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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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2
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Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ, Kubica J, Navarese EP. State of the Art: No-Reflow Phenomenon. Cardiol Clin 2020; 38:563-573. [PMID: 33036718 DOI: 10.1016/j.ccl.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary percutaneous coronary intervention is the preferred reperfusion strategy for the management of acute ST-segment elevation myocardial infarction. No reflow is characterized by the inadequate myocardial perfusion of a given segment without angiographic evidence of persistent mechanical obstruction of epicardial vessels. Both pharmacologic and device-based strategies have been tested to resolve coronary no reflow. This article provides an updated overview of the no-reflow phenomenon, discussing clinical evidence and ongoing investigations of existing and novel therapeutic strategies to counteract it.
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Affiliation(s)
- Gianluca Caiazzo
- ICCU, San Giuseppe Moscati Hospital, ASL CE, Via Gramsci 1, Aversa 81031, Italy
| | - Rita Leonarda Musci
- Department of Cardiology, Azienda Ospedaliera Bonomo, Viale Istria, Andria BT 76123, Italy
| | - Lara Frediani
- Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Viale Vittorio Alfieri, 36, Livorno LI 57124, Italy
| | - Julia Umińska
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, ul. Józefa Poniatowskiego 15, Kato 40-055, Katowice, Poland
| | - Krzysztof J Filipiak
- Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, Warszawa 02-091, Poland
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Eliano Pio Navarese
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland; University of Alberta, 116 Street & 85 Avenue, Edmonton, AB T6G 2R3, Canada.
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Effect of intracoronary tirofiban following aspiration thrombectomy on infarct size, in patients with large anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2019; 31:255-259. [PMID: 31658145 DOI: 10.1097/mca.0000000000000825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial recovery following primary percutaneous coronary intervention is often suboptimal despite of restoration of thrombolysis in myocardial infarction (TIMI) 3 flow, in part due to thrombus embolization which results in impairing microvascular reperfusion besides increasing infarct size. The purpose of the present study was to estimate the effect of aspiration thrombectomy followed by intracoronary delivery of tirofiban on decreasing the infarct size utilizing cardiac MRI (cMR) in large anterior ST-segment elevation myocardial infarction (STEMI) patients. PATIENTS A prospective randomized controlled study of 100 patients with large anterior STEMI were randomized to (Study group) using intracoronary tirofiban (intracoronary) and (control group) without intocoronary tirofiban. A 6 F thrombus aspiration catheter was used in all patients. Tirofiban was injected locally at the place of the highly thrombus burden through the aspiration device after flushing the aspiration device well. RESULTS Patients of intracoronary tirofiban group compared with control group had a significant difference in decreasing the infarct size at 30 days [median, 15.451 g - interquartile range (IQR), 17.404 gm - n = 50] vs (median, 43.828 g - IQR, 49.599 g - n = 50) P value = 0.002. CONCLUSION In patients early presented with large anterior STEMI, infarct size at 30 days was significantly decreased by intracoronary tirofiban delivered to the infarct lesion site followed aspiration thrombectomy.
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Umińska JM, Ratajczak J, Buszko K, Sobczak P, Sroka W, Marszałł MP, Adamski P, Steblovnik K, Noč M, Kubica J. Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest. Cardiol J 2019; 27:780-788. [PMID: 30799546 DOI: 10.5603/cj.a2019.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) frequently occurs in the early phase of acute myocardial infarction (MI). Survivors require percutaneous coronary intervention (PCI) with concomitant dual antiplatelet therapy. Target temperature management, including mild therapeutic hypothermia (MTH), should be applied in comatose patients after resuscitation. However, an increased risk of stent thrombosis in patients undergoing hypothermia is observed. The aim of this study was to assess the impact of MTH on pharmacokinetics of ticagrelor in cardiac arrest survivors with MI treated with MTH and PCI. METHODS In a prospective, observational, single-center study pharmacokinetics of ticagrelor were evaluated in 41 MI patients, including 11 patients after OHCA undergoing MTH (MTH group) and 30 MI patients without OHCA and MTH (no-MTH group). Blood samples were drawn before administration of a 180 mg ticagrelor loading dose, and 30 min, 1, 2, 4, 6, 12, and 24 h after the loading dose. RESULTS In patients treated with MTH total exposure to ticagrelor during the first 12 h after the loading dose and maximal plasma concentration of ticagrelor were significantly lower than in the no-MTH group (AUC(0-12): 3403 ± 2879 vs. 8746 ± 5596 ng·h/mL, difference: 61%, p = 0.01; Cmax: 475 ± 353 vs. 1568 ± 784 ng/mL, p = 0.0002). Time to achieve maximal ticagrelor plasma concentration was also delayed in the MTH group (tmax for ticagrelor: 12 [6-24] vs. 4 [2-12] h, p = 0.01). CONCLUSIONS Bioavailability of ticagrelor was substantially decreased and delayed in MI patients treated with MTH after OHCA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02611934.
