Improved outcome with AngioJet thrombectomy during primary stenting in acute myocardial infarction patients with high-grade thrombus

BACKGROUND: Primary stenting during acute myocardial infarction (MI) is often complicated by slow-flow/no-reflow due to distal embolization of intracoronary thrombus. The AngioJet® thrombectomy catheter has been utilized in this setting in order to limit distal embolization and improve flow. The effect of AngioJet during primary stenting in acute MI with high-grade thrombus (≥ grade 3, as per thrombolysis in MI [TIMI] classification) is not known. METHODS: We analyzed 95 consecutive acute MI patients with thrombus grade ≥ 3 who underwent primary stenting with AngioJet (n ≤ 52) and without AngioJet (n ≤ 43) for epicardial and microvascular flow, and followed for 30-day major adverse cardiac events (MACE) and 1-year survival. Baseline characteristics and in-hospital events were obtained from the interventional database. Two independent operators analyzed pre- and post-procedure TIMI flow rates, corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG). RESULTS: Baseline clinical and angiographic characteristics were comparable between the two groups. AngioJet use was associated with better TIMI flow, TMP grade, CTFC and a trend towards lower 30-day and 1-year MACE. Use of AngioJet thrombectomy prior to stenting of acute MI patients with high-grade thrombus improves epicardial and microvascular flow, with a trend toward better short- and long-term outcome.