Thrombus Aspiration Beneficial Before Stenting Heart Attack Patients

Using an aspiration catheter before stenting patients suffering acute myocardial infarction (AMI) can significantly improve blood flow and survival rates compared to conventional treatment with percutaneous coronary intervention (PCI) alone, according to a new study.

Researchers at the University Medical Center Groningen (UMCG, The Netherlands) performed a randomized trial to assess whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered successful if there was histopathological evidence of atherothrombotic material. The researchers assessed angiographic and electrocardiographic (ECG) signs of myocardial reperfusion, as well as clinical outcome. The primary end point was defined as absent or minimal myocardial reperfusion.

The researchers found that the aspiration group had 35% fewer patients than the conventional PCI group exhibiting angiographic signs of poor blood flow to the heart muscle. In addition, 28% more patients in the aspiration group had resolution of cardiac ST-segment elevation compared to the conventional PCI group. The study showed a reduction in death and major adverse cardiac events in patients that exhibited angiographic signs of improved blood flow to the heart muscle and resolution of ST-segment elevation. The results of the study were published in the February 7, 2008, issue of The New England Journal of Medicine (NEJM), and were also presented at the American College of Cardiology (ACC) annual meeting, held during March-April 2008 in Chicago (IL, USA).

"We are on the brink of a new development,” said lead author Felix Zijlstra, M.D., Ph.D., director of the Thorax Center at the department of cardiology. "Instead of fragmenting clot material with a balloon and potentially sending it downstream, where it could cause further damage to the heart muscle, it makes sense to get rid of the debris to start with.”

In their study, the researchers used the Export Aspiration Catheter, a product developed by Medtronic (Minneapolis, MN, USA).


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University Medical Center Groningen
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