Comparison of impact of primary percutaneous transluminal coronary angioplasty and primary stenting on short-term mortality in patients with cardiogenic shock and evaluation of prognostic determinants

Yip, Hon‐Kan; Wu, Chiung‐Jen; Chang, Hsueh‐Wen; Chen, Mien‐Cheng; Hang, Chi‐Ling; Fang, Chi-Yuang; Hsieh, Yao‐Ching; Yang, Cheng‐Hsu; Yeh, Kuo-Ho; Fu, Morgan

doi:10.1016/s0002-9149(01)01491-6

Cited by 73 publications

(71 citation statements)

References 18 publications

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“…Impact of thrombus burden on myocardial reperfusion: In the present study, we found that an RLD of the IRA ≥ 3.5 mm and a lesion length ≥ 3.5 mm were the independent predictors of unsuccessful reperfusion. Our finding was consistent with recent studies 22,23) which demonstrated that large vessels usually contain large amounts of plaque burden and high-burden thrombus formation. Furthermore, our clinical observations led us understand that the longer the lesion length, the greater the plaque burden.…”

Section: Discussionsupporting

confidence: 94%

“…During coronary intervention, the thrombus is crushed and the plaque is artificially ruptured, which in turn, cause a release of macro-and microthrombus, and lipid pool-like contents. 22,23) These materials subsequently cause macro-and microembolism, and microvascular dysfunction. 22,23) The dislodged thrombi further activate more platelets and therefore, the thrombosis cascade, and this ultimately yields slow-flow or no-reflow in the IRA.…”

Section: Discussionmentioning

confidence: 99%

“…22,23) These materials subsequently cause macro-and microembolism, and microvascular dysfunction. 22,23) The dislodged thrombi further activate more platelets and therefore, the thrombosis cascade, and this ultimately yields slow-flow or no-reflow in the IRA. Therefore, the large IRA and the longer lesion length had a mutual interaction which appeared to be a determinant for unsuccessful reperfusion.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Adjunctive Tirofiban Therapy on Angiographic and Clinical Outcomes in Patients With ST-segment Elevated Acute Myocardial Infarction Undergoing Primary Stenting

et al. 2004

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SUMMARYThe benefit of primary percutaneous coronary intervention is limited by a 5% to 20% incidence of suboptimal epicardial coronary blood (≤ TIMI-2 flow). Recently, data has demonstrated that when administered in conjunction with primary stenting for the treatment of acute myocardial infarction (AMI), abciximab improves the success rate of the stenting procedure and provides additional clinical benefits. But data on a combination of tirofiban and primary stenting for treatment of ST-segment elevated (ST-se) AMI is unknown.Between May 1999 and September 2000, primary stenting without adjunctive tirofiban therapy was performed in 136 consecutive patients (control group) with ST-se AMI. Between January 2001 and May 2002, we routinely administered tirofiban to 133 consecutive patients (study group) with ST-se AMI before they underwent primary stenting. The angiographic and clinical outcomes of both groups were compared in a chronologically consecutive manner. The overall mortality rate was significantly higher in patients with failed (≤ TIMI-2 flow) than in patients with successful (TIMI-3) reperfusion (20.0% vs 3.5%, P < 0.0001). Univariate analysis demonstrated that there were no significant differences in the successful reperfusion (85.7% vs 84.6%, P = 0.84) or 30-day combined end points  death, recurrent ischemia or reinfarction (8.3% vs 11.0%, P = 0.59) between study and control group patients. Clinical variables were used to statistically analyze potential risk factors for unsuccessful reperfusion (≤ TIMI-2 flow) in the study group patients. Multiple stepwise logistic regression analysis demonstrated that the reference lumen diameter (RLD) of the infarct-related artery (IRA) ≥ 3.5 mm (P = 0.0004) and the lesion length of the obstruction ≥ 20.0 mm (P = 0.018) were the significant independent predictors of failed normalized coronary blood flow. There were no significant differences in the restenotic rate of IRA (29.2% vs 30.8%, P = 0.9) or mortality rate (1.6% vs 1.6%, P = 1.0) at six-month follow-up. In conclusion, our study demonstrates that primary stenting with adjunctive tirofiban therapy in ST-se AMI did not provide additional From the

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Adjunctive Tirofiban Therapy on Angiographic and Clinical Outcomes in Patients With ST-segment Elevated Acute Myocardial Infarction Undergoing Primary Stenting

et al. 2004

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“…Definitions: STEMI was defined based on previous reports 2,3,10,22) as 1) typical chest pain lasting for more than 30 minutes with electrocardiogram identified ST-segment elevation > 1 mm in two consecutive precordial or inferior leads, 2) typical chest pain lasting for more than 30 minutes with a new onset of CLBBB. Procedural success was defined as a reduction to residual stenosis of < 20% by balloon angioplasty or successful stent deployment at the desired position with a residual stenosis < 10% followed by thrombolysis in myocardial infarction (TIMI) grade 3 flow in the infarct-related artery.…”

