RT Journal Article
SR Electronic
T1 Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 951
OP 957
DO 10.1136/hrt.2005.074716
VO 92
IS 7
A1 L De Luca
A1 G Sardella
A1 C J Davidson
A1 G De Persio
A1 M Beraldi
A1 T Tommasone
A1 M Mancone
A1 B L Nguyen
A1 L Agati
A1 M Gheorghiade
A1 F Fedele
YR 2006
UL http://heart.bmj.com/content/92/7/951.abstract
AB 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.