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INTRODUCTION: Aspiration thrombectomy is recommended only in selected patients with ST elevation myocardial infarction (STEMI). Optical coherence tomography analysis revealed limitations of some aspiration catheters in thrombus removal. Additionally, in vitro tests show significant differences in their effectiveness depending on the design of the distal tip and their internal diameter. The aim of this study is to compare the results of percutaneous coronary intervention (PCI) alone and adjunctive aspiration thrombectomy using catheters with small and large cross-sectional areas, compare the effectiveness of coronary angioplasty with and without aspiration thrombectomy, as well as check the effectiveness of different catheters depending on their internal diameter. MATERIAL AND METHODS: 773 patients with STEMI were enrolled in the study: 586 patients with PCI alone (Ctrl group), and 187 patients with PCI and aspiration thrombectomy. All the aspiration catheters were categorized as large-bore – 146 patients (LB group) and small-bore – 41 patients (SB group). Myocardial perfusion, left ventricular ejection fraction (LVEF) and the long-term all-cause mortality were compared. Statistical analysis was based on non-parametrical, ANOVA and Kaplan-Meier survival analysis. RESULTS: The groups were significantly biased with respect to demographics and the angiographic presentation of myocardial infarction. In comparison with the Ctrl group the LB and SB groups were younger and presented worse epicardial flow and thrombus burden according to the Thrombolysis in Myocardial Infarction (TIMI) classification. There is an insignificant trend towards inferior myocardial perfusion in the SB group in comparison with the Ctrl group. The LB group had a lower pre-discharge LVEF in comparison to the Ctrl group. The long-term all-cause mortality was comparable across the groups. CONCLUSIONS: There is not enough evidence to prove that SB catheters are less effective. A positive observation is the fact that the long-term all-cause mortality in the group of patients with adjunctive aspiration thrombectomy is comparable to the control group. However, this observation requires confirmation in future studies.

Abstract Type 2 diabetes mellitus (T2DM) and diminished myocardial perfusion increase the risk of heart failure (HF) and/or all-cause mortality during 6-year follow up following primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI). The aim of the present study was to evaluate the impact of myocardial perfusion on infarct size and left ventricular ejection fraction (LVEF) in patients with T2DM and STEMI treated with pPCI. This is an ancillary analysis of an observational cohort study of T2DM patients with STEMI. We enrolled 406 patients with STEMI, including 104 with T2DM. Myocardial perfusion was assessed with the Quantitative Myocardial Blush Evaluator (QUBE) and infarct size with the creatine kinase myocardial band (CK-MB) maximal activity and troponin area under the curve. LVEF was measured with biplane echocardiography using Simpson’s method at admission and hospital discharge. Analysis of covariance was used for modeling the association between myocardial perfusion, infarct size and left ventricular systolic function. Patients with T2DM and diminished perfusion (QUBE below median) had the highest CK-MB maximal activity (252.7 ± 307.2 IU/L, P

Background: Although the routine use of thrombus aspiration is not recommended, the thrombectomy technique still might be considered for a selected population of patients. Therefore, the assessment of the effectiveness of commercially available thrombectomy devices is still clinically relevant. Aim: Here, we present an in vitro comparison of several different types of catheters that can be used for thrombus aspiration or removal. Methods: Through the removal of 6 h and 24 h human blood clots in an in vitro model, four catheters were compared: the Launcher, Pronto V4, Vasco+ and the stent-retriever Catchview. The aspiration efficacy was expressed as a percentage of the initial thrombus weight. The effectiveness of the patient’s aspiration was dependent on the time of thrombus formation and was significantly higher for a thrombus formed over 24 h (58.5 ± 26.5%) than for one formed over 6 h (48.0 ± 22.5%; p < 0.001). In the presented in vitro model, Pronto V4 and Launcher showed the highest efficiency. Conclusions: Large-bore aspiration catheters were found to be more effective than narrow-bore catheters or stent-retrievers in an in vitro model of thrombus removal. The thrombus aspiration efficacy increases with longer thrombus formation times.