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Kotronias RA, Marin F, Emfietzoglou M, Langrish JP, Lucking AJ, Channon KM, Banning AP, De Maria GL. Rationale and Design of a Randomized Controlled Pilot Trial to Assess Stent Retriever Thrombectomy for Thrombus Burden Reduction in Patients with Acute Myocardial Infarction: The RETRIEVE-AMI Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:75-85. [PMID: 36894360 DOI: 10.1016/j.carrev.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is typically caused by thrombotic occlusion of a coronary artery with subsequent hypoperfusion and myocardial necrosis. In approximately half of patients with STEMI, despite successful restoration of epicardial coronary patency, downstream myocardium perfusion remains impeded. Coronary microvascular injury is one of the key mechanisms behind suboptimal myocardial perfusion and it is primarily, yet not exclusively, related to distal embolization of atherothrombotic material following recanalization of the culprit artery. Routine manual thrombus-aspiration has failed to show clinical efficacy in this scenario. This could be related with limitations in technology adopted as well as patients' selection. To this end, we set out to explore the efficacy and safety of stent retriever-assisted thrombectomy based on clot-removal device routinely used in stroke intervention. STUDY DESIGN AND OBJECTIVES The stent RETRIEVEr thrombectomy for thrombus burden reduction in patients with Acute Myocardial Infarction (RETRIEVE-AMI) study has been designed to establish whether stent retriever-based thrombectomy is safe and more efficacious in thrombus modification than the current standard of care: manual thrombus aspiration or stenting. The RETRIEVE-AMI trial will enrol 81 participants admitted for primary PCI for inferior STEMI. Participants will be 1:1:1 randomised to receive either standalone PCI, thrombus aspiration and PCI, or retriever-based thrombectomy and PCI. Change in thrombus burden will be assessed via optical coherence tomography imaging. A telephone follow-up at 6 months will be arranged. CONCLUSIONS It is anticipated by the investigators that stent retriever thrombectomy will more effectively reduce the thrombotic burden compared to current standard of care whilst being clinically safe.
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Affiliation(s)
- Rafail A Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Federico Marin
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Maria Emfietzoglou
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy P Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew J Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Keith M Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
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Low AF, Wongpraparut N, Chunhamaneewat N, Jeamanukoolkit A, Jhung LT, Zhen-Vin L, Tan CT, Hwa HH, Rajagopal R, Yahya AF, Kaur R, Narang M, West NEJ. Clinical use of optical coherence tomography during percutaneous coronary intervention and coronary procedures in Southeast Asia: a survey-based expert consensus summary. ASIAINTERVENTION 2023; 9:25-31. [PMID: 36936105 PMCID: PMC10015489 DOI: 10.4244/aij-d-22-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 03/14/2023]
Abstract
Optical coherence tomography (OCT), an established intravascular imaging technique, enables rapid acquisition of high-resolution images during invasive coronary procedures to assist physician decision-making. OCT has utility in identifying plaque/lesion morphology (e.g., thrombus, degree of calcification, and presence of lipid) and vessel geometry (lesion length and vessel diameter) and in guiding stent optimisation through identification of malapposition and underexpansion. The use of OCT guidance during percutaneous coronary interventions (PCI) has demonstrated improved procedural and clinical outcomes in longitudinal registries, although randomised controlled trial data remain pending. Despite growing data and guideline endorsement to support OCT guidance during PCI, its use in different countries is not well established. This article is based on an advisory panel meeting that included experts from Southeast Asia (SEA) and is aimed at understanding the current clinical utility of intracoronary imaging and OCT, assessing the barriers and enablers of imaging and OCT adoption, and mapping a path for the future of intravascular imaging in SEA. This is the first Southeast Asian consensus that provides insights into the use of OCT from a clinician's point of view.
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Affiliation(s)
- Adrian F Low
- National University Heart Centre Singapore, National University Hospital, Singapore
| | - Nattawut Wongpraparut
- Cardiac Catheterisation Laboratory, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Lee Zhen-Vin
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | - Achmad Fauzi Yahya
- Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital- Bandung, Indonesia
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Yin Y, Lei F, Fang C, Jiang S, Xu X, Sun S, Pei X, Jia R, Tang C, Peng C, Li S, Li L, Wang Y, Yu H, Dai J, Yu B. Predictors of Adverse Prognosis in Patients With Acute Coronary Syndrome Caused by Plaque Erosion With a Nonstent Strategy. J Am Heart Assoc 2022; 11:e026414. [PMID: 36533592 PMCID: PMC9798785 DOI: 10.1161/jaha.122.026414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The EROSION (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion) study demonstrated that antithrombotic therapy without stenting was safe and feasible in selected patients with acute coronary syndrome caused by plaque erosion. However, the factors related to the prognosis of these patients are not clear. This study aimed to explore the predictors of an adverse prognosis of a nonstent strategy in a larger sample size. Methods and Results A total of 252 (55 patients were from the EROSION study) patients with acute coronary syndrome with plaque erosion who met the inclusion criteria of the EROSION study and completed clinical follow-up were enrolled. Patients were divided into 2 groups according to the occurrence of major adverse cardiovascular events (MACE), which were defined as the composite of cardiac death, recurrent myocardial infarction, ischemia-driven target lesion revascularization, rehospitalization because of unstable or progressive angina, major bleeding, and stroke. Among 232 patients with acute coronary syndrome included in the final analysis, 50 patients (21.6%) developed MACE at a median follow-up of 2.9 years. Compared with patients without MACE, patients with MACE were older and had a higher degree of percentage of area stenosis (72.2%±9.4% versus 64.2%±15.7%, P<0.001) and thrombus burden (24.4%±10.4% versus 20.4%±10.9%, P=0.010) at baseline. Multivariate Cox regression analysis confirmed that age, percentage of area stenosis, and thrombus burden were predictors of MACE. The best cutoff values of predictors were age ≥60 years, percentage of area stenosis ≥63.5%, and thrombus burden ≥18.5%, respectively, and when they were all present, the rate of MACE rose to 57.7%. Conclusions The nonstent treatment strategy of patients with acute coronary syndrome caused by plaque erosion was heterogeneous, and patients aged ≥60 years, percentage of area stenosis ≥63.5%, and thrombus burden ≥18.5% may predict a worse clinical outcome.
