Effect of Macroscopic-Positive Thrombus Retrieval During Primary Percutaneous Coronary Intervention With Thrombus Aspiration on Myocardial Infarct Size and Microvascular Obstruction

• Published in: The American journal of cardiology Vol. 111; no. 2; pp. 159 - 165
• Main Authors: Chopard, Romain, MD, Plastaras, Philoktimon, MD, Jehl, Jerome, MD, Janin, Sebastien, MD, Descotes Genon, Vincent, MD, Seronde, Marie-France, MD, Davani, Siamak, MD, PhD, Kastler, Bruno, MD, Schiele, Francois, MD, PhD, Meneveau, Nicolas, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.01.2013; Elsevier Limited
• Subjects: Aged; Blood clots; Cardiology; Cardiovascular; Coronary Thrombosis - complications; Coronary Thrombosis - diagnosis; Coronary Thrombosis - surgery; Electrocardiography; Female; Follow-Up Studies; Heart attacks; Humans; Intraoperative Period; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - surgery; NMR; Nuclear magnetic resonance; Percutaneous Coronary Intervention; Prospective Studies; Suction - methods; Thrombectomy - methods; Treatment Outcome; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.09.009

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.