The Investigation On Application Of Thrombus Aspiration In Primary Percutaneous Coronary Intervention For Patients With ST-elevation Acute Myocardial Infarction

Background and Objectives:Acute Myocardial Infarction with ST-segment elevation is caused by the rupture of a vulnerable atherosclerotic plaque, initiating intraluminal thrombosis leading to partial or complete occlusion of a coronary artery. Primary Percutaneous Coronary Intervention is the best reperfusion strategy, and is effective in opening the culprit aq2artery timely.Usually these patients have heavy thrombus burden,the ingredients of thrombus or plaque debris can increase the incidence of distal embolism and no-reflow if its not handled previously. We could use thrombectomy catheter to reduce thrombus burden by aspirating thrombus prior to stenting or balloon angiography, and better reperfusion and improved prognosis are predicted. So far, we haven't conclused definite evidence based on those International Trials. This study is focused on the application of thrombectomy catheter for patients with ST-elevation Acute Myocardial Infarction in our hospital, to investigate the influence of thrombus aspiration on clinical outcomes.Study population and Methods:1. Ninety-five patients were enrolled to our study according to the inclusion and exclusion criteria.2. Patients were assigned to study and control group randomly, forty-six patients receive thrombus aspiration before PCI in the study group, and we perform conventional PCI procedure for the other people in the controls group.3. Record all the data and related indicators (no-reflow, TIMI, ST regression, heart failure, Echocardiography, Main Adverse Cardiac Events et al.).Compare the basic data of the two groups, to study whether there are any significant differences on TIMI flow grade, STR immediately, no-reflow/slow reflow, heart failure within one week and MACE within one month.Results:1. The incidence of no-reflow/slow reflow and is much lower in study group than controls,6.5%vs.18.4%(P<0.05). The postprocedural TIMI flow grade and normalized ST regression in study group is much better than controls, with a result of 2.96±0.21vs.2.73±0.60 (P＜0.05) and 43.5%vs.22.4%(P＜0.05) respectively.2. The occurrence of heart failure is much lower in study group than controls,the result is 4.3%vs.22.4%(P<0.05).3. LVEDD and LVEF measured by Echocardiography are comparable in the study and controls group, with a result of 52.8±9.9mmvs.54.1±6.5mm(P>0.05) and 48.5±4.4% vs.47.5±5.2%(P>0.05) respectively.There are no significant differences on malignant arrhythmia and Major Adverse Cardiac Events between the two groups.Conclusions:1. The application of thrombus aspiration in primary PCI could improve TIMI flow grade and ST regression, leading to better myocardial reperfusion and less cardiac insufficiency, and reduce the incidence of heart failure and no-flow/slow reflow significantly.2. Thrombus aspiration has obvious advantages over conventional PCI therapy, In all, we recommend thrombus aspiration in primary PCI based on the existing evidence.3. Thrombus aspiration contributes to better short-term prognosis, the long-term effect should be studied and confirmed by more clinical trials.