The randomized physiologic assessment of thrombus aspiration in patients with acute ST-segment elevation myocardial
Dejan Orlic1, Miodrag Ostojic, Branko Beleslin
1Clinical Center of Serbia, School of Medicine, Belgrade, Serbia.
Insights
Manual thrombus aspiration may improve myocardial perfusion in ST-segment elevation acute myocardial infarction (STEMI) patients. This study quantitatively assesses microcirculatory resistance (IMR) to compare thrombus aspiration with primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- ST-segment elevation acute myocardial infarction (STEMI) management often involves primary percutaneous coronary intervention (PCI).
- Thrombus aspiration is hypothesized to enhance myocardial perfusion compared to conventional primary PCI.
- Quantitative invasive assessment of microcirculatory resistance (IMR) after thrombus aspiration is lacking.
Purpose of the Study:
- To determine if manual thrombus aspiration improves myocardial perfusion.
- To compare index of microcirculatory resistance (IMR) after thrombus aspiration versus conventional primary PCI in STEMI patients.
Main Methods:
- A single-center, prospective, randomized trial (PATA STEMI) including 128 STEMI patients.
- Random assignment to manual thrombus aspiration or conventional primary PCI.
- Primary endpoint: comparison of mean IMR values between groups post-intervention.
Main Results:
- This section is not available in the provided abstract.
- Further details on myocardial perfusion grade, ST-segment resolution, infarct size, and adverse events are pending analysis.
Conclusions:
- Manual thrombus aspiration could potentially reduce microcirculatory resistance.
- If proven effective, thrombus aspiration may become a routine strategy in primary PCI for STEMI.
Introduction:
Routine thrombus aspiration is proposed to be superior to conventional primary percutaneous coronary intervention (PCI) in terms of improved myocardial perfusion, in patients with ST-segment elevation acute myocardial infarction (STEMI). However, myocardial perfusion after thrombus aspiration has not been evaluated by a quantitative, invasive method. We intend to determine whether manual thrombus aspiration in the infarct-related coronary artery increases myocardial perfusion assessed by index of microcirculatory resistance (IMR) compared with conventional primary PCI.
Study Design:
PATA STEMI is a single-center, prospective, randomized trial with a planned inclusion of 128 patients with the first STEMI. Prior to coronary angiography, patients are randomly assigned to thrombus aspiration using the Eliminate aspiration catheter (Terumo Medical Supply, Japan) or to conventional primary PCI. After completion of primary PCI, IMR is determined both in infarct-related artery and in noninfarct-related arteries without critical stenoses. The primary end-point is a group mean value of IMR after thrombus aspiration compared with conventional primary PCI. Secondary end-points are myocardial perfusion grade, resolution of ST-segment elevation, enzymatic estimation of infarct size, left ventricular remodeling assessed by echocardiographic indices, and major adverse cardiac events rate at 1, 6, and 12 months.
Conclusion:
If manual thrombus aspiration significantly reduces microcirculatory resistance, thereby improving myocardial perfusion, it may become the routine strategy in primary PCI.
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