OBJECTIVES: This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes. METHODS: The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipro's TransVascular Aspiration Catheter (Osaka, Japan). RESULTS: The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point-defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01). CONCLUSIONS: This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.
RCT Entities:
OBJECTIVES: This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes. METHODS: The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipro's TransVascular Aspiration Catheter (Osaka, Japan). RESULTS: The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point-defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01). CONCLUSIONS: This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.
Authors: Eliano Pio Navarese; Giuseppe Tarantini; Giuseppe Musumeci; Massimo Napodano; Roberta Rossini; Mariusz Kowalewski; Anna Szczesniak; Michalina Kołodziejczak; Jacek Kubica Journal: Am J Cardiovasc Dis Date: 2013-08-16
Authors: Sanjit S Jolly; John A Cairns; Salim Yusuf; Michael J Rokoss; Peggy Gao; Brandi Meeks; Sasko Kedev; Goran Stankovic; Raul Moreno; Anthony Gershlick; Saqib Chowdhary; Shahar Lavi; Kari Niemela; Ivo Bernat; Warren J Cantor; Asim N Cheema; Philippe Gabriel Steg; Robert C Welsh; Tej Sheth; Olivier F Bertrand; Alvaro Avezum; Ravinay Bhindi; Madhu K Natarajan; David Horak; Raymond C M Leung; Saleem Kassam; Sunil V Rao; Magdi El-Omar; Shamir R Mehta; James L Velianou; Samir Pancholy; Vladimír Džavík Journal: Lancet Date: 2015-10-22 Impact factor: 79.321
Authors: Umesh U Tamhane; Stanley Chetcuti; Irfan Hameed; P Michael Grossman; Mauro Moscucci; Hitinder S Gurm Journal: BMC Cardiovasc Disord Date: 2010-02-26 Impact factor: 2.298