Key result
Thrombus aspiration during primary PCI linked to ~15 percentage points fewer prolonged QRS cases.
Why the study?
There is continuing uncertainty as to whether reducing thrombus burden through catheter aspiration improves the arrhythmogenic structure of the myocardium in STEMI.
Does thrombus aspiration before primary PCI improve signal-averaged ECG parameters associated with ventricular arrhythmogenesis in patients with STEMI?
Cohort (n=170)
No
Does thrombus aspiration before primary PCI improve signal-averaged ECG parameters associated with ventricular arrhythmogenesis in patients with STEMI?
Absolute Event Rate: 8.8% vs 23.7%
p-value: p=0.011
Thrombus aspiration during primary PCI for STEMI may improve early signal-averaged ECG parameters associated with ventricular arrhythmogenesis compared to conventional PCI alone.
Thrombus aspiration was associated with fewer prolonged QRS complexes on SAECG after STEMI; hypothesis-generating and requires randomized confirmation before practice change.
Background/Aims: Percutaneous coronary intervention (PCI) is the standard method of treating ST-segment elevation myocardial infarction (STEMI).There is continuing uncertainty as to whether reducing the thrombus burden through catheter aspiration improves the arrhythmogenic structure of the myocardium in STEMI.We compared the changes in electrical instability after thrombus aspiration-assisted primary PCI using conventional primary PCI. Methods:The study population included 170 consecutive patients with STEMI who underwent primary PCI.The patients were divided into 80 patients who underwent primary PCI only and 90 patients who underwent thrombus aspiration before PCI.The signal-averaged ECG (SAECG) was obtained 5 ± 2 days after the intervention.Results: There were no significant differences between the groups in terms of sex, age, cardiovascular risk factors, or time from the onset of symptoms to treatment.The duration of the low amplitude signals less than 40 μV (LAS40), duration of the QRS complex (QRSD), and root mean square voltage of the terminal 40 ms of the QRS complex (RMS40) did not differ between the thrombus aspiration and no thrombus aspiration groups.The incidences of QRSD > 114 ms and RMS40 < 20 μV were significantly lower in the thrombus aspiration group than the no thrombus aspiration group (19 vs. 8, p = 0.011 and 16 vs.8, p = 0.047, respectively), while the incidence of LAS > 38 ms was significantly higher in the non-thrombus aspiration group (18 vs. 8, p = 0.018).Conclusions: Among random patients with STEMI, thrombus aspiration improved all of the parameters of SAECG, which is related to ventricular arrhythmogenesis, although the long-term clinical outcomes need to be assessed.(Korean J Med 2016;90:26-31)
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Choi et al. (2016) conducted a cohort in ST-segment Elevation Myocardial Infarction (n=170). Thrombus aspiration before primary percutaneous coronary intervention vs. Primary percutaneous coronary intervention only was evaluated on Incidence of prolonged QRS duration (≥114 ms) on signal-averaged ECG (p=0.011). Thrombus aspiration during primary percutaneous coronary intervention significantly reduced the incidence of prolonged QRS duration (≥114 ms) on signal-averaged ECG compared to PCI alone (8.8% vs 23.7%, p=0.011).
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