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Affiliation(s)
- Julia M Umińska
- Department of Geriatric, Collegium Medicum, Nicolaus Copernicus University, Ul. M.Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Biomedical Science and Medical Informatics, Collegium Medicum, Nicolaus Copernicus University, ul. Jagiellońska 13-15,, 85-067 Bydgoszcz, Poland
| | - Przemysław Sobczak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Wiktor Sroka
- Department of Medicinal Chemistry, Collegium Medicum, Nicolaus Copernicus University, Ul. M.Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Michał P Marszałł
- Department of Medicinal Chemistry, Collegium Medicum, Nicolaus Copernicus University, Ul. M.Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Piotr Adamski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Klemen Steblovnik
- Ljubljana University Medical Centre, University of Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Marko Noč
- Ljubljana University Medical Centre, University of Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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Amier RP, Tijssen RYG, Teunissen PFA, Fernández-Jiménez R, Pizarro G, García-Lunar I, Bastante T, van de Ven PM, Beek AM, Smulders MW, Bekkers SCAM, van Royen N, Ibanez B, Nijveldt R. Predictors of Intramyocardial Hemorrhage After Reperfused ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.005651. [PMID: 28862937 PMCID: PMC5586425 DOI: 10.1161/jaha.117.005651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Findings from recent studies show that microvascular injury consists of microvascular destruction and intramyocardial hemorrhage (IMH). Patients with ST‐segment elevation myocardial infarction (STEMI) with IMH show poorer prognoses than patients without IMH. Knowledge on predictors for the occurrence of IMH after STEMI is lacking. The current study aimed to investigate the prevalence and extent of IMH in patients with STEMI and its relation with periprocedural and clinical variables. Methods and Results A multicenter observational cohort study was performed in patients with successfully reperfused STEMI with cardiovascular magnetic resonance examination 5.5±1.8 days after percutaneous coronary intervention. Microvascular injury was visualized using late gadolinium enhancement and T2‐weighted cardiovascular magnetic resonance imaging for microvascular obstruction and IMH, respectively. The median was used as the cutoff value to divide the study population with presence of IMH into mild or extensive IMH. Clinical and periprocedural parameters were studied in relation to occurrence of IMH and extensive IMH, respectively. Of the 410 patients, 54% had IMH. The presence of IMH was independently associated with anterior infarction (odds ratio, 2.96; 95% CI, 1.73–5.06 [P<0.001]) and periprocedural glycoprotein IIb/IIIa inhibitor treatment (odds ratio, 2.67; 95% CI, 1.49–4.80 [P<0.001]). Extensive IMH was independently associated with anterior infarction (odds ratio, 3.76; 95% CI, 1.91–7.43 [P<0.001]). Presence and extent of IMH was associated with larger infarct size, greater extent of microvascular obstruction, larger left ventricular dimensions, and lower left ventricular ejection fraction (all P<0.001). Conclusions Occurrence of IMH was associated with anterior infarction and glycoprotein IIb/IIIa inhibitor treatment. Extensive IMH was associated with anterior infarction. IMH was associated with more severe infarction and worse short‐term left ventricular function in patients with STEMI.
