title: A prospective randomized trial of thrombectomy versus no thrombectomy in patients with ST-segment elevation myocardial infarction and thrombus-rich lesions: MUSTELA (MUltidevice Thrombectomy in Acute ST-Segment ELevation Acute Myocardial Infarction) trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether thrombectomy during primary percutaneous coronary intervention (pPCI) in patients with high thrombus burden improves myocardial reperfusion and reduces infarct size.
  
  
  BACKGROUND
  Thrombectomy aims at reducing distal thrombotic embolization during pPCI, improving myocardial reperfusion and clinical outcome.
  
  
  METHODS
  We randomized 208 patients with high thrombus burden in a 1:1 ratio to either pPCI with thrombectomy (Group T) or standard pPCI (Group S). Thrombectomy was performed with either rheolytic or manual aspiration catheters. Three-month magnetic resonance imaging was performed to assess infarct size and transmurality and microvascular obstruction (MVO). The primary endpoints were ST-segment elevation resolution (STR) >70% at 60 min and 3-month infarct size.
  
  
  RESULTS
  The baseline profile was similar between groups, except for a higher rate of initial Thrombolysis In Myocardial Infarction flow grade 3 in Group S (p = 0.002). Group T showed a significantly higher rate of STR (57.4% vs. 37.3%; p = 0.004) and of final myocardial blush 3 (68.3% vs. 52.9%; p = 0.03). Group T and Group S did not differ with regard to infarct size (20.4 ± 10.5% vs. 19.3 ± 10.6%; p = 0.54) and transmurality (11.9 ± 12.0% vs. 11.6 ± 12.7%; p = 0.92), but Group T showed significantly less MVO (11.4% vs. 26.7%; p = 0.02) and a higher prevalence of inhomogeneous scar (p < 0.0001). One-year freedom from major adverse cardiac events was similar between groups.
  
  
  CONCLUSIONS
  Thrombectomy as an adjunct to pPCI in patients with high thrombus load yielded better post-procedural STR and reduced MVO at 3 months but was not associated with a reduction in infarct size and transmurality. Thromboaspiration in Patients With High Thrombotic Burden Undergoing Primary Percutaneous (Coronary Intervention; NCT01472718).
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. marcodecarlo@gmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: Aquaro
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Elena
authors.initials: E
authors.lastname: Guerra
authors.forename: Leonardo
authors.initials: L
authors.lastname: Misuraca
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Petronio
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016037:Single-Blind Method; D017131:Thrombectomy; D013927:Thrombosis / Q000601:surgery*