Abstract
BackgroundStudies have not demonstrated consistent outcomes following thrombus aspiration in Primary Percutaneous Coronary Intervention (PPCI). We investigated the relationship between thrombus aspiration and microvascular obstruction as measured using Index of Microcirculatory Resistance (IMR) immediately following PPCI and Left Ventricle Function Improvement measured using Global Longitudinal Strain (GLS) six months following PPCI. Our aim is to determine microvascular obstruction and left ventricle function improvement six months following thrombus aspiration during PPCI.MethodsThis was a single-center, observational, prospective non-randomized study involving 45 patients with thrombus score 4–5 (defined as high thrombus burden) and Thrombolysis in Myocardial Infarction (TIMI) flow of 0–2 who subsequently underwent PPCI. Thrombus aspiration was conducted based on physician discretion. The IMR was measured immediately following the procedure. All patients underwent echocardiography to measure GLS at 24 h, 3 months and 6 months following PPCI.ResultsThirty-three (73%) patients underwent thrombus aspiration during PPCI and twelve (27%) patients underwent the conventional PPCI. No significant difference in IMR was found between the group that underwent thrombus aspiration and the group that underwent conventional PCI (51.9 ± 41.5 vs 47.1 ± 35.6 p = 0.723). TIMI flow after PPCI was worse in thrombus aspiration group (OR 5.2 [1.2–23.2], p = 0.041). There was no difference in GLS between two groups at 6-month follow-up (− 13.0 ± 3.4 vs − 12.8 ± 4.6, p = 0.912).ConclusionThis study indicates no benefit of thrombus aspiration during PPCI in reducing either microvascular obstruction or left ventricular function at 6-month follow-up for patients with high thrombus burden. Nevertheless, further studies are required before definite conclusions can be made.
Highlights
Successful remodeling of epicardial coronary arteries’ patency following prolonged occlusion might culminate in microvascular obstruction (MVO)
The purpose of this study is to evaluate MVO following thrombus aspiration during Primary Percutaneous Coronary Intervention (PPCI) through Index of Microcirculatory Resistance (IMR) immediately post-PPCI and left ventricular function measured by global longitudinal strain (GLS) six months after PPCI
Continuous variables are shown in Mean ± Standard Deviation GLS Global Longitudinal Strain, IMR Index of Microcirculatory Resistance, PPCI Primary Percutaneous Coronary Intervention, TIMI Thrombolysis in Myocardial Infarction. This prospective, non-randomized study indicates that the addition of manual thrombus aspiration to PPCI in patients with high thrombus burden was not associated with benefit in terms of IMR and LV function at 6-month follow-up
Summary
Successful remodeling of epicardial coronary arteries’ patency following prolonged occlusion might culminate in microvascular obstruction (MVO). The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) trial found that routinely performed thrombus aspiration yielded better myocardial reperfusion and clinical outcomes at one-year follow-up [3]. Thrombus aspiration has been considered as a gold standard procedure during Primary PCI (PPCI), until recently, after the emergence of ThrOmbecTomy with PCI vs PCI Alone in STEMI (TOTAL) and the Thrombus Aspiration in ST-Elevation myocardial infarction (TASTE) trials result [4]. The TOTAL trial has shown that routine thrombus aspiration during PCI for STEMI did not improve long-term clinical outcomes and was potentially linked to a higher risk of stroke at one-year follow up [5].
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