Author + information
- Received July 30, 2012
- Accepted August 31, 2012
- Published online December 1, 2012.
- Marco De Carlo, MD, PhD⁎,⁎ (, )
- Giovanni D. Aquaro, MD†,
- Cataldo Palmieri, MD‡,
- Elena Guerra, MD⁎,
- Leonardo Misuraca, MD⁎,
- Cristina Giannini, MD, PhD⁎,
- Massimo Lombardi, MD†,
- Sergio Berti, MD‡ and
- A. Sonia Petronio, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Marco De Carlo, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Cardiac Catheterization Laboratory, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy
Objectives The aim of this study was to evaluate whether thrombectomy during primary percutaneous coronary intervention (pPCI) in patients with high thrombus burden improves myocardial reperfusion and reduces infarct size.
Background Thrombectomy aims at reducing distal thrombotic embolization during pPCI, improving myocardial reperfusion and clinical outcome.
Methods We randomized 208 patients with high thrombus burden in a 1:1 ratio to either pPCI with thrombectomy (Group T) or standard pPCI (Group S). Thrombectomy was performed with either rheolytic or manual aspiration catheters. Three-month magnetic resonance imaging was performed to assess infarct size and transmurality and microvascular obstruction (MVO). The primary endpoints were ST-segment elevation resolution (STR) >70% at 60 min and 3-month infarct size.
Results The baseline profile was similar between groups, except for a higher rate of initial Thrombolysis In Myocardial Infarction flow grade 3 in Group S (p = 0.002). Group T showed a significantly higher rate of STR (57.4% vs. 37.3%; p = 0.004) and of final myocardial blush 3 (68.3% vs. 52.9%; p = 0.03). Group T and Group S did not differ with regard to infarct size (20.4 ± 10.5% vs. 19.3 ± 10.6%; p = 0.54) and transmurality (11.9 ± 12.0% vs. 11.6 ± 12.7%; p = 0.92), but Group T showed significantly less MVO (11.4% vs. 26.7%; p = 0.02) and a higher prevalence of inhomogeneous scar (p < 0.0001). One-year freedom from major adverse cardiac events was similar between groups.
Conclusions Thrombectomy as an adjunct to pPCI in patients with high thrombus load yielded better post-procedural STR and reduced MVO at 3 months but was not associated with a reduction in infarct size and transmurality. Thromboaspiration in Patients With High Thrombotic Burden Undergoing Primary Percutaneous (Coronary Intervention; NCT01472718)
Dr. Petronio has served as a clinical proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 30, 2012.
- Accepted August 31, 2012.
- American College of Cardiology Foundation