Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial.
OBJECTIVE
This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes.


METHODS
The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipro's TransVascular Aspiration Catheter (Osaka, Japan).


RESULTS
The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point-defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01).


CONCLUSIONS
This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.
Ikari
Yuji
Y
Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Sakurada
Masami
M
Kozuma
Ken
K
Kawano
Shigeo
S
Katsuki
Takaaki
T
Kimura
Kazuo
K
Suzuki
Takahiko
T
Yamashita
Takehiro
T
Takizawa
Akinori
A
Misumi
Kazuo
K
Hashimoto
Hideki
H
Isshiki
Takaaki
T
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D003326:Coronary Circulation; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D004867:Equipment Design; D006801:Humans; D007564:Japan; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome