Abstract 3008: Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Coronary Intervention The randomized Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Holger Thiele ◽  
Kathrin Schindler ◽  
Josef Friedenberger ◽  
Ingo Eitel ◽  
Georg Fürnau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Bolus Administration ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
St Elevation

Background Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary bolus application of abciximab results in high local drug concentrations and may be more effective than standard intravenous bolus application for reduction of infarct size, no-reflow and improvement in perfusion. Methods Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus administration of abciximab with subsequent 12 hour intravenous infusion. Primary endpoint was infarct size and extent of microvascular obstruction assessed by delayed enhancement magnetic resonance. Secondary endpoints were ST-resolution at 90 minutes, Thrombolysis in Myocardial Infarction (TIMI)-flow and perfusion grade post PCI, and the occurrence of major adverse cardiac events within 30 days. Results The primary endpoint infarct size could be reduced by absolute 7% (17.7% i.c. versus 24.7% i.v., p=0.005). Similarly, the extent of microvascular obstruction was significantly smaller in i.c. patients in comparison to i.v. patients (p=0.02). Myocardial perfusion measured as early ST-segment resolution was significantly improved in i.c. patients with an absolute ST-resolution of 76±23% versus 64±31% (p=0.009). The TIMI flow after PCI was not different between treatment groups (p=0.51), but there was a trend towards an improved perfusion grade (p=0.12). There was a trend towards a higher major adverse cardiac event rate after intravenous versus intracoronary abciximab application (15.6% versus 5.2%, p=0.06; relative risk 3.00; 95% confidence intervals 0.94 –10.80). Conclusions: Intracoronary bolus administration of abciximab is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion in primary PCI. An adequately powered trial for major adverse cardiac event reduction is warranted.

Risk factors of coronary microvascular obstruction (Preprint)

2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Neutrophil Percentage ◽  
Percutaneous Coronary ◽  
St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

Abstract 379: The Prognostic Value of Eosinophil to Leukocyte Ratio in Patients Presenting With ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Takao Konishi ◽  
Naohiro Funayama ◽  
Tadashi Yamamoto ◽  
Daisuke Hotta
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Infarct Size ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Elevated neutrophil to leukocyte ratio in patients with ST-segment elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. However, whether decreased eosinophil ratio after primary percutaneous coronary intervention (PCI) reflects larger infarct size has not been fully investigated. This study examined the relationship between eosinophil ratio and creatinine kinase-MB (CK-MB) elevation after primary PCI in patients presenting with STEMI. Methods and Results: We analyzed the data of 321 consecutive patients who underwent primary PCI for ST-elevation myocardial infarction between January 2009 and August 2015. Total and each type of leukocyte counts 24 hours after admission were measured. The eosinophil/leukocyte ratio (ER) was calculated as the ratio of eosinophil to leukocyte count. The primary end point was major adverse cardiac event (MACE) and the follow-up period was 180 days. The mean ER and max CK-MB was 0.44±0.65 % and 217.3±224.4 IU/l, respectively. ER obtained 24 hours after admission was inversely correlated with CK-MB concentration (r=-0.37, r2=0.14, P<0.001). MACE within 180 days occurred in 68 patients (21%) including death (9%), myocardial infarction (MI) (1%) and target lesion or vessel revascularization (10%). Patients who had MACE within 180 days had lower ER (0.20±0.51 vs 0.49±0.66, P<0.001) at 24 hours after admission. Conclusions: The decreased ER after primary PCI in patients presenting with STEMI was associated with increased CK-MB concentration, which might indicate larger infarct size, therefore, poor prognosis.

scholarly journals Glycoprotein IIb/IIIa Inhibitors Use and Outcome after Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
J. P. Howard ◽  
D. A. Jones ◽  
S. Gallagher ◽  
K. Rathod ◽  
S. Antoniou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Aims. We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.Methods and Results. This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P=0.136) or MACE (P=0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P=0.021).Conclusion. Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.

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