1
|
Cioffi GM, Zhi Y, Madanchi M, Seiler T, Stutz L, Gjergjizi V, Romero JP, Attinger-Toller A, Bossard M, Cuculi F. Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus burden: Insights from a prospective cohort study. BMC Cardiovasc Disord 2023; 23:506. [PMID: 37828421 PMCID: PMC10571234 DOI: 10.1186/s12872-023-03540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. METHODS From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. RESULTS Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. CONCLUSIONS Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.
Collapse
Affiliation(s)
- Giacomo Maria Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, McMaster University, Ontario, Hamilton, Canada
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Leah Stutz
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jean-Paul Romero
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
| |
Collapse
|
2
|
Dynamic Regulation of Cysteine Oxidation and Phosphorylation in Myocardial Ischemia-Reperfusion Injury. Cells 2021; 10:cells10092388. [PMID: 34572037 PMCID: PMC8469016 DOI: 10.3390/cells10092388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023] Open
Abstract
Myocardial ischemia-reperfusion (I/R) injury significantly alters heart function following infarct and increases the risk of heart failure. Many studies have sought to preserve irreplaceable myocardium, termed cardioprotection, but few, if any, treatments have yielded a substantial reduction in clinical I/R injury. More research is needed to fully understand the molecular pathways that govern cardioprotection. Redox mechanisms, specifically cysteine oxidations, are acute and key regulators of molecular signaling cascades mediated by kinases. Here, we review the role of reactive oxygen species in modifying cysteine residues and how these modifications affect kinase function to impact cardioprotection. This exciting area of research may provide novel insight into mechanisms and likely lead to new treatments for I/R injury.
Collapse
|
3
|
Mir T, Uddin M, Changal KH, Perveiz E, Kaur J, Sattar Y, Ullah W, Sheikh M. Long-term outcomes of ischemic post-conditioning primary PCI and conventional primary PCI in acute STEMI: a meta-analysis of randomized trials. Expert Rev Cardiovasc Ther 2021; 19:673-680. [PMID: 34115566 DOI: 10.1080/14779072.2021.1941874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data regarding ischemic postconditioning during percutaneous coronary intervention (PCI) as compared conventional PCI alone has yielded conflicting results. METHODS Online databases comparing use of ischemic postconditioning percutaneous coronary intervention (ICP-PPCI) in STEMI patients with conventional PPCI were selected. Mortality, heart failure (HF), myocardial infarction (MI), and major adverse cardiac events (MACE) were evaluated. The primary outcome was composite of HF, MI, and mortality. Pooled risk ratio (RR) with 95% confidence interval (CI) were computed using random-effects model. RESULTS Eight studies consisting of 2,566 patients (ICP-PPCI n = 1,228; PPCI n = 1,278) were included. The mean age for PPCI group was 61.38 ± 7.86 years (51% men) and for PCI 59.83 ± 8.94 years (47% men). There were no differences in outcome between ICP-PPCI and PPCI in terms of HF (RR 0.87 95% CI0.51-1.48; p = 0.29), MI (RR 1.28, 95%CI0.74-2.20; p = 0.20), mortality (RR 0.93, 95%CI0.64-1.34; p = 0.58), and MACE (RR 0.89, 95%CI0.74-1.07; p = 0.22). The results for composite event for the ICP-PPCI and PPIC procedures, at ≥1 year follow-up duration, were comparable (RR 1.00 95%CI0.82-1.22; p = 1). CONCLUSION Ischemic postconditioning post percutaneous coronary intervention in STEMI patients has no long-term benefits over conventional PCI.