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Affiliation(s)
- Yanwei Yin
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Fangmeng Lei
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Chao Fang
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Senqing Jiang
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Xueming Xu
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Sibo Sun
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Xueying Pei
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Ruyi Jia
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Caiying Tang
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Cong Peng
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Song Li
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Lulu Li
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Yini Wang
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Huai Yu
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Jiannan Dai
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
| | - Bo Yu
- Department of CardiologySecond Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of EducationHarbinChina
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Bonnet M, Marliere S, Mathieu V, Tronchi A, Delarche N, Abdellaoui M, Dubreuil O, Boueri Z, Chettibi M, Souteyrand G, Durier C, Bouisset F, Belle L. Safety of conservative management for non-stenotic culprit lesions in STEMI patients treated with a two-step reperfusion strategy: a SUPER-MIMI sub-study. Cardiovasc Diagn Ther 2022; 12:220-228. [PMID: 35433343 PMCID: PMC9011086 DOI: 10.21037/cdt-21-631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/02/2022] [Indexed: 08/21/2023]
Abstract
BACKGROUND In the observational SUPER-MIMI study, a minimalist immediate mechanical intervention (MIMI) technique-which involves restoring blood flow in the acute phase and postponing stenting-was shown to be safe and effective among patients with a high thrombotic burden after ST-segment elevation myocardial infarction (STEMI). We aim to assess whether a non-stenting strategy after a SUPER-MIMI strategy was safe at 4-year follow-up in patients enrolled in the SUPER-MIMI study who were not stented. METHODS This prospective cohort study assessed the long-term outcomes of a subgroup of patients included in the SUPER-MIMI study. RESULTS Among the 155 patients enrolled in the SUPER-MIMI study, 57 patients (36.8%) benefited from a conservative management (without stenting or balloon angioplasty) and were included in the current substudy. The mean duration of follow-up was 4.1±1.0 years. Four patients (7.0%) presented definite culprit lesion re-thrombosis, all of which occurred in the right coronary artery. The re-thrombosis rate appeared to be higher among patients with larger vessels: 2.9%, 8.3%, and 28.6% in arteries with diameters of 3-<4, 4-<5, and ≥5 mm, respectively. The overall rate of target lesion revascularization was 10.5%. There was one cardiac death and three rehospitalizations for heart failure. Overall, 82.5% of patients remained event free at a mean of 4.1±1.0 years. CONCLUSIONS Conservative management of non-stenotic culprit lesions after a SUPER-MIMI strategy was associated with a high rate of re-thrombosis, particularly in patients with large coronary arteries.
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Affiliation(s)
- Marc Bonnet
- Département de Cardiologie, Hôpital Universitaire de la Croix Rousse, Lyon, France
| | | | - Victor Mathieu
- Département de Cardiologie, Centre Hospitalier Annecy Genevois, Metz-Tessy, France
| | - Allan Tronchi
- Département de Cardiologie, Centre Hospitalier Annecy Genevois, Metz-Tessy, France
| | - Nicolas Delarche
- Département de Cardiologie, Centre Hospitalier de Pau, Pau, France
| | - Mohamed Abdellaoui
- Département de Cardiologie, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Olivier Dubreuil
- Département de Cardiologie, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Ziad Boueri
- Département de Cardiologie, Centre Hospitalier de Bastia, Bastia, France
| | - Mohamed Chettibi
- Département de Cardiologie, Hôpital Universitaire, Bilda, Algerie
| | - Geraud Souteyrand
- Département de Cardiologie, Hôpital Universitaire, Clermont Ferrand, France
| | - Chloé Durier
- Département de Cardiologie, Centre Hospitalier Argenteuil, Argenteuil, France
| | | | - Loic Belle
- Département de Cardiologie, Centre Hospitalier Annecy Genevois, Metz-Tessy, France
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Xie Z, Liu X, Huang X, Liu Q, Yang M, Huang D, Zhao P, Tian J, Wang X, Hou J. Remodelling of gut microbiota by Berberine attenuates trimethylamine N-oxide-induced platelet hyperreaction and thrombus formation. Eur J Pharmacol 2021; 911:174526. [PMID: 34599914 DOI: 10.1016/j.ejphar.2021.174526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/05/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022]
Abstract
Berberine is an extract derived from Chinese herbs with pleiotropic cardiovascular protective effects. However, the underlying mechanism remains unclear because of its poor bioavailability. Herin, we aimed to investigate whether berberine affects choline diet-induced arterial thrombosis and explore the potential mechanism. Ultrasound and optical coherence tomography were used to assess the potential risk of artery thrombosis in vivo. The plasma concentrations of trimethylamine N-oxide (TMAO) and trimethylamine (TMA) were quantified with mass spectrometry. Enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qPCR) were utilized to detect the levels of microbial TMA-lyase choline utilization C (CutC) in faeces. Gut microbiota analysis was performed with 16S rRNA gene sequencing. For in vitro studies, platelet aggregometry, intracellular Ca2+ measurement, ATP release assay, flow cytometry and Western blot were applied to identify the effects of TMAO on platelets. Berberine treatment significantly decreased the CutC levels in the caecal contents, reduced choline diet-induced TMA and TMAO production, and subsequently, reduced the arterial thrombosis potential risk. Berberine administration remodelled the structure of gut microbiota in rats and increased the levels of the genus Lactobacillus. Finally, TMAO enhanced platelet reactivity to collagen by promoting the phosphorylation levels of extracellular signal-regulated kinase 1/2 (ERK1/2) and Jun N-terminal kinase (JNK) in platelets. These results demonstrate that berberine attenuates the risk of choline diet-induced arterial thrombosis by changing the gut microbial composition and reducing TMAO generation.
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Affiliation(s)
- Zulong Xie
- Department of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xinxin Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China
| | - Xingtao Huang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China
| | - Qi Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China
| | - Mengyue Yang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China
| | - Dan Huang
- Department of Cardiology, Zhongda Hospital Southeast University, Nanjing, 210000, China
| | - Peng Zhao
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinwei Tian
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China
| | - Xuedong Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China.
| | - Jingbo Hou
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, and Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150086, China.
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Cao M, Wu T, Zhao J, Du Z, Wang Z, Li L, Wei G, Tian J, Jia H, Mintz GS, Yu B. Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study. Front Cardiovasc Med 2021; 8:709480. [PMID: 34568452 PMCID: PMC8457312 DOI: 10.3389/fcvm.2021.709480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: This study compared focal geometry and characteristics of culprit plaque erosion (PE) vs. non-culprit plaques in ST-segment elevated myocardial infarction (STEMI) patients in whom optical coherence tomography (OCT) identified PE as the cause of the acute event. Background: Culprit PE is a distinct clinical entity with specific coronary risk factors and its own tailored management strategy. However, not all plaques develop erosion resulting in occlusive thrombus formation. Methods: Between January 2017 and July 2019, there were 484 STEMI patients in whom OCT at the time of primary percutaneous intervention identified culprit lesion PE to be the cause of the event; 484 culprit PE were compared to 1,132 non-culprit plaques within 1,196 imaged vessels. Results: Culprit PE were highly populated at “hot spots” within the proximal 40 mm in the left anterior descending artery (LAD) and tended to cluster proximal to a nearby bifurcation mainly in the LAD. Minimal lumen area (MLA) <2.51 mm2 and AS (area stenosis) >64.02% discriminated culprit PE from non-culprit plaques. In the multivariable analysis, focal geometry (LAD location, distance from coronary ostium <40 mm, and location proximal to a nearby bifurcation), luminal narrowing (MLA <2.51 mm2, AS > 64.02%), and TCFA phenotype were independent predictors of culprit PE overall. Cholesterol crystals were predictive of culprit PE with underlying LRP morphology while the absence of calcification and microchannels were risk factors for culprit PE with an underlying non-LRP. Similarities and differences in predictors of culprit PE were found between males and females; distance from coronary ostium <40 mm, MLA <2.51 mm2, TCFA, and less spotty calcium were risk factors of culprit PE in males, but not in females while smaller RVD was associated with culprit PE only in females. Conclusions: Irrespective of underlying lesion substrates and patient risk factors, there are lesion-specific and OCT-identifiable predictors of developing culprit PE in erosion-prone vulnerable patients.
