Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction

Morishima, Itsuro; Sone, Toshio; Okumura, Kenji; Tsuboi, Hideyuki; Kondo, Junichiro; Mukawa, Hiroaki; Matsui, Hideo; Toki, Yukio; Itō, Takayuki; Hayakawa, Tetsuo

doi:10.1016/s0735-1097(00)00865-2

Cited by 509 publications

(362 citation statements)

References 35 publications

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“…LV function and remodeling after AMI are considered to be influenced by many factors including no-reflow phenomenon, 10) time for myocardial ischemia, infarct size, wall stress, and medications such as angiotensin converting enzyme inhibitors (ACE-I), β-blockers, nicorandil, 32,33) and human natriuretic peptide. 34,35) Several recent trials have suggested that nicorandil preserves LV function by reducing the no-reflow phenomenon, 32,33) and our anterior AMI patients were routinely treated with nicorandil if their blood pressures allowed it.…”

Section: Discussionmentioning

confidence: 99%

<b>Percutaneous Coronary Arterial Thrombectomy for Acute Myocardial Infarction Reduces No-Reflow Phenomenon and Protects Against Left Ventricular Remodeling Related to the Proximal Left Anterior Descending and Right Coronary Artery</b>

et al. 2007

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SUMMARYThe no-reflow phenomenon during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) causes impaired myocardial reperfusion. The aim of the present study was to evaluate the impact of thrombectomy on the prevention for no-reflow phenomenon and for LV remodeling. We performed a retrospective study comparing 116 patients treated for AMI with conventional angioplasty and 89 patients treated for AMI with the combination of angioplasty and thrombectomy. We performed manual aspirating thrombectomy using Thrombuster II. Baseline clinical and lesion characteristics were similar in the 2 groups. No-reflow phenomenon was significantly reduced in the thrombectomy group compared to the controls (8% versus 18%, P < 0.05). Maximum group mean CK was not significantly different between the two groups. During 6 months of followup, the mean LV ejection fractions of the 2 groups were not significantly different. However, in the cases involving the proximal left anterior descending (LAD) and right coronary arteries, changes in LV end-diastolic volume index (LVEDVI), LV end-systolic volume index, maximum CK and the incidence of LV remodeling, defined as an increase in LVEDVI of > 20%, were significantly lower in the thrombectomy group than in the control group. Multiple logistic regression analysis indicated that thrombectomy with Thrombuster II significantly reduced the no-reflow phenomenon and LV remodeling. These results suggest that adjunctive pretreatment with a manual aspirating thrombectomy by Thrombuster II reduces the no-reflow phenomenon, and in cases involving the LAD and right coronary arteries, protects against LV remodeling in AMI. (Int Heart J 2007; 48: 287-302)

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Section: Discussionmentioning

confidence: 99%

<b>Percutaneous Coronary Arterial Thrombectomy for Acute Myocardial Infarction Reduces No-Reflow Phenomenon and Protects Against Left Ventricular Remodeling Related to the Proximal Left Anterior Descending and Right Coronary Artery</b>

et al. 2007

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“…5,6,20,21 Most of them studied very small AMI populations treated with different reperfusion strategies at different times and were focused mainly on inhospital or intermediate prognosis. Our prospective study provides information on the prognostic role of microvascular dysfunction by MCE in a quite homogeneous and unselected study population with AMI successfully treated by means of primary PTCA.…”

Section: Microvascular Dysfunction and Long-term Clinical Outcomementioning

confidence: 99%

Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction

et al. 2004

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Background-We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction. Methods and Results-Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty[PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0ϭnot visible, 1ϭpatchy, 2ϭhomo-geneous contrast effect) within the area at risk. An MCESI Ն1 was considered adequate reperfusion. Mean follow-up was 46Ϯ32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD

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“…CME causing transient “no blood flow” or “slow flow” is the independent predictor of long-term poor prognosis in patients with acute myocardial infarction. [2] Furthermore, CME can also lead to progressive myocardial malfunction, including overt myocardial infarction, contractile dysfunction, arrhythmias and coronary reserve reduction. [4,5] Once CME occurs, clinical outcomes of such patients are not improved by using coronary thrombolysis agents, nitroglycerin and platelet GPIIb/IIIa receptor antagonists or direct thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of metoprolol on myocardial apoptosis after coronary microembolization in rats

Su¹,

Li²,

Liu³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Coronary microembolization (CME) is a serious complication following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. The use of metoprolol before PCI can significantly protect ischemic myocardium from myocardial damage, but the function of metoprolol in the treatment of CME is not entirely clear. This study was to explore the effect and significance of metoprolol on myocardial apoptosis and caspase-3 activation after CME in rats.METHODS:Thirty rats were randomly divided into three groups including sham-operation (control group), CME plus saline (CME group), CME plus metoprolol (metoprolol group), 10 rats for each group. The CME group was induced by injecting 3 000 polyethylene microspheres (42 μm) into the left ventricle during a 10-second occlusion of the ascending aorta; the control group was injected with physiological saline instead of microembolization ball; the metoprolol or saline group was given three intravenous bolus injections before CME. Echocardiography, TUNEL staining, and Western blotting were used to evaluate cardiac function, proportion of apoptotic cells and activation of caspase-3 respectively at 6 hours after operation.RESULTS:Echocardiographic parameters displayed that the metoprolol group improved cardiac function significantly compared with the CME group (P<0.05). The myocardial apoptotic rate of the CME group as well as the contents of activated caspase-3 increased significantly (P<0.05), both of which were ameliorated significantly by metoprolol treatment (P<0.05).CONCLUSIONS:This study demonstrates that metoprolol can protect the myocardium during CME in rats by inhibiting apoptosis and improving cardiac function. These results suggest that the inhibition of apoptosis can be a potential therapeutic strategy for the treatment of CME.

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Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction

Abstract: Angiographic no-reflow phenomenon strongly predicts long-term cardiac complications after AMI; these complications are possibly associated with LV remodeling.

Cited by 509 publications

References 35 publications

<b>Percutaneous Coronary Arterial Thrombectomy for Acute Myocardial Infarction Reduces No-Reflow Phenomenon and Protects Against Left Ventricular Remodeling Related to the Proximal Left Anterior Descending and Right Coronary Artery</b>

<b>Percutaneous Coronary Arterial Thrombectomy for Acute Myocardial Infarction Reduces No-Reflow Phenomenon and Protects Against Left Ventricular Remodeling Related to the Proximal Left Anterior Descending and Right Coronary Artery</b>

Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction

Effect of metoprolol on myocardial apoptosis after coronary microembolization in rats

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