Collapse
Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Mohammed Uddin
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | | | - Eskara Perveiz
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Jasmeet Kaur
- Department of Internal Medicine, Saint Joseph Mercy Oakland, Pontiac, MI, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Mujeeb Sheikh
- Department of Cardiovascular Medicine and Interventional Cardiology, Promedica Toledo Hospital, Ohio, USA
| |
Collapse
|
4
|
Li L, Li X, Zhang Z, Liu L, Liu T, Li S, Liu S, Zhou Y, Liu F. Effects of Hydrogen-rich Water on the PI3K/AKT Signaling Pathway in Rats with Myocardial Ischemia-reperfusion Injury. Curr Mol Med 2019; 20:396-406. [PMID: 31702499 DOI: 10.2174/1566524019666191105150709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effects of hydrogen-rich water on PI3K/AKT-mediated apoptosis were studied in rats subjected to myocardial ischemia-reperfusion injury (MIRI). Methdos: Sixty rats were divided randomly into a hydrogen-rich water group and a control group. The hearts were removed and fixed in a Langendorff device. Hearts from the control group were perfused with K-R solution, and hearts from the hydrogen-rich water group was perfused with K-R solution + hydrogen-rich water. The two treatment groups were then divided randomly into pre-ischemic period, ischemic period and reperfusion period groups(10 rats per group), which were subjected to reverse perfusion for 10 min, normal treatment for 20 min, and reperfusion for 20 min, respectively. The mRNA and protein expression levels of PI3K, AKT, p-AKT, FoxO1, Bim and Caspase-3 in each group were detected by RT-qPCR, immunohistochemistry (IHC) and Western blotting. Caspase-3 activity was detected by spectrophotometry. RESULTS Among the hydrogen-rich water group, the PI3K/AKT signaling pathway was significantly activated, and FoxO1, Bim, and Caspase-3 mRNA and protein levels were significantly decreased in ischemia-reperfusion subgroup compared with the preischemic and ischemic subgroups. In the ischemia-reperfusion hydrogen-rich water group, PI3K, AKT and p-AKT mRNA and protein expression levels were increased while the FoxO1, Bim and Caspase-3 expression levels were significantly decreased compared with those in the corresponding control group (P<0.05). CONCLUSION Hydrogen-rich water can activate the PI3K/AKT signaling pathway, alleviate ischemia-reperfusion injury in isolated rat hearts, and inhibit cardiomyocyte apoptosis.
Collapse
Affiliation(s)
- Liangtong Li
- Medical College, Hebei University, Baoding, 071000, China
| | - Xiangzi Li
- Medical College, Hebei University, Baoding, 071000, China
| | - Zhe Zhang
- Medical College, Hebei University, Baoding, 071000, China
| | - Li Liu
- Medical College, Hebei University, Baoding, 071000, China
| | - Tongtong Liu
- Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Shaochun Li
- Medical College, Hebei University, Baoding, 071000, China
| | - Sen Liu
- Medical College, Hebei University, Baoding, 071000, China
| | - Yujuan Zhou
- Medical College, Hebei University, Baoding, 071000, China
| | - Fulin Liu
- Affiliated Hospital of Hebei University, Baoding, 071000, China
| |
Collapse
|
5
|
Giustino G, Dangas GD. Ischemia-reperfusion injury and ischemic post-conditioning in acute myocardial infarction: Lost in translation. Catheter Cardiovasc Interv 2019; 90:1068-1069. [PMID: 29226578 DOI: 10.1002/ccd.27436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/12/2022]
Abstract
Ischemic post-conditioning (IPoC) has been proposed as a strategy to mitigate the risk of ischemia-reperfusion injury during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). In this comprehensive and updated meta-analysis of randomized controlled trials, IPoC during primary PCI for STEMI had no significant effect on all-cause mortality, re-infarction, or new-onset heart failure compared with no post-conditioning. Further strategies need to be prospectively evaluated to improve outcomes in patients with STEMI undergoing primary PCI.
