Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

Song, Young Bin; Hahn, Joo‐Yong; Gwon, Hyeon‐Cheol; Kim, Jun Hyung; Lee, Sang Yeub; Choe, Yeon Hyeon; Choi, Seung–Hyuk; Choi, Jin‐Ho

doi:10.1002/clc.20551

Cited by 14 publications

(7 citation statements)

References 24 publications

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“…Power calculation of the sample size was performed according to previous studies. 13 , 14 , 15 , 16 , 17 Previous studies assumed an average infarct size of total left ventricular mass between 15% and 25% and an expected treatment effect reduction of 4 to 10 absolute percentage points. The SD of myocardial infarct size is 8% to 10%.…”

Section: Methodsmentioning

confidence: 99%

Effect of Intramyocardial Grafting Collagen Scaffold With Mesenchymal Stromal Cells in Patients With Chronic Ischemic Heart Disease

Wang

Zhao

et al. 2020

JAMA Netw Open

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Section: Methodsmentioning

confidence: 99%

Effect of Intramyocardial Grafting Collagen Scaffold With Mesenchymal Stromal Cells in Patients With Chronic Ischemic Heart Disease

Wang

Zhao

et al. 2020

JAMA Netw Open

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“…All measurements were performed at our CMR core laboratory by an experienced observer blinded to patient data using commercialized software (CAAS MRV version 1.0, Pie Medical Imaging BV, Maastricht, The Netherlands). Infarct size was defined as the proportion of delayed hyperenhancement to LV myocardial volume, and hypoenhanced region surrounded by a hyperenhanced area was considered a sign of microvascular obstruction (MVO) . The myocardial salvage index was calculated as (area‐at risk−infarct size)×100/area‐at risk.…”

Section: Methodsmentioning

confidence: 99%

“…Infarct size was defined as the proportion of delayed hyperenhancement to LV myocardial volume, and hypoenhanced region surrounded by a hyperenhanced area was considered a sign of microvascular obstruction (MVO). 17 The myocardial salvage index was calculated as (area-at riskÀinfarct size)9100/areaat risk. Transmural infarct extent was expressed as a percentage of infarct thickness and categorized into 5 transmural scores.…”

Section: Randomization and Study Proceduresmentioning

confidence: 99%

Cardioprotective Effects of Intracoronary Morphine in ST‐Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: A Prospective, Randomized Trial

Gwag

Kim

Park

et al. 2017

JAHA

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BackgroundA cardioprotective role of morphine acting via opioid receptors has been demonstrated, and previous preclinical studies have reported that morphine could reduce reperfusion injury and myocardial infarct size in a way similar to that of ischemic periconditioning. This study aimed to evaluate the effect of intracoronary morphine on myocardial infarct size in patients with ST‐elevation myocardial infarction undergoing primary percutaneous coronary intervention.Methods and ResultsThis study was designed as a 2‐center, prospective, randomized, open‐label, blinded end point trial. A total of 91 ST‐elevation myocardial infarction patients with thrombolysis in myocardial infarction flow grade of 0 to 1 undergoing primary percutaneous coronary intervention were randomly assigned to a morphine or control group at a 1:1 ratio. The morphine group received 3 mg of morphine sulfate diluted with 3 mL of normal saline, and the control group received 3 mL of normal saline into a coronary artery immediately after restoration of coronary flow. The primary end point was myocardial infarct size assessed by cardiac magnetic resonance imaging The cardiac magnetic resonance images were evaluated for 42 and 38 patients in the morphine and control groups, respectively. Myocardial infarct size was not different between the 2 groups (25.6±11.2% versus 24.6±10.5%, P=0.77), nor was the extent of microvascular obstruction or myocardial salvage index (6.0±6.3% versus 5.1±4.6%, P=0.91; 31.1±15.2% versus 30.3±10.9%, P=0.75, respectively). There was no difference in peak creatine kinase‐MB level, final thrombolysis in myocardial infarction flow, myocardial brush grade, or complete resolution of ST‐segment.ConclusionsIntracoronary morphine administration could not reduce myocardial infarct size in ST‐elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01738100.

