Abstract 3474: Clinical Impact of Intracoronary Thrombectomy on 30-day Mortality in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention
Background: It has been reported that thrombus formation following plaque rupture plays an important role for the onset of acute myocardial infarction (AMI). Intracoronary thrombectomy prior to percutaneous coronary intervention (PCI) may theoretically have a beneficial effect on outcomes in patients with AMI through removing thrombus and improving coronary blood flow after reperfusion.
Methods and Results: To examine whether intracoronay thrombectomy is associated with a reduced risk of 30-day mortality in patients with AMI, we studied 3,913 AMI patients who underwent PCI within 24 hours after the symptoms onset. Of whole patients, 990 (25.3%) patients were treated with intracoronary thrombectomy before PCI procedure. The 30-day mortality was lower in patients with intracoronary thrombectomy than those without it (3.7% vs. 6.2%, P=0.004). The beneficial effect of intracoronary thrombectomy on 30-day mortality in a univariate analysis was disappeared after adjustment for baseline characteristics (Hazard ratio [HR]; 0.658, 95% CI: 0.363–1.190, P=0.166). To further evaluate subgroup of patients, we divided whole patients into tertiles according to the Thrombolysis In Myocardial Infarction risk score (TIMI RS). Although there was no significant difference in 30-day mortality between patients with and without intracoronary thrombectomy among the lowest (TIMI RS 0 to 3, 0.7% vs. 1.1, P=0.453) and the second (TIMI RS 4 to 5, 3.3% vs. 2.9%, P=0.792) tertile group, the 30-day mortality was lower in patients with than those without intracoronary thrombectomy among the highest tertile group (TIMI RS 6 to 14, 9.2% vs. 14.8%, P=0.020). After adjustment for baseline characteristics, intracoronary thrombectomy was associated with a reduced risk of 30-day mortality in patients with highest tertile (HR; 0.407, 95% CI 0.181– 0.912, P=0.029), but not in the lowest (HR; 0.860, 95% CI 0.087– 8.508, P=0.897) and second (HR; 1.766, 95% CI 0.555– 0.5.622, P=0.366) tertile of TIMI RS.
Conclusion: Intracoronary thrombectomy may have a beneficial effect on 30-day mortality in high risk patients defined as TIMI risk score 6 or more with AMI. Further studies will be required to confirm our observations in a randomized controlled study.