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Affiliation(s)
- Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tianyu Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiawei Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhuo Du
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhuozhong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Guo Wei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, United States
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography. J Interv Cardiol 2021; 2021:5590109. [PMID: 34393666 PMCID: PMC8342176 DOI: 10.1155/2021/5590109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/13/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT (p < 0.0001) and 2.7 ± 0.5 after ELCA (p=0.0001). The median residual thrombus volume after MT was 65.7 mm3, which significantly reduced to 47.5 mm3 after ELCA (p < 0.0001). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, p=0.001). Significantly larger thrombus burden after MT (69.6 mm3 vs. 56.3 mm3, p < 0.05) and greater thrombus reduction by ELCA (21.2 mm3 vs. 11.8 mm3, p < 0.01) were observed in ruptured lesions than nonruptured lesions. Conclusions ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.
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Roule V, Schwob L, Briet C, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI. J Thromb Thrombolysis 2021; 50:858-866. [PMID: 32306289 DOI: 10.1007/s11239-020-02113-8] [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] [Indexed: 11/28/2022]
Abstract
We compared residual platelet reactivity and post PCI atherothrombotic burden using OFDI in patients successfully treated by primary PCI versus pharmacoinvasive approach (PI) defined as PCI after successful pre-hospital fibrinolysis. Despite pre-hospital P2Y12-inhibitor loading dose, high rates of high on-treatment platelet reactivity were found at the time of PCI in both groups. Primary PCI patients had higher post stenting thrombus burden and lower rates of final normal myocardial blush grade compared to PI. These findings support the use of a pharmacoinvasive reperfusion strategy especially when primary PCI cannot be timely performed.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France. .,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France.
| | - Lin Schwob
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France.,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France
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9
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Karagiannidis E, Papazoglou AS, Sofidis G, Chatzinikolaou E, Keklikoglou K, Panteris E, Kartas A, Stalikas N, Zegkos T, Girtovitis F, Moysidis DV, Stefanopoulos L, Koupidis K, Hadjimiltiades S, Giannakoulas G, Arvanitidis C, Michaelson JS, Karvounis H, Sianos G. Micro-CT-Based Quantification of Extracted Thrombus Burden Characteristics and Association With Angiographic Outcomes in Patients With ST-Elevation Myocardial Infarction: The QUEST-STEMI Study. Front Cardiovasc Med 2021; 8:646064. [PMID: 33969012 PMCID: PMC8096895 DOI: 10.3389/fcvm.2021.646064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/22/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Angiographic detection of thrombus in STEMI is associated with adverse outcomes. However, routine thrombus aspiration failed to demonstrate the anticipated benefit. Hence, management of high coronary thrombus burden remains challenging. We sought to assess for the first time extracted thrombotic material characteristics utilizing micro-computed tomography (micro-CT). Methods: One hundred thirteen STEMI patients undergoing thrombus aspiration were enrolled. Micro-CT was undertaken to quantify retrieved thrombus volume, surface, and density. Correlation of these indices with angiographic and electrocardiographic outcomes was performed. Results: Mean aspirated thrombus volume, surface, and density (±standard deviation) were 15.71 ± 20.10 mm3, 302.89 ± 692.54 mm2, and 3139.04 ± 901.88 Hounsfield units, respectively. Aspirated volume and surface were significantly higher (p < 0.001) in patients with higher angiographic thrombus burden. After multivariable analysis, independent predictors for thrombus volume were reference vessel diameter (RVD) (p = 0.011), right coronary artery (RCA) (p = 0.039), and smoking (p = 0.027), whereas RVD (p = 0.018) and RCA (p = 0.019) were predictive for thrombus surface. Thrombus volume and surface were independently associated with distal embolization (p = 0.007 and p = 0.028, respectively), no-reflow phenomenon (p = 0.002 and p = 0.006, respectively), and angiographically evident residual thrombus (p = 0.007 and p = 0.002, respectively). Higher thrombus density was correlated with worse pre-procedural TIMI flow (p < 0.001). Patients with higher aspirated volume and surface developed less ST resolution (p = 0.042 and p = 0.023, respectively). Conclusions: Angiographic outcomes linked with worse prognosis were more frequent among patients with larger extracted thrombus. Despite retrieving larger thrombus load in these patients, current thrombectomy devices fail to deal with thrombotic material adequately. Further studies of novel thrombus aspiration technologies are warranted to improve patient outcomes. Clinical Trial Registration: QUEST-STEMI trial ClinicalTrials.gov number: NCT03429608 Date of registration: February 12, 2018. The study was prospectively registered.
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Affiliation(s)
- Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Sofidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Chatzinikolaou
- Hellenic Centre for Marine Research, Institute of Marine Biology, Biotechnology, and Aquaculture, Heraklion, Greece
| | - Kleoniki Keklikoglou
- Hellenic Centre for Marine Research, Institute of Marine Biology, Biotechnology, and Aquaculture, Heraklion, Greece.,Biology Department, University of Crete, Heraklion, Greece
| | - Eleftherios Panteris
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kleanthis Koupidis
- School of Mathematics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Arvanitidis
- Hellenic Centre for Marine Research, Institute of Marine Biology, Biotechnology, and Aquaculture, Heraklion, Greece.,LifeWatch ERIC, Sector II-II, Seville, Spain
| | - James S Michaelson
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Oishi Y, Tsujita H, Ogura K, Matsukawa N, Tanaka H, Masaki R, Sakai K, Sekimoto T, Kondo S, Tsukamoto S, Matsumoto H, Mori H, Arai K, Nomura K, Sato S, Yamamoto MH, Kosaki R, Wakabayashi K, Sakai R, Arai T, Suzuki H, Ochiai M, Shinke T. Early Vascular Response to Ultrathin Biodegradable Polymer Sirolimus-Eluting Stents for the Treatment of ST-Elevation Myocardial Infarction After Plaque Rupture. Int Heart J 2021; 62:42-49. [PMID: 33518665 DOI: 10.1536/ihj.20-458] [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] [Indexed: 11/18/2022]
Abstract
Recent clinical studies suggest that newer-generation drug-eluting stents that combine ultrathin struts and nanocoating (biodegradable polymer sirolimus-eluting stents, BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, the early vascular response to BP-SES in these patients has not been investigated so far.We examined this response in 20 patients with STEMI caused by plaque rupture using frequency-domain optical coherence tomography (OCT) to understand the underlying mechanisms. Plaque rupture was diagnosed by OCT before PCI with BP-SES implantation was performed. OCT was again performed before the final angiography (post-PCI) and after 2 weeks (2W-OCT).BP-SES placement caused protrusion of atherothrombotic material into the stent lumen and incomplete stent apposition in all patients. After 2 weeks, incomplete stent apposition was significantly reduced (% malapposed struts: post-PCI 4.7 ± 3.3%; 2W-OCT 0.9 ± 1.2%; P < 0.0001), and the percentage of uncovered struts also significantly decreased (% uncovered struts: post-PCI; 69.8 ± 18.3%: 2W-OCT; 29.6 ± 11.0%, P < 0.0001). The maximum protrusion area of the atherothrombotic burden was significantly reduced (post-PCI 1.36 ± 0.70 mm2; 2W-OCT 0.98 ± 0.55 mm2; P = 0.004).This study on the early vascular responses following BP-SES implantation showed rapid resolution of atherothrombotic material and progression of strut apposition and coverage. (UMIN000041324).
