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Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry

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Abstract

Background

Data about the impact of thrombectomy in primary percutaneous coronary intervention (PCI) are inconsistent. The aim of our study was an evaluation of both the real-world use of thrombectomy and the impact of thrombectomy on outcome in unselected patients treated with primary PCI for ST-elevation myocardial infarction (STEMI).

Methods and results

We used the data of the prospective ALKK PCI-registry of 35 hospitals from January 2010 to December 2013. A total of 10,755 patients receiving single-vessel primary PCI for acute STEMI were included. In 2176 patients (20.2 %) thrombectomy was performed. There was a wide range of use of thrombectomy in the different ALKK hospitals from 1.1 to 61.7 % (median 18.6 %, quartiles 6.0 and 40.3 %) with a general increase of use over the first years of the study period. In patients with and without thrombectomy there was TIMI 0 flow present before PCI in 6010 patients, TIMI 1 in 1338, TIMI 2 in 2002, and TIMI 3 in 1405. Patients with acute heart failure or cardiogenic shock received significantly more often thrombectomy. Fluoroscopy time (8.1 vs. 7.3 min, p < 0.0001) and dose area product (5373 cGy × cm2 vs. 4802 cGy × cm2, p < 0.0001) were significantly higher in patients treated with thrombectomy. The subgroup of patients with TIMI 0 flow before PCI had significantly higher rates of TIMI 3 flow after PCI when treated with thrombectomy (87.1 vs. 84.1 %, p < 0.01), while there was no difference in post-PCI TIMI 3 flow in patients with TIMI 1, 2 or 3 flow before PCI. Rates of major adverse cardiac and cerebrovascular events were similar in both groups in general and in all subgroups of TIMI flow.

Conclusions

The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany

    Tobias Härle & Albrecht Elsässer

  2. Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany

    Uwe Zeymer, Karin Schmidt & Ralf Zahn

  3. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Uwe Zeymer & Matthias Hochadel

  4. Klinik für Kardiologie, Angiologie und Intensivmedizin, Vivantes Klinikum Neukölln, Berlin, Germany

    Harald Darius

  5. Kardiologie, Pneumologie und konservative Intensivmedizin, Vivantes Klinikum Spandau, Berlin, Germany

    Steffen Behrens

  6. Klinik für Kardiologie, Zentralklinik Bad Berka, Bad Berka, Germany

    Bernward Lauer

  7. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum München, Munich, Germany

    Harald Mudra

  8. Medizinische Klinik I, Klinikum Fulda, Fulda, Germany

    Volker Schächinger

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  1. Tobias Härle
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  2. Uwe Zeymer
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  11. Albrecht Elsässer
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Correspondence to Tobias Härle.

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Härle, T., Zeymer, U., Hochadel, M. et al. Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry. Clin Res Cardiol 104, 803–811 (2015). https://doi.org/10.1007/s00392-015-0846-z

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