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Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction
  1. L De Luca1,
  2. G Sardella1,
  3. C J Davidson2,
  4. G De Persio1,
  5. M Beraldi1,
  6. T Tommasone1,
  7. M Mancone1,
  8. B L Nguyen1,
  9. L Agati1,
  10. M Gheorghiade2,
  11. F Fedele1
  1. 1Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy
  2. 2Northwestern Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to:
    Dr Leonardo De Luca
    Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Policlinico Umberto I, Viale del Policlinico, 155, 00100 Rome, Italy; leodeluca{at}virgilio.it

Abstract

Objective: To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI).

Methods: 76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement (n  =  38) or to conventional stenting (n  =  38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated.

Results: After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3 (36.8% v 13.1%, p  =  0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p  =  0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) ⩾ 20%: 15 in the conventional group and four in the thrombectomy group (p  =  0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p < 0.0001) and EDV (152.5 (18.1) ml v 138.1 (10.7) ml, p < 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed (10.5% in the conventional group v 8.6% in the thrombectomy group, not significant).

Conclusion: Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.

  • AiMI, AngioJet rheolytic thrombectomy in patients undergoing primary angioplasty for acute myocardial infarction
  • CHF, congestive heart failure
  • EDV, end diastolic volume
  • EF, ejection fraction
  • ESV, end systolic volume
  • EMERALD, enhanced myocardial efficacy and recovery by aspiration of liberated debris
  • IRA, infarct related artery
  • LV, left ventricular
  • MACE, major adverse cardiovascular events
  • MBG, myocardial blush grade
  • MI, myocardial infarction
  • PCI, percutaneous coronary intervention
  • REMEDIA, randomised evaluation of the effect of mechanical reduction of distal embolisation by thrombus aspiration in primary and rescue angioplasty
  • STEMI, ST elevation myocardial infarction
  • TIMI, thrombolysis in myocardial infarction
  • WMSi, wall motion score index
  • primary angioplasty
  • ST elevation myocardial infarction
  • thrombectomy
  • Diver CE aspiration catheter
  • left ventricular remodelling
  • echocardiography

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Footnotes

  • Published Online First 26 October 2005

  • Competing interests: None declared

  • Part of this paper was accepted for the Annual Meeting of the European Society of Cardiology, Stockholm, 3–7 September 2005.

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