Effect of Intra-Coronary (IC) Tirofiban Following Aspiration Thrombectomy on Infarct Size, in Patients with Large Anterior STEMI undergoing Primary PCI

Background: Thrombus embolization during the Percutaneous Coronary Intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI is bolus intracoronary Abciximab and manual aspiration thrombectomy. There are several factors which influence the decision of primary PCI in a patient with AMI in developing countries. Cost of therapy and affordability is probably the most important factor. The additional cost for thrombus aspiration needs to be considered against the additional advantages in terms of better clinical outcome. Objectives: To compare the use of a combination of intracoronary Abciximab with manual thrombus aspiration to intracoronary Abciximab alone, in patients with STEMI undergoing primary PCI. Patients and Methods: This is a prospective observational study of patients with STEMI who underwent primary PCI between June 2018 to May 2019. A pre-approved study protocol was designed to determine the eligibility of STEMI patients to be included in the study. Patients with The patients have analysed in two groups: 84 patients received a combination of intracoronary Abciximab with manual thrombus aspiration & 80 patients received intracoronary Abciximab alone. The primary endpoint was the assessment of myocardial perfusion parameters namely Myocardial Blush Grade (MBG) in the culprit vessel & ST-segment resolution of >70% on ECG at 90 min after PCI. Secondary endpoints were the improvement in LV ejection fraction, cardiovascular mortality & recurrent MI at one-month post-procedure. Results: Result of the 84 patients who received combination of intracoronary Abciximab with manual thrombus aspiration, the primary endpoints namely the myocardial blush grade (MBG) of 2/3 was achieved in 72 patients (90.74%) & ST-segment resolution of >70% at 90 min was seen in 66 patients (78.57%) (p<0.001). Of the 80 patients who received only intracoronary Abciximab without thrombus aspiration, MBG 2/3 was achieved in 38 patients (47.5%) & ST-segment resolution of >70% at 90 min was seen in 28 patients (35%). At one month of follow up the secondary endpoints namely the LVEF in the combination group improved from 43.42±3.73 to 47.88±4.16% (p=0.12)and in the Abciximab group improved from 44.78±3.34 to 46.20±3.63%. Recurrent MI was seen in one patient in the combination group (p<0.001) & two patients in the ic Abciximab group. There was no cardiovascular mortality noted in the present study (p<0.001). Conclusion: Intracoronary Abciximab + manual thrombus aspiration reduces thrombus burden with better results in microvascular perfusion assessed by ST-segment resolution of >70% at 90 min & higher Myocardial Blush Grade compared to intracoronary Abciximab alone in patients with STEMI undergoing primary PCI.

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Abstract 2667: Aspiration Coronary Thrombectomy for Acute Myocardial Infarction Improves Myocardial Salvage Index. Single Center Randomized Study

Circulation ◽

10.1161/circ.118.suppl_18.s_764-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Michal Ciszewski ◽

Jerzy Pregowski ◽

Anna Teresinska ◽

Maciej Karcz ◽

Witold Ruzyllo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Perfusion Imaging ◽

Randomized Study ◽

Myocardial Salvage ◽

Aspiration Thrombectomy ◽

Acute Stemi ◽

Final Infarct Size ◽

Myocardium At Risk

Primary percutaneus intervention (pPCI) is a recommended treatment strategy for acute myocardial infarction with ST segment elevation (STEMI). Adjunctive thrombectomy may add clinical benefits. The aim of our study was to compare the efficacy of aspiration thrombectomy versus standard pPCI for STEMI. The primary endpoint was salvage index assessed by sestamibi SPECT perfusion imaging. Single centre randomized study on aspiration thrombectomy in acute STEMI. 135 patients (88 males, mean age 64,3±12,4 yrs) with first acute STEMI were enrolled between Nov 2004 and Dec 2007. Inclusion criteria were: first anterior or inferior STEMI within 12 hours from pain onset with culprit lesion in left anterior descending (LAD) or right coronary artery (RCA) and TIMI flow ≤ 2. Patients were randomly assigned to thrombectomy with Rescue or Diver device followed by stent implantation (65) vs. standard pPCI with stenting (70 pts). 5 patients initially randomised to thrombectomy were finally treated with standard pPCI. Two SPECT examinations were performed: before and 5– 8 days after reperfusion therapy. Five patients died 3–7 days after the procedure, and in 3 pts second SPECT could not be performed because of patients’ severe condition. Thus two SPECT examinations were performed in 127 patients (63 treated with thrombectomy and 64 in control group). These 127 subject were the basis of the intention to treat analyses. There were 41 pts with anterior STEMI and 86 pts with inferior STEMI. Both treatment groups were similar regarding baseline demographic and clinical variables. Based on the SPECT perfusion imaging results, the final infarct size was assessed and myocardial salvage index (proportion of the myocardium at risk salvaged by reperfusion) was calculated. Baseline myocardium at risk area was 35,0%±2,8% in thrombectomy group vs 35,8%±10,9% in control patients. (p=NS). Myocardial salvage index was larger in patients treated with aspiration thrombectomy (0,33±0,27 vs. 0,20 ± 0,21 p = 0,004). Moreover, final infarct size was significantly smaller in patients treated with thrombectomy: 23,9% ± 13,1 % vs.28,3 % ±9,6% p = 0,005. Our results show that coronary thrombectomy is beneficial as an adjunctive therapy to pPCI in STEMI.

