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Impact of Aspiration Thrombectomy on Microvascular Obstruction in Patients With ST-segment Elevation Myocardial
Mahmoud Ismaiel1, Mohamed Shehata2, Tamer Elwasify1
1Cardiovascular Department, Specialized Heart Hospital, Kobri Elkoba Medical Complex, Cairo, Egypt.
Insights
Thrombus aspiration during primary percutaneous coronary intervention significantly reduces microvascular obstruction in ST-elevation myocardial infarction patients. This adjunctive technique lowers both the occurrence and extent of MVO, improving outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Primary percutaneous coronary intervention (PPCI) is the standard for ST-segment elevation myocardial infarction (STEMI) reperfusion.
- Thrombus aspiration is recognized for preventing distal embolization and reducing microvascular obstruction (MVO).
- Cardiac magnetic resonance (CMR) is the gold standard for MVO assessment.
Purpose of the Study:
- To assess the impact of thrombus aspiration as an adjunct to PPCI.
- To evaluate its effect on MVO incidence and extent in STEMI patients.
- To utilize CMR for precise MVO evaluation.
Main Methods:
- Sixty-five STEMI patients with heavy thrombus burden were analyzed.
- Patients were divided into aspiration thrombectomy followed by PCI (aspiration group) and conventional PCI (conventional group).
- Microvascular obstruction (MVO) and angiographic outcomes were primary endpoints.
Main Results:
- The incidence of MVO was significantly lower in the aspiration group (22.6%) compared to the conventional group (52.9%; p=0.012).
- MVO extent was also significantly reduced in the aspiration group.
- Fewer patients in the aspiration group had MVO extending to >4 segments (9.7%) versus the conventional group (38.2%; p=0.007).
Conclusions:
- Thrombus aspiration is a valuable adjunctive therapy to PPCI in STEMI.
- It significantly decreases both the incidence and extent of MVO in patients with substantial thrombus burden.
- This technique improves myocardial reperfusion outcomes evaluated by CMR.
Background:
Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization and reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for the evaluation of MVO.
Objectives:
The aim of this study was to evaluate the effect of thrombus aspiration in STEMI patients as an adjunctive technique to primary PCI in reducing both incidence and extent of MVO evaluated by CMR.
Methods:
Ninety-three patients with heavy thrombus burden were enrolled in this study; sixty-five patients met our inclusion criteria. After failed trial of restore the artery patency, aspiration thrombectomy was done followed by PCI for thirty-one patients (aspiration group), while conventional PCI without aspiration thrombectomy was performed for 34 patients (conventional group). The primary end points were both occurrence and extent of microvascular obstruction (MVO) evaluated mainly by CMR, in addition to angiographic data (MBG and TIMI flow grade).
Results:
The incidence of microvascular obstruction (MVO) was significantly higher in conventional group (18 patients, 52.9 %) when compared with aspiration group (7 patients, 22.6 %; p-value = 0.012). Moreover, significant differences existed between the studied groups regarding MVO extent. For instance, MVO extended to >4 segments in only 3 patients (9.7 %) in aspiration group, but in 13 patients in conventional group (38.2 %; p-value = 0.007).
Conclusions:
Aspiration thrombectomy substantially reduces both the incidence and extent of microvascular obstruction as an adjunctive technique to PPCI in STEMI patients with heavy thrombus burden.
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