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Affiliation(s)
- Yosuke Oishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hiroaki Tsujita
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kunihiro Ogura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Naoki Matsukawa
- Department of Legal Medicine, Showa University School of Medicine
| | - Hideaki Tanaka
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Ryota Masaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Koshiro Sakai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Teruo Sekimoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Shigeto Tsukamoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hidenari Matsumoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hiroyoshi Mori
- Department of Cardiology, Showa University Fujigaoka Hospital
| | - Ken Arai
- Department of Medicine, Hitachi Medical Center Hospital
| | | | - Syunya Sato
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Myong Hwa Yamamoto
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Ryota Kosaki
- Cardiovascular Centre, Showa University Koto-Toyosu Hospital
| | | | - Rikuo Sakai
- Department of Cardiology, Koyama Memorial Hospital
| | - Taito Arai
- Department of Cardiology, Koyama Memorial Hospital
| | - Hiroshi Suzuki
- Department of Cardiology, Showa University Fujigaoka Hospital
| | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
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11
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Subban V, Raffel OC. Optical coherence tomography: fundamentals and clinical utility. Cardiovasc Diagn Ther 2020; 10:1389-1414. [PMID: 33224764 DOI: 10.21037/cdt-20-253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although coronary angiography is the standard method employed to assess the severity of coronary artery disease and to guide treatment strategies, it provides only 2D image of the intravascular lesions. In contrast, intravascular imaging modalities such as optical coherence tomography (OCT) produce cross-sectional images of the coronary arteries at a far greater spatial resolution, capable of accurately determining vessel size as well as plaque morphology, eliminating many of the disadvantages inherent to angiography. This review will discuss the role of OCT in the catherization laboratory for the assessment and management of coronary disease.
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Affiliation(s)
- Vijayakumar Subban
- Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Owen Christopher Raffel
- CardioVascular Clinics, St. Andrews War Memorial Hospital, Queensland, Australia.,Cardiology Program, The Prince Charles Hospital, Queensland, Australia.,Queensland University of Technology, Queensland, Australia.,University of Queensland, Queensland, Australia
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12
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Bivalirudin vs. Heparin on Radial Artery Thrombosis during Transradial Coronary Intervention: An Optical Coherence Tomography Study. J Interv Cardiol 2020; 2020:7905021. [PMID: 33071677 PMCID: PMC7533783 DOI: 10.1155/2020/7905021] [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: 06/07/2020] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aimed to evaluate the antithrombotic efficacy between bivalirudin and unfractionated heparin (UFH) on radial artery thrombosis (RAT) during transradial coronary intervention (TRI) by optical coherence tomography (OCT). Methods and Results We consecutively reviewed a total of 307 patients who underwent radial artery OCT inspection after TRI in our centre from October 2017 to January 2019; afterwards, 211 screened patients were divided into the UFH group (n = 144) and the bivalirudin group (n = 67) according to their anticoagulation strategy during TRI. The thrombosis in the radial artery was observed in 51 cases (24.17%) with a median thrombus volume of 0.054 mm3 (0.024, 0.334) and median thrombus score of 7 (4, 15). Thrombus occurred in 28 cases in the bivalirudin group with an incidence of 41.8%, which was significantly higher than that in the UFH group (n = 23, 16.0%, P < 0.001). This difference was even more remarkable after propensity score matching (bivalirudin group n = 22, 42.3% vs. UHF group n = 11, 13.9%, P < 0.001). Multivariate logistic analysis revealed that bivalirudin increased the RAT risk by 3.872 times (95% CI 2.006–8.354, P < 0.001) after adjustment for the other predictors. Conclusion In this present study, the use of bivalirudin was associated with a higher risk of RAT than UFH. It highlighted UFH should be a more considerable choice to prevent radial artery access thrombosis in TRI.
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13
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Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome. J Thromb Thrombolysis 2020; 51:1026-1035. [PMID: 32955695 DOI: 10.1007/s11239-020-02281-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P < 0.001), and the incidence of STEMI caused by PE was significantly lower on antiplatelet therapy (P < 0.001) or on statin therapy (P < 0.001). Antiplatelet therapy is associated with lower probability of STEMI, regardless of underlying pathology, and statin therapy is associated with lower probability of STEMI in PE as clinical presentation of ACS. Statin therapy prior to the onset of acute coronary syndromes (ACS) may reduce the probability of plaque rupture. Antiplatelet therapy prior to the onset of ACS is associated with reduced probability of ST-segment elevation myocardial infarction (STEMI) following both plaque rupture and plaque erosion, and dual antiplatelet therapy offers additional protection compared to a single antiplatelet agent in plaque erosion. The combination of statin and antiplatelet therapy may have an additive effect on reducing the probability of STEMI caused by plaque erosion. Yellow: lipid pool(necrotic core); red: fibrin-rich thrombus; gray; platelet-rich thrombus.