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Affiliation(s)
- Raquel P Amier
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Ruben Y G Tijssen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul F A Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Rodrigo Fernández-Jiménez
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,The Zena and Michael A. Wiener CVI, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gonzalo Pizarro
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Aernout M Beek
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Borja Ibanez
- Centro Nacional Investigaciones Cardiovasculares Carlos III, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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6
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Clinic Predictive Factors for Insufficient Myocardial Reperfusion in ST-Segment Elevation Myocardial Infarction Patients Treated with Selective Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3823809. [PMID: 27891513 PMCID: PMC5116489 DOI: 10.1155/2016/3823809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022]
Abstract
Background. Insufficient data are available on the potential benefit of selective aspiration and clinical predictors for no-reflow in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) adjunct with aspiration thrombectomy. Objective. The aim of our study was to investigate clinical predictors for insufficient reperfusion in patients with high thrombus burden treated with PPCI and manual aspiration thrombectomy. Methods. From January 2011 till December 2015, 277 STEMI patients undergoing manual aspiration thrombectomy and PPCI were selected and 202 patients with a Thrombolysis in Myocardial Infarction (TIMI) thrombus grade 4~5 were eventually involved in our study. According to a cTFC value, patients were divided into Group I (cTFC > 40), namely, insufficient reperfusion group; Group II (cTFC ≤ 40), namely, sufficient reperfusion group. Results. Univariate analysis showed that hypertension, multivessel disease, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were negative predictors for insufficient reperfusion. After multivariate adjustment, age ≧ 60 years, hypertension, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were independently associated with insufficient reperfusion in STEMI patients treated with manual aspiration thrombectomy. Upfront intracoronary GP IIb/IIIa inhibitor (Tirofiban) was positively associated with improved myocardial reperfusion. Conclusion. Fully identifying risk factors will help to improve the effectiveness of selective thrombus aspiration.
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Ajlani B, Gibault-Genty G, Cherif G, Blicq E, Azzaz S, Schiano P, Brami M, Sarfati L, Charbonnel C, Convers-Domart R, Livarek B, Georges JL. [Intracoronary administration of antithrombotic agents via a perfusion balloon catheter in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration]. Ann Cardiol Angeiol (Paris) 2016; 65:299-305. [PMID: 27693166 DOI: 10.1016/j.ancard.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Massive intracoronary thrombus is associated with adverse procedural results including failed aspiration and unfavourable reperfusion. We aim to evaluate the effect of the intracoronary administration of antithrombotic agents via a perfusion catheter in patients with ST-segment elevation myocardial infarction (STEMI) presenting with a large thrombus burden and failed aspiration. METHODS We retrospectively analyzed the thrombus burden, the TIMI grade flow, and the myocardial Blush in 25 consecutive STEMI patients with a large thrombus burden and failed manual aspiration, who received intracoronary infusion of glycoprotein IIb/IIIa inhibitors (N=17) or bivalirudine (N=8) via a 6F-infusion catheter (ClearWay™ RX) RESULTS: Mean age was 67±14 years, 16 patients (64 %) presented with anterior STEMI, and 7 (28 %) with cardiogenic shock. Immediately after intracoronary infusion, the TIMI flow grade improved of 2 grades in 7 patients (28 %), and 1 grade in 14 (56 %), a complete resolution of the thrombus was observed in 9 patients, and a >50 % resolution in 12. Blush was improved of 3 grades in 15 patients (60 %), of 2 grades in 7 (28 %), and Blush grade 0 remained in 3. At the end of procedure, we observed normal TIMI 3flow in most patients (92 %), a complete resolution of thrombus in 80 %, and a Blush grade 3 in 68 %. CONCLUSIONS In STEMI patients presenting with a large thrombus burden and failed aspiration, intracoronary administration of glycoprotein IIb/IIIa inhibitors or bivalirudin via the perfusion catheter ClearWay™ RX significantly reduced the thrombus burden and improved the TIMI flow and the Blush grade, without bleeding.
