Author + information
- Received September 21, 2015
- Accepted September 24, 2015
- Published online January 25, 2016.
- Steffen Desch, MD∗,†∗ (, )
- Thomas Stiermaier, MD∗,†,
- Suzanne de Waha, MD∗,†,
- Philipp Lurz, MD, PhD‡,
- Matthias Gutberlet, MD§,
- Marcus Sandri, MD‡,
- Norman Mangner, MD‡,
- Enno Boudriot, MD‡,
- Michael Woinke, MD‡,
- Sandra Erbs, MD‡,
- Gerhard Schuler, MD‡,
- Georg Fuernau, MD∗,†,
- Ingo Eitel, MD∗,† and
- Holger Thiele, MD∗,†
- ∗University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- †German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- ‡Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
- §Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany
- ↵∗Reprint requests and correspondence:
Dr. Steffen Desch, University of Lübeck - Heart Center, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Objectives The aim of this study was to examine whether manual thrombus aspiration reduces microvascular obstruction assessed by cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction (STEMI) presenting late after symptom onset.
Background Thrombus aspiration is an established treatment option in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). However, there are only limited data on the efficacy of thrombus aspiration in patients with STEMI presenting ≥12 h after symptom onset.
Methods Patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset were randomized to primary PCI with or without manual thrombus aspiration in a 1:1 ratio. Patients underwent cardiac magnetic resonance imaging 1 to 4 days after randomization. The primary endpoint was the extent of microvascular obstruction.
Results A total of 152 patients underwent randomization. The mean time between symptom onset and PCI was 28 ± 12 h. Baseline characteristics were comparable between groups. The majority of patients (60%) showed at least a moderate amount of viable myocardium in the affected region. Extent of microvascular obstruction was not significantly different between patients assigned to thrombus aspiration and the control group (2.5 ± 4.0% vs. 3.1 ± 4.4% of left ventricular mass, p = 0.47). There were also no significant differences in infarct size, myocardial salvage, left ventricular ejection fraction, and angiographic and clinical endpoints between groups.
Conclusions In this first randomized trial of thrombectomy in patients with STEMI presenting late after symptom onset, routine thrombus aspiration before PCI failed to show a benefit for markers of reperfusion success. (Effect of Thrombus Aspiration in Patients With Myocardial Infarction Presenting Late After Symptom Onset; NCT01379248)
- cardiac microvascular obstruction
- magnetic resonance imaging
- ST-segment elevation myocardial infarction
- thrombus aspiration
This trial was investigator initiated and supported by Medtronic with an unrestricted grant. The authors are solely responsible for the design and conduct of the study, all analyses, and drafting and editing of the paper and its ﬁnal contents. Medtronic had no inﬂuence on study design, data collection, data analysis, or ﬁnal drafting of the paper. Dr. Desch has received a research grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 21, 2015.
- Accepted September 24, 2015.
- American College of Cardiology Foundation