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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

VALDEBENITO, Martín et al. Routine Thrombi Aspiration during Primary Anngioplasty does not improve micro vascular flow compared to conventional angioplasty in ST elevation Myocardial Infarction. Rev Chil Cardiol [online]. 2014, vol.33, n.3, pp.173-180. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602014000300002.

Background. There is controversy regarding the effectiveness of thrombi aspiration during primary angioplasty for ST elevation myocardial  Aim: to evaluate the effect of routine aspiration of thrombus upon micro vascular flow, both overall and according to the time from initial pain to intervention.  Method: 122 patients admitted to a general hospital for acute ST elevation myocardial infarction were prospectively randomized to undergo coronary angioplasty (PTCA) with prior aspiration of thrombi or PTCA alone. The final micro vascular flow was compared between groups. A similar analysis compared patients presenting before or after 3 hours from de initial pain.  Results: 59 patients underwent thrombi aspiration followed by PTCA (A+PTCA) and 63 PTCA alone (PTCA). Compared to the PTCA group, the A+PTCA group required less frequently balloon pre-dilation. (46.4% vs 80.3%; p=0.01) and a need for complex angioplasty of bifurcation lesions (3.6% vs 15.2%; p=0.03). No difference was observed in final micro vascular flow assessed by cTFC between corresponding groups (25.6 ± 11.8 vs 24.8 ± 10.9; p=0.12). Compared to Group A+PTCA, patients undergoing PTCA alone had no difference in final micro vascular flow, irrespective of time from initial pain to PTCA: cTFC 22.3 ± -9.1 vs 22.4 ±-8 in those treated <3 hours from initial pain and 27.7 +/- 13.4 vs 25.9 +/- 11.6, in those treated >= 3 hr after initial pain, respectively.  Conclusion: Manual thrombi aspiration before PTCA in patients with ST elevation myocardial infarction did not improve micro vascular flow, regardless of the time from initial pain to primary PTCA. The lesser need for complex angioplasty and balloon pre-dilatation in patients undergoing thrombi aspiration may reflect a better visualization of affected arteries during PTCA.

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