Manual Thrombus Aspiration Research Articles

ST-resolution and microvascular obstruction and infarct size after primary angioplasty: SMART-MRI substudy

Purpose: Optimal myocardial reperfusion in ST-elevation myocardial infarction (STEMI) is associated with better outcome. ST-segment elevation resolution quantifies extent of reperfusion, however it has not been extensively correlated with microvascolar obstruction (MVO) and infarct size (IZ) measured by cardiac magnetic resonance imaging (MRI). Based on the SMART-MRI sub-study, we sought to analyze in STEMI patients the relationship between ST-segment resolution and MVO and IS. Method and results: Eighty STEMI patients (≤6 hours from symptom onset) reperfused by primary angioplasty with routine abciximab therapy were randomly allocated (1:1) to a rheolytic thrombectomy (RT) or manual thrombus aspiration (MTA). MRI was performed within 10±6 days in 37 patients (19 RT, 18 MTA). IS and MVO were measured 15 min after gadolinium injection with late enhancement sequences and were analyzed quantitatively (as percentage of the left ventricular mass –gr/LV mass-) at a core laboratory blinded to randomization. Baseline clinical characteristics were similar between the RT and MTA groups, as well as baseline TIMI thrombus grade (4.47±0.84 vs 4.67±0.76, p=0.453) and rate of initial TIMI flow grade 0-1 (79% vs 83%, P=0.758). After thrombectomy in RT compared with MTA group the thrombus grade decreased to 1.11±1.04 vs 2.17±1.29 (P=0.04), and after infarct artery stenting TIMI 3 flow was 100% vs 89% (P=0.204), and ST-elevation resolution at 30 min and at 60 minutes were: 1±0.8 mm vs. 1.35±0.8 mm, and 0.75±0.67 mm vs. 1.1±0.92 mm (P=0.192 for both), respectively. RT compared with MTA group did not reduced significantly myocardial IS [12.2% (6.4-22.1) vs 19.0% (7-28.5), P=0.224] as well as the extent of MVO [0.0% (0.0-0.17) vs 0.6% (0.0-1.4), P=0.117], but a trend towards a lower incidence of MVO was observed (16% vs 44%, P=0.056). In the entire population, ST-resolution at 30 min showed a strong correlation with both MVO (P=0.024) and IZ (P=0.023), whether at 60 min a strong correlation remains with MVO (P=0.030), but not with IZ (P=0.079). Conclusions: ST-resolution determined at 30 min after primary angioplasty for STEMI is strongly associated with MVO and IZ assessed by cardiac MRI, supporting its use as an early and simple marker of better myocardial reperfusion.

Does mean platelet volume and platelet distribution width predict inadequate myocardial reperfision in primary percutaneous coronary intervention?

Backround: We sought to determine if Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) as markers of platelet activation are associated with inadequate Myocardial Reperfusion (MR) at microvasculature level and adverse clinical events 30 days after Primary Percutaneous Coronary Intervention (pPCI). Methods: Study included 209 consecutive STEMI patients in whom pPCI was done within 12h from the symptom onset from July 2012th to January 2013th. The manual thrombus aspiration was done in 106 (50.7%) patients. Inadequate MR was define as absence of angiographic (final TIMI flow ≤ 3 or final TIMI 3 flow with MBG 0 or 1) and/or ECG (ST resolution < 70% at ECG done 30-60 minutes after the end of procedure) signs of reperfusion. Venous peripheral blood samples were drawn at hospital admission. MACE were defined as composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA Class IV heart failure at 30 days. Results: Inadequate MR had 110 (51.4%) patients. Two groups had comparable demographic, clinical and procedural caracteristics exept higher age (62.4 vs. 57.1 year, p<0.001), less frequent use of manual thrombus aspiration (43.4% vs. 56.6%, p=0.017) and higher baseline creatinin level (87.0 vs 77.4 μmol/L, p=0.013) at inadequate MR group. Two groups had comparable MPV values while there were statistical higher PDW values in the inadequate MR group (16.32 vs. 16.04, p=0.039). The higher PDW values has observed in the subgroup of patients which had pPCI without manual aspiration thrombectomy (16.39 vs. 15.8, p=0.044), but this statistical difference had not observed in pPCI patients with manual aspiration thrombectomy (16.24 vs. 16.18, p=0.664). By the binary logistic regression as a predictor of inadequate MR is calculated age (p=0.021), and cratinine baseline levels (p=0.045) and there is a trend for manual aspiration thrombectomy (p=0.068). MACE rate at 30 days in inadequate MR group was 5 (5.0%) vs. 2 (2.2%) in the group of patients with adequate MR, (p=0.281). Conclusion: In addition to age and impaired renal function higher baseline PDW values could predict inadequate reperfusion on microvasculature level after primary percutaneous intervention.

