Thrombus aspiration in ST elevation myocardial infarction: comparative efficacy in patients treated early and late after onset of symptoms
- Maria De Vita1,
- Francesco Burzotta2,
- Italo Porto2,
- Dariusz Dudek3,
- Thierry Lefèvre4,
- Carlo Trani2,
- Waldemar Mielecki3,
- Giampaolo Niccoli2,
- Giuseppe G L Biondi-Zoccai5,
- Filippo Crea2
- 1Cardiology Department ‘Morgagni-Pierantoni’ Hospital, Forlì, Italy
- 2Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
- 3Department of Cardiology, Jagiellonian University, Kracow, Poland
- 4Institut Cardiovasculaire Paris Sud, Massy, France
- 5Division of Cardiology, University of Turin, Turin, Italy
- Correspondence to Dr M De Vita, Cardiology Department ‘Morgagni-Pierantoni’ Hospital, Via Porta Merlonia, 2, 47100 Forlì (FC), Italy;
- Accepted 6 April 2010
Background Restoration of myocardial perfusion is the goal of percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction. A major predictor of no-reflow is the increasing time to treatment (TTT). Thrombus aspiration (TA) is reported to improve myocardial reperfusion as compared with standard PCI (SP).
Objective To investigate the influence of TTT on TA efficacy.
Design Pooled analysis of individual patients' data of three prospective randomised trials comparing TA and SP.
Patients A total of 299 patients (150 in TA group and 149 in SP group) entered the study. The study population was divided into three subgroups according to the TTT: ≤3 h (short TTT subgroup), >3 h to ≤6 h (intermediate TTT subgroup), >6 h to ≤12 h (long TTT subgroup).
Main outcome measures The goal of the study was the comparison of optimal myocardial reperfusion, defined as the combination of myocardial blush grade 2 or 3 at post-PCI angiography and ST resolution more than 70% at post-PCI ECG, between SP and TA according to TTT.
Results In the SP group, increasing TTT was associated with a decreased rate of optimal reperfusion (27.4% vs 17.9% vs 10%, p for trend=0.06), whereas in the TA group the same trend was not seen (40.9% vs 33.8% vs 50%, p for trend=0.93). In a multivariate logistic regression model, a significant interaction (p=0.04) between time to treatment and thrombus aspiration was observed.
Conclusions TA limits the adverse effects of TTT prolongation on myocardial reperfusion.
- Acute myocardial infarction
- thrombus aspiration
- myocardial perfusion
- coronary angioplasty (PCI)
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the ethics committee of the Catholic University of Sacred Heart, Rome, Italy.
Provenance and peer review Not commissioned; externally peer reviewed.