title: Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: insights from INFUSE-AMI.
abstract: Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis in Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% [4.6, 21.8] vs. 22.6% [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.
authors.affiliation: New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Jan-Henk
authors.initials: JH
authors.lastname: Dambrink
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Saqib
authors.initials: S
authors.lastname: Chowdhary
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.forename: Jacques
authors.initials: J
authors.lastname: Koolen
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone