title: Microvascular damage prevention with thrombaspiration during primary percutaneous intervention in acute myocardial infarction.
abstract: BACKGROUND
  Despite rapid and complete recanalization of infarct-related artery with percutaneous coronary intervention, microvascular integrity is not often preserved. Several mechanical devices have been proposed to prevent distal embolization, but the impact of these devices on myocardial perfusion remains controversial.
  
  
  OBJECTIVE
  The aim of our study was to assess microvascular damage reduction with quantitative myocardial contrast perfusion echocardiography among patients with the first anterior acute myocardial infarction treated with thromboaspiration during percutaneous coronary intervention.
  
  
  METHODS
  Forty-two patients (57.4+/-10 years, 74% males) with first anterior acute myocardial infarction were randomized 1 : 1 to intracoronary thromboaspiration followed by stenting, or to a conventional strategy of stenting alone. Echocardiogram and quantitative myocardial contrast echocardiography were performed 7 days and 1 month later, respectively. Parameter A (reflecting myocardial blood volume), beta (reflecting velocity, myocardial blood flow), and product of A and beta as indicator of myocardial blood flow were analyzed. For each patient mean value of A, beta, and A x beta from all dysfunctional segments was calculated.
  
  
  RESULTS
  The study population was divided into two groups: thromboaspiration (group I, 19 patients) and stenting alone (group II, 23 patients). No difference was observed between the both groups in demographic, clinical, echocardiographic, and angiographic data. Parameter A and A x beta were significantly higher in group I than in group II: 8.58+/-2.54 versus 5.29+/-3.18 dB (P<0.001) and 5.29+/-3.73 versus 2.78+/-3.03 dB/s (P<0.001). Multivariate step-down regression analysis revealed that only thromboaspiration before stenting and lower maximum troponin I have been associated with viability preservation in infarcted region.
  
  
  CONCLUSIONS
  Thromboaspiration before stenting in patients with the first anterior myocardial infarction improves myocardial perfusion at the tissue level assessed by quantitative myocardial contrast echocardiography.
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.forename: Michał
authors.initials: M
authors.lastname: Lelek
authors.forename: Artur
authors.initials: A
authors.lastname: Filipecki
authors.forename: Maciej
authors.initials: M
authors.lastname: Turski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wróbel
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Tabor
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Szydło
authors.forename: Marek
authors.initials: M
authors.lastname: Elzbieciak
authors.forename: Maria
authors.initials: M
authors.lastname: Trusz-Gluza
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D001783:Blood Flow Velocity; D001810:Blood Volume; D003131:Combined Modality Therapy; D003287:Contrast Media; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010743:Phospholipids; D012044:Regression Analysis; D018570:Risk Assessment; D015607:Stents; D013396:Suction; D013459:Sulfur Hexafluoride; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride