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Attar A, Namvar S, Hosseinpour A, Azami P, Shekari A, Jamali L, Goudarzi N. Effect of different reperfusion strategies on recovery of ventricular function after ST-segment elevation myocardial infarction: A longitudinal single-center study. Health Sci Rep 2024; 7:e2220. [PMID: 38933425 PMCID: PMC11199175 DOI: 10.1002/hsr2.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Aims Although the clinical benefit of percutaneous coronary intervention (PCI) on cardiovascular outcomes has been widely investigated, the impact of this revascularization strategy compared to other alternatives on the degree of left ventricular function recovery is poorly demonstrated. In this regard, we investigated whether time delays between the presentation of ST-segment elevation myocardial infarction (STEMI) and PCI in reperfusion strategies have different impacts on left ventricular function recovery. Methods In this single-center study, all the patients who presented with STEMI and a reduced left ventricular ejection fraction (LVEF ≤ 40%) were enrolled. Included patients were subjected to four different treatment groups of primary, rescue (immediate transfer for angioplasty due to failed fibrinolytic therapy), facilitated (fibrinolytic therapy followed by angioplasty within 24 h), and deferred (successful fibrinolytic therapy and PCI after 24 h) PCI based on hospital facilities. Echocardiography was performed for all the patients at the time of hospitalization and 6 months later. Results A total of 128 patients were included in this study. The LVEF improved by 15.3 ± 6.3%, 11.5 ± 3.61%, 4.0 ± 1.0%, and -1.3 ± 7.0% in primary, rescue, facilitated, and deferred PCI groups, respectively (p < 0.001). Patients undergoing deferred PCI experienced a significantly lower improvement in LVEF compared with primary and rescue PCI (p < 0.001). Conclusion Primary PCI demonstrated the most promising recovery in left ventricular function following STEMI compared to other alternative strategies. Performing PCI as soon as possible provides better recovery of LVEF.
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Affiliation(s)
- Armin Attar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Soheila Namvar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Pouria Azami
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Arash Shekari
- Cardiovascular Diseases Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Leila Jamali
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Neda Goudarzi
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
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Coşkun G, Ozde C, Kayapinar O, Aktore G, Ekşi E, Afşin H, Sayın AE. The Relationship of Coronary Thrombus Burden and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Score in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2024; 30:10760296241237232. [PMID: 38644774 PMCID: PMC11036931 DOI: 10.1177/10760296241237232] [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: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND The anticoagulation and risk factors in atrial fibrillation (ATRIA) score is associated with adverse cardiovascular events. However, its relationship with coronary thrombus burden is unclear. Therefore, we aimed to investigate the relationship between the ATRIA score and thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). MATERIALS AND METHODS The study was designed as a prospective cross-sectional observational study. Our study included 319 patients who were prospectively admitted with STEMI between January 2021 and April 2022. Patients were divided into 2 groups with low thrombus burden (LTB) (grade <3) and high thrombus burden (HTB) (grade ≥3). ATRIA score was calculated and recorded for all patients. ATRIA scores of both groups were compared. RESULTS In our study, 58.9% (n = 188) of patients in the LTB group and 41% (n = 131) of patients in the HTB group. The ATRIA risk score (p < .001) was significantly higher in the HTB group. In multivariate logistic regression analysis, ATRIA score, glomerular filtration rate, hypertensıon, abciximab usage, and no-reflow were found to be independent predictors of HTB in STEMI patients undergoing primary PCI. In receiver operating characteristic analysis, ATRIA score >4 had a sensitivity of 66.2% and specificity of 95.2%, and ATRIA score >8 sensitivity of 98% and specificity of 100% predicted HTB. CONCLUSION In this study, we found that thrombus burden may be associated with ATRIA risk score in patients presenting with STEMI.
