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. 2015 Oct;104(10):803-11. doi: 10.1007/s00392-015-0846-z. Epub 2015 Mar 25.

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 × cm(2) vs. 4802 cGy × cm(2), 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.

Keywords: Germany; Myocardial infarction; STEMI; TIMI flow; Thrombectomy; Thrombus aspiration.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Disease
  • Combined Modality Therapy / mortality
  • Comorbidity
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / surgery*
  • Percutaneous Coronary Intervention / mortality*
  • Registries*
  • Risk Assessment
  • Survival Rate
  • Thrombectomy / mortality*
  • Treatment Outcome