151
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Polycythemia Vera Presenting as Cardiac Arrest: Novel Management Strategies. Case Rep Cardiol 2019; 2019:9656387. [PMID: 30805220 PMCID: PMC6362489 DOI: 10.1155/2019/9656387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/02/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022] Open
Abstract
Acute coronary syndromes (ACS) usually occur in patients with multiple cardiac risk factors. In young adults, drug use and hypercoagulable states are common causes for ACS presentations. We report a case of a man in his early 30s who was diagnosed with polycythemia vera (PV) and had a cardiac arrest due to an anterolateral ST elevation myocardial infarction. We discuss his unique management and review the evidence on the management of arterial thromboembolism in PV patients.
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152
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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153
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O'Gara P. Update on Aspiration Thrombectomy. JAMA Cardiol 2019; 4:119. [PMID: 30624567 DOI: 10.1001/jamacardio.2018.4488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Patrick O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.,Deputy Editor
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154
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Lattuca B, Montalescot G. The false illusion of coronary thrombus device-management. J Thorac Dis 2019; 10:S4117-S4121. [PMID: 30631570 DOI: 10.21037/jtd.2018.10.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benoit Lattuca
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France.,Cardiology department, Nîmes University Hospital, ACTION Study Group, Montpellier University, Nîmes, France
| | - Gilles Montalescot
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
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155
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Manolis AS. Is Atherothromboaspiration a Possible Solution for the Prevention of No-Reflow Phenomenon in Acute Coronary Syndromes? Single Centre Experience and Review of the Literature. Curr Vasc Pharmacol 2019; 17:164-179. [DOI: 10.2174/1570161116666180101150956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022]
Abstract
Background: Intracoronary thrombus in acute Myocardial Infarction (MI) confers higher
rates of no-reflow with attendant adverse consequences. Earlier Randomized-Controlled-Trials (RCTs)
of routine thromboaspiration during Percutaneous Coronary Intervention (PCI) indicated a clinical benefit,
but more recent RCTs were negative. However, data of selective use of this adjunctive approach
remain scarce.
</P><P>
Objective: The aim of this single-centre prospective study was to report the results of selective thromboaspiration
during PCI in patients with intracoronary thrombi, and also to provide an extensive literature
review on current status of thromboaspiration.
</P><P>
Methods: The study included 90 patients (77 men; aged 59.3±12.7 years) presenting with acute MI (STElevation
MI (STEMI) in 74, non-STEMI in 16) who had intracoronary thrombi and were submitted to
thromboaspiration.
</P><P>
Results: Total (n=67) or subtotal (n=18) vessel occlusions were present in 85 (94%) patients. Thromboaspiration
and subsequent PCI were successful in 89/90 (98.9%) patients, with coronary stenting in 86
(96.6%). In 4 patients with residual thrombus, a mesh-covered stent was implanted. IIb/IIIa-inhibitors
were administered in 57 (63.3%) patients. No-reflow occurred in only 1 (1.1%) patient. The postprocedural
course was uneventful. Review of the literature revealed several early observational and
RCTs and meta-analyses favouring manual, not mechanical, thrombectomy. However, newer RCTs and
meta-analyses significantly curtailed the initial enthusiasm for the clinical benefits of routine use of
thromboaspiration.
</P><P>
Conclusion: Selective thromboaspiration for angiographically visible thrombi in MI patients undergoing
PCI, as an adjunct to mechanical reperfusion and to IIb/IIIa-inhibitors, may be an option since this
manoeuvre may improve procedural and clinical outcome.
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Affiliation(s)
- Antonis S. Manolis
- Third Department of Cardiology, Athens University School of Medicine, Sotiria Hospital, Athens, Greece
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156
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Armstrong R, De Maria GL, Scarsini R, Banning AP. Assessing and managing coronary microcirculation dysfunction in acute ST-segment elevation myocardial infarction. Expert Rev Cardiovasc Ther 2018; 17:111-126. [PMID: 30569773 DOI: 10.1080/14779072.2019.1561279] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Microvascular dysfunction in the setting of acute ST-segment elevation myocardial infarction (STEMI) is an indicator of poor long-term prognosis. Prompt assessment and pharmacological or procedural therapy (prophylactic or post onset of dysfunction) may improve outcomes in STEMI post-primary percutaneous intervention. Areas covered: The aim of this review is to provide a comprehensive analysis of the evidence available about the assessment and management of coronary microcirculatory injury/dysfunction in STEMI. We also aim to elucidate the possible strategies that could be applied in clinical practice to support the application of already available or novel therapeutic strategies for the prevention and management of microvascular impairment. Expert commentary: There are multiple established methods in assessing microvascular dysfunction, both non-invasively and invasively. Invasive physiological measurements allow real-time assessment of microvascular dysfunction and have prognostic cut-off values. Multiple therapeutic modalities exist for both preventing and treating microvascular dysfunction. These can be either pharmacological or mechanical, and there is no algorithm to guide if, how and when to apply them. Future research into both procedural and pharmacological therapy guided by physiological measurements is needed, with the aim of recognizing high-risk patients who would benefit from therapy.
