1
|
Bianchini E, Lombardi M, Buonpane A, Ricchiuto A, Maino A, Laborante R, Anastasia G, D'Amario D, Aurigemma C, Romagnoli E, Leone AM, D'Ascenzo F, Trani C, Crea F, Porto I, Burzotta F, Vergallo R. Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials. Int J Cardiol 2024; 397:131590. [PMID: 37979785 DOI: 10.1016/j.ijcard.2023.131590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI). METHODS PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA. RESULTS A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04). CONCLUSION TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.
Collapse
Affiliation(s)
- Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Maino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianluca Anastasia
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
2
|
Comparison of Successful Myocardial Reperfusion and Adverse Events in Patients With ST-Elevation Myocardial Infarction Who Underwent Rescue Percutaneous Coronary Intervention After Failed Fibrinolytic Therapy With Versus Without Manual Coronary Thrombus Aspiration. Am J Cardiol 2015; 116:1185-92. [PMID: 26298304 DOI: 10.1016/j.amjcard.2015.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 12/29/2022]
Abstract
It has been unclear the impact of manual thrombus aspiration (TA) on procedural outcomes in patients with ST-elevation myocardial infarction (STEMI) who underwent rescue percutaneous coronary intervention (PCI) after failed fibrinolytic therapy in comparison with primary PCI. Our aim was to test the hypothesis that manual TA may improve myocardial reperfusion and clinical outcomes in patients with STEMI who underwent rescue PCI after failed fibrinolytic therapy. From March 2011 to March 2014, 70 patients with STEMI after unsuccessful fibrinolysis were randomized to either rescue PCI with TA (TA group) or without TA (NTA group). Primary end points were rate of myocardial blush grade ≥2 and ST-segment resolution ≥70%. The secondary end point included 30 days follow-up for major adverse cardiac events (MACEs). Baseline clinical and angiographic characteristics were similar in the 2 groups. The TA and NTA groups were compared as follows: myocardial blush grade ≥2, 71% versus 46% (p <0.05); complete ST-segment resolution 71% versus 46% (p <0.05); no reflow 20% versus 49% (p <0.05); procedure time (min) 65.0 ± 38.6 versus 90.1 ± 28.8 (p <0.05); contrast amount (ml) 99.0 ± 45.2 versus 121.2 ± 33.4 (p <0.05); and direct stenting 60% versus 37% (p <0.05). There was a significant reduction of MACE in the TA group, 20% versus 37% (p <0.05). In conclusion, rescue PCI with manual TA leads to better myocardial reperfusion and significant reduction of MACE.
Collapse
|
3
|
Rathod KS, Hamshere SM, Choudhury TR, Jones DA, Mathur A. Use of Thrombectomy Devices in Primary Percutaneous Interventions for ST-elevation Myocardial Infarction - An Update. Interv Cardiol 2014; 9:102-107. [PMID: 29588786 DOI: 10.15420/icr.2011.9.2.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion modality in patients with ST-elevation myocardial infarction (STEMI). While PPCI is highly effective in achieving epicardial coronary reperfusion, a significant proportion of patients fail to achieve adequate myocardial reperfusion. This is in part due to the distal microembolisation of thrombus and plaque debris during PCI. Recognition of this has led to the development of a number of devices with different mechanisms of action that aim to reduce such distal embolisation and therefore improve end myocardial perfusion. Study results of thrombectomy devices however have been largely inconsistent, especially about clinical outcome data, and several meta-analyses have been carried out as a result. This review aims to critically analyse the literature data on thrombectomy during PPCI, taking into account the most recent studies and the latest meta-analyses looking to see whether thrombectomy use is associated with improved outcomes.