Relationship Between Myocardial Reperfusion, Infarct Size, and Mortality: The INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) Trial

This study sought to compare infarct size (IS) measured by magnetic resonance imaging in patients with successful (myocardial blush grade [MBG] 2/3) versus unsuccessful (MBG 0/1) microcirculatory reperfusion in the INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial. Successful microcirculatory reperfusion, defined angiographically by MBG 2 or 3, is associated with improved outcomes in patients with ST-segment elevation myocardial infarction. The precise mechanism underlying this association is not well defined. The INFUSE-AMI trial randomized 452 patients with anterior ST-segment elevation myocardial infarction to intracoronary bolus abciximab delivered locally at the infarct lesion versus no abciximab, and to manual thrombus aspiration versus no aspiration. The primary endpoint was IS (percentage of left ventricular mass) at 30 days. MBG 2/3 was achieved in 367 patients (81.4%). IS was significantly lower in patients with MBG 2/3 than in those with MBG 0/1 (median: 16.7% [interquartile range (IQR): 7.0 to 22.7] vs. 19.5% [IQR: 11.1 to 29.2]; p = 0.002). Intracoronary abciximab further reduced IS in patients with MBG 2/3 (median: 14.4% [IQR: 5.4 to 20.9] vs. 17.4% [IQR: 10.5 to 23.8]; p = 0.01). MBG 2/3 was associated with ∼30% reduction in infarct mass (p = 0.002) and ∼90% reduction in microvascular obstruction on day 5. Ejection fraction was higher with MBG 2/3 at 30 days: median: 50.3% (IQR: 43.8 to 57.8) versus 46.9% (IQR: 37.5 to 54.0); p = 0.004. At 30 days, the rate of death was significantly lower (1.7% vs. 8.3%; p = 0.0008) in the MBG 2/3 group. MBG 2/3 occurs in 80% of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention and is associated with smaller infarct size, less microvascular obstruction, improved ejection fraction, and significantly lower 30-day mortality. (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction [INFUSE-AMI]; NCT00976521).

Coronary reperfusion and clinical outcomes after thrombus aspiration during primary percutaneous coronary intervention: Findings from the HORIZONS‐AMI trial

To assess the quality of coronary reperfusion and long-term clinical outcomes of patients enrolled in the HORIZONS-AMI trial according to the use of thrombus aspiration (TA). The impact of manual TA on microvascular perfusion and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unsettled. In this retrospective, nonrandomized, subgroup analysis, the authors evaluated thrombolysis in myocardial infarction (TIMI) flow, tissue myocardial perfusion grade (TMPG), ST-segment resolution (STR), net adverse clinical events (NACE), and major adverse cardiac events (MACE) in patients undergoing pPCI with or without manual TA. A total of 318 patients had pPCI with upfront TA, and 2,917 patients had pPCI without TA. Patients who had TA were more likely to have TIMI 0/1 flow at baseline (75.1% vs. 63.7%, P < 0.0001). There was no difference in the rates of final TIMI 3 flow (90.2% vs. 92.3%, P = 0.19) or dynamic TMPG 2-3 (77.4% vs. 76.4%, P = 0.68). STR ≥70% was similar in both groups at 60 minutes but higher in the TA group at discharge (71.8% vs. 64.6%, P = 0.02). After multivariable adjustment, TA did not predict MACE at 30 days (HR 0.96 [0.51-1.80], P = 0.90), 1 year (HR 1.03 [0.68-1.55], P = 0.89), or 3 years (HR 1.13 [0.86-1.48], P = 0.39). Stent thrombosis did not differ at 1 year or 3 years. In STEMI patients undergoing pPCI, the use of manual TA was associated with improved STR at discharge, but not with any difference in final TIMI flow, TMPG, or MACE.

Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: insights from INFUSE-AMI

Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis in Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% [4.6, 21.8] vs. 22.6% [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.