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14
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Evaluation of Left Main Coronary Artery Using Optical Frequency Domain Imaging and Its Pitfalls. J Interv Cardiol 2020; 2020:4817239. [PMID: 32581660 PMCID: PMC7306070 DOI: 10.1155/2020/4817239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to assess the quality of optical frequency domain imaging (OFDI) of the left main (LM) arterial wall and describe and analyse potential artefacts in this setting. Background OFDI is increasingly used to assess ambiguous lesions and optimize LM percutaneous coronary intervention. However, its ability to provide artefact-free high-quality images of coronary ostia and large segments such as the LM remains uncertain. Methods We included 42 consecutive patients who underwent OFDI, including LM imaging. Each OFDI frame was subdivided into four quadrants and analysed. The number of quadrants with artifacts was calculated within the proximal, mid, and distal LM and the first 5 mm of the left anterior descending artery (LAD) and/or left circumflex artery (LCX). Results The quadrants analysis showed an overall artifact rate of 8.9%, mostly out-of-field (45.1%) or residual blood (44.7%) artefacts. Most artifacts were located in the proximal LM (18.6%) with a stepwise reduction of artifact rates towards distal segments (mid LM 5.8%; distal LM 3.6%, ostial LAD 2.6%, and ostial LCX 0%; p < 0.001). While 20 (48.8%) patients had angiographically visible plaques, OFDI showed plaques in 32 patients (76.2%; p=0.007). Conclusion OFDI can accurately evaluate the LM and detect and assess angiographically unvisualized atherosclerotic plaques providing accurate assessment of >90% of the quadrants of the LM and the ostia of its bifurcation branches. However, artifacts mainly located in the proximal LM and decreasing distally in a stepwise fashion should be considered in the interpretation of OFDI in this setting.
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15
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Thrombus resolution with tirofiban in the conservative management of patients presenting with plaque erosion. Coron Artery Dis 2019; 29:301-308. [PMID: 29494363 DOI: 10.1097/mca.0000000000000614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Recent studies suggest that conservative management with antithrombotic therapy without stenting may be an option in selected patients with acute coronary syndrome (ACS). We evaluated whether a glycoprotein IIb/IIIa inhibitor, tirofiban, would offer additional benefit in patients with plaque erosion presenting with ACS who were treated with antiplatelet therapy without stenting. PATIENTS AND METHODS Forty-nine patients who completed 1-year follow-up optical coherence tomography imaging in the EROSION study were divided into two groups: tirofiban (n=32) versus no tirofiban (n=17). Thrombus volume, thrombus burden, and the incidence of major adverse cardiovascular events were evaluated. RESULTS At baseline, the tirofiban group had similar thrombus volume [3.73 (1.27-12.49) vs. 3.51 (1.70-8.65) mm, P=0.983] and marginally greater thrombus burden [17.9 (10.1-26.1) vs. 10.6 (6.8-19.0)%, P=0.097]. At 1 month, the tirofiban group had smaller residual thrombus volume [0.00 (0.00-1.78) vs. 0.94 (0.07-4.20) mm, P=0.054], thrombus burden [0.0 (0.0-6.4) vs. 7.0 (1.8-14.8)%, P=0.024], and greater reduction of thrombus volume (85.4±24.6 vs. 67.1±27.1%, P=0.021). These differences were maintained up to 1 year. Complete resolution of thrombus at 1 month was more frequent in the tirofiban group (53.1 vs. 17.6%, P=0.031). None of the patients experienced major bleeding during the initial hospitalization. The 1-year major adverse cardiovascular events rate was not different (5.6 vs. 15.0%, P=0.336). CONCLUSION In patients with ACS caused by plaque erosion who were managed conservatively without stenting, tirofiban provided additional benefit in reducing residual thrombus without an increased risk for bleeding.
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16
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Vergallo R, Porto I, De Maria GL, D'Amario D, Annibali G, Galli M, Migliaro S, Buccimazza G, Aurigemma C, Leone AM, Niccoli G, Kharbanda R, Burzotta F, Prendergast BD, Channon KM, Trani C, Banning AP, Crea F. Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in patients with acute coronary syndrome: Comparison with optical coherence tomography imaging. Int J Cardiol 2019; 292:25-31. [PMID: 31043319 DOI: 10.1016/j.ijcard.2019.04.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/22/2018] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dual quantitative coronary angiography (QCA) has been recently tested for assessment of intracoronary thrombus volume in experimental models. The present study aimed to validate dual QCA in vivo for the assessment of thrombus burden by exploring the correlations between dual QCA-thrombus volume and optical coherence tomography (OCT)-derived indices of thrombotic burden. METHODS AND RESULTS Fifty-one patients with ACS and angiographic evidence of thrombus undergoing OCT of the culprit lesion before stenting were included. Dual QCA-thrombus volume was calculated as difference between edge-detection and video-densitometry area functions along the target segment. Culprit lesion was categorized using the Ambrose's and AHA/ACC angiographic classifications. Thrombus volume (mean thrombus area × thrombus length), thrombus burden [(mean thrombus area/mean lumen area) x100] and Prati thrombus score (number of quadrants with thrombus) were measured by OCT, and the presence of plaque rupture (PR) or intact fibrous cap (IFC) was assessed. Dual QCA-thrombus volume correlated significantly with OCT-thrombus volume (R = 0.791), thrombus burden (R = 0.767) and Prati thrombus score (R = 0.600) (all p < 0.001). Dual-QCA thrombus volume was significantly higher in patients with PR compared with those with IFC (3.48 mm3 [1.45-11.26] vs. 1.69 mm3 [0.09-5.02], p = 0.013). Compared with IFC, PR showed higher prevalence of eccentric type II Ambrose lesion (41.7% vs. 7.4%, p = 0.004), complex B2/C lesion (87.5% vs. 55.6%, p = 0.012), and heavy calcification (29.2% vs. 3.7%, p = 0.013). CONCLUSIONS Dual QCA analysis appears to be a promising tool for quantification of intracoronary thrombus in vivo. This novel methodology may be useful to guide intracoronary thrombus removal during percutaneous coronary intervention and to aid prognostic stratification in patients with ACS.
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Affiliation(s)
- Rocco Vergallo
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino, Genova; Università di Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties (DIMI).
| | | | - Domenico D'Amario
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianmarco Annibali
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Mattia Galli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Migliaro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Giorgio Buccimazza
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Giampaolo Niccoli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Rajesh Kharbanda
- Oxford Heart Center, Oxford University Hospitals, Oxford, United Kingdom
| | - Francesco Burzotta
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Keith M Channon
- Oxford Heart Center, Oxford University Hospitals, Oxford, United Kingdom
| | - Carlo Trani
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Adrian P Banning
- Oxford Heart Center, Oxford University Hospitals, Oxford, United Kingdom
| | - Filippo Crea
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy.
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Morino Y, Terashita D, Otake H, Kikuchi T, Fusazaki T, Kuriyama N, Suzuki T, Ito Y, Hibi K, Tanaka H, Ishihara S, Kataoka T, Morita T, Otsuka Y, Hayashi T, Tanabe K, Shinke T. Early vascular responses to everolimus-eluting cobalt-chromium stent in the culprit lesions of st-elevation myocardial infarction: results from a multicenter prospective optical coherence tomography study (MECHANISM-AMI 2-week follow-up study). Cardiovasc Interv Ther 2019; 34:14-24. [PMID: 29318464 PMCID: PMC6329740 DOI: 10.1007/s12928-017-0507-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/27/2017] [Indexed: 01/10/2023]
Abstract
The use of cobalt-chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECHANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm2, p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm2, p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions-including a significant reduction of thrombus-that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks.
