Document Detail

Prospective study of extraction atherectomy in patients with acute myocardial infarction.
MedLine Citation:
PMID:  8752204     Owner:  NLM     Status:  MEDLINE    
Although percutaneous transluminal coronary angioplasty (PTCA) has been an effective treatment for primary reperfusion in acute myocardial infarction, patients with thrombolytic ineligibility, thrombolytic failure, cardiogenic shock, and vein graft occlusion remain at high risk for complications with PTCA treatment. The transluminal extraction catheter may be useful for treatment for such patients owing to its ability to aspirate thrombus. At 2 clinical centers, extraction atherectomy was prospectively evaluated in 100 patients (age 62 +/- 10 years). High-risk features included thrombolytic failure in 40%, postinfarct angina in 28%, presence of angiographic thrombus in 66%, presence of cardiogenic shock in 11%, and a saphenous vein graft occlusion in 29%. Procedural success, defined as a final residual stenosis <50% and Thrombolysis in Myocardial Infarction 2 or 3 grade flow, was seen in 94%. Events during the hospitalization included death in 5%, bypass surgery in 4%, and blood transfusion in 18%. In a substudy, patients enrolled at William Beaumont Hospital (n = 65) underwent elective predischarge angiography, which revealed a patent infarct-related vessel in 95%. These patients were also followed for 6 months with angiographic follow-up in 60%. Target vessel revascularization was necessary in 38%, and 6-month mortality was 10%. Although long-term vessel patency was 90%, angiographic restenosis occurred in 68%. Acute myocardial infarction patients can be treated with extraction atherectomy with a high technical success rate and a low incidence of complication. Infarct artery patency at 1 week and 6 months was excellent; however, angiographic restenosis remains a problem. Extraction of thrombus in this high-risk group of patients is associated with low in-hospital mortality and a high rate of vessel patency at 6 months.
B M Kaplan; T Larkin; R D Safian; W W O'Neill; B Kramer; M Hoffmann; T Schreiber; C L Grines
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  78     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-10-01     Completed Date:  1996-10-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  383-8     Citation Subset:  AIM; IM    
Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan.
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MeSH Terms
Angina Pectoris / complications
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects
Atherectomy / methods*
Blood Transfusion
Coronary Angiography
Coronary Artery Bypass
Coronary Thrombosis / therapy
Follow-Up Studies
Graft Occlusion, Vascular / complications
Middle Aged
Myocardial Infarction / surgery*,  therapy
Prospective Studies
Risk Factors
Saphenous Vein / transplantation
Shock, Cardiogenic / complications
Survival Rate
Thrombolytic Therapy
Treatment Failure
Treatment Outcome
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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