Effect of intracoronary thrombectomy on 30-day mortality in patients with acute myocardial infarction

Am J Cardiol. 2007 Oct 15;100(8):1212-7. doi: 10.1016/j.amjcard.2007.05.040. Epub 2007 Aug 2.

Abstract

Insertion of intracoronary thrombectomy (ICT) devices, as a precedent to percutaneous coronary intervention (PCI), theoretically could have a beneficial effect on the outcome in patients with acute myocardial infarction. To examine whether ICT was associated with a lower 30-day mortality rate in patients with acute myocardial infarction, we studied 3,913 patients who underwent PCI within 24 hours after onset. A total of 990 patients (25.3%) were treated with ICT before PCI. The 30-day mortality rate was lower in the patients receiving ICT than in those without (3.7% vs 6.2%, p = 0.004), but this beneficial effect disappeared after adjustment for baseline characteristics (hazard ratio [HR] 0.658, p = 0.166). We also divided the patients into tertiles according to the Thrombolysis In Myocardial Infarction (TIMI) risk score. After adjustment for baseline characteristics, ICT was associated with a lower 30-day mortality rate in patients from the highest TIMI risk score tertile (HR 0.407, p = 0.029), but not in patients from the lower 2 tertiles. ICT was also an independent predictor of a lower 30-day mortality risk in patients aged > or =70 years (HR 0.239, p = 0.007), patients with diabetes mellitus (HR 0.275, p = 0.039), and those with stent implantation (HR 0.437, p = 0.034). In conclusion, in selected patients with high TIMI risk scores, an age > or =70 years, diabetes mellitus, or stenting, ICT is associated with a lower 30-day mortality rate.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary* / methods
  • Coronary Vessels / surgery
  • Female
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / pathology
  • Myocardial Infarction / therapy*
  • Postoperative Complications
  • Prospective Studies
  • Registries
  • Severity of Illness Index
  • Survival Analysis
  • Thrombectomy