Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation
Emiliano Bianchini1, Marco Lombardi1, Angela Buonpane1
1Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
Insights
Thrombus aspiration (TA) in ST-segment-elevation myocardial infarction (STEMI) improves left ventricular (LV) function, particularly with manual techniques and left anterior descending artery involvement. This meta-analysis of RCTs highlights TA
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Routine thrombus aspiration (TA) in ST-segment-elevation myocardial infarction (STEMI) has shown no consistent clinical outcome improvement.
- Previous meta-analyses suggest potential benefits of TA in patients with high thrombus burden.
- The effect of TA on left ventricular (LV) functional recovery and remodeling post-STEMI remains debated.
Purpose of the Study:
- To evaluate the impact of thrombus aspiration (TA) on left ventricular (LV) functional recovery and remodeling after primary percutaneous coronary intervention (pPCI) in STEMI patients.
- To pool data from randomized controlled trials (RCTs) to clarify the role of TA in post-STEMI LV remodeling.
- To compare manual TA versus mechanical TA in STEMI patients.
Main Methods:
- Systematic literature search of PubMed and CENTRAL databases for relevant randomized controlled trials (RCTs).
- Primary outcome measures included LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and wall motion score index (WMSI).
- A pre-specified subgroup analysis compared manual thrombus aspiration (TA) with mechanical TA.
Main Results:
- A total of 28 studies with 4990 patients were analyzed.
- Thrombus aspiration (TA) was associated with a lower wall motion score index (WMSI) compared to control.
- Manual TA demonstrated a greater LV ejection fraction (LVEF) and smaller LV end-systolic volume (LVESV) compared to control. Meta-regression indicated TA use, particularly in left anterior descending artery (LAD) involvement, reduced LVEDV and LVESV and improved myocardial salvage index.
Conclusions:
- Thrombus aspiration (TA) is linked to enhanced left ventricular (LV) function post-myocardial infarction.
- The effectiveness of TA in improving post-infarction LV remodeling appears influenced by the TA technique, duration of ischemia, and involvement of the left anterior descending artery (LAD).
Background:
Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI).
Methods:
PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA.
Results:
A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04).
Conclusion:
TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.
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