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Among subjects with first-time anterior STEMI due to a proximal or mid LAD lesion who undergo successful PCI, administration of MTP-131 was safe and well tolerated. Treatment with MTP-131 was not associated with a decrease in myocardial infarct size as assessed by AUC0-72 of CK-MB.

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By achieving high local drug concentrations, intracoronary abciximab may be more effective in reducing platelet thromboemboli than when administered intravenously. 7,8 However,Background-Whether intralesional abciximab administration and thrombus aspiration confer clinical benefits to patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction is controversial. Methods and Results-A total of 452 patients with ST-segment-elevation myocardial infarction caused by proximal or mid left anterior descending artery occlusion undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation were randomized in a 2×2 factorial design to bolus abciximab delivered locally at the infarct lesion site versus no abciximab and to manual thrombus aspiration versus no aspiration. Treatment with intralesional abciximab, thrombus aspiration, or both therapies compared with no active therapy before stent implantation resulted in lower 1-year rates of death (4.5% versus 10.4%; P=0.03), severe heart failure (4.2% versus 10.3%; P=0.02), and stent thrombosis (0.9% versus 3.8%; P=0.046). Between 30 days and 1 year of follow-up, treatment with intralesional abciximab compared with no abciximab was associated with a lower rate of death (1.4% versus 4.9%; P=0.04) and composite major adverse ischemic events (3.3% versus 7.8%; P=0.04), with nonsignificantly different overall 1-year rates of mortality, composite ischemic events, and heart failure-related events. Thrombus aspiration compared with no aspiration was associated with lower rates of new-onset severe heart failure between 30 days and 1 year (0.9% versus 4.5%; P=0.02) and of rehospitalization for heart failure from randomization to 1 year (0.9% versus 5.4%; P=0.0008), with nonsignificantly different rates of mortality. Conclusions-Intralesional abciximab and thrombus aspiration may have long-term benefits in patients with anterior STsegment-elevation myocardial infarction presenting early after symptom onset and undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00976521.(Circ Cardiovasc Interv. 2013;6:527-534.)

Objective-We assessed the relationship between fibrin clot properties and the no-reflow phenomenon after primary coronary intervention (PCI). Methods and Results-Epicardial blood flow was assessed by TIMI scale and corrected TIMI frame count (cTFC), and perfusion by TIMI Myocardial Perfusion Grade (TMPG) after PCI during ST-segment elevation myocardial infarction (STEMI). Fibrin clot permeability (K s ) and susceptibility to lysis in assays using exogenous thrombin (t 50% ) and without thrombin (t TF ) were determined in 30 no-reflow patients (TIMI Յ2) and in 31 controls (TIMI-3) after uneventful 6 to 14 months from PCI. Key Words: myocardial infarction Ⅲ primary coronary angioplasty Ⅲ no-reflow phenomenon Ⅲ fibrin clot Ⅲ fibrinolysis T he efficiency of reperfusion therapy in acute myocardial infarction (MI) is limited by impaired microvascular reperfusion occurring after opening an infarct related artery (IRA). 1-3 The absence of a complete myocardial perfusion despite successful opening of the IRA is known as the no-reflow phenomenon, 4 which affects up to 30% of the primary angioplasty patients. 2,[5][6][7] The occurrence of the noreflow phenomenon during an acute phase of MI has a negative prognostic value. Incomplete coronary reperfusion is associated with a larger infarct size, 8,9 lower left ventricular (LV) ejection fraction, 10 increased mortality, 5,11 and more frequent congestive heart failure attributable to LV remodeling. 6,9 Main causes of this phenomenon are not fully understood and involve: microvascular embolization by the aggregates composed of platelets, erythrocytes, neutrofiles, and fragments of thrombus and ruptured plaque; endothelial dysfunction; vascular smooth muscle cell (VSMC) contraction, and surrounding tissue edema. 12 Complex pathways of blood coagulation lead ultimately to the formation of a fibrin clot that is preceded by thrombin-mediated fibrinogen conversion to fibrin and fibrin cross-linking by activated factor XIII. 13 The structure and function of the fibrin clot is affected by genetic and environmental factors, especially fibrinogen levels. 14 Despite the data showing that fibrin thrombi may participate in microvascular obstruction 4,12 and an early intervention in a closed artery with a large thrombus leads to distal embolization and tissue perfusion deterioration in some patients, 7,15 an association between fibrin clot properties and the no-reflow phenomenon has not yet been studied. Therefore, we sought to evaluate the fibrin clot properties in patients with impaired epicardial and tissue reperfusion after primary coronary intervention (PCI) in myocardial infarction with persistent ST-segment elevation (STEMI) in ECG. Methods PatientsSixty-one patients, 43 men, aged 62.7Ϯ10.2 years, who underwent PCI for STEMI were enrolled in this case-control study. We studied 30 consecutive patients with a final TIMI Յ2 coronary blood flow after PCI (the no-reflow group) performed 6 to 14 (average 10.2Ϯ2.5) months before the enrolment. Thirty-one Original

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