Routine aspiration thrombectomy improves the diagnosis and management of embolic myocardial infarction.

OBJECTIVES: Assess the effect of aspiration thrombectomy on diagnosis and management of embolic acute myocardial infarction. BACKGROUND: Discrimination of embolic acute myocardial infarction from atherosclerotic plaque rupture/erosion prompts oral anticoagulation treatment of source of embolus, as well as avoiding unnecessary stenting and dual antiplatelet therapy. However, detection is difficult without aspiration. METHODS: We compared rates of diagnosis of embolic infarction for 2.5 years prior to (pre-RAT) and 2.5 years post routine aspiration thrombectomy (post-RAT). Baseline demographics, outcomes, and treatment strategies were also compared between the embolic infarction and atherosclerotic infarction. RESULTS: Diagnosed embolic infarction rose from 1.2% in the pre-RAT era to 2.8% in the post-RAT period (P < 0.05). In addition, more successful removal of thrombus by aspiration led to less stenting (20% vs. 55% P < 0.05) in the post-RAT period thus avoiding the hazards of "triple therapy." Embolic infarction was more frequently associated with atrial fibrillation (55% vs. 8%), had higher mortality (17% vs. 4%), and had higher rates of embolic stroke (13% vs. 0.3%) when compared with atherosclerotic MI (all P < 0.05). CONCLUSIONS: Routine aspiration thrombectomy more readily identifies embolic infarction allowing more specific therapy and avoidance of stenting and triple anticoagulant therapy.

Prospective survey of serial troponin T requesting in an acute teaching hospital.

BACKGROUND: Requests for troponin T, a biomarker for myocardial infarction, may be sent in a variety of clinical situations. In most cases, a single sample 12 hours or more after symptom onset should be sufficient for diagnosis. We chose to investigate how troponin T testing is used in our hospital with emphasis on those who had serial rather than single troponin measurements during their hospital stay. METHODS: Prospective survey of 50 patients with serial troponin T requests out of a total of 321 patients who had troponin T levels measured during the same time period. RESULTS: The time of symptom onset could be clearly identified in 40/50 patients. In 22 of these the first troponin was taken prior to 12 hours after symptom onset. For the 18 patients whose first troponin was taken after 12 hours, the second result remained in the same category (normal or high) as the first in all cases. This was not the case for 3/10 patients whose first troponin was sent within 12 hours and was normal. Early troponin results rarely affected immediate patient management and did not inform decisions about fibrinolytic therapy. CONCLUSIONS: Serial troponin testing was most commonly due to a sample being sent within 12 hours of symptom onset or to unnecessary repetition of an appropriately timed sample. Patient management was rarely enhanced by early troponin testing.