Index of microvascular resistance and outcomes following intra-coronary thrombolysis with percutaneous intervention in STEMI: a meta-analysis of randomized control trials

AbstractMicrovascular obstruction following percutaneous coronary intervention (PCI) is highly prevalent and independently associated with adverse clinical outcomes. Microvascular obstruction is determined by index of the microvascular resistance. We performed a systematic review with meta-analysis of all published randomized clinical trials (RCTs) studying the effect of intra-coronary thrombolysis with PCI as compared to standard treatment among patients with ST-segment elevated myocardial infarction. We included 6 RCTs summing up to 947 patients in the final analysis. Intra-coronary thrombolysis resulted in significantly lower index of microvascular resistance [standardized mean difference: − 13.74, 95% confidence interval (CI): − 16.74 to − 10.73, P value 
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research

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Abstract BACKGROUND: Prompt and potent antiplatelet effects are important aspects of management of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We evaluated the association between platelet-derived thrombogenicity during PPCI and enzymatic infarct size in STEMI patients.Methods and Results:Platelet-derived thrombogenicity was assessed in 127 STEMI patients undergoing PPCI by: (1) the area under the flow-pressure curve for the PL-chip (PL18-AUC10) using the total thrombus-formation analysis system (T-TAS); and (2) P2Y12reaction units (PRU) usi...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Conclusion: In adults with AF after PCI, dual therapy reduces risk for bleeding compared with triple therapy, whereas its effects on risks for death and ischemic end points are still unclear. Primary Funding Source: None. PMID: 32176890 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
AbstractPatients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have traditionally received triple antithrombotic therapy (TAT) consisting of aspirin and a P2Y12 inhibitor plus an oral anticoagulant (OAC) to reduce atherothrombotic events, even though this strategy is associated with a high risk of severe bleeding. Recent trials have indicated that dual antithrombotic therapy (DAT), consisting of a P2Y12 inhibitor plus an OAC, may be superior to TAT in terms of bleeding risk; however, the  trade-off regarding ischemic complications may be questionable. Patients who have had a myocard...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
ConclusionSufficient coronary collateralization has a positive impact on microvascular obstruction, infarct size and long-term mortality in STEMI patients presenting between 12 and 48  h after symptom onset.
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
CONCLUSIONS: In this multi-center prospective study, the APTITUDE® BRS was shown to be safe and effective in the treatment of single coronary lesions at 24-months clinical follow up. PMID: 32149709 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
AbstractHigh on treatment platelet reactivity (HPR) during treatment with clopidogrel has been consistently found to be strong risk factor for recurrent ischemic events after percutaneous coronary intervention (PCI). Insufficient P2Y12 receptor inhibition contributes to HPR measured by the VerifyNow (VN) assay. Prasugrel and ticagrelor are more potent P2Y12 inhibitors than clopidogrel and commonly substituted for clopidogrel when HPR is documented, however benefit of VN guided intensified antiplatelet therapy is uncertain. We identified patients who had undergone platelet reactivity testing after PCI with VN after pretreat...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Authors: Costa Moreira A, Sousa A, de Ribamar Costa J, Costa R, Damiani L, Campos Neto C, Maldonado G, Sousa JE Abstract BACKGROUND: We sought to develop a risk score to estimate the risk of major adverse cardiac event (MACE) occurrence during the in-hospital and long-term follow-up periods after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. METHODS: This score was developed and validated in a single-center database encompassing all consecutive patients treated with DES between 2007 and 2014 (n = 4061). For the development of the score, we analyzed all patients treated bet...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
AbstractGuidelines advice against dual antiplatelet therapy (DAPT) discontinuation less than 12  months after percutaneous coronary intervention with drug-eluting stents (DES-PCI). However, any delay of necessary surgery in patients with descending thoracic (DTA) or abdominal aortic aneurysm (AAA), treated by DES-PCI, increases the risk of aneurysm rupture/dissection. We evaluated the safety of 8-week waiting time between DES-PCI and endovascular aortic repair (EVAR). 1152 consecutive patients with coronary artery disease (CAD) needing elective DTA or AAA repair were enrolled and divided into two groups. Group A inclu...
Source: Updates in Surgery - Category: Surgery Source Type: research
During the past decade, the estimated rates of hospital admission for ST-segment elevation myocardial infarction (STEMI) had increased from 3.5 to 15.4 per 100,000 people in China.1 Primary percutaneous coronary intervention (PPCI) has been recommended as the standard treatment for patients with STEMI in the current guideline.2 However, a major limitation of PPCI is microvascular embolization leading to tissue hypoperfusion after balloon dilation or stent implantation, especially for lesions with high thrombus burden, which is associated with increased mortality for patients undergoing PPCI.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
This study aims to investigate the clinical and angiographic characteristics of patients with spontaneous reperfusion in ST-segment elevation myocardial infarction (STEMI). A total of 519 patients with STEMI were enrolled in this study, who underwent primary percutaneous coronary intervention (PCI) treatments at Beijing Anzhen Hospital from January 2015 to December 2018. The patients were divided into 2 groups according to the TIMI flow grade before primary PCI, the non-spontaneous reperfusion group (TIMI flow grade 0–II) and the spontaneous reperfusion group (TIMI flow grade III). The incidence rate, the clinically...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
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