Comparison of the reperfusion efficacy of thrombus aspiration without preceding balloon inflation and thrombus aspiration followed by balloon inflation in patients with acute ST-segment elevation myocardial infarction

초록

Background The effects of thrombus aspiration (TA) during primary percutaneous coronary intervention(PPCI) for ST-elevation myocardial infarction (STEMI) have been well evaluated. TA may cause damage at unstable plaque of culprit lesion leading to distal embolization. In this concept, ballooning before TA can minimize damage of culprit lesion from TA. However, there was no study for effect of ballooning before TA on angiographic outcomes in STEMI. Method In INTERSTELLAR registry, this study enrolled the 411 STEMI patients underwent PPCI using TA. Patients were divided in two groups as suction-first and ballooning-first. Primary endpoint was angiographic outcome defined as a final TIMI 3. Secondary endpoint were cardiovascular death during mean 2 years. Results Baseline clinical characteristics was similar in both group including age (p=0.816), diabetes and hypertension between two group. In angiographic analysis, use of glycoprotein inhibitor, multivessel disease and stent diameter were also similar between two groups. Initial TIMI 0-1 was comparable between suction-first and ballooning-first group (15% vs. 20%, p=0.266). As a primary endpoint, final TIMI3 was slightly higher in the balloon-first than suction-first (15.0% vs. 7.1%, p=0.055). CV death as a secondary endpoint did not differ between two groups (8.0% vs. 11.6%, p=0.460). Conclusion This study demonstrated that TA with preceding ballooning may be more effective in obtain of final TIMI 3 flow than TA first. Keywords: ST-elevation myocardial infarction, postprocedural outcomes, primary percutaneous coronary intervention, thrombus aspiration