News:Aspiration before Primary PCI Improves Outcomes: Results of EXPIRA and EXPORT

'C. Michael Gibson M.S., M.D. October 23, 2007

While the majority of patients have excellent flow down their epicardial arteries following primary PCI, the majority of patients leave the cath lab with impaired myocardial perfusion following primary PCI. One of the biggest predictors of poor survival following primary PCI is impaired TIMI myocardial perfusion grades (TMPG) as reported in the past by our group and others (http://www.theblush.org). Reasons for impaired perfusion include embolization of clot during the procedure, edema and vasospasm. Two trials presented at TCT 2007 today report on the benefits of using an aspiration device prior to primary PCI.

In the EXPIRA trial, use of the Export catheter improved the odds of achieving normal TIMI 3 myocardial perfusion grades (TMPG 3) following the procedure from 28.7% to 70.3%. Complete ST resolution (>70% resolution) was improved from 37.5% to 80% with use of the Export catheter. By 9 months there were 4 deaths in the control arm (4.6%) compared with no deaths (0%) in the Export catheter arm (p=0.059).

In the EXPORT trial of 250 patients, rates of the composite endpoint of normal TMPG 3 or > 50% ST resolution were increased from 71.9% to 85% with use of the Export catheter. The corrected TIMI frame counts following the procedure were also faster or improved with the Export catheter (22.8 frames vs 20 frames). MACE at the 30 days did not differ between the two arms in the EXPORT trial.

While distal protection devices have not improved clinical outcomes in native arteries, these two trials indicate that a pre-PCI aspiration technique may improve angiographic, electrocardiographic and clinical outcomes. Largely clinical endpoint trials appear warranted.