Author + information
- Yukio Mizuguchi,
- Akihiko Takahashi,
- Sho Hashimoto,
- Takeshi Yamada,
- Norimasa Taniguchi,
- Shunsuke Nakajima and
- Tetsuya Hata
Although removal of the thrombus by manual aspiration thrombectomy (AT) before stent deployment maybe have the potential of reducing distal embolization and improving microvascular perfusion in the patient with ST segment elevation myocardial infarction (STEMI), some recent trials suggested that thrombectomy might increase the risk of stroke. Current ESC guidelines for the management of STEMI recommend transradial coronary intervention (TRI). However, safety and efficacy of the combination of thrombus aspiration and TRI in STEMI are unclear. In this study, we sought to evaluate whether the safety and efficacy of AT combined with TRI is similarly observed in the STEMI patients treated by transfemoral coronary intervention (TFI).
We retrospectively evaluated the clinical outcomes of 384 STEMI patients underwent percutaneous coronary intervention in our institute between January 2008 and December 2014. For patients other than those undergoing hemodialysis for chronic renal failure and poor radial pulsation owing to a previous TRI procedure or cardiopulmonary arrest, we chose the right radial artery as the primary approach site. TRI was performed in 367 patients (95.6%) and TFI was performed in 17 patients (4.5%) in this study population. We retrospectively evaluated the clinical outcomes of these patients, in terms of clinical indices including door-to-balloon time, procedural success rate, major adverse cardiovascular events including 30-days mortality rate and stroke.
Of the patients treated during the study period, manual AT was performed in 363 (94.5%) and 17 (100%) STEMI patients treated by TRI and TFI, respectively. The procedural success rate were similar between the 2 groups; 98.6 % in TRI with AT group and 100% in TFI with AT group. The door-to-balloon time and the peak creatinine kinase levels was similar between the 2 groups (43.1 vs. 50.8 minutes; p=0.15, 2445 vs. 2512 IU/L; p=0.92, respectively). The 30-day mortality rates were significantly higher in TFI with AT group than TRI with AT group (11.8% vs. 2.8%, p<0.05). Within 30 days, acute stent thrombosis and stroke occurred in 1.7% of TRI with AT group and 5.9% of TFI with AT group (p=0.20). No stroke event occurred in both groups.
Routine manual thrombus aspiration did not increase the incidence of stroke in the setting of acute STEMI. The combination therapy of AT and TRI is equivalently safe and effective to that of AT and TFI for STEMI patients.