Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for S-T elevation myocardial infarction (STEMI).
Purpose
To investigate whether a strategy of thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors without stent implantation is associated with a reduced incidence of slow- or no-reflow, and other thrombotic complications compared with stenting in patients with high thrombus burden.
Methods
A total of 210 patients with STEMI and high thrombus burden (thrombolysis in myocardial infarction thrombus grade ≥3) treated with thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into 2 groups: non-stent PCI group (deferred stenting, n = 105) and stent PCI group (immediate stenting, n = 105). A new catheterisation and deferred stent implantation was performed 48 - 72 hours after primary PCI. The end points were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively) and the postprocedural frequencies of a TIMI flow grade of 3, complete resolution of ST-segment elevation immediately after primary PCI, target vessel revascularization, reinfarction, death and the combination of major adverse cardiac events by 30 days after randomisation.
Results
A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI group (p < 0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p = 0.35). At 30 days, the rate of death in the stent PCI group and non-stent PCI group was 1.7% and 1.0%, respectively (p = 0.33) and the rate of adverse events was 12.1% and 2.2%, respectively (p < 0.01).
Conclusions
Thrombus aspiration, in combination with glycoprotein IIb/IIIa inhibitors without immediate stenting, is an applicable and effective method in a large majority of patients with myocardial infarction with ST-segment elevation and a high thrombus burden.
SPONTANEOUS COMPLETE RESOLUTION OF ST-SEGMENT ELEVATION: TO EMERGENCY REVASCULARIZATION OR NOT?
