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Published on: May 28, 2019
Time-dependent benefit of initial thrombosuction on myocardial reperfusion in primary percutaneous coronary
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Initial thrombosuction during primary PCI improves myocardial reperfusion in STEMI patients. This benefit is most significant when performed 4-8 hours after symptom onset, enhancing blood flow and tissue recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Distal embolisation during primary PCI for STEMI can impair myocardial reperfusion.
- Thromboembolic protection strategies have yielded controversial clinical results.
- The time-dependent benefit of thrombus removal in STEMI requires further investigation.
Purpose of the Study:
- To investigate the time-dependent efficacy of initial thrombosuction (IT) during primary PCI in STEMI patients.
- To compare IT with standard PCI in improving myocardial reperfusion.
- To analyze the impact of onset-to-lab time on the benefits of IT.
Main Methods:
- A randomized trial involving 74 STEMI patients treated within 12 hours of symptom onset.
- Patients were assigned to either primary PCI with IT or standard PCI.
- Subgroup analysis was performed based on onset-to-lab time intervals (0-240, 241-480, 481-720 min).
Main Results:
- Initial thrombosuction (IT) significantly improved post-procedure thrombolysis in myocardial infarction flow (DeltaTIMI) and myocardial blush grade (DeltaMBG) compared to standard PCI.
- The benefits of IT were most pronounced in the 241-480 minute onset-to-lab time subgroup.
- No significant difference was observed between IT and standard PCI in the other time subgroups.
Conclusions:
- Primary PCI with IT improves epicardial flow and myocardial reperfusion in STEMI patients.
- The therapeutic benefit of IT is most significant in patients treated between 4 and 8 hours after symptom onset.
- This finding highlights the importance of timely intervention with thrombosuction in STEMI management.
Background:
In ST-segment elevation acute myocardial infarction (STEMI), dislodgement of thrombus within the culprit artery during primary percutaneous coronary intervention (PCI) may cause distal embolisation and impaired myocardial reperfusion. Clinical results of thromboembolic protection strategies have been controversial. We conducted this study to investigate whether the benefit of thrombus removal is time dependent.
Methods:
Seventy-four STEMI patients within 12 h from onset were randomised to receive either primary PCI with initial thrombosuction (IT) or standard strategy. Results were analysed in subgroups according to the onset-to-lab time intervals (subgroup 1: 0-240 min, subgroup 2: 241-480 min and subgroup 3: 481-720 min).
Results:
The primary end-points were improvements in thrombolysis in myocardial infarction flow (DeltaTIMI) and myocardial blush grade (DeltaMBG) postprocedure. Better DeltaTIMI (2.2 +/- 1.1 vs. 1.5 +/- 1.3, p = 0.014) and DeltaMBG (2.3 +/- 1.1 vs. 1.0 +/- 1.5, p < 0.001) were observed in IT patients, compared with standard PCI patients. In onset-to-lab time subgroup analysis, the difference between IT and standard PCI is significant only in subgroup 2 (DeltaTIMI 2.6 +/- 1.0 vs. 1.3 +/- 1.2, p = 0.007; DeltaMBG 2.6 +/- 0.9 vs. 1.0 +/- 1.1, p = 0.010), but not in the other two subgroups.
Conclusions:
This prospective randomised study shows that primary PCI with IT may improve epicardial flow and myocardial reperfusion in patients with STEMI, and this benefit is the most significant in patients treated within 4-8 h after symptom onset.
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