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Affiliation(s)
| | - Cem Ozde
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
| | | | | | - Ensar Ekşi
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
| | - Hamdi Afşin
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
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Quintal Martínez JP, Segura Campos MR. Bioactive compounds and functional foods as coadjuvant therapy for thrombosis. Food Funct 2023; 14:653-674. [PMID: 36601778 DOI: 10.1039/d2fo03171j] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death. The most common cardiovascular pathologies are thromboembolic diseases. Antithrombotic therapy prevents thrombus formation or dissolves that previously constituted. However, it presents a high rate of accidents such as gastric bleeding and cerebrovascular embolism. Plant foods and their secondary metabolites have been reported to regulate blood hemostasis. This review article aims to propose plant foods and their metabolites as adjuvant therapy for the management of thromboembolic diseases. Various databases were consulted, using antiplatelet, anticoagulant, and fibrinolytic as key terms. In total, 35 foods and 24 secondary metabolites, via in vitro, in vivo, and clinical studies, have been reported to regulate platelet aggregation, blood coagulation, and fibrinolysis. According to the studies presented in this review, plant foods with effects at concentrations less than 50 μg mL-1 and secondary metabolites with IC50 less than 100 μM can be considered agents with high antithrombotic potential. This review suggests that plant foods and their secondary metabolites should be used to develop foods, ingredients and nutraceuticals with functional properties. The evidence presented in this review shows that plant foods and their bioactive compounds could be used as adjuvants for the treatment and prevention of thrombotic complications. However, further in vivo and clinical trials are required to establish effective and safe doses.
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Shen M, Liao Y, Wang J, Zhou X, Guo Y, Nong Y, Guo Y, Lu H, Jin R, Wang J, Fu Z, Li D, Zhao S, Tian J. Intracoronary artery retrograde thrombolysis combined with percutaneous coronary interventions for ST-segment elevation myocardial infarction complicated with diabetes mellitus: A case report and literature review. Front Cardiovasc Med 2022; 9:962127. [PMID: 35935661 PMCID: PMC9354457 DOI: 10.3389/fcvm.2022.962127] [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: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background The management of a large thrombus burden in patients with acute myocardial infarction and diabetes is still a worldwide problem. Case presentation A 74-year-old Chinese woman presented with ST-segment elevation myocardial infarction (STEMI) complicated with diabetes mellitus and hypertension. Angiography revealed massive thrombus formation in the mid-segment of the right coronary artery leading to vascular occlusion. The sheared balloon was placed far from the occlusion segment and urokinase (100,000 u) was administered for intracoronary artery retrograde thrombolysis, and thrombolysis in myocardial infarction (TIMI) grade 3 blood flow was restored within 7 min. At last, one stent was accurately implanted into the culprit’s vessel. No-reflow, coronary slow flow, and reperfusion arrhythmia were not observed during this process. Conclusion Intracoronary artery retrograde thrombolysis (ICART) can be effectively and safely used in patients with STEMI along with diabetes mellitus and hypertension, even if the myocardial infarction exceeds 12 h (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).
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Affiliation(s)
- Mingzhi Shen
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yichao Liao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jian Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xinger Zhou
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuting Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingqiao Nong
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yi Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Haihui Lu
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Rongjie Jin
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jihang Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Zhenhong Fu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China
| | - Dongyun Li
- The First Department of Health Care, Second Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Dongyun Li,
| | - Shihao Zhao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- Shihao Zhao,
| | - Jinwen Tian
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Jinwen Tian,
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Esenboğa K, Şahin E, Özyüncü N, Tan TS, Atmaca Y. Apixaban for massive intracoronary thrombosis: A case series. Anatol J Cardiol 2021; 25:661-664. [PMID: 34498598 DOI: 10.5152/anatoljcardiol.2021.32746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kerim Esenboğa
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Ebru Şahin
- Department of Cardiology, Bilecik Training and Research Hospital; Bilecik-Turkey
| | - Nil Özyüncü
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Türkan Seda Tan
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Yusuf Atmaca
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
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Huang D, Qian J, Liu Z, Xu Y, Zhao X, Qiao Z, Fang W, Jiang L, Hu W, Shen C, Liang C, Zhang Q, Ge J. Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:710994. [PMID: 34409082 PMCID: PMC8364959 DOI: 10.3389/fcvm.2021.710994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To determine whether intracoronary pro-urokinase or tirofiban improves myocardial reperfusion during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: The study included patients with acute STEMI presenting within 12 h of symptoms at 11 hospitals in China between November 2015 and July 2017. Patients were randomized to receive selective intracoronary infusion of recombinant pro-urokinase (20 mg), tirofiban (10 μg/kg), or saline (20 mL) proximal to the infarct-related lesion over a 3-min period before stent implantation during primary PCI. The primary outcome was final corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) after PCI. Results: This study included 345 patients. Initial angiography identified a high-grade thrombus (TIMI 4–5) in 80% of patients. Final CTFC after PCI was significantly lower in the pro-urokinase (P < 0.001) and tirofiban (P < 0.001) groups than in the saline group and similar between the pro-urokinase and tirofiban groups (P > 0.05). The pro-urokinase (P = 0.008) and tirofiban groups (P = 0.022) had more complete ST-segment resolution at 2 h and lower peak creatine kinase-MB levels after PCI than the saline group (P = 0.006 and P = 0.023). The 30-day incidence of major adverse cardiac events was 4.5% in the pro-urokinase group, 3.4% in the tirofiban group, and 2.6% in the saline group. The incidence of in-hospital TIMI major bleeding events was low and comparable between groups. Conclusions: Adjunctive intracoronary pro-urokinase or tirofiban given before stent implantation during primary PCI improves myocardial reperfusion without increasing the incidence of major bleeding events.
