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Thrombus Aspiration Reduces Microvascular Obstruction After Primary Coronary Intervention

A Myocardial Contrast Echocardiography Substudy of the REMEDIA Trial

Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy

View larger version (100K): [in a new window]   Figure 1 Example of myocardial contrast echocardiography images in 4-chamber view. Microvascular network reached by microbubbles is colored in orange, whereas the area of microvascular obstruction (MO) is shown in both images as a black area at the apex (within arrows). The MO area is larger in A (control group patient) compared with that in B (thrombus-aspiration group patient).

View larger version (20K): [in a new window]   Figure 2 Contrast score index (CSI) (upper panel), contrast defect length (CDL)/left ventricular (LV) length (%) (lower panel) at 24 h, 1 week, and 6 months in control patients (white bars) and thrombus aspiration (black bars). At each time point, both MO parameters are significantly reduced by thrombus-aspiration device (upper panel: *p < 0.01 vs. controls, p < 0.0005 vs. control patients; lower panel: *p < 0.05 vs. control patients). In both groups, a significant reduction of myocardial contrast echocardiography (MCE) score over time has been observed at 1 week (upper panel: p = 0.01 vs. 24 h and $p < 0.0001 vs. 24 h), whereas myocardial contrast echocardiography /LV length was reduced only in thrombus aspiration (lower panel: p < 0.001 vs. 24 h).

View larger version (104K): [in a new window]   Figure 3 Example of reduction of the extent of microvascular obstruction (MO) at 1 week compared to 24-h myocardial contrast echocardiographic imaging performed in 2-chamber view. The area of MO between arrows is larger at 24 h compared to 1 week.

View larger version (23K): [in a new window]   Figure 4 Wall motion (WM) score index (WMSI) (upper panel) and left ventricular (LV) length WML/LV length (%) (lower panel) at 24 h, 1 week, and 6 months in control patients (white bars) and thrombus aspiration patients (black bars). At each time point, both WM parameters are significantly reduced by thrombus-aspiration device (upper panel: *p < 0.005 vs. control patients, lower panel: *p < 0.05 vs. control patients). In both groups, a significant reduction of WM score over time has been observed at 1 week and 6 months (p = 0.0001 vs. 24 h). At 1 week and 6 months, WM/LV length was also reduced in controls (p < 0.005 vs. 24 h) and in thrombus aspiration (p < 0.0005 vs. 24 h).

View larger version (16K): [in a new window]   Figure 5 End-diastolic volume (A) and end-systolic volume (B) at 24 h, 1 week, and 6 months in controls (white bars) and thrombus aspiration (black bars). Although a slight reduction in both volumes could be observed at each time point in thrombus aspiration compared with control patients, such differences did not reach statistical significance. (C) Ejection fraction at 24 h, 1 week, and 6 months in control patients (white bars) and thrombus aspiration (black bars). In thrombus-aspiration patients, at each time point, ejection fraction was significantly better compared with control patients (*p < 0.05 vs. control patients), and it further improved at 1 week and 6 months (p < 0.05 compared to 24 h).