Thrombus aspiration followed by direct stenting: A novel strategy of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial)

Dudek, Dariusz; Mielecki, Waldemar; Burzotta, Francesco; Gąsior, Mariusz; Witkowski, Adam; Horváth, Iván; Legutko, Jacek; Ochała, Andrzej; Rubartelli, Paolo; Wojdyla, Roman; Siudak, Zbigniew; Buchta, Piotr; Pręgowski, Jerzy; Aradi, Dániel; Machnik, Andrzej; Hawranek, Michał; Rakowski, Tomasz; Dziewierz, Artur; Żmudka, Krzysztof

doi:10.1016/j.ahj.2010.07.024

Cited by 85 publications

(70 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Burzotta et al 58) (REMEDIA trial) Lefévre et al 59) (X AMINE ST trial) Silva-Orrego et al 60) (DEAR-MI study) Chevalier et al 61) (Export study) Sardella et al 62) (EXPIRA trial) Dudek et al 63) (PIHRATE trial) De Luca et al…”

Section: )unclassified

“…In this regard, the use of a mechanical device for thrombus removal or trapping to improve clinical outcomes after p-PCI is attractive, and the efficacy of these devices has been tested in many clinical trials. 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) .…”

Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

See 1 more Smart Citation

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

Yunoki

Naruko

Sugioka

et al. 2013

JAT

View full text Add to dashboard Cite

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.

show abstract

Section: )unclassified

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

View full text Add to dashboard Cite

show abstract

“…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%

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

Elgendy

Huo

Bhatt

et al. 2015

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

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.

show abstract

“…The 2015 revision followed two more randomized trials, (16,17) which, taken together with the earlier trials, were interpreted as showing harm. Figure 2, shows the randomized trials of aspiration thrombectomy versus no aspiration thrombectomy in patients with STEMI, ranked by the size of effects on death (cardiac death used when available) or myocardial infarction (upper part of Figure 2) (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). The confidence intervals for every trial except one (25), cross the line of unity, indicating no clear evidence of benefit or harm.…”

Section: Aspiration Thrombectomymentioning

confidence: 99%

Preventive percutaneous coronary intervention and aspiration thrombectomy—updates in the management of ST-elevation myocardial infarction

Wald

Bestwick

2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Thrombus aspiration followed by direct stenting: A novel strategy of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial)

Cited by 85 publications

References 21 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

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

Preventive percutaneous coronary intervention and aspiration thrombectomy—updates in the management of ST-elevation myocardial infarction

Contact Info

Product

Resources

About