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“…There are a few recent studies that have investigated the effects of this agent on myocardial infarct size. In a small study, Song et al 45 tested high-dose tirofiban plus PCI versus conventional primary PCI, assessing infarct size by contrast-enhanced MRI at 1 month. Although tirofiban improved TIMI flow grade and myocardial blush grade during the index procedure at 1 month, myocardial infarct size was similar in the tirofiban plus facilitated PCI group versus primary PCI group (22 versus 25%; P=NS).…”

Section: Tirofibanmentioning

confidence: 99%

“…45 In a larger trial 46 prehospital tirofiban did reduce infarct size in diabetic patients compared to placebo…”

Section: Tirofibanmentioning

confidence: 99%

Current State of Clinical Translation of Cardioprotective Agents for Acute Myocardial Infarction

Kloner

2013

Circulation Research

137

112

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Abstract:There is continued interest in the concept of limiting myocardial infarct size with adjunctive agents administered along with reperfusion injury; however, there remains considerable controversy in the literature. The purpose of this article is to review the medical literature on clinical trials performed during the past 3 years that have attempted to reduce myocardial infarct size by administration of adjunctive therapies along with reperfusion therapy. A PubMed-driven literature search revealed a host of clinical trials focusing on the following prominent types of therapies: endogenous conditioning (postconditioning and remote ischemic conditioning); rapid cooling; pharmacological therapy (cyclosporine, abciximab, clopidogrel, tirofiban, erythropoietin, thrombus aspiration, adenosine, glucose-insulin-potassium, statins, antidiabetic agents, FX06, iron chelation, and ranolazine). Although there remains some controversy, quite a few of these studies showed that adjunctive therapy further reduced myocardial infarct size when coupled with reperfusion. Antiplatelet agents are emerging as some of the newest agents that seem to have cardioprotective capabilities. Postconditioning has become a bit more controversial in the clinical literature; remote conditioning, early and rapid cooling, adenosine, and ranolazine are intriguing therapies deserving of larger studies. Certain agents and maneuvers, such as erythropoietin, protein kinase C δ inhibitors, iron chelation, and intra-aortic balloon counterpulsation, perhaps should be retired. The correct adjunctive therapy administered along with reperfusion has the capability of further reducing myocardial injury during ST-segment-elevation myocardial infarction. ( infarct size reducing agents in clinical trials. Some of these disappointing agents included antibodies that prevent white blood cell adhesion to the endothelium; eniporide, a sodium/hydrogen exchange inhibitor; caldaret, an intracellular calcium-handling modulator; nicorandil, a potassium ATP channel opener/vasodilator; glucose-insulin-potassium (GIK); delcasertib (a protein kinase C δ inhibitor); and erythropoietin. 5 However, some agents and maneuvers that were observed to work in experimental models did show promise in clinical trials of MI under the right circumstances: postconditioning; remote conditioning; cyclosporine (maintains the mitochondrial permeability transition pore closed); intravenous adenosine infusions; atrial natriuretic peptide; mild hypothermia induced before reperfusion; supersaturated oxygen therapy and others. [4][5][6][7] The reasons for discrepancies between experimental findings and clinical trials have been reviewed in detail. 6,7 Since these reviews were written there have been a large number of new clinical trials recently published during the past 3 years, on the basis of literature searches through PubMed. These trials cover additional new studies on therapies, such as conditioning, abciximab, clopidogrel, erythropoietin, hypothermia, thrombectomy, intracoronary adenosine...

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Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

Cited by 14 publications

References 24 publications

Effect of Intramyocardial Grafting Collagen Scaffold With Mesenchymal Stromal Cells in Patients With Chronic Ischemic Heart Disease

Effect of Intramyocardial Grafting Collagen Scaffold With Mesenchymal Stromal Cells in Patients With Chronic Ischemic Heart Disease

Cardioprotective Effects of Intracoronary Morphine in ST‐Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: A Prospective, Randomized Trial

Current State of Clinical Translation of Cardioprotective Agents for Acute Myocardial Infarction

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