Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (firstname.lastname@example.org).
To the Editor: The study by Dr Stone and colleagues1 investigated the effect on infarct size of a pharmacological strategy, a mechanical strategy, or both aimed at improving myocardial perfusion at the tissue level. Distal embolization is considered to play a major role in poor myocardial perfusion at the tissue level and is associated with poor angiographic results, larger infarct size, and subsequent worse clinical outcomes after primary percutaneous coronary intervention (PCI).2 Previous studies have shown a beneficial effect of manual thrombectomy on markers of reperfusion and infarct size.3 The Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction study (TAPAS) showed that manual thrombectomy resulted in better myocardial blush and ST-segment resolution.4 However, in the INFUSE-AMI study, manual thrombectomy was not associated with an improvement in these surrogate end points and subsequent smaller infarct size.
Kikkert WJ, Henriques JPS. Abciximab vs Thrombectomy for Reperfusion in Myocardial Infarction. JAMA. 2012;308(6):565–567. doi:10.1001/jama.2012.8155