Abstract 1759: Does Thrombus Aspiration Improve Angiographic and Clinical Outcomes for Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention?
Background: The use of thrombus aspiration devices for percutaneous coronary intervention (PCI) for management of ST elevation myocardial infarction (STEMI) remains controversial. We examined the efficacy of the thrombus aspiration export catheter in the setting of primary PCI.
Methods: We examined 100 patients who presented with STEMI and a visible thrombus in the infarct related artery (IRA); of which 50 were treated with the export aspiration catheter as an adjunct to the PCI while the other 50 were treated with PCI without aspiration. The angiographic and clinical outcomes of these groups were compared with an emphasis on restoration of TIMI III flow, abrupt closure, no reflow, and a composite endpoint of TVR-MACE (death, Q-wave MI, and TVR) at 6 months.
Results: The baseline clinical characteristics, including rates of inferior and anterior MI were comparable, though there was a trend toward higher rates of TIMI 0 flow at baseline and cardiogenic shock in the export catheter group (46.8% vs 37.1%, p = 0.24 and 33.7% vs 17.8%, p = 0.09, respectively). There was a higher rate of no reflow or slow flow in the control group (7.7% vs 0.0%, p = 0.01). TIMI III flow was achieved in a higher percentage of patients in the export catheter cohort (92.3% vs 74.3%, p = 0.003).There was no significant difference in procedure length (53 ± 27 control, 58 ± 34 min export, p = 0.42), and the TVR-MACE rates at 6 months were significantly lower with the use of the export catheter (11.1% vs 34.1%, p = 0.02).
Conclusions: This study supports the use of export catheter as adjunct to primary PCI for patients who present with STEMI and a visible thrombus in terms of immediate improved angiographic results and late clinical outcomes.