Author + information
- User1 (, )
- Miodrag Ostojic2,
- Branko Beleslin3,
- Sinisa Stojkovic4,
- Milan Nedeljkovic5,
- Milorad Tesic6,
- Purnachandra Rao Kondru7,
- Yimin zhang8 and
- Milika Asanin9
- 2Medical School University of Belgrade, University City Hospital, Belgrade, Serbia
- 3Clinic of cardiology, Clinical center od Serbia, Belgrade, Serbia
- 4Cardiology clinic, KCS, Belgrade, Serbia
- 5Clinical Center of Serbia, Belgrade, Serbia
- 6Borgess Medical Center, Kalamazoo, MI
- 7Aayush Hospitals, Vijayawada
- 8School of biomedical engineering, Shanghai
Routine manual thrombus aspiration is superior to standard primary PCI in terms of improved myocardial perfusion. However, routine thrombus aspiration has similar impact on clinical outcome as standard primary PCI at mid-term follow up. Therefore, we sought to evaluate predefined patient subgroups that would benefit the most from manual thrombus aspiration. We assumed that the specific patients may have the greatest improvement in myocardial perfusion and potentially the greatest clinical benefit.
In the randomized clinical trial aimed to evaluate impact of manual thrombus aspiration on microcirculatory resistance after primary PCI, the total of 128 patients were randomly assigned to thrombus aspiration (N=65) or standard primary PCI group (N=63). The primary endpoint was a mean value of corrected index of microcirculatory resistance (IMRcorr). The subgroups were prespecified according to age (>65 vs. ≤65 years), gender, diabetes, total ischemic time (>240 min vs ≤240 min), preprocedural total ST-segment deviation (>14 vs. ≤14 mm), infarct related artery (LAD vs. Cx or RCA), TIMI pre (0 or 1 vs. 2 or 3), TIMI post wiring (0 or 1 vs. 2 or 3), thrombus length (>2 RVD vs ≤2 RVD) and thrombus age (fresh vs. lytic or organized).
Manual thrombus aspiration, as compared with standard PCI, resulted in significantly lower IMRcorr (27,5±16,8 U vs. 39,9±32,7 U, P = 0,039). In a multiple regression model with the log-transformed IMR as dependent variable, after adjusting for clinical, angiographic and procedural variables, thrombus aspiration was not an independent predictor of lower IMR (28.4 U; 95% CI, 24.7 to 32.8 U, vs. 32.4 U; 95% CI, 28.1 to 37.4 U; estimate 0,877, 95%CI 0,715-1,077, P=0.21). Intergroup difference was found for age>65 years (aspiration vs. standard pPCI: 28,2±11,2 vs. 63,2±45,5U, p<0,01; -35,0 vs -4,0, interaction p<0,01) and TIMI 2 or 3 after wiring (aspiration vs. standard pPCI: 23,9±15,6 vs. 44,2±38,6U, p<0,01; interaction p=0,04). Student t-test was performed on natural log IMRcorr disclosing intergroup difference for age>65 years (aspiration vs. standard pPCI: 3,3±0,4 vs. 3,9±0,7, p<0,01; -0,7 vs. -0,1, interaction p=0,03) and TIMI flow 2 or 3 after wiring (aspiration vs. standard pPCI: 3,0±0,6 vs. 3,5±0,8, p<0,01; 0,1 vs -0,5, interaction p=0,03).
The greatest reduction of microcirculatory resistance is achieved by manual thrombus aspiration in elderly patients and in those with TIMI flow 2 or 3 obtained after wire placement in distal part of infarct related artery.
CORONARY: Acute Myocardial Infarction