Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

Jolly, Sanjit S.; James, Stefan; Džavík, Vladimir; Cairns, John A.; Mahmoud, Karim; Zijlstra, Felix; Yusuf, Salim; Olivecrona, Göran; Renlund, Henrik; Gao, Peggy; Lagerqvist, Bo; Alazzoni, Ashraf; Kedev, Saško; Stanković, Goran; Meeks, Brandi; Fröbert, Ole

doi:10.1161/circulationaha.116.025371

Cited by 253 publications

(57 citation statements)

References 12 publications

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“…However, in the subset with high thrombus burden, the trend towards a reduction in cardiovascular death were balanced by an increased risk of stroke or transient ischemic attack. 10 The meta-analysis supports the current guideline recommendation against routine use of aspiration in STEMI. 11…”

Section: Thrombus-containing Lesionssupporting

confidence: 63%

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Percutaneous Coronary Intervention: Developments in the Last 12 Months

Davies

Abbott

2019

US Cardiology Review

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In 2018, there were several studies that significantly added to the field of interventional cardiology. Research was focused on understanding the role of percutaneous coronary intervention (PCI) in various clinical syndromes, optimizing outcomes for high-risk lesion subsets, and building an evidence base for greater adoption of PCI guided by physiology and intracoronary imaging. In the area of innovation, novel and iterative developments in drug-eluting stents (DES) and scaffold platforms were compared with current generation DES. This article summarizes the research from last year which has had the most impact on PCI techniques and clinical care.

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Section: Thrombus-containing Lesionssupporting

confidence: 63%

“…A meta-analysis by Jolly et al evaluated the use of thrombus aspiration during primary PCI. 10 Randomized controlled trials, including at least 1,000 patients comparing manual thrombectomy and PCI alone in patients with STEMI were included. Routine thrombus aspiration did not improve clinical outcomes.…”

Section: Thrombus-containing Lesionsmentioning

confidence: 99%

Percutaneous Coronary Intervention: Developments in the Last 12 Months

Davies

Abbott

2019

US Cardiology Review

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“…8 However, aspiration thrombectomy was subsequently challenged by the results of two trials, Thrombus Aspiration in ST-elevation Myocardial Infarction in Scandinavia (TASTE) and Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL), which both failed to show substantial clinical and perfusion benefit in patients despite successful aspiration of clotting material. [9][10][11] Coronary thrombus material triggers thrombotic, inflammatory, vasoconstrictor and other pathways, and evacuating a portion of the thrombus and plaque material addresses only a part of the pathophysiological problem. Pharmacologically disrupting thrombus formation may be more effective.…”

Section: Discussionmentioning

confidence: 99%

“…ST-segment elevation persists in more than 40% of cases of patients in whom a TIMI 3 flow has been achieved by primary PCI, a drawback associated with subsequent impairment of left ventricular (LV) function and a worse prognosis. [4][5][6] Over the past decade, several approaches have been directed to prevent or reverse the no-reflow phenomenon, including aspiration thrombectomy [7][8][9][10][11] and intracoronary glycoprotein IIb/ IIIa inhibitor administration, such as abciximab. [12][13][14][15][16][17] Abciximab, the Fab fragment of the chimeric human-murine monoclonal antibody 7E3, binds to the glycoprotein IIb/IIIa receptor of human platelets and inhibits platelet aggregation.…”

mentioning

confidence: 99%

Intracoronary or intravenous abciximab after aspiration thrombectomy in patients with STEMI undergoing primary percutaneous coronary intervention

Bedjaoui¹,

Allal²,

Lounes³

et al. 2019

CVJA

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Objectives: To test whether aspiration thrombectomy with intracoronary (IC) instead of intravenous (IV) administration of abciximab could reduce the no-reflow phenomenon in patients undergoing primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI). Background: Despite recanalisation with PCI, failure to restore microvascular flow may affect the prognosis of patients with STEMI. A combination of aspiration thrombectomy with IC abciximab may improve distal perfusion. Methods: After aspiration thrombectomy during primary PCI for STEMI, 160 patients were randomly assigned to either an IV or IC abciximab bolus delivered through the aspiration catheter, both followed by a 12-hour IV abciximab infusion. Results: ST-segment resolution ≥ 70% was achieved in 36 of 78 patients with IC versus 30 of 82 patients with IV abciximab (46.1 vs 36.6%, p = 0.368), and partial resolution in 28 of 78 versus 31 of 82 patients (35.9 vs 37.8%, p = 0.368). Postprocedural myocardial blush grade (MBG) 3 was obtained in 62.8 vs 63.4% (p = 0.235) and MBG ≥ 2 in 89.7 vs 81.7% (p = 0.148) of patients given IC and IV abciximab, respectively. There were three deaths in each group (3.8%). Major adverse cardiac events occurred in six of 78 patients given the IC and seven of 82 patients given the IV abciximab bolus (7.6 vs 8.5%, p = 0.410). One stroke occurred in each group, and two patients in the IC and nine in the IV group developed renal failure (2.5 vs 10.9 %, p = 0.414). Conclusion: IC versus IV abciximab did not enhance myocardial reperfusion in non-selected patients with STEMI undergoing primary PCI after aspiration thrombectomy had successfully been performed.

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“…В случае эмболического генеза ИМ причина, как правило, становится понятна уже в ходе проведения КАГ, в процессе которой следует рассмотреть возможность применения аспирационной тромбэкстракции, необходимость баллонной ангиопластики и стентирования при сопутствующем атеросклеротическом по- ражении коронарных артерий. Однако на сегодняшний день исследования на тему применения аспирационной тромбэкстракции демонстрируют противоречивые данные: с одной стороны, были получены результаты снижения сердечно-сосудистой смертности, с другойувеличения риска инсульта после процедуры [12][13][14][15]. Также описаны отдельные случаи эффективности интракоронарного тромболизиса [16].…”

Section: Discussionunclassified

Embolic Myocardial Infarction. Experience in Diagnosis and Management

Shilova¹,

Gilyarova²,

Андреев³

et al. 2018

Racionalʹnaâ farmakoterapiâ v kardiologii

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Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.

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Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

Abstract: URLs: http://www.ClinicalTrials.gov http://www.crd.york.ac.uk/prospero/. Unique identifiers: NCT02552407 and CRD42015025936.

Cited by 253 publications

References 12 publications

Percutaneous Coronary Intervention: Developments in the Last 12 Months

Percutaneous Coronary Intervention: Developments in the Last 12 Months

Intracoronary or intravenous abciximab after aspiration thrombectomy in patients with STEMI undergoing primary percutaneous coronary intervention

Embolic Myocardial Infarction. Experience in Diagnosis and Management

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