Thrombus aspiration prior to primary angioplasty in acute myocardial infarction: estimation of rescued myocardial tissue by return of ST-segment elevation.
BACKGROUND
The goal of the study was to validate the clinical benefit of adjunctive thrombus aspiration prior to balloon or stent angioplasty in patients with acute myocardial infarction.


OBJECTIVE
Adjunctive thrombus aspiration reduces no-reflow by eliminating peripheral thromboembolism.


METHODS
In all, 143 consecutive patients underwent primary angioplasty for acute myocardial infarction in our institution. We excluded patients with subacute stent thrombosis or bundle-branch pattern of the electrocardiogram (ECG) and divided the remaining 131 into two groups: 62 patients who underwent intervention without a thrombus aspiration device (Group 1) and 69 patients who were treated as soon as a specifically designed thrombus aspiration catheter became available at our institution (Group 2). The intention was to use thrombus aspiration in every suitable case with proximal occlusion of a major vessel. The reduction of the sum of ST-segment elevation following angioplasty as a marker of rescued myocardial tissue was compared between the two groups.


RESULTS
Thrombus aspiration was technically feasible in 23 of 25 attempted cases. The reduction of the sum of ST-segment elevation following intervention was 0.41 +/- 0.39 mV in Group 1 and 0.37 +/- 0.42 mV in Group 2 (p > 0.05).


CONCLUSIONS
Thrombus aspiration may be helpful during primary angioplasty in selected cases but does not improve the general outcome. Other reasons for "no-reflow," apart from peripheral thromboembolism, seem to be responsible for the lack of clinical benefit.
Hofmann
Robert
R
Cardiovascular Division, City Hospital Linz, Linz, Austria. Robert.Hofmann@Akh.Linz.at
Kypta
Alexander
A
Kerschner
Klaus
K
Grund
Michael
M
Steinwender
Clemens
C
Leisch
Franz
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D016009:Chi-Square Distribution; D003328:Coronary Thrombosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D020127:Recovery of Function; D015607:Stents; D013396:Suction / Q000295:instrumentation