A trombectomia aspirativa na reperfusão do enfarte agudo de miocárdio: preditores e impacto clínico da sua ineficácia

Abstract

Total ischemic time and SYNTAX score were independent predictors of TA failure. However, in medium-term follow-up, ineffective manual TA was not independently related to cumulative mortality.

Aspiration thrombectomy: Just another piece of the puzzle – Intuitive, but not sufficient

“…In the study by Luz et al 12 mean ischemic time was over five hours in patients in whom TA was ineffective (332.5 min, interquartile range: 393 min) and significantly shorter in successful TA (210 min, p=0.002). By way of comparison, in the study by Vink et al, 13 mean ischemic time was three hours for both effective and ineffective TA.…”

“…19 Similarly, intracoronary fibrinolysis with low-dose urokinase, tenecteplase or alteplase has also been described in cases of large thrombus burden and failed manual aspiration. 20,21 It is surprising that in the study by Luz et al, 12 while aspirin 300 mg and clopidogrel 600 mg were given to all patients before PCI, use of Gp IIb/IIIa inhibitors was low overall and similar in those with ineffective (38%) and effective TA (33.5%). In the Portuguese National Registry of Interventional Cardiology, of 3311 patients who underwent thrombectomy between January 2006 and December 2012 (performed in 46.1% of PCI procedures in 2012), use of Gp IIb/IIIa inhibitors was also low (36.9%) but significantly higher than in those undergoing primary angioplasty alone (18.9%, p=0.001).…”

“…The article by Luz et al 12 published in this issue of the Journal assesses the impact of ineffective TA in a series of 417 consecutive patients at a single center where the technique was routinely used. The authors defined TA failure as persistence of TIMI flow 0 or 1, which was observed in 12.5% of the study population.…”