Meta‐analysis of randomized trials comparing anti‐embolic devices with standard PCI for improving myocardial reperfusion in patients with acute myocardial infarction

Kunadian, Babu; Dunning, Joel; Vijayalakshmi, Kunadian; Thornley, Andrew; Belder, Mark de

doi:10.1002/ccd.20990

Cited by 47 publications

(30 citation statements)

References 20 publications

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“…Resuming, no differences were reported on ST-segment resolution, infarct size and MACE rates with distal EPDs compared to standard PPCI [84][85][86] . These data were confirmed by the meta-analysis by Kunadian et al [87] , where the use of distal EPDs resulted in no decrease of early mortality or recurrent myocardial infarction rate. Probably, the absence of benefits with the use of distal EPDs could be explained by the fact that such devices can themselves induce distal embolization when crossing highly thrombotic lesions and may not be completely effective in preventing all debris from embolizing.…”

Section: Embolic Protection Devicesmentioning

confidence: 54%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Section: Embolic Protection Devicesmentioning

confidence: 54%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

View full text Add to dashboard Cite

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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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“…Meta-analytic overviews of these studies showed a clinical benefit of MTA, and guidelines recommend as a reasonable approach (class IIA, level of evidence B) the use of manual aspiration catheters. [2][3][4][5][6][7][8][9] However, manual aspiration catheters are completely ineffective in ≈30% of cases, and the high profile of the devices limits their use in tortuous and calcified vessels. 10 Among the available mechanical thrombectomy techniques, the rheolytic thrombectomy (RT) device has the potential for improved thrombus removal in acute myocardial infarction (AMI) as compared with MTA.…”

mentioning

confidence: 99%

Comparison of Manual Thrombus Aspiration With Rheolytic Thrombectomy in Acute Myocardial Infarction

Parodi

Valenti²,

Migliorini³

et al. 2013

Circ: Cardiovascular Interventions

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Background-Manual thrombus aspiration (MTA) is completely ineffective in 30% of cases, and the high profiles of the catheters prevent their use in tortuous and calcified vessels. The rheolytic thrombectomy (RT) device has the potential for improved thrombus removal in acute myocardial infarction as compared with MTA. No data exist on the comparison between the 2 techniques. Methods and Results-Randomized study, including 80 acute myocardial infarction patients allocated to RT or MTA before infarct artery stenting. Primary end point of this study is residual thrombus burden by optical coherence tomography. Secondary end points are (1) residual thrombolysis in myocardial infarction thrombus grade; (2) postintervention thrombolysis in myocardial infarction flow and myocardial blush; (3) early ST-segment resolution; (4) percentage of malapposed stent struts at 6 months; (5) 6-month restenosis; and (6) 6-month major adverse cardiovascular events. All but 1 patient had residual thrombus after manual aspiration thrombectomy or RT. The number of optical coherence tomography quadrants containing thrombus in MTA arm was higher than in the RT arm, but this difference did not reach significance (median value 65 and 53, respectively; P=0.083). Large residual thrombus was more frequently revealed in the manual aspiration thrombectomy arm (patients with number of quadrants above the median value 60% in the manual aspiration thrombectomy arm and 37% in the RT arm, P=0.039). All markers of reperfusion were better in the RT arm. At 6 months, the percentage of malapposed stent struts in the MTA arm was higher than in the RT arm (2.7±4.5% and 0.8±1.6%, respectively; P=0.019). Conclusions-MTA or RT allows only incomplete removal of thrombus in patients with acute myocardial infarction. The primary end point of the study was not met. However, RT as compared with MTA seems to be more effective in thrombus removal and myocardial reperfusion.

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Meta‐analysis of randomized trials comparing anti‐embolic devices with standard PCI for improving myocardial reperfusion in patients with acute myocardial infarction

Cited by 47 publications

References 20 publications

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

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

Comparison of Manual Thrombus Aspiration With Rheolytic Thrombectomy in Acute Myocardial Infarction

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