Abstract 4201: Benefit of Thrombus Aspiration for Myocardial Infarction With ST-Segment Elevation: Analysis by Biomarkers of Thrombosis and Inflammation
Background Thrombus aspiration (TA) is useful for the treatment of ST-segment elevation myocardial infarction (STEMI), and had better clinical outcomes than percutaneous coronary intervention (PCI). Although TA may protect from microvascular obstruction and failure of myocardial reperfusion by aspirating atherothrombotic debris, detailed mechanisms of its benefit is not fully elucidated. We focused on materials aspirated from atherothrombotic lesion in coronary artery.
Methods Consecutive 15 patients (age 60±11y) with STEMI who underwent primary percutaneous coronary intervention using manual TA for the treatment of TIMI flow grade 0 to 1 with the onset of the symptoms less than 6-hours were enrolled in this study. Plasma concentrations of platelet derived growth factor (PDGF), soluble CD40 ligand (sCD40L), pentraxin3, P-selectin, high-sensitive CRP (hs-CRP), interleukin-6 and matrix metalloproteinase-9 (MMP-9) were measured by the first aspiration sample from infarct related artery (IRA) and from femoral artery as systemic circulation during the procedure. Also, they were collected at 24, 48, 72 and 120 hours after TA from peripheral vessel.
Results Mean time from the onset of the symptoms to first aspiration was 224±132 min. Blood samples were collected from all cases but visible debris was aspirated in 8 cases (54%). At the time of first aspiration, PDGF and sCD40L were increased in IRA compared with peripheral artery. However, pentraxin3 and MMP-9 were not different between them. Hs-CRP tended to be higher in peripheral artery than IRA. The levels of pentraxin3 and IL-6 peaked 24 hours after TA, and hsCRP was 48 hours.
Conclusion Platelets play an important role in embolization and microvascular dysfunction. Our results suggest that the benefit of TA was to aspirate proinflammatory mediators associated with platelet thrombus, and not to evoke inflammation.