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Thrombus aspiration versus conventional primary PCI in STEMI patients

Thrombus aspiration versus conventional primary PCI in STEMI patients. V. Mironov Russian Cardiology Research Center 2014. Do we need thrombus aspiration?. No-reflow mechanism. Niccoli , Burzotta , Galiuto , Crea . No Reflow in man. JACC 2009. Reperfusion.

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Thrombus aspiration versus conventional primary PCI in STEMI patients

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  1. Thrombus aspiration versus conventional primary PCI in STEMI patients V. Mironov Russian Cardiology Research Center 2014

  2. Do we need thrombus aspiration?

  3. No-reflow mechanism Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009

  4. Reperfusion Niccoli, Burzotta, Galiuto, Crea. No Reflow in man. JACC 2009

  5. TAPAS Primary endpoint: Myocardial blush grade % P < 0.001 Thrombus aspiration Conventional PCI

  6. TAPAS ST-segment elevation resolution P < 0.001 Thrombus aspiration Conventional PCI

  7. TAPAS Myocardial blush grade and death or death/reinfarction at 30-days % P = 0.001 Myocardial blush grade

  8. TAPAS TAPAS one year outcome: Myocardial blush grade and death or death/reinfarction at 1 year P = 0.001 % Myocardial blush grade

  9. TAPAS Mortality at 1 year Log-Rank p = 0.040 Lancet. 2008 Jun 7;371(9628):1915-20.

  10. TAPAS Mortality or non-fatal ReMI at 1 year Log-Rank p = 0.016 Lancet. 2008 Jun 7;371(9628):1915-20.

  11. No-reflow in STEMIRussian Cardiology Research Center 472 STEMI pts Impossible of TA N=12 Conventional pPCI N=232 PCI+TA n=240 Success of TA N=228 Stenting Primary EP: “optimal” reperfusion: TIMI III, MBG 3, ST resolution Secondary EP: MACE

  12. Russian Cardiology Research CenterPrimary end point

  13. Optimal reperfusion (TIMI III, MBG 3, ST resolution>70%) % P = 0.001

  14. In-hospital mortality % P = 0.001

  15. Russian Cardiology Research CenterMACE 2y FU % 11,5% Months P=0,002

  16. 65 yo male patient with STEMI Пациент с многососудистым поражением коронарного русла с вовлечением ствола ЛКА Диссекция среднего отдела ствола ЛКА

  17. Result and 1 year follow up

  18. Kaplan–Meier Curves for Death from Any Cause and Hospitalization Due to Reinfarction. Kaplan–Meier curves are shown for the cumulative probability of death from any cause (Panel A) and of hospitalization due to reinfarction (Panel B) up to 30 days after PCI only (PCI) or after PCI with thrombus aspiration (PCI+TA). The insets show the same data on an enlarged y axis.

  19. 51 years old male patient Infero-lateral STEMI. Paroxysmal AF.

  20. Thrombus aspiration versus balloon dilatation in primary and rescue PCI 160 pts with STEMI Primary PCI (80 pts) Rescue PCI (80 pts) Randomization TA + PCI (40 pts) PCI (40 pts) TA + PCI (40 pts) PCI (40 pts) 1 year follow up Primary end points: Echo (EF, ESV, EDV) after PCI, at discharge and after 1 year follow up Secondary end points: MACE

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