scholarly journals Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials

2017 ◽  
Vol 38 (47) ◽  
pp. 3502-3510 ◽  
Author(s):  
Suzanne de Waha ◽  
Manesh R Patel ◽  
Christopher B Granger ◽  
E Magnus Ohman ◽  
Akiko Maehara ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomized Trials ◽  
Microvascular Obstruction ◽  
Individual Patient Data ◽  
Coronary Intervention ◽  
Pooled Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

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.

Recurrence of angina after ST-segment elevation myocardial infarction: the role of coronary microvascular obstruction

2019 ◽  
pp. 204887261988066
Author(s):  
Rocco A Montone ◽  
Vincenzo Vetrugno ◽  
Giovanni Santacroce ◽  
Marco Giuseppe Del Buono ◽  
Maria Chiara Meucci ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: The recurrence of angina after percutaneous coronary intervention affects 20–35% of patients with stable coronary artery disease; however, few data are available in the setting of ST-segment elevation myocardial infarction. We evaluated the relation between coronary microvascular obstruction and the recurrence of angina at follow-up. Methods: We prospectively enrolled patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Microvascular obstruction was defined as thrombolysis in myocardial infarction flow less than 3 or 3 with myocardial blush grade less than 2. The primary endpoint was the recurrence of angina at follow-up. Moreover, angina status was evaluated by the Seattle angina questionnaire summary score (SAQSS). Therapy at follow-up and the occurrence of major adverse cardiovascular events were also collected. Results: We enrolled 200 patients. Microvascular obstruction occurred in 52 (26%) of them. Follow-up (mean time 25.17±9.28 months) was performed in all patients. Recurrent angina occurred in 31 (15.5%) patients, with a higher prevalence in patients with microvascular obstruction compared with patients without microvascular obstruction (13 (25.0%) vs. 18 (12.2%), P=0.008). Accordingly, SAQSS was lower and the need for two or more anti-anginal drugs was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. At multiple linear regression analysis a history of previous acute coronary syndrome and the occurrence of microvascular obstruction were the only independent predictors of a worse SAQSS. Finally, the occurrence of major adverse cardiovascular events was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. Conclusions: The recurrence of angina in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention is an important clinical issue. The occurrence of microvascular obstruction portends a worse angina status and is associated with the use of more anti-anginal drugs.

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