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Affiliation(s)
| | | | - Roberto Scarsini
- b Oxford Heart Centre, John Radcliffe Hospital , Oxford University Hospitals , Oxford , UK
| | - Adrian P Banning
- b Oxford Heart Centre, John Radcliffe Hospital , Oxford University Hospitals , Oxford , UK
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157
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Sardu C, Barbieri M, Balestrieri ML, Siniscalchi M, Paolisso P, Calabrò P, Minicucci F, Signoriello G, Portoghese M, Mone P, D'Andrea D, Gragnano F, Bellis A, Mauro C, Paolisso G, Rizzo MR, Marfella R. Thrombus aspiration in hyperglycemic ST-elevation myocardial infarction (STEMI) patients: clinical outcomes at 1-year follow-up. Cardiovasc Diabetol 2018; 17:152. [PMID: 30497513 PMCID: PMC6262961 DOI: 10.1186/s12933-018-0795-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/24/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives We evaluate whether the thrombus aspiration (TA) before primary percutaneous coronary intervention (PPCI) may improve STEMI outcomes in hyperglycemic patients. Background The management of hyperglycemic patients during STEMI is unclear. Methods We undertook an observational cohort study of 3166 first STEMI. Patients were grouped on the basis of whether they received TA or not. Moreover, among these patients we selected a subgroup of STEMI patients with hyperglycemia during the event (glycaemia > 140 mg/dl). The endpoint at 1 year included all-cause mortality, cardiac mortality and re-hospitalization for coronary disease, heart failure and stroke. Results One-thousand STEMI patients undergoing PPCI to plus TA (TA-group) and 1504 STEMI patients treated with PPCI alone (no-TA group) completed the study. In overall study-population, Kaplan–Meier-analysis demonstrated no significant difference in mortality rates between patients with and without TA (P = 0.065). After multivariate Cox-analysis (HR: 0.94, 95% CI 0.641–1.383) and the addition of propensity matching (HR: 0.86 95% CI 0.412–1.798) TA was still not associated with decreased mortality. By contrast, in hyperglycemic subgroup STEMI patients (TA-group, n = 331; no-TA group, n = 566), Kaplan–Meier-analysis demonstrated a significantly lower mortality (P = 0.019) in TA-group than the no-TA group. After multivariate Cox-analysis (HR: 0.64, 95% CI 0.379–0.963) and the addition of propensity matching (HR: 0.54, 95% CI 0.294–0.984) TA was still associated with decreased mortality. Conclusions TA was not associated with lower mortality in PPCI for STEMI when used in our large all-comer cohort. Conversely, TA during PPCI for STEMI reduces clinical outcomes in hyperglycemic patients. Trial registration NCT02817542. 25th, June 2016 Electronic supplementary material The online version of this article (10.1186/s12933-018-0795-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Luisa Balestrieri
- Department of Biochemistry, Biophysics and General Pathology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Pasquale Paolisso
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Fabio Minicucci
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Public Medicine, Section of Statistic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Pasquale Mone
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Davide D'Andrea
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Felice Gragnano
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
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158
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Ge J, Li J, Dong B, Ning X, Hou B. Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2018; 93:E269-E276. [PMID: 30419614 DOI: 10.1002/ccd.27944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/04/2018] [Accepted: 10/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to investigate the determinants of thrombus burden (TB) and the impact of thrombus aspiration (TA) on outcome in young adults with ST segment elevation myocardial infarction (STEMI). BACKGROUND The determinants of TB in young STEMI patients are not fully understood now. METHODS The 182 young (age ≤ 45 years) STEMI patients, who underwent coronary angiography and percutaneous coronary intervention (PCI) in our hospital from January 2013 to September 2016, were included. Angiographic TB and impact of TA on major adverse cardiac events (MACEs) were evaluated. Median clinical follow-up period was 875 (641-1,052) days. RESULTS All patients were male, mean age was 40 ± 5 years. High thrombus burden (HTB) was evidenced in 100 (54.9%) patients. TA was performed in 62 out 100 (62%) patients with high TB (HTB) during PCI. The prevalence of hypertension was significantly higher in the HTB group than in the low thrombus burden (LTB) group (75 vs. 17%, P < 0.001). The proportion of smoking, alcohol consumption, and family history of premature coronary artery disease were similar between HTB and LTB groups. During follow-up, 2 patients died and 31 patients underwent repeat PCI. MACE rate was significantly higher in the HTB group than in the LTB group (24.0 vs. 9.8%, P = 0.012) and significantly lower in HTB patients with TA than HTB patients without TA (14.5 vs. 39.5%, P = 0.018). CONCLUSIONS Hypertension is an independent determinant of HTB and TA could be considered as an effective therapeutic option in young male STEMI patients with HTB.
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Affiliation(s)
- Junhua Ge
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bingzi Dong
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xianfeng Ning
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bo Hou
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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159
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Moscarella E, Brugaletta S, Sabaté M. Latest STEMI treatment: a focus on current and upcoming devices. Expert Rev Med Devices 2018; 15:807-817. [DOI: 10.1080/17434440.2018.1538778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elisabetta Moscarella
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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160
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Sabaté M, Brugaletta S. Thrombectomy and Stroke: Guilty or Innocent Bystander? J Am Coll Cardiol 2018; 72:1597-1599. [PMID: 30261960 DOI: 10.1016/j.jacc.2018.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Manel Sabaté
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Salvatore Brugaletta
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. https://twitter.com/sbrugaletta
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161
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Hugelshofer S, Roffi M, Witassek F, Eberli FR, Pilgrim T, Pedrazzini G, Rickli H, Radovanovic D, Erne P, Degrauwe S, Muller O, Masci PG, Windecker S, Iglesias JF. Impact of total ischemic time on manual thrombus aspiration benefit during primary percutaneous coronary intervention. Am Heart J 2018; 204:34-42. [PMID: 30075324 DOI: 10.1016/j.ahj.2018.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/30/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The benefits of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) remain uncertain. We assessed the influence of total ischemic time (TIT) on clinical outcomes among STEMI patients undergoing manual TA during pPCI. METHODS AND RESULTS We conducted a retrospective study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing pPCI with (TA group) or without (PCI-alone group) manual TA were stratified based on short (<3 hours), intermediate (3-6 hours), and long (>6 hours) TIT. The primary endpoint was in-hospital all-cause mortality. The secondary endpoint was in-hospital major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction and stroke. Between 2008 and 2014, 4'154 patients (TA 48%) were included. Risk-adjusted in-hospital all-cause mortality was not different between TA and PCI-alone groups (OR 1.29; 95%CI 0.83-1.98; p=0.26), whereas there was significantly increased risk of MACE (OR 1.52; 95%CI 1.05-2.19; p=0.03) in patients treated with manual TA compared with PCI-alone. There was no significant difference between manual TA and PCI-alone with respect to risk-adjusted all-cause mortality according to TIT groups, but risk-adjusted MACE rates were significantly higher in the group of patients with long TIT treated with manual TA compared with PCI-alone (OR 2.42; 95%CI 1.16-5.04; p=0.02). CONCLUSION In a large registry of STEMI patients, manual TA was not associated with lower risk-adjusted in-hospital all-cause mortality compared with PCI-alone regardless of TIT but was associated with significantly greater risk of MACE. In patients with prolonged TIT, manual TA was associated with higher risk-adjusted MACE rates compared with PCI-alone.
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162
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Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial. J Am Coll Cardiol 2018; 72:1589-1596. [DOI: 10.1016/j.jacc.2018.07.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
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163
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Blumenstein J, Kriechbaum SD, Leick J, Meyer A, Kim WK, Wolter JS, Abu-Samra M, Weipert K, Bayer M, Dörr O, Walther C, Hamm CW, Nef H, Liebetrau C, Möllmann H. Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study. J Thromb Thrombolysis 2018; 45:240-249. [PMID: 29274046 DOI: 10.1007/s11239-017-1601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P = 0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405-959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P = 0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90-0.71; P = 0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge (P = 0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 (P = 0.14), left ventricular ejection fraction (P = 0.47), and non-fatal reinfarction during follow-up (P = 0.17). Rehospitalization rate (1.82 vs. 10.3%; P < 0.0001) and Canadian Cardiovascular Society (CCS) grading (P = 0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients.
