Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Fernández-Rodríguez, Diego; Álvarez-Contreras, Luis; Martín-Yuste, Victoria; Brugaletta, Salvatore; Ferreira, Ignacio; Antonio, Marta de; Cardona, Montserrat; Martı́, Vicens; García-Picart, Juan; Sabaté, Manel

doi:10.4330/wjc.v6.i9.1030

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…Also, the mean length of the stented segments was significantly lower in the thrombectomy group than in the conventional group (22.5 ± 13 vs 28.5 ± 15 mm, respectively, p = 0.001). Along the same line, Rodriguez et al, (2014) [28] reported a mean length of stented segments of (24.1 ± 11.8 vs 26.9 ± 15.7 mm, p = 0.03). In the current study, the thrombectomy group required fewer stents (1 ± 0.5 vs 1.2 ± 0.6, p = 0.001).…”

Section: Discussionmentioning

confidence: 75%

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To Whom Thrombus Aspiration May Concern?

Samy

Nassar

Mohamed

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Thrombus aspiration for ST-segment elevation myocardial infarction (STEMI) may improve myocardial perfusion. However, these favourable results called into a question by data indicating not only a lack of efficacy but a risk of potentially deleterious complications.AIM: To assess the effect of thrombus aspiration during the primary percutaneous coronary intervention (PPCI) on procedural angiographic results, stent characteristics, and major adverse cardiac and cerebrovascular events (MACCE).METHODS: All consecutive STEMI patients candidate for PPCI and admitted to Critical Care Department, Cairo University hospitals, managed either by thrombectomy before primary PCI (if thrombus score ≥ 3) or conventional PPCI, Six hundred seven subjects were enrolled in the study divided into Group with thrombectomy before PPCI (107 subjects, 18%), and group with Conventional PCI (500 subjects, 82%). ST-segment resolution, peak CK-MB, TIMI score, thrombus score, and MBG were assessed; stent number, diameter, length and stented segment were reported and follow up MACCE was reported (in hospital and 1-year post-intervention).RESULTS: Mean values for peak CKMB were less in thrombectomy group (228 ± 174 I/U vs 269 ± 186 I/U, p = 0.04), ST segment resolution ≥ 70% occurred in {63 subjects (58.9%) vs 233 (46.6%), p = 0.001} in thrombectomy vs conventional group respectively. TIMI score pre procedure was zero in (102 subjects (95%) vs 402 (80.4%), p = 0.001), while TIMI III post procedure was reported in (100 subjects (93.4%) vs 437 (87%), p = 0.06), MBG mean values were (2.4 ± 0.6 vs 2.0 ± 1, p = 0.001), thrombus score was higher in thrombectomy group (4.6 ± 0.4 vs 0.8 ± 1.7, p = 0.001) in thrombectomy vs conventional group respectively .Direct stenting was { 34 patients (31%) vs 102 patients (20%), p = 0.05} , mean stent diameter (2.7 ± 1.3 mm vs 3.5 ± 1.3 mm, p = 0.3), mean stent length was (19.9 mm ± 10 versus 22.7 mm ± 8 in p 0.01). mean stent number was (1.0 ± 0.5 vs 1.2 ± 0.6, p = 0.001), mean stented segment was (22.5 ± 13.5 vs 28.5 ± 15.2 mm, p = 0.001) in thrombectomy vs conventional group respectively. MACCE in hospital were reported in {9 subjects (8.4%) vs 70 (14%), p = 0.07)}. Follow up MACCE after 1 year reported in {6 subjects (5.6 %) vs 80 (16 %), p 0.= 4} in thrombectomy vs conventional group respectively.CONCLUSION: Thrombus aspiration before primary PCI (in a selected group with thrombus score ≥ 3) improves myocardial perfusion, suggested by better ST-segment resolution, TIMI flow, less peak CKMB and MBG, associated with a higher rate of direct stenting, shorter stent length, stented segments and less number of stents. Although thrombus aspiration was done in more risky patients (higher thrombus score) MACCE (in hospital and 1 year follow up) showed no statistical difference.

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Section: Discussionmentioning

confidence: 75%

“…In our study, direct stenting was more frequent in the thrombectomy group than the conventional group (38% vs 20%, p = 0.001). Rodriguez et al, (2014) [28] reported direct stenting rates of (58% vs 45% for the thrombectomy group vs the conventional group, p = 0.009).…”

Section: Discussionmentioning

confidence: 99%

To Whom Thrombus Aspiration May Concern?

Samy

Nassar

Mohamed

et al. 2019

Open Access Maced J Med Sci

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Use and outcome of thrombus aspiration in patients with primary PCI for acute ST-elevation myocardial infarction: results from the multinational Euro Heart Survey PCI Registry

et al. 2015

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The clinical benefit of thrombus aspiration (TA) in patients presenting with acute ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI) is not well defined. Furthermore, there is a large variation in the use of TA in real-world registries. Between 2005 and 2008, a total of 7146 consecutive patients with acute STEMI undergoing primary PCI were prospectively enrolled into the PCI Registry of the Euro Heart Survey Programme. For the present analysis, patients treated additionally with TA (n = 897, 12.6 %) were compared with those without TA (n = 6249, 87.4 %). Patients with hemodynamic instability at initial presentation (15.1 vs. 11.0 %; p < 0.001) and resuscitation prior to PCI (10.4 vs. 7.4 %; p = 0.002) were more frequently treated with TA. TIMI flow grade 0/1 before PCI was more often found among those with TA (73.5 vs. 58.6 %; p < 0.001). After adjustment for confounding factors in the propensity score analysis, TA was not associated with improved in-hospital survival (risk difference -1.1 %, 95 % confidence interval -2.7 to 0.6 %). In this European real-world registry, the rate of TA use was low. Hemodynamically unstable patients were more likely to be treated with TA. Consistent with the results of the TASTE study and the TOTAL trial, TA was not associated with a significant reduction in short-term mortality.

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