title: Aspiration coronary thrombectomy for acute myocardial infarction increases myocardial salvage: single center randomized study.
abstract: OBJECTIVE
  The aim of the study was to assess if aspiration thrombectomy in high risk patients with STEMI and angiographic evidence of thrombus may improve myocardial salvage.
  
  
  BACKGROUND
  It is unclear if thrombus aspiration before percutaneous intervention (PCI) improves myocardial salvage.
  
  
  METHODS
  The trial was a prospective randomized study. The inclusion criteria were: first STEMI within 12 hr from symptoms onset, culprit lesion in left anterior descending or right coronary artery, culprit artery TIMI flow ≤ 2 and angiographic evidence of thrombus. The primary endpoint was myocardial salvage index (MSI) as assessed by (99m) Tc-sestamibi SPECT imaging.
  
  
  RESULTS
  We randomized 137 patients (98 male, mean age 64.1 ± 12.5 years) either to aspiration thrombectomy followed by standard PCI with stent implantation (n = 67) or to standard primary PCI (n = 70). Index perfusion defect was similar in both study groups: 34.2% ± 13.1% in thrombectomy group versus 37.1% ± 12.0% in primary PCI group (P = 0.2). MSI was larger in aspiration thrombectomy group than in control patients [25.4% (IQR 13.5-44) vs. 18.5% (IQR 7.7-30.3) respectively, P = 0.02]. The final infarct size was smaller in patients treated with aspiration thrombectomy (23.1% ± 13.3% vs. 28.9% ± 10.2% in the control group, P = 0.002).
  
  
  CONCLUSIONS
  Aspiration thrombectomy improves myocardial salvage in high risk STEMI patients with angiographic evidence of thrombus.
authors.affiliation: Institute of Cardiology, Warsaw, Poland. mciszewski@ikard.pl
authors.forename: Michał
authors.initials: M
authors.lastname: Ciszewski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.forename: Anna
authors.initials: A
authors.lastname: Teresińska
authors.forename: Maciej
authors.initials: M
authors.lastname: Karcz
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Kalińczuk
authors.forename: Radosław
authors.initials: R
authors.lastname: Pracon
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009206:Myocardium / Q000473:pathology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011044:Poland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013396:Suction; D017256:Technetium Tc 99m Sestamibi; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D000077284:Abciximab