Thrombus Aspiration is useful in AMI

Original title: A Prospective Randomized Trial of Trombectomy Versus No Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction and Thrombus-Rich Lesion. MUSTELA (MUltidevice Thrombectomy in Acute ST-Segment ELevation Acute Myocardial Infarction) Trial Reference: Marco De Carlo, et al. J Am Coll Cardiol Intv 2012;5:1223–30

The main objective during primary PCI is myocardial reperfusion, which is limited by distal embolization of thrombi. Several thrombectomy devices have been developed with controversial results since, till now, all studies have included patients with variable thrombus load; therefore whether thrombectomy should be routine or alternative practice to treat high thrombus burden patients remains a question. The aim of this randomized study was to assess the impact of manual or reolytic thrombectomy during primary PCI in patients with high thrombus burden. 208 AMI patients undergoing PCI were included, randomized 1:1 to two groups: thrombus aspiration (TG) and standard (ST), the GT group to manual aspiration or AngiJet Ultra.

Primary end point was ST resolution at 60 minutes and AMI size at 3 months, assessed by MRI. Secondary end point included TIMI flow, myocardial blush, transmurality, microvascular obstruction and one year freedom from mayor cardiac events.

Baseline characteristics were similar, radial approach was used in 95.2% of the population, reolytic thrombectomy was 51.9% and 3.8% required dilation previous to thrombus aspiration. AngioJet Ultra was more effective to achieve complete aspiration of thrombi.

Thrombectomy allowed a significantly greater use of primary stent, lower TIMI 2 flow and a trend to a higher TIMI 3. Primary end point (complete resolution of STEMI) was significantly better in GT (57.4% vs. 37.3%; p=0.004). At 3 months, MRI showed significantly less microvascular obstruction in GT, but there was no difference in infarction size, transmurality, ejection fraction and ventricular volumes, which remained similar. Freedom from mayor cardiac events was also similar in both groups (91.4% vs. 90.2%).

Conclusion 

The use of thrombus aspiration in primary PCI was effective to achieve STEMI resolution, improve TIMI flow and reduce microvascular obstruction but did not reduce infarction size or transmurality.

Editorial Comment:

This randomized study showed that thrombectomy is beneficial to solve STEMI, improve myocardial flow and microvascular obstruction, which leads to infer this technique is indeed beneficial, despite the fact that it has not shown to improve hard events at one year. A larger number of patients may surely show this benefit. 

Courtesy of Dr. Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.

Dr. Carlos Fava para SOLACI.ORG

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...