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Original Articles

Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional Recovery and Remodeling After Primary Angioplasty

Francesco Liistro, MD; Simone Grotti, MD; Paolo Angioli, MD; Giovanni Falsini, MD; Kenneth Ducci, MD; Silvia Baldassarre, MD; Alessandra Sabini, MD; Rossella Brandini, MD; Eugenia Capati, MD and Leonardo Bolognese, MD

From the Cardiovascular Department (F.L., S.G., P.A., G.F., K.D., S.B., A.S., R.B., E.C., L.B.), San Donato Hospital, Arezzo, Italy; and Department of Cardiology (E.C.), University of Siena, Italy.

Correspondence to Francesco Liistro, MD, Department of Cardiovascular Disease, San Donato Hospital, Arezzo, Italy. E-mail francescoliistro{at}hotmail.com

Received January 20, 2009; accepted July 30, 2009.

Background— Failure to achieve myocardial reperfusion often occurs during percutaneous coronary intervention (PCI) in patients with myocardial infarction with ST-segment elevation. We hypothesized that manual thrombus aspiration during primary PCI would favorably influence tissue-level myocardial perfusion and left ventricular (LV) functional recovery and remodeling.

Methods and Results— We prospectively randomized 111 patients with ST-segment elevation myocardial infarction to either standard or thrombus-aspiration PCI. Primary end point of the study was postprocedural incidence of ST-segment resolution 70%. Secondary end points included Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade 2, the combination of TIMI myocardial perfusion grade 2 and ST-segment resolution 70%, post-PCI TIMI grade 3 flow, corrected TIMI frame count, myocardial contrast echocardiography score index, the absence of persistent ST-segment deviation, and time course of wall-motion score index, LV ejection fraction, and LV volume in the 2 groups. The incidence of ST-segment resolution 70% was 71% and 39% in the thrombus-aspiration and standard PCI groups, respectively (odds ratio, 3.7; 95% CI, 1.7 to 8.3; P=0.001). TIMI myocardial perfusion grade 2 was attained in 93% in the thrombus-aspiration group compared with 71% in the standard PCI group (P=0.006). The percentage of patients with ST-segment resolution 70% and TIMI myocardial perfusion grade 2 was significantly greater in the thrombus-aspiration group compared with the standard PCI group (69% versus 36%, P=0.0006). Myocardial contrast echocardiography score index was significantly higher in the thrombus-aspiration group compared with the standard PCI group (0.86±0.20 versus 0.65±0.31; P<0.0001). A significantly greater improvement in LV ejection fraction and in wall-motion score index from baseline to 6-month follow-up was observed in the thrombus-aspiration group compared with the standard PCI group (LV ejection fraction from 48±6% to 55±6% versus 48.7±7% to 49±8%, P<0.0001; wall-motion score index from 1.59±0.13 to 1.31±0.19 versus 1.64±0.20 to 1.51±0.26, P=0.008). Twelve patients (11%) developed LV remodeling at 6 months, 2 (4%) in the thrombus-aspiration group and 10 (18%) in the standard PCI group (P=0.02).

Conclusions— Manual thrombus aspiration in the setting of primary PCI improves myocardial tissue-level perfusion as well as LV functional recovery and remodeling.

Key Words: thrombus aspiration • angioplasty • remodeling • myocardial infarction • reperfusion

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