Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients With ST-Segment Elevation Acute Myocardial Infarction

Ikari, Yuji; Sakurada, Masami; Kozuma, Ken; Kawano, Shigeo; Katsuki, Takaaki; Kimura, Kazuo; Suzuki, Takahiko; Yamashita, Takehiro; Takizawa, Akinori; Misumi, Kazuo; Hashimoto, Hideki; Isshiki, Takaaki; Investigators, Vampire

doi:10.1016/j.jcin.2008.06.004

Cited by 143 publications

(106 citation statements)

References 38 publications

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“…Hovewer, Silva-Orrego et al (44) showed that manual thrombus aspiration before primary PCI led to lower risk of distal embolization, and no reflow compared with standard primary PCI in the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study. In addition, these findings were confirmed by recent studies (45,46). It is therefore likely to say that thrombus aspiration improves myocardial reperfusion and is associated with lower rate of no-reflow.…”

Section: Discussionsupporting

confidence: 76%

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

Topsakal¹,

Kaya²,

Karakaya³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Our aim was to investigate the effects of serotonin, which is a severe vasoconstrictor agent, on the occurrence of no-reflow phenomenon. Methods: In this cross-sectional controlled study, 40 patients, admitted to our clinic with chest pain in the first 12 hours and underwent primary percutaneous coronary intervention because of acute myocardial infarction were enrolled. Patients with TIMI 0 grade basal flow and normal post-procedure flow were included in group 1 and patients with flow grade TIMI ≤were enrolled in group 2. To measure the serotonin levels, blood samples were collected from the coronary ostium before the procedure. Results: In group 1, there were 25 patients (20 males, 5 females) and the mean age was 58±11 years; in group 2 there were 15 patients (13 males, 2 females) and the mean age was 62±8 years. The mean serotonin level in platelet in group 1 was 476±208 ng/10 9 platelet and in group 2-542±273 ng/10 9 platelet. The difference was not statistically significant (p=0.39). When we compared the serum serotonin levels, it was 41.4±40.8 ng/ml for group 1, but 66.7±45.7 ng/ml for group 2. Although the serum serotonin levels were higher in group 2, the difference was not statistically significant (p=0.07). Conclusion: There was no effect of serotonin level in the development of no-reflow, in patients to whom primary coronary percutaneous intervention was applied. (Anadolu Kardiyol Derg 2010; 10: 253-9) Key words: No-reflow phenomenon, serotonin, vasoconstriction, myocardial infarction ÖZET Amaç: Çalışmamızın amacı, vazokonstriktör bir ajan olan serotoninin no-reflow fenomeni gelişimi üzerine olan etkisini araştırmaktı. Yöntemler: Bu enine-kesitli kontrollü çalışmaya akut miyokart enfarktüsü nedeniyle, göğüs ağrılarının ilk 12 saati içinde kliniğimize başvuran ve primer perkütan girişim uygulanan 40 hasta alındı. İşlem öncesi akım TIMI 0 iken işlem sonrası akım normal olanlar grup 1'i, işlem sonrası akım TIMI ≤2 olanlar grup 2'yi oluşturdu. Serotonin düzeyini ölçmek için işlem öncesi koroner ostiumdan kan alındı. Bulgular: Grup 1'de 25 hasta (20 erkek, 5 kadın) vardı, ortalama yaş 58±11 yıl idi; Grup 2' de 15 hasta vardı (13 erkek, 2 kadın) ve ortalama yaş 62±8 yıl idi. Grup'1 de trombosit içi ortalama serotonin düzeyi 476±208 ng/10 9 trombosit ve grup 2'de 542±273 ng/10 9 trombosit idi. Fark istatistiksel olarak anlamlı değildi (p=0.39). Serum serotonin düzeyi grup'1 de 41.4±40.8 ng/ml, grup'2 de 66.7±45.7 ng/ml olarak bulundu. Aradaki fark anlamlı değildi (p=0.07). Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention Akut ST yükselmeli miyokart enfarktüsü nedeniyle primer perkütan girişim uygulanan hastalarda no-reflow fenomeni ile serotonin düzeyi arasındaki ilişki

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Section: Discussionsupporting

confidence: 76%

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

Topsakal¹,

Kaya²,

Karakaya³

et al. 2010

Anadolu Kardiyol Derg

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“…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%

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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“…22 The VAMPIRE study showed that the application of thrombus aspiration during emergency PCI did not increase surgical complexity or extend the operation time, and that thrombus aspiration devices could improve the microcirculation of patients with STEMI myocardial reperfusion compared with conventional PCI. 23 The JETSTENT study suggested that, in cases of STEMI with obvious thrombosis in coronary angiography, thrombus aspiration in the infarct-related artery before routine stent implantation would significantly improve myocardial perfusion and reduce the 6-month follow-up MACE. 24 Among patients with a relatively long lag time between infarction and PCI, to prevent distal embolization and no/slow reflow, active thrombus aspiration should be used to clear thrombi or plaque material (especially within the molecular constituents of plaque) if the patient has a TIMI flow grade is 0-1 or 2-3 and severe stenosis.…”

Section: Findingmentioning

confidence: 99%

Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention

et al. 2013

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Objective: To compare the efficacy and safety of combined treatment with thrombus aspiration and intracoronary tirofiban in patients with acute myocardial infarction (MI), with elective percutaneous coronary intervention (PCI). Methods: Patients undergoing elective PCI during recovery from acute MI were randomized into two groups; the intervention group received thrombus aspiration and intracoronary tirofiban; the control group received conventional PCI. Baseline clinical characteristics, postoperative coronary blood flow (thrombolysis in myocardial infarction [TIMI] grade), TIMI myocardial perfusion (TMP) grade, no/slow reflow rate and cardiac function (measured by echocardiography 1 month postoperatively) were evaluated. Major adverse cardiac event rate and bleeding complications during surgery (and at 1 month and 1 year postoperatively) were also evaluated. Results: A total of 80 patients were included. Postoperatively, the number of patients with TIMI flow grade 3 and the mean TMP grade were both significantly higher, and the no/slow reflow rate was significantly lower, in the intervention group versus the control group. Echocardiography indicated that cardiac function was significantly improved in the intervention group compared with the control group. There were no major complications in either study group. Conclusion: Thrombus aspiration combined with intracoronary tirofiban during recovery from acute MI was effective and relatively well tolerated.

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Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients With ST-Segment Elevation Acute Myocardial Infarction

Cited by 143 publications

References 38 publications

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention

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

Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention

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