Direct stenting after thrombus removal before primary angioplasty in acute myocardial infarction

J Interv Cardiol. 2008 Aug;21(4):300-6. doi: 10.1111/j.1540-8183.2008.00371.x.

Abstract

Objectives: To verify whether direct stenting (DS) after thrombus removal during primary angioplasty (PPCI) in patients with ST-elevation acute myocardial infarction (STEMI) can improve myocardial reperfusion and prevent distal embolization compared to conventional stent implantation.

Background: Both mechanical removal and DS reduce thrombus dislodgment and improve microcirculatory reperfusion during PPCI. However, the additional effect of DS after thrombus removal has not been definitely assessed.

Methods: The DEAR-MI study included 148 consecutive STEMI patients who were randomly assigned to undergo or not thrombus aspiration before PPCI. For the purpose of the present study, we interrogated the DEAR-MI data bank to compare the occurrence of complete (>70%) ST-segment resolution (STR), myocardial blush grade (MBG)-3, no-reflow, and angiographic embolization in patients treated and untreated with DS.

Results: Clinical and angiographic characteristics were similar in the two groups. Comparing DS and no-DS groups, complete STR was found in 67% versus 51% (P = 0.08), MBG-3 in 86% versus 49% (P < 0.001), no-reflow in 1% versus 14% (P < 0.01), angiographic embolization in 3% versus 19% (P < 0.01), TIMI flow-3 in 89% versus 70% (P < 0.01), and the corrected TIMI frame count was 16.2 versus 18.8 (P < 0.05). Among patients undergoing thrombus aspiration, the odds ratio of DS for MBG-3 and distal embolization was 4 (95% CI 1-16.6) and 0.10 (95% CI 0.01-0.93), respectively. At multivariable analysis, thrombus aspiration (P < 0.001) and DS (P < 0.05) independently predicted MBG-3, while thrombus aspiration was the only independent predictor of DS.

Conclusions: DS during PPCI reduces distal embolization and improves myocardial reperfusion. This effect is significantly more relevant after thrombus aspiration.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Anticoagulants / therapeutic use
  • Aspirin / therapeutic use
  • Female
  • Heparin / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / surgery*
  • Myocardial Infarction / therapy
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Stents*
  • Thromboembolism / surgery*
  • Thromboembolism / therapy
  • Time Factors

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Heparin
  • Aspirin