Collapse
Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Health NHS Trust.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London.,NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London
| | - Stephen M Hamshere
- Department of Cardiology, Barts Health NHS Trust.,NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London
| | - Tawfiq R Choudhury
- Department of Cardiology, Barts Health NHS Trust.,NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London
| | - Daniel A Jones
- Department of Cardiology, Barts Health NHS Trust.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London.,NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London.,NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London
| |
Collapse
|
4
|
Boztosun B, Acar RD. Treating thrombus in the coronary arteries. Herz 2013; 40:60-5. [PMID: 23925412 DOI: 10.1007/s00059-013-3920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
Primary percutaneous coronary intervention (PCI) has greatly improved outcomes in patients with ST-elevation myocardial infarction (STEMI) and has, therefore, become the preferred reperfusion strategy for this patient group. The goal of primary PCI is to achieve a thrombolysis in myocardial infarction (TIMI) 3 flow and also to restore adequate perfusion at the myocardial level. Distal thrombus embolization during primary PCI occurs frequently and is also associated with compromised long-term outcomes. In this article, we provide an overview of the treatment of thrombus and the role of thrombectomy in PCI for STEMI.
Collapse
Affiliation(s)
- B Boztosun
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Mevlanakapi Mah. Dingil Sok. No: 23/5, Sehremini/Fatih, İstanbul, Turkey
| | | |
Collapse
|
5
|
Weitsman T, Meerkin D. Primary percutaneous coronary intervention: devices to prevent no-reflow phenomenon. Interv Cardiol 2013. [DOI: 10.2217/ica.13.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
6
|
Horne A, Chacko M. Thrombectomy Devices in Coronary Intervention. Interv Cardiol Clin 2013; 2:347-359. [PMID: 28582141 DOI: 10.1016/j.iccl.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary percutaneous coronary intervention is the favored mode of reperfusion therapy for ST-elevation myocardial infarction (STEMI) when able to be performed in a timely fashion in appropriately selected patients. However, controversy about the role of coronary thrombectomy in the management of STEMI persists because of a paucity of favorable historical data. After the TAPAS trial thrombectomy has gained favor in recent years. The results of the TOTAL, TASTE, and SMART percutaneous coronary intervention trials will provide further insight into the use of thrombectomy in STEMI. This article examines the relevant trial evidence regarding how to best manage and apply thrombectomy in clinical practice.
Collapse
Affiliation(s)
- Aaron Horne
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Matthews Chacko
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| |
Collapse
|
7
|
Costopoulos C, Gorog DA, Di Mario C, Kukreja N. Use of thrombectomy devices in primary percutaneous coronary intervention: A systematic review and meta-analysis. Int J Cardiol 2013; 163:229-241. [DOI: 10.1016/j.ijcard.2011.11.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/30/2011] [Accepted: 11/04/2011] [Indexed: 12/23/2022]
|
8
|
Mehta S, Kostela JC, Oliveros E, Flores AI, Pena C, Cohen S, Rowen R, Treto K. Compulsive Thrombus Management in STEMI Interventions. Interv Cardiol Clin 2012; 1:485-505. [PMID: 28581966 DOI: 10.1016/j.iccl.2012.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Thrombus is a fundamental concept in the pathophysiology of ST-elevated myocardial infarction (STEMI). Distal embolization and no reflow are associated with less angiographic success, reduced myocardial blush, less ST resolution after primary percutaneous coronary intervention, larger enzymatic infarct size, lower left ventricular ejection fraction at discharge, and higher long-term mortality. We believe that with the use of thrombectomy devices, these shortcomings can be minimized. Based on our experience from the Single Individual Community Experience Registry (SINCERE) database, we formulated a selective thrombus burden management strategy (the Mehta classification) for thrombus management.
