Safety and efficacy of the AngioJet in patients with acute myocardial infarction: results from the Florence Appraisal Study of Rheolytic Thrombectomy (FAST).

OBJECTIVES

To assess the safety and efficacy of the AngioJet coronary device, given the uncertain risk-benefit balance of rheolytic thrombectomy in patients with acute myocardial infarction (AMI).

BACKGROUND

Current risk of inadequate myocardial perfusion for thrombus embolization in primary coronary interventions is not negligible. The AngioJet thrombectomy device showed promising results in terms of safety and efficacy, but failed to confirm them in a large, multicenter, randomized trial, and the risk-benefit balance is still uncertain.

METHODS

The AngioJet device was employed in 116 consecutive patients with AMI and angiographic evidence of extensive thrombosis in a vessel with a reference diameter > 2.5 mm. Stents and glycoprotein IIb/IIIa inhibitors were liberally used. Epicardial and myocardial reperfusion angiographic parameters, and in-hospital major adverse cardiac events (MACE, i.e., cardiac death, myocardial infarction, target vessel revascularization) were assessed.

RESULTS

The AngioJet was successfully used in all patients. Angiographic analysis showed that the AngioJet significantly improved epicardial coronary flow (p < 0.01), frame count (p < 0.01) and myocardial blush (p < 0.01), while stenting yielded significant improvements only in diameter stenosis, minimum lesion diameter and correlated vessel parameters (p < 0.01). In-hospital MACE were uncommon [9 (8%)], despite the patientsO characteristics. When compared to an AMI population with similar thrombus burden but not undergoing thrombectomy, our AngioJet population showed significant improvement of reperfusion parameters. Moreover, there was greater AngioJet benefit in the high versus moderate thrombus burden subset; laboratory and operator experience also correlated significantly with final angiographic results.

CONCLUSIONS

Our study supports the favorable risk-benefit profile of AngioJet device use in selected patients with AMI when used in experienced laboratories and by trained operators.