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Feasibility of primary clot extraction prior to percutaneous coronary intervention in acute myocardial infarction
Author(s) -
Aqel Raed,
Zoghbi Gilbert,
Hage Fadi,
Philips George,
Perry Gilbert,
Iskandrian Ami,
Dell'Italia Louis
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21465
Subject(s) - medicine , timi , conventional pci , cardiology , myocardial infarction , ejection fraction , percutaneous coronary intervention , circumflex , right coronary artery , artery , heart failure , coronary angiography
Objectives : To test the feasibility, safety, and in‐hospital outcomes of utilizing the FilterWire EZ to extract clot prior to percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (MI). Background : PCI in patients with acute MI is associated with a higher incidence of distal embolization, no‐reflow, or slow flow partly due to the presence of clot burden. Methods : The authors describe the feasibility, safety, and outcomes of using a FilterWire EZ distal protection device as a clot extraction device in patients who presented with acute MI and documented clot on coronary angiography. Results : Fifteen consecutive male patients with a mean age of 54 ± 8 years presented with acute MI (60% ST elevation MI). MI involved left anterior descending artery ( n = 4), circumflex artery ( n = 3), and right coronary artery ( n = 8). Clot extraction followed by PCI reduced the percent diameter stenosis from 94 ± 12 to 65 ± 11 ( P < 0.001) and restored TIMI 3 flow in all patients without distal embolization. The angiographic, procedural, and clinical success rates were 100%. The mean left ventricular ejection fraction (LVEF) was 52 ± 8% (range 30–62%) with only three patients (15%) who had an LVEF <50% and five patients (33%) without apparent wall motion abnormalities on echocardiography. Conclusions : Clot extraction before PCI during acute MI in native coronaries is feasible, safe, and effective in restoring TIMI 3 flow without distal embolization. Whether this approach results in better outcomes and improved LV function compared with standard therapy alone requires further investigation. © 2008 Wiley‐Liss, Inc.