Purpose: the study of effectiveness and safety of manual vacuum thrombextraction (MVT) from the IRA in STEMI patients after pre-hospital systemic TLT.
Material and Methods: 242 patients with STEMI after pre-hospital TLT with signs of thrombus (TTG>1) were divided into 2 groups: in Group 1 (n=121) standard percutaneous coronary interventions (PCI) were complemented by MVT, in Group 2 (n=121) only standard PCI were performed. Baseline clinical, historical and angiographic data were similar in both groups. The average time interval between the onset of angina pain and the PCI was 5,8±1,9 hours in Group 1 and 5,2±1,3 hours in Group2 (р>0,05). Systemic TLT was effective in 58 patients (47,8%) in Group1 and in 66 patients (54,6%) in Goup.2 (р>0,05). The fragments of thrombus were evacuated in 73 (60,3%) patients. Hospital mortality was 0,8% (1 case) in Group 1 and 1,6% (2 cases) in Group 2 (р>0,05). The «no-reflow» phenomenon was noted in 2 patients (1,6%) from Group 1 and in 3 patients (2,5%) in Group 2 (р>0,05).
Mid-term (7,8±1,2 months) mortality was 1,6% in Group 1 and 2,5% in Group 2 (р>0,05). The rate of target vessel restenosis in Group 1 was insignificantly lower than in Group 2: 18 (14,8%) vs. 25 (20,6%) (р=0,07). Reliable increase of LV EF was noted in both groups, however in Group 1 it was insignificantly higher than in Group 2 (р<0,01).
Conclusions: Vacuum thrombextraction is safe and does not increase total duration of myocardial ischemia and the rate of MACE and allows to evacuate thrombotic mass from the IRA. The combination of this method with interventional procedures permits to achieve fuller restoration of the blood flow in the microcirculatory bed of the IRA in STEMI patients after pre-hospital systemic TLT.
