The Physiologic Assessment of Thrombus Aspiration in ST-segment Elevation Myocardial Infarction (PATA-STEMI) trial is a single center, prospective, randomized trial with a planned inclusion of 128 patients with the first ST-segment elevation myocardial infarction (STEMI). Patients are, before coronary angiography, randomly assigned to thrombus aspiration using 6 or 7 French Eliminate aspiration catheter (Terumo Medical Supply, Japan) or to conventional primary percutaneous coronary intervention (PCI). The primary endpoint is index of microcirculatory resistance (IMR), measured in infarct-related artery, in thrombus aspiration compared to conventional PCI group.
Background and Objective Routine thrombus aspiration is superior to conventional primary PCI in terms of improved myocardial perfusion in STEMI patients. However, myocardial perfusion after thrombus aspiration has not been evaluated by a quantitative, invasive method. Investigators intend to determine whether thrombus aspiration of the infarct-related artery increases myocardial perfusion, as measured by IMR, compared to conventional primary PCI. Study design PATA-STEMI is a single center, prospective, randomized trial with a planned inclusion of 128 patients with the first STEMI. Patients are randomly assigned, before coronary angiography, to thrombus aspiration using the 6 or 7 French Eliminate aspiration catheter (Terumo Medical Supply, Japan) or to conventional primary PCI. The IMR will be determined in infarct-related artery and non-infarct-related arteries without critical stenosis to measure microcirculatory resistance. The primary endpoint is defined as IMR in infarct-related artery in thrombus aspiration compared to conventional PCI group. Secondary end points are myocardial perfusion grade and resolution of ST-segment elevation, infarct size and left ventricle remodeling, as assessed by echocardiographic indices. Transthoracic echocardiography will be conducted within 24 hours and at 4 months after the primary PCI. Implications: If manual thrombus aspiration reduces microcirculatory resistance, indicating improved myocardial perfusion, as compared to conventional PCI, it might become the preferred strategy in patients with STEMI.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
128
Eliminate aspiration catheter
Primary angioplasty without thrombus aspiration
Clinical center of Serbia
Belgrade, Serbia
RECRUITINGClinical Center of Serbia
Belgrade, Serbia
RECRUITINGIMR (mmHg seconds) in thrombus aspiration compared to conventional PCI group
IMR will be measured after final balloon inflation or stent implantation, an expected average of 45 minutes after sheath insertion
Time frame: At the end of the primary PCI , an expected average of 45 minutes after sheath insertion
Resolution of ST-segment elevation
ST-segment resolution ≥70% at 60 minutes after guiding catheter removal
Time frame: at 60 minutes after guiding catheter removal
myocardial blush grade (0-3)
myocardial blush grade will be assessed after IMR measurements, following the final balloon inflation or stent implantation, an expected average of 55 minutes after sheath insertion
Time frame: at final angiogram, an expected average of 55 minutes after sheath insertion
infarct size assessed by peak enzyme release (Troponin, creatine kinase MB (CK-MB))
infarct size will be determined based on peak enzyme release (Troponin, CK-MB) during in-hospital stay, an expected average of 5 days
Time frame: in hospital course after primary PCI, an expected average of 5 days
indices of left ventricle remodeling on Echocardiography
left ventricle remodeling will be assessed on Echocardiography within 24 hours and at 4 months after primary PCI
Time frame: within 24 hours and at 4 months after primary PCI
infarct size determined by SPECT
infarct size will be determined by SPECT within 7-14 days and at 4 months after primary PCI
Time frame: within 7-14 days and at 4 months after primary PCI
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