Adjunctive devices in primary or rescue PCI: A meta-analysis of randomized trials

Burzotta, Francesco; Testa, Luca; Giannico, Floriana; Biondi‐Zoccai, Giuseppe; Trani, Carlo; Romagnoli, Enrico; Mazzari, Mario Attilio; Mongiardo, Rocco; Siviglia, Massimo; Niccoli, Giampaolo; Vita, Maria De; Porto, Italo; Schiavoni, Giovanni; Crea, Filippo

doi:10.1016/j.ijcard.2006.12.018

Cited by 73 publications

(44 citation statements)

References 27 publications

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“…Although some data, especially those regarding the use of distal protection devices, have failed to show clinical benefits due in part to patient and device selection [48][49][50][51][52][53] , many recent large-scale randomized trials have demonstrated significant improvements in myocardial perfusion 45,[54][55][56][57][58][59][60][61][62][63][64][65][66][67] and the left ventricular function 64,65) in addition to reduced mortality 68) ( 69) . In addition, Burzotta et 70) . With regard to long-term clinical outcomes, Burzotta et al also performed a pooled analysis of 2,686 individual patients evaluated in 11 prospective randomized trials comparing standard PCI with or without thrombectomy to evaluate the impact of thrombectomy on long-term clinical outcomes.…”

Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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Inflammation and oxidative stress play key roles in atherosclerotic plaque instability, and plaque rupture/erosion and subsequent thrombus formation constitute the principal mechanisms of total vessel occlusion and acute ST-elevation myocardial infarction (STEMI). Plaque disruption triggers the formation of initial platelet aggregates that grow in association with an increase in fibrin formation, leading to persistent coronary flow obstruction and blood coagulation. The fibrin network may trap large numbers of erythrocytes and inflammatory cells to form an erythrocyte-rich thrombus. In fact, previous clinical studies have shown that not only platelet-rich white thrombi, but also erythrocyte-rich red thrombi can be visualized using angioscopy in patients with acute coronary syndrome. Recently, the development of thrombus aspiration and distal protection devices has significantly improved the clinical outcomes of percutaneous intervention in STEMI patients and has enabled the evaluation of antemortem coronary artery thrombi. This is important because previous autopsy studies were unable to differentiate coronary thrombi responsible for myocardial ischemia from postmortem clots. Using frozen samples of aspirated thrombi and specific monoclonal antibodies, we investigated the cellular components of thrombi (platelets, erythrocytes, fibrin and inflammatory cells, such as myeloperoxidase-positive cells) and pathologically evaluated the relationships between erythrocyterich thrombi and inflammation, oxidative stress and clinical outcomes in STEMI patients. Therefore, this review article focuses on the efficacy of thrombus aspiration therapy and the components of aspirated intracoronary thrombi in STEMI patients and presents the results of recent studies regarding the relationship between the composition of aspirated intracoronary thrombi and clinical outcomes.

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Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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“…A number of metaanalyses of previous studies have reached similar conclusions. [59][60][61] However, it is not clear whether these benefits also lead to smaller infarcts or better clinical outcomes. [62][63][64] Distal embolic protection failed to show improved microvascular flow, greater reperfusion success, reduced infarct size or enhanced event-free survival.…”

Section: Prevention and Treatment Of Distal Embolizationmentioning

confidence: 99%

Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Guo

Sheng²,

Xu³

et al. 2013

J Int Med Res

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After successful primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, adequate myocardial reperfusion is not achieved in up to 50% of patients. This phenomenon of no-reflow is associated with a poor in-hospital and long-term prognosis. Four main factors are thought to contribute to the occurrence of no-reflow: ischaemic injury; reperfusion injury; distal embolization; susceptibility of the microcirculation to injury. This review evaluates the literature, and in particular the clinical trials, concerned with pharmacological and physical methods for prevention and treatment of no-reflow. A number of drugs may improve no-reflow experimentally and clinically, but some have not yet been associated with conclusive improvements in clinical outcome. The complex interacting factors in no-reflow make it unlikely that any single agent will be effective for all patients. Confirmed methods known to be beneficial in the prevention of no-reflow (such as aspirin therapy, chronic statin therapy, blood glucose control, thrombus aspiration in patients with a high thrombus burden and ischaemic preconditioning) should be offered to patients as often as possible, to prevent and treat no-reflow.

