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Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation
Insights
Manual thrombus aspiration in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI increased severe diastolic dysfunction. However, this intervention did not affect major adverse cardiovascular events during follow-up.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Limited data exist on the impact of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) patients.
- Assessing diastolic function is crucial for understanding long-term outcomes after myocardial infarction.
Purpose of the Study:
- To compare diastolic function indices and clinical outcomes in STEMI patients treated with and without manual thrombus aspiration.
- To evaluate the role of manual thrombus aspiration in a high-volume percutaneous coronary intervention (PCI) center.
Main Methods:
- A total of 433 STEMI patients undergoing primary PCI were analyzed.
- Exclusion criteria included prior myocardial infarction, revascularization, cardiogenic shock, significant valvular disease, atrial fibrillation, or pacemaker.
- Comprehensive echocardiography was performed within 48 hours, with follow-up assessing patient status.
Main Results:
- Patients receiving thrombus aspiration (TA+) showed similar baseline characteristics and ischemic times compared to those without (TA-).
- The TA+ group had higher peak troponin I levels but similar left ventricular volumes and systolic function.
- A significantly higher incidence of severe diastolic dysfunction (E/e' > 15) was observed in the TA+ group (23.1% vs. 15.2%, p=0.050).
- Major adverse cardiac/cerebral events occurred at similar rates in both groups during follow-up.
Conclusions:
- Manual thrombus aspiration in unselected STEMI patients undergoing primary PCI is associated with an increased risk of severe diastolic dysfunction.
- Thrombus aspiration did not significantly impact the incidence of major adverse cardiovascular events in this cohort.
Introduction:
Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce.
Objective:
We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center.
Methods:
A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients'status was assessed by an office visit or telephone interview.
Results:
Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n = 217). Groups had similar total ischemic time (319 ± 276 vs. 333 ± 372 min; p = 0.665), but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p < 0.001). The echocardiography revealed similar left ventricular volumes and systolic function, but TA+ group had significantly higher incidence of E/e' > 15, as a marker of severe diastolic dysfunction' (TA+ 23.1% vs. TA- 15.2%; p = 0.050). During average follow-up of 14 ± 5 months, major adverse cardiac/cerebral events occurred at the similar rate (log rank p = 0.867).
Conclusion:
Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn't influence the incidence of major adverse cardiovascular events.
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