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Geum MJ, Yu YM, Jeon J, Lee HW, Shin J, Chung WY, Hahn J, Ah YM. Intracoronary antithrombotic therapy during primary percutaneous coronary intervention in patients with STEMI: A systematic review and network meta-analysis. Thromb Res 2024; 233:127-134. [PMID: 38041878 DOI: 10.1016/j.thromres.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION The efficacy of intracoronary (IC) antithrombotic therapy, which may best prevent the no-reflow phenomenon during percutaneous coronary intervention (PCI), remains unclear. Therefore, we compared the efficacy and safety of different IC antithrombotic agents. MATERIALS AND METHODS This systematic review and network meta-analysis of randomized controlled trials (RCTs) compared IC fibrinolytic agents (recombinant tissue plasminogen activators [rtPAs] and non-rtPAs) or glycoprotein IIb/IIIa inhibitors (small molecules and monoclonal antibodies) with placebo by searching the relevant studies published before September 21, 2022. Bayesian network meta-analyses were performed using random-effects models. RESULTS Twenty-five RCTs with 4546 patients were included. Non-rtPAs and small molecules were significantly more effective in achieving thrombolysis in myocardial infarction (TIMI) grade 3 flow than placebo (odds ratio [OR] 2.28, 95 % credible intervals [CrI] 1.24-4.13; OR 2.06, 95 % CrI 1.17-3.46). Moreover, these agents' efficacy was observed in other microcirculation-related outcomes, including TIMI myocardial perfusion grade 3, complete ST-segment resolution, and corrected TIMI frame counts. Within 6 months, small molecules were associated with both an improved left ventricular ejection fraction (MD 3.90, 95 % CrI 0.48-7.46) and major adverse cardiac events (MACE) reduction (OR 0.36, 95 % CrI 0.20-0.61). Non-rtPAs demonstrated a reduced MACE incidence within 6 months (OR 0.51, 95 % CrI 0.31-0.81). The results were consistent in the subgroup with a total ischemic time > 6 h. No significant differences in mortality or bleeding events were observed. CONCLUSIONS IC non-rtPAs and small molecules may be effective for adjunctive therapy to PCI, particularly in patients with longer ischemia periods.
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Affiliation(s)
- Min Jung Geum
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea; Department of Pharmaceutical Medicine and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Jinyoung Jeon
- Department of Pharmaceutical Medicine and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea; Department of Pharmacy, National Cancer Center Hospital, Goyang, Republic of Korea
| | - Hyun Woo Lee
- Department of Pharmaceutical Medicine and Regulatory Science, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul National University Boramae Medical Center and College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - JongSung Hahn
- College of Pharmacy, Jeonbuk National University, Jeonju, Republic of Korea.
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea.
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Kaddoura R, Mohamed Ibrahim MI, Al-Badriyeh D, Omar A, Al-Kindi F, Arabi AR. Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials. PLoS One 2022; 17:e0263270. [PMID: 35512007 PMCID: PMC9071172 DOI: 10.1371/journal.pone.0263270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thrombus load in STEMI patients remains a challenge in practice. It aggravates coronary obstruction leading to impaired myocardial perfusion, worsened cardiac function, and adverse clinical outcomes. Various strategies have been advocated to reduce thrombus burden. OBJECTIVES This meta-analysis aimed to evaluate the effectiveness of intracoronary-administered thrombolytics or glycoprotein IIb/IIIa inhibitors (GPI) in comparison with aspiration thrombectomy (AT) as an adjunct to percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS A comprehensive literature search for randomized trials that compared intracoronary-administered thrombolytics or GPI with AT in STEMI patients who underwent PCI, was conducted using various databases (e.g., MEDLINE, EMBASE, CENTRALE). Primary outcome was procedural measures (e.g., TIMI flow grade 3, TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, ST-segment resolution (STR)). RESULTS Twelve randomized trials enrolled 1,466 patients: 696 were randomized to intracoronary-administered pharmacological interventions and 553 to AT. Patients randomized to PCI alone were excluded. Thrombolytics significantly improved TIMI flow grade 3 (odds ratio = 3.71, 95% CI: 1.85-7.45), complete STR (odds ratio = 3.64, 95% CI: 1.60-8.26), and TMPG 3 (odds ratio = 5.31, 95% CI: 2.48-11.36). Thrombolytics significantly reduced major adverse cardiovascular events (MACE) (odds ratio = 0.29, 95% CI: 0.13-0.65) without increasing bleeding risk. Trial sequential analysis assessment confirmed the superiority of thrombolytics for the primary outcome. Intracoronary GPI, either alone or combined with AT, did not improve procedural or clinical outcomes. CONCLUSIONS Compared with AT, intracoronary-administered thrombolytics significantly improved myocardial perfusion and MACE in STEMI patients.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Amr Omar
