VAMPIRE: No Adverse Effects of Aspiration with PCI in Acute MI Patients
The prospective, randomized VAMPIRE trial showed that using a thrombus vacuum catheter had no adverse effect on patients and did not complicate PCI or lengthen the procedural time.
Major procedural characteristics did not significantly differ between procedures using the TVAC catheter and standard PCI (Figure), according to Takaaki Isshiki, MD, from the Department of Medicine, Cardiology, at Teikyo University, Tokyo, who presented the results yesterday.
A subgroup analysis of patients with late reperfusion revealed a higher blush score and higher TIMI flow post-procedure for those who received upfront thrombus aspiration with TVAC.
TIMI-3 flow
By dividing the patients according to reperfusion time, researchers found that among patients with late reperfusion (more than six hours), more patients in the TVAC group (91.9%) than in the standard PCI group (63.4%) achieved post-procedural TIMI-3 flow (P = .01). There was no difference between the two groups after early reperfusion, Isshiki said.
The VAMPIRE data also suggested that a thrombus aspiration system better maintains myocardial microcirculation compared with conventional primary PCI for the treatment of STEMI, he said.
VAMPIRE design
After coronary angiography, patients with STEMI in the VAMPIRE Trial were randomized to receive aspiration or no aspiration, then PCI with a six-month follow-up coronary angiography and eight-month clinical evaluation. A total of 355 patients were enrolled at 23 hospitals.
Limitations
The results did not reach statistical significance but were promising for a new procedure, according to discussant Michael Haude, MD, from the University of Essen, Germany.
While the myocardial blush score was better in the aspiration group, left ventricular function and cardiac death were not different between the two study groups, Isshiki said.
Additionally, the sample size of patients with follow-up left ventriculography or measured brain natriuretic peptide levels was not sufficient to detect a benefit.
Isshiki also said that the data would benefit from a longer follow-up period. The study excluded patients who theoretically could have seen the most benefit, those with thrombus-rich coronary lesions (coronary diameter larger than 5 mm).