Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction

Abstract

RIMARY PERCUTANEOUS COROnary intervention (PCI) is widely accepted as the most effective reperfusion modality for ST-segment elevation myocardial infarction (STEMI). However, myocardial recovery after primary PCI is often suboptimal despite restoration of coronary blood flow, in part due to thrombus embolization resulting in impaired microvascular perfusion. 1-4 Two strategies proposed to reduce distal embolization after primary PCI are bolus infusion of intracoronary abciximab 5-8 and manual thrombus aspiration. 9-13 The mechanism through which reduced embolization and improved myo-Author Affiliations and the INFUSE-AMI Trial Investigators are listed at the end of the article.

Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

“…This conclusion is confirmed by the neutral results of the TASTE (n=7244) and TOTAL (n=10 732) trials, both of which were specifically designed to reliably detect differences in clinical outcomes. 7,8 The findings of TOTAL are also consistent with the Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction (INFUSE AMI) trial, 26 which showed no difference in infarct size with routine thrombus aspiration.…”

Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction

“…17,18 Mortality at 1 year in the thrombusaspiration group (4.9%) was similar to that in the TASTE trial (5.3%) and was not significantly different from that in the PCI-only group of the INFUSE-AMI trial (7.0%). Recently, observational data from 1498 patients with STEMI that was identified in a randomized trial of treatment with drug-eluting stents showed that clinical outcomes with thrombus aspiration were similar to those with stenting alone.…”

Randomized Trial of Primary PCI with or without Routine Manual Thrombectomy

“…10,14 Our study was the largest of these three trials and thus had the most power to detect a benefit, since it was designed to detect a relative reduction of 20% in the risk of the composite primary outcome. In addition, our trial, unlike the TASTE trial, used detailed event definitions, and the outcomes were adjudicated in a blinded fashion by an independent central committee rather than relying on registry data.…”