Key result
Aspiration thrombectomy before primary PCI improved the myocardial salvage index compared to standard PCI alone (25.4% vs 18.5%; P=0.02) in high-risk STEMI patients.
Why the study?
Does aspiration thrombectomy improve myocardial salvage index in high-risk STEMI patients with angiographic evidence of thrombus?
RCT (n=137)
randomized
Does aspiration thrombectomy improve myocardial salvage index in high-risk STEMI patients with angiographic evidence of thrombus?
Absolute Event Rate: 25.4% vs 18.5%
p-value: p=0.02
Aspiration thrombectomy prior to primary PCI significantly improves myocardial salvage and reduces final infarct size in high-risk STEMI patients with angiographic evidence of thrombus.
Supports selective aspiration thrombectomy in high-risk STEMI with thrombus; confirms myocardial salvage benefit in this RCT population.
OBJECTIVES: The aim of the study was to assess if aspiration thrombectomy in high risk patients with STEMI and angiographic evidence of thrombus may improve myocardial salvage. BACKGROUND: It is unclear if thrombus aspiration before percutaneous intervention (PCI) improves myocardial salvage. METHODS: The trial was a prospective randomized study. The inclusion criteria were: first STEMI within 12 hr from symptoms onset, culprit lesion in left anterior descending or right coronary artery, culprit artery TIMI flow ≤ 2 and angiographic evidence of thrombus. The primary endpoint was myocardial salvage index (MSI) as assessed by (99m) Tc-sestamibi SPECT imaging. RESULTS: We randomized 137 patients (98 male, mean age 64.1 ± 12.5 years) either to aspiration thrombectomy followed by standard PCI with stent implantation (n = 67) or to standard primary PCI (n = 70). Index perfusion defect was similar in both study groups: 34.2% ± 13.1% in thrombectomy group versus 37.1% ± 12.0% in primary PCI group (P = 0.2). MSI was larger in aspiration thrombectomy group than in control patients [25.4% (IQR 13.5-44) vs. 18.5% (IQR 7.7-30.3) respectively, P = 0.02]. The final infarct size was smaller in patients treated with aspiration thrombectomy (23.1% ± 13.3% vs. 28.9% ± 10.2% in the control group, P = 0.002). CONCLUSIONS: Aspiration thrombectomy improves myocardial salvage in high risk STEMI patients with angiographic evidence of thrombus.
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Ciszewski et al. (2011) conducted an RCT in STEMI (n=137). Aspiration thrombectomy vs. Standard primary PCI was evaluated on Myocardial salvage index (MSI) as assessed by (99m) Tc-sestamibi SPECT imaging (p=0.02). Aspiration thrombectomy before primary PCI improved the myocardial salvage index compared to standard PCI alone (25.4% vs 18.5%; P=0.02) in high-risk STEMI patients.
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