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Affiliation(s)
- B Ajlani
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Gibault-Genty
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Cherif
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - E Blicq
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Azzaz
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Schiano
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - M Brami
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France; Service de cardiologie, centre médico chirurgical de l'Europe, 78560 Le Port Marly, France
| | - L Sarfati
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France; Service de cardiologie, centre médico chirurgical de l'Europe, 78560 Le Port Marly, France
| | - C Charbonnel
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - R Convers-Domart
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - B Livarek
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - J-L Georges
- Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
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Savonitto S, De Luca G, Goldstein P, van T' Hof A, Zeymer U, Morici N, Thiele H, Montalescot G, Bolognese L. Antithrombotic therapy before, during and after emergency angioplasty for ST elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:173-190. [PMID: 26124456 DOI: 10.1177/2048872615590148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The first three hours after symptom onset hold the maximum potential for myocardial reperfusion and salvage in ST-elevation myocardial infarction (STEMI) patients. During this period timely primary percutaneous coronary intervention (PPCI) or, when PPCI is not promptly feasible, pre-hospital administration of fibrinolyis or a glycoprotein IIb/IIIa-inhibitor (GPI) have been shown to restore coronary patency and reperfusion and even result in myocardial infarction (MI) abortion. On the other hand, oral antiplatelet therapy may not yet guarantee sufficient platelet inhibition. Patients presenting after this golden time have less, if any, benefit from an aggressive antithrombotic treatment prior to PPCI. Antithrombotic treatment during primary angioplasty should be tailored on the basis of the coronary thrombotic burden, vascular approach and the patient's risk of bleeding complications. A GPI-based approach may be favourable in patients presenting early with large MI and high thrombus burden, whereas a bivalirudin-based approach without GPI may be preferred in patients with higher bleeding risk. There are no data to support the use of GPI in bailout conditions. The powerful oral P2Y12 inhibitors, prasugrel and ticagrelor, have been clearly shown to prevent stent thrombosis and recurrent ischaemic events after emergency percutaneous coronary intervention in STEMI patients. Open issues remaining are the treatment of patients with high bleeding risk, such as the elderly and those requiring anticoagulation, as well as the duration of dual antiplatelet therapy after STEMI.
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Affiliation(s)
| | | | | | | | - Uwe Zeymer
- 5 Klinikum Ludwigshafen, Ludwigshafen, Germany
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9
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Aspiration thrombectomy and intracoronary tirofiban in ST-segment elevation myocardial infarction. Herz 2016; 41:732-740. [DOI: 10.1007/s00059-016-4426-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/06/2016] [Indexed: 01/27/2023]
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10
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Carrabba N, Parodi G, Maehara A, Pradella S, Migliorini A, Valenti R, Comito V, Marrani M, Rega L, Colagrande S, Mintz GS, Antoniucci D. Rheolityc thrombectomy in acute myocardial infarction: Effect on microvascular obstruction, infarct size, and left ventricular remodeling. Catheter Cardiovasc Interv 2016; 87:E1-8. [PMID: 26108162 DOI: 10.1002/ccd.25961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to analyze whether rheolytic thrombectomy (RT) in comparison with manual thrombus aspiration (MTA) may reduce microvascular obstruction (MVO), infarct size (IS), and left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI). BACKGROUND Conflicting results have been reported as to whether MTA reduces MVO and IS. METHODS