- Department of Cardiothoracic Surgery/Cardiac Anesthesia, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fahad Al-Kindi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Rahman Arabi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Sotomi Y, Ueda Y, Hikoso S, Nakatani D, Suna S, Dohi T, Mizuno H, Okada K, Kida H, Oeun B, Sunaga A, Sato T, Kitamura T, Sakata Y, Sato H, Hori M, Komuro I, Sakata Y. Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction. J Am Heart Assoc 2021; 10:e022258. [PMID: 34779225 PMCID: PMC8751963 DOI: 10.1161/jaha.121.022258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited. Methods and Results We investigated the association between manual TA and stroke risk during primary PCI in the OACIS (Osaka Acute Coronary Insufficiency Study) database (N=12 093). The OACIS is a prospective, multicenter registry of myocardial infarction. The primary end point of the present study is stroke at 7 days. A total of 9147 patients who underwent primary PCI within 24 hours of hospitalization were finally analyzed (TA group, n=4448, versus non‐TA group, n=4699 patients). TA was independently associated with risk of stroke at 7 days (odds ratio [OR], 1.92 [95% CI, 1.19‒3.12]; P=0.008) in the simple logistic regression model, while the multilevel random effects logistic regression model with hospital treated as a random effect showed that manual TA was not associated with incremental risk of stroke at 7 days (OR, 0.91 [95% CI, 0.71‒1.16]; P=0.435). The 7‐day stroke risk of manual TA was significantly heterogeneous in different institutions (Pfor interaction=0.007). Conclusions Manual TA during primary PCI for patients with acute myocardial infarction was independently associated with the overall increased risk of periprocedural stroke. However, this result was substantially skewed because of institution specific risk variation, suggesting that the periprocedural stroke may be preventable by prudent PCI procedure or appropriate periprocedural management. Registration URL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000005464. Unique identifier: UMIN000004575.
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Affiliation(s)
- Yohei Sotomi
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Yasunori Ueda
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan.,Department of Genome Informatics Osaka University Graduate School of Medicine Osaka Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Osaka Japan
| | - Yasuhiko Sakata
- Department of Clinical Medicine and Development and Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Hiroshi Sato
- School of Human Welfare Studies Health Care Center and Clinic Kwansei Gakuin University Hyogo Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
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Zhang Z, Li W, Wu W, Xie Q, Li J, Zhang W, Zhang Y. Myocardial reperfusion with tirofiban injection via aspiration catheter : Efficacy and safety in STEMI patients with large thrombus burden. Herz 2018; 45:280-287. [PMID: 29947833 DOI: 10.1007/s00059-018-4716-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/23/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is no consensus on the use of thrombus aspiration (TA) in primary percutaneous coronary intervention (PPCI), and few studies have focused on the performance of tirofiban via TA catheter after PPCI. Our study investigated the clinical outcome of tirofiban injection through TA in acute ST-segment elevation myocardial infarction (STEMI) patients with large thrombus burden undergoing PPCI treatment. PATIENTS AND METHODS The study comprised 122 STEMI patients who underwent TA during PPCI. Participants were randomly divided into two groups. Group A received intravenous tirofiban injection and tirofiban injection via a TA catheter to the infarcted coronary artery after aspiration (n = 61). Group B received intravenous tirofiban injection only (n = 61). Baseline clinical information and follow-up data were collected for both groups. Coronary angiography, electrocardiography, and echocardiography findings as well as major adverse cardiovascular events (MACE) were recorded. RESULTS There were significant differences in postprocedural Thrombolysis in Myocardial Infarction (TIMI) grade 2 and 3 flow between the two groups (p = 0.021, p = 0.006, respectively). The incidence of slow-flow in group A was significantly lower than that of group B (p = 0.011). An increased incidence of no ST-segment resolution was observed in group B (p = 0.011). There were fewer major adverse cardiovascular events in group A than in group B, but the difference was not statistically significant. CONCLUSION Selective tirofiban injection via TA catheter during PPCI may improve myocardial reperfusion in STEMI patients with large thrombus burden.