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Affiliation(s)
- Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongjun Liu
- Department of Cardiology, Putuo District Central Hospital, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Tenth Hospital, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Shanghai, China
| | - Zengyong Qiao
- Department of Cardiology, Fengxian District Central Hospital, Shanghai, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Li Jiang
- Department of Cardiology, Tongren Hospital, Shanghai, China
| | - Wei Hu
- Department of Cardiology, Minhang District Central Hospital, Shanghai, China
| | - Chengxing Shen
- Department of Cardiology, Sixth Hospital, Shanghai, China
| | - Chun Liang
- Department of Cardiology, Changzheng Hospital, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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7
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Yalta K, Öztürk C, Yalta T, Özkan U. Intracoronary fibrinolysis: An effective yet underutilized therapeutic strategy in clinical practice. Anatol J Cardiol 2021; 25:598-599. [PMID: 34369891 DOI: 10.5152/anatoljcardiol.2021.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kenan Yalta
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Cihan Öztürk
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Tülin Yalta
- Department of Pathology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Uğur Özkan
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
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8
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Agarwal S, Agarwal SK. STEMI with flush occlusion of a coronary artery: An interventional dilemma. J Cardiol Cases 2021; 23:108-111. [PMID: 33717373 DOI: 10.1016/j.jccase.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/10/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
Flush occlusions of coronary arteries present with multiple challenges during primary percutaneous coronary intervention (PPCI). We describe a case of anterior ST-elevation myocardial infarction in cardiogenic shock, where it was not possible to identify the origin of left anterior descending artery (LAD) as it was flush occluded and initial attempts to place a coronary guidewire in the LAD during PPCI were unsuccessful. After failed attempts with multiple guidewires, a combined pharmacological-mechanical approach resulted in successful timely revascularization and subsequent recovery of the patient. <Learning objective: Acute flush occlusion of a major coronary artery is a challenge to interventionists as there may not be any clue of occluded coronary artery. In this difficult scenario, when the wire placement is not possible, the intracoronary infusion of a thrombolytic agent helps in visualization of stump of an occluded artery, facilitating its quick wiring and procedure.>.
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Affiliation(s)
- Shubham Agarwal
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, USA
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9
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Valizadeh A, Soltanabadi S, Koushafar S, Rezaee M, Jahankhah R. Comparison of QT dispersion in patients with ST elevation acute myocardial infarction (STEMI) before and after treatment by streptokinase versus primary percutaneous coronary intervention (PCI). BMC Cardiovasc Disord 2020; 20:493. [PMID: 33228554 PMCID: PMC7685573 DOI: 10.1186/s12872-020-01767-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background QT dispersion (QTD) represents inhomogeneous ventricular repolarization such that an increased QTD may predispose the heart to malignant ventricular arrhythmias (VAs). This study was conducted to compare QTD in patients with ST-elevation myocardial infarction (STEMI) before and after treatment by streptokinase (SK) versus primary percutaneous coronary intervention (PCI). Methods The present case–control study was conducted on 185 STEMI patients who received SK (115 cases) or underwent primary PCI (70 cases). QTD and QT corrected dispersion before and 24 h after treatment. Likewise, they were also found to correct fatal arrhythmias (VT and VF) during the first 24 h after admission, and ejection fraction (EF) 24 h after treatment was evaluated. Results QTD decreased in the primary PCI group, though no significant difference was seen between the two studied groups (P > 0.05). A significant increase was detected in the EF mean values for the primary PCI-treated patients (P = 0.022). Moreover, there was a significant reduction in QTD of patients with fatal arrhythmias in the primary PCI group (P = 0.022). Conclusion An overall QTD reduction in the primary PCI group and a significant decrease in QTD of patients with fatal arrhythmias in the primary PCI group show that this treatment strategy is more efficient than thrombolytic therapy. As an important indicator of proper myocardial function, EF can independently predict improved myocardial function in the primary PCI group.
