Clinical Research
Interventional Cardiology
Thrombus Aspiration During Primary Percutaneous Coronary Intervention Improves Myocardial Reperfusion and Reduces Infarct Size: The EXPIRA (Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention) Prospective, Randomized Trial

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Objectives

The purpose of this study was to evaluate the impact on myocardial perfusion and infarct size as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of a manual thrombectomy device, Export Medtronic (EM) (Medtronic Inc., Minneapolis, Minnesota), as adjunctive therapy in primary percutaneous coronary intervention (PPCI) in a subset of patients with anterior ST-segment elevation myocardial infarction (STEMI).

Background

PPCI may cause thrombus dislodgment, leading to microvascular damage.

Methods

One hundred seventy-five STEMI patients were randomly assigned to standard percutaneous coronary intervention (PCI) (n = 87) or EM-PCI (n = 88). The primary end points were the occurrence of myocardial blush grade ≥2 and the rate of 90-min ST-segment resolution >70%. The CE-MRI substudy was performed in 75 patients with anterior STEMI to assess microvascular obstruction and infarct size.

Results

Myocardial blush grade ≥2 and ST-segment resolution occurred more frequently in the EM-PCI group (88% vs. 60%, p = 0.001; and 64% vs. 39%, p = 0.001). In the acute phase, microvascular obstruction extent was significantly lower in the EM-PCI group and at 3 months, infarct size was significantly reduced only in the EM-PCI group. A lower incidence of cardiac death in the EM-PCI group (4.6% vs. 0%, log-rank test p = 0.02) was observed at 9 months.

Conclusions

Thrombectomy prevents thrombus embolization and preserves microvascular integrity reducing infarct size, and it therefore represents an useful adjunctive therapy in PPCI.

Key Words

myocardial infarction
magnetic resonance imaging
microcirculation
infarct size

Abbreviations and Acronyms

CE-MRI
contrast-enhanced magnetic resonance imaging
EM-PCI
Export Medtronic-percutaneous coronary intervention
IS
infarct size
LV
left ventricular
MACE
major adverse cardiac events
MBG
myocardial blush grade
MVO
microvascular obstruction
PPCI
primary percutaneous coronary intervention
S-PCI
standard percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
STr
ST-segment resolution
TIMI
Thrombolysis In Myocardial Infarction

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