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Affiliation(s)
- Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Steffen Daniel Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Jürgen Leick
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Alexander Meyer
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Maisun Abu-Samra
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Kay Weipert
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Matthias Bayer
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Oliver Dörr
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Claudia Walther
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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164
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Lee FY, Sun CK, Sung PH, Chen KH, Chua S, Sheu JJ, Chung SY, Chai HT, Chen YL, Huang TH, Huang CR, Li YC, Luo CW, Yip HK. Daily melatonin protects the endothelial lineage and functional integrity against the aging process, oxidative stress, and toxic environment and restores blood flow in critical limb ischemia area in mice. J Pineal Res 2018; 65:e12489. [PMID: 29570854 DOI: 10.1111/jpi.12489] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
We tested the hypothesis that daily melatonin treatment protects endothelial lineage and functional integrity against the aging process, oxidative stress/endothelial denudation (ED), and toxic environment and restored blood flow in murine critical limb ischemia (CLI). In vitro study using HUVECs, in vivo models (ie, CLI through left femoral artery ligation and ED through carotid artery wire injury), and model of lipopolysaccharide-induced aortic injury in young (3 months old) and aged (8 months old) mice were used to elucidate effects of melatonin treatment on vascular endothelial integrity. In vitro study showed that menadione-induced oxidative stress (NOX-1/NOX-2), inflammation (TNF-α/NF-kB), apoptosis (cleaved caspase-3/PARP), and mitochondrial damage (cytosolic cytochrome c) in HUVECs were suppressed by melatonin but reversed by SIRT3-siRNA (all P < .001). In vivo, reduced numbers of circulating endothelial progenitor cells (EPCs) (C-kit/CD31+/Sca-1/KDR+/CXCR4/CD34+), and angiogenesis (Matrigel assay of bone marrow-derived EPC and ex vivo aortic ring cultures) in older (compared with younger) mice were significantly reversed through daily melatonin administration (20 mg/kg/d, ip) (all P < .001). Aortic vasorelaxation and nitric oxide release were impaired in older mice and reversed in age-match mice receiving melatonin (all P < .01). ED-induced intimal/medial hyperplasia, reduced blood flow to ischemic limb, and angiogenesis (reduced CD31+/vWF+ cells/small vessel number) were improved after daily melatonin treatment (all P < .0001). Lipopolysaccharide-induced aortic endothelial cell detachment, which was more severe in aged mice, was also alleviated after daily melatonin treatment (P < .0001). Daily melatonin treatment protected both structural and functional integrity of vascular endothelium against aging-, oxidative stress-, lipopolysaccharide-, and ischemia-induced damage probably through upregulating the SIRT signaling pathway.
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Affiliation(s)
- Fan-Yen Lee
- Division of thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Jye Sheu
- Division of thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Han-Tan Chai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tien-Hung Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ruei Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Wen Luo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
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165
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Arslan F, Bongartz L, Ten Berg JM, Jukema JW, Appelman Y, Liem AH, de Winter RJ, van 't Hof AWJ, Damman P. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group. Neth Heart J 2018; 26:417-421. [PMID: 29974355 PMCID: PMC6115313 DOI: 10.1007/s12471-018-1134-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
On behalf of the Dutch ACS working group, we discuss the most important changes in recommendations in the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation relevant for both the general and interventional cardiologist.
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Affiliation(s)
- F Arslan
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - L Bongartz
- Department of Cardiology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y Appelman
- Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands
| | - A H Liem
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - P Damman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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166
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Taglieri N, Bacchi Reggiani ML, Ghetti G, Saia F, Compagnone M, Lanati G, Di Dio MT, Bruno A, Bruno M, Della Riva D, Corsini A, Narducci R, Rapezzi C. Efficacy and safety of thrombus aspiration in ST-segment elevation myocardial infarction: an updated systematic review and meta-analysis of randomised clinical trials. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:24-38. [PMID: 30160519 DOI: 10.1177/2048872618795512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. METHODS: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. RESULTS: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79-1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80-1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63-1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004-1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58-1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. CONCLUSIONS: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak.
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Affiliation(s)
- Nevio Taglieri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Gabriele Ghetti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Francesco Saia
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Miriam Compagnone
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Gianluca Lanati
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Maria Teresa Di Dio
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Antonio Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Matteo Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Diego Della Riva
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Anna Corsini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Riccardo Narducci
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
| | - Claudio Rapezzi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Italy
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167
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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168
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Neumann FJ, Gick M. Direct stenting in ST-elevation myocardials infarction: convenient, but not improving outcomes. Eur Heart J 2018; 39:2480-2483. [PMID: 29931300 DOI: 10.1093/eurheartj/ehy353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Centre Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Michael Gick
- Division of Cardiology and Angiology II, University Heart Centre Freiburg - Bad Krozingen, Bad Krozingen, Germany
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169
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Shilova AS, Gilyarova EM, Andreev DA, Shchekochikhin DY, Novikova NA, Gilyarov MY. EMBOLIC MYOCARDIAL INFARCTION. EXPERIENCE IN DIAGNOSIS AND MANAGEMENT. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-3-361-369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.
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170
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Jayagopal PB, Sarjun Basha KM. Intracoronary tenecteplase in STEMI with massive thrombus. Indian Heart J 2018; 70:446-449. [PMID: 29961467 PMCID: PMC6034014 DOI: 10.1016/j.ihj.2017.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022] Open
Abstract
Primary percutaneous coronary intervention is the current standard of care in ST elevation myocardial infarction (STEMI). However, large thrombus is an independent predictor for stent thrombosis and major adverse cardiac events in patients undergoing primary angioplasty for STEMI. Here we report a series of STEMI patients with large thrombus burden treated successfully with low dose intracoronary thrombolysis. There was prompt and early ST resolution. There was improvement in thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade postlysis in all patients. Majority had recanalised infarct related coronary artery thus obviating the need for stenting. There was no inhospital or 1 month mortality or bleeding events. Hence intracoronary thrombolysis is an option in patients with large thrombus burden.
