061 Thrombectomy in Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial infarction. Observational data From the RICO Survey

Abstract

The use of adjunctive thrombectomy (AT) as device to primary percutaneous coronary intervention (PCI) for an acute ST segment elevation myocardial infarction (STEMI) has shown clinical benefit in randomized trials. Whether this benefit could translate to all patients with partial or complete occlusion of a coronary artery in primary PCI remains to be determined. From the RICO Survey, all the patients admitted with TIMI grade 0 or 1 before primary PCI for a STEMI < 12 H after symptom onset were included in the study. Among the study population, 156 (29%) patients underwent AT (AT group) and were compared with patients with TIMI grade 0/1 who do not undergo AT (control group, n=384). Patients with AT were younger and less frequently hypertensive. Glycoprotein IIb/IIIa inhibitors were more frequently administrated in the AT group. However, a decrease in the rate of patients with TIMI 3 flow grade post PCI was observed in the AT group. Peak creatine kinase was significantly higher in patients with AT while ischemic time was similar for the 2 groups. Stenting the infarct-related lesion was less frequent than in the control group. CV mortality at 30 days and at 1-year were higher in the AT group (11.4 vs. 5.2%, p=0.016, and 14.6 vs. 7%, p=0.013) respectively. By multivariate analysis, AT remains an independent predictor of 1-Y mortality even when adjusted for potential confounders (HR(95%CI):4.95(2.08-11.77)). These results were unchanged when the propensity score for AT was introduced into the model. In the contemporary era of interventional therapy, this large observational study revealed that routine use of AT in primary PCI with a baseline TIMI 0 or 1 flow was not associated with an improved outcome. Prospective studies are warranted to precisely analyse the impact of AT in such patients and to further investigate its potential benefit.