Thrombus Burden and Myocardial Damage During Primary Percutaneous Coronary Intervention

Napodano, Massimo; Dariol, Gilberto; Mamary, Ahmed H Al; Marra, Martina Perazzolo; Tarantini, Giuseppe; D’Amico, Gianpiero; Frigo, Anna Chiara; Buja, Paolo; Razzolini, Renato; Iliceto, Sabino

doi:10.1016/j.amjcard.2014.01.423

Cited by 58 publications

(45 citation statements)

References 26 publications

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“…7) A high thrombus burden has also been reported to be associated with distal embolization and no/ slow re-flow phenomenon. 21) In the present study, the pre-intervention thrombus burdens were similar between the two groups. We did not find any significant differences in the study endpoints of patients with a large thrombus burden.…”

Section: Discussionsupporting

confidence: 49%

Stent Versus Non-Stent in Treating Intermediate Stenosis Culprit Lesions in Acute ST-Segment Elevation Myocardial Infarction Patients

et al. 2017

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SummaryTo investigate the efficacy and safety of stent versus non-stent in treating acute ST-segment elevation myocardial infarction (STEMI) patients with single vessel disease and intermediate stenosis culprit lesions.Between September 2009 and May 2015, 475 acute STEMI patients (time from symptom onset < 12 hours) with single vessel disease and intermediate stenosis culprit lesions were retrospectively studied at Beijing Anzhen Hospital. The patients were divided into a stent group (n = 308) and non-stent group (n = 167) based on whether they received stent implantation or not during primary coronary angiography.During follow-up, the stent group patients had a lower major adverse cardiac and cerebrovascular event (MACCE) rate than the non-stent group: 5.5% versus 12.0%; P = 0.01; hazard ratio (HR) 0.35 [95% confidence interval (CI): 0.18-0.69]). The nonfatal myocardial infarction (MI) rate was lower in the stent group (2.9% versus 7.2%, P = 0.03). The cardiac death rate (1.9% versus 3%, P = 0.45) and stroke (0.6% versus 1.8%, P = 0.35) rate were similar between the stent and non-stent groups. The two groups shared similar all cause death rates: 4.9% versus 5.4%, respectively, P = 0.81; HR: 1.23 [95%CI: 0.51-2.99]. The composite ischemia outcome of death/MI/stroke was lower in the stent group (8.1% versus 14.4%, P = 0.02). The stent and non-stent groups had similar repeat revascularization rates (10.1% versus 11.4%, P = 0.67); ischemia driven readmission (19.5% versus 15.0%, P = 0.27), and bleeding (1.3% versus 1.2%, P = 1) rates.Stent implantation has a better efficacy and safety in reducing adverse ischemia events in acute STEMI patients with single vessel disease and intermediate stenosis culprit lesions. (Int Heart J 2017; 58: 357-364)

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Section: Discussionsupporting

confidence: 49%

Stent Versus Non-Stent in Treating Intermediate Stenosis Culprit Lesions in Acute ST-Segment Elevation Myocardial Infarction Patients

et al. 2017

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“…[33][34][35][36][37] Several previous studies have found that higher thrombus burden in patients with STEMI is independently associated with higher risks of distal embolization, no-reflow phenomenon, transmural myocardial necrosis, major adverse cardiac events, stent thrombosis, and death. [38][39][40][41][42] However, subgroup analyses from the TASTE and TOTAL trials did not suggest relative benefit from aspiration thrombectomy before primary PCI in patients with higher thrombus burden or in patients with initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0-1 or left anterior descending artery/anterior infarction. 34,35 On the basis of the results of these studies, the prior Class IIa recommendation for aspiration thrombectomy has been changed.…”

Section: Class Iii: No Benefitmentioning

confidence: 99%

2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

et al. 2016

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“…Previous studies have reported significant associations of diabetes and hypertension with increased MPV in patients with coronary artery disease, which might contribute to the increased MPV in patients with impaired myocardial reperfusion at least in part. Coronary thrombus, and longer lesion were associated with platelets activation, coronary microcirculation neutrophils and platelets aggregates infiltration, increased vascular reactivity and sustained vasoconstriction of coronary microcirculation, which have been shown to contribute to the risk of impaired myocardial reperfusion, and might also contribute to the increased MPV in patients with impaired myocardial reperfusion [7,[23][24][25][26]. Therefore, it is possible that MPV may impact on the myocardial reperfusion through these impaired myocardial reperfusion risk factors.…”

Section: Discussionmentioning

confidence: 92%

Association of mean platelet volume with impaired myocardial reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Lai

Chen

Yang

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Impaired myocardial reperfusion, defined angiographically by myocardial blush grade (MBG) 0 or 1, is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the impact of admission mean platelet volume (MPV) on the myocardial reperfusion and 30-day all-cause mortality in patients with STEMI with successful epicardial reperfusion after primary percutaneous coronary intervention (PCI). A total of 453 patients with STEMI who underwent primary PCI within 12 h of symptoms onset and achieved thrombolysis in myocardial infarction (TIMI) 3 flow at infarct-related artery after PCI were enrolled and divided into two groups based on postinterventional MBG: those with MBG 2/3 and those with MBG 0/1. Admission MPV was measured before coronary angiography. The primary endpoint was all-cause mortality at 30 days. MPV was significantly higher in patients with MBG 0/1 than in patients with MBG 2/3 (10.38 ± 0.98 vs. 9.59 ± 0.73, P < 0.001). The cumulative 30-day all-cause mortality rate was significantly higher in the groups with high MPV and MBG 0/1 (6.8 vs. 1.5%, P = 0.005, 7.6 vs. 1.9%, P = 0.006, respectively). Multivariate logistic regression analysis demonstrated MPV was independently associated with postinterventional impaired myocardial reperfusion (odds ratio 2.684, 95% confidence interval 2.010-3.585, P < 0.001) and 30-day all-cause mortality (hazard ratio 1.763, 95% confidence interval 1.009-3.079, P = 0.046). Increased MPV on admission is an independent predictor of impaired myocardial reperfusion and short-term mortality in patients with STEMI with successful epicardial reperfusion after primary PCI. Admission MPV may be additive to conventional risk factors in patients with STEMI undergoing PCI.

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Thrombus Burden and Myocardial Damage During Primary Percutaneous Coronary Intervention

Cited by 58 publications

References 26 publications

Stent Versus Non-Stent in Treating Intermediate Stenosis Culprit Lesions in Acute ST-Segment Elevation Myocardial Infarction Patients

Stent Versus Non-Stent in Treating Intermediate Stenosis Culprit Lesions in Acute ST-Segment Elevation Myocardial Infarction Patients

Association of mean platelet volume with impaired myocardial reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

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