Comparison of Manual Thrombus Aspiration With Rheolytic Thrombectomy in Acute Myocardial Infarction

Manual thrombus aspiration (MTA) is completely ineffective in 30% of cases, and the high profiles of the catheters prevent their use in tortuous and calcified vessels. The rheolytic thrombectomy (RT) device has the potential for improved thrombus removal in acute myocardial infarction as compared with MTA. No data exist on the comparison between the 2 techniques. Randomized study, including 80 acute myocardial infarction patients allocated to RT or MTA before infarct artery stenting. Primary end point of this study is residual thrombus burden by optical coherence tomography. Secondary end points are (1) residual thrombolysis in myocardial infarction thrombus grade; (2) postintervention thrombolysis in myocardial infarction flow and myocardial blush; (3) early ST-segment resolution; (4) percentage of malapposed stent struts at 6 months; (5) 6-month restenosis; and (6) 6-month major adverse cardiovascular events. All but 1 patient had residual thrombus after manual aspiration thrombectomy or RT. The number of optical coherence tomography quadrants containing thrombus in MTA arm was higher than in the RT arm, but this difference did not reach significance (median value 65 and 53, respectively; P=0.083). Large residual thrombus was more frequently revealed in the manual aspiration thrombectomy arm (patients with number of quadrants above the median value 60% in the manual aspiration thrombectomy arm and 37% in the RT arm, P=0.039). All markers of reperfusion were better in the RT arm. At 6 months, the percentage of malapposed stent struts in the MTA arm was higher than in the RT arm (2.7±4.5% and 0.8±1.6%, respectively; P=0.019). MTA or RT allows only incomplete removal of thrombus in patients with acute myocardial infarction. The primary end point of the study was not met. However, RT as compared with MTA seems to be more effective in thrombus removal and myocardial reperfusion. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01281033.

Effect of manual thrombus aspiration during primary percutaneous coronary intervention on infarct size: Evaluation with cardiac computed tomography

Thrombus aspiration during percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) may improve myocardial reperfusion. In the present study, we sought to assess whether manual thrombus aspiration could reduce infarct size in patients with acute ST-elevation MI undergoing primary PCI utilizing cardiac computed tomography (CCT) on a delayed enhancement (DE) scanning (DE-CCT).

046 MECHANICAL THROMBECTOMY USE IS ASSOCIATED WITH DECREASED MORTALITY IN PATIENTS TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION (9935 PATIENTS FROM THE LONDON HEART ATTACK GROUP)

<h3>Introduction</h3> During Primary Percutaneous Coronary Intervention (PPCI) post ST-Segment Myocardial Infarction (STEMI), distal embolisation of thrombus may lead to failure to re-establish normal flow in the infarct-related artery. Manual thrombus aspiration has been shown to improve coronary perfusion as assessed by time to ST-segment resolution and myocardial blush grade. Evidence supporting the benefit of thrombus aspiration on clinical outcomes, however, is limited and inconsistent. We aimed to assess the impact of manual thrombectomy on mortality in patients presenting with STEMI across all PPCI centres in London over a 5 year period from 2007 until 2012. <h3>Methods</h3> This was an observational cohort study of 9935 consecutive patients with STEMI treated with PPCI between 2007 and 2012 at eight tertiary cardiac centres across London, UK. Patient9s details were recorded at the time of the procedure into the British Cardiac Intervention Society (BCIS) database. Outcome was assessed by all-cause mortality. Anonymous datasets from the eight centres were merged for analysis. The primary end-point was all-cause mortality at a median follow-up of 2.0 years (IQR range 1.1–3.1 years). <h3>Results</h3> Of the 9935 consecutive STEMI patients presenting for PPCI, 2859 had mechanical thrombectomy. Patients who had manual thrombectomy were significantly younger (average age 60.6 vs 62.9) and were less likely to have had a previous myocardial infarction (11.9% of thrombectomy patients vs 14.7% of non-thrombectomy patients). Patients receiving manual thromectomy were found to be significantly more likely to have had PPCI via a radial approach (33.1% in thrombectomy patients vs 19.9% in non-thromectomy patients). Procedural success (defined as TIMI 3 flow at the end of procedure) was found to be significantly more likely in patients receiving manual thrombectomy (89.5% vs 86.7%) (table&nbsp;1). Patients with thrombectomy use had similar unadjusted all-cause mortality rates to those without thrombectomy use (12.7% vs 16.5%, p=NS) during the 5-year follow-up period (figure&nbsp;1). After multivariable adjustment thrombectomy use was associated with significantly decreased mortality rates (HR: 0.82, 95% CI 0.68 to 0.9, p=0.04). <h3>Conclusion</h3> Mechanical thrombectomy use appears to be associated with improved outcome, in the form of decreased mortality, in this large observational trial.

