Cardiovascular Intervention and Therapeutics

, Volume 30, Issue 1, pp 22–28 | Cite as

Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit

  • Jun Shiraishi
  • Yoshio Kohno
  • Takeshi Nakamura
  • Takashi Yanagiuchi
  • Sho Hashimoto
  • Daisuke Ito
  • Masayoshi Kimura
  • Akihiro Matsui
  • Hirokazu Yokoi
  • Masayasu Arihara
  • Masayuki Hyogo
  • Takatomo Shima
  • Takahisa Sawada
  • Satoaki Matoba
  • Hiroyuki Yamada
  • Akiyoshi Matsumuro
  • Takeshi Shirayama
  • Makoto Kitamura
  • Keizo Furukawa
Original Article

Abstract

Data regarding clinical efficacy of thrombectomy in patients with acute myocardial infarction (AMI) have been still limited in Japan. Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary percutaneous coronary intervention (PCI) results and in-hospital prognoses were retrospectively compared between AMI patients with totally occluded infarct-related artery (IRA) (TIMI flow grade 0) undergoing thrombus aspiration during primary PCI (with-aspiration patients, n = 568) and those without thrombus aspiration (without-aspiration patients, n = 266). The with-aspiration patients were more likely to have higher TIMI grade in the IRA immediately after primary PCI, and had a lower in-hospital mortality rate than the without-aspiration patients. According to a multivariate analysis, thrombectomy as well as stent usage was found to be independent predictor of final TIMI flow grade ≥2 in the IRA, and the final TIMI flow grade ≥2 in the IRA was found to be an independent factor for in-hospital survival. These results suggest that among real-world, unselected Japanese AMI patients with totally occluded IRA on initial coronary angiography, thrombus aspiration is an effective adjunctive therapy during primary PCI to improve final epicardial coronary flow in the IRA, which might lead to better in-hospital prognosis.

Keywords

Acute myocardial infarction Aspiration Thrombectomy 

Notes

Conflict of interest

None.

