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

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• 作者：Romain Chopard ; MD^a ; ^{rchopard@chu-besancon.fr} ; Philoktimon Plastaras ; MD^a ; Jerome Jehl ; MD^b ; Sebastien Janin ; MD^a ; Vincent Descotes Genon ; MD^a ; Marie-France Seronde ; MD^a ; Siamak Davani ; MD ; PhD^c ; Bruno Kastler ; MD^b ; Francois Schiele ; MD ; PhD^a ; Nicolas Meneveau ; MD ; PhD^a
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 January, 2013
• 年：2013
• 卷：111
• 期：2
• 页码：159-165
• 全文大小：214 K

文摘

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 ¡À 1.1 % vs 7.6 ¡À 2.1 % , respectively, p?= 0.003; late MVO 2.1 ¡À 0.9 % vs 5.4 ¡À 2.9 % , p?= 0.006; and IS 14.9 ¡À 8.7 % vs 28.2 ¡À 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 ¡À 8.3 % vs 22.3 ¡À 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.