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Thrombus aspiration versus conventional primary PCI in STEMI patients. V. Mironov Russian Cardiology Research Center 2014. Do we need thrombus aspiration?. No-reflow mechanism. Niccoli , Burzotta , Galiuto , Crea . No Reflow in man. JACC 2009. Reperfusion. - PowerPoint PPT Presentation
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Thrombus aspiration versus conventional primary PCI in STEMI patients
V. MironovRussian Cardiology Research Center
2014
Do we need thrombus aspiration?
Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009
No-reflow mechanism
Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009
Reperfusion
Primary endpoint: Myocardial blush grade
Series10
10
20
30
40
50
60
17
26
3741
46
32
0/123
P < 0.001
Thrombus aspiration Conventional PCI
TA PA S
%
ST-segment elevation resolution
Series10
10
20
30
40
50
60
1318
31
38
57
44< 30% 30-70%
> 70%
% P < 0.001
Thrombus aspiration Conventional PCI
TA PA S
Myocardial blush grade and death or death/reinfarction at 30-days
3 2 0 or 10
2
4
6
8
10
1.1
2.9
5.7
1.6
3.9
8.1
Death
Death/reinfarction
Myocardial blush grade
P = 0.001
TA PA S
%
TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year
3 2 0 or 10
2
4
6
8
10
12
14
16
3.74.7
11
6.17.6
14.8
Death
Death/reinfarction
P = 0.001
Myocardial blush grade
TA PA S
%
Mortality at 1 year
Log-Rank p = 0.040
Lancet. 2008 Jun 7;371(9628):1915-20.
TA PA S
Log-Rank p = 0.016
Mortality or non-fatal ReMI at 1 year
Lancet. 2008 Jun 7;371(9628):1915-20.
TA PA S
472 STEMI pts
Conventional pPCIN=232
PCI+TAn=240
Success of TAN=228
Impossible of TAN=12
Stenting
Primary EP: “optimal” reperfusion: TIMI III, MBG 3, ST resolutionSecondary EP: MACE
No-reflow in STEMIRussian Cardiology Research Center
Russian Cardiology Research CenterPrimary end point
pPCI Thrombus aspiration p
TIMI 0-1 17 (7.3%) 2 (0,9%) 0,002
TIMI 2 42 (18,1%) 18 (7,9%)
TIMI 3 173 (74,6%) 94 (91,2%)
MBG 0-1 36 (15,5%) 21 (9,2%) 0,003
MBG 2 118 (50,8%) 32 (14%)
MBG 3 78 (33,7%) 175 (76,8%)
Resolution of ST > 70% 80 (34,5%) 138 (60,5%) 0,02
Balloon dilatation 206 (88,8%) 33 (14,5%) 0,001
PCI+TA PCI0
10
20
30
40
50
60
70
60.7
34.6
P = 0.001
Optimal reperfusion (TIMI III, MBG 3, ST resolution>70%)
%
P = 0.001
In-hospital mortality
PCI+TA PCI0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0.8
1.7
%
Russian Cardiology Research CenterMACE 2y FU
0 12 24 3680828486889092949698
100
MACE-free survival
pPCI TA-PCI
11,5%
Months
%
P=0,002
65 yo male patient with STEMI
Диссекция среднего отдела ствола ЛКАПациент с многососудистым поражением коронарного русла с вовлечением ствола ЛКА
Result and 1 year follow up
Kaplan–Meier Curves for Death from Any Cause and Hospitalization Due to Reinfarction.
Kaplan–Meier curves are shown for the cumulative probability of death from any cause (Panel A) and of hospitalization due to reinfarction (Panel B) up to 30 days after PCI only (PCI) or after PCI with thrombus aspiration (PCI+TA). The insets show the same data on an enlarged y axis.
51 years old male patientInfero-lateral STEMI. Paroxysmal AF.
Thrombus aspiration versus balloon dilatation in primary and rescue PCI
160 pts with STEMI
Primary PCI (80 pts) Rescue PCI (80 pts)
TA + PCI (40 pts) PCI (40 pts) TA + PCI (40 pts) PCI (40 pts)
Randomization
Primary end points: Echo (EF, ESV, EDV) after PCI, at discharge and after 1 year follow up
Secondary end points: MACE
1 year follow up