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171
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Zhang Z, Li W, Wu W, Xie Q, Li J, Zhang W, Zhang Y. Myocardial reperfusion with tirofiban injection via aspiration catheter : Efficacy and safety in STEMI patients with large thrombus burden. Herz 2018; 45:280-287. [PMID: 29947833 DOI: 10.1007/s00059-018-4716-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/23/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is no consensus on the use of thrombus aspiration (TA) in primary percutaneous coronary intervention (PPCI), and few studies have focused on the performance of tirofiban via TA catheter after PPCI. Our study investigated the clinical outcome of tirofiban injection through TA in acute ST-segment elevation myocardial infarction (STEMI) patients with large thrombus burden undergoing PPCI treatment. PATIENTS AND METHODS The study comprised 122 STEMI patients who underwent TA during PPCI. Participants were randomly divided into two groups. Group A received intravenous tirofiban injection and tirofiban injection via a TA catheter to the infarcted coronary artery after aspiration (n = 61). Group B received intravenous tirofiban injection only (n = 61). Baseline clinical information and follow-up data were collected for both groups. Coronary angiography, electrocardiography, and echocardiography findings as well as major adverse cardiovascular events (MACE) were recorded. RESULTS There were significant differences in postprocedural Thrombolysis in Myocardial Infarction (TIMI) grade 2 and 3 flow between the two groups (p = 0.021, p = 0.006, respectively). The incidence of slow-flow in group A was significantly lower than that of group B (p = 0.011). An increased incidence of no ST-segment resolution was observed in group B (p = 0.011). There were fewer major adverse cardiovascular events in group A than in group B, but the difference was not statistically significant. CONCLUSION Selective tirofiban injection via TA catheter during PPCI may improve myocardial reperfusion in STEMI patients with large thrombus burden.
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Affiliation(s)
- Z Zhang
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - W Li
- Department of Cardiology, Ganzhou City People's Hospital, 341000, Ganzhou, China
| | - W Wu
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - Q Xie
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - J Li
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - W Zhang
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - Y Zhang
- Department of Ultrasound, Guangdong Women and Children Hospital, No. 521 Xingnan Avenue, 511400, Guangzhou, China.
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172
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Mori H, Narula J, Virmani R. Juxta-Lesional Cavitary Formation in Coronary Intervention. JACC Cardiovasc Imaging 2018; 11:868-871. [DOI: 10.1016/j.jcmg.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
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173
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German contribution to development and innovations in the management of acute myocardial infarction and cardiogenic shock. Clin Res Cardiol 2018; 107:74-80. [PMID: 29770854 DOI: 10.1007/s00392-018-1276-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Treatment of acute coronary syndromes has evolved over time leading to a significantly reduced mortality. Multiple major trials have been performed in Germany leading to new treatment strategies in acute coronary syndromes including cardiogenic shock. This review article will summarize major trials and their impact on guideline recommendations in acute myocardial infarction highlighting reperfusion strategies, antiplatelet regimens, prognosis assessment and also mechanical circulatory support in stable infarction patients and in cardiogenic shock.
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174
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Higuchi S, Suzuki M, Horiuchi Y, Tanaka H, Saji M, Yoshino H, Nagao K, Yamamoto T, Takayama M. Clinical impact of thrombus aspiration on in-hospital mortality in each culprit lesion in the setting of ST-segment elevation myocardial infarction. Heart Vessels 2018; 33:1168-1174. [PMID: 29704101 DOI: 10.1007/s00380-018-1171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
Recent randomized clinical trials have questioned the clinical benefits of thrombus aspiration (TA) in ST-segment elevation myocardial infarction (STEMI). Real-world data on TA and the efficacy of TA for various culprit lesions have not been sufficiently evaluated. This study mainly aimed to evaluate whether the clinical impact of TA depends on culprit lesions in the setting of STEMI. We surveyed the Tokyo Coronary Care Unit Network Registry, a prospective cohort study, between 2010 and 2014, which included 10,232 patients with STEMI. In-hospital deaths occurred in 538 patients (5.3%). Improved Thrombolysis in Myocardial Infarction flow was more frequently observed in patients who underwent TA than in those who did not (87 vs. 80%; p < 0.001). Univariate logistic regression analysis revealed that TA was associated with a lower in-hospital mortality rate [odds ratio (OR), 0.80; 95% confidential interval (CI), 0.66-0.96; p = 0.016]. However, the difference was not significant after multivariate logistic regression analysis (OR 0.95; 95% CI 0.71-1.17; p = 0.355). Only TA for the left circumflex (LCx) lesions was associated with a better prognosis (OR 0.38; 95% CI 0.21-0.72; p = 0.003). The effect persisted after adjustment (OR 0.50; 95% CI 0.25-0.99; p = 0.049) but was attenuated after analysis using inverse probability weighting (OR 0.97; 95% CI 0.93-0.99; p = 0.048). On the basis of the findings in a large Japanese cohort, a prognostic benefit of TA on in-hospital mortality was not observed. The effect of TA on the LCx lesions was marginally significant and limited. Therefore, TA is not recommended in Japanese patients with STEMI.
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Affiliation(s)
- Satoshi Higuchi
- Department of Cardiology, Kyorin University School of Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan. .,Tokyo CCU Network Scientific Committee, Tokyo, Japan.
| | - Makoto Suzuki
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Yu Horiuchi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Mike Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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175
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Xhepa E, Kastrati A. Reduction of thrombus burden: a still unmet need in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2018; 29:181-182. [PMID: 29629961 DOI: 10.1097/mca.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erion Xhepa
- German Heart Centre Munich, Technical University of Munich
| | - Adnan Kastrati
- German Heart Centre Munich, Technical University of Munich.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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176
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Hizoh I, Banhegyi G, Domokos D, Gulyas Z, Major L, Kiss RG. Impact of Selective Aspiration Thrombectomy on Mortality in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 121:796-804. [PMID: 29397104 DOI: 10.1016/j.amjcard.2017.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Abstract
Although routine aspiration thrombectomy (AT) is not recommended by the current American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline, for selected cases, a class IIb indication is given because of lack of data. We studied the impact of selective AT on mortality in patients with ST-segment elevation myocardial infarction using a prospective registry. We analyzed data of 1,255 patients, of whom 535 underwent AT based on operator's decision. Separate propensity score matching procedures were performed including all patients and only those with initial TIMI (Thrombolysis In Myocardial Infarction) 0 to 1 flow, indicating the highest thrombus burden. Primary outcome measure was time to all-cause death at 1 year. Both studies were sufficiently powered to detect the hazard ratio (HR) of 0.52 seen in the TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study) trial. In the study with open inclusion criteria, 1-year mortality rates were 15.5% and 14.5% in the AT and conventional percutaneous coronary intervention arm, respectively (p = 0.77). The unadjusted HR was 1.05 (95% CI 0.73 to 1.51), p = 0.80, whereas the adjusted HR was 0.97 (95% CI 0.66 to 1.41), p = 0.87. In patients with initial TIMI 0 to 1 flow, mortality rate at 1 year was 15.6% in the AT and 16.7% in the standard percutaneous coronary intervention group (p = 0.76). The unadjusted and adjusted HRs were similar: 0.91 (95% CI 0.62 to 1.34), p = 0.65 and 0.93 (95% CI 0.62 to 1.37), p = 0.70, respectively. In conclusion, selective AT based on operator's discretion offers no mortality benefit of the magnitude detected in the TAPAS trial, even for patients with initial TIMI 0 to 1 flow grade.
