الفهرس 
S-T SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI)Only 14 pages are availabe for public view
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Abstract
ST-elevation myocardial infarction (STEMI) is one of the most common acute and serious cardiovascular diseases and has become one of the main causes of sudden death in adults. Primary percutaneous coronary intervention (PPCI) is the gold standard of treatment of ST segment elevation myocardial infarction (STEMI).
Primary percutaneous coronary intervention (PCI) is effective in opening the infarct related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion.
Manual thrombus aspiration of the infarct-related vessel with dedicated catheters has gained intense interest over the course of the last decade as a useful technology for rapid reduction of thrombus burden, prevention of thrombus embolization, preservation of microvascular integrity, and reduction of the infarct size.
Cardiovascular magnetic resonance is now considered the gold standard imaging modality for quantifying the microvascular obstruction (MVO) myocardial infarct size (IS) & can detect small subendocardial myocardial infarction with good accuracy. Moreover, cardiac MRI provides an accurate modality for the assessment of LV anatomy, function, viability, and myocardial tissue characterization.
The Study aims to assess the myocardial reperfusion by Cardiac Magnetic Resonance Imaging after primary percutaneous coronary intervention with and without thrombus aspiration in patients with ST- elevation myocardial infarction with high thrombus burden, more over to assess the efficacy and safety of the manual thrombus aspiration during primary PCI for the acute STEMI patients with high thrombus burden.
Methodology: This was prospective cohort study, conducted on 100 patients presenting to cardiology department in Ain Shams University hospitals with STEMI comparing two groups (50 patients in each group): the thrombus aspiration group who underwent manual thrombus aspiration before the provisional stenting and the conventional PCI group who underwent provisional stenting using standard technique without thrombus aspiration. full detailed history was taken with special emphasize on cardiovascular risk factors and previous ischemic history and the current complain. General and local examination were done, and percutaneous intervention was done, and the details of angiographic data were recorded. ECG, full labs including cardiac enzymes were done and follow up full detailed echocardiography was done within a week.
Cardiac MRI was done at 3 months following the myocardial infarction for measurement of LV volumes and EF, as well as assessment of the infarct size by delayed hyperenhancement of the gadolinium contrast and finally the data on the major adverse cardiovascular events (MACE) during the 6 months of the post procedure follow-up were collected.
There were no statistically significant differences between the two groups in terms of the demographic data, the cardiovascular risk factors, the vital data at the time of the hospital admission, the Killip class and the pain to door.
The current study proved a significant higher final TIMI flow, higher myocardial blush grade (MBG) in the thrombus aspiration group than the conventional PCI group. The post procedure ECHO showed significant smaller Left ventricular dimensions with higher Left ventricular systolic and diastolic function in the thrombus aspiration group compared to the conventional PCI group. Moreover, the post procedure cardiac MRI showed significant smaller Left ventricular end -systolic and end -diastolic volumes index with higher Left ventricular systolic function and Left ventricular Stroke volume index in the thrombus aspiration group compared to the conventional PCI group.
Moreover, the post procedure cardiac MRI showed a significant smaller LV Size of infarction (LV myocardia scar) in the thrombus aspiration group than the conventional PCI group.
Finally, there was a significant reduced rate of cardiovascular death and major adverse cardiovascular events (MACE) with no difference regarding the rate of the cerebrovascular stroke within 6 months post procedure in the thrombus aspiration group compared to the conventional PCI group.
So, our study proved that the manual thrombus aspiration during the primary PCI for the STEMI patients with high thrombus burden can better improve the myocardial reperfusion, reduce the size of the infarction and associate with a significant reduced rate of the major adverse cardiovascular events (MACE) with no difference regarding the rate of the cerebrovascular stroke resulting in better clinical outcomes than the conventional PCI alone.
Furthermore, our study proved the efficacy of the cardiac MRI for proper assessment of the global ventricular volumes, function, and the myocardial reperfusion after primary PCI with and without thrombus aspiration.