Bambang Budiono
Awal Bros Hospital Makassar, Indonesia
Title: Should thrombus aspiration be routinely used in ACS-STEMI with TIMI-0 flow
Biography
Biography: Bambang Budiono
Abstract
Statement of the Problem: The aim of using thrombus aspiration in STEMI is preventing distal embolization. Routine use of thrombus aspiration for STEMI has been down grade in recent guidelines from class IIA to Class IIB, and even class III, due to lack of benefit regarding cardiovascular endpoints, and evidence of harm as suggested by the increased risk of stroke. However, in total study there are only 64% with TIMI 0 flow in initial angiography, and 8% without evidence of thrombus. Therefore, in STEMI patients with heavy thrombus burden, or with TIMI-0 flow, the usefulness of thrombus aspiration needs to be evaluated.
Methodology: A prospective non randomized study was conducted with 36 STEMI patients with TIMI 0 flow in initial angiography. Adult patients (≥18 years of age) with STEMI were eligible for inclusion in this study if they were referred for primary PCI within 12 h of symptom onset. Patients who had undergone previous coronary artery bypass surgery or had received fibrinolytic therapy were not eligible. All participants provided written informed consent. 6 Fr. Compatible thrombus aspirations were used in all of patients.
Result: Final angiography after stenting, demonstrated 34 patients (94.4%) with TIMI 3 flow and 32 (88.89%) patients with TIMI Myocardial Blush Score 3. 2 (5.56%) patients with TIMI 2 flow and TIMI myocardial blush Score 2. 2 Patients (5.56%) with TIMI-1 flow and Myocardial blush score 1. 6-month clinical evaluation, showed no evidence of stroke or repeat revascularization, but 2 patients (5.56%) showed recurrent hospitalization due to heart failure.
Conclusion: In STEMI with TIMI-0 flow, it is unable to recognize the amount of thrombus distal to the occluded vessel. Thrombus aspiration should be used in STEMI patients when the heavy thrombus burden is suspected, to reduce the risk of distal embolization that leads to micro-vascular obstruction. This preliminary study demonstrated potential benefit of thrombus aspiration in STEMI patients with TIMI-0 flow. Further study needs to confirm this preliminary result.