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177
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Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 2018; 33:178-203. [PMID: 29594964 PMCID: PMC5880864 DOI: 10.1007/s12928-018-0516-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/28/2022]
Abstract
While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.,Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Satoru Otsuji
- Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Takafumi Ueno
- Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kinzo Ueda
- Rakuwakai Kyoto Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | | | | | - Eisho Kyo
- Kusatsu Heart Center, Kusatsu, Japan
| | | | | | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | | | | | | | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Michishita
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
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178
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Ormiston JA, Webster MW. It seemed like a good idea at the time. EUROINTERVENTION 2018; 13:1876-1879. [PMID: 29555619 DOI: 10.4244/eijv13i16a306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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179
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Kristensen SD, Maeng M, Capodanno D, Wijns W. The year in cardiology 2017: coronary interventions. Eur Heart J 2018; 39:914-924. [PMID: 29300878 DOI: 10.1093/eurheartj/ehx798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/20/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland
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180
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Elgendy IY, Jneid H. Microvascular obstruction in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: another frontier to conquer? J Thorac Dis 2018; 10:1343-1346. [PMID: 29708124 DOI: 10.21037/jtd.2018.03.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX, USA
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181
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Thrombus aspiration and prehospital ticagrelor administration in ST-elevation myocardial infarction: Findings from the ATLANTIC trial. Am Heart J 2018; 196:1-8. [PMID: 29421001 DOI: 10.1016/j.ahj.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580). METHODS This analysis included 1,630 patients who underwent primary PCI. Multivariate analysis was used to explore the potential association of TA and pre-H treatment to clinical outcomes. Potential interactions between TA and pre-H ticagrelor were also explored. RESULTS A total of 941 (57.7%) patients underwent TA. In adjusted multivariate logistic model, pre-H ticagrelor treatment was significantly associated with less frequent new MI or definite stent *thrombosis (ST) (odds ratio [OR] 0.43, 95% CI 0.20-0.92, P=.031), or definite ST (OR 0.26, 95% CI 0.07-0.91, P=.036) at 30 days. Patients treated with TA had higher frequency of Thrombolysis in Myocardial Infarction (TIMI) flow 0-1 compared with no-TA group (80.7% vs 51.9%, P<.0001). TA when also adjusted for TIMI flow 0-1 showed significant association only for higher bailout use of glycoprotein IIb/IIIa inhibitors (OR 1.72, 95% CI 1.18-2.50, P=.004) and more frequent 30-day TIMI major bleeding (OR 2.92, 95% CI 1.10-7.76, P=.032). No significant interactions between TA and pre-H ticagrelor were present for the explored end points. CONCLUSIONS TA when left to physicians' discretion was used in high-risk patients, was associated with bailout use of glycoprotein IIb/IIIa inhibitors and TIMI major bleeding, and had no impact on 30-day clinical outcomes. Conversely, pre-H ticagrelor treatment predicted lower 30-day rates of ST or new MI without interaction with TA.
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182
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Spronk HMH, Padro T, Siland JE, Prochaska JH, Winters J, van der Wal AC, Posthuma JJ, Lowe G, d'Alessandro E, Wenzel P, Coenen DM, Reitsma PH, Ruf W, van Gorp RH, Koenen RR, Vajen T, Alshaikh NA, Wolberg AS, Macrae FL, Asquith N, Heemskerk J, Heinzmann A, Moorlag M, Mackman N, van der Meijden P, Meijers JCM, Heestermans M, Renné T, Dólleman S, Chayouâ W, Ariëns RAS, Baaten CC, Nagy M, Kuliopulos A, Posma JJ, Harrison P, Vries MJ, Crijns HJGM, Dudink EAMP, Buller HR, Henskens YMC, Själander A, Zwaveling S, Erküner O, Eikelboom JW, Gulpen A, Peeters FECM, Douxfils J, Olie RH, Baglin T, Leader A, Schotten U, Scaf B, van Beusekom HMM, Mosnier LO, van der Vorm L, Declerck P, Visser M, Dippel DWJ, Strijbis VJ, Pertiwi K, Ten Cate-Hoek AJ, Ten Cate H. Atherothrombosis and Thromboembolism: Position Paper from the Second Maastricht Consensus Conference on Thrombosis. Thromb Haemost 2018; 118:229-250. [PMID: 29378352 DOI: 10.1160/th17-07-0492] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherothrombosis is a leading cause of cardiovascular mortality and long-term morbidity. Platelets and coagulation proteases, interacting with circulating cells and in different vascular beds, modify several complex pathologies including atherosclerosis. In the second Maastricht Consensus Conference on Thrombosis, this theme was addressed by diverse scientists from bench to bedside. All presentations were discussed with audience members and the results of these discussions were incorporated in the final document that presents a state-of-the-art reflection of expert opinions and consensus recommendations regarding the following five topics: 1. Risk factors, biomarkers and plaque instability: In atherothrombosis research, more focus on the contribution of specific risk factors like ectopic fat needs to be considered; definitions of atherothrombosis are important distinguishing different phases of disease, including plaque (in)stability; proteomic and metabolomics data are to be added to genetic information. 2. Circulating cells including platelets and atherothrombosis: Mechanisms of leukocyte and macrophage plasticity, migration, and transformation in murine atherosclerosis need to be considered; disease mechanism-based biomarkers need to be identified; experimental systems are needed that incorporate whole-blood flow to understand how red blood cells influence thrombus formation and stability; knowledge on platelet heterogeneity and priming conditions needs to be translated toward the in vivo situation. 3. Coagulation proteases, fibrin(ogen) and thrombus formation: The role of factor (F) XI in thrombosis including the lower margins of this factor related to safe and effective antithrombotic therapy needs to be established; FXI is a key regulator in linking platelets, thrombin generation, and inflammatory mechanisms in a renin-angiotensin dependent manner; however, the impact on thrombin-dependent PAR signaling needs further study; the fundamental mechanisms in FXIII biology and biochemistry and its impact on thrombus biophysical characteristics need to be explored; the interactions of red cells and fibrin formation and its consequences for thrombus formation and lysis need to be addressed. Platelet-fibrin interactions are pivotal determinants of clot formation and stability with potential therapeutic consequences. 4. Preventive and acute treatment of atherothrombosis and arterial embolism; novel ways and tailoring? The role of protease-activated receptor (PAR)-4 vis à vis PAR-1 as target for antithrombotic therapy merits study; ongoing trials on platelet function test-based antiplatelet therapy adjustment support development of practically feasible tests; risk scores for patients with atrial fibrillation need refinement, taking new biomarkers including coagulation into account; risk scores that consider organ system differences in bleeding may have added value; all forms of oral anticoagulant treatment require better organization, including education and emergency access; laboratory testing still needs rapidly available sensitive tests with short turnaround time. 5. Pleiotropy of coagulation proteases, thrombus resolution and ischaemia-reperfusion: Biobanks specifically for thrombus storage and analysis are needed; further studies on novel modified activated protein C-based agents are required including its cytoprotective properties; new avenues for optimizing treatment of patients with ischaemic stroke are needed, also including novel agents that modify fibrinolytic activity (aimed at plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor.
