Author + information
- Ruben Vergara1,
- Renato Valenti2,
- Angela Migliorini3,
- Guido Parodi4,
- Roberto Rondine5,
- Maria Grazia De gregorio6,
- Eleonora Gabrielli7,
- Elena De Vito8,
- Sofia Morini9 and
- David Antoniucci10
- 1DivCardiology-Careggi Hospital, Florence, Italy
- 2Careggi Hospital, Florence, Italy
- 3careggi Hospital, Florence, Florence, Italy
- 4Unknown, Florence, Italy
- 5Division of Cardiology - Careggi Hospital
- 6Division of Cardiology Careggi Hospital
- 7Division of Cardiology Careggi Hospital
- 8Division of Cardiology Careggi Hospital
- 9Division of Cardiology - Careggi Hospital
- 10Careggi Hospital, Florence, Italy
Very few data exist on thrombus removal before stenting in patients with AMI and CS treated with primary percutaneous coronary intervention (PCI). We sought to investigate the prognostic impact of rheolytic thrombectomy (RT) in patients with AMI complicated by cardiogenic shock (CS).
Of 4023 patients who underwent PCI for AMI between 1995 and 2012, we focused on 371 patients presenting CS at admission separated into two groups: the first included 63 treated with RT (RT-group), and the remaining 308 underwent standard PCI (Non-RT group). The primary end point was the composite of cardiac death, reinfarction, stroke, target vessel revascularization (TVR) at 2-year follow-up (MACE).
The primary end point rate was lower in the RT-group (57.1% and 70.8%,respectively, p = 0.038). The difference between groups was driven by a lower rate of TVR (9.5% vs 23.4%, p = 0.017) and reinfarction (1.6% versus 9.1%, p = 0.041), while no difference between groups were revealed in mortality (46,0% RT vs. 49,4% p= 0.679) and stroke (1.6% RT vs 3.2% p= .698). At multivariable analysis the variables related to the risk of the primary end point were age (HR: 1.036 95% CI=1.022 - 1.048, p <0.001), three vessel disease (HR: 1.504, 95% CI 1.163 – 1.946, p= 0.002), RT (HR 0.689, 95% CI 0.476 – 0.998, p= 0.049) and successful primary PCI (HR 0.367, 95% CI 0.266 – 0.505, p< 0.001).
RT reduce 2-year MACE in patients with large thrombus burden and AMI complicated by CS.
CORONARY: Thrombus / Thrombectomy and Embolic Protection