AND RESULTS Eighty STEMI reperfused by primary angioplasty and abciximab were randomly allocated (1:1) to RT or MTA. Cardiac magnetic resonance imaging (MRI) was performed in 37 patients (19 RT) and after 1 year in 19 (9 RT); baseline, 1- and 6-month 2D-echo was performed in all patients. MVO and IS were measured 8 min after gadolinium injection with late enhancement sequences and were analyzed quantitatively at a core laboratory blinded to randomization. At baseline TIMI thrombus grade were similar (RT: 4.47 ± 0.84 vs. MTA: 4.67 ± 0.76, P = 0.453). After thrombectomy, thrombus grade decreased to 1.11 ± 1.04 in RT vs. 2.17 ± 1.29 in MTA arm (P = 0.009). RT compared with MTA did not reduced significantly myocardial IS [12.2% (6.4-22.1) vs. 19.0% (7-28.5), P = 0.224] as well as the extent of MVO [0.0% (0.0-0.17) vs. 0.6% (0.0-1.4), P = 0.117], but a trend toward a lower incidence of MVO (16% vs. 44%, P = 0.056) and a less LV remodeling rate were found in RT arm (11% vs. 24%, P < 0.140). CONCLUSION RT in comparison with MTA was more effective in thrombus removal, but it did not reduced significantly the IS and the extent of MVO. However, a trend toward a lower incidence of MVO and a better preservation of LV volumes were found in RT arm. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Guido Parodi
- Division of Cardiology, Careggi Hospital, Florence, Italy
| | - Akiko Maehara
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York
| | | | | | - Renato Valenti
- Division of Cardiology, Careggi Hospital, Florence, Italy
| | | | - Marco Marrani
- Division of Cardiology, Careggi Hospital, Florence, Italy
| | - Luigi Rega
- Department of Radiology, Careggi Hospital, Florence, Italy
| | | | - Gary S Mintz
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York
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Prati F, Romagnoli E, Limbruno U, Pawlowski T, Fedele S, Gatto L, Di Vito L, Pappalardo A, Ramazzotti V, Picchi A, Trivisonno A, Materia L, Pfiatkosky P, Paoletti G, Marco V, Tavazzi L, Versaci F, Stone GW. Randomized evaluation of intralesion versus intracoronary abciximab and aspiration thrombectomy in patients with ST-elevation myocardial infarction: The COCTAIL II trial. Am Heart J 2015; 170:1116-23. [PMID: 26678633 DOI: 10.1016/j.ahj.2015.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thrombus burden and distal embolization are predictive of no-reflow during primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). We sought to compare the efficacy of pharmacological and catheter-based strategies for thrombus in patients with STEMI and high atherothrombotic burden. METHODS Between January 2012 and December 2013, 128 STEMI patients undergoing primary PCI at 5 centers were randomly assigned in a 2 × 2 factorial design to intracoronary (IC) abciximab bolus (via the guide catheter) versus intralesion (IL) abciximab bolus, each with versus without aspiration thrombectomy (AT). Study end points were residual intrastent atherothrombotic burden, defined as the number of cross-sections with residual tissue area >10% as assessed by optical coherence tomography, and indices of angiographic and myocardial reperfusion. RESULTS Residual intrastent atherothrombotic burden did not significantly differ with IL versus IC abciximab (median [interquartile range] 6.0 [1-15] vs 6.0 [2-11], P = .806) and with AT versus no aspiration (6.0 [1-13] vs 6.0 [2-12], P = .775). Intralesion abciximab administration was associated with improved angiographic myocardial reperfusion in terms of thrombolysis in myocardial infarction (TIMI) flow (3 [3-3] vs 3 [2-3], P = .040), corrected TIMI frame count (12 ± 5 vs 17 ± 16, P = .021), and myocardial blush grade (3 [2-3] vs 3 [2-3], P = .035). In particular, IL abciximab was associated with higher occurrence of final TIMI 3 flow (90% vs 73.8%, P = .032) and myocardial blush grade 3 (71.6% vs 52.4%, P = .039). Conversely, AT had no significant effect on indices of angiographic or myocardial reperfusion. CONCLUSIONS In patients with STEMI and high thrombotic burden, neither IL versus IC abciximab nor AT versus no aspiration reduced postprocedure intrastent atherothrombotic burden in patients with STEMI undergoing primary PCI. However, IL abciximab improved indices of angiographic and myocardial reperfusion compared to IC abciximab, benefits not apparent with AT.
