Key result
Thrombus aspiration improves TIMI flow in STEMI but fails to reduce 30-day MACE.
Why the study?
The efficacy and safety of thrombus aspiration catheters during emergency PCI for STEMI patients with high thrombus load were uncertain.
Does thrombus catheter aspiration improve myocardial reperfusion in acute STEMI patients with high thrombus load undergoing emergency PCI?
RCT (n=204)
No
Does thrombus catheter aspiration improve myocardial reperfusion in acute STEMI patients with high thrombus load undergoing emergency PCI?
p-value: p=0.335
Thrombus aspiration during emergency PCI for STEMI with high thrombus burden improves immediate angiographic reperfusion but does not significantly reduce 30-day MACE or improve early left ventricular function.
Thrombus aspiration improves TIMI flow without reducing 30-day MACE; challenges routine use in STEMI PCI and extends prior negative trial evidence.
OBJECTIVE: This study aims to discuss the efficacy and safety of the application of thrombus aspiration catheters during emergency PCI operations for acute ST-elevation myocardial infarction (STEMI) patients with high thrombus load. METHODS: A total of 204 patients diagnosed with acute STEMI and high thrombus load in the Sixth Affiliated Hospital of Guangxi Medical University from July 1, 2016 to June 30, 2017 were selected for the present study. These patients were randomly divided into two groups: thrombus catheter aspiration group (group A, n = 101), and balloon dilatation group (group B, n = 103). The blood flow of the culprit coronary artery in the thrombolysis in myocardial infarction (TIMI) immediately after the emergency PCI operation in these two groups of patients was recorded. Then, an echocardiogram was performed to determine the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) after the operation, and data on major adverse cardiovascular events (MACE) during the 30 days of postoperative follow-up were collected. RESULTS: The comparative difference between these two groups of patients in terms of hypertension, smoking, diabetes, usage rate of GPIIb/IIIa receptor antagonist, time from hospitalization to balloon dilatation (D2B) and other basic clinical data was not statistically significant (P > 0.05). The postoperative TIMI flow grade of these two groups of patients improved, and the comparative difference between the data obtained from these two groups was statistically significant (P < 0.05). The comparative difference between these two groups in terms of LVEDD and LVEF at 7 days after the operation was not statistically significant (P > 0.05). There was a difference in the occurrence rate of MACE in these two groups of patients during the 30 days of postoperative follow-up, but the comparative difference between these two groups was not statistically significant (P = 0.335). CONCLUSION: The application of thrombus aspiration catheter during the emergency PCI operation of STEMI patients with high thrombus load can better improve the myocardial reperfusion. There is no basis for increasing the stroke occurrence risk. However, it obviously fails to improve the recent prognosis and more studies need to explore its effect on myocardial remodeling and major adverse cardiovascular events.
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Li et al. (2019) conducted an RCT in Acute ST-elevation myocardial infarction (STEMI) with high thrombus load (n=204). Thrombus aspiration catheter vs. Balloon dilatation was evaluated on Major adverse cardiovascular events (MACE) during 30 days of postoperative follow-up (p=0.335). Thrombus aspiration catheter during emergency PCI for STEMI improved postoperative TIMI flow (P<0.05) but did not significantly reduce 30-day major adverse cardiovascular events (P=0.335).
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