title: Effect of macroscopic-positive thrombus retrieval during primary percutaneous coronary intervention with thrombus aspiration on myocardial infarct size and microvascular obstruction.
abstract: Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention improves myocardial perfusion and survival; however, the effect of effective thrombus retrieval remains unclear. We evaluated whether macroscopic-positive TA in patients with ST-segment elevation myocardial infarction would reduce the infarct size (IS) and microvascular obstruction (MVO), as assessed by contrast-enhanced magnetic resonance imaging. A total of 88 patients with ST-segment elevation myocardial infarction were prospectively recruited and assigned to the TA-positive group (n = 38) or TA-negative group (n = 50) according to whether macroscopic aspirate thrombus was visible to the naked eye. The primary end points were the extent of early and late MVO as assessed by contrast-enhanced magnetic resonance imaging performed during in-hospital stay and IS evaluated in the acute phase and at 6 months of follow-up. The incidence of early and late MVO and IS in the acute phase was lower in the TA-positive group than in the TA-negative group (early MVO 3.8 ± 1.1% vs 7.6 ± 2.1%, respectively, p = 0.003; late MVO 2.1 ± 0.9% vs 5.4 ± 2.9%, p = 0.006; and IS 14.9 ± 8.7% vs 28.2 ± 15.8%, p = 0.004). At the 6-month contrast-enhanced magnetic resonance imaging study, the final IS was significantly lower in the TA-positive group (12.0 ± 8.3% vs 22.3 ± 14.3%, respectively) than in the TA-negative group (p = 0.002). After multivariate adjustment, macroscopic-positive TA represented an independent predictor of final IS (odds ratio 0.34, 95% confidence interval 0.03 to 0.71, p = 0.01). In conclusion, effective macroscopic thrombus retrieval before stenting during percutaneous coronary intervention for ST-segment elevation myocardial infarction is associated with an improvement in myocardial reperfusion, as documented by a clear reduction in the MVO extent and IS.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, University of Franche-Comte, EA 3920, Besançon, France. rchopard@chu-besancon.fr
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.forename: Philoktimon
authors.initials: P
authors.lastname: Plastaras
authors.forename: Jerome
authors.initials: J
authors.lastname: Jehl
authors.forename: Sebastien
authors.initials: S
authors.lastname: Janin
authors.forename: Vincent
authors.initials: V
authors.lastname: Descotes Genon
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Seronde
authors.forename: Siamak
authors.initials: S
authors.lastname: Davani
authors.forename: Bruno
authors.initials: B
authors.lastname: Kastler
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
mesh_terms: D000368:Aged; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013396:Suction / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome