DOI: https://doi.org/10.53350/pjmhs2023171856 ORIGINAL ARTICLE 856 P J M H S Vol. 17, No. 01, January, 2023 Outcomes of Patients who Received Bailout Thrombectomy for Primary Percutaneous Coronary Intervention OSAMA 1 , BADR MANSOOR 2 , SYED MOHAMMAD ALI ZAIN SHAH 3 , MASSIHA GULZAR AHMAD 4 , AHMAD MUSTAFA 5 , FARAZ ALI 6 , MUHAMMAD ALI KHAN 7 , GULZAR AHMAD 8 1,2,3,6 Fellow Interventional Cardiology, Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan 4 Emergency Medicine Resident, Emergency Medicine Department, Combined Military Hospital, Lahore, Pakistan 5 Assistant Professor of Medicine, Rashid Lateef Khan University, Lahore, Pakistan 7 Senior House Officer FY2, Emergency Department, Queen Alexandra Hospital, Portsmouth, United Kingdom 8 Professor of Psychology, Lahore Leads University, Lahore, Pakistan Corresponding author: Osama, Email: osamagulzar@gmail.com ABSTRACT Objective: The purpose of this study was to compare outcomes among patients undergoing primary percutaneous coronary intervention with and without bailout thrombectomy. Study Design: Observational/ cross sectional study. Place and Duration: This observational/cross sectional study was conducted at Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan in the period from March,2022 to August, 2022. Methods: Total 140 patients of both gender had ST elevation myocardial infarction were presented for primary percutaneous coronary intervention. Patients were included after getting informed written consent for detailed demographics such as gender, age, comorbidities and history of CAD. We divided patients into two groups. Group I received only PPCI in 70 cases and 70 cases of group II received only PPCI with bailout thrombectomy. After PPCI comma results of both groups were compared. To analyzation of data, we use SPSS 18.0. Results: Among all presented cases, 80 (57.1%) were male patients and 60 (42.9%) were females. The patients mean age in group I was 53.17±11.62 years and in group II mean age was 55.9±10.94 years. Diabetes mellitus was the most common comorbidity found among both groups 35(50%) in group I and 27(38.6%) in group II followed by hypertension 21(30%) in group I and 24(34.3%) in group II. Family history of coronary artery disease (CAD) in group I was 19(27.1%) and in group II was 23(32.9%).There was no significance difference found in both groups in terms of mortality. There was significant higher number of renal impairment, stroke, heart failure, excess bleeding and renal infarction in group II as compared to group I with p value<0.05. Hospital stay was also higher in group II as compared to group I with p value<0.04. Conclusion: It is determined that patients who underwent bailout thrombectomy for percutaneous coronary intervention (PCI) had a significant risk of comorbidities. Between the two groups, there was no discernible variation in mortality. Those who underwent bailout thrombectomy, however, had higher rates of post-procedure stroke and renal impairment. Keywords, Bailout thrombectomy, Outcomes, ST-segment elevated myocardial infarction, PPCI. INTRODUCTION In patients with ST-segment elevation myocardial infarction, primary percutaneous coronary intervention (PCI), when possible, is the most efficient way to achieve reperfusion (STEMI). [1] The potential for thrombus distal embolization and failure to restore flow at the microvascular level, however, are significant drawbacks of primary PCI. It has been demonstrated that indicators of microvascular tissue reperfusion, such as the degree of ST- segment resolution or the grade of angiographic myocardial blush, can predict the mortality rate following initial PCI. [2,3] Before the placement of a stent, the thrombus can be removed manually to reduce distal embolization and increase microvascular perfusion. Improvements in tissue reperfusion indicators have been observed in small, randomised studies of thrombectomy. [4]In the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), the primary endpoint of myocardial blush grade was improved, and thrombectomy was associated with decreased mortality. [5,6] After this, regular manual thrombectomy was advocated in practise recommendations. [7] Because of this, thrombectomy has rapidly expanded in popularity and been incorporated into clinical practise. One of the variables most significantly linked to outcome in ST-segment elevation myocardial infarction (STEMI) is time to reperfusion. [8,9] After first percutaneous coronary intervention, ischemia duration may be related to the degree of myocardial healing (PCI). There is a theory that thrombus aspiration is advantageous for patients who appear early since observational analyses have revealed that it is less helpful for individuals with prolonged ischemia durations. [10] Others claim that patients with prolonged ischemia periods have structured thrombi, necessitating and benefiting more from thrombus aspiration. This topic was ready to be answered by the TOTAL (Thrombectomy with PCI versus PCI Alone in Patients with STEMI) experiment, which randomly assigned 10 732 STEMI patients to receive either upfront thrombus aspiration with PCI or PCI alone. Overall, the TOTAL trial found that manual thrombectomy followed by PCI, as opposed to PCI alone, was not associated with a lower risk of the primary outcomes of cardiovascular (CV) death, myocardial infarction (MI), cardiogenic shock, or heart failure. Instead, it was linked to a higher risk of stroke. [11] However, two more substantial randomized clinical trials, the TASTE (Thrombus Aspiration in STEMI in Scandinavia) as well as TOTAL (Trial of Routine Aspiration Thrombectomy with PCI vs PCI Alone in Patients with STEMI) studies, did not find any advantages of aspiration thrombectomy in lowering the risk of all-cause or cardiovascular mortality, reoccurring myocardial infarction, or stent thrombosis. [12] Even elevated stroke rates at 30 days and a year were discovered in the TOTAL research in relation to aspiration thrombectomy. [13] Aspiration thrombectomy is used more selectively in real- world settings than in randomised control trials because it is dependent on the doctor's assessment of the target lesions' unique architecture, coronary flow, and thrombus load. Hence, thrombectomy used selectively vs used in randomised control studies may result in differing clinical results. The prognosis of PPCI has also been shown to be related to hospital and physician volumes. [14,15] The goal of the current study was to compare the results of bailout thrombectomy for PPCI with patients who only got PCI in order to assess the effectiveness of the procedure in patients with acute STEMI. MATERIALS AND MEHODS This observational/cross sectional study was conducted at Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan in the period from March,2022 to August, 2022 and comprised of 140 cases of STEMI. Patients over