Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional Recovery and Remodeling After Primary Angioplasty

Abstract

Background-Failure to achieve myocardial reperfusion often occurs during percutaneous coronary intervention (PCI) in patients with myocardial infarction with ST-segment elevation. We hypothesized that manual thrombus aspiration during primary PCI would favorably influence tissue-level myocardial perfusion and left ventricular (LV) functional recovery and remodeling. Methods and Results-We prospectively randomized 111 patients with ST-segment elevation myocardial infarction to either standard or thrombus-aspiration PCI. Primary end point of the study was postprocedural incidence of ST-segment resolution Ն70%. Secondary end points included Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade Ն2, the combination of TIMI myocardial perfusion grade Ն2 and ST-segment resolution Ն70%, post-PCI TIMI grade 3 flow, corrected TIMI frame count, myocardial contrast echocardiography score index, the absence of persistent ST-segment deviation, and time course of wall-motion score index, LV ejection fraction, and LV volume in the 2 groups. The incidence of ST-segment resolution Ն70% was 71% and 39% in the thrombus-aspiration and standard PCI groups, respectively (odds ratio, 3.7; 95% CI, 1.7 to 8.3; Pϭ0.001). TIMI myocardial perfusion grade Ն2 was attained in 93% in the thrombus-aspiration group compared with 71% in the standard PCI group (Pϭ0.006). The percentage of patients with ST-segment resolution Ն70% and TIMI myocardial perfusion grade Ն2 was significantly greater in the thrombus-aspiration group compared with the standard PCI group (69% versus 36%, Pϭ0.0006). Myocardial contrast echocardiography score index was significantly higher in the thrombus-aspiration group compared with the standard PCI group (0.86Ϯ0.20 versus 0.65Ϯ0.31; PϽ0.0001). A significantly greater improvement in LV ejection fraction and in wall-motion score index from baseline to 6-month follow-up was observed in the thrombus-aspiration group compared with the standard PCI group (LV ejection fraction from 48Ϯ6% to 55Ϯ6% versus 48.7Ϯ7% to 49Ϯ8%, PϽ0.0001; wall-motion score index from 1.59Ϯ0.13 to 1.31Ϯ0.19 versus 1.64Ϯ0.20 to 1.51Ϯ0.26, Pϭ0.008). Twelve patients (11%) developed LV remodeling at 6 months, 2 (4%) in the thrombus-aspiration group and 10 (18%) in the standard PCI group (Pϭ0.02). Conclusions-Manual

Vaporizing Thrombus With Excimer Laser Before Coronary Stenting Improves Myocardial Reperfusion in Acute Coronary Syndrome

“…22 Among the different strategies to limit the no reflow phenomenon, that of reducing distal embolization with a manual thrombus aspiration device is promising. 23 Despite the logical advantage of thrombus aspiration during PCI, however, a previous early study failed to confirm superiority of this approach in reducing infarct size or death rates. 24 A recent large, single-center, randomized trial and meta-analysis showed that manual thrombus aspiration is associated with a significant improvement in myocardial perfusion and reductions in shortand long-term mortalities in patients treated with primary PCI, but whether such improvements in myocardial reperfusion and TIMI flow grades in the pre-and post-lasing or aspiration angiograms and the final angiogram are shown in Figure 2, and MBG and STR are shown in Figures 3,4, respectively.…”

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

“…In this regard, the use of a mechanical device for thrombus removal or trapping to improve clinical outcomes after p-PCI is attractive, and the efficacy of these devices has been tested in many clinical trials. Although some data, especially those regarding the use of distal protection devices, have failed to show clinical benefits due in part to patient and device selection [48][49][50][51][52][53] , many recent large-scale randomized trials have demonstrated significant improvements in myocardial perfusion 45,[54][55][56][57][58][59][60][61][62][63][64][65][66][67] and the left ventricular function 64,65) in addition to reduced mortality 68) ( 69) . In addition, Burzotta et 70) .…”

Adjunctive Thrombectomy for Acute Myocardial Infarction

“…To test whether aspiration devices lead to better outcomes compared with standard PCI, we repeated the meta-analysis including only trials that used aspiration. [12][13][14][15][16][17][18][19][20]23,27,28,30,34,35,37 …”