Rheolytic Thrombectomy for Acute Myocardial Infarction Complicated by Cardiogenic Shock

Objectives. We sought to investigate the prognostic impact of rheolytic thrombectomy (RT) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background. Very few data exist on thrombus removal before stenting in patients with AMI and CS treated with primary percutaneous coronary intervention (PCI). Methods. Of 4023 patients who underwent PCI for AMI between 1995 and 2012, we focused on 371 patients presenting with CS at admission and separated them into two groups: the first included 63 patients treated with RT (RT group), and the remaining 308 underwent standard PCI (non-RT group). The primary endpoint was the composite of cardiac death, reinfarction, stroke, and target-vessel revascularization (TVR) at 2-year follow-up (MACE). Results. The primary endpoint rate was lower in the RT-group (57.1% RT vs 70.8% non-RT; P=.04). The difference between groups was driven by a lower TVR rate (9.5% RT vs 23.4% non-RT; P=.02) and reinfarction (1.6% RT vs 9.1% non-RT; P=.04), while no difference between groups was revealed in mortality (46.0% RT vs 49.4% non-RT; P=.68) or stroke rate (1.6% RT vs 3.2% non-RT; P=.70). At multivariable analysis, the variables related to the risk of the primary endpoint were age (hazard ratio [HR], 1.036; 95% confidence interval [CI], 1.022-1.048; P<.001), three-vessel disease (HR, 1.504; 95% CI, 1.163-1.946; P=.01), RT (HR, 0.689; 95% CI, 0.476-0.998; P=.049), and successful primary PCI (HR, 0.367; 95% CI, 0.266-0.505; P<.001). Conclusion. RT reduces 2-year MACE rate in patients with large thrombus burden and AMI complicated by CS.