0200: Predictors of angiographically visible distal embolization in ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention and thrombectomy

Abstract

Aspiration thrombectomy during primary percutaneous coronary intervention (p-PCI) in ST elevation myocardial infarction (STEMI) has been proposed to restore myocardial reperfusion. But important controversies remain concerning the usefulness of thrombectomy to improve this perfusion. Our objective was to evaluate the impact of manual thrombectomy on the occur-rence of angiographically visible distal embolization (AVDE) during p-PCI in STEMI. 346 consecutive patients admitted for STEMI who underwent p-PCI and thrombectomy were included. Clinical, angiographic and therapeutics characteristics were assessed. AVDE was defined as an abrupt vessel closure occurring at any point during the PCI procedure and that was not present at baseline. Patients were divided into 2 groups: with AVDE (59 patients) and without AVDE 287 patients. Comparing the 2 groups, patients with AVDE were more likely to be older than 60 year-old (67 vs. 50%; p=0.014), with a higher proportion of women (34 vs. 20%; p=0,027), of right coronary artery lesion (57 vs. 34.5%; p=0.001). Conversely, smoking and left anterior descending coronary artery lesion were more frequent in patients without AVDE (respectively 63 vs. 46%; p=0.014 and 50 vs. 30%; p=0.005). Univariate analysis identify age >60 (OR[95% CI]:2.09(1.15-3.78), p=0.015), female gender (OR[95% CI]:2.02(1.09-3.73), p=0,024), culprit coronary diameter >3mm (OR[95% CI] as predictors of AVDE during p-PCI for STEMI. By multivariate analysis, culprit coronary diameter >3mm (OR[95% CI]: 1.90 (1.01-3.56); p=0.048) and and the right coronary artery culprit lesion site (OR[95% CI]:2.48(1.36-4.52); p=0.003) were independent factors associated with AVDE. AVDE complicating p-PCI during STEMI is frequent (17%). Strikingly we found that successful thrombectomy does not prevent from AVDE. Conversely, we highlight that patients with culprit coronary artery diameter >3mm and STEMI due to right coronary artery occlusion are more likely to develop AVDE.