Author + information
- Received May 15, 2008
- Revision received September 12, 2008
- Accepted October 7, 2008
- Published online January 27, 2009.
- Gennaro Sardella, MD, FACC, FESC⁎,⁎ (, )
- Massimo Mancone, MD⁎,
- Chiara Bucciarelli-Ducci, MD⁎,‡,
- Luciano Agati, MD⁎,
- Raffaele Scardala, MD⁎,
- Iacopo Carbone, MD†,
- Marco Francone, MD†,
- Angelo Di Roma, MD⁎,
- Giulia Benedetti, MD⁎,
- Giulia Conti, MD⁎ and
- Francesco Fedele, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Gennaro Sardella, Department of Cardiovascular, Respiratory and Morphologic Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Viale del Policlinico 155, Rome 00161, Italy
Objectives The purpose of this study was to evaluate the impact on myocardial perfusion and infarct size as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of a manual thrombectomy device, Export Medtronic (EM) (Medtronic Inc., Minneapolis, Minnesota), as adjunctive therapy in primary percutaneous coronary intervention (PPCI) in a subset of patients with anterior ST-segment elevation myocardial infarction (STEMI).
Background PPCI may cause thrombus dislodgment, leading to microvascular damage.
Methods One hundred seventy-five STEMI patients were randomly assigned to standard percutaneous coronary intervention (PCI) (n = 87) or EM-PCI (n = 88). The primary end points were the occurrence of myocardial blush grade ≥2 and the rate of 90-min ST-segment resolution >70%. The CE-MRI substudy was performed in 75 patients with anterior STEMI to assess microvascular obstruction and infarct size.
Results Myocardial blush grade ≥2 and ST-segment resolution occurred more frequently in the EM-PCI group (88% vs. 60%, p = 0.001; and 64% vs. 39%, p = 0.001). In the acute phase, microvascular obstruction extent was significantly lower in the EM-PCI group and at 3 months, infarct size was significantly reduced only in the EM-PCI group. A lower incidence of cardiac death in the EM-PCI group (4.6% vs. 0%, log-rank test p = 0.02) was observed at 9 months.
Conclusions Thrombectomy prevents thrombus embolization and preserves microvascular integrity reducing infarct size, and it therefore represents an useful adjunctive therapy in PPCI.
- Received May 15, 2008.
- Revision received September 12, 2008.
- Accepted October 7, 2008.
- American College of Cardiology Foundation