Michael Woinke

Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction Presenting Late After Symptom Onset.

OBJECTIVES The aim of this study was to examine whether manual thrombus aspiration reduces microvascular obstruction assessed by cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction (STEMI) presenting late after symptom onset. BACKGROUND Thrombus aspiration is an established treatment option in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). However, there are only limited data on the efficacy of thrombus aspiration in patients with STEMI presenting ≥12 h after symptom onset. METHODS Patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset were randomized to primary PCI with or without manual thrombus aspiration in a 1:1 ratio. Patients underwent cardiac magnetic resonance imaging 1 to 4 days after randomization. The primary endpoint was the extent of microvascular obstruction. RESULTS A total of 152 patients underwent randomization. The mean time between symptom onset and PCI was 28 ± 12 h. Baseline characteristics were comparable between groups. The majority of patients (60%) showed at least a moderate amount of viable myocardium in the affected region. Extent of microvascular obstruction was not significantly different between patients assigned to thrombus aspiration and the control group (2.5 ± 4.0% vs. 3.1 ± 4.4% of left ventricular mass, p = 0.47). There were also no significant differences in infarct size, myocardial salvage, left ventricular ejection fraction, and angiographic and clinical endpoints between groups. CONCLUSIONS In this first randomized trial of thrombectomy in patients with STEMI presenting late after symptom onset, routine thrombus aspiration before PCI failed to show a benefit for markers of reperfusion success. (Effect of Thrombus Aspiration in Patients With Myocardial Infarction Presenting Late After Symptom Onset; NCT01379248).

Grading of aortic valve stenosis at 64-slice spiral computed tomography: comparison with transthoracic echocardiography and calibration against cardiac catheterization.

Purpose:We sought to determine the accuracy of multislice spiral computed tomography (MSCT) for assessing of aortic valve stenosis and to establish threshold values of the planimetric aortic valve orifice area (AVA) that best separate between different grades of stenosis severity. Materials and Methods:A total of 202 patients (among them 160 patients with aortic valve stenosis) underwent MSCT, transthoracic echocardiography (TTE) and cardiac catheterization (CATH). Planimetric AVA measurements at MSCT were compared with calculations based on Doppler flow velocity measurements by TTE (using the continuity equation) and pressure gradient measurements by CATH (using the Gorlin formula). Results:Series of AVA measurements correlated well between MSCT and TTE (r = 0.86) and between MSCT and CATH (r = 0.90). However, AVA at MSCT (0.98 ± 0.47 cm2) was significantly larger than AVA at TTE (0.81 ± 0.36 cm2; P < 0.05) and CATH (0.80 ± 0.39 cm2; P < 0.05). For severity grades 0 through IV the AVAs at MSCT were 2.69 ± 0.75, 1.86 ± 0.30, 1.48 ± 0.17, 0.95 ± 0.20, and 0.68 ± 0.20 cm2, respectively. For separating, the 5 severity grades optimal thresholds at MSCT were 2.1, 1.6, 1.2, and 0.9 cm2. Using these adjusted thresholds there was perfect agreement in classification between MSCT and CATH in 156 (77%), but a mismatch by 1 grade in 43 (21.5%) and 2 grades in 3 (1.5%) patients (κw = 0.86). Conclusion:Planimetric AVA measurements on MSCT allows for an accurate grading of aortic valve stenosis severity. However, AVA measurements on MSCT are usually larger than measurements on TTE and CATH. Consequently, the thresholds for discriminating between different severity grades have to be adjusted in MSCT.