"percutaneous coronary intervention"
Adjunctive Catheter Aspiration Thrombectomy Versus PCI Alone in Patients With STEMI: Intermediate Health Outcomes
In RCTs evaluating patients with STEMI undergoing PCI and comparing a catheter aspiration thrombectomy device versus a control, the use of catheter aspiration devices significantly increased the occurrence of ST-segment resolution and achieved a MBG-3 and TIMI-3 blood flow while significantly reducing the risk of distal embolization and the occurrence of no reflow versus a control. For ST-segment resolution [RD 0.22 (0.15, 0.30), (CER 0.11 to 0.65)], five people would need to be treated with a catheter aspiration device to allow one person to experience ST-segment resolution. For MBG-3 [RD 0.22 (0.16, 0.28), (CER 0.12 to 0.71)], five people would need to receive the catheter aspiration device to cause one person to experience a MBG-3. For TIMI-3 blood flow [RD 0.06 (0.03, 0.10), (CER 0.68 to 0.88)], 17 people would need to be treated with a catheter aspiration device to cause 1 person to achieve TIMI-3 blood flow. For a decreased risk of distal embolization [RD -0.09 (-0.17, -0.01), (CER 0.03 to 0.66)], 12 people would need to be treated with a catheter aspiration device to prevent 1 person from experiencing distal embolization. In RCTs, ejection fraction was not significantly impacted by catheter aspiration use versus a control in most trials (9 of 11), while one controlled observational study found a decreased ejection fraction in the catheter aspiration group versus a control. For the no-reflow outcome [RD -0.07 (-0.11, -0.03), (CER 0.05 to 0.27)], 15 people would need to be treated with a catheter aspiration device in order to prevent 1 no reflow event from occurring.
Two direct comparative randomized trials compared the use of catheter aspiration devices to distal balloon embolic protection devices in patients undergoing STEMI. In these RCTs, no significant differences were found between groups for ST-segment resolution (one trial), ejection fraction (two trials), MBG-3 (one trial), TIMI-3 blood flow (one trial), or no reflow (one trial) with insufficient data for other intermediate end points. One direct comparative randomized trial compared the use of one catheter aspiration device to another catheter aspiration device in patients with STEMI. In this controlled trial, no significant differences in ST-segment resolution, MBG-3, or TIMI- 3 blood flow occurred with insufficient data for other intermediate end points.
- Burzotta F, Trani C, Romagnoli E, et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J Am Coll Cardiol 2005;46:371-6. PMID: 16022970.
- Chao CL, Hung CS, Lin YH, et al. Time-dependent benefit of initial thrombosuction on myocardial reperfusion in primary percutaneous coronary intervention. Int J Clin Pract 2008;62:555-61. PMID: 18067561.
- Chevalier B, Gilard M, Lang I, et al. Systematic primary aspiration in acute myocardial percutaneous intervention: a multicentre randomised controlled trial of the export aspiration catheter. EuroIntervention 2008;4:222-8. PMID: 19110787.
- De Luca L, Sardella G, Davidson CJ, et al. Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction. Heart 2006;92:951-7. PMID: 16251226.
- Dudek D, De Feyter PJ. Polish-Italian-Hungarian Randomized Thrombectomy Trial (PIHRATE trial). European Society of Cardiology Congress; 2008 Aug 30 to Sep 03; Munich, Germany. Available at www.escardio.org/CONGRESSES/ESC2008/CONGRESS-REPORTS/Pages/779-980-dudek-defeyter.aspx. Accessed April 23, 2010.
- Ikari Y, Sakurada M, Kozuma K, et al. Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial. JACC Cardiovasc Interv 2008;1:424-31. PMID: 19463340.
- Kaltoft A, Bottcher M, Nielsen SS, et al. Routine thrombectomy in percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: a randomized, controlled trial. Circulation 2006;114:40-7. PMID: 16801464.
- Noel B, Morice MC, Lefevre T. Thromboaspiration in acute ST elevation MI improves myocardial infarction. Circulation 2005;112(Suppl II):519.
- Sardella G, Mancone M, Bucciarelli-Ducci C, et al. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial. J Am Coll Cardiol 2009;53:309-15. PMID: 19161878.
- Sardella G, Mancone M, Canali E, et al. Impact of thrombectomy with EXPort Catheter in Infarct-Related Artery during Primary Percutaneous Coronary Intervention (EXPIRA Trial) on cardiac death. Am J Cardiol 2010;106:624-9. PMID: 20723635.
- Silva-Orrego P, Colombo P, Bigi R, et al. Thrombosis aspiration before primary angioplasty improves myocardial peperfusion in acute myocardial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) Study. J Am Coll Cardiol 2006;48:1552-9. PMID: 17045887.
- Sobieraj DM, White CM, Kluger J, et al. Adjunctive Devices for Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Comparative Effectiveness Review No. 42 (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I). Rockville, MD: Agency for Healthcare Research and Quality; December 2011. AHRQ Publication No. 11(12)-EHC089-EF. Available at www.effectivehealthcare.ahrq.gov/thrombusacs.cfm.
- Svilaas T, Vlaar PJ, van der Horst IC, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 2008;358:557-67. PMID: 18256391
- Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 2008;371:1915-20. PMID: 18539223.
- Dudek D, Mielecki W, Burzotta F, et al. Thrombus aspiration followed by direct stenting: a novel strategy of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial). Am Heart J 2010;160:966-72. PMID: 21095287.
Your slide tray is being processed.