References

  1. 1.
    Mehta RH, Bates ER. Coronary stent implantation in acute myocardial infarction. Am Heart J. 1999;137:603–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1999;341:1949–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002;346:957–66.PubMedCrossRefGoogle Scholar
  4. 4.
    Brosh D, Assali AR, Mager A, Porter A, Hasdai D, Teplitsky I, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol. 2007;99:442–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Zijlstra F, Hoorntje JC, de Boer MJ, Reiffers S, Miedema K, Ottervanger JP, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1999;341:1413–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Cura FA, L’Allier PL, Kapadia SR, Houghtaling PL, Dipaola LM, Ellis SG, et al. Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol. 2001;88:124–8.PubMedCrossRefGoogle Scholar
  7. 7.
    De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J. 2008;29:3002–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008;358:557–67.PubMedCrossRefGoogle Scholar
  9. 9.
    Burzotta F, Testa L, Giannico F, Biondi-Zoccai GG, Trani C, Romagnoli E, et al. Adjunctive devices in primary or rescue PCI: a meta-analysis of randomized trials. Int J Cardiol. 2008;123:313–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Sardella G, Mancone M, Bucciarelli-Ducci C, Agati L, Scardala R, Carbone I, 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013;369:1587–97.PubMedCrossRefGoogle Scholar
  12. 12.
    Ikari Y, Sakurada M, Kozuma K, Kawano S, Katsuki T, Kimura K, VAMPIRE Investigators 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. J Am Coll Cardiol Intv 2008;1:424–31.Google Scholar
  13. 13.
    Shiraishi J, Kohno Y, Sawada T, Hashimoto S, Ito D, Kimura M, et al. Prognostic impact of pulse pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction. Heart Vessels. 2013;28:434–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Gillum RF, Fortmann SP, Prineas RJ, Kottke TE. International diagnostic criteria for acute myocardial infarction and acute stroke. Am Heart J. 1984;108:150–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Collaborators developing the Japanese equation for estimated GFR et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis; (2009) 53:982–92.Google Scholar
  16. 16.
    Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975;51:5–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, et al. INFUSE-AMI Investigators. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012;307:1817–26.PubMedCrossRefGoogle Scholar
  18. 18.
    De Carlo M, Aquaro GD, Palmieri C, Guerra E, Misuraca L, Giannini C, et al. A prospective randomized trial of thrombectomy versus no thrombectomy in patients with ST-segment elevation myocardial infarction and thrombus-rich lesions: MUSTELA (MUltidevice Thrombectomy in Acute ST-Segment ELevation Acute Myocardial Infarction) trial. J Am Coll Cardiol Intv. 2012;5:1223–30.CrossRefGoogle Scholar
  19. 19.
    De Luca G, Navarese EP, Suryapranata H. A meta-analytic overview of thrombectomy during primary angioplasty. Int J Cardiol. 2013;166:606–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Isshiki T, Kozuma K, Kyono H, Suzuki N, Yokoyama N, Yamamoto Y. Initial clinical experience with distal embolic protection using “Filtrap”, a novel filter device with a self-expandable spiral basket in patients undergoing percutaneous coronary intervention. Cardiovasc Interv Ther. 2011;1:12–7.CrossRefGoogle Scholar
  21. 21.
    Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, 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.PubMedCrossRefGoogle Scholar
  22. 22.
    Burzotta F, De Vita M, Gu YL, Isshiki T, Lefèvre T, Kaltoft A, et al. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J. 2009;30:2193–203.PubMedCrossRefGoogle Scholar
  23. 23.
    Noman A, Egred M, Bagnall A, Spyridopoulos I, Jamieson S, Ahmed J. Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction. Eur Heart J. 2012;33:3054–61.PubMedCrossRefGoogle Scholar
  24. 24.
    Mongeon FP, Bélisle P, Joseph L, Eisenberg MJ, Rinfret S. Adjunctive thrombectomy for acute myocardial infarction: a bayesian meta-analysis. Circ Cardiovasc Interv. 2010;3:6–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Taguchi E, Sakamoto T, Kamio T, Kotono Y, Suzuyama H, Fukunaga T, et al. Inadvertent coronary endarterectomy during aspiration thrombectomy with a Thrombuster III GR catheter in a patient with acute coronary syndrome. Cardiovasc Interv Ther. 2013;2:222–5.CrossRefGoogle Scholar
  26. 26.
    Westaby S, Kharbanda R, Banning AP. Cardiogenic shock in ACS. Part 1: prediction, presentation and medical therapy. Nat Rev Cardiol. 2011;9:158–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Morishima I, Sone T, Mokuno S, Taga S, Shimauchi A, Oki Y, et al. Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J. 1995;130:239–43.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2014

Authors and Affiliations

  • Jun Shiraishi
    • 1
  • Yoshio Kohno
    • 1
  • Takeshi Nakamura
    • 3
  • Takashi Yanagiuchi
    • 1
  • Sho Hashimoto
    • 1
  • Daisuke Ito
    • 1
  • Masayoshi Kimura
    • 1
  • Akihiro Matsui
    • 1
  • Hirokazu Yokoi
    • 1
  • Masayasu Arihara
    • 2
  • Masayuki Hyogo
    • 1
  • Takatomo Shima
    • 1
  • Takahisa Sawada
    • 1
  • Satoaki Matoba
    • 3
  • Hiroyuki Yamada
    • 3
  • Akiyoshi Matsumuro
    • 3
  • Takeshi Shirayama
    • 3
  • Makoto Kitamura
    • 4
  • Keizo Furukawa
    • 5
  1. 1.Department of CardiologyKyoto First Red Cross HospitalKyotoJapan
  2. 2.Department of Emergency MedicineKyoto First Red Cross HospitalKyotoJapan
  3. 3.Department of Cardiovascular MedicineKyoto Prefectural University School of MedicineKyotoJapan
  4. 4.Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
  5. 5.Department of CardiologyTanabe Central HospitalKyotanabeJapan

Personalised recommendations