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Aspiration thrombectomy and intracoronary tirofiban in ST-segment elevation myocardial infarction

Combination treatment for patients undergoing primary percutaneous coronary intervention

Aspirationsthrombektomie und intrakoronare Tirofibangabe bei ST-Hebungs-Infarkt

Kombinationstherapie bei Patienten mit primärer perkutaner Koronarintervention

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Abstract

Aim

Primary percutaneous coronary intervention is the most effective treatment for patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate whether the combination of aspiration thrombectomy with intracoronary tirofiban treatment can result in smaller infarcts and better patient prognosis compared with aspiration thrombectomy alone.

Patients and methods

In all, 150 patients with STEMI underwent primary percutaneous coronary intervention. Group A received aspiration thrombectomy and group B received a combination treatment of aspiration thrombectomy with intracoronary tirofiban. The endpoint was major adverse cardiovascular events, including myocardial (re)infarction, cardiovascular death, and target vessel revascularization.

Results

The clinical characteristics of the groups were not significantly different (p > 0.05). The percentage of patients whose thrombolysis in myocardial infarction (TIMI) myocardial perfusion grades were less than 3 was significantly higher for group B than for group A (13.9 vs. 3.8 %, p = 0.029). The infarct size on cardiac magnetic resonance imaging was significantly different between groups (p = 0.036). At 6 months after the operation, the echocardiography results were better for patients in group B than for those in group A (p = 0.024 and p = 0.016, respectively). The frequency of bleeding complications and major adverse cardiac events of the groups were not significantly different (p > 0.05).

Conclusion

Aspiration thrombectomy with intracoronary tirofiban in patients with STEMI is safe and effective. For cases with a large angiographic thrombus burden, tirofiban did not increase the rate of bleeding complications or major adverse cardiovascular events.

Zusammenfassung

Ziel

Die primäre perkutane Koronarintervention ist die wirksamste Behandlung für Patienten mit ST-Hebungs-Infarkt (STEMI). Ziel der vorliegenden Studie war zu untersuchen, ob die Kombination der Aspirationsthrombektomie mit intrakoronarer Tirofibantherapie zu kleineren Infarkten und einer besseren Prognose für den Patienten als die alleinige Aspirationsthrombektomie führen kann.

Patienten und Methoden

Insgesamt 150 Patienten mit STEMI wurden mit primärer perkutaner Koronarintervention behandelt. Bei Gruppe A erfolgte eine Aspirationsthrombektomie und bei Gruppe B eine Kombinationsbehandlung aus Aspirationsthrombektomie und intrakoronarer Tirofibangabe. Der Endpunkt bestand aus schweren unerwünschten kardiovaskulären Ereignissen einschließlich Myokard(re)infarkt, Tod aus kardiovaskulärer Ursache und Zielgefäßrevaskularisierung.

Ergebnisse

Bei den klinischen Kennzeichen der Gruppen gab es keine signifikanten Unterschiede (p > 0,05). Der Anteil an Patienten, deren Myokardperfusionsgrad nach TIMI („thrombolysis in myocardial infarction“) unter 3 lag, war in Gruppe B signifikant höher als in Gruppe A (13,9 vs. 3,8 %; p = 0,029). Die Infarktgröße der beiden Gruppen in der kardialen Magnetresonanztomographie unterschied sich in signifikanter Weise (p = 0,036). In der Echokardiographie waren 6 Monate nach der Operation die Befunde bei den Patienten der Gruppe B besser als bei denen der Gruppe A (p = 0,024 bzw. p = 0,016). Die Häufigkeit von Blutungskomplikationen und schweren unerwünschten kardialen Ereignissen unterschied sich in den Gruppen nicht signifikant (p > 0,05).

Schlussfolgerung

Die Aspirationsthrombektomie mit intrakoronarer Tirofibangabe stellt bei Patienten mit STEMi eine sichere und wirksame Therapie dar. In Fällen mit einer hohen angiographischen Thrombuslast erhöhte sich durch Tirofiban die Rate an Blutungskomplikationen oder schweren unerwünschten kardiovaskulären Ereignissen nicht.

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Authors and Affiliations

  1. The Second Department of Cangzhou Cardiovascular Institute, No. 16 Xinhua Road, 061000, Cangzhou, Hebei, People’s Republic of China

    T. Geng, J.-G. Zhang, Z.-Y. Song, S.-P. Dai, Y. Luo & Z.-S. Xu

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  1. T. Geng
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  2. J.-G. Zhang
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Correspondence to T. Geng.

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T. Geng, J.-G. Zhang, Z.-Y. Song, S.-P. Dai, Y. Luo, and Z.-S. Xu state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Geng, T., Zhang, JG., Song, ZY. et al. Aspiration thrombectomy and intracoronary tirofiban in ST-segment elevation myocardial infarction. Herz 41, 732–740 (2016). https://doi.org/10.1007/s00059-016-4426-4

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