Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients With ST-Segment Elevation Acute Myocardial InfarctionReport of the VAMPIRE (VAcuuM asPIration thrombus REmoval) Trial
Yuji Ikari, MD, PhD, FACC*,
Masami Sakurada, MD ,
Ken Kozuma, MD, PhD ,
Shigeo Kawano, MD ,
Takaaki Katsuki, MD, PhD||,
Kazuo Kimura, MD¶,
Takahiko Suzuki, MD#,
Takehiro Yamashita, MD, PhD**,
Akinori Takizawa, MD,
Kazuo Misumi, MD,
Hideki Hashimoto, MD, PhD,
Takaaki Isshiki, MD, FACC,* VAMPIRE Investigators
* Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
Department of Cardiology, Tokorozawa Heart Clinic, Tokorozawa, Japan
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
|| Department of Cardiology, Jichi Medical University, Shimotsuke, Japan
¶ Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
# Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
** Department of Cardiology, Cardiovascular Center Hokkaido Ohno Hospital, Sapporo, Japan
Department of Cardiology, Shizuoka City Hospital, Shizuoka, Japan
Department of Cardiology, Chiba West General Hospital, Matsudo, Japan
Department of Health Economics and Epidemiology Research, University of Tokyo, Tokyo, Japan.
* Reprint requests and correspondence: Dr. Takaaki Isshiki, Department of Cardiology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan. (Email: isshiki{at}med.teikyo-u.ac.jp).
Objectives: This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Background: Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes.
Methods: The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipro's TransVascular Aspiration Catheter (Osaka, Japan).
Results: The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point—defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01).
Conclusions: This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.
Key Words: ST-segment elevation myocardial infarction • thrombectomy • coronary flow
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Abbreviations and Acronyms
| | CK = creatine kinase | | CK-MB = creatine kinase-myocardial band | | cTFC = corrected Thrombolysis In Myocardial Infarction frame count | | ECG = electrocardiographic/electrocardiogram | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction | | TIMI = Thrombolysis In Myocardial Infarction | | TVAC = TransVascular Aspiration Catheter |
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