Receiving both manual thrombus aspiration and intra-lesion abciximab resulted in the smallest 30-day infarct size compared to the other three groups (14.7% vs. 17.3%, p=0.03).
RCT (n=452)
randomized
Does thrombus aspiration and/or intra-lesion abciximab improve pre-stent TIMI flow and reduce infarct size in patients with anterior STEMI undergoing primary PCI?
Optimizing coronary flow before stenting with thrombus aspiration and intra-lesion abciximab reduces infarct size in patients with anterior STEMI undergoing primary PCI.
Absolute Event Rate: 14.7% vs 17.3%
p-value: p=0.03
AIMS: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis In Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% 4.6, 21.8 vs. 22.6% 14.7, 28.0 for TIMI 2 vs. 19.5 14.4, 27.8 for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). CONCLUSIONS: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.
Brener et al. (Sat,) conducted a rct in anterior STEMI (n=452). Intra-lesion abciximab and/or manual thrombus aspiration vs. No abciximab and/or no thrombus aspiration was evaluated on cMRI-determined infarct size at 30 days (p=0.03). Receiving both manual thrombus aspiration and intra-lesion abciximab resulted in the smallest 30-day infarct size compared to the other three groups (14.7% vs. 17.3%, p=0.03).