Key result
Efficient manual thrombectomy modestly reduced infarct size compared to inefficient thrombectomy in STEMI patients with an area at risk ≥28% (7.87 vs 8.36 IU/L, P=0.005), but showed no clinical benefit.
Why the study?
Does manual thrombectomy reduce infarct size and improve clinical outcomes in STEMI patients with TIMI 0-1 flow undergoing PCI?
Observational (n=850)
Does manual thrombectomy reduce infarct size and improve clinical outcomes in STEMI patients with TIMI 0-1 flow undergoing PCI?
Absolute Event Rate: 7.87% vs 8.36%
p-value: p=0.005
Efficient manual thrombectomy may modestly reduce infarct size in STEMI patients with a large area at risk, but it does not translate to significant in-hospital clinical benefits compared to PCI alone.
No clinical benefit with efficient manual thrombectomy; hypothesis-generating for modest infarct size reduction in large-risk STEMI and needs randomized trials.
OBJECTIVES: To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST-elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0-1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in-hospital clinical events, emphasizing neurological outcomes. BACKGROUND: The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality. RESULTS: In 850 consecutive STEMI-patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2-3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P-interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln-transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI-only groups were not different. CONCLUSION: In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI-only, no difference was found regarding stroke.
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Luz et al. (2017) conducted an observational in ST-elevation myocardial infarction (STEMI) with TIMI 0-1 coronary flow (n=850). Manual thrombectomy vs. Inefficient manual thrombectomy or PCI-only was evaluated on Infarct size (Ln-transformed peak CK) in patients with area at risk ≥28% (p=0.005). Efficient manual thrombectomy modestly reduced infarct size compared to inefficient thrombectomy in STEMI patients with an area at risk ≥28% (7.87 vs 8.36 IU/L, P=0.005), but showed no clinical benefit.
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