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Topic Suggestion Description

Date submitted: June 19, 2008

1. Your Nomination - Please briefly describe in your own words the question about a health care test or treatment that interests or concerns you:

Thrombosis plays a a key role in the pathophysiology of myocardial infarction-a leading cause of morbidity and mortality. There have been a number of devices proposed for mechanical thrombectomy in patients with in the setting of acute coronary syndromes. What are the various mechanical thrombectomy devices used in patients with acute coronary syndromes? What are the indications for their use (e.g. ST elevation myocardial infarction with an angiographically visible thrombus, acute or sub acute stent thrombosis) What are the advantages and disadvantages of such devices compared to cadiac catherization without use of such a device?

What are the associated harms?

2. Why do you think your question is important? (you may select more than one category if appropriate)
 My question relates to a very common disease or problem

 People with this disease or problem have considerable health or financial hardships

 There is uncertainty about how well the test, treatment, or intervention works

 There is significant potential for side effects/harms using this test, treatment, or intervention

 Funding of this test, treatment, or intervention is uncertain or variable

 There is unequal access or application of this health care intervention across providers

 There is potential for cost savings from better information on this subject

 This is a new technology/development

 There is new evidence of clinical and/or cost effectiveness for this test, treatment, or intervention

 Other

3. What illness or health condition is related to your question? (You can also specify a particular health-promoting activity, such as breast-feeding)
Coronary artery disease
4. What group(s) or patients does your question apply to?
Persons with acute myocardial infarction or unstable angina undergoing cardiac catherization
5. What is the specific purpose of the health care test or treatment you have a question about? (mark all that you think apply)
Identification of a disease or condition:

 Screening or diagnosis/identification for a particular disease, or risk assessment for a disease

 Risks or harms that can come from a disease identification tool or test

 Diagnostic tests and tools

 Diagnosis of co-occurring diseases

 Intervention (such as a drug treatment, therapy, device)

 Management of a condition or particular system of care

 Delivery of a health service

 Referral

 Risks or harms associated with treatment of a disease or condition

 Prevention or health promotion

 Specific population health concerns, such as ethnic group or gender

 Other

 Dont know

6. Does your question include a comparison of different health care approaches?
Yes

If yes, please list what you would like to see compared:

unclear whether using a mechanical thrombectomy device such as an aspiration device confers additional benefit compared to more traditional cardiac catherization (+/- glycoprotein IIb/IIIa inhibitors)and stent, or thromolytics. Which patients benefit from such an intervention?
7. Desired Health Improvements: If you question focuses on:
Identification of a particular disease or condition, what improvements in identification or diagnosis would you like to see?




Treatment of a particular disease or condition, what improvements in patient symptoms or problems would you like to see?
Improved morbidity and mortality (unsure whether there are long term studies, the few I saw looked primarily at short term outcomes, improved TIMI flow, 30 day mortality etc)
8. Harms: Are there risks, side effects, or harms you are concerned about? If yes, please specify what those are:
In addition to the inherent risks associated with cardiac catherization, are there increased risk of bleeding vessel rupure, distal embolization?
9. Based on your answers to the previous questions, what research question(s) would you like to have answered?
There have been a number of devices proposed for mechanical thrombectomy in patients with angiographically visible thrombus in the setting of acute coronary syndromes. What are the various mechanical thrombectomy devices used in patients with acute coronary syndromes? What are the indications for their use (e.g. ST elevation myocardial infarction with a visible thrombus, acute or sub acute stent thrombosis) What are the advantages and disadvantages of such devices? What are the associated harms?
10. Are there health-care focused, disease-focused, or patient-focused organizations that you see as being relevant to this issue? Who do you think we should contact as we consider your nomination?
American college of cardiology American heart association
11. Other Information About You (OPTIONAL)
In order to help us understand the context of your health care question, it would be helpful to know more about you. The answers you give will not influence the progress of your suggestion. Thank you.
a. Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Other



b. Is there any other information about you that is relevant to your question?




c. Are you making a suggestion as an individual or on behalf of an organization?

 Individual

 Organization
Adjunctive Devices for Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention