title: Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact on myocardial perfusion and infarct size as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of a manual thrombectomy device, Export Medtronic (EM) (Medtronic Inc., Minneapolis, Minnesota), as adjunctive therapy in primary percutaneous coronary intervention (PPCI) in a subset of patients with anterior ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  PPCI may cause thrombus dislodgment, leading to microvascular damage.
  
  
  METHODS
  One hundred seventy-five STEMI patients were randomly assigned to standard percutaneous coronary intervention (PCI) (n = 87) or EM-PCI (n = 88). The primary end points were the occurrence of myocardial blush grade > or =2 and the rate of 90-min ST-segment resolution >70%. The CE-MRI substudy was performed in 75 patients with anterior STEMI to assess microvascular obstruction and infarct size.
  
  
  RESULTS
  Myocardial blush grade > or =2 and ST-segment resolution occurred more frequently in the EM-PCI group (88% vs. 60%, p = 0.001; and 64% vs. 39%, p = 0.001). In the acute phase, microvascular obstruction extent was significantly lower in the EM-PCI group and at 3 months, infarct size was significantly reduced only in the EM-PCI group. A lower incidence of cardiac death in the EM-PCI group (4.6% vs. 0%, log-rank test p = 0.02) was observed at 9 months.
  
  
  CONCLUSIONS
  Thrombectomy prevents thrombus embolization and preserves microvascular integrity reducing infarct size, and it therefore represents an useful adjunctive therapy in PPCI.
authors.affiliation: Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, Sapienza University, Rome, Italy. rino.sardella@uniroma1.it
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scardala
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Roma
authors.forename: Giulia
authors.initials: G
authors.lastname: Benedetti
authors.forename: Giulia
authors.initials: G
authors.lastname: Conti
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017131:Thrombectomy; D013927:Thrombosis; D016896:Treatment Outcome