Routine aspiration thrombectomy improves the diagnosis and management of embolic myocardial infarction

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Abstract

Objectives:

Assess the effect of aspiration thrombectomy on diagnosis and management of embolic acute myocardial infarction.

Background:

Discrimination of embolic acute myocardial infarction from atherosclerotic plaque rupture/erosion prompts oral anticoagulation treatment of source of embolus, as well as avoiding unnecessary stenting and dual antiplatelet therapy. However, detection is difficult without aspiration.

Methods:

We compared rates of diagnosis of embolic infarction for 2.5 years prior to (pre-RAT) and 2.5 years post routine aspiration thrombectomy (post-RAT). Baseline demographics, outcomes, and treatment strategies were also compared between the embolic infarction and atherosclerotic infarction.

Results:

Diagnosed embolic infarction rose from 1.2% in the pre-RAT era to 2.8% in the post-RAT period (P< 0.05). In addition, more successful removal of thrombus by aspiration led to less stenting (20% vs. 55%P< 0.05) in the post-RAT period thus avoiding the hazards of “triple therapy.” Embolic infarction was more frequently associated with atrial fibrillation (55% vs. 8%), had higher mortality (17% vs. 4%), and had higher rates of embolic stroke (13% vs. 0.3%) when compared with atherosclerotic MI (allP< 0.05).

Conclusions:

Routine aspiration thrombectomy more readily identifies embolic infarction allowing more specific therapy and avoidance of stenting and triple anticoagulant therapy. © 2015 Wiley Periodicals, Inc.

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