Key result
Age ≥60 years, hypertension, symptom-to-PCI time ≥4.8 hours, and postaspiration cTFC >40 independently predicted insufficient reperfusion in STEMI patients undergoing aspiration thrombectomy.
Why the study?
What are the clinical predictors of insufficient myocardial reperfusion in STEMI patients with high thrombus burden undergoing PPCI with manual aspiration thrombectomy?
Cohort (n=202)
What are the clinical predictors of insufficient myocardial reperfusion in STEMI patients with high thrombus burden undergoing PPCI with manual aspiration thrombectomy?
In STEMI patients with high thrombus burden undergoing primary PCI with aspiration thrombectomy, older age, hypertension, delayed presentation, and high post-aspiration cTFC predict poor reperfusion, while intracoronary tirofiban improves outcomes.
These predictors identify high-risk STEMI patients for insufficient reperfusion after aspiration thrombectomy; hypothesis-generating and requires prospective validation.
Background . Insufficient data are available on the potential benefit of selective aspiration and clinical predictors for no-reflow in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) adjunct with aspiration thrombectomy. Objective . The aim of our study was to investigate clinical predictors for insufficient reperfusion in patients with high thrombus burden treated with PPCI and manual aspiration thrombectomy. Methods . From January 2011 till December 2015, 277 STEMI patients undergoing manual aspiration thrombectomy and PPCI were selected and 202 patients with a Thrombolysis in Myocardial Infarction (TIMI) thrombus grade 4~5 were eventually involved in our study. According to a cTFC value, patients were divided into Group I (cTFC > 40), namely, insufficient reperfusion group; Group II (cTFC ≤ 40), namely, sufficient reperfusion group. Results . Univariate analysis showed that hypertension, multivessel disease, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were negative predictors for insufficient reperfusion. After multivariate adjustment, age ≧ 60 years, hypertension, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were independently associated with insufficient reperfusion in STEMI patients treated with manual aspiration thrombectomy. Upfront intracoronary GP IIb/IIIa inhibitor (Tirofiban) was positively associated with improved myocardial reperfusion. Conclusion . Fully identifying risk factors will help to improve the effectiveness of selective thrombus aspiration.
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Tian et al. (2016) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=202). Primary percutaneous coronary intervention with manual aspiration thrombectomy was evaluated on Insufficient myocardial reperfusion (cTFC > 40). Age ≥60 years, hypertension, symptom-to-PCI time ≥4.8 hours, and postaspiration cTFC >40 independently predicted insufficient reperfusion in STEMI patients undergoing aspiration thrombectomy.
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