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De Luca G, Savonitto S, van’t Hof AWJ, Suryapranata H. Platelet GP IIb-IIIa Receptor Antagonists in Primary Angioplasty: Back to the Future. Drugs 2015; 75:1229-53. [DOI: 10.1007/s40265-015-0425-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Secco GG, Sansa M, Rognoni A, Parisi R, Fattori R, Rossi L, Lazzero M, Rolla R, Bellomo G, Bongo AS, Agostoni P, Di Mario C, Lupi A. Similar anti-inflammatory effects of intracoronary and intravenous Abciximab during primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2015; 16:189-96. [DOI: 10.2459/jcm.0000000000000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Navarese EP, Schulze V, Andreotti F, Kowalewski M, Kołodziejczak M, Kandzari DE, Rassaf T, Gorny B, Brockmeyer M, Meyer C, Berti S, Kubica J, Kelm M, Valgimigli M. Comprehensive Meta-Analysis of Safety and Efficacy of Bivalirudin Versus Heparin With or Without Routine Glycoprotein IIb/IIIa Inhibitors in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2015; 8:201-213. [DOI: 10.1016/j.jcin.2014.10.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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Abstract
The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment-elevation myocardial infarction and non-ST-segment-elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment-elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system-related delays in reperfusion include regionalization of ST-segment-elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention-capable hospitals, bypassing the percutaneous coronary intervention-capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non-ST-segment-elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non-ST-segment-elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.
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Affiliation(s)
- Akshay Bagai
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.).
| | - George D Dangas
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Gregg W Stone
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Christopher B Granger
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
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Cortese B, Sebik R, Valgimigli M. The conundrum of antithrombotic drugs before, during and after primary PCI. EUROINTERVENTION 2014; 10 Suppl T:T64-73. [DOI: 10.4244/eijv10sta11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shakoor MT. Complications of intracoronary abciximab bolus-only versus standard protocol during percutaneous coronary intervention in acute coronary syndrome. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:64-67. [PMID: 29450173 PMCID: PMC5801446 DOI: 10.1016/j.ijchv.2014.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 06/08/2023]
Abstract
BACKGROUND Abciximab reduces major adverse cardiac events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Standard protocol is intravenous abciximab bolus during PCI plus abciximab infusion for 12-18 h post pPCI. Intracoronary (IC) abciximab bolus administration results in high local drug concentrations and hence it should have higher antiplatelet effect. In this study, we assess the short-term efficacy and safety of IC compared to IV bolus of abciximab in ACS patients during pPCI. METHODS We compared the clinical outcomes between the IC (n = 56) and standard protocol (n = 170) group of patients. Primary endpoints included bleeding/vascular/ischemic complications and MACE. RESULTS The two groups were similar with respect to baseline characteristics. IC abciximab bolus only reduced bleeding complications, with no moderate bleed versus 7.2% in standard protocol group (p value 0.04). Ischemic/vascular complications had statistically insignificant difference between the two groups. CONCLUSION We found no significant difference between IC abciximab bolus only and standard abciximab therapy in terms of ischemic/vascular complications and MACE. But there was higher risk of moderate bleed in standard therapy group. The IC bolus route of abciximab may be superior to the intravenous route. Prospective randomized trials are warranted to validate these findings.
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Affiliation(s)
- Muhammad Tariq Shakoor
- Corresponding author at: Baystate Medical Center, MA, United States. Tel.: + 1 413 231 2431 (Cell)Corresponding author at: Baystate Medical CenterTel.: + 1 413 231 2431 (Cell)MAUnited States
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Kubica J, Kozinski M, Navarese EP, Tantry U, Kubica A, Siller-Matula JM, Jeong YH, Fabiszak T, Andruszkiewicz A, Gurbel PA. Cangrelor: an emerging therapeutic option for patients with coronary artery disease. Curr Med Res Opin 2014; 30:813-28. [PMID: 24393016 DOI: 10.1185/03007995.2014.880050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. METHODS A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. RESULTS Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. CONCLUSIONS With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.
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Affiliation(s)
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
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Ahn SG, Lee SH, Lee JH, Lee JW, Youn YJ, Ahn MS, Kim JY, Yoo BS, Yoon J, Choe KH, Tahk SJ. Efficacy of combination treatment with intracoronary abciximab and aspiration thrombectomy on myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary coronary stenting. Yonsei Med J 2014; 55:606-16. [PMID: 24719126 PMCID: PMC3990073 DOI: 10.3349/ymj.2014.55.3.606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. RESULTS IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). CONCLUSION Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).
