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TCT-147 Local intracoronary delivery of eptifibatide plus verapamil via thrombus aspiration catheter to prevent No-reflow in acute ST elevation myocardial infarction patients with large thrombus burden
B60
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
and reinfarction (1.6% versus 9.1%, p ¼ 0.041), while no difference between groups were revealed in mortality (46,0% RT vs. 49,4% p¼ 0.679) and stroke (1.6% RT vs 3.2% p¼ .698). At multivariable analysis the variables related to the risk of the primary end point were age (HR: 1.036 95% CI¼1.022 - 1.048, p <0.001), three vessel disease (HR: 1.504, 95% CI 1.163 – 1.946, p¼ 0.002), RT (HR 0.689, 95% CI 0.476 – 0.998, p¼ 0.049) and successful primary PCI (HR 0.367, 95% CI 0.266 – 0.505, p< 0.001). CONCLUSION RT reduce 2-year MACE in patients with large thrombus burden and AMI complicated by CS. CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection TCT-146 Routine Aspiration thrombectomy is associated with increased stroke rates during primary percutaneous coronary intervention for myocardial infarction Oliver Guttmann,1 Dhanuka Perera,2 Ajay Jain,3 Anthony Mathur,4 Andrew Wragg,5 Daniel Jones6 1 London, United Kingdom; 2Barts Health, Colchester, United Kingdom; 3 London Chest Hospital, London, United Kingdom; 4Barts and the London NHS Trust, London, United Kingdom; 5Barts and The London NHS Trust, London, United Kingdom; 6London chest, london, United Kingdom
(n¼50). Primary end point was assessment of post procedural myocardial blush grade (MPG) and corrected TIMI frame count (cTFC). Major adverse cardiovascular events were reported at the end of 3 months follow up. RESULTS Thrombus aspiration with intracoronary eptifibatide and verapamil was superior to thrombus aspiration alone as regards MBG3 (72% vs 36%; p¼0.001), cTFC was shorter in the local intracoronary group (19.864.74 vs 27.745.16; p¼0.001). TIMI3 flow wasn’t different between the 2 groups (88% vs 80%; p¼0.716). The study also showed that intracoronary eptifibatide led to less time to reach peak CK (13.08 hours vs 18.9 hours; p-value¼ 0.001). IC tirofiban + aspiration
Aspiration alone
P-value
Before angioplasty
0.51 0.37
0.56 0.33
0.752
After angioplasty
2.74 0.34
2.53 0.58
0.251
Before angioplasty
83.3 9.5
81.2 10.5
0.794
After angioplasty
5.24 3.27
4.21 3.07
0.822
Minimal lumen diameter, mm
Diameter stenosis, %
MBG3
72%
36%
0.0001
cTFC
19.86 4.74
27.74 5.16
0.0001
TIMI3
88%
80%
0.716
BACKGROUND Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality outcomes and may be associated with an increased stroke rate. In this study we have sought to determine whether routine thrombus aspiration in patients undergoing primary PCI for ST elevation myocardial infarction (STEMI) are associated with increased stroke rates.
CONCLUSION In STEMI patients undergoing aspiration thrombectomy for large thrombus burden, local intracoronary eptifibatide plus verapamil via aspiration catheter is associated with improved cTFC and MBG compared to thrombectomy alone.
METHODS This was an observational study analysing data from a prospective database of 6494 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates.