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Affiliation(s)
- H M H Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Padro
- Cardiovascular Research Center (ICCC), Hospital Sant Pau, Barcelona, Spain
| | - J E Siland
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - J H Prochaska
- Center for Cardiology/Center for Thrombosis and Hemostasis/DZHK, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - J Winters
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - A C van der Wal
- Department of Pathology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - J J Posthuma
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - E d'Alessandro
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Pathology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - P Wenzel
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | - D M Coenen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - P H Reitsma
- Einthoven Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - W Ruf
- Center for Cardiology/Center for Thrombosis and Hemostasis/DZHK, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - R H van Gorp
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - R R Koenen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - T Vajen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - N A Alshaikh
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - A S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - F L Macrae
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - N Asquith
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - J Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - A Heinzmann
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - M Moorlag
- Synapse, Maastricht, The Netherlands
| | - N Mackman
- Department of Medicine, UNC McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, United States
| | - P van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J C M Meijers
- Department of Plasma Proteins, Sanquin, Amsterdam, The Netherlands
| | - M Heestermans
- Einthoven Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - T Renné
- Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Dólleman
- Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - W Chayouâ
- Synapse, Maastricht, The Netherlands
| | - R A S Ariëns
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - C C Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - M Nagy
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - A Kuliopulos
- Tufts University School of Graduate Biomedical Sciences, Biochemistry/Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts
| | - J J Posma
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - P Harrison
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - M J Vries
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - H J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - E A M P Dudink
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - H R Buller
- Department of Vascular Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Y M C Henskens
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - S Zwaveling
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Synapse, Maastricht, The Netherlands
| | - O Erküner
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - J W Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - A Gulpen
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - F E C M Peeters
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Douxfils
- Department of Pharmacy, Thrombosis and Hemostasis Center, Faculty of Medicine, Namur University, Namur, Belgium
| | - R H Olie
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Baglin
- Department of Haematology, Addenbrookes Hospital Cambridge, Cambridge, United Kingdom
| | - A Leader
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Tel Aviv, Israel
| | - U Schotten
- Center for Cardiology/Center for Thrombosis and Hemostasis/DZHK, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - B Scaf
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - H M M van Beusekom
- Department of Experimental Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L O Mosnier
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, United States
| | | | - P Declerck
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | | | - D W J Dippel
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | | | - K Pertiwi
- Department of Cardiovascular Pathology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - A J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - H Ten Cate
- Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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183
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Angerås O, Haraldsson I, Redfors B, Fröbert O, Petursson P, Albertsson P, Ioanes D, Odenstedt J, Olsson H, Witt N, Rück A, Millgård J, Nilsson J, Persson J, Söderbom M, Wedel H, Erlinge D, James S, Råmunddal T, Omerovic E. Impact of Thrombus Aspiration on Mortality, Stent Thrombosis, and Stroke in Patients With ST-Segment-Elevation Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2018; 7:e007680. [PMID: 29317403 PMCID: PMC5778972 DOI: 10.1161/jaha.117.007680] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/17/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). METHODS AND RESULTS We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatment-preference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: -1.2; 95% confidence interval [CI], -5.4 to 3.0; P=0.57) and 1 year (risk reduction: -2.4; 95% CI, -7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: -2.7; 95% CI, -4.1 to -1.4; P<0.001) and 1 year (risk reduction: -3.5; 95% CI, -5.3 to -1.7; P<0.001). In-hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, -0.8 to 1.1; P=0.76). CONCLUSIONS Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.
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Affiliation(s)
- Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Olsson
- Department of Cardiology, Karlstad Hospital, Karlstad, Sweden
| | - Nils Witt
- Department of Cardiology, South Hospital Stockholm, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Millgård
- Department of Cardiology, Sunderby Hospital, Sunderbyn, Sweden
| | - Johan Nilsson
- Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Jonas Persson
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Måns Söderbom
- Department of Economics, University of Gothenburg, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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184
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Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, Holmes DR. Coronary Embolus. JACC Cardiovasc Interv 2018; 11:172-180. [DOI: 10.1016/j.jcin.2017.08.057] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
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185
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6074] [Impact Index Per Article: 1012.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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186
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Roldan LP, Rowan C, Sheldon M, Roldan CA. Three-vessel coronary artery aneurysmal disease complicated by multivessel thrombosis and cardiogenic shock: the saving role of intracoronary thrombolysis. BMJ Case Rep 2017; 2017:bcr-2017-222038. [PMID: 29248881 DOI: 10.1136/bcr-2017-222038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The benefit of intracoronary thrombolytics in ST-elevation myocardial infarction (STEMI) is not well established. Mainstays of STEMI management include intravenous thrombolytics, percutaneous coronary interventions and surgical revascularisation. However, in cases of STEMI secondary to coronary artery aneurysmal disease (CAAD), standard treatment options may not be suitable due to high thrombus burden, perioperative risk and factors unique to each patient. Thus, STEMI management in CAAD can represent a therapeutically challenging clinical scenario. Here, we describe a patient with severe three-vessel CAAD complicated by multivessel thrombosis and cardiogenic shock for whom traditional management options including placement of haemodynamic support devices were not feasible. As an alternative measure, the patient was treated with intracoronary thrombolysis with remarkable clinical stabilisation and angiographic resolution of thrombosis. He remains clinically stable several years later without recurrent events. This case serves to demonstrate the potential lifesaving benefit of intracoronary thrombolysis in complicated multivessel CAAD.
