Key result
Manual thrombus aspiration during primary PCI significantly improved the myocardial salvage index compared to PCI alone (60.1% vs 28.1%; P<0.001) in STEMI patients presenting 12 to 48 hours after onset.
Why the study?
Does manual thrombus aspiration improve myocardial salvage index in patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset undergoing primary PCI?
RCT (n=60)
1:1
No
Does manual thrombus aspiration improve myocardial salvage index in patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset undergoing primary PCI?
Manual thrombus aspiration during primary PCI significantly improved the myocardial salvage index and reperfusion markers in late-presenting STEMI patients (12-48 hours after symptom onset).
Supports TA for better myocardial salvage in late STEMI; extends RCT data but leaves clinical benefit open.
OBJECTIVES: To examine whether routine thrombus aspiration (TA) is associated with improved myocardial salvage in patients with ST-elevation myocardial infarction (STEMI) presenting ≥12 h after onset of symptoms. BACKGROUND: TA is a recognized treatment option in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) especially in the setting of heavy thrombus burden. However, data on the role of TA in STEMI patients presenting late after onset of symptoms are limited. METHODS: In this single-center prospective randomized study, patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset were randomized to primary PCI with or without manual TA in a 1:1 ratio. The primary endpoint was the myocardial salvage index assessed with Single Photon Emission Computed Tomography (SPECT) on admission and 4 days later. RESULTS: A total of 60 patients underwent randomization. Baseline characteristics were comparable between groups. TA was associated with improved myocardial salvage index compared with control group (60.1 ± 11.1% vs 28.1 ± 21.3%; P = <0.001). Furthermore, TA was associated with improved post-procedural TIMI flow (2.9 ± 0.3 vs 2.5 ± 0.6; P = 0.003), myocardial blush grade (2.9 ± 0.3 vs 2.2 ± 0.8, P = <0.001), and reduction in left ventricular end-diastolic dimensions (50.4 ± 4.3 mm vs 54.4 ± 5.8 mm, P = 0.004) compared with the control group. Clinical outcomes at 30 days and 6 months were similar between both groups. CONCLUSIONS: TA might be associated with improved reperfusion and myocardial salvage especially in STEMI patients presenting after 12 h from symptom onset who are likely to have a heavy thrombus burden.
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Rezq et al. (2018) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=60). Manual thrombus aspiration (TA) vs. Primary PCI without manual TA was evaluated on Myocardial salvage index assessed with SPECT on admission and 4 days later (p=<0.001). Manual thrombus aspiration during primary PCI significantly improved the myocardial salvage index compared to PCI alone (60.1% vs 28.1%; P<0.001) in STEMI patients presenting 12 to 48 hours after onset.
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