Comparison of Successful Myocardial Reperfusion and Adverse Events in Patients With ST-Elevation Myocardial Infarction Who Underwent Rescue Percutaneous Coronary Intervention After Failed Fibrinolytic Therapy With Versus Without Manual Coronary Thrombus Aspiration

Abstract

It has been unclear the impact of manual thrombus aspiration (TA) on procedural outcomes in patients with ST-elevation myocardial infarction (STEMI) who underwent rescue percutaneous coronary intervention (PCI) after failed fibrinolytic therapy in comparison with primary PCI. Our aim was to test the hypothesis that manual TA may improve myocardial reperfusion and clinical outcomes in patients with STEMI who underwent rescue PCI after failed fibrinolytic therapy. From March 2011 to March 2014, 70 patients with STEMI after unsuccessful fibrinolysis were randomized to either rescue PCI with TA (TA group) or without TA (NTA group). Primary end points were rate of myocardial blush grade ≥2 and ST-segment resolution ≥70%. The secondary end point included 30days follow-up for major adverse cardiac events (MACEs). Baseline clinical and angiographic characteristics were similar in the 2 groups. The TA and NTA groups were compared as follows: myocardial blush grade ≥2, 71% versus 46% (p <0.05); complete ST-segment resolution 71% versus 46% (p <0.05); no reflow 20% versus 49% (p <0.05); procedure time (min) 65.0 ± 38.6 versus 90.1 ± 28.8 (p <0.05); contrast amount (ml) 99.0 ± 45.2 versus 121.2 ± 33.4 (p <0.05); and direct stenting 60% versus 37% (p <0.05). There was a significant reduction of MACE in the TA group, 20% versus 37% (p <0.05). In conclusion, rescue PCI with manual TA leads to better myocardial reperfusion and significant reduction of MACE.