SUCCESS RATES OF THROMBECTOMY IN STEMI PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

Authors

  • MAUR SAQI Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan
  • M BUBAKAR Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan
  • M FAROOQ Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan
  • MW ASHRAF Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan
  • M ASLAM Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan
  • F FAROOQ Department of Cardiology, National institute of cardiovascular diseases Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1136

Keywords:

PCI; STEMI; Thrombectomy; Outcomes; Renal Dysfunction; Stroke; Heart Failure; Mortality

Abstract

Percutaneous coronary intervention (PCI) is a standard treatment for ST-segment elevation myocardial infarction (STEMI) patients. The role of thrombectomy as an adjunct to PCI remains debated, with conflicting evidence regarding its benefits and associated risks. Objective: This study aimed to compare the outcomes of patients receiving PCI with and without thrombectomy in managing STEMI, evaluating key parameters such as mortality, re-infarction, heart failure, cardiogenic shock, renal dysfunction, bleeding complications, stroke, and hospital stay duration. Methods: This cross-sectional study included 100 patients who met the inclusion criteria. Patients were divided into two groups: Group A (n=50) underwent PCI alone, and Group B (n=50) received PCI with adjunctive thrombectomy. Outcomes were compared between the two groups, including mortality, re-infarction, cardiac failure, cardiogenic shock, renal dysfunction, bleeding complications, stroke, and hospital stay. Statistical analysis was performed using appropriate tests, with significance at p < 0.05. Results: Of the 100 patients, 62% were male, and 38% were female. The mean age of patients in Group A was 54.19 ± 12.62 years, while in Group B, it was 55.22 ± 13.51 years. The mean BMI in Group A was 25.5 ± 3.16 kg/m², compared to 24.35 ± 5.75 kg/m² in Group B. Diabetes was present in 54% of Group A and 44% of Group B, and a history of smoking was reported in 38% of Group A and 34% of Group B. There was no significant difference in mortality between the two groups. However, renal dysfunction occurred in 1 patient in Group A and five in Group B (p = 0.03). Heart failure was noted in 3 patients in Group A and 6 in Group B (p = 0.002). Significantly more cases of stroke, excessive bleeding, and renal dysfunction were observed in Group B (PCI with thrombectomy) compared to Group A. Conclusion: Patients undergoing PCI with thrombectomy were at higher risk of developing complications, including stroke, renal dysfunction, and heart failure, compared to those receiving PCI alone. Although there was no significant difference in mortality between the two groups, the increased risk of post-procedure complications in the thrombectomy group suggests that careful patient selection is crucial for optimizing outcomes.

Downloads

Download data is not yet available.

References

Mughal LH, Sastry S. Advances in treating ST elevation myocardial infarction in the UK. JRSM Cardiovascular Disease. 2022;11:20480040221075519.

Mathews SJ, Parikh SA, Wu W, Metzger DC, Chambers JW, Ghali MG, et al. Sustained mechanical aspiration thrombectomy for high thrombus burden coronary vessel occlusion: the multicenter CHEETAH study. Circulation: Cardiovascular Interventions. 2023;16(2):e012433.

Doherty DJ, Sykes R, Mangion K, Berry C. Predictors of microvascular reperfusion after myocardial infarction. Current Cardiology Reports. 2021;23:1-13.

De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. European heart journal. 2008;29(24):3002-10.

Svilaas T, van der Horst IC, Zijlstra F. Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS)—study design. American heart journal. 2006;151(3):597. e1-. e7.

Luz A, Rodrigues P, Sousa MJ, Silveira I, Anjo D, Brochado B, et al. Thrombus aspiration for reperfusion in myocardial infarction: Predictors and clinical impact of ineffectiveness. Revista Portuguesa de Cardiologia (English Edition). 2014;33(12):753-60.

Jolly SS, Cairns JA, Yusuf S, Rokoss MJ, Gao P, Meeks B, et al. Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial. The Lancet. 2016;387(10014):127-35.

Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. New England Journal of Medicine. 2013;369(17):1587-97.

Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. New England journal of medicine. 2008;358(6):557-67.

Sahami N, Akl E, Sanjanwala R, Shah AH. Safety and Efficacy of Low-Dose Intracoronary Thrombolysis During Primary Percutaneous Coronary Intervention in Patients with ST Elevation Myocardial Infarction: A Meta-Analysis of Randomized Trials. Current Problems in Cardiology. 2024:102616.

Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. New England Journal of Medicine. 2015;372(15):1389-98.

Deng S-B, Wang J, Xiao J, Wu L, Jing X-D, Yan Y-L, et al. Adjunctive manual thrombus aspiration during ST-segment elevation myocardial infarction: a meta-analysis of randomized controlled trials. PLoS One. 2014;9(11):e113481.

Jolugbo P, Ariëns RA. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischemic stroke. Stroke. 2021;52(3):1131-42.

Shahjouei S, Sadighi A, Chaudhary D, Li J, Abedi V, Holland N, et al. A 5-decade analysis of incidence trends of ischemic stroke after transient ischemic attack: a systematic review and meta-analysis. JAMA neurology. 2021;78(1):77-87.

Köktürk U, Somuncu MU, Uygur B, Akgül Ö, Püşüroğlu H. Prognostic significance of thrombus burden on short-and long-term clinical outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coronary artery disease. 2022;33(7):559-65.

Watanabe T, Akasaka T, Kobara S, Yamamoto K. Successful visible thrombus aspiration in ST-segment elevation myocardial infarction: associated factors and the clinical impact. Coronary Artery Disease. 2022;33(6):479-84.

Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, et al. Intracoronary Abciximab and Aspiration Thrombectomy During Primary Pci For Anterior Stemi: One–Year Results from The Randomized Infuse–Ami Trial. Journal of the American College of Cardiology. 2013;61(10S):E1853-E.

Tamhane UU, Chetcuti S, Hameed I, Grossman PM, Moscucci M, Gurm HS. Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials. BMC cardiovascular disorders. 2010;10:1-17.

Kumar D, Patra S, Pande A, Chakraborty R, Mukherjee SS, Roy RR, et al. Long-term clinical outcomes of thrombus aspiration in STEMI patients undergoing primary percutaneous coronary intervention. American Journal of Cardiovascular Disease. 2020;10(2):117

Downloads

Published

2024-09-26

How to Cite

SAQI , M., BUBAKAR , M., FAROOQ , M., ASHRAF , M., ASLAM , M., & FAROOQ, F. (2024). SUCCESS RATES OF THROMBECTOMY IN STEMI PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. Biological and Clinical Sciences Research Journal, 2024(1), 1136. https://doi.org/10.54112/bcsrj.v2024i1.1136

Most read articles by the same author(s)