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“…Além disso, tirofiban e eptifibatide apresentam, como oportuna vantagem, a mais rápida reversibilidade da inibição da agregação plaquetária, após interrupção de sua administração e um custo menor. [12][13][14] O uso genérico desse grupo de antiplaquetários tem indicação Classe IIa ou IIb nos mais recentes consensos (norte-americano e europeu) sobre IMCSST e ICPp. De acordo com o último consenso norte-americano sobre IMCSST, os IGP IIb/IIIa têm indicação Classe IIa, pois considera-se aceitável iniciar o tratamento com abciximabe, tirofiban ou eptifibatide como adjuvantes à ICPp, com ou sem clopidogrel, ou implante de stent, em pacientes que estejam recebendo heparina não fra cionada.…”

Section: Discussionunclassified

A Inibição da Via Final Comum da Agregação Plaquetária Reduz o Fenômeno de Não Reperfusão Durante a Intervenção Coronária Percutânea Primária? Tirofiban no Infarto Agudo do miocárdio e a não ReperfusÃo (TIARA)

Lago¹,

Marin‐Neto²,

Lima-Filho³

et al. 2014

Rev. Bras. Cardiol. Invasiva

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ResumoIntrodução: A intervenção coronária percutânea primária é hoje o método preferencial de reperfusão na abordagem de pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST. Em boa parte desses casos, ocorre o fenômeno de não reperfusão, que é a incapacidade de se reperfundir uma região do miocárdio após o restabelecimento da patência de uma artéria coronária epicárdica previamente ocluída. O benefício de inibidores da glicoproteína IIb/IIIa, bloqueando a via final comum da agregação plaquetária, tem sido sugerido em estudos de síndromes coronárias agudas, mas persistem pontos obscuros quanto à sua real eficácia, no contexto da não reperfusão, em pacientes tratados com intervenção coronária percutânea primária. métodos: Investigação multicêntrica que avaliou o impacto da administração precoce do inibidor da glicoproteína IIb/IIIa de baixo peso molecular tirofiban, em forma duplo-mascarada, controlada por placebo, sobre a ocorrência de não reperfusão, empregando métodos angiográficos e eletrocardiográfico para documentar (1) os fluxos coronário epicárdico, pelo escore TIMI, e microcirculatório, pelo escore MBG de opacificação e escoamento miocárdicos; (2) a resolução do supradesnivelamento do segmento ST, como índice final do sucesso da reperfusão. Conclusões: Se comprovada redução da incidência de não reperfusão tanto 90 minutos como 24 horas após a intervenção coronária percutânea primária, este estudo-piloto, deve nortear a implementação de estudo mais abrangente, para investigar o possível impacto do bloqueio AbsTRACT Does the Inhibition of the Final Common Pathway of Platelet Aggregation Reduce the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention? Tirofiban no Infarto Agudo do miocárdio e a não ReperfusÃo (TIARA)background: Primary percutaneous coronary intervention is currently the preferred method to treat patients with ST-segment elevation acute myocardial infarction. The no-reflow phenomenon, which is the inability to reperfuse a region of the myocardium after restoration of patency of a previously occluded epicardial coronary artery, is observed in a considerable proportion of these patients. The benefit of IIb/IIIa glycoprotein inhibitors, blocking the final common pathway of platelet aggregation, has been suggested in studies of acute coronary syndromes, but their actual efficacy in the context of no-reflow in patients treated with primary percutaneous coronary intervention remains unclear. methods: The aim of this multicenter, double-blinded, placebo controlled study is to assess the impact of the early administration of the low molecular weight glycoprotein IIb/ IIIa inhibitor tirofiban on the incidence of no-reflow using angiographic and electrocardiographic methods to determine:(1) the epicardial coronary flow, using the TIMI score, and the microcirculatory flow, using the MBG score of opacification and myocardial flow; (2) the resolution of the ST segment elevation, as the final index of the success of reperfusion. Conclusions:If the decrease in n...

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Adjunctive devices in primary or rescue PCI: A meta-analysis of randomized trials

Cited by 73 publications

References 27 publications

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

A Inibição da Via Final Comum da Agregação Plaquetária Reduz o Fenômeno de Não Reperfusão Durante a Intervenção Coronária Percutânea Primária? Tirofiban no Infarto Agudo do miocárdio e a não ReperfusÃo (TIARA)

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