Background: High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for ST-elevation MI (STEMI).
Hypothesis: The aim was to investigate whether a strategy of mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors without stent implantation is associated with a reduced incidence of no-reflow phenomenon and other thrombotic complications compared with stenting in patients with high thrombus burden.
Methods: A total of 210 patients with STEMI and high thrombus burden treated with mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into two groups: non-stent PCI group (n=105) and stent PCI group (n=105). We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcomes. The endpoints were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively) and the postprocedural frequencies of a TIMI flow grade of 3, 48 hours after primary PCI, complete resolution of ST-segment elevation immediately after primary PCI, target vessel revascularisation, reinfarction, death and the combination of major adverse cardiac events by 30 days after randomisation. A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI group (p<0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p=0.35). At 30 days, the rate of death in the stent PCI group and non-stent PCI group was 1.7%, and 1.0%, respectively (p=0.33), and the rate of adverse events was 12.1% and 2.2%, respectively (p<0.01). The rate of adverse events was 12.1% and 2.2%, respectively (p<0.01).
Conclusion: Mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors without stenting is applicable and effective method in a large majority of patients with MI with ST-segment elevation and high thrombus burden. It results in better reperfusion outcomes than conventional PCI with stent, irrespective of clinical and angiographic characteristics at baseline.