A Prospective Randomized Trial of Thrombectomy Versus No Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction and Thrombus-Rich Lesions

Carlo, Marco De; Aquaro, Giovanni Donato; Palmieri, Cataldo; Guerra, Elena; Misuraca, Leonardo; Giannini, Cristina; Lombardi, Massimo; Berti, Sérgio; Petronio, Anna Sonia

doi:10.1016/j.jcin.2012.08.013

Cited by 69 publications

(42 citation statements)

References 24 publications

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“…208 Also, no reduction of microvascular obstruction and infarct size was found with MRI. [209][210][211] Hyperoxemia, 212,213 aspiration or mechanical thrombectomy, [214][215][216][217][218][219][220][221] and intra-aortic balloon counterpulsation 222 did not reduce infarct size or improve coronary blood flow. More recently, also the cardioprotection by cyclosporine A which had been shown in a small-scale proof-of-concept trial 223 was not confirmed in another smaller study with prethrombolytic cyclosporine A 224 and, importantly, not in 2 larger-scale phase III trials, Does Cyclosporine Improve Clinical Outcome in ST Elevation Myocardial Infarction Patients (CIRCUS) and CyclosporinE A in Reperfused Myocardial Infarct (CYCLE).…”

Section: Clinical Studiesmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

204

160

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Abstract:The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/ reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre-and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available. (Circ Res.

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Section: Clinical Studiesmentioning

confidence: 99%

The Coronary Circulation as a Target of Cardioprotection

Heusch

2016

Circulation Research

204

160

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“…4,5,[12][13][14][15][26][27][28][29][30][31][32][33][34][35][36][37] The weighted mean follow-up duration was 3.7±2.7 months. Three trials reported outcomes at both 1 and 12 months.…”

Section: Included Studiesmentioning

confidence: 99%

“…12,[32][33][34]37 MACE was defined in 5 studies as death, reinfarction, or target vessel revascularization. 14,15,26,27,31 In 1 study, death, reinfarction, or stroke was used as the MACE definition, 36 whereas another study used death, reinfarction, or hospitalization for heart failure as the MACE definition. 35 Another study defined MACE as composite of death from cardiovascular causes, reinfarction, cardiogenic shock, or New York Heart Association class IV heart failure.…”

Section: Included Studiesmentioning

confidence: 99%

Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention?

Elgendy

Huo

Bhatt

et al. 2015

Circ: Cardiovascular Interventions

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Background— It is unclear whether intravenous glycoprotein IIb/IIIa inhibitors or ischemic time might modify any clinical benefits observed with aspiration thrombectomy before primary percutaneous coronary intervention (PCI) in patients with ST-segment–elevation myocardial infarction. Methods and Results— Electronic databases were searched for trials that randomized ST-segment–elevation myocardial infarction patients to aspiration thrombectomy before PCI versus conventional PCI. Summary estimates were constructed using a DerSimonian-Laird model. Seventeen trials with 20 960 patients were available for analysis. When compared with conventional PCI, aspiration thrombectomy was not associated with a significant reduction in the risk of mortality 2.8% versus 3.2% (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.76–1.04; P =0.13), reinfarction 1.3% versus 1.4% (RR, 0.93; 95% CI, 0.73–1.17; P =0.52), the combined outcome of mortality or reinfarction 4.1% versus 4.6% (RR, 0.90; 95% CI, 0.79–1.02; P =0.11), or stent thrombosis 0.9% versus 1.2% (RR, 0.82; 95% CI, 0.62–1.08; P =0.15). Aspiration thrombectomy was associated with a nonsignificant increase in the risk of stroke 0.6% versus 0.4% (RR, 1.45; 95% CI, 0.96–2.21; P =0.08). Meta-regression analysis did not identify a difference for the log RR of mortality, reinfarction, and the combined outcome of mortality or reinfarction with intravenous glycoprotein IIb/IIIa inhibitors ( P =0.17, 0.70, and 0.50, respectively) or with ischemic time ( P =0.29, 0.66, and 0.58, respectively). Conclusions— Aspiration thrombectomy before primary PCI is not associated with any benefit on clinical end points and might increase the risk of stroke. Concomitant administration of intravenous glycoprotein IIb/IIIa inhibitors and ischemic time did not seem to influence any potential benefits observed with aspiration thrombectomy.

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“…В группе с применение тромбаспирацией была достигнута более быстрая резолюция сегмента ST, а также уменьшение частоты развития дистальной эмболизации и феномена "no-reflow". [9] Применение катетера Export довольно широко изучалось в различных рандомизированных исследованиях. Так, в рандомизированном исследовании EXPIRA [10], включавшем 175 пациентов, первичными конечными точками являлись снижение сегмента ST и степени миокардиального свечения.…”

Section: актуальностьunclassified