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Mathews SJ, Brown CL, Kolski BC, Marques VM, Huynh A, Dohad SY, George JC. Initial experience with a continuous mechanical aspiration system for thrombus removal before percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 100:950-954. [PMID: 36183400 DOI: 10.1002/ccd.30389] [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: 04/21/2022] [Revised: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Here we investigate the safety and efficacy of a continuous mechanical aspiration system when used before percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). BACKGROUND Historically, trials of routine manual aspiration thrombectomy in ACS patients have reported mixed results. This may be due to the technical limitations of manual aspiration, which suffers from decreasing vacuum power as aspiration is performed. METHODS This is a retrospective case series of all patients treated with continuous mechanical aspiration (Indigo CAT RX Aspiration System; Penumbra Inc.) before PCI between August 2017 and July 2020 at five centers in the United States. Data regarding angiographic assessments, procedure, and safety were examined. RESULTS Seventy-two patients (mean age 60 ± 12.5 years, 34.7% female) with ST Elevation Myocardial Infarction (STEMI) (80.6%) or Non-ST Elevation Myocardial Infarction (NSTEMI) (19.4%) were included. Target vessels were the right coronary (43.1%), left anterior descending (33.3%), and left circumflex (23.6%). Preprocedure, 94.4% had a high thrombus burden (thrombolysis in myocardial infarction [TIMI] thrombus grade ≥ 3). Median aspiration time was 35 s and median access-to-reperfusion time was 10 min. After CAT RX alone, 86.1% had complete perfusion (TIMI flow grade 3). After the procedure, 94.4% had TIMI thrombus grade <3% and 97.2% had TIMI flow grade 3. There were no cases of ischemic stroke. Cardiovascular mortality at 30 days was 1.4%. CONCLUSIONS In our initial experience, aspirating thrombus from ACS patients using the Indigo CAT RX Aspiration System before PCI was safe and effective for reducing thrombus burden and restoring flow.
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Affiliation(s)
- S Jay Mathews
- Bradenton Cardiology Center, Manatee Memorial Hospital, Bradenton, Florida, USA
| | - Christopher L Brown
- Interventional Cardiology, Scripps Memorial La Jolla, San Diego, California, USA
| | - Brian C Kolski
- Division of Cardiology, Providence St. Joseph Hospital, Orange, California, USA
| | - Vasco M Marques
- Department of Cardiology, Florida Hospital, Tampa, Florida, USA
| | - Andrew Huynh
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston/Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA
| | - Suhail Y Dohad
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon C George
- Division of Interventional Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Zhang X, Qi L, Liu Y. Aspirin in combination with clopidogrel in the treatment of acute myocardial infarction patients undergoing percutaneous coronary intervention. Pak J Med Sci 2019; 35:348-352. [PMID: 31086513 PMCID: PMC6500819 DOI: 10.12669/pjms.35.2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To investigate the clinical effect of aspirin combined with clopidogrel on acute myocardial infarction after percutaneous coronary intervention (PCI). Methods: One hundred thirty two patients with acute myocardial infarction who were admitted to the hospital between December 2016 and December 2017 were divided into a control group and an observation group according to random number table, 66 each group. Both groups were given emergency PCI and symptomatic treatment. The control group was given aspirin on the basis of conventional treatment before and after operation, while the observation group was given clopidogrel treatment on the basis of the treatment the same as the control group. The treatment lasted for 4 months. The clinical efficacy of the two groups was analyzed, and the cardiac function indicator, coagulation indicator and occurrence of adverse reactions were compared before and after treatment. Results: There was no thrombosis at the infarct site in coronary angiography after treatment in both groups. The efficacy in the observation group and control group were 89.4% and 81.8%, respectively; there was no significant difference between the two groups. The incidence of re-thrombosis in the two groups was 1.5% and 12.1% respectively, which was significantly lower in the observation group than in the control group (P<0.05). The cardiac function indicator of both groups improved after treatment, especially the observation group (P<0.05). There was no significant difference in prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin activity (PA) and platelet aggregation rate (PAR) in the two groups before treatment (P>0.05). There was also no significant difference in PT and PA before and after treatment (P>0.05). The APTT and PAR were significantly different after treatment (P<0.05), and the PAR of the observation group was significantly higher than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was 7.58%, which was not significantly different with that of the control group (12.12%) (P<0.05). Conclusion: Aspirin combined with clopidogrel can effectively reduce the occurrence of re-thrombosis after PCI and improve the recovery of cardiac function after acute operation, moreover the safety is high. It has important clinical application values.