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Affiliation(s)
- Abbas Valizadeh
- Department of Cardiology, Fasa University of Medical Sciences, Fasa, Iran
| | - Sahar Soltanabadi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
| | - Saeed Koushafar
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Maryam Rezaee
- Dermatology Department, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jahankhah
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Barua S, Geenty P, Deshmukh T, Ada C, Tanous D, Cooper M, Fahmy P, Denniss AR. The role of intracoronary thrombolysis in selected patients presenting with ST-elevation myocardial infarction: a case series. Eur Heart J Case Rep 2020; 4:1-10. [PMID: 33204968 PMCID: PMC7649476 DOI: 10.1093/ehjcr/ytaa227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 01/22/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022]
Abstract
Background Primary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies. Case summary This series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization. Discussion Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.
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Affiliation(s)
- Sumita Barua
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Paul Geenty
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Tejas Deshmukh
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Cuneyt Ada
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - David Tanous
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Mark Cooper
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Peter Fahmy
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Alan Robert Denniss
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
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Wang H, Feng M. Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2020; 99:e20402. [PMID: 32501985 PMCID: PMC7306376 DOI: 10.1097/md.0000000000020402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tirofiban is widely used in patients with acute ST elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI). This drug can efficiently improve myocardial perfusion and cardiac function, but its dose still remains controversial. We here investigated the effects of different dose of tirofiban on myocardial reperfusion and heart function in patients with STEMI. A total of 312 STEMI patients who underwent PCI in our hospital from March 2017 to March 2018 were enrolled and randomly divided into control group (75 cases, 0 μg/kg), low-dose group (79 cases, 5 μg/kg), medium-dose group (81 cases, 10 μg/kg) and high-dose group (77 cases, 20 μg/kg). The infarction-targeted artery flow grade evaluated by thrombolysis in myocardial infarction (TIMI), corrected TIMI frame count (CTFC) and sum-ST-segment resolution were recorded. At Day 7 and Day 30 after PCI, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, left ventricular end systolic diameter, major adverse cardiovascular events and the hemorrhage and thrombocytopenia were also evaluated. After PCI, the rate of TIMI grade 3, CTFC and incidence of sum-ST-segment resolution > 50% of high-dose group were significantly higher than those of control group, low-dose group and medium-dose group (P < .05), and the CTFC of medium -dose group were significantly higher than that of control group, low-dose group (P < .05). Moreover, the LVEF, left ventricular end diastolic diameter and left ventricular end systolic diameter of high-dose group were significantly improved than those of other groups, and the LVEF of medium-dose group was significantly superior to that of low-dose group (P < .05). However, the incidence of major adverse cardiac events in high-dose group was significantly decreased, while the hemorrhage and incidence of thrombocytopenia of high-dose group were significantly higher than those of other 3 groups (P < .05). The tirofiban can effectively alleviate the myocardial ischemia-reperfusion injury and promote the recovery of cardiac function in STEMI patients underwent PCI. Although the high-dose can enhance the clinical effects, it also increased the hemorrhagic risk. Therefore, the rational dosage application of tirofiban become much indispensable in view of patient's conditions and hemorrhagic risk, and a medium dose of 10 μg/kg may be appropriate for patients without high hemorrhagic risk.
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Affiliation(s)
- Haixia Wang
- Department Pharmacy, the Second Clinical Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Meiqin Feng
- AstraZeneca (Wuxi) trading co. LTD, Wuxi, Jiangsu, China
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Management of No-Reflow. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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