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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ERheolytic thrombectomy plus stenting is associated with better 6-month outcomes and improved myocardial reperfusion compared with direct stenting alone in patients with ST-elevation myocardial infarction. While procedure time was higher in the thrombectomy group (60 minutes) than in the direct stenting group (46 minutes; p\u0026lt;0.001), this did not appear to impact the rate of procedural complications, such as the need for pacing to vessel perforation. This article discusses results from the Comparison of Angiojet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting to Direct Stenting Alone in Patients with Acute Myocardial Infarction [JETSTENT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00275990\u0026amp;atom=%2Fspmdc%2F10%2F2%2F17.atom\u0022\u003ENCT00275990\u003C\/a\u003E[Trial].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ERheolytic thrombectomy plus stenting is associated with better 6-month outcomes and improved myocardial reperfusion compared with direct stenting alone in patients with ST-elevation myocardial infarction (STEMI). While procedure time was higher in the thrombectomy group (60 minutes) than in the direct stenting group (46 minutes; p\u0026lt;0.001), this did not appear to impact the rate of procedural complications, such as the need for pacing to vessel perforation. David Antoniucci, MD, Careggi Hospital, Florence, Italy, discussed results from the Comparison of Angiojet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting to Direct Stenting Alone in Patients with Acute Myocardial Infarction (JETSTENT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00275990\u0026amp;atom=%2Fspmdc%2F10%2F2%2F17.atom\u0022\u003ENCT00275990\u003C\/a\u003E) Trial.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe JETSTENT study included 500 patients with STEMI within 12 hours of symptom onset, at least moderate thrombus burden, and infarct artery vessel diameter \u22652.5 mm. Patients were randomized to either rheolytic thrombectomy (RT) plus stenting (n=256) or direct stenting (DS) alone (n=245). The use of a temporary pacemaker and balloon predilation was strongly discouraged. Patients with recent stroke (\u226430 days), recent surgery (\u22646 weeks), a prestented infarct-related artery, or lysis were excluded from participation in the study. However, cardiogenic shock was not grounds for exclusion and accounted for 2.7% of patients in the RT group and 5.3% of patients in the DS group. The mean follow-up was 6 months, and the mean age was 63 years. Patients were well matched at baseline.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe primary surrogate endpoints were early ST-segment resolution, defined as \u226550% reduction in ST-segment elevation at 30 minutes, and final infarct size at one month, determined by scintigraphy. Clinical endpoints were major adverse cardiac events (MACEs) at 1, 6, and 12 months and death or readmission for congestive heart failure at 12 months. The secondary surrogate endpoints included Thrombolysis in Myocardial Infarction (TIMI) flow, corrected TIMI frame count, and TIMI blush grade.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThere was no significant difference in final infarct size between RT and DS (p=0.40). However, ST-segment resolution at 30 minutes was significantly improved in patients who underwent RT compared with DS (p=0.04). However, anterior acute MI appeared to be a predictor of ST-segment resolution (p\u0026lt;0.001). At one month, there was a 2-fold increase in MACEs in patients who received DS compared with RT (6.9% vs 3.1% for RT; p=0.05). DS was also associated with higher rates of death, MI, total vessel revascularization, and stroke compared with RT at one month. This trend continued at 6 months, with the exception of stroke incidence, which was identical in both groups (0.4% for both). TIMI major bleeding occurred in 3.9% of RT patients versus 1.6% of DS patients (p=0.12). However, this difference did not reach statistical significance. Total MACE rate at 6 months was 20.7% for the DS group versus 12.0% for the RT group (p=0.01). Randomization to RT, age, and bleeding appeared to be predictors of MACEs at 6 months (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u00226-Month MACE Kaplan-Meier Estimate.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1747871320\u0022 data-figure-caption=\u00226-Month MACE Kaplan-Meier Estimate.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/17\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/2\/17\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11197\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003E6-Month MACE Kaplan-Meier Estimate.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from D. Antoniucci, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe JETSTENT trial demonstrated benefit for RT use in patients with STEMI. This strategy is associated with higher rates of early ST-segment resolution and improved clinical outcomes at 6 months. These improvements occurred without any apparent increase in stroke or major bleeding. Further evaluation is required to confirm the long-term safety and efficacy of this strategy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/2\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmtg2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmtg2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}