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Affiliation(s)
- Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | | | - Hiromasa Otake
- Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Nehiro Kuriyama
- Miyazaki Medical Association Hospital, Miyazaki, Miyazaki, Japan
| | - Takahide Suzuki
- Hokkaido Welfare Federation of Agricultural Cooperative Engaru Kosei General Hospital, Monbetsugun, Hokkaido, Japan
| | - Yoshiaki Ito
- Saiseikai Yokohama-City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Kiyoshi Hibi
- Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | | | | | | | | | | | | | | | - Toshiro Shinke
- Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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18
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Cassese S, Belle L, Ndrepepa G, Bosson JL, Fusaro M, Lønborg J, Ahtarovski KA, Kelbæk H, Fusaro M. Deferred vs Immediate Stenting in Primary Percutaneous Coronary Intervention: A Collaborative Meta-analysis of Randomized Trials With Cardiac Magnetic Resonance Imaging Data. Can J Cardiol 2018; 34:1573-1580. [PMID: 30527145 DOI: 10.1016/j.cjca.2018.07.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The role of deferred vs immediate stenting during primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. METHODS We undertook a collaborative meta-analysis of study-level data by searching electronic scientific databases for investigations of primary PCI patients randomized to deferred or immediate stenting and subsequent cardiac magnetic resonance imaging. Primary angiographic and imaging outcomes were slow/no-reflow and microvascular obstruction (MVO), respectively. Main secondary outcome was recurrent ischemia. RESULTS Among 4 trials, a total of 1570 patients with STEMI were assigned to primary PCI with either deferred (n = 779) or immediate stenting (n = 791). Of these, 797 participants had analyzable cardiac magnetic resonance imaging examinations. Median clinical follow-up was 9 months. Patients treated with deferred stenting showed a lower risk of developing slow/no-reflow in the culprit vessel (risk ratio [RR], 0.54 [95% confidence interval (CI), 0.41-0.72]; P < 0.001), a similar risk for MVO (RR, 0.93 [95% CI, 0.76-1.14]; P = 0.51), and trended higher in the risk of recurrent ischemia (RR, 2.42 [95% CI, 0.88-6.63]; P = 0.09) compared with those treated with immediate stenting. The treatment effect for slow/no-reflow and MVO correlated with a thrombus score grade > 3 at the baseline angiography and with the total stent length implanted in the culprit artery. CONCLUSIONS A strategy of deferred stenting during primary PCI improves angiographic but not imaging or clinical outcomes compared with immediate stenting. The potential lower risk for myocardial injury by deferred stenting in primary PCI patients with STEMI and high thrombus burden requires a confirmation in adequately sized randomized trials.
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Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
| | - Loic Belle
- Departments of Cardiology and Radiology, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jean Luc Bosson
- Clinical Investigation Centre, University Hospital of Grenoble, Grenoble, France
| | - Michele Fusaro
- Department of Diagnostic and Interventional Radiology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiril A Ahtarovski
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Potent effect of prasugrel on acute phase resolution of intra-stent athero-thrombotic burden after percutaneous intervention to acute coronary syndrome. J Cardiol 2018; 72:403-410. [PMID: 29731189 DOI: 10.1016/j.jjcc.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/11/2018] [Accepted: 04/02/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies suggested protruding thrombus and atheroma after stent placement could be a substrate for subsequent adverse ischemic events. Although protruded atherothrombotic burden can be assessed as intra-stent tissue (IST) by optical coherence tomography (OCT), the effects of potent antiplatelet therapy on the acute phase resolution of IST in patients with acute coronary syndrome (ACS) was unknown. METHODS Ninety-six consecutive ACS patients with multi-vessel disease were enrolled in this prospective registry. In combination with aspirin, either clopidogrel or prasugrel was selected according to the date of enrolment. OCT examination was done immediately after percutaneous coronary intervention (post-PCI) and 10 days after index PCI (follow-up acute phase) to calculate averaged IST score as semi-quantitative measures of IST. High residual platelet reactivity (HRPR) was defined as platelet reactivity units (PRU)≥240 by VerifyNow P2Y12 assay (Accumetrics Inc., San Diego, CA, USA). RESULTS Thirty two patients (38 stents) were enrolled in the prasugrel group and sixty four patients (72 stents) in the clopidogrel group. Averaged IST scores post-PCI were similar between the two groups (0.68±0.41 vs. 0.68±0.40, p=0.99), which decreased in all of the prasugrel group and in 87.5% of the clopidogrel group (p=0.02). Consequently, changes in averaged IST score (delta averaged IST score) were significantly greater in the prasugrel group compared to those in the clopidogrel group (-0.411±0.288 vs. -0.299±0.270, p=0.045). The frequency of HRPR was significantly lower in the prasugrel group (10.0% vs 32.4%, p=0.028). CONCLUSIONS Prasugrel plus aspirin achieved greater acute phase reduction of IST than clopidogrel plus aspirin, which might underlie the clinical benefit of potent antiplatelet therapy in ACS. (UMIN000018751).
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Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, Xu M, Yao Y, Hu S, Yamamoto E, Lee H, Zhang S, Yu B, Jang IK. Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J 2018; 38:792-800. [PMID: 27578806 DOI: 10.1093/eurheartj/ehw381] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/09/2016] [Indexed: 12/26/2022] Open
Abstract
Aims Plaque erosion, compared with plaque rupture, has distinctly different underlying pathology and therefore may merit tailored therapy. In this study, we aimed to assess whether patients with acute coronary syndrome (ACS) caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation. Methods and results This was a single-centre, uncontrolled, prospective, proof-of concept study. Patients with ACS including ST-segment elevation myocardial infarction were prospectively enrolled. If needed, aspiration thrombectomy was performed. Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis <70% on coronary angiogram were treated with anti-thrombotic therapy without stenting. OCT was repeated at 1 month and thrombus volume was measured. The primary endpoint was >50% reduction of thrombus volume at 1 month compared with baseline. The secondary endpoint was a composite of cardiac death, recurrent ischaemia requiring revascularization, stroke, and major bleeding. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients. Sixty patients enrolled and 55 patients completed the 1-month follow-up. Forty-seven patients (47/60, 78.3%; 95% confidence interval: 65.8-87.9%) met the primary endpoint, and 22 patients had no visible thrombus at 1 month. Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0) mm3. Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2. One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained asymptomatic. Conclusion For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without stenting may be an option.
