Predictors of angiographically visible distal embolization in STEMI

Yaméogo, Nobila Valentin; Guenancia, Charles; Porot, G.; Stamboul, Karim; Richard, Carole; Gudjoncik, Aurélie; Hamblin, Joelle; Buffet, Philippe; Lorgis, Luc; Cottin, Yves

doi:10.1007/s00059-018-4723-1

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…Parameters for improved reperfusion, such as myocardial blush grade and ST‐segment resolution are consistently improved with manual aspiration, however a correlation with decreased mortality or MACE has not been demonstrated 25,26 . Although these were not recorded in our registry, these parameters could have contributed to improved post‐procedural TIMI 3 flow and overall procedural success, despite increased rates of transient and persistent no‐reflow.…”

Section: Discussionmentioning

confidence: 83%

“…Parameters for improved reperfusion, such as myocardial blush grade and ST-segment resolution are consistently improved with manual aspiration, however a correlation with decreased mortality or MACE has not been demonstrated. 25,26 Although these were not recorded in our registry, these parameters could have contributed to improved post-procedural TIMI 3 flow and overall procedural success, despite increased rates of transient and persistent no-reflow. Additionally, postprocedural Q-waves were also not recorded, and although decreased rates in previous TA groups were considered secondary to myocardial salvage, this has not been linked to improved short or long-term clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Rajakariar

Andrianopoulos

Gayed

et al. 2022

Internal Medicine Journal

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BackgroundPrevious large multi‐centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST‐elevation myocardial infarction (STEMI).AimTo determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI.MethodsWe analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30‐day major adverse cardiovascular and cerebrovascular events (MACCE) and long‐term mortality.ResultsWe compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP‐IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post‐procedural TIMI flow, stroke, 30‐day mortality, or long‐term mortality were identified. Multivariable analysis demonstrated a reduction in 30‐day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63–0.89; P < 0.01) in the TA group, but was not associated with long‐term mortality (HR 0.98; CI 0.85–1.1; P = 0.73).ConclusionThe use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long‐term mortality when compared with PCI alone.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Rajakariar

Andrianopoulos

Gayed

et al. 2022

Internal Medicine Journal

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“…Previous studies have reported a lower degree of distal embolization in smaller infarct‐related arteries. 5 , 8 , 9 Despite this observation, smaller culprit lesion vessel size has been identified as an independent predictor of adverse outcomes in patients treated with primary PCI for STEMI. 5 , 6 This represents a complex and somewhat paradoxical relationship, considering the role of distal embolization in microvascular injury and its substantial prognostic implications.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 , 7 On the other hand, few studies have examined the relationship between culprit lesion vessel size and myocardial reperfusion with conflicting results. 5 , 8 , 9 Moreover, an important limitation of these studies was the lack of comprehensive myocardial tissue characterization by CMR imaging to accurately determine reperfusion success. Therefore, the pathophysiology of myocardial reperfusion injury in relation to culprit lesion vessel size in acute STEMI is incompletely understood.…”

mentioning

confidence: 99%

Culprit Lesion Vessel Size and Risk of Reperfusion Injury in ST‐Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Lechner,

Reindl,

Tiller

et al. 2024

JAHA

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Background Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well‐established imaging biomarkers of failed myocardial tissue reperfusion in patients with ST‐segment elevation–myocardial infarction treated with percutaneous coronary intervention. MVO and IMH are associated with an increased risk of adverse outcome independent of infarct size, but whether the size of the culprit lesion vessel plays a role in the occurrence and severity of reperfusion injury is currently unknown. This study aimed to evaluate the association between culprit lesion vessel size and the occurrence and severity of reperfusion injury as determined by cardiac magnetic resonance imaging. Methods and Results Patients (n=516) with first‐time ST‐segment–elevation myocardial infarction underwent evaluation with cardiac magnetic resonance at 4 (3–5) days after infarction. MVO was assessed with late gadolinium enhancement imaging and IMH with T2* mapping. Vessel dimensions were determined using catheter‐based reference. Median culprit lesion vessel size was 3.1 (2.7–3.6) mm. MVO and IMH were found in 299 (58%) and 182 (35%) patients. Culprit lesion vessel size was associated with body surface area, diabetes, total ischemic time, postinterventional thrombolysis in myocardial infarction flow, and infarct size. There was no association between vessel size and MVO or IMH in univariable and multivariable analysis ( P >0.05). These findings were consistent across patient subgroups with left anterior descending artery and non–left anterior descending artery infarctions and those with thrombolysis in myocardial infarction 3 flow post–percutaneous coronary intervention. Conclusions Comprehensive characterization of myocardial tissue reperfusion injury by cardiac magnetic resonance revealed no association between culprit lesion vessel size and the occurrence of MVO and IMH in patients treated with primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction.

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“…Percutaneous coronary interventions (PCI) in acute settings differ significantly from planned procedures. During primary PCI, any instrumentation in the vessel with a high thrombus burden increases the risk of distal embolization (DE), worsening the patient’s prognosis [ 1 ]. Thrombectomy was introduced to mitigate myocardial damage caused by DE but did not appear to be better in comparison to PCI alone in the TOTAL study [ 2 ].…”

mentioning

confidence: 99%

Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction

Chyrchel¹,

Maruszak²,

Pilch³

et al. 2022

pwki

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Predictors of angiographically visible distal embolization in STEMI

Abstract: AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.

Cited by 8 publications

References 15 publications

Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Culprit Lesion Vessel Size and Risk of Reperfusion Injury in ST‐Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction

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