Key result
Primary PCI with thrombectomy did not significantly differ from PCI without thrombectomy in percentage of incompletely apposed struts at 6-month follow-up (0.42% vs 0.38%, P=0.76).
Why the study?
Does primary percutaneous coronary intervention with thrombectomy improve stent apposition and neointima formation at 6 months compared to intervention without thrombectomy in patients with STEMI?
RCT (n=141)
Yes
Does primary percutaneous coronary intervention with thrombectomy improve stent apposition and neointima formation at 6 months compared to intervention without thrombectomy in patients with STEMI?
Absolute Event Rate: 0.42% vs 0.38%
p-value: p=0.76
Routine thrombectomy during primary PCI for STEMI does not significantly improve stent apposition or coverage at 6 months as assessed by optical frequency domain imaging.
Residual thrombus or incomplete apposition did not affect neointima formation in STEMI; leaves open whether OFDI optimization improves healing.
AIMS: To investigate the incidence of incomplete stent apposition and to explore the impact of the presence of thrombus and protruding plaque after stent implantation on neointima formation at follow-up in ST-segment elevation myocardial infarction (STEMI) patients with serial optical frequency domain imaging (OFDI) investigations. METHODS AND RESULTS: In a multi-centre study, 141 patients with ST elevation myocardial infarction <12 h from onset were randomized to either PPCI with thrombectomy (TB) using an Eliminate catheter (TB: n = 71) or without TB (non-TB: n = 70). OFDI after drug-eluting stenting was performed using TERUMO OFDI system. Per protocol, at follow-up 49 patients segments were reimaged. At post-procedure and follow-up, there were no differences in stent and lumen areas between the two groups. At follow-up, per strut-level analysis, percentage of incompletely apposed struts was 0.42 ± 0.94 vs. 0.38 ± 0.77% (P = 0.76), and percentage of covered struts was 92.7 ± 7.2 vs. 94.4 ± 9.2% (P = 0.47) in the TB and non-TB groups, respectively. There was a positive correlation between intra-stent structure (ISS) volume at post-procedure and the neointima volume at 6-month follow-up (Pearson's r = 0.409, P = 0.04). Up to 12 months, there have been two and four patients having target vessel failure in the TB and in the non-TB groups, respectively. CONCLUSIONS: In patients with STEMI, there were no significant differences in OFDI parameters between TB and non-TB groups at both post-procedure and 6-month follow-up. However, ISS volume at post-procedure was positively associated with neointimal volume at 6-month follow-up.
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García‐García et al. (2014) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=141). Primary PCI with thrombectomy vs. Primary PCI without thrombectomy was evaluated on Percentage of incompletely apposed struts at follow-up (p=0.76). Primary PCI with thrombectomy did not significantly differ from PCI without thrombectomy in percentage of incompletely apposed struts at 6-month follow-up (0.42% vs 0.38%, P=0.76).
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