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Yildiz BS, Cetin N, Gunduz R, Bilge A, Ozgur S, Orman MN. Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit? Angiology 2022; 73:565-578. [PMID: 35104154 DOI: 10.1177/00033197211053404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We assessed the effect of thrombus aspiration (TA) during percutaneous coronary intervention (PCI) on in-hospital and 3-year mortality in consecutive non-ST segment elevation myocardial infarction (n = 189) and unstable angina pectoris (n = 148) patients (n = 337) between 2011 and 2016. In total, 153 patients (45.4%) underwent TA. The number of patients with postoperative thrombolysis in terms of myocardial infarction grade 3 blood flow (P < .001) and myocardial blush grade 3 (P < .001) were significantly higher in all TA groups. At 6-, 12- and 24-month post-PCI, the mean left ventricular ejection fraction was significantly higher in the all TA groups versus the stand alone PCI group (P < .001). Thrombus aspiration was associated with a significant improvement both in epicardial flow, myocardial perfusion and left ventricular ejection fraction. Thrombus aspiration during PCI in all acute coronary syndrome (except ST segment elevation) patients was associated with better survival compared with stand alone PCI group at 3-year follow-up (P = .019).
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Affiliation(s)
- Bekir S Yildiz
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Nurullah Cetin
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ramazan Gunduz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Adnan Bilge
- Department of Emergency Medicine, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet N Orman
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
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Saadat N, Saadatagah S, Aghajani Nargesi A, Alidoosti M, Poorhosseini H, Amirzadegan A, Lashkari R, Mortazavi SH, Jalali A, Ghodsi S, Salarifar M. Short-term safety and long-term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study. Catheter Cardiovasc Interv 2019; 95:1249-1256. [PMID: 31318488 DOI: 10.1002/ccd.28396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/25/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
AIM Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long-term outcomes in patients with and without stent postdilation. METHODS A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)-comprising cardiac death, nonfatal MI, and repeat revascularization-and the device-oriented composite endpoint (DOCE)-consisting of cardiac death, target lesion revascularization, and target vessel revascularization. RESULTS The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score-matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18-0.87], p = .021). CONCLUSIONS Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.
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Affiliation(s)
- Nasser Saadat
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Aghajani Nargesi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Reza Lashkari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Heusch G, Gersh BJ. The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge. Eur Heart J 2018; 38:774-784. [PMID: 27354052 DOI: 10.1093/eurheartj/ehw224] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/12/2016] [Indexed: 12/15/2022] Open
Abstract
The incidence of ST segment elevation myocardial infarction (STEMI) has decreased over the last two decades in developed countries, but mortality from STEMI despite widespread access to reperfusion therapy is still substantial as is the development of heart failure, particularly among an expanding older population. In developing countries, the incidence of STEMI is increasing and interventional reperfusion is often not available. We here review the pathophysiology of acute myocardial infarction and reperfusion, notably the temporal and spatial evolution of ischaemic and reperfusion injury, the different modes of cell death, and the resulting coronary microvascular dysfunction. We then go on to briefly characterize the cardioprotective phenomena of ischaemic preconditioning, ischaemic postconditioning, and remote ischaemic conditioning and their underlying signal transduction pathways. We discuss in detail the attempts to translate conditioning strategies and drug therapy into the clinical setting. Most attempts have failed so far to reduce infarct size and improve clinical outcomes in STEMI patients, and we discuss potential reasons for such failure. Currently, it appears that remote ischaemic conditioning and a few drugs (atrial natriuretic peptide, exenatide, metoprolol, and esmolol) reduce infarct size, but studies with clinical outcome as primary endpoint are still underway.
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Affiliation(s)
- Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN, USA
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Keskin M, Kaya A, Tatlısu MA, Uzman O, Börklü EB, Çinier G, Tekkeşin Aİ, Türkkan C, Hayıroğlu Mİ, Kozan Ö. Effect of Adjunctive Thrombus Aspiration on In-Hospital and 3-Year Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and Large Native Coronary Artery Thrombus Burden. Am J Cardiol 2017; 120:1708-1714. [PMID: 28864320 DOI: 10.1016/j.amjcard.2017.07.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/03/2023]
Abstract
Although the long-term clinical benefit of adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) remains controversial, the impact of TA in patients with large thrombus has not been evaluated. The aim of the present study was to investigate the effect of adjunctive TA during PPCI on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and a large thrombus. We assessed the effect of adjunctive TA on in-hospital and 3-year clinical outcomes in 627 patients with STEMI and a large thrombus in the native coronary artery. The cumulative 3-year incidence of all-cause death was not significantly different between the 2 groups (91.5% vs 89.0%, log-rank test p = 0.347). After adjusting for confounders, the risk of all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio 1.11, 95% confidence interval 0.60 to 3.54, p = 0.674). The adjusted risks of target lesion revascularization, nonfatal acute myocardial infarction, and stent thrombosis were also not significantly different between the 2 groups. In conclusion, adjunctive TA during PPCI was not associated with better in-hospital and 3-year all-cause deaths in patients with STEMI and a large coronary artery thrombus.
