Aspiration Coronary Thrombectomy for Acute Myocardial Infarction Increases Myocardial Salvage: Single center randomized study

Objectives: The aim of the study was to assess if aspiration thrombectomy in high risk patients with STEMI and angiographic evidence of thrombus may improve myocardial salvage. Background: It is unclear if thrombus aspiration before percutaneous intervention (PCI) improves myocardial salvage. Methods: The trial was a prospective randomized study. The inclusion criteria were: first STEMI within 12 hr from symptoms onset, culprit lesion in left anterior descending or right coronary artery, culprit artery TIMI flow <= 2 and angiographic evidence of thrombus. The primary endpoint was myocardial salvage index (MSI) as assessed by Tc-99m-sestamibi SPECT imaging. Results: We randomized 137 patients (98 male, mean age 64.1 +/- 12.5 years) either to aspiration thrombectomy followed by standard PCI with stent implantation (n = 67) or to standard primary PCI (n = 70). Index perfusion defect was similar in both study groups: 34.2% +/- 13.1% in thrombectomy group versus 37.1% +/- 12.0% in primary PCI group (P = 0.2). MSI was larger in aspiration thrombectomy group than in control patients [25.4% (IQR 13.5-44) vs. 18.5% (IQR 7.7-30.3) respectively, P = 0.02]. The final infarct size was smaller in patients treated with aspiration thrombectomy (23.1% +/- 13.3% vs. 28.9% +/- 10.2% in the control group, P = 0.002). Conclusions: Aspiration thrombectomy improves myocardial salvage in high risk STEMI patients with angiographic evidence of thrombus. (C) 2011 Wiley-Liss, Inc.