Rheolityc Thrombectomy in Acute Myocardial Infarction: Effect on Microvascular Obstruction, Infarct Size, and Left Ventricular Remodeling

摘要

Objectives: We sought to analyze whether rheolytic thrombectomy (RT) in comparison with manual thrombus aspiration (MTA) may reduce microvascular obstruction (MVO), infarct size (IS), and left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI). Background: Conflicting results have been reported as to whether MTA reduces MVO and IS. Methods and Results: Eighty STEMI reperfused by primary angioplasty and abciximab were randomly allocated (1: 1) to RT or MTA. Cardiac magnetic resonance imaging (MRI) was performed in 37 patients (19 RT) and after 1 year in 19 (9 RT); baseline, 1- and 6-month 2D-echo was performed in all patients. MVO and IS were measured 8 min after gadolinium injection with late enhancement sequences and were analyzed quantitatively at a core laboratory blinded to randomization. At baseline TIMI thrombus grade were similar (RT: 4.47 +/- 0.84 vs. MTA: 4.67 +/- 0.76, P=0.453). After thrombectomy, thrombus grade decreased to 1.11 +/- 1.04 in RT vs. 2.17 +/- 1.29 in MTA arm (P=0.009). RT compared with MTA did not reduced significantly myocardial IS [12.2% (6.4-22.1) vs. 19.0% (7-28.5), P=0.224] as well as the extent of MVO [0.0% (0.0-0.17) vs. 0.6% (0.0-1.4), P=0.117], but a trend toward a lower incidence of MVO (16% vs. 44%, P=0.056) and a less LV remodeling rate were found in RT arm (11% vs. 24%, P < 0.140). Conclusion: RT in comparison with MTA was more effective in thrombus removal, but it did not reduced significantly the IS and the extent of MVO. However, a trend toward a lower incidence of MVO and a better preservation of LV volumes were found in RT arm. (C) 2015 Wiley Periodicals, Inc.