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Affiliation(s)
- Z Zhang
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - W Li
- Department of Cardiology, Ganzhou City People's Hospital, 341000, Ganzhou, China
| | - W Wu
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - Q Xie
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - J Li
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - W Zhang
- Department of Cardiology, Panyu Central Hospital (Cardiovascular Institute of Panyu District), 511400, Guangzhou, China
| | - Y Zhang
- Department of Ultrasound, Guangdong Women and Children Hospital, No. 521 Xingnan Avenue, 511400, Guangzhou, China.
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Ge J, Schäfer A, Ertl G, Nordbeck P. Thrombus Aspiration for ST-Segment-Elevation Myocardial Infarction in Modern Era: Still an Issue of Debate? Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005739. [PMID: 29042400 DOI: 10.1161/circinterventions.117.005739] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The role of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for acute ST-segment-elevation myocardial infarction has been a matter of intense research and debate now. Although recent randomized controlled clinical trials (notably TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) do not supply evidence supporting the routine use of TA in patients with ST-segment-elevation myocardial infarction, manual TA remains a therapeutic option for interventional cardiologists when treating patients with substantial thrombus burden during PPCI. It remains unknown whether patients might actually benefit from TA applied in a more selective manner depending on the thrombus burden during PPCI, instead of routine application. In this review, we summarize current knowledge on the instruments used in the TA procedure, positive as well as negative clinical effects of TA during PPCI, and analyze the potential reasons for observed effects, in an effort to help the clinical decision making by physicians for the use of TA in individual ST-segment-elevation myocardial infarction patients during PPCI.
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Affiliation(s)
- Junhua Ge
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Andreas Schäfer
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Georg Ertl
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Peter Nordbeck
- From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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6
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Fu K, Liu HD, MaMuTi K, Hu DN, Hao P. Relationship Between Carbohydrate Antigen 125 and Coronary Artery Calcification in Patients without Known Coronary Artery Disease. Med Sci Monit 2018; 24:2873-2877. [PMID: 29731508 PMCID: PMC5960219 DOI: 10.12659/msm.907418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study was designed to investigate the association between serum carbohydrate antigen 125 (CA125) and coronary artery calcification (CAC) score in patients without known coronary artery disease. MATERIAL AND METHODS The study groups included 348 consecutive subjects with chest pain but without known coronary artery disease, and who underwent an estimation of CAC score in our hospital. RESULTS The clinical and laboratory characteristics of all subjects are presented according to serum CA125 concentrations tertiles. The CAC score was found to be increased in the tertiles (31.6 ±82.10, 73.3±125.6, 122.9±135.9 U/mL, p<0.001). Serum CA125 concentrations are increased in calcium-positive patients compared with calcium-negative ones (9.3±4.79 vs. 11.2±7.36, p=0.003). A positive correlation between serum CA125 and CAC score was observed (r=0.319, p<0.001) in all participants. Similarly, the serum concentrations of CA125 were found to be positively correlated with CAC score in both women and men (r=0.328, p<0.001; r=0.265, p=0.001, respectively). Multiple linear regression analysis results indicated that serum CA125 concentrations are independently related to CAC score in the study population (beta=0.173, p=0.001), and age, sex, diabetes mellitus, and high-sensitivity C-reactive protein (hs-CRP) were also associated with CAC score in multiple linear regression analysis. CONCLUSIONS Serum CA125 concentrations are correlated with CAC score in the population without known coronary artery disease, and serum CA125 may be considered as a marker to estimate CAC in the study population.
