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Nakajima A, Araki M, Kurihara O, Lee H, Nakamura S, Jang IK. Potent platelet inhibition with peri-procedural tirofiban may attenuate progression of atherosclerosis in patients with acute coronary syndromes. J Thromb Thrombolysis 2021; 53:241-248. [PMID: 34275055 DOI: 10.1007/s11239-021-02500-9] [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] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
Organization of platelet-rich thrombus at the site of plaque disruption may contribute to rapid progression of atherosclerosis. This study was conducted to investigate if potent platelet inhibition therapy in patients with acute coronary syndromes (ACS) mitigates plaque progression. Patients enrolled in the EROSION study who presented with ACS caused by plaque erosion and underwent serial imaging of the culprit lesion by optical coherence tomography at baseline, 1 month, and 1 year were included. Among 49 patients, 32 (65.3%) patients were treated with glycoprotein IIb/IIIa inhibitor (GPI) in addition to aspirin and ticagrelor. The increase in area stenosis from baseline to 1-year follow-up was significantly smaller in patients treated with GPI, compared to those without GPI therapy (4.8% [- 1.6 to 10.9] vs. 9.6% [4.0 to 21.3], p = 0.031). The cohort was divided into 2 groups based on culprit lesion phenotype at 1 year: Group A, new layer formation at 1-year that was not present at baseline (n = 18); Group B, no new layer formation (n = 31). A new layer was less frequently found at 1 year in patients treated with GPI than in those without GPI (25.0% vs. 58.8%, p = 0.019). Group A, compared to Group B, was associated with a greater increase in area stenosis (19.0 ± 16.4% vs. 3.7 ± 7.1%; p < 0.001). Potent platelet inhibition with GPI in patients with ACS caused by plaque erosion was associated with lower incidence of new layer formation and less plaque progression.
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Affiliation(s)
- Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA. .,Kyung Hee University, Seoul, Korea.
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Yacob O, Garcia-Garcia HM, Dan K, Soud M, Adamo M, Picchi A, Sardella G, Frigoli E, Limbruno U, Rigattieri S, Diletti R, Boccuzzi G, Zimarino M, Contarini M, Russo F, Calabro P, Ando G, Varbella F, Garducci S, Palmieri C, Briguori C, Kuku KO, Karagiannis A, Valgimigli M. Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study. Int J Cardiovasc Imaging 2020; 37:1143-1150. [PMID: 33225426 DOI: 10.1007/s10554-020-02098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients. METHODS STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm2), dissection (> 200 µm in width and < 5 mm from stent segment), malapposition (> 200 µm distance of stent from vessel wall), a thrombus (area > 5% of lumen area) were compared. RESULTS A total of 151 patients were included; after excluding patients with suboptimal OCT quality, the population with available OCT was classified into 2 groups: under-expanded < 90% (N = 72, 51%) and well-expanded ≥ 90% (N = 67, 49%). In the well-expanded group, a significant number of the proximal vessels had a lumen area < 4.5mm2 (16.1%, p < 0.001) and a greater thrombus burden within stent (56.7%, p = 0.042). The overall 30 day and 1 year major adverse cardiovascular event (MACE) rates were 5% and 6.1%, respectively. CONCLUSION Irrespective of the degree of stent expansion, the OCT findings, in STEMI patients, and the MACE at 30 days and one year follow up was low; further, well-expanded stents led to a more significant residual thrombotic burden within the stent but seemed to have insignificant clinical impact. Acknowledged stent optimization criteria, traditionally related to worse outcomes in stable patients, do not seem to be associated with worse outcomes in this STEMI population.
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Affiliation(s)
- Omar Yacob
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Kazuhiro Dan
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Mohamad Soud
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardio-Thoracic Department, University of Brescia, Brescia, Italy
| | - Andrea Picchi
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Ugo Limbruno
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Marco Zimarino
- Institute of Cardiology "G. D'Annunzio" University, Chieti, Italy
| | - Marco Contarini
- Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Calabro
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Ando
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Stefano Garducci
- Unita' Operativa Complessa Di Cardiologia ASST Di Vimercate (MB), Vimercate, Italy
| | - Cataldo Palmieri
- Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Pisa/Massa, Italy
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Napoli, Italy
| | - Kayode O Kuku
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Marco Valgimigli
- Swiss Cardiovascular Center, University of Bern, Bern, Switzerland.
