Effects of thrombus suction therapy on myocardial blood flow disorders in males with acute inferior myocardial infarction

Several studies have reported that the use of a distal protection device decreases the incidence of slow-flow and/or no-reflow in patients with myocardial infarctions. In the present study, we investigated the influence of a RESCUE/Thrombuster system and a PercuSurge Guard Wire catheter on coronary microcirculation disorders in patients with acute myocardial infarction using the natriuretic polypeptide (ANP), the brain natriuretic peptide (BNP), and 99mTc-tetrofosmin myocardial scintigraphy (TF). The group consisted of a77patients with initial inferior myocardial infarction who had undergone emergency coronary angioplasty. The patients were randomly divided into : Group D (n=28), in which a direct stent alone was inserted, Group R/T (n=25), in which a stent was inserted after RESCUE system or a Thrombuster system was performed, and Group P (n=24), in which a stent was inserted after thrombus suction using a PercuSurge Guard Wire catheter. Patients with coronary slow-flow/no-reflow were 3, 2 and 0cases in Group D, Group R / T and Group P, respectively. In the present study, patients with good-reflow were enrolled in order to investigate the coronary microcirculation disorder in patients with visually similar coronary blood flow obtained in coronary angiography after percutaneous coronary reperfusion therapy. TF myocardial scintigraphy was performed 10±3 days after admission. Bull’s eye images were divided into 8 sections, and each section was evaluated in 4 grades. The grade of each segment was regarded as the defect score. The results were compared with the database prepared based on bull’s eye maps from50 healthy adults in our hospital, and count areas of －2×SD(standard deviation) or less were calculated as the extent score (%), reflecting the area in which myocardial blood flow was decreased. The extent and severity scores in Groups P and R/T were significantly lower than those in Group D. Coronary angiography at the chronic stage (6 months after surgery) showed the patency of the responsible vascular lesion in all patients. However, the ANP, BNP, cardiac index, and pulmonary capillary wedge pressure (PCWP) were significantly improved in Groups R/T and P, compared to Group D (p<0.01). These results suggest that the use of a RESCUE/ Thrombuster system and a PercuSurge GuardWire catheter systemin patients with acute inferior wall infarction improves coronary microcirculation disorders and acute- to chronicphase cardiac function.