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Routine aspiration thrombectomy improves the diagnosis and management of embolic myocardial infarction
Author(s) -
Huang Alex L,
Murphy J. Conleth,
Shaw Elizabeth,
Kozor Rebecca,
Yan Warren,
Loxton Anne,
Soo Hoo Soon Y.,
Figtree Gemma A.,
Rasmussen Helge H.,
Hansen Peter S.,
Nelson Gregory I.C.,
Bhindi Ravinay,
Ward Michael R.
Publication year - 2016
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.26047
Subject(s) - medicine , myocardial infarction , embolic stroke , thrombus , infarction , stroke (engine) , cardiology , intracranial embolism , embolism , atrial fibrillation , embolus , surgery , radiology , ischemic stroke , ischemia , mechanical engineering , engineering
Objectives Assess the effect of aspiration thrombectomy on diagnosis and management of embolic acute myocardial infarction. Background Discrimination of embolic acute myocardial infarction from atherosclerotic plaque rupture/erosion prompts oral anticoagulation treatment of source of embolus, as well as avoiding unnecessary stenting and dual antiplatelet therapy. However, detection is difficult without aspiration. Methods We compared rates of diagnosis of embolic infarction for 2.5 years prior to (pre‐RAT) and 2.5 years post routine aspiration thrombectomy (post‐RAT). Baseline demographics, outcomes, and treatment strategies were also compared between the embolic infarction and atherosclerotic infarction. Results Diagnosed embolic infarction rose from 1.2% in the pre‐RAT era to 2.8% in the post‐RAT period ( P < 0.05). In addition, more successful removal of thrombus by aspiration led to less stenting (20% vs. 55% P < 0.05) in the post‐RAT period thus avoiding the hazards of “triple therapy.” Embolic infarction was more frequently associated with atrial fibrillation (55% vs. 8%), had higher mortality (17% vs. 4%), and had higher rates of embolic stroke (13% vs. 0.3%) when compared with atherosclerotic MI (all P < 0.05). Conclusions Routine aspiration thrombectomy more readily identifies embolic infarction allowing more specific therapy and avoidance of stenting and triple anticoagulant therapy. © 2015 Wiley Periodicals, Inc.