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Affiliation(s)
- Xiaoyan Zhang
- Xiaoyan Zhang, Interventional Operating Theater, Binzhou People's Hospital, Shandong, 256610, China
| | - Lizhen Qi
- Lizhen Qi, Nuclear Medicine, Binzhou People's Hospital, Shandong, 256610, China
| | - Yongxuan Liu
- Yongxuan Liu, Department of Cardiology, Binzhou People's Hospital, Shandong, 256610, China
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Yaméogo NV, Guenancia C, Porot G, Stamboul K, Richard C, Gudjoncik A, Hamblin J, Buffet P, Lorgis L, Cottin Y. Predictors of angiographically visible distal embolization in STEMI. Herz 2018; 45:288-292. [PMID: 29926119 DOI: 10.1007/s00059-018-4723-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/06/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy. PATIENTS AND METHODS This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow. RESULTS Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36-4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01-3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE. CONCLUSION AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.
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Affiliation(s)
- N V Yaméogo
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - C Guenancia
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France. .,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France.
| | - G Porot
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - K Stamboul
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France
| | - C Richard
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France
| | - A Gudjoncik
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France
| | - J Hamblin
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - P Buffet
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - L Lorgis
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France
| | - Y Cottin
- Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.,PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France
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Ge J, Schäfer A, Ertl G, Nordbeck P. Thrombus Aspiration for ST-Segment-Elevation Myocardial Infarction in Modern Era: Still an Issue of Debate? Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005739. [PMID: 29042400 DOI: 10.1161/circinterventions.117.005739] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The role of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for acute ST-segment-elevation myocardial infarction has been a matter of intense research and debate now. Although recent randomized controlled clinical trials (notably TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) do not supply evidence supporting the routine use of TA in patients with ST-segment-elevation myocardial infarction, manual TA remains a therapeutic option for interventional cardiologists when treating patients with substantial thrombus burden during PPCI. It remains unknown whether patients might actually benefit from TA applied in a more selective manner depending on the thrombus burden during PPCI, instead of routine application. In this review, we summarize current knowledge on the instruments used in the TA procedure, positive as well as negative clinical effects of TA during PPCI, and analyze the potential reasons for observed effects, in an effort to help the clinical decision making by physicians for the use of TA in individual ST-segment-elevation myocardial infarction patients during PPCI.
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Affiliation(s)
- Junhua Ge
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Andreas Schäfer
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Georg Ertl
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Peter Nordbeck
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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李 慧, 向 定, 张 金, 段 天, 龙 锋, 李 爱. [Dynamic changes of brain natriuretic peptide concentration and its diagnostic value for heart failure in early phase of acute myocardial infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:112-116. [PMID: 33177027 PMCID: PMC6765625 DOI: 10.3969/j.issn.1673-4254.2018.01.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the dynamic changes in brain natriuretic peptide (BNP) concentration and the diagnostic value of BNP for heart failure at different time points in the early phase of acute myocardial infarction (AMI). METHODS AMI patients who were admitted in our department between January 1, 2016 and July 31, 2016 and underwent emergency percutaneous coronary intervention (PCI) within 12 h after onset were enrolled in this study. All the patients received bedside examinations of BNP concentration and clinical cardiac function within 1 h after PCI and at 12, 20, 24 and 48 h after the onset of AMI. According to the peak BNP concentration, the patients were divided into high peak BNP group (> 400 pg/mL) and normal peak BNP group (≤400 pg/mL). RESULTS Seventy patients were enrolled in the study. Within 48 h after AMI onset, BNP concentration variations followed a pattern of an initial increase till reaching the peak concentration at 20 to 24 h, with subsequent gradual decrease. BNP concentrations differed significantly among the indicated time points (χ2=141.7, P < 0.05) except for those between 20 h and 24 h (χ2=0.173, P > 0.05). Compared with those in normal peak BNP group, the patients in high peak BNP group had an older age, a lower BMI, a longer time to perfusion, and a higher likeliness of anterior myocardial infarction and pulmonary infection (P < 0.05). Logistic regression analysis showed that age, BMI and anterior myocardial infarction were independently associated with the increase of peak BNP concentration. ROC curve analysis showed that BNP concentration within 1 h after emergency PCI was unable to diagnose heart failure at that time (P > 0.05), while BNP concentrations at 12, 20, 24 and 48 h after AMI onset had significant diagnostic values for heart failure (P < 0.05) with areas under ROC of 0.860, 0.786, 0.768 and 0.863, and optimal cutoff values of 156.5, 313.7, 240.9 and 285.9 pg/mL, respectively. CONCLUSIONS BNP concentration increases first and then decreases in the early phase of AMI, and the peak concentration occurs at 20-24 h after the onset. The diagnostic values of BNP concentrations at different time points also vary.
