Abstract 412: Impact of Thrombectomy Devices for Reperfusion of STEMI in the Real World: Insights From Cardiac Magnetic Resonance Imaging
Objective We sought to assess the impact of routine thrombectomy (Export catheter) in the setting of primary percutaneous coronary intervention (PPCI) during ST elevation myocardial infarction (STEMI) in a “real world” population.
Design: Retrospective, multicenter, case-control (Dijon and Marseille) observational study
Study population: Patients treated by PPCI within 12 hours of evolution of STEMI and who underwent cardiac magnetic resonance imaging (CMR) were included in the analysis. CMR was performed in patients within the week following successfully reperfused STEMI. First-pass images were performed to evaluate extent of microvascular obstruction (MO) and late Gadolinium-enhanced images to assess persistent microvascular obstruction (PMO) and Infarct size (IS). Left ventricular ejection fraction (LVEF) and left ventricular volumes were also determined.
Results: N=102 patients were finally analyzed: n=37 patients underwent PPCI with adjunct thrombectomy (TG) and n=69 underwent a PPCI only (CG). There were no difference regarding baseline characteristics, pharmacological management (especially Glycoprotein IIb/IIIa inhibitor use), angiographic features and stenting rate between the 2 groups. The final angiographic flow grade was the same in the 2 groups (2.57±0.12vs 2.72±0.08, p=0.29). The creatinine kinase (CK) peak was significantly higher in the TG patients than controls (4017±479 vs. 2400±272 UI/l, p=0.001). Moreover, the IS was significantly higher in TG group than in controls subjects (28.7±4 vs. 17.8±2.5 % of LV mass, p=0.03). The incidence of PMO lesions was high and did not significantly differ between the 2 groups (70% vs. 52%, p=0.1). LVEF was significantly lower in the TG (46±1.7 vs. 51±1.7%, p=0.05).
Conclusions In the contemporary era of interventional therapy, this multicenter observational study with a population-based approach revealed that routine used of thrombectomy in PPCI was not associated with an improvement in infarct size and LVEF. This study suggests the need to develop prospective studies in order to precisely identify the population that could benefit from this procedure.