Aspiration thrombectomy during primary percutaneous coronary intervention as adjunctive therapy to early (in-ambulance) abciximab administration in patients with acute ST elevation myocardial infarction: an analysis from Leiden MISSION! acute myocardial infarction treatment optimization program.

BACKGROUND: The benefits of early abciximab administration and thrombus aspiration in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) have previously been elaborated. However, whether there is an adjunctive effect of thrombus aspiration among STEMI patients, with angiographic evidence of thrombus, receiving early prehospital abciximab remains unclear.

METHODS:  In the context of a fixed protocol for PPCI, 158 consecutive patients with STEMI were enrolled, in whom abciximab was started early before hospital arrival (in-ambulance); 79 patients who had PPCI with thrombus aspiration (thrombectomy-facilitated PCI group), were compared to 79 who had PPCI without thrombus aspiration (conventional PCI group) in a prospective nonrandomized study. The primary end-point was complete ST-segment resolution within 90 minutes. Secondary end points included distal embolization, enzymatic infarct size as well as left ventricular ejection fraction (LVEF) assessed by gated single-photon emission computed tomography. Major adverse cardiac events (MACEs) were evaluated up to 12 months.

RESULTS:  Both groups were comparable for baseline characteristics. ST-segment resolution was significantly higher in the thrombectomy-facilitated group (P = 0.002), and multivariate analysis identified thrombectomy as an independent predictor of ST-segment resolution (OR = 9.4, 95% CI = 2.6-33.5, P = 0.001). Distal embolization was higher in the conventional PCI group among patients with higher thrombus grades. No difference was observed between both groups in infarct size assessed by peak creatine kinase (p = 0.689) and peak Tn-T levels (P = 0.435). Also, the LVEF at 3 months was similar (P = 0.957). At 12 month clinical follow-up, thrombus aspiration was, however, associated with reduced all-cause mortality (log-rank p = 0.032).

CONCLUSION:  Among STEMI patients treated with PPCI and in-ambulance abciximab, it appears that a selective strategy of thrombus aspiration still has additive benefit.