April 29, 2026Journal of the American College of Cardiology
Comparison of AngioJet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting With Direct Stenting Alone in Patients With Acute Myocardial Infarction
Key result
Pre-stenting rheolytic thrombectomy cuts 6-month MACE ~42% vs direct stenting alone despite missing primary endpoints.
- P=0.043
- n=501
Why the study?
The routine removal of thrombus before infarct artery stenting in patients with acute myocardial infarction remained a matter of debate.
Population
501 patients with acute myocardial infarction, thrombus grade 3 to 5, and reference vessel diameter >=2.5 mm
Comparison
Rheolytic thrombectomy before direct stenting vs direct stenting alone
Design
Multicenter, international, prospective randomized trial
Follow-up
12 months
Authors
Discussion
Loading...
Member takes
Implication
Caution against routine rheolytic thrombectomy before direct stenting; leaves open its efficacy for MACE reduction in primary PCI.
Study Design
Type
RCT (n=501)
Randomization
randomly allocated
Multicenter
Yes
PICO
P
Population
acute myocardial infarction (n=501)
I
Intervention / Comparator
rheolytic thrombectomy (RT) before direct infarct artery stenting vs direct stenting (DS) alone
O
Primary Outcome
early ST-segment resolution and (99m)Tc-sestamibi infarct size, p=0.043
Main Result
Absolute Event Rate: 85.8% vs 78.8%
p-value: p=0.043
Cite This Study
Migliorini et al. (2010) conducted an RCT in acute myocardial infarction (n=501). rheolytic thrombectomy (RT) before direct infarct artery stenting vs. direct stenting (DS) alone was evaluated on early ST-segment resolution and (99m)Tc-sestamibi infarct size (p=0.043). Rheolytic thrombectomy before direct stenting did not meet primary efficacy endpoints but reduced 6-month MACE vs direct stenting alone (11.2% vs 19.4%; p=0.011).