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Abstract 12938: Long-Term Mortality Benefit With Intracoronary Thrombus Aspiration Before Primary Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.130.suppl_2.12938 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Partha Sardar ◽

Saurav Chatterjee ◽

Mandeep Singh ◽

Ramez Nairooz ◽

Robert Frankel ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Primary Pci ◽

Mortality Benefit ◽

Thrombus Aspiration ◽

Aspiration Thrombectomy ◽

Percutaneous Coronary ◽

Long Term Mortality

Background: Mortality benefit of routine intracoronary thrombus aspiration during primary percutaneous coronary intervention (PCI) has been questioned. The recent TASTE trial did not show a mortality benefit with thrombus aspiration at 1 month, however benefits from accompanying reductions in myocyte injury might accrue over time. A meta-analysis of randomized trials (RCTs) was performed to evaluate the effect of follow up duration on effectiveness of aspiration thrombectomy. Methods: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched through March, 2014. We included RCTs with acute myocardial infarction (AMI) patients randomized to aspiration thrombectomy prior to primary PCI compared with conventional primary PCI alone. Two individuals reviewed the trials for inclusion and extracted data from the RCTs. We used random-effects models. Results: Data were pooled from 16 RCTs with 11,649 patients. All-cause mortality was significantly lower with aspiration thrombectomy after at least 12 months of follow up (Odds ratio [OR] =0. 61; 95% CI 0.37-0.99; p=0. 05). Pooled data for other time frames, i.e in-hospital, 1 month, 6 month follow up, did not reach statistical significance. Conclusion: Beneficial effects of thrombus aspiration on mortality are not evident until 12 months post-procedure, consistent with the long-term effects of myocardial salvage. Subsequent trials evaluating thrombus removal should accordingly be powered for long-term mortality in addition to known procedural and angiographic endpoints.

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Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽

10.1161/circ.116.suppl_16.ii_630-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Stanley Chia ◽

O. Christopher Raffel ◽

Faisal Merchant ◽

Frans J Wackers ◽

Fred Senatore ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Troponin I ◽

Troponin T ◽

Coronary Intervention ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Primary Pci ◽

Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

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TCT-485 Does the Time of Day of Primary PCI Influence Infarct Size and Prognosis in Patients With Acute STEMI? Analysis From an Individual Patient Data Pooled Database of Randomized Trials

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.580 ◽

2019 ◽

Vol 74 (13) ◽

pp. B480

Author(s):

Shmuel Chen ◽

Bjorn Redfors ◽

Aaron Crowley ◽

Ori Ben-Yehuda ◽

Fotios Gkargkoulas ◽

...

Keyword(s):

Infarct Size ◽

Randomized Trials ◽

Individual Patient Data ◽

Time Of Day ◽

Patient Data ◽

Primary Pci ◽

Acute Stemi

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Balloon Deflation Strategy during Primary Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Clinical Trial and Numerical Simulation-Based Analysis

Cardiology Research and Practice ◽

10.1155/2020/4826073 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Jun Gu ◽

Yang Zhuo ◽

Tian-jiao Liu ◽

Jie Li ◽

Zhao-fang Yin ◽

...

Keyword(s):

Infarct Size ◽

Coronary Flow ◽

Coronary Intervention ◽

Primary Pci ◽

Hemodynamic Changes ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary

Background. Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy in patients with acute ST-segment elevation myocardial infarction (STEMI). However, PCI is associated with a serious problem known as no-reflow phenomenon, resulting in poor clinical and functional outcomes. This study aimed to compare the influences of different balloon deflation velocity on coronary flow and cardiovascular events during primary PCI in STEM as well as transient hemodynamic changes in in vitro experiments. Method and Results. 211 STEMI patients were randomly assigned to either a rapid or a slow balloon deflation group during stent deployment. The primary end point was coronary flow at the end of PCI procedure, and secondary end points included myocardial infarct size. Transient hemodynamic changes were evaluated through an in vitro experimental apparatus and a computer model. In clinical practice, the level of corrected TIMI frame count (cTFC) in slow balloon deflation after primary PCI was significantly lower than that of rapid balloon deflation, which was associated with smaller infarct size. Numerical simulations revealed that the rapid deflation led to a sharp acceleration of flow in the balloon-vessel gap and a concomitant abnormal rise in wall shear stress (WSS). Conclusion. This randomized study demonstrated that the slow balloon deflation during stent implantation improved coronary flow and reduced infarct size in reperfused STEMI. The change of flow in the balloon-vessel gap and WSS resulted from different balloon deflation velocity might be partly accounted for this results.

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