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Affiliation(s)
- Muhammed Keskin
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
| | - Adnan Kaya
- Department of Cardiology, Duzce University, Duzce, Turkey
| | - Mustafa Adem Tatlısu
- Texas A&M Institute for Preclinical Studies, Department of Cardiovascular Sciences, Texas A&M University, College Station, Texas
| | - Osman Uzman
- Training and Research Hospital, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Edibe Betül Börklü
- Training and Research Hospital, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Göksel Çinier
- Training and Research Hospital, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Training and Research Hospital, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Ceyhan Türkkan
- Training and Research Hospital, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ömer Kozan
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Tilsted HH, Olivecrona GK. To Aspirate or Not to Aspirate: That Is the Question. JACC Cardiovasc Interv 2016; 8:585-7. [PMID: 25907085 DOI: 10.1016/j.jcin.2015.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hans-Henrik Tilsted
- Department of Cardiology, Rigshospitalet/Copenhagen University Hospital, Copenhagen, Denmark
| | - Goran K Olivecrona
- Department of Cardiology, Rigshospitalet/Copenhagen University Hospital, Copenhagen, Denmark.
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Weipert KF, Bauer T, Nef HM, Möllmann H, Hochadel M, Marco J, Weidinger F, Zeymer U, Gitt AK, Hamm CW. Use and outcome of thrombus aspiration in patients with primary PCI for acute ST-elevation myocardial infarction: results from the multinational Euro Heart Survey PCI Registry. Heart Vessels 2015; 31:1438-45. [DOI: 10.1007/s00380-015-0754-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/25/2015] [Indexed: 01/08/2023]
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Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Cung TT, Morel O, Cayla G, Rioufol G, Garcia-Dorado D, Angoulvant D, Bonnefoy-Cudraz E, Guérin P, Elbaz M, Delarche N, Coste P, Vanzetto G, Metge M, Aupetit JF, Jouve B, Motreff P, Tron C, Labeque JN, Steg PG, Cottin Y, Range G, Clerc J, Claeys MJ, Coussement P, Prunier F, Moulin F, Roth O, Belle L, Dubois P, Barragan P, Gilard M, Piot C, Colin P, De Poli F, Morice MC, Ider O, Dubois-Randé JL, Unterseeh T, Le Breton H, Béard T, Blanchard D, Grollier G, Malquarti V, Staat P, Sudre A, Elmer E, Hansson MJ, Bergerot C, Boussaha I, Jossan C, Derumeaux G, Mewton N, Ovize M. Cyclosporine before PCI in Patients with Acute Myocardial Infarction. N Engl J Med 2015; 373:1021-31. [PMID: 26321103 DOI: 10.1056/nejmoa1505489] [Citation(s) in RCA: 506] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Experimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODS In a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTS A total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval [CI], 0.78 to 1.39; P=0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONS In patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. (Funded by the French Ministry of Health and NeuroVive Pharmaceutical; CIRCUS ClinicalTrials.gov number, NCT01502774; EudraCT number, 2009-013713-99.).
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Affiliation(s)
- Thien-Tri Cung
- From Centre Hospitalier Universitaire (CHU) Arnaud de Villeneuve (T.-T.C.) and Clinique du Millénaire (C.P.), Montpellier, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (O.M.), CHU de Nimes, Nimes (G.C.), Hôpital Cardiovasculaire Louis Pradel (G. Rioufol, E.B.-C., C.B., I.B., C.J., G.D., N.M., M.O.), Claude Bernard University (G. Rioufol, E.B.-C., C.B., I.B., C.J., G.D., N.M., M.O.), Centre Hospitalier Saint-Joseph et Saint-Luc (J.-F.A.), Clinique de la Sauvegarde (V.M.), Clinique du Tonkin (P.S.), Clinical Investigation Center and Explorations Fonctionnelles Cardiovasculaires (C.B., I.B., C.J., G.D., N.M., M.O.), Lyon, CHU de Tours (D.A.) and Clinique Saint-Gatien (D.B.), Tours, Hôpital Guillaume et René Laennec, Nantes (P.G.), CHU de Rangueil, Toulouse (M.E.), Centre Hospitalier de Pau, Pau (N.D.), Hôpital Haut Lévèque, Bordeaux (P. Coste), Hôpital A. Michallon-CHU de Grenoble, Grenoble (G.V.), Hôpital Henri Duffau, Avignon (M.M.), Centre Hospitalier du Pays d'Aix, Aix-en-Provence (B.J.), Hôpital Gabriel Montpied, Clermont Ferrand (P.M.), Hôpital Charles Nicolle, Rouen (C.T.), Clinique de la Fourcade, Bayonne (J.-N.L.), Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris (P.G.S.), Hôpital du Bocage, Dijon (Y.C.), Centre Hospitalier General, Chartres (G. Range), Centre Hospitalier de Compiègne, Compiègne (J.C.), CHU d'Angers, Angers (F.P.), CHU de Nancy-Brabois, Vandœuvre-lès-Nancy (F.M.), CHU de Mulhouse (O.R.) and Clinique du Diaconat (O.I.), Mulhouse, Centre Hospitalier d'Annecy, Annecy (L.B.), Polyclinique des Fleurs, Ollioules (P.B.), Hôpital de La Cavale Blanche, Brest (M.G.), Clinique Esquirol, Agen (P. Colin, F.D.P.), Institut Jacques Cartier, Massy (M.-C.M.), Centre Hospitalier Henri Mondor, Créteil (J.-L.D.-R.), Hôpital Claude Galien, Quincy sous Sénat (T.U.), Hôpital Pontchaillou, Rennes (H.L.B.), Clinique de l'Ormeau, Tarbes (T.B.), Hôpital de la Côte de Nacre, Caen (G.G.), and Hôpital Cardi
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9
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (M.V., D.L.B.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (M.V., D.L.B.)
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