Home > Interventional Cardiology, Journal Club > Journal Club 1 April 2015

Journal Club 1 April 2015

Paper

Randomized Trial of Primary PCI with or
without Routine Manual Thrombectomy

Presenter

CB

Summary

Background

During primary percutaneous coronary intervention (PCI), manual thrombectomy
may reduce distal embolization and thus improve microvascular perfusion. Small
trials have suggested that thrombectomy improves surrogate and clinical outcomes,
but a larger trial has reported conflicting results.

Methods

We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction
(STEMI) undergoing primary PCI to a strategy of routine upfront manual
thrombectomy versus PCI alone. The primary outcome was a composite of death
from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or
New York Heart Association (NYHA) class IV heart failure within 180 days. The key
safety outcome was stroke within 30 days.

Results

The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy
group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the
thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P = 0.86). The
rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone;
hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.34) and the primary outcome plus
stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio,
1.00; 95% CI, 0.89 to 1.14; P = 0.95) were also similar. Stroke within 30 days occurred
in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%)
in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P = 0.02).

Conclusions

In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy,
as compared with PCI alone, did not reduce the risk of cardiovascular
death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart
failure within 180 days but was associated with an increased rate of stroke within
30 days.

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