Assessment of myocardial contractile function of left ventricle in patients with STEMI after use of manual thrombus aspiration: results of three years of observation

Abstract

Introduction: According to current guidelines on primary percutaneous coronary intervention (PCI), the routine use of manual thrombus aspiration is not essential in patients with STEMI (2015 ACC/AHA/SCAI Focus update). Nevertheless the results of the TOTAL trial angiographic sub-study demonstrated a statistically significant improvement in myocardial perfusion after manual thrombus aspiration. Moreover conducted trials did not assessed the impact of manual thromboaspiration on left ventricular remodeling. The purpose of our study was to evaluate the use of manual thrombus aspiration in patients with STEMI undergoing primary (pPCI) or rescue PCI (rPCI) and its impact on left ventricular remodeling.
Materials and methods: the study included 200 STEMI patients with primary (n=100) rescue PCI (n=100). After coronary angiography the patients were randomized in two groups: PCI with the use of manual thrombus aspiration (TA+) and standard PCI (TA-). At the one and three years follow-up we estimated ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESW) and asynergia index (IA).
Results: At one-year follow-up a greater improvement in LV ejection fraction was observed after primary PCI in the thrombus-aspiration subgroup compared with the standard PCI subgroup (4.99% vs 3.78%, respectively, p=0.003). In the TA- rescue PCI subgroup LVEF increase was 2.35% (p=0.006). EDW LV had increased in all subgroups, less in the TA+ primary PCI subgroup There were significant changes in the ESW during the year in all groups. AI significantly decreased in the TA+ primary PCI subgroup and TA+ rescue PCI subgroup. Three-year follow-up analysis showed a significant increase in LVEF in all groups. The greatest increase of LVEF was observed in TA+ primary PCI subgroup (6%, p=0.001). In TA- rescue PCI subgroup LVEF increase was just over 2% (p=0.002). The greatest increase in volume parameters of the left ventricle was recorded in patients from the TA+ rescue PCI subgroup (p<0.05). Significant improvement of the local contractility was observed only in the TA+ primary PCI subgroup.
Conclusion: in patients with STEMI who underwent primary PCI with the use of manual thromboaspiration, the process of left ventricular remodeling tends to be more favorable compared to standard primary PCI. In the rescue PCI group, on the other hand, the implementation of the thrombus aspiration is associated with worse outcome.