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Abstract

Background and objective:

Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization and reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for the evaluation of MVO. The aim of this study is to evaluate the effect of thrombus aspiration in STEMI patients as an adjunctive technique to primary PCI in reducing the incidence and extent of MVO evaluated by CMR.

Methods

Ninety-three patients with heavy thrombus burden were enrolled in this study; sixty-five patients met our inclusion criteria. Aspiration thrombectomy followed by PCI was done for thirty-one patients (aspiration group), and conventional PCI without aspiration thrombectomy, was performed for thirty-four patients (conventional group). The primary end points were the occurrence and extent of microvascular obstruction (MVO) evaluated mainly by cardiac magnetic resonance (CMR) in addition to angiographic data ( MBG and TIMI flow grade).

Results

The incidence of microvascular obstruction (MVO) was significantly higher in the conventional group (18 patients, 52.9%) when compared with the aspiration group (7 patients, 22.6%) (p-value = 0.012). Moreover, significant differences existed between the studied groups with regard to MVO extent. For instance, MVO extended to > 4 segments in only 3 patients (9.7%) in the aspiration group, while in the conventional group, MVO extended to > 4 segments in 13 patients (38.2%) (p-value = 0.007).

Conclusion:

Aspiration thrombectomy substantially reduces both the incidence and extent of microvascular obstruction as an adjunctive technique to PPCI in STEMI patients with heavy thrombus burden.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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