Manual catheter aspiration appears to be a useful adjunct to primary percutaneous
coronary intervention (PCI) in ST-elevation myocardial infarction. We investigated
effects of catheter aspiration during primary PCI in patients with different extents
of coronary thrombus. The study included 46 patients with no or possible thrombus
(thrombus scale [TS] grades 0 to 1) and 135 patients with angiographic evidence of
obvious thrombus (TS grades 2 to 5). Reference vessel diameter, which was significantly
larger in the group with TS grades 2 to 5 (3.4 vs 3.2 mm, p = 0.004), was the only
independent predictor of angiographically visible thrombus (odds ratio 3.3, 95% confidence
interval 1.3 to 8.7, p = 0.015, per millimeter increase). Aspiration catheter was
successfully advanced across the lesion in 89% of patients with TS grades 0 to 1 and
96% of those with TS grades 2 to 5 (p = 0.115). Number of aspirations varied from
1 to 5 and was significantly larger in patients with TS grades 2 to 5. Visually observable
aspirate was obtained in 90% of patients with TS grades 2 to 5 and in 67% of patients
with TS grades 0 to 1 (p <0.001) with more patients with TS grades 2 to 5 having aspirate
>5 mm in length (49% vs 11%, p <0.001). Final Thrombolysis In Myocardial Infarction
grade 3 flow (89% vs 92%), residual TS (0.2 vs 0.1), frequency of distal embolization
(2% vs 6%), and early complete ST resolution (65% vs 70%) were comparable between
groups with TS grades 0 to 1 and 2 to 5. In conclusion, although the amount of aspirate
is larger in patients with angiographically obvious thrombus, visually observable
aspirate can be obtained in most patients without definite signs of thrombus. Extent
of coronary thrombus does not influence primary PCI result if manual aspiration is
used.
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Article info
Publication history
Published online: January 20, 2011
Accepted:
October 19,
2010
Received in revised form:
October 19,
2010
Received:
August 24,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