TCT-148 Role of chronic total occlusion in patients undergoing primary angioplasty
RESULTS 2,482 (38.2%) patients underwent thrombus aspiration during the PCI procedure with 4,012 (67.8%) did not. Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (Prev. MI, PCI, CABG), cardiovascular risk factors (Hypertension, Diabetes, hypercholestrolaemia and smoking) and cardiogenic shock prior to procedure. In patients who received thrombus aspiration, stroke rates within 30 days, the primary outcome, were increased compared to patients who did not undergo aspiration [15 (0.6%) vs. 11 (0.27%) (p¼0.03), hazard ratio (HR) 2.01; 95% confidence interval (CI) 1.23-2.95]. No difference in mortality rates were seen overall between the 2 study groups (HR 0.85 (0.651.25) however higher rates were seen in patients who had a stroke compared to those who did not (p<0.001). CONCLUSION Our data series suggest that routine thrombus aspiration during primary PCI is associated with a significant increase in stroke. Further study is required to address this issue. CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection TCT-147 Local intracoronary delivery of eptifibatide plus verapamil via thrombus aspiration catheter to prevent No-reflow in acute ST elevation myocardial infarction patients with large thrombus burden Mohamed Hamza,1 Mohamed Shehata2 1 Ain Shams University, Cairo, Egypt; 2Ain shams university BACKGROUND Primary PCI is considered the preferred reperfusion modality for patients presenting with ST-segment elevation myocardial infarction (STEMI). However, a proportion of patients treated with PCI experience distal embolization and microvascular obstruction. we compared local intracoronary delivery of eptifibatide and verapamil via thrombus aspiration catheter in the target vessel versus thrombus aspiration alone to prevent No-reflow in acute STEMI patients with large thrombus burden. METHODS One hundred patients with acute STEMI with heavy thrombus burden were randomized to local intracoronary eptifibatide and verapamil via aspiration catheter after thrombus aspiration prior to the first balloon inflation (n¼50), or thrombus aspiration alone
CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection
Eva Rumiz,1 Alberto Berenguer,2 Juan Vicente Vilar,3 Dario Sanmiguel,4 Andres Cubillos,5 Pablo Almela,6 Isidoro López,7 Ernesto Valero,8 Salvador Morell9 1 Hospital General de Valencia, Valencia, Spain; 2Unknown, Valencia, Spain; 3General Hospital Valencia, Valencia, Spain; 4Hospital General Valencia, Valencia, Spain; 5Hospital General Universitario de Valencia; 6 Hospital General Universitario de Valencia; 7Hospital General Universitario de Valencia; 8Hospital Clínico Universitario de Valencia; 9 Hospital General Universitario de Valencia BACKGROUND Recent studies have shown that complete revascularization of patients with multivessel disease undergoing primary angioplasty (primary PCI) reduces long-term mortality. However, these studies do not include patients with chronic total occlusions (CTO). The aim of this study was to evaluate the prognostic role of CTO in a non culprit vessel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary / rescue PCI. METHODS We prospectively included 554 consecutive patients admitted for a STEMI who underwent primary / rescue PCI from 01/ 06/2009 to 01/12/2014. In order to evaluate the effect of the interaction of a CTO in mortality and readmission we used the Cox regression and binomial models respectively. RESULTS The patient mean age was 6524 years old and 64.1% of the patients underwent primary PCI. 50 patients (9%) showed a CTO in a non culprit vessel. Patients with a CTO showed a higher percentage of severe systolic dysfunction (<35%), with a higher incidence of cardiogenic shock at the time of infarction. During a median follow-up of 57 months (interquartile range: 17-101), no significant differences in reinfarction or rehospitalization for heart failure were observed in both groups. Nevertheless, we observed an increase in inhospital mortality (20.5% vs 6.2%, p <0.001) and during outpatient follow-up (38.8% vs 12.4%, p <0.001) in patients with a CTO. In multivariate analysis, and after adjusting for clinical and haemodynamic variables, we observed that the presence of a CTO is independently associated with an increased risk of death (HR 3.16, 95% CI 1.1-8.70). CONCLUSION The presence of a CTO triples the risk of long-term death in patients with a STEMI undergoing primary / rescue PCI, constituting a high-risk subgroup that could also benefit of a complete preventive revascularization. CATEGORIES CORONARY: Acute Myocardial Infarction
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