Collapse
Affiliation(s)
- Sameer Mehta
- Miller School of Medicine, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA; Mercy Medical Center, 3663 South Miami Avenue, FL 33133, USA; Lumen Foundation, 55 Pinta Road, Miami, FL 33133, USA.
| | - Jennifer C Kostela
- Internal Medicine, New York Hospital Queens, 56-45 Main Street, Flushing, NY 11355, USA; Ross University School of Medicine, 630 US Highway 1, North Brunswick, NJ 08902, USA
| | | | | | - Camilo Pena
- Lumen Foundation, 55 Pinta Road, Miami, FL 33133, USA
| | - Salomon Cohen
- Departamento de Neurocirugia, Instituto Mexicano del Seguro Social, Avenida Club de Golf #3 Torre A Dep. 1501, Lomas Country, Huixquilucan Edo de Mexico, 52779, Mexico
| | - Rebecca Rowen
- Ross University School of Medicine, 630 US Highway 1, North Brunswick, NJ 08902, USA
| | - Kevin Treto
- Ross University School of Medicine, 786 Seneca Meadows Road, Winter Springs, FL 32708, USA
| |
Collapse
|
9
|
AHMED TAREKAN, ATARY JAELZ, WOLTERBEEK RON, HASAN-ALI HOSAM, ABDEL-KADER SAMIRS, SCHALIJ MARTINJ, JUKEMA JWOUTER. Aspiration Thrombectomy During Primary Percutaneous Coronary Intervention as Adjunctive Therapy to Early (in-ambulance) Abciximab Administration in Patients with Acute ST Elevation Myocardial Infarction: An Analysis from Leiden MISSION! Acute Myocardial I. J Interv Cardiol 2011; 25:1-9. [DOI: 10.1111/j.1540-8183.2011.00686.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
10
|
Tamhane UU, Chetcuti S, Hameed I, Grossman PM, Moscucci M, Gurm HS. Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2010; 10:10. [PMID: 20187958 PMCID: PMC2838805 DOI: 10.1186/1471-2261-10-10] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 02/26/2010] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI) in patients with acute ST elevation myocardial infarction (STEMI) have produced conflicting results. The objective of our study was to systematically evaluate currently available data comparing thrombectomy followed by PCI with conventional PCI alone in patients with acute STEMI. METHODS Seventeen randomized trials (n = 3,909 patients) of thrombectomy versus PCI were included in this meta-analysis. We calculated the summary odds ratios for mortality, stroke, post procedural myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) grade flow, and post procedural ST segment resolution (STR) using random-effects and fixed-effects models. RESULTS There was no difference in risk of 30-day mortality (44/1914 vs. 50/1907, OR 0.84, 95% CI 0.54-1.29, P = 0.42) among patients randomized to thrombectomy, compared with conventional PCI. Thrombectomy was associated with a significantly greater likelihood of TIMI 3 flow (1616/1826 vs. 1533/1806, OR 1.41, P = 0.007), MBG 3 (730/1526 vs. 486/1513, OR 2.42, P < 0.001), STR (923/1500 vs. 715/1494, OR 2.30, P < 0.001), and with a higher risk of stroke (14/1403 vs. 3/1413, OR 2.88, 95% CI 1.06-7.85, P = 0.04). Outcomes differed significantly between different device classes with a trend towards lower mortality with manual aspiration thrombectomy (MAT) (21/949 vs.36/953, OR 0.59, 95% CI 0.35-1.01, P = 0.05), whereas mechanical devices showed a trend towards higher mortality (20/416 vs.10/418, OR 2.07, 95% CI 0.95-4.48, P = 0.07). CONCLUSIONS Thrombectomy devices appear to improve markers of myocardial perfusion in patients undergoing primary PCI, with no difference in overall 30-day mortality but an increased likelihood of stroke. The clinical benefits of thrombectomy appear to be influenced by the device type with a trend towards survival benefit with MAT and worsening outcome with mechanical devices.
