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January 11, 2012

Thromboaspiration Before Intra-aortic Balloon Counterpulsation—Reply

Author Affiliations

Author Affiliations: Duke University Medical Center, Durham, North Carolina (Drs Patel and Ohman) (Manesh.patel@duke.edu); and Memorial Hermann Heart and Vascular Institute, University of Texas Medical School at Houston, Houston (Dr Smalling).

JAMA. 2012;307(2):146-147. doi:10.1001/jama.2011.1987

In Reply: Dr Potter questions the use of thromboaspiration in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI) trial. There is growing evidence that, when possible, a strategy of thrombectomy with stent placement at the time of primary PCI improves clinical outcomes, leading to a class IIA recommendation in the most recent American College of Cardiology Foundation/American Heart Association PCI guidelines1 However, the rates of thrombectomy were similar in both randomized groups of the CRISP trial, and evaluation of infarct size by thromboaspiration (41% of the left ventricle) compared with no thromboaspiration (39%) did not demonstrate a significant difference. Investigators were asked to perform PCI based on guideline recommendations and standard of care, and the rates represent the evolving evidence and practice of primary PCI. We agree that as the knowledge base becomes solidified, future studies should make stronger recommendations on the use of thrombectomy at the time of primary PCI.