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Published on: May 28, 2019
Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction Presenting Late After Symptom Onset
Steffen Desch1, Thomas Stiermaier1, Suzanne de Waha1
1University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Insights
Manual thrombus aspiration did not reduce microvascular obstruction in ST-segment elevation myocardial infarction (STEMI) patients presenting late. This study found no significant benefit for reperfusion markers with routine aspiration before percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Thrombus aspiration is a standard treatment for ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI).
- Limited data exist on thrombus aspiration's efficacy in STEMI patients presenting late (≥12 hours after symptom onset).
Purpose of the Study:
- To evaluate if manual thrombus aspiration reduces microvascular obstruction in STEMI patients with late presentation.
- To assess the impact of thrombus aspiration on reperfusion markers using cardiac magnetic resonance imaging (CMR).
Main Methods:
- Randomized trial of 152 patients with STEMI presenting 12-48 hours after symptom onset.
- Patients received primary PCI with or without manual thrombus aspiration.
- CMR imaging was performed 1-4 days post-randomization to measure microvascular obstruction.
Main Results:
- No significant difference in microvascular obstruction between thrombus aspiration and control groups (2.5% vs. 3.1% of left ventricular mass, p=0.47).
- Infarct size, myocardial salvage, ejection fraction, and clinical outcomes were comparable between groups.
- The majority of patients (60%) had moderate viable myocardium in the affected region.
Conclusions:
- Routine manual thrombus aspiration before PCI in late-presenting STEMI patients did not improve markers of reperfusion success.
- This is the first randomized trial to investigate thrombectomy in this specific patient population.
- Findings suggest thrombus aspiration may not be beneficial for late STEMI presentation.
Objectives:
The aim of this study was to examine whether manual thrombus aspiration reduces microvascular obstruction assessed by cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction (STEMI) presenting late after symptom onset.
Background:
Thrombus aspiration is an established treatment option in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). However, there are only limited data on the efficacy of thrombus aspiration in patients with STEMI presenting ≥12 h after symptom onset.
Methods:
Patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset were randomized to primary PCI with or without manual thrombus aspiration in a 1:1 ratio. Patients underwent cardiac magnetic resonance imaging 1 to 4 days after randomization. The primary endpoint was the extent of microvascular obstruction.
Results:
A total of 152 patients underwent randomization. The mean time between symptom onset and PCI was 28 ± 12 h. Baseline characteristics were comparable between groups. The majority of patients (60%) showed at least a moderate amount of viable myocardium in the affected region. Extent of microvascular obstruction was not significantly different between patients assigned to thrombus aspiration and the control group (2.5 ± 4.0% vs. 3.1 ± 4.4% of left ventricular mass, p = 0.47). There were also no significant differences in infarct size, myocardial salvage, left ventricular ejection fraction, and angiographic and clinical endpoints between groups.
Conclusions:
In this first randomized trial of thrombectomy in patients with STEMI presenting late after symptom onset, routine thrombus aspiration before PCI failed to show a benefit for markers of reperfusion success. (Effect of Thrombus Aspiration in Patients With Myocardial Infarction Presenting Late After Symptom Onset; NCT01379248).
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