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Thrombus aspiration before PCI fails to reduce microvascular obstruction

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SAN FRANCISCO — In patients with STEMI presenting for care late after the onset of symptoms, routine thrombus aspiration before PCI did not improve reperfusion success markers, according to data presented at the annual TCT Scientific Symposium.

“In patients with subacute STEMI, routine manual thrombus aspiration before PCI did not show a significant reduction in microvascular obstruction assessed by [MRI],” Steffen Desch, MD, of the University Heart Center Lübeck and University Hospital Schleswig-Holstein, Germany, said in a presentation.

Steffen Desch

“This finding is supported by a variety of secondary endpoints, which also did not show any benefit,” he said.

Desch and colleagues randomly assigned, in a 1:1 ratio, 152 patients (mean age, 66 years) with subacute STEMI who presented for care 12 to 48 hours after symptom onset to primary PCI with thrombus aspiration (n = 70) or without (n = 74).

The between-group baseline characteristics were comparable. The average time between symptom onset and PCI was 28 ± 12 hours.

At 1 to 4 days after randomization, cardiac MRI was conducted; only 111 patients underwent the imaging, according to Desch. The investigators sought microvascular obstruction as primary outcome.

A moderate amount of viable myocardium was observed in the affected region in 60% of patients.

No significant differences were observed for the extent of microvascular obstruction in the left ventricular mass in patients with thrombus aspiration and those without (2.5 ± 4% vs. 3.1 ± 4.4%; P = .47).

Further, the investigators observed no significant differences between groups for infarct size, myocardial salvage or LV ejection fraction, and the same was true for angiographic and clinical endpoints. – by Allegra Tiver

References:

Desch S, et al. A prospective randomized trial of thrombus aspiration in patients with ST-segment elevation myocardial infarction presenting late after symptom onset. Presented at: Scientific Symposium 2015; Oct. 11-15, 2015; San Francisco.

Desch S, et al. JACC Cardiovasc Interv. 2015;doi:10.1016/j.jcin.2015.09.010.

Disclosure: Desch reports grants and research support from Medtronic.