Skip Navigation



European Heart Journal Advance Access published online on September 2, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp348
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
30/18/2193    most recent
ehp348v1
Right arrow E-letters: Submit a response
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in EHJ
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Burzotta, F.
Right arrow Articles by Zijlstra, F.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Burzotta, F.
Right arrow Articles by Zijlstra, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials

Francesco Burzotta1,*,{dagger}, Maria De Vita1,{dagger}, Youlan L. Gu2, Takaaki Isshiki3, Thierry Lefèvre4, Anne Kaltoft5, Dariusz Dudek6, Gennaro Sardella7, Pedro Silva Orrego8, David Antoniucci9, Leonardo De Luca10, Giuseppe G.L. Biondi-Zoccai11, Filippo Crea1 and Felix Zijlstra2

1 Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
2 University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
3 Department of Cardiology, Teykio University School of Medicine, Tokyo, Japan
4 Institut Cardiovasculaire Paris Sud, Massy, France
5 Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
6 Department of Cardiology, Jagiellonian University, Kracow, Poland
7 Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy
8 Interventional Cardiology, A. De Gasperis Department, Niguarda Hospital, Milan, Italy
9 Division of Cardiology, Careggi Hospital, Florence, Italy
10 Department of Cardiovascular Sciences, European Hospital, Rome, Italy
11 Division of Cardiology, University of Turin, Turin, Italy

Received 30 June 2009; revised 3 August 2009; accepted 7 August 2009 * Corresponding author. Tel: +39 3494295290, Fax: +39 06 3055535, Email: f.burzotta{at}rm.unicatt.it

See page 2180 for the commentary on this article (doi:10.1093/eurheartj/ehp349)

Aims: Thrombectomy in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is associated to better myocardial reperfusion. However, no single trial was adequately powered to asses the impact of thrombectomy on long-term clinical outcome and to identify patients at higher benefit. Thus, we sought to assess these issues in a collaborative individual patient-data pooled analysis of randomized studies (study acronym: ATTEMPT, number of registration: NCT00766740 [ClinicalTrials.gov] ).

Methods and results: Individual data of 2686 patients enrolled in 11 trials entered the pooled analysis. Primary endpoint of the study was all-cause mortality. Major adverse cardiac events (MACE) were considered as the occurrence of all-cause death and/or target lesion/vessel revascularization and/or myocardial infarction (MI). Subgroups analysis was planned according to type of thrombectomy device (manual or non-manual), diabetic status, IIb/IIIa-inhibitor therapy, ischaemic time, infarct-related artery, pre-PCI TIMI flow. Clinical follow-up was available in 2674 (99.6%) patients at a median of 365 days. Kaplan–Meier analysis showed that allocation to thrombectomy was associated with significantly lower all-cause mortality (P = 0.049). Thrombectomy was also associated with significantly reduced MACE (P = 0.011) and death + MI rate during the follow-up (P = 0.015). Subgroups analysis showed that thrombectomy is associated to improved survival in patients treated with IIb/IIIa-inhibitors (P = 0.045) and that the survival benefit is confined to patients treated in manual thrombectomy trials (P = 0.011).

Conclusion: The present large pooled analysis of randomized trials suggests that thrombectomy (in particular manual thrombectomy) significantly improves the clinical outcome in patients with STEMI undergoing mechanical reperfusion and that its effect may be additional to that of IIb/IIIa-inhibitors.

Key Words: ST-elevation myocardial infarction • Thrombectomy • Primary PCI • Long-term clinical outcome

{dagger} The first two authors contributed equally to the study.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in EHJ:

Thrombectomy in acute ST-elevation myocardial infarction: keep it simple
Eric Eeckhout
EHJ 2009 30: 2180-2181. [Extract] [Full Text]  



This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2205 - 2241.
[Full Text] [PDF]

Home page
 CirculationHome page
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation, December 1, 2009; 120(22): 2271 - 2306.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
J. C. George and G. D. Dangas
European Society of Cardiology Congress 2009: Update in Interventional Cardiology
J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1160 - 1162.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. Eeckhout
Thrombectomy in acute ST-elevation myocardial infarction: keep it simple
Eur. Heart J., September 2, 2009; (2009) ehp349v1.
[Full Text] [PDF]

E-letters:

Read all E-letters

Before complete acceptance, keep an eye on safety:
Anthony A Bavry, et al.
European Heart Journal, 22 Oct 2009 [Full text]
An Increase in Mortality Between 400-500 Days After Acute ST Elevation Myocardial Infarction
Hideaki Kaneda, et al.
European Heart Journal, 22 Oct 2009 [Full text]
The impact of inter-center variability on the study outcomes in the ATTEMPT study
Yoichi Inaba, et al.
European Heart Journal, 3 Nov 2009 [Full text]
Reply to doctor Bavry and doctor Bhatt comment letter to the ATTEMPT study
Maria De Vita, et al.
European Heart Journal, 26 Oct 2009 [Full text]
Thrombectomy and Primary PCI, there is still a need for a large randomized trial
Sanjit S. Jolly, et al.
European Heart Journal, 26 Nov 2009 [Full text]
THROMBECTOMY AND PRIMARY PCI: LARGE RANDOMIZED TRIAL PROBABLY NEEDED BUT VERY DIFFICULT TO ORGANIZE.
Maria De Vita, et al.
European Heart Journal, 15 Dec 2009 [Full text]
Reply to "The impact of center-to-center variability on the study outcomes in the ATTEMPT study" by
Maria De Vita, et al.
European Heart Journal, 14 Dec 2009 [Full text]
Reply to "An Increase in Mortality Between 400-500 Days After Acute ST Elevation Myocardial Infarcti
Maria De Vita, et al.
European Heart Journal, 14 Dec 2009 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.