Manual versus nonmanual thrombectomy in primary and rescue percutaneous coronary angioplasty

Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing...

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Bibliographic Details
Published in:	Heart and vessels 2010-07, Vol.25 (4), p.275-281
Main Authors:	Tarsia, Giandomenico, De Michele, Mario, Polosa, Domenico, Biondi-Zoccai, Giuseppe, Costantino, Fabio, Del Prete, Giuseppe, Osanna, Rocco Aldo, Innelli, Pasquale, Sisto, Francesco, Sheiban, Imad, Lisanti, Pasquale
Format:	Article
Language:	eng
Subjects:	Aged Angioplasty Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - mortality Biomedical Engineering and Bioengineering Cardiac Surgery Cardiology Chi-Square Distribution Comparative studies Coronary Angiography Coronary Circulation Equipment Design Female Heart attacks Hemorrhage - etiology Humans Italy Logistic Models Male Medical equipment Medicine Medicine & Public Health Middle Aged Myocardial Infarction - diagnostic imaging Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Odds Ratio Original Article Propensity Score Recurrence Retrospective Studies Risk Assessment Risk Factors Stroke - etiology Stroke Volume Suction Thrombectomy - adverse effects Thrombectomy - instrumentation Thrombectomy - methods Thrombectomy - mortality Time Factors Treatment Outcome Vascular Surgery Ventricular Function, Left
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Summary:	Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing primary or rescue percutaneous coronary intervention in a tertiary care center. We identified 232 consecutive patients with STEMI and time from symptom onset to emergency room contact of ≤12 h undergoing percutaneous coronary intervention with coronary thrombectomy devices. Primary end point was ST-segment resolution of ≥70%. Several angiographic, procedural and clinical secondary end points were also evaluated. The manual thrombectomy group included 110 patients and the nonmanual group 122 patients. Both groups were similar in their clinical characteristics. The primary end point occurred with similar frequency in patients treated with manual versus nonmanual thrombectomy (67.9% vs 60.0%, P = 0.216). No significant differences were found in the two groups with regard to procedural complications, angiographic reperfusion parameters, in-hospital major adverse cardiac events, or infarct size, whereas manual thrombectomy was associated with a better left ventricle ejection fraction at discharge. Furthermore, treatment with a manual thrombectomy device was associated with significantly shorter procedural times (69 min vs 95 min, P < 0.001) and lower procedural costs (2981 euros vs 7505 euros, P < 0.001). The use of manual thrombus-aspiration catheters appeared equivalent to nonmanual thrombectomy devices in the setting of primary or rescue percutaneous intervention in terms of clinical efficacy, and led to shorter procedures and cost savings.
ISSN:	0910-8327 1615-2573