045 PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION: DOES DIRECT STENTING IMPACT ON MORTALITY?

Introduction Randomised trial data suggest that direct stenting (DS) during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) is associated with improved markers of reperfusion, such as ST segment resolution, myocardial blush grade and TIMI flow. However, there are few data as to whether these angiographic surrogates translate into a mortality benefit. Methods Consecutive patients attending two high-volume centres undergoing PPCI for STEMI between September 2008 and December 2010 were included in the analysis. All patients received aspirin 300 mg and clopidogrel 600 mg at point of STEMI diagnosis in the community. Use of predilatation (PD), manual thrombus aspiration (TA) and glycoprotein inhibitors (GPI) were at operator discretion. Demographic data and clinical outcomes were obtained by interrogation of local and national databases. Results A total of 1664 patients (mean age 65.3±12.5 years, 74.7% male) underwent PPCI during the study period. We excluded 77 who were not stented from the final analysis. Overall in hospital mortality was 3.0% (47/1587), with 30-day and 1-year mortality of 4.2% (66/1587) and 7.2% (114/1587) respectively. There was a significant 1-year survival advantage in patients who underwent DS (30.2%) compared with those who were stented after PD (3.16% vs 8.63%; p Conclusion In an unselected real-world population undergoing PPCI for STEMI, DS is associated with a significant reduction in 1-year mortality. This effect appears to be independent of both GPI and TA use.

Randomized trial of standard versus ClearWay-infused abciximab and thrombectomy in myocardial infarction

Patients with ST-elevation myocardial infarction (STEMI) are at substantial risk of suboptimal procedural results and late adverse events. Angiography and optical coherence tomography (OCT) studies have identified residual coronary thrombus and microcirculatory injury as potential culprits for these adverse outcomes. We hypothesized that coronary thrombectomy and local infusion of glycoprotein IIb/IIIa inhibitors by means of a dedicated infusion device can synergistically improve results of percutaneous coronary intervention (PCI) for STEMI, as appraised by OCT. A total of 128 patients with STEMI will be randomized, to one of the following: abciximab infusion with the ClearWay coronary catheter (C), standard abciximab infusion (A), thrombectomy followed by abciximab infusion with the ClearWay catheter (T+C), or thrombectomy followed by standard abciximab infusion (T+A). The primary objective is to demonstrate that abciximab infusion with the ClearWay catheter with or without manual thrombus aspiration (groups C or T+C) will result in a significant reduction of intrastent thrombus formations when compared with intravenous or intracoronary abciximab with or without thrombectomy (groups A or T+A). The primary endpoint will be the number of cross-sections with thrombus area more than 10% immediately after stent implantation as assessed with OCT. Additional angiographic, ECG and clinical endpoints will be collected and adjudicated. This trial will provide important mechanistic insights on the most appropriate invasive treatment strategy for patients with STEMI and significant thrombus burden, by exploiting its factorial design and reliance on sensitive OCT endpoints.

Additional Value of Manual Thrombus Aspiration Using Diver CE Catheter during Primary PCI in Patients with Acute STEMI

Additional Value of Manual Thrombus Aspiration Using Diver CE Catheter during Primary PCI in Patients with Acute STEMI

Excimer laser coronary angioplasty with manual thrombus aspiration for a case of very late stent thrombosis of sirolimus-eluting stent

Very late stent thrombosis occurring after drug-eluting stent implantation is a rare complication. However, it is often associated with poor outcome. Manual thrombectomy has been shown to lower the rate of distal embolization in the case of ST-elevation myocardial infarction of native coronary arteries. However, the presence of abundant thrombus material may lead to manual thrombus aspiration failure. Here, we describe the case of a patient with acute myocardial infarction due to stent thrombosis of a sirolimus-eluting stent occurring 50 months after stent deployment showing abundant thrombus material, which led to manual thrombus aspiration failure and was then successfully treated by excimer laser coronary angioplasty. In these cases, excimer laser coronary angioplasty may be useful due to its ability to dissolve thrombus.

