Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit

Abstract

Data regarding clinical efficacy of thrombectomy in patients with acute myocardial infarction (AMI) have been still limited in Japan. Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary percutaneous coronary intervention (PCI) results and in-hospital prognoses were retrospectively compared between AMI patients with totally occluded infarct-related artery (IRA) (TIMI flow grade 0) undergoing thrombus aspiration during primary PCI (with-aspiration patients, n = 568) and those without thrombus aspiration (without-aspiration patients, n = 266). The with-aspiration patients were more likely to have higher TIMI grade in the IRA immediately after primary PCI, and had a lower in-hospital mortality rate than the without-aspiration patients. According to a multivariate analysis, thrombectomy as well as stent usage was found to be independent predictor of final TIMI flow grade ≥2 in the IRA, and the final TIMI flow grade ≥2 in the IRA was found to be an independent factor for in-hospital survival. These results suggest that among real-world, unselected Japanese AMI patients with totally occluded IRA on initial coronary angiography, thrombus aspiration is an effective adjunctive therapy during primary PCI to improve final epicardial coronary flow in the IRA, which might lead to better in-hospital prognosis.

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology

“…In a cohort with more than 10,000 patients with STEMI (about 3500 of STEMI patients treated with TA and P-PCI), TA did not show improvement in the risk of mortality [ 15 ]. Inversely, other observational studies showed that a ‘selective’ TA in P-PCI can improve outcomes, mortality included [ 16 , 17 ]. The best available evidence, based on RCTs, is robust for not using ‘routinely’ the TA in P-PCI but do not preclude the use of TA in selected cases, as occurs with other interventions available for acute cardiac care setting [ 18 ].…”

In vitro assessment of six aspiration catheters using a distal protection filter

“…Recent data suggest that a primary PCI with thrombus aspiration in MI patients was more likely to result in a higher TIMI grade in the infarctrelated artery and a lower in-hospital mortality rate compared to primary PCI without aspiration [13]. Moreover, another report demonstrated that distal protection during PCI effectively retrieved the embolic debris and preserved the index of microcirculatory resistance in patients with an acute anterior STEMI [14].…”