scholarly journals GW25-e2321 Thrombus aspiration improves all-cause death in long term follow-up in patients undergoing percutaneous coronary intervention for ST-segment elevation myocardial infarction: a meta-analysis of randomized trials

2014 ◽  
Vol 64 (16) ◽  
pp. C128
Author(s):  
Liao Li-Zhen ◽  
Zhuang Xiao-Dong ◽  
Du Zhi-Min ◽  
Liao Xin-Xue
Keyword(s):  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Long Term Follow Up

Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Po Huang ◽  
Qingquan Liu ◽  
Yuhong Guo ◽  
Bo Li ◽  
Xiaolei Fang
Keyword(s):  
Meta Analysis ◽  
Coronary Intervention ◽  
Controlled Study ◽  
Short Term ◽  
St Segment Elevation ◽  
Randomized Controlled ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Hospital Cardiac Arrest

Abstract Objective: The meta-analysis aims to identify whether out of hospital cardiac arrest (OHCA) survivors of non ST-segment elevation (NSTE) can benefit from early coronary angiography (CAG) and percutaneous coronary intervention (PCI).Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, USA) was used for statistical analysis. Results: A total of 12 studies (9 observational studies, 1 cohort study and 2 randomized control trials) were identified and incorporated into the meta-analysis. For overall analysis, the strategy of early angiography was associated with decreased short-term (hospital discharged) mortality (RR=0.72, 95% CI=0.56-0.93, P=0.000) and long-term (follow up) mortality (RR=0.84, 95% CI=0.71-0.99, P=0.007). However, when analyzed in the subgroup of randomized controlled study, the strategy of early angiography didn’t have survival benefit in the randomized controlled study group for short-term mortality (RR=1.12, 95% CI=0.89-1.41, P=0.331) and long-term mortality (RR=1.06, 95% CI=0.85-1.32, P=0.572). Meanwhile, our analysis found that, if early CAG performed, PCI followed by CAG is not associated with hospital discharged mortality (RR=1.14, 95% CI=0.96-1.37, P=0.132) compared with CAG alone. No significant differences between the groups were found in the remaining secondary endpoints.Conclusion: Due to the observational nature of the studies available, we may consider that early CAG and PCI is not be recommended for patients with NSTE OHCA.

scholarly journals Glycoprotein IIb/IIIa Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction and Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 15 (6) ◽  
pp. 918-927 ◽  
Author(s):  
A. S. Tereshchenko ◽  
Е. V. Merkulov ◽  
A. M. Samko
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Randomized Trials ◽  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Recently, there has been a positive trend to reduce mortality from myocardial infarction. One of the reasons for such dynamics is the development of angiographic service in our country and the increase in the number of primary percutaneous coronary interventions. One of the most serious complications of endovascular interventions affecting the prognosis is the development of the phenomenon of slow or unrecoverable blood flow (≪slow/no-reflow≫ phenomenon). The reason for the development of this phenomenon is associated, first of all, with distal embolization by thrombotic masses and fragments of atherosclerotic plaque. In order to prevent this complication, manual thromboextraction was developed – the aspiration of thrombotic masses from the infarct-related artery. The manual thrombus aspiration has not been proven effective in a number of large randomized trials. In addition to the lack of influence on the prognosis, the method of manual thrombus aspiration significantly more often led to the development of ischemic strokes and currently should not be routinely carried out. Another method of preventing the phenomenon of delayed or unrecoverable blood flow is the use of glycoprotein IIb/IIIa receptor inhibitors which is, in contrast to the instrumental method, effective and relatively safe. According to a number of large randomized trials, drug treatment of this complication influences life expectancy in patients with ST-elevation myocardial infarction. At a time when there is already a meta-analysis on the routine use of glycoprotein IIb/IIIa receptor inhibitors during primary percutaneous coronary intervention and their positive impact on survival, in our country, unfortunately, the importance of these drugs is underestimated and according to the register they are used only in 3% of patients with ST-segment elevation myocardial infarction. This review presents studies and comparisons of glycoprotein IIb/IIIa receptor inhibitors existing on the market.

Effect of Coronary Collaterals on Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

Angiology ◽  
2018 ◽  
Vol 69 (9) ◽  
pp. 803-811 ◽  
Author(s):  
Kongyong Cui ◽  
Shuzheng Lyu ◽  
Xiantao Song ◽  
Fei Yuan ◽  
Feng Xu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Observational Studies ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Collaterals ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Long Term Mortality

The impact of coronary collaterals on the prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) in the era of coronary revascularization remains controversial. The purpose of this meta-analysis was to investigate the effect of coronary collateral on clinical outcomes, especially mortality (≥6 months), in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. Eligible observational studies were selected by searching PubMed, EMBASE, and Cochrane Library up to August 9, 2017. Overall, 14 observational studies involving 10 411 patients were included. Coronary collaterals were found to reduce the risk of long-term mortality (≥6 months; risk ratio [RR]: 0.65, 95% confidence interval [CI]: 0.55-0.76) as well as in-hospital plus 30-day mortality (RR: 0.61, 95% CI: 0.47-0.78) in patients undergoing PCI for STEMI. In addition, pooling the risk-adjusted or propensity-matched data showed a significant reduction in long-term mortality (RR: 0.68, 95% CI: 0.49-0.95) and in-hospital plus 30-day mortality (RR: 0.27, 95% CI: 0.13-0.55) in patients with collateral circulation. However, no significant difference was found in the risk of recurrent myocardial infarction and target vessel revascularization between the 2 groups. Therefore, it was found that coronary collaterals have a beneficial effect on long-term survival (≥6 months) as well as in-hospital plus 30-day survival in patients undergoing primary PCI for STEMI.

scholarly journals Impact of thrombus aspiration in frail STEMI patients

2021 ◽  
Author(s):  
Pasquale Mone ◽  
Jessica Gambardella ◽  
Antonella Pansini ◽  
Mario Rizzo ◽  
Ciro Mauro ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Frail Patients ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Patients

Abstract Background Despite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients. Aims We hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI. Methods We conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the “Cardarelli” Hospital in Naples, Italy. Results The study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016). Conclusion These results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.

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