Effect of Coronary Thrombus Aspiration During Primary Percutaneous Coronary Intervention on One-Year Survival (from the FAST-MI 2010 Registry)

Puymirat, Étienne; Aïssaoui, Nadia; Cottin, Yves; Vanzetto, Gérald; Carrié, Didier; Isaaz, Karl; Valy, Yann; Tchétché, Didier; Schiele, François; Steg, Philippe Gabriel; Simon, Tabassome; Danchin, Nicolás

doi:10.1016/j.amjcard.2014.08.039

Cited by 11 publications

(7 citation statements)

References 30 publications

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“…Registry studies may provide an indication of a possible effect in patients presumed to be at higher risk of distal embolization because thrombus aspiration is probably more often used in daily clinical practice in these patients, but results have varied (13)(14)(15). …”

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confidence: 98%

To Aspirate or Not to Aspirate

Tilsted

Olivecrona

2015

JACC: Cardiovascular Interventions

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A cute ST-segment elevation myocardial infarction (STEMI) is most often caused by plaque rupture with overlying thrombus formation in a coronary artery for which the preferred treatment today is primary percutaneous coronary intervention (PPCI) (1,2). With PPCI came the observation of slow flow/no-reflow after opening the vessel, which may occur in up to 30% of PPCIs and is associated with a worse outcome (3). The genesis of slow flow/no-reflow is considered to be multifactorial and thought to consist of peripheral embolization of thrombus and plaque debris, myocardial swelling or spasm, all of which, alone or in combination, causes obstruction of the microcirculation (3). However, it has been assumed that the thrombus burden is a major cause of the adverse outcome and that thrombus aspiration, especially with macroscopically visible thrombi, can improve outcome. On the basis of this assumption, many different mechanical thrombectomy and manual thrombus aspiration devices were evaluated, albeit with little or no effect on clinical endpoints (4). The major breakthrough came with the TAPAS (Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study) (2008), which was a single-center, randomized, all-comer trial of routine thrombus aspiration versus conventional percutaneous coronary intervention (PCI). The study enrolled 1,071 patients, with thrombus aspiration being performed in 89% in the active arm and in 1% in the control arm (5).Although not powered for clinical endpoints, the study was positive not only with respect to the primary endpoint but also mortality at 1 year (6). The result of TAPAS led to thrombus aspiration being upgraded in the STEMI revascularization guidelines (7).The TAPAS trial was, however, considerably challenged by the TASTE (Thrombus Aspiration in STElevation Myocardial Infarction in Scandinavia) trial and recently by the TOTAL (A Randomized Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI) trial (8,9). These trials were prospective, multicenter studies that randomized 7,244 and 10,732 STEMI patients, respectively, to either thrombus aspiration or conventional PCI. Both trials were negative with regard to both their primary endpoints as well as their major secondary endpoints except for stroke rates in TOTAL which were slightly increased in the thrombus aspiration group, and possibly due to chance (8-11). With the published results of the TOTAL and TASTE trials it seems certain that there is no clinical benefit of routine thrombus aspiration in patients with STEMI during PCI. However, criticism has been raised that both trials have included a lowerrisk population, and bail-out thrombus aspiration was performed in 4.9% in TASTE and 7.1% in TOTAL.Thus, there is still some uncertainty regarding the benefit for high-risk patients.There may be several reasons for the difference between the TASTE and TOTAL trials versus TAPAS.Mainly, the event rates for the primary endpoints were lower than e...

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confidence: 98%

To Aspirate or Not to Aspirate

Tilsted

Olivecrona

2015

JACC: Cardiovascular Interventions

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“…1 Nevertheless, the rates of death, heart failure, and recurrent ischemic events occurring in the first year after infarction remain unacceptably elevated in this highrisk population. Although many advances have been made in the development of methods to reopen the culprit coronary artery and prevent reocclusion, there is currently no specific treatment that targets myocardial reperfusion injury, which is a paradoxical form of myocardial damage that occurs as a result of the restoration of vessel patency.…”

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confidence: 99%

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

et al. 2015

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BACKGROUNDExperimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODSIn a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTSA total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval, 0.78 to 1.39; P = 0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONSIn patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. ( n engl j med 373;11 nejm.org September 10, 2015 1022T h e ne w e ngl a nd jou r na l o f m e dicine O ver the past three decades, major progress has been made in the treatment of patients with ST-segment elevation myocardial infarction (STEMI).1 Nevertheless, the rates of death, heart failure, and recurrent ischemic events occurring in the first year after infarction remain unacceptably elevated in this highrisk population. Although many advances have been made in the development of methods to reopen the culprit coronary artery and prevent reocclusion, there is currently no specific treatment that targets myocardial reperfusion injury, which is a paradoxical form of myocardial damage that occurs as a result of the restoration of vessel patency.2 Growing evidence from experimental studies and small-size proof-of-concept clinical trials shows that reperfusion injury contributes greatly to the final infarct size.3-5 Preclinical studies indicate that the opening of the mitochondrial permeability transition pore (PTP) in the inner mitochondrial membrane plays a major role in reperfusion injury. ...

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“…Fourth, they also failed to report the prevalence of predilation, which is a known predictor of mortality, and the no‐reflow phenomenon . Finally, significant alterations have been made to the standards of care for patients with acute coronary syndrome since 2001–2006, the time period of the study by Zhang et al These changes include the enhanced accessibility of PCI, the routine deployment of drug‐eluting stents, the clarification of the role of thrombus aspiration, and the usage of high‐dose statin therapy in patients with acute coronary syndrome suffering acute MI . Although our study was also carried out between 2011 and 2015 and, thus, more or less deviates from the most recent developments in this field, we can safely argue that our study method is more compliant with the current standards of care in patients with STEMI.…”

Section: Discussionmentioning

confidence: 86%

Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study

Saadat

Saadatagah

Nargesi

et al. 2019

Cathet Cardio Intervent

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Aim Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST‐elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long‐term outcomes in patients with and without stent postdilation. Methods A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)—comprising cardiac death, nonfatal MI, and repeat revascularization—and the device‐oriented composite endpoint (DOCE)—consisting of cardiac death, target lesion revascularization, and target vessel revascularization. Results The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score‐matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18–0.87], p = .021). Conclusions Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.

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Effect of Coronary Thrombus Aspiration During Primary Percutaneous Coronary Intervention on One-Year Survival (from the FAST-MI 2010 Registry)

Cited by 11 publications

References 30 publications

To Aspirate or Not to Aspirate

To Aspirate or Not to Aspirate

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study

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