AS-8: Angiographic Improvement after Thrombus Aspiration Concomitant with Glycoprotein IIb/IIIa Inhibitor Therapy Does Not Affect Long-Term Mortality during Primary PCI

Background: Primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) may cause thrombus dislodgment and impaired microcirculatory reperfusion. We sought to determine whether thrombus removal with a manual thrombus-aspirating device paired with glycoprotein (GP) IIb/IIIa inhibitor therapy during primary PCI could improve myocardial reperfusion and long-term mortality compared with standard PCI. Methods: One hundred sixty-nine patients (male:female 125:44, mean age: 62 12 years) who had undergone primary PCI in our institution since 2005 were retrospectively enrolled in this study. Achievement of 70% resolution of ST segment elevation (STR) on an electrocardiogram recorded 90 min after the procedure, postprocedural thrombolysis in myocardial infarction (TIMI) grade 3, and myocardial blush grade (MBG) 3 were compared in the mechanical aspiration (Export, Medtronic, group 1, n 27), GP IIb/IIIa inhibitor (group 2, n 19), combined (group 3, n 10), and conventional PCI groups (group 4, n 113). Additionally, major cardiac adverse events rate at 7 days and 18 months after PCI were compared. The mean follow-up duration was 21 9 months. Results: See Table. Comparing groups 1, 2, 3, and 4, differences in the complete STR rate did not reach statistical significance. However, the achievement rate for TIMI grade 3 was significantly higher in the group undergoing aspiration combined with GP IIb/IIIa inhibition. MBG-3 grade was more frequently noted in the aspiration group. Nevertheless, MACE rate at 7 days and 18 months was not different among the groups. Group 1. Asp 2. GP 3. Asp GP 4. Conventional