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Affiliation(s)
- Luis Pablo Roldan
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Chris Rowan
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Mark Sheldon
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Carlos A Roldan
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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187
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Stiermaier T, Jobs A, de Waha S, Fuernau G, Pöss J, Desch S, Thiele H, Eitel I. Optimized Prognosis Assessment in ST-Segment-Elevation Myocardial Infarction Using a Cardiac Magnetic Resonance Imaging Risk Score. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006774. [PMID: 29122844 DOI: 10.1161/circimaging.117.006774] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) demonstrated great potential for the prediction of major adverse cardiac events (MACE) in ST-segment-elevation myocardial infarction. The aim of this study was to develop and validate a CMR-based risk score for ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS The scoring model was developed and validated on ST-segment-elevation myocardial infarction cohorts from 2 independent randomized controlled trials (n=738 and n=458 patients, respectively) and included left ventricular (LV) ejection fraction, infarct size, and microvascular obstruction. Primary end point was the 12-month MACE rate consisting of death, reinfarction, and new congestive heart failure. In the derivation cohort, LV ejection fraction ≤47%, infarct size ≥19%LV, and microvascular obstruction ≥1.4%LV were identified as the best cutoff values for MACE prediction. According to the hazard ratios in multivariable regression analysis, the CMR risk score was created by attributing 1 point for LV ejection fraction ≤47%, 1 point for infarct size ≥19%LV, and 2 points for microvascular obstruction ≥1.4%LV. In the validation cohort, the score showed a good prediction of MACE (area under the curve: 0.76). Stratification into a low (0/1 point) and high-risk group (≥2 points) resulted in significantly higher MACE rates in high-risk patients (9.0% versus 2.2%; P=0.001). Inclusion of the CMR score in addition to a model of clinical risk factors led to a significant increase of C statistics from 0.74 to 0.83 (P=0.037), a net reclassification improvement of 0.18 (P=0.009), and an integrated discriminative improvement of 0.04 (P=0.010). CONCLUSIONS Our approach integrates the prognostic information of CMR imaging into a simple risk score that showed incremental prognostic value over clinical risk factors in ST-segment-elevation myocardial infarction patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00712101 and NCT02158468.
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Affiliation(s)
- Thomas Stiermaier
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Alexander Jobs
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Suzanne de Waha
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Georg Fuernau
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Janine Pöss
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Steffen Desch
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Holger Thiele
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Ingo Eitel
- From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany.
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188
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Nishihira K, Shibata Y, Yamashita A, Kuriyama N, Asada Y. Relationship between thrombus age in aspirated coronary material and mid-term major adverse cardiac and cerebrovascular events in patients with acute myocardial infarction. Atherosclerosis 2017; 268:138-144. [PMID: 29223872 DOI: 10.1016/j.atherosclerosis.2017.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Recent studies have shown that coronary thrombus histopathology is associated with impaired myocardial reperfusion and poor clinical outcome in patients with acute myocardial infarction (AMI). We sought to investigate the age of thrombi aspirated during percutaneous coronary intervention (PCI) in patients with AMI and evaluate the relationship between histopathologic findings and major adverse cardiac and cerebrovascular events (MACCEs) defined as all-cause death, stroke, or myocardial infarction within 6 months of PCI. METHODS In this prospective 2-center observational study, coronary material was obtained during PCI from 305 patients with AMI within 24 h of symptom onset. Thrombi were morphologically classified as either only fresh or older (lytic changes or organization). RESULTS MACCE occurred in 38 (12.5%) patients. Only fresh thrombi were observed in 114 (37%) of 305 patients; older thrombi were identified in 191 (63%). The rate of MACCE was significantly higher among patients with older thrombus (p = 0.011). Multivariate analysis also showed the presence of older thrombus [odds ratio (OR) 3.03, 95% confidence interval (CI) 1.122-9.522] is an independent predictor of MACCE within 6 months of PCI, as well as age (OR 1.051, 95% CI 1.013-1.094) and creatine kinase concentration (OR 1.025, 95% CI 1.013-1.037). The prevalence of slow flow or distal embolization during PCI and peak creatine kinase concentration were significantly higher in the older thrombus group (p < 0.05, respectively). CONCLUSIONS Older thrombus found in aspirated coronary material is associated with impaired myocardial reperfusion and is an independent predictor of mid-term MACCE in patients with AMI.
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Affiliation(s)
- Kensaku Nishihira
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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189
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Alkhalil M, Cahill TJ, Boardman H, Choudhury RP. Concomitant pulmonary embolism and myocardial infarction due to paradoxical embolism across a patent foramen ovale: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx010. [PMID: 31020069 PMCID: PMC6177106 DOI: 10.1093/ehjcr/ytx010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 01/21/2023]
Abstract
Concomitant acute myocardial infarction (MI) and pulmonary embolism (PE) is exceedingly rare. However, establishing the diagnosis early is essential, since delay in treating the patient may lead to a potential fatal outcome. Right ventricular (RV) infarction in the setting of inferior ST-segment elevation MI (STEMI), coupled with acute massive PE confers particular risk due acute RV failure and low cardiac output, threatening survival. We report a rare case of concomitant PE and inferior STEMI in a 43-year-old woman with a history of acute chest pain. She was haemodynamically compromised, with Type I respiratory failure but lack of signs of heart failure. Early recognition of dual pathologies prompted administration of thrombolytic therapy and simultaneous right coronary artery thrombectomy to treat PE and STEMI. Prompt clinical diagnosis and delivery of targeted therapies adapted for the specific clinical presentation may have averted fatal outcome.