Abstract 19450: Manual Thrombus Aspiration is not Associated with Reduction in Infarct Size Assessed by Delayed Enhancement MDCT

Objective: We sought to assess whether manual thrombus aspiration could reduce infarct size in patients with acute ST-elevation myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). Background: The efficacy of manual thrombus aspiration during primary PCI for acute MI remains controversial. Methods: Between April 2009 and Mar 2011, 86 consecutive patients presenting with first acute STEMI (Killip≤II) within 12 hours after the symptom onset were randomized to manual thrombus aspiration (group I, N=44) or conventional PCI without thrombus aspiration (group II, N=42). The use of glycoprotein IIb/IIIa inhibitor (GPI) was left to the discretion of the operator. All patients received aspirin 300 mg and clopidogrel 600 mg before PCI and underwent delayed enhancement (DE) multi-detector computed tomography (MDCT) immediately after PCI without injection of an additional contrast media for assessment of infarct size, determined as the total volume of myocardium showing DE. DE MDCT was repeated at 2 months after PCI. The primary endpoint was infarct size reduction at 2 months. Results: Baseline clinical characteristics and angiographic findings were similar between the 2 groups. There were no differences between group I and II in symptom-to-door time, door-to-balloon time, PCI-to-MDCT time, Pre-PCI TIMI 0/1, post-PCI TIMI 3, or the use of GPI. Markers of myocardial reperfusion showed better outcome in group I but without statistical difference: ST-resolution rate &gt;70% (74% vs. 65%), myocardial blush grade 3 (88% vs. 68%), and corrected TIMI frame count &lt;28 (31% vs. 24%). Initial infarct size determined by DE MDCT and left ventricular ejection fraction (LVEF) by 2-dimensional echocardiography were similar between group I and II (17±18 mL vs. 22±23 mL and 58±11% vs. 55±10%, respectively). At 2 months, there was no difference in infarct size and left ventricular ejection fraction between the groups: 14±10 mL vs. 17±12 mL and 62±12% vs. 60±2%, respectively. No adverse cardiac events occurred in either group during the 2-month clinical follow-up. Conclusion: Manual thrombus aspiration was not associated with reduction in infarct size in patients with acute ST-elevation MI undergoing primary percutaneous coronary intervention.

The impact of successful manual thrombus aspiration on in-stent restenosis after primary PCI

This study sought to investigate the impact of successful manual thrombus aspiration on angiographic in-stent restenosis and clinical outcome in patients treated by bare metal stent implantation for ST-segment elevation acute myocardial infarction. There are very limited data on the impact of manual thrombus aspiration on the occurrence of in-stent restenosis after bare metal stent implantation. This was a prospective, randomized, single-center study. Patients (N=60) presenting within 12 h of ST-segment elevation acute myocardial infarction symptom onset were randomized to primary percutaneous coronary intervention (PCI) with (N=30) or without (N=30) upfront manual thrombus aspiration using the Export aspiration catheter. All patients underwent control coronary angiography after 6 months. Baseline, clinical, and angiographic preprocedural findings did not differ between the two groups. Patients who underwent successful manual thrombus aspiration had significantly higher minimal lumen diameter after 6 months (2.25±0.90 vs. 1.63±0.76, P=0.005), significantly lower percentage diameter stenosis (28.81 vs. 45.03%, P=0.017), and significantly lower late lumen loss (0.73±0.84 vs. 1.18±0.79, P=0.035). There was a trend for lower rate of major adverse cardiocerebrovascular events such as death, myocardial reinfarction, stroke, and target lesion revascularization in the same group of patients (16.67 vs. 26.67%, P=0.347). Successful upfront manual thrombus aspiration during primary PCI showed beneficial effects on the reduction of in-stent restenosis after bare metal stent implantation compared with standard PCI.

TCT-467 Clinical Outcomes after Anterior ST-Elevation Myocardial Infarction According to LAD Lesion Location: The INFUSE-AMI Trial

Background: Prognosis of ST-elevation myocardial infarction (STEMI) is determined predominantly by the extent of myocardial damage and hemodynamic status. Thus, in previous studies patients with proximal LAD occlusion have had worse outcome than those with more distal LAD lesions. It is not known whether modern reperfusion therapy has altered this relationship. Methods: The INFUSE-AMI trial randomized patients with anterior STEMI due to proximal or mid LAD occlusion to intracoronary bolus abciximab delivered locally via the ClearWay RX catheter vs. no abciximab, and to manual thrombus aspiration with the Export catheter vs. no aspiration. The primary endpoint was core laboratory assessed MRI infarct size (IS, % of LV mass) at 30 days. Lesion location was assessed at a core laboratory blinded to randomization and outcomes and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mid (mLAD) if beyond it. Results: The study enrolled 452 patients. The median age was 61y, 74% were men and 11% had diabetes. Intracoronary abciximab reduced IS (% LV mass): 15.1[6.8-22.7] vs. 17.9[10.3-25.4], P=0.03. Thrombectomy had no effect on IS. There were 292 (64.7%) patients with pLAD and 159 (35.3%) with mLAD occlusion. Patients with pLAD presented more often within 3h of symptom onset and had lower systolic blood pressure, but did not differ from mLAD patients with respect to heart rate, Killip class or extent of coronary disease. Thrombectomy was performed in 49.3% and 56.0% of the two groups, P=0.18 and intracoronary abciximab was used in 46.9% and 47.2%, respectively, P=0.79. Reperfusion succes, infarct size and major clinical outcomes are listed in Table. Conclusions: These data confirm the excess risk of death associated with pLAD infarcts even with contemporary reperfusion therapy. Reduced TIMI 3 flow rates and larger IS in pLAD infarcts translate into increased mortality.

