Key result
Manual thrombectomy in STEMI patients was associated with a higher incidence of microvascular obstruction compared to no thrombectomy (59.5% vs. 38.9%, p<0.001), especially with high thrombus burden.
Why the study?
The study was conducted to assess the effect of manual thrombectomy on microvascular obstruction assessed by CMR in STEMI patients undergoing primary PCI.
Does manual thrombectomy affect the occurrence and extent of microvascular obstruction in STEMI patients undergoing primary PCI?
Observational (n=383)
Does manual thrombectomy affect the occurrence and extent of microvascular obstruction in STEMI patients undergoing primary PCI?
Effect estimate: OR 1.802 (95% CI 1.080-3.009)
Absolute Event Rate: 59.5% vs 38.9%
p-value: p=<0.001
Manual thrombectomy during primary PCI for STEMI is associated with an increased occurrence and extent of microvascular obstruction on CMR, particularly in patients with a high thrombus burden.
Caution against routine manual thrombectomy in STEMI PCI; leaves open randomized confirmation of MVO effects.
OBJECTIVE: To assess the effect of manual thrombectomy (MT) on microvascular obstruction (MVO) using cardiac magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Three hundred and eighty-three patients admitted for STEMI and undergoing CMR fulfilled the inclusion criteria and were categorized into two groups (did or did not undergo MT). The two primary endpoints were the occurrence and extent of MVO, analyzed as a categorical variable and as a semicontinuous variable. Among the 383 patients, 49.1% exhibited MVO. Both the incidence of MVO and the median number of segments presenting with MVO were significantly higher in the MT group than in the no-MT group, (59.5 vs. 38.9%, p < .001) and (1.5 [0;4] vs. 0 [0;2], p < .001). Analysis stratified on coronary thrombus grade showed similar results, only in patients with a high thrombus burden (60.7 vs. 43.5%, p = .004, and 2 [0;4] vs. 0 [0;3], p = .001. When adjusting for baseline differences, MT remained a determinant of MVO occurrence and extent (odds ratio, OR 1.802 [95% confidence interval, CI 1.080-3.009], p = .024) and β = .137, p = .024) in patients with a high thrombus grade. CONCLUSION: In STEMI patients, MT was associated with the occurrence and extent of MVO, on CMR, especially in patients with a high thrombus burden.
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Meier et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=383). Manual thrombectomy (MT) vs. No manual thrombectomy was evaluated on Occurrence and extent of microvascular obstruction (MVO) (OR 1.802, 95% CI 1.080-3.009, p=<0.001). Manual thrombectomy in STEMI patients was associated with a higher incidence of microvascular obstruction compared to no thrombectomy (59.5% vs. 38.9%, p<0.001), especially with high thrombus burden.
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