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Affiliation(s)
- Haibo Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Jiannan Dai
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA
| | - Jingbo Hou
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Lei Xing
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA
| | - Lijia Ma
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Huimin Liu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Maoen Xu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Yuan Yao
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Sining Hu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Erika Yamamoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St. Suite 560, Boston, MA 02114, USA
| | - Shaosong Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA
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Jia H, Kubo T, Akasaka T, Yu B. Optical Coherence Tomography Guidance in Management of Acute Coronary Syndrome Caused by Plaque Erosion. Circ J 2018; 82:302-308. [PMID: 29332908 DOI: 10.1253/circj.cj-17-1373] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For several decades, most physicians have believed that acute coronary syndrome (ACS) is caused by coronary thrombosis resulting from rupture of vulnerable plaque characterized by a thin fibrous cap overlying a large necrotic core and massive inflammatory cell infiltration. However, nearly one-third of ACS cases are caused by plaque erosion characterized by intact fibrous cap, less or absent necrotic core, less inflammation, and large lumen. Because of the limitations of current imaging modalities, including angiography and intravascular ultrasound, the importance of plaque erosion as a cause of acute coronary events is less well known. Optical coherence tomography (OCT) as an emerging modality with extremely high resolution is the only intravascular imaging modality available for identification of plaque erosion in vivo, which provides new insight into the mechanism of ACS. More importantly, the introduction of OCT to clinical practice enables us to differentiate the patients with ACS caused by plaque erosion from those caused by plaque rupture, thereby providing precise and personalized therapy based on the different underlying mechanisms. We systematically review the morphological characteristics of plaque erosion identified by OCT and its implications for the management of ACS.
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Affiliation(s)
- Haibo Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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Optical Coherence Tomography Guided Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1267-1276. [DOI: 10.1016/j.hlc.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
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Kuno T, Hashimoto K, Imaeda S, Ryuzaki T, Saito T, Yamazaki H, Tabei R, Kodaira M, Numasawa Y. A case with a large intracoronary mobile mass diagnosed with a calcified thrombus using optical frequency domain imaging and intravascular ultrasound. SAGE Open Med Case Rep 2017; 5:2050313X17724059. [PMID: 28835828 PMCID: PMC5542075 DOI: 10.1177/2050313x17724059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/12/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A calcified thrombus is rare, but needs to be recognized and to be differentiated from calcified nodule. METHODS We report a case of acute coronary syndrome and a large intracoronary mobile mass, which was identified as a calcified thrombus by optical frequency domain imaging and intravascular ultrasound. RESULTS Successful direct stenting indicated that mobile mass was a calcified thrombus, not a calcified nodule. CONCLUSIONS Cardiologists should be aware that an intracoronary mobile mass could be a calcified thrombus. This diagnosis can be confirmed through the combined use of optical frequency domain imaging and intravascular ultrasound.
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Affiliation(s)
- Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Syohei Imaeda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Toshinobu Ryuzaki
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tetsuya Saito
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hiroyuki Yamazaki
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Ryota Tabei
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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Ndrepepa G, Kastrati A. Mechanical strategies to enhance myocardial salvage during primary percutaneous coronary intervention in patients with STEMI. EUROINTERVENTION 2017; 12:319-28. [PMID: 27320426 DOI: 10.4244/eijv12i3a52] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary percutaneous coronary intervention (PPCI) has become the mainstay of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI). Despite timely reperfusion by PPCI and restoration of epicardial blood flow in up to 95% of patients, tissue reperfusion remains suboptimal in a sizeable proportion of patients with STEMI. Over the years mechanical and pharmacological strategies to enhance myocardial salvage during PPCI have been developed and used in patients with STEMI. The most common mechanical strategies used in the setting of PPCI include: coronary stenting, direct stenting, mesh-covered stents, self-expanding stents, deferred stenting, thrombectomy, distal protection devices, intra-aortic balloon pumping, left ventricular assist devices and ischaemic conditioning. These strategies are thought to enhance myocardial salvage via improving acute procedural success, attenuation of distal embolisation, microvascular obstruction and reperfusion injury, and providing haemodynamic support. Coronary (direct) stenting is almost the default approach of reperfusion during PPCI procedures. Evidence on the use of mesh-covered stents, self-expanding stents, deferred stenting or left ventricular assist devices is scant and their use in the setting of PPCI remains limited. Mechanical thrombectomy, distal protection devices or routine intra-aortic balloon counterpulsation seem to offer no clinical benefit when used in the setting of PPCI. Although manual aspiration may improve indices of tissue reperfusion, recent research showed no clinical benefit of routine use of this strategy in patients with STEMI undergoing PPCI. Ischaemic conditioning, although promising, remains at an investigational stage and needs further research.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
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Harbaoui B, Emsellem P, Cassar E, Besnard C, Dauphin R, Motreff P, Courand PY, Lantelme P. Primary angioplasty: Effect of deferred stenting on stent size. Arch Cardiovasc Dis 2017; 110:206-213. [PMID: 28139456 DOI: 10.1016/j.acvd.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/22/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary angioplasty with immediate stenting (IS) is the gold standard for ST-segment elevation myocardial infarction (STEMI). Deferred stenting (DS) has been proposed to limit periprocedural complications, and may influence stent size because of thrombus and spasm alleviation. AIM We sought to study the effect of DS on stent size. METHODS Over the study period, 258 patients underwent primary angioplasty for STEMI (DS, n=84; IS, n=174). An informative coronary angiogram run - i.e. allowing for proper lesion analysis - was selected and anonymized by an independent operator. Two experienced operators randomly analysed these runs, and proposed stent dimensions after having measured vessel diameter and lesion length by quantitative coronary analysis. The primary objective was the variation in stent size between the two coronary angiograms. RESULTS The median delay between the two coronary angiograms was 2 days. Overall, the stent length was shorter (-1.64mm; P=0.030) and its diameter was larger (+0.13mm; P<0.001) during the second coronary angiogram, especially in the right coronary arteries. CONCLUSIONS DS led to the implantation of a larger and shorter stent; this is probably because DS allows for more accurate assessment of the residual lesion after relief of spasm and thrombus, and may have clinical consequences in terms of stent thrombosis and restenosis.
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Affiliation(s)
- Brahim Harbaoui
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France
| | - Philippe Emsellem
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Emmanuel Cassar
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Cyril Besnard
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Raphael Dauphin
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Pascal Motreff
- Université d'Auvergne, Cardio-Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR 6284, 63000 Clermont-Ferrand, France; University Hospital of Clermont-Ferrand, Cardiology Department, 63000 Clermont-Ferrand, France
| | - Pierre-Yves Courand
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France
| | - Pierre Lantelme
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France.
