RT Journal Article
SR Electronic
T1 Thrombus aspiration in ST elevation myocardial infarction: comparative efficacy in patients treated early and late after onset of symptoms
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1287
OP 1290
DO 10.1136/hrt.2009.184341
VO 96
IS 16
A1 Maria De Vita
A1 Francesco Burzotta
A1 Italo Porto
A1 Dariusz Dudek
A1 Thierry Lefèvre
A1 Carlo Trani
A1 Waldemar Mielecki
A1 Giampaolo Niccoli
A1 Giuseppe G L Biondi-Zoccai
A1 Filippo Crea
YR 2010
UL http://heart.bmj.com/content/96/16/1287.abstract
AB 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.