Collapse
Affiliation(s)
- Umesh U Tamhane
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stanley Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Irfan Hameed
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - P Michael Grossman
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Mauro Moscucci
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Mongeon FP, Bélisle P, Joseph L, Eisenberg MJ, Rinfret S. Adjunctive thrombectomy for acute myocardial infarction: A bayesian meta-analysis. Circ Cardiovasc Interv 2010; 3:6-16. [PMID: 20118149 DOI: 10.1161/circinterventions.109.904037] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In available trials and meta-analyses, adjunctive thrombectomy in acute myocardial infarction (MI) improves markers of myocardial reperfusion but has limited effects on clinical outcomes. Thrombectomy devices simply aspirate thrombus or mechanically fragment it before aspiration. Simple aspiration thrombectomy may offer a distinct advantage. METHODS AND RESULTS We identified 21 eligible trials (16 that used a simple aspiration thrombectomy device) involving 4299 patients with ST-segment elevation MI randomized to reperfusion therapy by primary percutaneous coronary intervention with or without thrombectomy. By using Bayesian meta-analysis methods, we found that thrombectomy yielded substantially less no-reflow (odds ratio [OR], 0.39; 95% credible interval [CrI], 0.18 to 0.69), more ST-segment resolution > or =50% (OR, 2.22; 95% CrI, 1.60 to 3.23), and more thrombolysis in myocardial infarction/myocardial perfusion grade 3 (OR, 2.50; 95% CrI, 1.48 to 4.41). There was no evidence for a decrease in death (OR, 0.94; 95% CrI, 0.47 to 1.80), death, recurrent MI, or stroke (OR, 1.07; 95% CrI, 0.63 to 1.92) with thrombectomy. Restriction of the analysis to trials that used simple aspiration thrombectomy devices did not yield substantially different results, except for a positive effect on postprocedure thrombolysis in myocardial infarction grade 3 flow (OR, 1.49; 95% CrI, 1.14 to 1.99). CONCLUSIONS In this Bayesian meta-analysis, adjunctive thrombectomy improves early markers of reperfusion but does not substantially effect 30-day post-MI mortality, reinfarction, and stroke. The use of aspiration thrombectomy devices is not associated with a reduction in post-MI clinical outcomes. Thrombectomy is one of the rare effective preventive measures against no-reflow.
Collapse
Affiliation(s)
- François-Pierre Mongeon
- Department of Medicine, Echocardiography, and Noninvasive Cardiology Service, Montreal Heart Institute, Canada
| | | | | | | | | |
Collapse
|
12
|
Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study. Int J Cardiovasc Imaging 2009; 26:125-33. [PMID: 19802729 DOI: 10.1007/s10554-009-9513-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
Whether distal protection devices (DPDs) during percutaneous coronary intervention (PCI) can improve myocardial function in patients with acute myocardial infarction (AMI) is still under debate. Using tissue Doppler imaging (TDI), we evaluate the global and regional left ventricular systolic and diastolic functions in patients with anterior AMI using DPDs compared with conventional PCI. Ninety-six patients with anterior AMI were randomly assigned to either PCI with DPDs (DPD, n = 46) or traditional PCI (control, n = 50) groups. At the 3- and 6-month follow-ups, the DPD group had a higher left ventricular ejection fraction than the control group (51.6 +/- 3.6 vs. 49.3 +/- 5.3% and 53.0 +/- 3.7 vs. 50.8 +/- 5.2%, respectively; both P < 0.05). Moreover, peak systolic (S (a)) and early diastolic (E (a)) mitral annular velocities obtained by TDI were significantly higher in the DPD group than in the control group (S (a): 7.57 +/- 0.53 vs. 7.12 +/- 0.62 cm/s and 7.71 +/- 0.63 vs. 7.32 +/- 0.59 cm/s; E (a): 7.23 +/- 0.78 vs. 6.89 +/- 0.86 cm/s and 7.49 +/- 0.69 vs. 7.04 +/- 0.85 cm/s, respectively; all P < 0.05). However, systolic and diastolic regional myocardial velocities significantly improved in the DPD group from the 1-month follow-up compared with those in the control group (all P < 0.05). Patients who received treatment with DPDs experienced enhanced improvement of cardiac function. Thus, anterior AMI patients can benefit from DPDs during PCI.
Collapse
|