Thrombus aspiration versus conventional primary PCI in STEMI patients

V. MironovRussian Cardiology Research Center

2014

Do we need thrombus aspiration?

Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009

No-reflow mechanism

Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009

Reperfusion

Primary endpoint: Myocardial blush grade

Series10

10

20

30

40

50

60

17

26

3741

46

32

0/123

P < 0.001

Thrombus aspiration Conventional PCI

TA PA S

%

ST-segment elevation resolution

Series10

10

20

30

40

50

60

1318

31

38

57

44< 30% 30-70%

> 70%

% P < 0.001

Thrombus aspiration Conventional PCI

TA PA S

Myocardial blush grade and death or death/reinfarction at 30-days

3 2 0 or 10

2

4

6

8

10

1.1

2.9

5.7

1.6

3.9

8.1

Death

Death/reinfarction

Myocardial blush grade

P = 0.001

TA PA S

%

TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year

3 2 0 or 10

2

4

6

8

10

12

14

16

3.74.7

11

6.17.6

14.8

Death

Death/reinfarction

P = 0.001

Myocardial blush grade

TA PA S

%

Mortality at 1 year

Log-Rank p = 0.040

Lancet. 2008 Jun 7;371(9628):1915-20.

TA PA S

Log-Rank p = 0.016

Mortality or non-fatal ReMI at 1 year

Lancet. 2008 Jun 7;371(9628):1915-20.

TA PA S

472 STEMI pts

Conventional pPCIN=232

PCI+TAn=240

Success of TAN=228

Impossible of TAN=12

Stenting

Primary EP: “optimal” reperfusion: TIMI III, MBG 3, ST resolutionSecondary EP: MACE

No-reflow in STEMIRussian Cardiology Research Center

Russian Cardiology Research CenterPrimary end point

pPCI Thrombus aspiration p

TIMI 0-1 17 (7.3%) 2 (0,9%) 0,002

TIMI 2 42 (18,1%) 18 (7,9%)

TIMI 3 173 (74,6%) 94 (91,2%)

MBG 0-1 36 (15,5%) 21 (9,2%) 0,003

MBG 2 118 (50,8%) 32 (14%)

MBG 3 78 (33,7%) 175 (76,8%)

Resolution of ST > 70% 80 (34,5%) 138 (60,5%) 0,02

Balloon dilatation 206 (88,8%) 33 (14,5%) 0,001

PCI+TA PCI0

10

20

30

40

50

60

70

60.7

34.6

P = 0.001

Optimal reperfusion (TIMI III, MBG 3, ST resolution>70%)

%

P = 0.001

In-hospital mortality

PCI+TA PCI0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

0.8

1.7

%

Russian Cardiology Research CenterMACE 2y FU

0 12 24 3680828486889092949698

100

MACE-free survival

pPCI TA-PCI

11,5%

Months

%

P=0,002

65 yo male patient with STEMI

Диссекция среднего отдела ствола ЛКАПациент с многососудистым поражением коронарного русла с вовлечением ствола ЛКА

Result and 1 year follow up

Kaplan–Meier Curves for Death from Any Cause and Hospitalization Due to Reinfarction.

Kaplan–Meier curves are shown for the cumulative probability of death from any cause (Panel A) and of hospitalization due to reinfarction (Panel B) up to 30 days after PCI only (PCI) or after PCI with thrombus aspiration (PCI+TA). The insets show the same data on an enlarged y axis.

51 years old male patientInfero-lateral STEMI. Paroxysmal AF.

Thrombus aspiration versus balloon dilatation in primary and rescue PCI

160 pts with STEMI

Primary PCI (80 pts) Rescue PCI (80 pts)

TA + PCI (40 pts) PCI (40 pts) TA + PCI (40 pts) PCI (40 pts)

Randomization

Primary end points: Echo (EF, ESV, EDV) after PCI, at discharge and after 1 year follow up

Secondary end points: MACE

1 year follow up