Comparative efficacy analysis of an aspiration device before primary angioplasty in patients with acute myocardial infarction: a single-center experience.

BACKGROUND: ST-elevation myocardial infarction is caused by occlusive coronary thrombosis where antecedent plaque disruption occurs. When treating STEMI the main goal is to achieve prompt reperfusion of the infarction area. Several studies have demonstrated the efficacy of an aspiration device before percutaneous coronary intervention in patients with acute myocardial infarction. OBJECTIVES: To determine the added value of thrombus aspiration prior to primary PCI by comparing AMI patients with totally occluded infarct-related artery treated with routine primary PCI to those treated with extraction device prior to primary PCI. METHODS: The study group comprised 122 consecutive patients with AMI and a totally occluded infarct artery (TIMI flow 0) who underwent primary PCI. The patients were divided into two groups: 68 who underwent primary PCI only (control group) and 54 who underwent primary thrombus extraction with an extraction device before PCI (extraction group). Baseline clinical and lesion characteristics were similar in both groups. Final TIMI grade flow and myocardial blush as well as 1 year mortality, target lesion revascularization, recurrent myocardial infarction, unstable angina and stroke were compared between the two groups. RESULTS: Primary angiographic results were better for the extraction group versus the control group: final grade 3 TIMI flow was 100% vs. 95.6% (P= 0.03) and final grade 3 myocardial blush grade 50% vs. 41.18% (although Pwas not significant). Long-term follow-up total MACE showed a nonsignificant positive trend in the extraction group (12.96% vs. 24.71%, P= 0.26). CONCLUSIONS: The use of extraction devices for intracoronary thrombectomy during primary PCI in patients with totally occluded infarct artery significantly improved epicardial reperfusion in the infarct-related vessel and showed a trend for more favorable long-term outcome.

The predictive value of white blood cell count on the success of primary percutaneous intervention of the left anterior descending artery in patients admitted with acute anterior wall myocardial infarction.

Background: Epidemiological studies have shown correlations between the white blood cell (WBC) count and the risk of acute myocardial infarction (AMI) and stroke. The risk of AMI is four times as great in patients with WBC counts in the high-normal range (>9000/microl) as it is in those in the low-normal range (<6000/microl). A high WBC count also predicts a greater risk of re-infarction and in-hospital death. Data are still missing about the role of WBC count in the success rate of primary angioplasty. Methods: A total of 125 consecutive patients aged 40-65 years (mean age 54+/-8 years) had a primary percutaneous coronary intervention (PCI) as their first-line therapy for AMI. We evaluated interrelationships between WBC count, hemoglobin (Hg), platelets (PLT), heart rate (HR), left ventricular systolic (LVS) pressure, left ventricular diastolic (LVD) pressure, and the success rate of primary angioplasty to the occluded left anterior descending artery (LAD) in patients with AMI. Results: Of the 125 patients (30 females and 95 males), 72 underwent primary PCI to the LAD and 31 patients were referred for an emergency coronary artery bypass graft surgery (CABG). One patient died. Twenty-one patients had non-occluded arteries, most of them with a fresh thrombus and after spontaneous reperfusion. Multiple logistic dregression analysis demonstrated that low ejection fraction (p=0.01) and high WBC counts (p=0.04) were correlated with failure of angioplasty and referral for an emergency CABG. WBC counts were positively correlated with heart rate (p=0.005), platelet count (p=0.0006), and Hg level (p=0.001). Conclusions: These data suggest that measuring WBC count on admission to the catheterization laboratory for primary angioplasty provides clinically important prognostic information.