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EXPEDITED REVIEW

Manual Thrombus-Aspiration Improves Myocardial Reperfusion

The Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus-Aspiration in Primary and Rescue Angioplasty (REMEDIA) Trial

Institute of Cardiology, Catholic University, Rome, Italy

Manuscript received February 2, 2005; revised manuscript received April 18, 2005, accepted April 26, 2005.

^_* Reprint requests and correspondence: Dr. Francesco Burzotta, Via Prati Fiscali 158, 00141 Rome, Italy (Email: f.burzotta{at}eudoramail.com).

OBJECTIVES: The aim of this study was to evaluate the use of a new manual thrombus-aspirating device in unselected patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI).

BACKGROUND: Failure to achieve myocardial reperfusion often occurs during PCI in patients with STEMI. The use of thrombus-aspirating devices might improve myocardial reperfusion by reducing distal embolization.

METHODS: We prospectively randomized before coronary angiography 100 consecutive patients with STEMI to either standard PCI or PCI with manual thrombus-aspiration. Primary end points of the study were post-procedural rates of myocardial blush grade (MBG) 2 and ST-segment resolution (STR) 70%. Analyses were planned by intention to treat.

RESULTS: Ninety-nine patients entered the analyses. The rates of post-procedural MBG 2 and STR 70% were, respectively, 68.0% and 44.9% in the thrombus-aspiration group compared with 58.0% and 36.7% in the standard PCI group: odds ratio (OR) 2.6 (95% confidence interval [CI] 1.2 to 5.9), p = 0.020, and 2.4 (95% CI 1.1 to 5.3), p = 0.034, respectively. Moreover, the rate of patients achieving both the angiographic and electrocardiographic (ECG) criteria of optimal reperfusion was significantly higher in the thrombus-aspiration group compared with standard PCI: 46.0% versus 24.5%, OR 2.6 (95% CI 1.1 to 6.2), p = 0.025. In multivariate analysis, randomization to thrombus-aspiration was a significant independent predictor of achievement of MBG 2 and STR 70% (p = 0.013).

CONCLUSIONS: This prospective randomized study shows that manual thrombus-aspiration in unselected patients with STEMI undergoing primary or rescue PCI is clinically feasible and results in better angiographic and ECG myocardial reperfusion rates compared with those achieved by standard PCI.

Abbreviations and Acronyms   CTFC = corrected TIMI frame count   MBG = myocardial blush grade   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation acute myocardial infarction   STR = ST-segment resolution   TIMI = Thrombolysis In Myocardial Infarction

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