Presentation on theme: "Comparison of AngioJET Rheolytic Thrombectomy Before Direct Infarct Artery STENTing in Patients with Acute Myocardial Infarction: the JETSTENT trial David."— Presentation transcript:
Comparison of AngioJET Rheolytic Thrombectomy Before Direct Infarct Artery STENTing in Patients with Acute Myocardial Infarction: the JETSTENT trial David Antoniucci on behalf of the JETSTENT Investigators
Co-Principal Investigators David Antoniucci, MD; Florence Antonio Colombo, MD; Milan Clinical Event Adjudication Committee Isaam Moussa, M.D., Chairman Weill Cornell Medical Center, NYC Gian Battista Danzi, M.D., Ospedale Maggiore Policlinico University of Milan, Milan Carlo DiMario, M.D., PhD, Royal Brompton Hospital, London Data Management and Monitoring Director: Maria Cristina Jori, M.D. Mediolanum Cardio Research, Milan ECG Core Laboratory Serenella Castelvecchio, M.D. Mediolanum Cardio Research, Milan Angiographic Core Laboratory Maria Antonietta Bonardi, M.D. Mediolanum Cardio Research, Milan Nuclear Scan Core Laboratory Prof. Roberto Sciagrà, University of Florence, Florence Steering Committe D Antoniucci, A Colombo, F-J Neumann, A Rodriguez, A Stabile, J Gustafson Sponsor: Medrad Interventional/Possis
After angiography and IRA wiring: thrombus grade 3 to 5 Randomization 1:1 Pts with STEMI admitted within 12 hours from symptom onset Lysis Stroke < 30 days Surgery < 6 weeks Pre-stented IRA Rheolytic Thrombectomy +DSDirect Stenting (DS) Study Design N = 500
JETSTENT TRIAL Primary surrogate end points: Early ST-segment resolution (≥ 50% ST segment elevation reduction at 30 minutes) Infarct size (1-month 99m Tc sestamibi scintigraphy) Clinical end points: MACE at 1, 6, and 12 months, Death and Readmission for HCF at 12 months Secondary surrogate end points: TIMI flow, cTFC, and TIMI blush
Conclusions Rheolytic thrombectomy before direct IRA stenting as compared to direct IRA stenting alone is associated with a better myocardial reperfusion (higher early ST-segment resolution rate) and improved 6-month clinical outcome (lower MACCE rate). The results of the JETSTENT trial support the routine use of rheolytic thrombectomy in STEMI patients with evidence of thrombus.
30 min. ST Reduction ≥ 50% (n=471) OR95%CIp value Randomization to RT 1.811.09 – 3.00.022 Anterior AMI0.280.17 – 0.46<.001 Abciximab4.281.22 – 14.95.023 TIMI 3 flow2.101.17 - 3.80.013 Predictors of ST-segment resolution and 1-month MACE Logistic regression (forward stepwise) 1-month MACE (n=486) OR95%CIp value Randomization to RT 0.300.11 – 0.80.017 Abciximab0.100.02 – 0.43.002 TIMI 3 flow0.160.06 – 0.41<.001 Major bleeding9.112.17 – 38.17.003