: 7 pts (13,7%)
Killip II: 1 pt (2%)
Killip II: 2 pts (3,9%)

Contrapulsation balon

2 pts (3,9%)

Inotropic drug

6 pts (11,8%)

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

Direct stent: 38/48 (79.1%)
Balon predilatation: 13 (25,5%)

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