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Affiliation(s)
- Kun Fu
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China (mainland)
| | - Hua-Dong Liu
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China (mainland)
| | - KuerBanJiang MaMuTi
- Department of Internal Medicine, Urumqi City People's Hospital (Children's Hospital) North Hospital, Urumqi, Xinjiang, China (mainland)
| | - Dong-Nan Hu
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China (mainland)
| | - Peng Hao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China (mainland)
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Qi Q, Niu J, Chen T, Yin H, Wang T, Jiang Z. Intracoronary Nicorandil and the Prevention of the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction. Med Sci Monit 2018; 24:2767-2776. [PMID: 29726480 PMCID: PMC5954842 DOI: 10.12659/msm.906815] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to investigate intracoronary nicorandil treatment on the no-reflow phenomenon (NRP) during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and to compare nicorandil with sodium nitroprusside. Material/Methods Patients with sustained acute STEMI who underwent primary PCI (N=120) were randomly assigned to three groups: the nicorandil-treated group (N=40) had 2 mg of nicorandil injected into the coronary artery at 2 mm beyond the occlusion with balloon pre-dilation; the sodium nitroprusside-treated group (N=40) underwent the same procedure, but with 200 μg of sodium nitroprusside; the control group (N=40) received PCI and balloon pre-dilation only. Coronary angiography, incidence of NRP, hypotensive episodes, ST-segment resolution (STR) rate, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), wall motion score index (WMSI), and left ventricular ejection fraction (LVEF) were measured before and after primary PCI. Major adverse cardiovascular events (MACEs) post-PCI and at three-month follow-up were recorded. Results Patients in the sodium nitroprusside and nicorandil groups had significantly improved thrombolysis in myocardial infarction (TIMI) scores, TIMI myocardial perfusion grade (TMPG), and ST-segment elevation resolution (STR) (P<0.05), and a significantly lower incidence of NRP (P=0.013). The incidence of intraoperative hypotension in the sodium nitroprusside group was significantly greater than the nicorandil and control groups (P=0.035). Conclusions Patients with sustained acute STEMI undergoing primary PCI, treated with intracoronary nicorandil had a reduced incidence of the NRP, improved myocardial perfusion and cardiac function.
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Affiliation(s)
- Qi Qi
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jinghui Niu
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Tao Chen
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hongshan Yin
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Tao Wang
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Zhian Jiang
- Department of Cardiology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Yu J, Wang L, Peng Y, Xiong M, Cai X, Luo J, Zhang M. Dynamic Monitoring of Erythrocyte Distribution Width (RDW) and Platelet Distribution Width (PDW) in Treatment of Acute Myocardial Infarction. Med Sci Monit 2017; 23:5899-5906. [PMID: 29233957 PMCID: PMC5737569 DOI: 10.12659/msm.904916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background This study investigated the role of erythrocyte distribution width (RDW) and platelet distribution width (PDW) in evaluating the treatment efficacy for acute myocardial infarction (AMI). Material/Methods A total of 120 AMI patients receiving conventional myocardial infarction treatment were included. The patients were divided into an effective group and an ineffective group based on treatment efficacy. The RDW and PDW were measured before and after treatment. We used the independent samples t test, chi-square test, logistic regression, and ROC curves for analysis. Results The change and change rate of RDW and PDW were significantly improved (p<0.01) and the positive change rate of RDW, PDW, and RDW + PDW were significantly lower in the effective group compared with those in the ineffective group (p<0.01). The change and change rate of RDW and PDW are independent factors for treatment efficacy evaluation (p<0.05). ROC curve analysis showed that the changes and change rate of RDW and PDW were all significant in evaluating treatment efficacy (p<0.05). Conclusions The change and change rate of RDW and PDW or their combination can be used to evaluate treatment efficacy; however, the absolute value of RDW and PDW are not as significant.
