Vol 61, No 12 (2004)
Other
Published online: 2005-12-12
Submitted: 2012-12-28
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Percutaneous thrombectomy with the RESCUE system in acute myocardial infarction

Dariusz Dudek, Waldemar Mielecki, Jacek Legutko, Michał Chyrchel, Danuta Sorysz, Stanisław Bartuś, Łukasz Rzeszutko, Jacek Dubiel
Kardiol Pol 2004;61(12):529-533.
Vol 61, No 12 (2004)
Other
Published online: 2005-12-12
Submitted: 2012-12-28

Abstract

Background: Percutaneous coronary interventions (PCI) in acute myocardial infarction with ST segment elevation (STEMI) are associated with distal coronary embolisation. It may be speculated that percutaneous thombectomy preceding stent implantation may prevent coronary microcirculation from embolisation.
Aim: To assess safety and efficacy of percutaneous thrombectomy in patients with STEMI.
Methods: Seventy two patients with STEMI were randomised to PCI with stent implantation alone (n=32) or percutaneous thrombectomy with the RESCUE system, followed by stent implantation (n=40). Coronary flow in infarct related artery before and after the procedure was assessed using TIMI scale and corrected TIMI frame count - cTFC. Myocardial blood flow was measured using TIMI myocardial perfusion grade - tMPG. The degree of ST segment resolution 60 min after PCI was also assessed. Left ventricular ejection fraction (LVEF) was measured in hospital and three months later.
Results: The two groups did not differ with respect to the time from the onset of symptoms to the procedure (236±162 min vs 258±198 min, NS) or the baseline TIMI, cTFC and tMPG values. An effective thrombectomy procedure was performed in 35 (87%) patients from group B. After the procedure, the number of patients with TIMI 3 grade as well as cTFC values and the proportion of patients with tMPG 3 were similar in both groups (86% vs 85%, NS; 19 vs 21, NS; and 38% vs 54%, NS). The sum of ST segment elevations after the procedure was significantly greater in patients who underwent PCI only compared with patients who had thrombectomy and PCI (6.8±5.2 mm vs 3.6±2.9 mm, p=0.004). Complete normalisation of ST segment was achieved in 68% of patients treated with thrombectomy and PCI compared with 25% of patients who had PCI only (p=0.005). CK-MB peak values occurred significantly earlier in patients treated with thrombectomy (92.1% vs 66.7% up to 360 min, p=0.01). After 3 months of follow-up, LVEF tended to be greater in patients treated with thrombectomy and PCI than in those who underwent PCI only (55.3±14.7% vs 60.3±9.2%, NS).
Conclusions: Thrombectomy with the RESCUE system in patients with STEMI is safe and effectively restores patency of infarct related artery. Thrombectomy better improves myocardial perfusion than standard PCI.

Abstract

Background: Percutaneous coronary interventions (PCI) in acute myocardial infarction with ST segment elevation (STEMI) are associated with distal coronary embolisation. It may be speculated that percutaneous thombectomy preceding stent implantation may prevent coronary microcirculation from embolisation.
Aim: To assess safety and efficacy of percutaneous thrombectomy in patients with STEMI.
Methods: Seventy two patients with STEMI were randomised to PCI with stent implantation alone (n=32) or percutaneous thrombectomy with the RESCUE system, followed by stent implantation (n=40). Coronary flow in infarct related artery before and after the procedure was assessed using TIMI scale and corrected TIMI frame count - cTFC. Myocardial blood flow was measured using TIMI myocardial perfusion grade - tMPG. The degree of ST segment resolution 60 min after PCI was also assessed. Left ventricular ejection fraction (LVEF) was measured in hospital and three months later.
Results: The two groups did not differ with respect to the time from the onset of symptoms to the procedure (236±162 min vs 258±198 min, NS) or the baseline TIMI, cTFC and tMPG values. An effective thrombectomy procedure was performed in 35 (87%) patients from group B. After the procedure, the number of patients with TIMI 3 grade as well as cTFC values and the proportion of patients with tMPG 3 were similar in both groups (86% vs 85%, NS; 19 vs 21, NS; and 38% vs 54%, NS). The sum of ST segment elevations after the procedure was significantly greater in patients who underwent PCI only compared with patients who had thrombectomy and PCI (6.8±5.2 mm vs 3.6±2.9 mm, p=0.004). Complete normalisation of ST segment was achieved in 68% of patients treated with thrombectomy and PCI compared with 25% of patients who had PCI only (p=0.005). CK-MB peak values occurred significantly earlier in patients treated with thrombectomy (92.1% vs 66.7% up to 360 min, p=0.01). After 3 months of follow-up, LVEF tended to be greater in patients treated with thrombectomy and PCI than in those who underwent PCI only (55.3±14.7% vs 60.3±9.2%, NS).
Conclusions: Thrombectomy with the RESCUE system in patients with STEMI is safe and effectively restores patency of infarct related artery. Thrombectomy better improves myocardial perfusion than standard PCI.
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Keywords

thrombectomy - percutaneous coronary intervention

About this article
Title

Percutaneous thrombectomy with the RESCUE system in acute myocardial infarction

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 61, No 12 (2004)

Pages

529-533

Published online

2005-12-12

Bibliographic record

Kardiol Pol 2004;61(12):529-533.

Keywords

thrombectomy - percutaneous coronary intervention

Authors

Dariusz Dudek
Waldemar Mielecki
Jacek Legutko
Michał Chyrchel
Danuta Sorysz
Stanisław Bartuś
Łukasz Rzeszutko
Jacek Dubiel

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