THE EFFICACY OF THROMBECTOMY IN REDUCING THE NO-REFLOW PHENOMENON IN STEMI PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Thrombectomy, no-reflow phenomenon, STEMI, PPCI, myocardial perfusion, left ventricular function, coronary intervention
Abstract
Background
The no-reflow phenomenon, characterized by inadequate myocardial perfusion despite successful recanalization of the coronary artery, remains a significant complication during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been proposed as a potential intervention to reduce no-reflow by preventing distal embolization of thrombus during PPCI.
Objective
This study aimed to assess the effectiveness of manual aspiration thrombectomy in reducing the incidence of the no-reflow phenomenon in STEMI patients undergoing PPCI.
Methods
We conducted a retrospective cohort study of 311 STEMI patients who underwent PPCI at a tertiary care center from January 1, 2023, to December 31, 2023. Of these, 156 patients received thrombectomy before PPCI, while 155 underwent PPCI without thrombectomy. The primary outcome was the incidence of the no-reflow phenomenon, defined as a post-PPCI TIMI (Thrombolysis in Myocardial Infarction) flow grade less than 3. Secondary outcomes included left ventricular ejection fraction (LVEF) and 30-day all-cause mortality. Data were analyzed using multivariate logistic regression to adjust for potential confounders.
Results
The no-reflow phenomenon occurred in 12.2% of patients in the thrombectomy group compared to 25.8% in the control group (p = 0.003). LVEF was significantly higher in the thrombectomy group (54.3% ± 7.9%) compared to the control group (49.6% ± 8.2%, p < 0.001). There was a non-significant trend toward lower all-cause mortality in the thrombectomy group (2.6% vs. 5.8%, p = 0.15).
Conclusion
Manual aspiration thrombectomy significantly reduces the incidence of the no-reflow phenomenon in STEMI patients undergoing PPCI and may improve left ventricular function. These findings suggest thrombectomy as a beneficial adjunctive therapy for select STEMI patients undergoing PPCI.
References
2. Ndrepepa G, Mehilli J, Schwaiger M, Schömig A, Kastrati A. Prognostic value of myocardial salvage assessed by myocardial perfusion imaging in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. J Nucl Med. 2005 Aug;46(8):1245-51.
3. Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008 Apr 10;358(6):557-67.
4. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Primary percutaneous coronary intervention in acute ST-elevation myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008 Feb 23;371(9628):1915-20.
5. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. Randomized trial of primary PPCI with or without routine manual thrombectomy. N Engl J Med. 2015 Aug 13;373(8):623-32.
6. Jolly SS, James S, Džavík V, Cairns JA, Mahmoud KD, Zijlstra F, et al. Thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis. Circ Cardiovasc Interv. 2017 Jan;10(1)
7. Gibson, C. M., Cannon, C. P., Murphy, S. A., et al. (2002). Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation, 101(2), 125-130. https://doi.org/10.1161/01.CIR.101.2.125
8. Svilaas T, Vlaar PJ, van der Horst IC, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008;358(6):557-67. doi:10.1056/NEJMoa0706416
9. Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Primary percutaneous coronary intervention in acute ST-elevation myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008;371(9628):1915-20. doi:10.1016/S0140-6736(08)60833-8
10. Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PPCI with or without routine manual thrombectomy. N Engl J Med. 2015;373(8):623-32. doi:10.1056/NEJMoa1415098
11. Jolly SS, James S, Džavík V, et al. Thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis. Circ Cardiovasc Interv. 2017;10(1). doi:10.1161/CIRCINTERVENTIONS.116.004645
12. Ito H, Maruyama A, Iwakura K, et al. Clinical implications of the 'no reflow' phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior myocardial infarction. Circulation. 1996;93(2):223-8. doi:10.1161/01.CIR.93.2.223
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Dr Syed Akber
Lady Reading Hospital Peshawar, Pakistan.
Dr Muhammad Azam Khan
Lady Reading Hospital Peshawar, Pakistan.
Dr Sumbul Fazal
Final Year Resident at Cardiology Department, LUMHS, Pakistan.
Dr Fahad Raja Khan
Lady Reading Hospital Peshawar, Pakistan