Abstract 2853: Export Aspiration Catheter Thrombosuction Before Actual Primary PCI in AMI: TSUNAMI study
Introduction: Primary PCI for ST-elevation myocardial infarction in lesions with a occlusive thrombus load increases the procedural complication rate and remains a challenge. But distal protection devices have no clinical benefits despite of high cost and operator’s labor.
Hypothesis: We assessed the hypothesis that active manual thrombosuction using export aspiration catheter before actual primary PCI procedure may effective method for improve the myocardial reperfusion and reduce the microembolization.
Methods: We randomly assigned 142 patients with ST-elevation myocardial infarction who were scheduled to primary PCI to initial thrombosuction group or actual primary PCI group. Thrombosuction was done unless cardiogenic shock, left main disease, TIMI 3 with no visible thrombus after guidewire passage or reference diameter< 2 mm. The primary efficacy end points were post-procedural myocardial blush grade (MBG), rates of no reflow and ST segment resolution ≥50%.
Results: 133 patients (60.8±1.05 years, male 69.9%) entered the analyses. The culprit vessels were LAD 42.9%, LCX 6.7% and RCA 52.3%, most lesions with proximal location(51.8%). The initial thrombus scores were higher in thrombosuction group, the rates of post-procedural MBG 2 and 3 were 59.7% and 23.9% in the thrombosuction group compared with 56.1% and 12.1% in the actual primary PCI group respectively (p=.05). The rates of no reflow, distal embolization and ST resolution ≥50% were higher in thrombosuction group than actual primary PCI group without significance.
Conclusions :This prospective randomized study showed that simple manual thrombosuction in patients with STEMI before actual primary PCI results in better angiographic myocardial reperfusion rates compared with primary PCI despite of initial high thrombus burden. In conclusion, primary thrombosuction technique may effective method for improve the myocardial reperfusion and thrombus burden reduction in patients with STEMI.