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Amabile N, Cayla G, Motreff P, Trouillet C, Range G, Dubreuil O, Vautrin E, Derimay F, Mangin L, Meneveau N, Caussin C, Souteyrand G. Antiplatelet Drug Regimen in Patients With Stent Thrombosis ― Insights From the PESTO French Optical Coherence Tomography Registry ―. Circ J 2017; 81:1469-1476. [DOI: 10.1253/circj.cj-17-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand
- Cardio Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR CNRS 6284, Auvergne University
| | | | | | | | | | | | | | | | | | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand
- Cardio Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR CNRS 6284, Auvergne University
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27
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Impact of thrombus burden on procedural and mid-term outcomes after primary percutaneous coronary intervention. Coron Artery Dis 2016; 27:169-75. [DOI: 10.1097/mca.0000000000000317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Souteyrand G, Amabile N, Mangin L, Chabin X, Meneveau N, Cayla G, Vanzetto G, Barnay P, Trouillet C, Rioufol G, Rangé G, Teiger E, Delaunay R, Dubreuil O, Lhermusier T, Mulliez A, Levesque S, Belle L, Caussin C, Motreff P. Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry. Eur Heart J 2016; 37:1208-16. [DOI: 10.1093/eurheartj/ehv711] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
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Pascal J, Veugeois A, Slama M, Rahal S, Belle L, Caussin C, Amabile N. Delayed Stenting for ST-Elevation Acute Myocardial Infarction in Daily Practice: A Single-Centre Experience. Can J Cardiol 2015; 32:988-95. [PMID: 26838663 DOI: 10.1016/j.cjca.2015.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/02/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The minimalist immediate mechanical intervention (MIMI) strategy aims to restore normal anterograde flow in the culprit artery (by using manual thrombectomy or small-sized balloon predilation) and to defer potential stent implantation. This study evaluated the applicability and midterm clinical results of the MIMI strategy for ST-elevation myocardial infarction (STEMI) management. METHODS This observational study included consecutive patients admitted for ongoing STEMI (<24 hours' evolution) at 1 institution between June 2010 and June 2013. Revascularization was performed at the physician's discretion. We compared retrospectively "intentional immediate stenting" (standard technique) and "intentional delayed stenting" (MIMI technique). RESULTS Twenty percent of the 279 included patients were treated with the MIMI strategy. These patients were significantly younger and were more frequently men and smokers compared with patients who underwent the standard procedure. The rate of acute reocclusion of the culprit artery related to STEMI in the MIMI group was 1.8%. Drug-eluting stents were used more frequently in the MIMI group (52% vs 27% in the standard group; P < 0.001). The culprit lesion was stented less frequently in the patients treated with MIMI compared with patients in the other group (28.5% vs 9%; P < 0.001). The 1-year actuarial survival free from major adverse cardiovascular events was higher in the MIMI group than in the standard group (96.3% ± 1.8% vs 83.8% ± 2.5%; P = 0.01). CONCLUSIONS The MIMI strategy can be applied in selected patients with STEMI. In our centre, this strategy is associated with less systematic culprit lesion stenting and more implantation of drug-eluting stents. However, this needs to be evaluated further in a randomized trial.
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Affiliation(s)
- Julien Pascal
- Cardiology Department, Centre Hospitalier Le Raincy-Montfermeil, Montfermeil, France
| | - Aurélie Veugeois
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Michel Slama
- Cardiology Department, CHU Antoine Beclère, Clamart, France; Cardiology Department, Centre Marie Lannelongue, LePlessis Robinson, France
| | - Saliah Rahal
- Cardiology Department, Centre Marie Lannelongue, LePlessis Robinson, France
| | - Loic Belle
- Cardiology Department, CH Annecy, Annecy, France
| | | | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
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Bounafaa A, Berrougui H, Ghalim N, Nasser B, Bagri A, Moujahid A, Ikhlef S, Camponova P, Yamoul N, Simo OK, Essamadi A, Khalil A. Association between Paraoxonase 1 (PON1) Polymorphisms and the Risk of Acute Coronary Syndrome in a North African Population. PLoS One 2015; 10:e0133719. [PMID: 26241956 PMCID: PMC4524730 DOI: 10.1371/journal.pone.0133719] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 07/01/2015] [Indexed: 01/27/2023] Open
Abstract
The purpose of the present study was to investigate the distribution of PON1 Q192R and L55M polymorphisms and activities in a North African population and to determine their association with cardiovascular complications. The prevalence of the QQ, QR, RR, LL, LM, and MM genotypes in the study population was 55.4%, 34.09%, 9.83%, 41.97%, 48.20%, and 9.83% respectively. The Q, R, L, and M alleles had a gene frequency of 0.755, 0.245, 0.67, and 0.33, respectively. The PON1 192 RR genotype was significantly more prevalent among ACS patients than among healthy subjects. There was a 4.33-fold increase in the risk of ACS in subjects presenting the PON1 192 RR genotype compared to those with the QQ genotype (OR=4.33; 95% CI=1.27–17.7). There was a significantly different distribution of PON1 L55M in the ACS patient groups (UA, STEMI, NSTEMI). Moreover, individuals presenting the PON1 55MM genotype present a higher risk for ACS than those with LL genotype (OR=3.69; 95% CI=1.61–11.80). Paraoxonase activities were significantly lower in coronary patients than in healthy subjects. The decrease in PON1 activity was inversely correlated with the number of concomitant risk factors for CVD (r=0.57, p<0.0001). The results of the present study suggested that the PON1 R and M alleles may play a role in the pathogenesis of cardiac ischemia in our North African population and that a decrease in PON1 activity may be a valuable marker for monitoring the development of the atherosclerosis process and the associated cardiovascular complications.
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Affiliation(s)
- Abdelghani Bounafaa
- Laboratory of Biochemistry & Neuroscience, Applied Biochemistry and Toxicology Team, Faculty of Sciences and Technology, Hassan First University, Settat, Morocco
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Hicham Berrougui
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Biology, Polydisciplinary Faculty, Sultan Moulay Sliman University, Beni-Mellal, Morocco
| | - Noreddine Ghalim
- Laboratory of Biochemistry, Pasteur Institute of Morocco, Casablanca, Morocco
| | - Boubker Nasser
- Laboratory of Biochemistry & Neuroscience, Applied Biochemistry and Toxicology Team, Faculty of Sciences and Technology, Hassan First University, Settat, Morocco
| | - Abdallah Bagri
- Laboratory of Biochemistry & Neuroscience, Applied Biochemistry and Toxicology Team, Faculty of Sciences and Technology, Hassan First University, Settat, Morocco
| | - Abderrahmane Moujahid
- Laboratory of Biochemistry & Neuroscience, Applied Biochemistry and Toxicology Team, Faculty of Sciences and Technology, Hassan First University, Settat, Morocco
| | - Souad Ikhlef
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pamela Camponova
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Najoua Yamoul
- Cardiology Service, Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Olivier Kamtchueng Simo
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Abdelkhalid Essamadi
- Laboratory of Biochemistry & Neuroscience, Applied Biochemistry and Toxicology Team, Faculty of Sciences and Technology, Hassan First University, Settat, Morocco
| | - Abdelouahed Khalil
- Department of Medicine, Geriatrics Service, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
- * E-mail:
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Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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