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Affiliation(s)
- Jian Yu
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Li Wang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Yuchong Peng
- Department of General Surgery, The Ninth People's Hospital of Chongqing, Chongqing, China (mainland)
| | - Mingjie Xiong
- Health Management Center, Southwest University Hospital, Chongqing, China (mainland)
| | - Xiaozhong Cai
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Juan Luo
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
| | - Minghao Zhang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China (mainland)
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9
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Niu XW, Zhang JJ, Bai M, Peng Y, Zhang Z. Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention: a meta-analysis. J Geriatr Cardiol 2017; 14:614-623. [PMID: 29238362 PMCID: PMC5721196 DOI: 10.11909/j.issn.1671-5411.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/06/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Suboptimal myocardial reperfusion is common in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Furthermore, it results in increased infarct size and mortality rates. We performed a meta-analysis to evaluate the role of aspiration thrombectomy (AT) combined with intracoronary administration of glycoprotein IIb/IIIa inhibitors (GPI) in the improvement of myocardial reperfusion and clinical outcomes. METHODS PubMed, Embase, Web of Science, and CENTRAL databases were searched for randomized controlled trials (RCTs) investigating combined AT and intracoronary GPI treatment versus AT alone. Outcomes of interest were thrombolysis in myocardial infarction myocardial perfusion grade (TMPG), infarct size (IS) assessed by cardiac magnetic resonance imaging, left ventricular ejection fraction (LVEF), major adverse cardiac events (MACE) at short-term (≤ 1 month) and long-term (6-12 months) follow-up, and bleeding complications during the hospital stay. RESULTS Eight trials involving 923 patients were included. Compared with AT alone, combined AT and intracoronary GPI significantly increased TMPG 3 flow (RR: 1.15, 95% CI: 1.04 to 1.26), reduced IS [mean difference (MD): -3.46, 95% CI: -5.18 to -1.73], and improved LVEF (MD: 1.44, 95% CI: 0.54 to 2.33). Furthermore, GPI use decreased the risk of MACE at long-term follow-up (RR: 0.60, 95% CI: 0.37 to 0.98). There was no significant difference between the two groups in the incidence of minor and major bleeding complications. CONCLUSIONS Our findings showed that compared with AT alone, combined AT and intracoronary GPI treatment resulted in improved myocardial reperfusion, better cardiac function, and MACE-free survival benefits at the long-term follow-up for patients with STEMI undergoing PPCI.
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Affiliation(s)
- Xiao-Wei Niu
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | | | - Ming Bai
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Yu Peng
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Zheng Zhang
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
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10
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Mangiacapra F, Sticchi A, Barbato E. Thrombus aspiration in primary percutaneous coronary intervention: still a valid option with improved technique in selected patients! Cardiovasc Diagn Ther 2017; 7:S110-S114. [PMID: 28748161 DOI: 10.21037/cdt.2017.05.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Sticchi
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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Tomioka T, Takeuchi S, Ito Y, Shioiri H, Koyama J, Inoue K. Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:939-943. [PMID: 27941711 PMCID: PMC5156557 DOI: 10.12659/ajcr.900474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) can be caused not only by plaque rupture/erosion, but also by many other mechanisms. Thromboembolism due to atrial fibrillation and coronary thrombosis due to coronary artery ectasia are among the causes. Here we report on a case of recurrent myocardial infarction with coronary artery ectasia. CASE REPORT Our case was a 78-year-old woman with hypertension. Within a one-month interval, she developed AMI twice at the distal portion of her right coronary artery along with coronary artery ectasia. On both events, emergent coronary angiography showed no obvious organic stenosis or trace of plaque rupture at the culprit segment after thrombus aspiration. After the second acute event, we started anticoagulation therapy with warfarin to prevent thrombus formation. In the chronic phase, we confirmed, by using coronary angiography, optimal coherence tomography and intravascular ultrasound, that there was no plaque rupture and no obvious thrombus formation along the coronary artery ectasia segment of the distal right coronary artery, which suggested effectiveness of anticoagulant. Furthermore, by Doppler velocimetry we found sluggish blood flow only in the coronary artery ectasia lesion but not in the left atrium which is generally the main site of systemic thromboembolism revealed by transesophageal echocardiography. CONCLUSIONS These results suggest that the two AMI events at the same coronary artery ectasia segment were caused by local thrombus formation due to local stagnant blood flow. Although it has not yet been generally established, anticoagulation therapy may be effective to prevent thrombus formation in patients with coronary artery ectasia regardless of the prevalence of atrial fibrillation.
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Affiliation(s)
- Tomoko Tomioka
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
| | - Satoshi Takeuchi
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
| | - Yoshitaka Ito
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
| | - Hiroki Shioiri
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
| | - Jiro Koyama
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
| | - Kanichi Inoue
- Department of Cardiology, South-Miyagi Medical Center, Shibata, Miyagi, Japan
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