Comparison of AngioJet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting With Direct Stenting Alone in Patients With Acute Myocardial Infarction The JETSTENT Trial

Careggi Hospital, Florence, Italy.
Journal of the American College of Cardiology (Impact Factor: 16.5). 10/2010; 56(16):1298-306. DOI: 10.1016/j.jacc.2010.06.011
Source: PubMed


The aim of this study was to determine whether rheolytic thrombectomy (RT) before direct infarct artery stenting as compared with direct stenting (DS) alone results in improved myocardial reperfusion and clinical outcome in patients with acute myocardial infarction.
The routine removal of thrombus before infarct artery stenting is still a matter of debate.
This is a multicenter, international, randomized, 2-arm, prospective study. Eligible patients were patients with acute myocardial infarction, angiographic evidence of thrombus grade 3 to 5, and a reference vessel diameter ≥2.5 mm. Coprimary end points were early ST-segment resolution and (99m)Tc-sestamibi infarct size. An α value = 0.05 achieved by both coprimary surrogate end points or an α value = 0.025 for a single primary surrogate end point would be considered evidence of statistical significance. Other surrogate end points were Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, corrected TIMI frame count, and TIMI grade 3 blush. Clinical end points were a composite of major adverse cardiovascular events at 1, 6, and 12 months.
From December 2005 to September 2009, 501 patients were randomly allocated to RT before DS or to DS alone. The ST-segment resolution was more frequent in the RT arm as compared with the DS alone arm: 85.8% and 78.8%, respectively (p = 0.043), while no difference between groups were revealed in the other surrogate end points. The 6-month major adverse cardiovascular events rate was 11.2% in the thrombectomy arm and 19.4% in the DS alone arm (p = 0.011). The 1-year event-free survival rates were 85.2 ± 2.3% for the RT arm, and 75.0 ± 3.1% for the DS alone arm (p = 0.009).
Although the primary efficacy end points were not met, the results of this study support the use of RT before infarct artery stenting in patients with acute myocardial infarction and evidence of coronary thrombus. (AngioJet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting in Patients Undergoing Primary PCI for Acute Myocardial Infarction [JETSTENT]; NCT00275990).


Available from: Alfredo E Rodríguez
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    • "Mechanical (Export Medtronic device) or Rheolytic (AngioJet rheolytic thrombectomy System, Medrad Interventional/Possis, Minneapolis, Minnesota) thrombus aspiration was performed according to the interventional cardiologist's discretion [12] [14]. The primary outcomes were mortality rate during ICCU stay and at follow-up. "

    International journal of cardiology 04/2013; 168(3). DOI:10.1016/j.ijcard.2013.04.077 · 4.04 Impact Factor
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    • "The use of AngioJet Rheolytic Thrombectomy (Medrad Interventional/Possis, Minneapolis, MN) was studied in two relatively large randomized trials. In both the AIMI (AngioJet Rheolytic Thrombectomy in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction) [39] and JETSTENT (AngioJet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting in Patients Undergoing Primary PCI for Acute Myocardial Infarction) [40] trials, the primary endpoints were not met. In 480 patients in the AIMI trial, the use of rheolytic thrombectomy (RT) was associated with the increase of infarct size (p = 0.03), reduction in TIMI-3 flow (p < 0.05), and higher MACE rate at 30 days (p = 0.01). "
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    ABSTRACT: Primary percutaneous coronary intervention is the best treatment of patients with ST elevation myocardial infarction (STEMI). When managing a STEMI patient, our approach must be rapid and aggresive in order to interrupt the pathological process of thrombus formation and stabilization. The therapy must be initiated prior to angiography (pretreatment), continued during the procedure (periprocedural), recovery phase (in-hospital), and follow-up. The treatment strategies resulting in thrombus dissolution/extraction have focused on optimization of both pharmacological and interventional therapies. At present, there is no optimal evidence-based approach to all patients with STEMI, and the treatment of these patients needs to be modified with respect to the risk profile, availability of medical resources, and our experience. In this review, we summarize current pharmacological and interventional strategies used in the setting of STEMI and discuss potential benefits of novel dosing regimens and combinations of drugs and techniques.
    Journal of Cardiovascular Translational Research 02/2013; 6(3). DOI:10.1007/s12265-013-9448-1 · 3.02 Impact Factor
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    • "It may be that these two techniques (AT vs. MT) have differential benefits relative to the angiographic situation applied. For example, AT is not always successful, especially in patients with large thrombus, and may also promote by itself distal embolization and no-reflow [29], whereas RT is very effective in removing large thrombus [21-24, 26]. Therefore, large studies comparing the two techniques, possibly under different angiographic scenarios are needed. "
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    ABSTRACT: Primary percutaneous coronary intervention, (pPCI), of native coronaries and saphenous vein grafts (SVGs), is the recommended reperfusion strategy for STEMI, and an early invasive approach is recommended for high risk patients with UA/NSTEMI. Although PCI effectively restores flow in the infarct related artery/culprit vessel in both situations, myocardial perfusion often remains suboptimal due to microvascular obstruction, partly attributed to distal embolization of thrombus. Hence, thrombectomy (manual or mechanical), prior to stenting may further reduce hard clinical end points in patients with ACS. This article discusses accumulated evidence regarding the safety and effectiveness of thrombectomy in culprit native coronaries and SVGs in such patients, as well as possible strategies for maximizing its benefits relative to the size of the thrombotic burden.
    Current Cardiology Reviews 08/2012; 8(3). DOI:10.2174/157340312803217265
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