PMID- 21095287
OWN - NLM
STAT- MEDLINE
DCOM- 20110118
LR  - 20101124
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 160
IP  - 5
DP  - 2010 Nov
TI  - Thrombus aspiration followed by direct stenting: a novel strategy of primary 
      percutaneous coronary intervention in ST-segment elevation myocardial infarction. 
      Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE 
      Trial).
PG  - 966-72
LID - 10.1016/j.ahj.2010.07.024 [doi]
AB  - BACKGROUND: Previous studies with thrombectomy showed different results, mainly 
      due to use of thrombectomy as an additional device not instead of balloon 
      predilatation. The aim of the present study was to assess impact of aspiration 
      thrombectomy followed by direct stenting. METHODS: Patients with ST elevation 
      myocardial infarction (STEMI) <6 hours from pain onset and occluded 
      infarct-related artery in baseline angiography were randomized into aspiration 
      thrombectomy followed by direct stenting (TS, n = 100) or standard balloon 
      predilatation followed by stent implantation (n = 96). The primary end point of 
      the study was the electrocardiographic ST-segment elevation resolution >70% (STR 
      > 70%) 60 minutes after primary angioplasty (percutaneous coronary intervention 
      [PCI]). Secondary end points included angiographic myocardial blush grade (MBG) 
      after PCI, combination of STR > 70% immediately after PCI and MBG grade 3 
      (optimal myocardial reperfusion), Thrombolysis In Myocardial Infarction flow 
      after PCI, angiographic complications, and in-hospital major adverse cardiac 
      events. RESULTS: Aspiration thrombectomy success rate was 91% (crossing of the 
      lesion with thrombus reduction and flow restoration). There was no significant 
      difference in STR >/= 70% after 60 minutes (53.7% vs 35.1%, P = .29). STR > 70% 
      immediately after PCI (41% vs 26%, P < .05), MBG grade 3 (76% vs 58%, P < .03), 
      and optimal myocardial reperfusion (35.1% vs 11.8%, P < .001) were more frequent 
      in TS. There was no difference in between the groups in 6-month mortality (4% vs 
      3.1%, P = .74) and reinfarction rate (1% vs 3.1%, P = .29). CONCLUSIONS: 
      Aspiration thrombectomy and direct stenting is safe and effective in STEMI 
      patients with early presentation (<6 hours). The angiographic parameters of 
      microcirculation reperfusion and ECG ST-segment resolution directly after PCI 
      were significantly better in thrombectomy group despite the lack of the 
      difference in ST-segment resolution 60 minutes after PCI.
CI  - Copyright (c) 2010 Mosby, Inc. All rights reserved.
FAU - Dudek, Dariusz
AU  - Dudek D
AD  - Department of Interventional Cardiology Jagiellonian University Medical College, 
      Krakow, Poland. mcdudek@cyf-kr.edu.pl
FAU - Mielecki, Waldemar
AU  - Mielecki W
FAU - Burzotta, Francesco
AU  - Burzotta F
FAU - Gasior, Mariusz
AU  - Gasior M
FAU - Witkowski, Adam
AU  - Witkowski A
FAU - Horvath, Ivan G
AU  - Horvath IG
FAU - Legutko, Jacek
AU  - Legutko J
FAU - Ochala, Andrzej
AU  - Ochala A
FAU - Rubartelli, Paolo
AU  - Rubartelli P
FAU - Wojdyla, Roman M
AU  - Wojdyla RM
FAU - Siudak, Zbigniew
AU  - Siudak Z
FAU - Buchta, Piotr
AU  - Buchta P
FAU - Pregowski, Jerzy
AU  - Pregowski J
FAU - Aradi, Daniel
AU  - Aradi D
FAU - Machnik, Andrzej
AU  - Machnik A
FAU - Hawranek, Michal
AU  - Hawranek M
FAU - Rakowski, Tomasz
AU  - Rakowski T
FAU - Dziewierz, Artur
AU  - Dziewierz A
FAU - Zmudka, Krzysztof
AU  - Zmudka K
LA  - eng
SI  - ClinicalTrials.gov/NCT00377650
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Coronary Angiography
MH  - Coronary Thrombosis/complications/*surgery
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hungary
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/etiology/physiopathology/*therapy
MH  - Poland
MH  - Retrospective Studies
MH  - *Stents
MH  - Suction/*methods
MH  - Thrombectomy/*methods
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2010/11/26 06:00
MHDA- 2011/01/19 06:00
CRDT- 2010/11/25 06:00
PHST- 2010/04/12 00:00 [received]
PHST- 2010/07/25 00:00 [accepted]
PHST- 2010/11/25 06:00 [entrez]
PHST- 2010/11/26 06:00 [pubmed]
PHST- 2011/01/19 06:00 [medline]
AID - S0002-8703(10)00667-8 [pii]
AID - 10.1016/j.ahj.2010.07.024 [doi]
PST - ppublish
SO  - Am Heart J. 2010 Nov;160(5):966-72. doi: 10.1016/j.ahj.2010.07.024.