034 The effect of thrombus aspiration during primary percutaneous coronary intervention on in-hospital mortality and thrombolysis in myocardial infarction flow grade

BackgroundThrombus aspiration (TA) has been shown to improve Myocardial Blush Grade and ST-segment resolution in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). However, the...

The impact of intracoronary thrombus aspiration on STEMI outcomes

Manual coronary thrombus aspiration was associated with improved outcomes of ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the outcome of aspiration in a "real-world" setting of primary percutaneous coronary intervention (PPCI). We analyzed the outcome of STEMI patients who underwent PPCI (initial Thrombolysis in Myocardial Infarction flow grade 0/1), comparing patients who underwent aspiration (ASP) to those who had standard (STD) therapy. Various subgroups outcomes were further analyzed. Clinical end points included mortality and major adverse cardiovascular events (MACE) at 30 days and at 1 year. One thousand thirty-five consecutive patients were included: 189 (18.26%) with ASP and 846 (81.74%) with STD. ASP patients were younger (58±12 vs. 61±13, P<.05) and had higher incidence of direct stenting compared to STD patients (34% vs. 16.7%, P<.05). No significant differences were noted in the outcome of ASP vs. STD at 30 days (mortality rate 4.2% vs. 4.5%, P=.9; MACE 6.9% vs. 9.8%, P=.2) and at 1 year (mortality rate 8.0% vs. 8.3%, P=.9; MACE 20.0% vs. 22.3%, P=.5). A significant advantage in favor of ASP was evident in patients with proximal culprit lesions, anterior infarcts, and right ventricular involvement. Although this was largely a negative study, when STEMI involved a large jeopardized myocardium, aspiration was associated with sustained improved clinical outcomes.

Microvascular Obstruction In PCI - A Review

DOI: http://dx.doi.org/10.3329/uhj.v7i1.10211 UHJ 2011; 7(1): 48-52

Impact of vascular approach (transradial vs. transfemoral) on the efficacy of thrombus aspiration in acute myocardial infarction patients

Manual thrombus aspiration improves the efficacy of percutaneous coronary interventions (PCIs) in ST-elevation acute myocardial infarction (STEMI). The transradial approach (TRA) is an emerging vascular approach for PCI but is associated with specific technical requirements. As data on the combination of thrombus aspiration and TRA are scarce, we sought to assess the feasibility of TRA manual thrombus aspiration in STEMI patients. All consecutive patients treated with manual thrombectomy for acute STEMI in three Italian hospitals were considered. Patients were divided according to the vascular approach into two groups: TRA and transfemoral (TFA). Two primary end points were defined: thrombectomy feasibility (ability to cross the occlusion with the device) and thrombectomy efficacy (absolute thrombus score reduction after device crossing). From January 2008 to December 2009, 303 patients were included: 151 patients (63±13 years) were treated through TFA, and 152 patients (61±12 years, P=.25) were treated through TRA. There were no significant differences in thrombectomy feasibility (75% in the TRA compared to 74.8% in the TFA group, P=.97) or in thrombectomy efficacy (2.6±.8 for TRA and 2.9±2 for TFA, P=.15). In both groups, there was a significant reduction in thrombus score after manual thrombus aspiration. Angiographically evident distal embolization after device crossing was low and observed in seven cases (5%) either for TFA and TRA (P=.99). The present study suggests that, in the setting of acute STEMI, manual thrombus aspiration through TRA is feasible, and its efficacy is comparable to the TFA.

Comparison of delayed versus immediate stenting for ST-segment elevation acute myocardial infarction with high thrombus burden

BackgroundHigh thrombus burden (HTB) is an independent predictor of no- or low-reflow during primary percutaneous coronary intervention (pPCI). This study sought to compare immediate versus delayed stenting in ST-elevation acute...