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Affiliation(s)
- 慧娣 李
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - 定成 向
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - 金霞 张
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - 天兵 段
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - 锋 龙
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - 爱敏 李
- />广州军区广州总医院心血管内科,广东 广州 510010Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
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Aghlmandi S, Schärer N, Heg D, Räber L, Zwahlen M, Gencer B, Nanchen D, Carballo D, Carballo S, Jüni P, von Eckardstein A, Landmesser U, Rodondi N, Mach F, Windecker S, Matter CM, Lüscher TF, Klingenberg R. Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:522-531. [DOI: 10.1177/2048872617706480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Randomised controlled trials have provided conflicting results regarding procedural and clinical outcomes of thrombus aspiration combined with percutaneous coronary intervention, when compared with primary percutaneous coronary intervention alone in patients with acute coronary syndromes. Methods: Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM–ACS cohort. At the discretion of the interventional cardiologist, patients underwent thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Procedural success was defined as post-procedural thrombolysis in myocardial infarction III flow in the infarct-related artery. Serial changes in high-sensitivity troponin T (ΔhsTnT) and adjudicated 30 days (1 year) clinical events defined as the composite of cardiac death, recurrent myocardial infarction or clinically indicated coronary revascularisation were assessed. Results: Among 1641 patients, 777 (47.4%) had angiographic evidence of coronary thrombus. Patients were categorised into thrombus aspiration with percutaneous coronary intervention ( n=663) or percutaneous coronary intervention alone ( n=114). ST-segment elevation myocardial infarction (STEMI) patients more often received thrombus aspiration with percutaneous coronary intervention (87.8%) than non-STEMI patients (73.5%), P<0.001. Procedural success was not different in thrombus aspiration with percutaneous coronary intervention compared with percutaneous coronary intervention alone (93.8% vs. 90.7%, P=0.243). ΔhsTnT was similar in STEMI patients (3.09±4.52 vs. 2.19±4.92 µg/l, P=0.086) as was clinical outcome in the entire cohort at 30 days (2.9% vs. 3.6%, P=0.76) and 1 year (7.2% vs. 5.3%, P=0.55) regardless of whether thrombus aspiration was used during primary percutaneous coronary intervention or not. Conclusions: In this real-world acute coronary syndrome cohort, patients treated by thrombus aspiration with percutaneous coronary intervention showed no difference in the restoration of coronary blood flow compared with percutaneous coronary intervention alone immediately after the procedure. Furthermore, ΔhsTnT and clinical outcomes at either 30 days or 1 year were similar between thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Clinical Trials Registration: SPUM–ACS cohort NCT01000701
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Affiliation(s)
- Soheila Aghlmandi
- Institute of Social and Preventive Medicine (IPSM), University of Bern, Switzerland
- Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Switzerland
| | - Nadine Schärer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine (IPSM), University of Bern, Switzerland
- Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (IPSM), University of Bern, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - David Carballo
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - Sebastian Carballo
- Department of General Internal Medicine, University Hospital Geneva, Geneva, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, Canada
| | | | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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