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Bikdeli B, McAndrew T, Crowley A, Chen S, Mehdipoor G, Redfors B, Liu Y, Zhang Z, Liu M, Zhang Y, Francese DP, Erlinge D, James SK, Han Y, Li Y, Kastrati A, Schüpke S, Stables RH, Shahzad A, Steg PG, Goldstein P, Frigoli E, Mehran R, Valgimigli M, Stone GW. Individual Patient Data Pooled Analysis of Randomized Trials of Bivalirudin versus Heparin in Acute Myocardial Infarction: Rationale and Methodology. Thromb Haemost 2020; 120:348-362. [PMID: 31820428 PMCID: PMC7040882 DOI: 10.1055/s-0039-1700872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Individual randomized controlled trials (RCTs) of periprocedural anticoagulation with bivalirudin versus heparin during percutaneous coronary intervention (PCI) have reported conflicting results. Study-level meta-analyses lack granularity to adjust for confounders, explore heterogeneity, or identify subgroups that may particularly benefit or be harmed. OBJECTIVE To overcome these limitations, we sought to develop an individual patient-data pooled database of RCTs comparing bivalirudin versus heparin. METHODS We conducted a systematic review to identify RCTs in which ≥1,000 patients with acute myocardial infarction (AMI) undergoing PCI were randomized to bivalirudin versus heparin. RESULTS From 738 identified studies, 8 RCTs met the prespecified criteria. The principal investigators of each study agreed to provide patient-level data. The data were pooled and checked for accuracy against trial publications, with discrepancies addressed by consulting with the trialists. Consensus-based definitions were created to resolve differing antithrombotic, procedural, and outcome definitions. The project required 3.5 years to complete, and the final database includes 27,409 patients (13,346 randomized to bivalirudin and 14,063 randomized to heparin). CONCLUSION We have created a large individual patient database of bivalirudin versus heparin RCTs in patients with AMI undergoing PCI. This endeavor may help identify the optimal periprocedural anticoagulation regimen for patient groups with different relative risks of adverse ischemic versus bleeding events, including those with ST-segment and non-ST-segment elevation MI, radial versus femoral access, use of a prolonged bivalirudin infusion or glycoprotein inhibitors, and others. Adherence to standardized techniques and rigorous validation processes should increase confidence in the accuracy and robustness of the results.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States
- Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, United States
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Shmuel Chen
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Ghazaleh Mehdipoor
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - Dominic P. Francese
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | - Stefan K. James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Stefanie Schüpke
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Rod H. Stables
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Adeel Shahzad
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Philippe Gabriel Steg
- Hôpital Bichat, Paris, France
- Imperial College, Royal Brompton Hospital, London, United Kingdom
| | | | - Enrico Frigoli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregg W. Stone
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States
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Garcia-Garcia HM, Adamo M, Soud M, Yacob O, Picchi A, Sardella G, Frigoli E, Limbruno U, Rigattieri S, Diletti R, Boccuzzi G, Zimarino M, Contarini M, Russo F, Calabrò P, Andò G, Varbella F, Garducci S, Palmieri C, Briguori C, Karagiannis A, Valgimigli M. Assessment of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing bivalirudin versus unfractionated heparin infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study. Catheter Cardiovasc Interv 2019; 96:1156-1171. [PMID: 31883294 DOI: 10.1002/ccd.28661] [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: 07/10/2019] [Accepted: 12/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Residual stent strut thrombosis after primary percutaneous coronary intervention (PCI), negatively affects myocardial perfusion, may increase stent thrombosis risk, and it is associated with neointima hyperplasia at follow-up. OBJECTIVES To study the effectiveness of any bivalirudin infusion versus unfractionated heparin (UFH) infusion in reducing residual stent strut thrombosis in patients with ST-elevation myocardial infarction (STEMI). METHODS Multi-vessel STEMI patients undergoing primary PCI and requiring staged intervention were selected among those randomly allocated to two different bivalirudin infusion regimens in the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) Treatment-Duration study. Those receiving heparin only were enrolled into a registry arm. Optical coherence tomography (OCT) of the infarct-related artery was performed at the end of primary PCI and 3-5 days thereafter during a staged intervention. The primary endpoint was the change in minimum flow area (ΔMinFA) defined as (stent area + incomplete stent apposition [ISA] area) - (intraluminal defect + tissue prolapsed area) between the index and staged PCI. RESULTS 123 patients in bivalirudin arm and 28 patients in the UFH arm were included. Mean stent area, percentage of malapposed struts, and mean percent thrombotic area were comparable after index or staged PCI. The ΔMinFA in the bivalirudin group was 0.25 versus 0.05 mm2 in the UFH group, which resulted in a between-group significant difference of 0.36 [95% CI: (0.05, 0.71); p = .02]. This was mostly related to a decrease in tissue protrusion in the bivalirudin group (p = .03). There was a trend towards more patients in the bivalirudin group who achieved a 5% difference in the percentage of OCT frames with the area >5% (p = .057). CONCLUSIONS The administration of bivalirudin after primary PCI significantly reduces residual stent strut thrombosis when compared to UFH. This observation should be considered hypothesis-generating since the heparin-treated patients were not randomly allocated.
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Affiliation(s)
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Cardio-Thoracic Department, Civil Hospitals, Brescia, Italy
| | - Mohamad Soud
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Omar Yacob
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Andrea Picchi
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Ugo Limbruno
- Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy
| | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Giacomo Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Marco Zimarino
- Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy
| | - Marco Contarini
- Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Calabrò
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Stefano Garducci
- Unita' Operativa Complessa di Cardiologia ASST di Vimercate (MB), Vimercate, Italy
| | - Cataldo Palmieri
- Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Pisa/Massa, Massa, Italy
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | | | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
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