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MUSTELA: Coronary thrombectomy reduced ST-segment elevation but not infarct size in certain STEMI patients

Issue: December 2011

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TCT 2011

SAN FRANCISCO — The combination of coronary thrombectomy and percutaneous coronary intervention improved rates of ST-segment elevation in certain STEMI patients, according to findings presented here.

The addition of coronary thrombectomy to PCI, however, did not reduce infarct size in these patients, who also had thrombus-rich lesions.

Anna Sonia Petronio, MD, associate professor and Head of the Cath Lab in the Cardiothoracic and Vascular Department at the University of Pisa in Italy, presented findings from MUSTELA trial at the 2011 Transcatheter Cardiovascular Therapeutics scientific symposium.

The aim of the trial was to determine whether coronary thrombectomy improved myocardial perfusion and reduced infarct size when administered with PCI in patients with high thrombotic burden. Primary outcome measures included infarct size at 3 months (as assessed by delayed enhancement MRI) and ST-segment elevation resolution greater than 70% at 60 minutes after primary PCI.

Eligibility criteria for the 208 patients with STEMI included pain-to-balloon time <12 hours and angiographic evidence of high thrombotic burden, which was defined as thrombus grade ≥3. Half of the patients were randomly assigned thrombectomy plus PCI and the other half were assigned standard PCI.

ST-segment elevation resolution greater than 70% was observed in 57.4% of patients in the study group and 37.3% of controls. The study group experienced a 20.4% reduction in infarct size, compared with a 19.3% reduction among controls.

Controls experienced the presence of myocardial vascular obstruction and less dysomogeneus scar, according to secondary analysis results.

“There were no coronary complications associated with thrombectomy,” Petronio said in a press release.

Disclosure: The MUSTELA trial is partially funded by Medrad. Dr. Petronio reported no financial relationship with the company.

For more information:

• Petronio AS. Plenary session XIII. Late-breaking clinical trials and first report investigations II. Presented at: the 2011 Transcatheter Cardiovascular Therapeutics Scientific Symposium; Nov. 7-11; San Francisco.

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