Routine manual vacuum in patients with acute coronary syndrome and ST-segment elevation improves myocardial perfusion according to non-invasive parameters. Invasive assessment of microcirculation has not been adequately studied in this group of patients. The objective of this study was to compare the effect of manual thromboaspiration in perfusion according to the microcirculation resistance index (MRI). This study included 128 patients with myocardial infarction and ST-segment elevation within 12 hours of onset of symptoms being randomized to manual thromboaspiration or otherwise during primary angioplasty. Then, pressure-wire based MRI was calculated in hyperemia.
There were no differences between groups in the final epicardial flow; however, there was a relative reduction of 32% in the MRI values in the group treated with thromboaspiration, as well as a higher resolution of ST and better myocardial BLUSH. The occurrence of MACE was significantly lower in the thromboaspiration group (3.9% vs 13.5%, p=0.045).
Conclusion: manual aspiration during primary angioplasty reduces the microcirculation resistance, indicating an improvement in myocardial perfusion. In the 9-month clinical follow-up, the incidence of events was lower with thromboaspiration.
Dejan Orlic, MD.
2013-05-23
Original title: The randomised physiologic assessment of thrombus aspiration in patients with STEMI: PATA – STEMI Study.