Collapse
Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
6
|
Pharmacological protection of reperfusion injury in ST-segment elevation myocardial infarction. Gone with the wind? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:5-8. [PMID: 29743898 PMCID: PMC5939539 DOI: 10.5114/aic.2018.74349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022] Open
|
7
|
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
| |
Collapse
|
8
|
Kloner RA, Brown DA, Csete M, Dai W, Downey JM, Gottlieb RA, Hale SL, Shi J. New and revisited approaches to preserving the reperfused myocardium. Nat Rev Cardiol 2017; 14:679-693. [PMID: 28748958 PMCID: PMC5991096 DOI: 10.1038/nrcardio.2017.102] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early coronary artery reperfusion improves outcomes for patients with ST-segment elevation myocardial infarction (STEMI), but morbidity and mortality after STEMI remain unacceptably high. The primary deficits seen in these patients include inadequate pump function, owing to rapid infarction of muscle in the first few hours of treatment, and adverse remodelling of the heart in the months that follow. Given that attempts to further reduce myocardial infarct size beyond early reperfusion in clinical trials have so far been disappointing, effective therapies are still needed to protect the reperfused myocardium. In this Review, we discuss several approaches to preserving the reperfused heart, such as therapies that target the mechanisms involved in mitochondrial bioenergetics, pyroptosis, and autophagy, as well as treatments that harness the cardioprotective properties of inhaled anaesthetic agents. We also discuss potential therapies focused on correcting the no-reflow phenomenon and its effect on healing and adverse left ventricular remodelling.
Collapse
Affiliation(s)
- Robert A Kloner
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
| | - David A Brown
- Department of Human Nutrition, Foods, and Exercise, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
- Virginia Tech Center for Drug Discovery, Virginia Tech, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
- Virginia Tech Metabolic Phenotyping Core, Virginia Tech, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
| | - Marie Csete
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90017, USA
| | - Wangde Dai
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
| | - James M Downey
- Department of Physiology and Cell Biology, University of South Alabama, 5851 USA Drive North, Mobile, Alabama 36688, USA
| | - Roberta A Gottlieb
- Department of Medicine, Barbra Streisand Women's Heart Center, Heart Institute of Cedars-Sinai, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Los Angeles, California 90048, USA
| | - Sharon L Hale
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
| | - Jianru Shi
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, California 91101, USA
- Division of Cardiovascular Medicine and Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, California 90033, USA
| |
Collapse
|
9
|
Mahmoud AN, Saad M, Elgendy AY, Mentias A, Elgendy IY. Deferred or immediate stent implantation for primary percutaneous coronary intervention: A meta-analysis of randomized trials. Catheter Cardiovasc Interv 2017; 91:260-264. [PMID: 28799712 DOI: 10.1002/ccd.27240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/22/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To perform a meta-analysis of randomized trials comparing a deferred versus immediate stenting strategy for primary percutaneous coronary intervention (PCI). BACKGROUND Deferred stent implantation has emerged as a potential strategy aiming to reduce the thrombus burden and improve micro-vascular reperfusion during primary PCI. METHODS Electronic databases were searched for randomized trials that compared a deferred stent implantation versus immediate stent implantation strategy in patients undergoing primary PCI. Random effects risk ratios (RR) were estimated for the outcomes of interest. RESULTS Four trials with 1,570 patients were included. A deferred stent implantation strategy was associated with a lower incidence of no-/slow reflow (RR 0.49, 95% confidence interval [CI] 0.24-0.96), and improved myocardial blush grade 3 (RR 1.42, 95% CI 1.14-1.77). At a mean follow up of 34 ± 15 months, both strategies were associated with a similar risk of all-cause mortality (RR 0.85, 95% CI 0.58-1.24), cardiovascular mortality (RR 0.84, 95% CI 0.48-1.45), reinfarction (RR 1.54, 95% CI 0.43-5.49), and stent thrombosis (RR = 0.35, 95% CI 0.04-3.35, P = 0.36). CONCLUSION In patients undergoing primary PCI, deferred stent implantation is associated with improvement in surrogate outcomes, but does not appear to improve clinical outcomes. Future randomized trials are encouraged to identify the patient population who might benefit from a deferred stent implantation strategy (e.g., high thrombus burden).
Collapse
Affiliation(s)
- Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Marwan Saad
- Department of Medicine, University of Arkansas, Little Rock, Arkansas
| | - Akram Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Amgad Mentias
- Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|