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J Am Coll Cardiol, 2009; 53:309-315, doi:10.1016/j.jacc.2008.10.017
© 2009 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Thrombus Aspiration During Primary Percutaneous Coronary Intervention Improves Myocardial Reperfusion and Reduces Infarct Size

The EXPIRA (Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention) Prospective, Randomized Trial

Gennaro Sardella, MD, FACC, FESC*,*, Massimo Mancone, MD*, Chiara Bucciarelli-Ducci, MD*,{ddagger}, Luciano Agati, MD*, Raffaele Scardala, MD*, Iacopo Carbone, MD{dagger}, Marco Francone, MD{dagger}, Angelo Di Roma, MD*, Giulia Benedetti, MD*, Giulia Conti, MD* and Francesco Fedele, MD*

* Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico "Umberto I," "Sapienza" University, Rome, Italy
{dagger} Department of Radiology Sciences, Policlinico "Umberto I," "Sapienza" University, Rome, Italy
{ddagger} Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Imperial College, National Heart and Lung Institute, London, United Kingdom

Manuscript received May 15, 2008; revised manuscript received September 12, 2008, accepted October 7, 2008.

* Reprint requests and correspondence: Dr. Gennaro Sardella, Department of Cardiovascular, Respiratory and Morphologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, Rome 00161, Italy (Email: rino.sardella{at}uniroma1.it).

Objectives: The purpose of this study was to evaluate the impact on myocardial perfusion and infarct size as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of a manual thrombectomy device, Export Medtronic (EM) (Medtronic Inc., Minneapolis, Minnesota), as adjunctive therapy in primary percutaneous coronary intervention (PPCI) in a subset of patients with anterior ST-segment elevation myocardial infarction (STEMI).

Background: PPCI may cause thrombus dislodgment, leading to microvascular damage.

Methods: One hundred seventy-five STEMI patients were randomly assigned to standard percutaneous coronary intervention (PCI) (n = 87) or EM-PCI (n = 88). The primary end points were the occurrence of myocardial blush grade ≥2 and the rate of 90-min ST-segment resolution >70%. The CE-MRI substudy was performed in 75 patients with anterior STEMI to assess microvascular obstruction and infarct size.

Results: Myocardial blush grade ≥2 and ST-segment resolution occurred more frequently in the EM-PCI group (88% vs. 60%, p = 0.001; and 64% vs. 39%, p = 0.001). In the acute phase, microvascular obstruction extent was significantly lower in the EM-PCI group and at 3 months, infarct size was significantly reduced only in the EM-PCI group. A lower incidence of cardiac death in the EM-PCI group (4.6% vs. 0%, log-rank test p = 0.02) was observed at 9 months.

Conclusions: Thrombectomy prevents thrombus embolization and preserves microvascular integrity reducing infarct size, and it therefore represents an useful adjunctive therapy in PPCI.

Key Words: myocardial infarction • magnetic resonance imaging • microcirculation • infarct size

Abbreviations and Acronyms
  CE-MRI = contrast-enhanced magnetic resonance imaging
  EM-PCI = Export Medtronic-percutaneous coronary intervention
  IS = infarct size
  LV = left ventricular
  MACE = major adverse cardiac events
  MBG = myocardial blush grade
  MVO = microvascular obstruction
  PPCI = primary percutaneous coronary intervention
  S-PCI = standard percutaneous coronary intervention
  STEMI = ST-segment elevation myocardial infarction
  STr = ST-segment resolution
  TIMI = Thrombolysis In Myocardial Infarction


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