Thrombus aspiration with export catheter in ST elevation myocardial infarction.

ABSTRACT

BACKGROUND: Many thrombectomy devices have failed to confirm initial promising results during primary angioplasty. This may be due to device complexity and operator experience. The objective of this study was to assess the safety and efficacy of the EXPORT catheter for thrombus aspiration in patients with ST elevation myocardial infarction (STEMI). METHODS: EXPORT catheter was used in patients with STEMI and angiographic evidence of thrombus in vessels with a reference diameter > or =1.5 mm. Direct stenting and glycoprotein IIb/IIIa inhibitors were liberally employed to optimize angiographic and clinical results. Epicardial and myocardial angiographic parameters, in-hospital major adverse cardiac events (MACE, i.e., cardiac death, myocardial infarction, target vessel revascularization) were assessed. RESULTS: EXPORT catheter was used in 129 patients without any device-related complications. Angiographic analysis following thrombus aspiration revealed a significant improvement in TIMI frame count (P = 0.0001), myocardial perfusion (P = 0.0001), TIMI thrombus grade (P = 0.0001), and TIMI flow (P = 0.0001). Stent implantation did not significantly improve myocardial perfusion, TIMI thrombus grade, or TIMI flow, but improved TIMI frame count, minimal lumen, and reference vessel diameter. When compared to a historical STEMI control group not undergoing thrombus aspiration, our EXPORT population showed significant improvements in reperfusion parameters. In-hospital MACE were uncommon (4.5%) despite high-risk patient characteristics. CONCLUSIONS: Our study demonstrates that routine use of EXPORT catheter in patients with STEMI and coronary thrombosis is feasible, safe, and associated with significant improvements in flow-related angiographic parameters. The relative simplicity of this approach makes it an attractive option in this challenging situation.