Upfront thrombus aspiration during PCI may improve outcomes

NEW YORK (Reuters Health) - Upfront thrombus aspiration during percutaneous coronary intervention (PCI) may improve outcomes in patients with ST-segment-elevation acute myocardial infarction (STEMI), according to a report in the August Journal of the American College of Cardiology: Cardiovascular Interventions.

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Upfront thrombus aspiration during PCI may improve outcomes

Last Updated: 2008-08-20 11:27:54 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Upfront thrombus aspiration during percutaneous coronary intervention (PCI) may improve outcomes in patients with ST-segment-elevation acute myocardial infarction (STEMI), according to a report in the August Journal of the American College of Cardiology: Cardiovascular Interventions.

"Thrombus itself contains many vasoactive, thrombogenic substances," Dr. Takaaki Isshiki from Teikyo University School of Medicine, Tokyo, Japan told Reuters Health. "To take these substances out from the coronary circulation in addition to the sticky thrombus is better than pushing them away to the infarcted area."

In their VAMPIRE trial (VAcuuM asPIration thrombus REmoval), Dr. Isshiki and colleagues evaluated the safety and efficacy of upfront thrombus aspiration strategy using the novel TransVascular Aspiration Catheter (TVAC; Nipro, Osaka, Japan) in patients with STEMI.

The TVAC reached the lesion in all patients and crossed the target obstruction without predilation in 83% of cases, the authors report.

More than 90% of patients randomized to primary PCI with TVAC achieved TIMI flow grade 2 or 3 immediately after aspiration, the report indicates, compared with 47.4% of patients in a control group treated with standard PCI.

Furthermore, angiographic measures of myocardial perfusion were generally better in patients treated with thrombectomy, and their incidence of coronary dissection and final distal embolism was significantly lower compared to patients in the control group.

There were no differences in procedural success rate, time from catheterization laboratory door to TIMI flow grades 2 or 3, or procedural time, the researchers note.

Only 12.5% of the aspiration group experienced the primary end point of slow flow or no reflow, the investigators say, compared with 19.4% of the control group.

The 8-month major adverse cardiac event rate was significantly lower in the thrombus aspiration group (12.9%) than in the control group (21.0%), mainly as a result of the low target lesion revascularization rates in patients with late reperfusion between 6 and 24 hours.

"Our results support the concept that upfront thrombectomy in patients with acute STEMI undergoing primary PCI is safe and may improve acute reperfusion and clinical outcomes, particularly in patients presenting later after symptom onset," the authors write.

"In Japan, upfront thrombus aspiration has been so popular that the majority of interventional cardiologists have been using this procedure for years," Dr. Isshiki told Reuters. "However, there is still some room to get better outcomes by preventing no reflow. We are now studying this issue."

"Thrombus aspiration is of course very useful for the patients with stent thrombosis," Dr. Isshiki added. "All interventional cardiologists should become used to this procedure to prepare for emergency."

J Am Coll Cardiol Intv 2008;1:424-431.