title: Thrombus aspiration during primary percutaneous coronary intervention is associated with reduced myocardial edema, hemorrhage, microvascular obstruction and left ventricular remodeling.
abstract: BACKGROUND
  Thrombus aspiration (TA) has been shown to improve microvascular perfusion during primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI). The objective of our study was to assess the relationship between TA and myocardial edema, myocardial hemorrhage, microvascular obstruction (MVO) and left ventricular remodeling in STEMI patients using cardiovascular magnetic resonance (CMR).
  
  
  METHODS
  Sixty patients were enrolled post primary PCI and underwent CMR on a 1.5 T scanner at 48 hours and 6 months. Patients were retrospectively stratified into 2 groups: those that received TA (35 patients) versus that did not receive thrombus aspiration (NTA) (25 patients). Myocardial edema and myocardial hemorrhage were assessed by T2 and T2* quantification respectively. MVO was assessed via a contrast-enhanced T1-weighted inversion recovery gradient-echo sequence.
  
  
  RESULTS
  At 48 hours, infarct segment T2 (NTA 57.9 ms vs. TA 52.1 ms, p = 0.022) was lower in the TA group. Also, infarct segment T2* was higher in the TA group (NTA 29.3 ms vs. TA 37.8 ms, p = 0.007). MVO incidence was lower in the TA group (NTA 88% vs. TA 54%, p = 0.013).At 6 months, left ventricular end-diastolic volume index (NTA 91.9 ml/m2 vs. TA 68.3 ml/m2, p = 0.013) and left ventricular end systolic volume index (NTA 52.1 ml/m2 vs. TA 32.4 ml/m2, p = 0.008) were lower and infarct segment systolic wall thickening was higher in the TA group (NTA 3.5% vs. TA 74.8%, p = 0.003).
  
  
  CONCLUSIONS
  TA during primary PCI is associated with reduced myocardial edema, myocardial hemorrhage, left ventricular remodeling and incidence of MVO after STEMI.
authors.affiliation: Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. mo.zia@utoronto.ca
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: Zia
authors.forename: Nilesh R
authors.initials: NR
authors.lastname: Ghugre
authors.forename: Kim A
authors.initials: KA
authors.lastname: Connelly
authors.forename: Subodh B
authors.initials: SB
authors.lastname: Joshi
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Strauss
authors.forename: Eric A
authors.initials: EA
authors.lastname: Cohen
authors.forename: Graham A
authors.initials: GA
authors.lastname: Wright
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Dick
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation / Q000502:physiology; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004487:Edema / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology; D020127:Recovery of Function; D012189:Retrospective Studies; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D020257:Ventricular Remodeling