782-6 Clinical and Angiographic Followup to a Prospective Study of Transluminal Extraction Atherectomy in High Risk Patients with Acute Myocardial Infarction

Abstract

Acute myocardial infarction (AMI) patients with an infarct related artery (IRA) containing thrombus are a high risk group for percutaneous transluminal coronary angioplasty. TEC may be a useful device for treatment of these patients due to its ability to aspirate thrombus. TEC was prospectively evaluated in 63 patients (age 61 ± 12 years) including 23 (36.5%) ineligible for thrombolysis, 24 (38%) with lytic failure, and 16 (25.5%) with post infarct angina and a thrombotic coronary occlusion. Immediate, one week, and six month angiographic and clinical followup were obtained. The IRA was a SVG in 18 (29%) and a native coronary artery (NAT) in 45 (71%). Acute procedural success with a residual stenosis < 50% and TIMI 2 or 3 grade flow was acheived in 94% of patients. There were no major procedural complications. Other events during the hospitalization included death in 3 (4.8%), CABG in 2 (3%) and blood transfusion in 12 (19%). Elective predischarge angiography revealed an IRA stenosis < 50% in 34/38 (89%). Patients were followed for 6 months with clinical followup in 100% and angiographic in 38/63. Death CABG Patency at F/U IRA RePTCA NAT 3/45 (6.7%) 1145 (2.2%) 29/31 (94%) 15/45 (33%) SVG 4/18 (22.2%) 2/18 (11.1%) 4/7 (57%) 4/18 (22%) TOTAL 7/63 (11.1%) 3/63 (4.8%) 34/38 (90%) 19/63 (30%) Angiographic restenosis occurred in 27/38 (71%) although most patients returned for followup cath secondary to symptom recurrence. Clinical restenosis occurred in 22 (42%). High risk AMI patients can be successfully treated with TEC with a high technical success rate and a low incidence of complications. IRA patency at 1 week and 6 months was excellent; however, angiographic restenosis remains a problem. Extraction of thrombus in AMI may help maintain vessel patency but does not appear to prevent restenosis.