Patterns of ST segment resolution after guidewire passage and thrombus aspiration in primary percutaneous coronary intervention (PPCI) for acute myocardial infarction
Paul Russhard1, Firas Al Janabi1, Michael Parker2
1Department of Cardiology , Essex Cardiothoracic Centre, Nether Mayne , Basildon, Essex , UK.
Insights
Mechanical thrombus aspiration in ST-elevation myocardial infarction (STEMI) did not improve ST resolution compared to guidewire passage alone. While it increased 50% ST resolution, it also led to worse ST elevation in some patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- ST segment elevation is crucial for identifying acute myocardial infarction (AMI) patients needing emergency reperfusion.
- Primary percutaneous coronary intervention (PPCI) is the leading reperfusion strategy for ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To evaluate the impact of mechanical thrombus aspiration following guidewire passage on ST segment displacement in STEMI patients.
Main Methods:
- A study involving 289 STEMI patients.
- Assessed ST segment displacement after simple angioplasty guidewire passage.
- Further assessed ST segment displacement after mechanical thrombus aspiration.
Main Results:
- Simple guidewire passage significantly reduced mean ST elevation (5.9mm to 4.9mm, p<0.001).
- Mechanical thrombus aspiration did not significantly improve mean ST displacement compared to guidewire passage alone (4.8mm).
- Thrombus aspiration increased 50% ST resolution (21.8% vs 15.2%, p=0.009) but also increased worsening of ST elevation (19.7% vs 13.5%, p=0.041).
Conclusions:
- Mechanical thrombus aspiration in STEMI does not enhance mean ST resolution over simple guidewire passage.
- The procedure increases both successful 50% ST resolution and adverse ST elevation worsening.
- Findings may clarify uncertainties regarding routine thrombus aspiration in STEMI and support using guidewire passage time to assess PPCI service efficiency.
Background:
ST segment elevation allows the rapid identification of patients with acute myocardial infarction who benefit from emergency reperfusion. Primary percutaneous coronary intervention (PPCI) has emerged as the preferred perfusion strategy for patients presenting with ST segment elevation myocardial infarction (STEMI).
Methods And Results:
We studied the effects of the simple passage of an angioplasty guidewire followed by mechanical thrombus aspiration on the ST segment displacement in 289 patients presenting with acute STEMI. Simple guidewire passage led to a statistically significant fall in the mean ST elevation from 5.9 to 4.9 mm (p<0.001), but the mean ST displacement after subsequent mechanical thrombus aspiration was 4.8 mm, not statistically significantly different from guidewire passage. When compared with simple guidewire passage, thrombus aspiration resulted in more patients achieving more than 50% ST resolution (21.8% vs 15.2%, p=0.009), but a higher proportion had a worsening of ST elevation compared to baseline (19.7% vs 13.5%, p=0.041).
Conclusions:
Mechanical thrombus aspiration in acute STEMI did not improve the mean ST resolution compared with simple guidewire passage. Thrombus aspiration increased the proportion achieving 50% resolution but also increased the proportion who had a worsening of ST elevation. These data may help explain some of the uncertainties surrounding the routine use of thrombus aspiration in STEMI and potentially supports the use of 'time to angioplasty guidewire passage' as one of the ways to judge the promptness of PPCI services.
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