Effect of thrombus aspiration on infarct size and left ventricular function in high-risk patients with acute myocardial infarction treated by percutaneous coronary intervention. Results of a prospective controlled pilot study
Received 1 October 2008; accepted 26 November 2008. published online 05 February 2009.
Background
Thrombus aspiration devices have been shown to improve reperfusion criteria and to reduce distal embolization in patients treated by percutaneous coronary interventions (PCI) in the acute phase of ST-elevation myocardial infarction (STEMI). There are, however, little data about their efficacy in the reduction of infarct size.
Methods
We sought to assess in a prospective randomized trial the impact of thrombus aspiration on infarct size and severity and on left ventricular function in high-risk patients with a first STEMI. The primary end point was scintigraphic infarct size, and secondary end points were infarct severity and regional and global left ventricular function. Forty-four patients with completely occluded (Thrombolysis in Myocardial Infarction flow 0-1) proximal segments of infarct-related artery were randomly assigned to thrombus aspiration group with the Export catheter (n = 20) (Medtronic, Inc, Minneapolis, MN) or PCI-only group. A rest Tc-99-mibi gated single-photon emission computed tomographic and contrast-enhanced magnetic resonance imaging were performed 6 ± 2 days later.
Results
Infarct size was comparable in patients in the thrombus aspiration group and PCI-only group (30.6% ± 15.8% vs 28.5% ± 17.9% of the left ventricle, P = .7) as was infarct severity in infarct-related artery territory (55% ± 12% vs 55% ± 14%, P = .9). Transmurality score as assessed by magnetic resonance imaging was similar in both groups (2.03 ± 1.05 vs 2.16 ± 1.21, P = .7). There was no impact of thrombus aspiration on other secondary end points.
Conclusion
In our study, thrombus aspiration with the Export catheter performed as adjunctive therapy in high-risk patients with total occlusion of the proximal part of major coronary arteries does not decrease infarct size or severity and has no effect on left ventricular regional and global function.
aDepartment of Cardiology, G. Montpied University Hospital, Clermont-Ferrand, France
bDepartment of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France
cDepartment of Radiology, G. Montpied University Hospital, Clermont-Ferrand, France
dDepartment of Statistics, G. Montpied University Hospital, Clermont-Ferrand, France
Reprint requests: Janusz Lipiecki, MD, Department of Cardiology, G. Montpied University Hospital, rue Montalembert, 63000 Clermont-Ferrand, France.
ABSTRACT