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Affiliation(s)
- Mohammad Alkhalil
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Thomas J Cahill
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Henry Boardman
- Department of Cardiology, Oxford Heart Centre, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
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190
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Niu XW, Zhang JJ, Bai M, Peng Y, Zhang Z. Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention: a meta-analysis. J Geriatr Cardiol 2017; 14:614-623. [PMID: 29238362 PMCID: PMC5721196 DOI: 10.11909/j.issn.1671-5411.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/06/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Suboptimal myocardial reperfusion is common in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Furthermore, it results in increased infarct size and mortality rates. We performed a meta-analysis to evaluate the role of aspiration thrombectomy (AT) combined with intracoronary administration of glycoprotein IIb/IIIa inhibitors (GPI) in the improvement of myocardial reperfusion and clinical outcomes. METHODS PubMed, Embase, Web of Science, and CENTRAL databases were searched for randomized controlled trials (RCTs) investigating combined AT and intracoronary GPI treatment versus AT alone. Outcomes of interest were thrombolysis in myocardial infarction myocardial perfusion grade (TMPG), infarct size (IS) assessed by cardiac magnetic resonance imaging, left ventricular ejection fraction (LVEF), major adverse cardiac events (MACE) at short-term (≤ 1 month) and long-term (6-12 months) follow-up, and bleeding complications during the hospital stay. RESULTS Eight trials involving 923 patients were included. Compared with AT alone, combined AT and intracoronary GPI significantly increased TMPG 3 flow (RR: 1.15, 95% CI: 1.04 to 1.26), reduced IS [mean difference (MD): -3.46, 95% CI: -5.18 to -1.73], and improved LVEF (MD: 1.44, 95% CI: 0.54 to 2.33). Furthermore, GPI use decreased the risk of MACE at long-term follow-up (RR: 0.60, 95% CI: 0.37 to 0.98). There was no significant difference between the two groups in the incidence of minor and major bleeding complications. CONCLUSIONS Our findings showed that compared with AT alone, combined AT and intracoronary GPI treatment resulted in improved myocardial reperfusion, better cardiac function, and MACE-free survival benefits at the long-term follow-up for patients with STEMI undergoing PPCI.
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Affiliation(s)
- Xiao-Wei Niu
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | | | - Ming Bai
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Yu Peng
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Zheng Zhang
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
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191
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Desch S, Stiermaier T, Thiele H, de Waha S. Requiem for routine thrombus aspiration. Cardiovasc Diagn Ther 2017; 7:S107-S109. [PMID: 28748160 DOI: 10.21037/cdt.2017.05.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Steffen Desch
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Suzanne de Waha
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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192
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Mangiacapra F, Sticchi A, Barbato E. Thrombus aspiration in primary percutaneous coronary intervention: still a valid option with improved technique in selected patients! Cardiovasc Diagn Ther 2017; 7:S110-S114. [PMID: 28748161 DOI: 10.21037/cdt.2017.05.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Sticchi
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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193
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Karamasis GV, Davies JR, Clesham GJ. Letter by Karamasis et al Regarding Article, "Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration". Circulation 2017; 135:e1097-e1098. [PMID: 28559503 DOI: 10.1161/circulationaha.116.027126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - John R Davies
- From Cardiology Department, The Essex Cardiothoracic Centre, Basildon, UK
| | - Gerald J Clesham
- From Cardiology Department, The Essex Cardiothoracic Centre, Basildon, UK
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194
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Shah R. Letter by Shah Regarding Article, "Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration". Circulation 2017; 135:e1101-e1102. [PMID: 28559505 DOI: 10.1161/circulationaha.117.027488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rahman Shah
- From Veterans Affairs Medical Center, Section of Cardiology, University of Tennessee, School of Medicine, Memphis
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195
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Jurado-Román A, Sánchez-Pérez I, Lozano-Ruíz-Poveda F. Letter by Jurado-Román et al Regarding Article, "Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration". Circulation 2017; 135:e1099-e1100. [PMID: 28559504 DOI: 10.1161/circulationaha.117.027198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alfonso Jurado-Román
- From Interventional Cardiology Department, University General Hospital of Ciudad Real, Spain
| | - Ignacio Sánchez-Pérez
- From Interventional Cardiology Department, University General Hospital of Ciudad Real, Spain
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196
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Jolly SS, James S, Džavík V, Cairns JA, Frøbert O. Response by Jolly et al to Letters Regarding Article, “Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration”. Circulation 2017; 135:e1103-e1104. [DOI: 10.1161/circulationaha.117.028198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanjit S. Jolly
- From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.J.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Sweden (S.J.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (V.D.); University of British Columbia, Vancouver, Canada (J.A.C.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.)
| | - Stefan James
- From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.J.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Sweden (S.J.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (V.D.); University of British Columbia, Vancouver, Canada (J.A.C.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.)
| | - Vladimír Džavík
- From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.J.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Sweden (S.J.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (V.D.); University of British Columbia, Vancouver, Canada (J.A.C.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.)
| | - John A. Cairns
- From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.J.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Sweden (S.J.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (V.D.); University of British Columbia, Vancouver, Canada (J.A.C.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.)
| | - Ole Frøbert
- From McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.J.); Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Sweden (S.J.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (V.D.); University of British Columbia, Vancouver, Canada (J.A.C.); and Örebro University, Faculty of Health, Department of Cardiology, Södra Grev Rosengatan, Örebro, Sweden (O.F.)
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197
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Elgendy AY, Elgendy IY, Mahmoud AN, Bavry AA. Long-term outcomes with aspiration thrombectomy for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials. Clin Cardiol 2017; 40:534-541. [PMID: 28409835 DOI: 10.1002/clc.22691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 01/12/2023] Open
Abstract
Randomized clinical trials that examined long-term clinical outcomes of routine aspiration thrombectomy prior to primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction have yielded different results. We hypothesized that the routine use of manual thrombus aspiration prior to primary PCI lacks long-term clinical benefits. Electronic databases were searched for randomized trials comparing routine aspiration thrombectomy and conventional PCI. We included only trials that reported clinical outcomes beyond 6 months. The primary outcome was all-cause mortality, and the secondary outcomes included major adverse cardiovascular events, re-infarction, cardiovascular mortality, and stent thrombosis (ST). A DerSimonian-Laird model was used to construct the summary estimates risk ratio (RR). We retrieved 18 trials with 20 641 ST-segment elevation myocardial infarction patients, of whom 10 331 patients underwent routine aspiration thrombectomy prior to primary PCI. At a mean follow-up of 12 months, there was no significant decrease in the risk of all-cause mortality (RR: 0.93, 95% confidence interval [CI]: 0.82-1.05, P = 0.22), major adverse cardiac events (RR: 0.95, 95% CI: 0.87-1.03, P = 0.18), re-infarction (RR: 0.95, 95% CI: 0.80-1.13, P = 0.59), cardiovascular mortality (RR: 0.80, 95% CI: 0.47-1.36, P = 0.40), or ST (RR: 0.80, 95% CI: 0.63-1.01, P = 0.06) with routine aspiration thrombectomy. Routine aspiration thrombectomy prior to primary PCI was not associated with a reduction in long-term mortality or clinical outcomes. Future randomized trials are warranted to further evaluate the role of aspiration thrombectomy in select patients and coronary lesions.
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Affiliation(s)
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville.,North Florida/South Georgia Veterans Health System, Gainesville, Florida
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