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Affiliation(s)
- Sung Gyun Ahn
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyun Lee
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun-Won Lee
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Jin Youn
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min-Soo Ahn
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jang-Young Kim
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Junghan Yoon
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyung-Hoon Choe
- Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
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Osnabrugge RL, Capodanno D, Cummins P, Kappetein P, Serruys PW. Review and recommendations on the current practice of meta-analyses: a guide to appraise the evidence. EUROINTERVENTION 2014; 9:1013-20. [DOI: 10.4244/eijv9i9a172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stone GW, Witzenbichler B, Godlewski J, Dambrink JHE, Ochala A, Chowdhary S, El-Omar M, Neunteufl T, Metzger DC, Dizon JM, Wolff SD, Brener SJ, Mehran R, Maehara A, Gibson CM. Intralesional Abciximab and Thrombus Aspiration in Patients With Large Anterior Myocardial Infarction. Circ Cardiovasc Interv 2013; 6:527-34. [DOI: 10.1161/circinterventions.113.000644] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gregg W. Stone
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Bernhard Witzenbichler
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Jacek Godlewski
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Jan-Henk E. Dambrink
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Andrzej Ochala
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Saqib Chowdhary
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Magdi El-Omar
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Thomas Neunteufl
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - David Christopher Metzger
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Jose M. Dizon
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Steven D. Wolff
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Sorin J. Brener
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Roxana Mehran
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - Akiko Maehara
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
| | - C. Michael Gibson
- From the Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY (G.W.S., J.M.D., A.M.); The Cardiovascular Research Foundation, New York, NY (G.W.S., J.M.D., S.D.W., S.J.B., R.M., A.M.); Charité Campus Benjamin Franklin, Berlin, Germany (B.W.); Jagiellonian University School of Medicine, Krakow, Poland (J.G.); Isala Klinieken, Zwolle, The Netherlands (J.-H.E.D.); Silesian Medical Academy, Katowice, Poland (A.O.); University Hospital of South Manchester, Manchester,
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Intracoronary abciximab in STEMI using local drug delivery catheter - single center experience. Indian Heart J 2013; 65:256-9. [PMID: 23809377 DOI: 10.1016/j.ihj.2013.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/31/2012] [Accepted: 04/03/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite restoration of epicardial flow during primary PCI in STEMI, microvascular obstruction may persist as a result of both atheromatous and thrombotic embolization and vasospasm. Compared with the systemic administration of IV pharmaco-therapies, highly localized administration of intracoronary pharmacotherapy may be associated with a several-hundred-fold increase in the local concentration of an agent in the epicardial artery and microcirculation. Despite restoration of epicardial flow during primary PCI in STEMI, microvascular obstruction may persist as a result of both atheromatous and thrombotic embolization and vasospasm. We are presenting our experience with use of intracoronary abciximab using local drug delivery catheter in STEMI patients. METHODS We retrospectively evaluated 15 patients presented to us with STEMI undergoing primary PCI between March 2011 and September 2012 who had super selective intracoronary abciximab using local drug delivery catheter. With standard antiplatelet therapy, both Pre and Post TIMI flow, TMP grading were assessed. RESULTS Mean age was 55 years. The TIMI flow increased by 3 grades in thirteen patients, TMP grading increased by 2 grades in five patients and by 3 grades in nine patients. Thus TIMI flow and TMP grading improved after super selective intracoronary abciximab. CONCLUSION Super selective intracoronary abciximab using local drug delivery catheter during primary PCI in STEMI patients significantly improves TMP grading without increased risk of bleeding. This benefit is achieved even in patients without thrombus aspiration. We need to assess the long-term outcomes in the form of reduction in infarct size using this strategy in large group of patients.
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Eitel I, Wöhrle J, Suenkel H, Meissner J, Kerber S, Lauer B, Pauschinger M, Birkemeyer R, Axthelm C, Zimmermann R, Neuhaus P, Brosteanu O, de Waha S, Desch S, Gutberlet M, Schuler G, Thiele H. Intracoronary Compared With Intravenous Bolus Abciximab Application During Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2013; 61:1447-54. [DOI: 10.1016/j.jacc.2013.01.048] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/19/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
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