A-58 | Process Times in High Thrombus Burden ST-Elevation Myocardial Infarction Patients Treated with Sustained Mechanical Aspiration Thrombectomy Before Percutaneous Coronary Intervention: A Subset Analysis of the CHEETAH Study

BackgroundSustained mechanical aspiration thrombectomy before percutaneous coronary intervention (PCI) may improve outcomes for high thrombus burden ST-elevation myocardial infarction (STEMI) patients. The effect of adding an aspiration thrombectomy step on process times was evaluated.MethodsCHEETAH was a post-market, prospective study that enrolled patients treated frontline with the Indigo CAT RX Aspiration System (Penumbra, Inc.) before PCI at 25 US hospitals. Adults presenting within 12 hours with a target lesion(s) located in a native coronary artery and TIMI thrombus grade 4-5 by physician visual estimate were enrolled. Door to device time, door to reperfusion time, and total aspiration time were recorded. Door to device time was defined as the time from treatment facility arrival (or symptom onset, for in-hospital STEMI subjects) to the first insertion of the aspiration catheter. The rates of final TIMI flow grade 3, final myocardial blush grade (MBG) 3, and major adverse cardiovascular events (MACE) within 30 days were also recorded.ResultsOf the 400 patients enrolled in CHEETAH, 350 (87.50%) presented with STEMI (mean age, 61.0 years; 24.3% female). For these patients, the median door to device time was 48 minutes (IQR 32-71), the median door to reperfusion time was 53 minutes (IQR 36-76), and the median aspiration time was 65 seconds (IQR 44-123). Final TIMI flow grade 3 was achieved by 97.43%, final MBG 3 was achieved by 99.71%, and MACE occurred in 3.14%.ConclusionsFor CHEETAH patients with STEMI, the median door to device and door to reperfusion times were consistent with the median door to balloon time recently reported from the NCDR CathPCI registry (61 minutes). Sustained mechanical aspiration thrombectomy before PCI facilitated flow and reperfusion restoration, had a low MACE rate, and had a fast door to reperfusion time.DisclosuresS. A. Parikh: Abbott: Advisory Board/Board Member and Principal Investigator for a Research Study; Boston Scientific Corp.: Advisory Board/Board Member and Principal Investigator for a Research Study; Medtronic: Advisory Board/Board Member; Philips: Advisory Board/Board Member; Cordis: Advisory Board/Board Member; Janssen: Advisory Board/Board Member; Terumo: Consulting; Penumbra: Consulting; Canon: Consulting; Inari: Consulting; Abiomed: Consulting; Surmodics: Principal Investigator for a Research Study; TriReme: Principal Investigator for a Research Study; Acotec: Principal Investigator for a Research Study; Heartflow: Principal Investigator for a Research Study; Shockwave: Principal Investigator for a Research Study; J. W. Chambers: Boston Scientific Corp.: Consulting; Teleflex: Consulting and Royalties; CSI: Consulting; Cordis: Consulting; 4c medical: Ownership Interests: Stocks, Stock Options; S. J. Mathews: Penumbra: Consulting, Principal Investigator for a Research Study and Speaker Bureau; J. Singh Nothing to disclose. D. C. Metzger Nothing to disclose. M. G. H. Ghali Nothing to disclose. W. Wu Nothing to disclose. BackgroundSustained mechanical aspiration thrombectomy before percutaneous coronary intervention (PCI) may improve outcomes for high thrombus burden ST-elevation myocardial infarction (STEMI) patients. The effect of adding an aspiration thrombectomy step on process times was evaluated. Sustained mechanical aspiration thrombectomy before percutaneous coronary intervention (PCI) may improve outcomes for high thrombus burden ST-elevation myocardial infarction (STEMI) patients. The effect of adding an aspiration thrombectomy step on process times was evaluated. MethodsCHEETAH was a post-market, prospective study that enrolled patients treated frontline with the Indigo CAT RX Aspiration System (Penumbra, Inc.) before PCI at 25 US hospitals. Adults presenting within 12 hours with a target lesion(s) located in a native coronary artery and TIMI thrombus grade 4-5 by physician visual estimate were enrolled. Door to device time, door to reperfusion time, and total aspiration time were recorded. Door to device time was defined as the time from treatment facility arrival (or symptom onset, for in-hospital STEMI subjects) to the first insertion of the aspiration catheter. The rates of final TIMI flow grade 3, final myocardial blush grade (MBG) 3, and major adverse cardiovascular events (MACE) within 30 days were also recorded. CHEETAH was a post-market, prospective study that enrolled patients treated frontline with the Indigo CAT RX Aspiration System (Penumbra, Inc.) before PCI at 25 US hospitals. Adults presenting within 12 hours with a target lesion(s) located in a native coronary artery and TIMI thrombus grade 4-5 by physician visual estimate were enrolled. Door to device time, door to reperfusion time, and total aspiration time were recorded. Door to device time was defined as the time from treatment facility arrival (or symptom onset, for in-hospital STEMI subjects) to the first insertion of the aspiration catheter. The rates of final TIMI flow grade 3, final myocardial blush grade (MBG) 3, and major adverse cardiovascular events (MACE) within 30 days were also recorded. ResultsOf the 400 patients enrolled in CHEETAH, 350 (87.50%) presented with STEMI (mean age, 61.0 years; 24.3% female). For these patients, the median door to device time was 48 minutes (IQR 32-71), the median door to reperfusion time was 53 minutes (IQR 36-76), and the median aspiration time was 65 seconds (IQR 44-123). Final TIMI flow grade 3 was achieved by 97.43%, final MBG 3 was achieved by 99.71%, and MACE occurred in 3.14%. Of the 400 patients enrolled in CHEETAH, 350 (87.50%) presented with STEMI (mean age, 61.0 years; 24.3% female). For these patients, the median door to device time was 48 minutes (IQR 32-71), the median door to reperfusion time was 53 minutes (IQR 36-76), and the median aspiration time was 65 seconds (IQR 44-123). Final TIMI flow grade 3 was achieved by 97.43%, final MBG 3 was achieved by 99.71%, and MACE occurred in 3.14%. ConclusionsFor CHEETAH patients with STEMI, the median door to device and door to reperfusion times were consistent with the median door to balloon time recently reported from the NCDR CathPCI registry (61 minutes). Sustained mechanical aspiration thrombectomy before PCI facilitated flow and reperfusion restoration, had a low MACE rate, and had a fast door to reperfusion time. For CHEETAH patients with STEMI, the median door to device and door to reperfusion times were consistent with the median door to balloon time recently reported from the NCDR CathPCI registry (61 minutes). Sustained mechanical aspiration thrombectomy before PCI facilitated flow and reperfusion restoration, had a low MACE rate, and had a fast door to reperfusion time.