Section: )mentioning

confidence: 99%

“…1,2) Studies have further shown that patients with cardiogenic shock, [3][4][5] left ventricular dysfunction, [3][4][5][6] and multiple vessel disease 7,8) usually have poorer short-term and long-term clinical outcomes after AMI. Actually, the prevalence of multivessel disease (MVD) has been reported to be up to 40-65% in patients with AMI undergoing primary PCI.…”

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Benefit of Revascularization in Non-Infarct-Related Artery in Multivessel Disease Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

et al. 2010

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SummaryThis study compared the prognosis of ST-elevation myocardial infarction (STEMI) in patients with multivessel disease (MVD) with that of single vessel disease (SVD) and investigated the revascularization benefit of noninfarct-related artery (IRA) in MVD patients undergoing primary percutaneous coronary intervention (PCI). Between 2002 and 2009, 1278 patients with STEMI underwent primary PCI. Of these patients, 717 (56.1%) with SVD (only IRA obstruction) were placed in group A, while 561 (43.9%) with MVD (Group B) were further categorized into group 1 (PCI for IRA) and group 2 (staged PCI for IRA+non-IRA). The results demonstrated a lower degree of successful reperfusion in IRA and higher 30-day and 1-year cumulative mortality rates in group B (P < 0.001). While there was no difference in successful reperfusion in IRA between group 1 and group 2, the 30-day and one-year cumulative mortality rates were higher in group 1. Multivariate analysis identified MVD as an independent predictor of 1-year mortality (P < 0.001). In conclusion, patients with subsequent PCI for MVD had better 30-day and 1-year outcomes than those with conservative treatment. (Int Heart J 2010; 51: 319-324)

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Transradial application of percusurge guardwire device during primary percutaneous intervention of infarct‐related artery with high‐burden thrombus formation

Yip

Chen

Chang

et al. 2004

Cathet Cardio Intervent

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A large infarct-related artery (IRA), which mostly contains high-burden thrombus formation (HBTF) and lipid pool-like plaque contents, has been suggested to play a pivotal role in the no-reflow phenomenon during primary percutaneous coronary intervention (p-PCI). To reduce the thrombus burden of the IRA using the PercuSurge GuardWire device before intervention may be of crucial importance to preventing no-reflow. The purposes of this study were to test the transradial application (TRA) of this new mechanical device and to determine its impact on prevention of no-reflow during p-PCI. From May to September 2002, the PercuSurge GuardWire device was utilized in 42 consecutive patients with acute myocardial infarction and large IRA (vessel size >or= 3.5 mm with HBTF; group 1). From January to December 2000, p-PCI was performed in large IRA (vessel size >or= 3.5 mm) with HBTF using tranfemoral arterial approach in 101 consecutive patients (group 2). The angiographic and clinical outcomes of the two groups were compared in a chronologically consecutive manner. Successful reperfusion (final TIMI-3 flow) was significantly higher in group 1 than in group 2 patients (95.2% vs. 79.1%; P = 0.005). Moreover, the combined incidence of vascular complications, post-PCI thromboembolisms (defined as a distal embolism and a post-PCI residual thrombus score of >or= 3), and combined 30-day major adverse cardiac events were significantly lower in group 1 than in group 2 patients (all P values < 0.05). In group 1 patients, post-p-PCI myocardial blush (MB) of >or= 2 grades was found to be more than 88.0%. Furthermore, when compared with preintervention, thrombus scores were significantly reduced after aspiration (P = 0.0001), whereas the minimal lumen diameter (P = 0.0001), TIMI flow grade (P = 0.0001), and MB grade (P = 0.0001) had all significantly increased after aspiration using Export Aspiration Catheter. There were no significant differences in corrected TIMI frame count (P = 0.42), TIMI flow grade (P > 0.5), or MB grade (all P values > 0.5) between postaspiration and post-PCI. The TRA of the PercuSurge GuardWire device during primary intervention of large IRA with HBTF was safe and feasible and provided benefits to patients. The initial successful reduction of the thrombus burden with this mechanical device before intervention can be translated into increased final TIMI-3 flow, a combined MB of >or= 2 grades, and fewer final thromboembolic events.

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Comparison of impact of primary percutaneous transluminal coronary angioplasty and primary stenting on short-term mortality in patients with cardiogenic shock and evaluation of prognostic determinants

Cited by 73 publications

References 18 publications

Effect of Adjunctive Tirofiban Therapy on Angiographic and Clinical Outcomes in Patients With ST-segment Elevated Acute Myocardial Infarction Undergoing Primary Stenting

Effect of Adjunctive Tirofiban Therapy on Angiographic and Clinical Outcomes in Patients With ST-segment Elevated Acute Myocardial Infarction Undergoing Primary Stenting

Benefit of Revascularization in Non-Infarct-Related Artery in Multivessel Disease Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Transradial application of percusurge guardwire device during primary percutaneous intervention of infarct‐related artery with high‐burden thrombus formation

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