Perfil de pacientes tratados com cateteres de aspiração de trombos durante intervenção coronária percutânea primária

Abstract

Background: The benefits of using thrombus aspiration catheters during primary percutaneous coronary intervention (PCI) to obtain better coronary flow and myocardial perfusion and to reduce late mortality are established in the literature. However, in clinical practice, this approach does not appear to be used for all patients. This study attempted to determine which clinical and angiographic variables have led to the use of these devices in primary PCI at this institution. Methods: From August of 2006 to November of 2010, 558 consecutive patients underwent primary PCI. Thrombus aspiration catheters were used in 79 patients (group 1), who were then compared to 479 patients in whom these devices were not used (group 2). Results: Group 1 showed a prevalence of males, smokers, large acute myocardial infarctions (AMI), and thrombotic lesions. The use of glycoprotein IIb/IIIa inhibitors, direct stenting, larger diameter stents, and the presence of transient coronary flow disturbances were also more frequent in group 1. The procedural success rate was high (93.7% vs. 92.3%; P = 0.4), and it was similar between groups. At hospital discharge, the incidence of major adverse cardiac and cerebrovascular events (6.3% vs. 6.5%; P = 0.6), death (5.1% vs. 3.8%; P = 0.58), stroke (1.3% vs. 0.4%; P = 0.09), and reinfarction (0% vs. 2.3%; P = 0.17) were not different between the groups. Conclusions: Thrombus aspiration catheters have been used in 15% of primary PCIs, usually in AMIs with greater extension and thrombotic burden. Despite the more severe clinical and angiographic profile of these patients, the success rate is high and similar to that of low-risk patients.

Mudanças no perfil populacional e resultados da intervenção coronária percutânea do Registro Angiocardio

“…Regarding the care of AMI, the rate of use of glycoprotein IIb/IIIa inhibitors remained stable and low (6.4 % to 7.5 %) during the study period, which has been a trend in literature since the advent of clopidogrel, new antiaggregants, and the use of thrombus aspiration catheters 12 The more frequent use of aspiration catheters in the second period group coincides with the publication, in 2008, of the TAPAS trial results, which showed the superiority of thrombus aspiration technique to treat AMI with ST-segment elevation, reducing cardiac mortality combined with non fatal reinfarction within one year. 15,16 The continuous improvement of the material used in the PCI, such as balloons and stents of better navigability and smaller calibre, guide wires with different characteristics of flexibility and stiffness, and drug-eluting stents, for instance, has increased the possibilities of using of the percutaneous technique in patients with greater angiographic complexity. This was also observed in the present study, with patients from P2 showing more severe coronary disease, such as multivessel involvement, thrombotic lesions, and diffuse (> 20 mm) and bifurcation lesions, requiring the use of longer and pharmacological stents.…”