title: Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction.
abstract: OBJECTIVE
  To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI).
  
  
  METHODS
  76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement (n = 38) or to conventional stenting (n = 38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated.
  
  
  RESULTS
  After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3 (36.8% v 13.1%, p = 0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p = 0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) >or= 20%: 15 in the conventional group and four in the thrombectomy group (p = 0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p < 0.0001) and EDV (152.5 (18.1) ml v 138.1 (10.7) ml, p < 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed (10.5% in the conventional group v 8.6% in the thrombectomy group, not significant).
  
  
  CONCLUSIONS
  Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.
authors.affiliation: Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy. leodeluca@virgilio.it
authors.forename: L
authors.initials: L
authors.lastname: De Luca
authors.forename: G
authors.initials: G
authors.lastname: Sardella
authors.forename: C J
authors.initials: CJ
authors.lastname: Davidson
authors.forename: G
authors.initials: G
authors.lastname: De Persio
authors.forename: M
authors.initials: M
authors.lastname: Beraldi
authors.forename: T
authors.initials: T
authors.lastname: Tommasone
authors.forename: M
authors.initials: M
authors.lastname: Mancone
authors.forename: B L
authors.initials: BL
authors.lastname: Nguyen
authors.forename: L
authors.initials: L
authors.lastname: Agati
authors.forename: M
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: F
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D015588:Observer Variation; D011446:Prospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D020257:Ventricular Remodeling / Q000502:physiology