Optical coherence tomography assessment of efficacy of thrombus aspiration in patients undergoing a primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

OBJECTIVE We used optical coherence tomography (OCT) to assess the impact of thrombus aspiration before angioplasty on poststenting tissue protrusions in patients undergoing a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS A total of 188 patients with STEMI who underwent thrombus-aspiration PCI (n=113) or standard PCI (n=75) were examined in this study. OCT was performed immediately after primary PCI to assess lesion morphology in the stented segment. The minimum stent area was similar between the thrombus-aspiration PCI group and the standard PCI group [7.4 interquartile range (IQR): 5.8-9.4 vs. 7.4 IQR: 5.8-8.9 mm², P=0.788]. The maximum tissue protrusion area [0.6 (IQR: 0.3-1.1) vs. 1.2 (IQR: 0.8-1.9) mm², P<0.001], the mean tissue protrusion area [0.1 (IQR: 0.1-0.2) vs. 0.5 (IQR: 0.3-0.8) mm², P<0.001], and tissue protrusion volume [2.3 (IQR: 1.3-4.3) vs. 8.3 (IQR: 5.4-14.6) mm², P<0.001] were significantly smaller in the thrombus-aspiration PCI group compared with the standard PCI group. Minimum lumen area was significantly greater in the thrombus-aspiration PCI group compared with the standard PCI group [6.9 (IQR: 5.4-8.8) vs. 6.3 (IQR: 4.6-7.8) mm², P=0.033]. CONCLUSION Thrombus aspiration before angioplasty in patients with STEMI was associated with significantly smaller tissue protrusion and larger lumen poststenting compared with standard PCI. Thrombus aspiration in primary PCI favorably influenced lesion morphologies in the stented segment.