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1. JOURNAL CLUBDr Awadhesh Kumar Sharma
2. INTRODUCTION Primary percutaneous coronary intervention
(pPCI) is highly effective in restoring a normal Thrombolysis In
Myocardial Infarction (TIMI) flow in patients with ST segment
elevation acute myocardial infarction (STEMI). But a relevant
proportion of patients (approx 15%) shows a poor myocardial
reperfusion, which strongly correlates with larger infarct size and
worse clinical outcome. Thrombectomy devices aim at improving
myocardial reperfusion by preventing distal thrombus embolization
during pPCI.
3. After controversial results of the initial studies, 2 recent
randomized single-center studies demonstrated a significant benefit
of thrombus aspiration on clinical outcome although not on infarct
size. Currently, magnetic resonance imaging (MRI) with late
gadolinium enhancement (LGE) is the best method to assess infarct
size. (TAPAS): a 1-year follow-up study. Lancet 2008;371:191520.
JETSTENT trial. J Am Coll Cardiol 2010;56:1298 306
4. Cardiac death and reinfarction after 1 year in the Thrombus
Aspiration duringPercutaneous coronary intervention in Acute
myocardial infarction Study(TAPAS): a 1-year follow-up study
Findings Cardiac death at 1 year was 36% (19 of 535 patients) in
the thrombus aspiration group and 67% (36 of 536) in the
conventional PCI group (hazard ratio [HR] 193; 95% CI 111 337;
p=0020). 1-year cardiac death or non-fatal reinfarction occurred in
56% (30 of 535) of patients in the thrombus aspiration group and
99% (53 of 536) of patients in the conventional PCI group (HR 181;
95% CI 116284; p=0009). Interpretation Compared with conventional
PCI, thrombus aspiration before stenting of the infarcted artery
seems to improve the 1-year clinical outcome after PCI for
ST-elevation myocardial infarction. Lancet 2008;371:191520.
5. TAPAS: 1-Year Results Trial design: Patients with
ST-elevation myocardial infarction were randomized to thrombus
aspiration prior to PCI (n = 535) or standard PCI without
aspiration (n = 536) and followed for 1 year. Results All-cause
mortality: 4.7% vs. 7.6% (p = (p = 0.042) (p = 0.05) 0.042),
respectively Cardiac death: 3.6% vs. 6.7% (p = 0.02), 4.7 7.6
respectively 8 Reinfarction: 2.2% vs. 4.3% (p = 0.05),% 2.2 4.3
respectively 4 Conclusions In earlier presentation of TAPAS,
thrombus aspiration 0 Reinfarction during acute MI improved
reperfusion All-cause mortality All-cause mortality Re-infarction
Extended follow-up to 1 year demonstrates that this strategy
reduces death and MI Thrombus Standard PCI aspiration Vlaar PJ, et
al. Lancet 2008;371:1915-20
6. Comparison of AngioJet Rheolytic Thrombectomy Before Direct
Infarct ArteryStenting With Direct Stenting Alone in Patients With
Acute MyocardialInfarctionThe JETSTENT Trial Results From December
2005 to September 2009, 501 patients were randomly allocated to RT
before DS or to DS alone. The ST- segment resolution was more
frequent in the RT arm as compared with the DS alone arm: 85.8% and
78.8%, respectively (p = 0.043), while no difference between groups
were revealed in the other surrogate end points. The 6-month major
adverse cardiovascular events rate was 11.2% in the thrombectomy
arm and 19.4% in the DS alone arm (p = 0.011). The 1-year event-
free survival rates were 85.2 2.3% for the RT arm, and 75.0 3.1%
for the DS alone arm (p = 0.009). Conclusions Although the primary
efficacy end points were not met, the results of this study support
the use of RT before infarct artery stenting in patients with acute
myocardial infarction and evidence of coronary thrombus. JETSTENT
trial. J Am Coll Cardiol 2010;56:1298 306
7. The aim of the study The aim of this study was to assess the
impact of thrombectomy, either manual or rheolytic, on myocardial
reperfusion and infarct size in patients with high thrombotic
burden.
8. Methods Study design and patients- A multicenter prospective
randomized study Assigned patients in a 1:1 ratio to either
thrombectomy as an adjunct to pPCI (Group T) or standard pPCI
without thrombectomy (Group S)
9. Inclusion criteria Age >/= 18 years; STEMI (new
ST-segment elevation of >1 mm in at least 2 contiguous leads or
new left bundle branch block) within 12 h of symptom onset TIMI
thrombus grade >3 after diagnostic angiography according to
Sianos et al. Reference diameter of the infarct related artery
>/= 3.0 mm at visual estimate Sianos G, Papafaklis MI, Daemen J,
et al. Angiographic stent thrombosis after routine use of
drug-eluting stents in ST-segment elevation myocardial infarction:
the importance of thrombus burden. J Am Coll Cardiol 2007;50:573
83.
10. Exclusion criteria Previous infarct in the same ventricular
wall; Cardiogenic shock; Severe liver/renal failure;
Contraindications to abciximab; and Contraindications to MRI.
Recent PCI (1/2 but