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| * These
news are selected from 'TCT Daily (2004)' provided
by Cardiovascular Research Foundation (CRF). |
Rheolytic thrombectomy using
the AngioJet Thrombectomy System (Possis Medical)
during PCI failed to reduce infarct size at 30 days
according to results presented by principal investigator
Arshad Ali, MD, from Robert Packer Hospital in Sayre,
Pa.
The AIMI (AngioJet Rheolytic Thrombectomy In Patients
Undergoing Primary Angioplasty for Acute Myocardial
Infarction) study randomized 480 patients to undergo
either primary PCI or rheolytic thrombectomy followed
by definitive PCI. Researchers had speculated that
removal of coronary thrombus prior to definitive
angioplasty and stenting would reduce distal embolization
of thrombus, which could improve myocardial perfusion
and salvage.
In the primary endpoint of final infarct size, patients
in the control group had a significant advantage.
Ejection fraction, however, was not statistically
different, and neither was the number of patient
deaths. Researchers concluded that this study does
not support the routine use of rheolytic thrombectomy
with primary PCI in all STEMI patients.
Inclusion criteria were transmural acute MI. Patients
had to undergo PCI within 12 hours of symptom onset
and have reference vessel diameter >2.0 mm. Patients
with and without clear angiographic evidence of
thrombus were eligible for inclusion.
Exclusion criteria included prior left ventricular
dysfunction (EF <35%), cardiogenic shock, contraindication
to treatment with the GP IIb/IIIa inhibitor eptifibatide,
major surgery within six weeks of PCI, stroke within
30 days, history of hemorrhagic stroke, severe uncontrolled
hypertension and prior CABG.
Infarct size was assessed 14 to 28 days after the
PCI using Tc-99m sestamibi SPECT imaging. The primary
endpoint was infarct size, and secondary endpoints
were TIMI flow grade, TIMI blush grade, TIMI frame
count (corrected), ST-segment resolution, major
adverse coronary events and ejection fraction. |
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