and reinfarction (1.6% versus 9.1%, p ¼ 0.041), while no difference between groups were revealed in mortality (46,0% RT vs. 49,4% p¼ 0.679) and stroke (1.6% RT vs 3.2% p¼ .698). At multivariable analysis the variables related to the risk of the primary end point were age (HR: 1.036 95% CI¼1.022 - 1.048, p <0.001), three vessel disease (HR: 1.504, 95% CI 1.163 – 1.946, p¼ 0.002), RT (HR 0.689, 95% CI 0.476 – 0.998, p¼ 0.049) and successful primary PCI (HR 0.367, 95% CI 0.266 – 0.505, p< 0.001). CONCLUSION RT reduce 2-year MACE in patients with large thrombus burden and AMI complicated by CS. CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection TCT-146 Routine Aspiration thrombectomy is associated with increased stroke rates during primary percutaneous coronary intervention for myocardial infarction Oliver Guttmann,1 Dhanuka Perera,2 Ajay Jain,3 Anthony Mathur,4 Andrew Wragg,5 Daniel Jones6 1 London, United Kingdom; 2Barts Health, Colchester, United Kingdom; 3 London Chest Hospital, London, United Kingdom; 4Barts and the London NHS Trust, London, United Kingdom; 5Barts and The London NHS Trust, London, United Kingdom; 6London chest, london, United Kingdom
(n¼50). Primary end point was assessment of post procedural myocardial blush grade (MPG) and corrected TIMI frame count (cTFC). Major adverse cardiovascular events were reported at the end of 3 months follow up. RESULTS Thrombus aspiration with intracoronary eptifibatide and verapamil was superior to thrombus aspiration alone as regards MBG3 (72% vs 36%; p¼0.001), cTFC was shorter in the local intracoronary group (19.864.74 vs 27.745.16; p¼0.001). TIMI3 flow wasn’t different between the 2 groups (88% vs 80%; p¼0.716). The study also showed that intracoronary eptifibatide led to less time to reach peak CK (13.08 hours vs 18.9 hours; p-value¼ 0.001). IC tirofiban + aspiration
Aspiration alone
P-value
Before angioplasty
0.51 0.37
0.56 0.33
0.752
After angioplasty
2.74 0.34
2.53 0.58
0.251
Before angioplasty
83.3 9.5
81.2 10.5
0.794
After angioplasty
5.24 3.27
4.21 3.07
0.822
Minimal lumen diameter, mm
Diameter stenosis, %
MBG3
72%
36%
0.0001
cTFC
19.86 4.74
27.74 5.16
0.0001
TIMI3
88%
80%
0.716
BACKGROUND Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality outcomes and may be associated with an increased stroke rate. In this study we have sought to determine whether routine thrombus aspiration in patients undergoing primary PCI for ST elevation myocardial infarction (STEMI) are associated with increased stroke rates.
CONCLUSION In STEMI patients undergoing aspiration thrombectomy for large thrombus burden, local intracoronary eptifibatide plus verapamil via aspiration catheter is associated with improved cTFC and MBG compared to thrombectomy alone.
METHODS This was an observational study analysing data from a prospective database of 6494 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates.
TCT-148 Role of chronic total occlusion in patients undergoing primary angioplasty
RESULTS 2,482 (38.2%) patients underwent thrombus aspiration during the PCI procedure with 4,012 (67.8%) did not. Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (Prev. MI, PCI, CABG), cardiovascular risk factors (Hypertension, Diabetes, hypercholestrolaemia and smoking) and cardiogenic shock prior to procedure. In patients who received thrombus aspiration, stroke rates within 30 days, the primary outcome, were increased compared to patients who did not undergo aspiration [15 (0.6%) vs. 11 (0.27%) (p¼0.03), hazard ratio (HR) 2.01; 95% confidence interval (CI) 1.23-2.95]. No difference in mortality rates were seen overall between the 2 study groups (HR 0.85 (0.651.25) however higher rates were seen in patients who had a stroke compared to those who did not (p<0.001). CONCLUSION Our data series suggest that routine thrombus aspiration during primary PCI is associated with a significant increase in stroke. Further study is required to address this issue. CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection TCT-147 Local intracoronary delivery of eptifibatide plus verapamil via thrombus aspiration catheter to prevent No-reflow in acute ST elevation myocardial infarction patients with large thrombus burden Mohamed Hamza,1 Mohamed Shehata2 1 Ain Shams University, Cairo, Egypt; 2Ain shams university BACKGROUND Primary PCI is considered the preferred reperfusion modality for patients presenting with ST-segment elevation myocardial infarction (STEMI). However, a proportion of patients treated with PCI experience distal embolization and microvascular obstruction. we compared local intracoronary delivery of eptifibatide and verapamil via thrombus aspiration catheter in the target vessel versus thrombus aspiration alone to prevent No-reflow in acute STEMI patients with large thrombus burden. METHODS One hundred patients with acute STEMI with heavy thrombus burden were randomized to local intracoronary eptifibatide and verapamil via aspiration catheter after thrombus aspiration prior to the first balloon inflation (n¼50), or thrombus aspiration alone
CATEGORIES CORONARY: Thrombus / Thrombectomy and Embolic Protection
Eva Rumiz,1 Alberto Berenguer,2 Juan Vicente Vilar,3 Dario Sanmiguel,4 Andres Cubillos,5 Pablo Almela,6 Isidoro López,7 Ernesto Valero,8 Salvador Morell9 1 Hospital General de Valencia, Valencia, Spain; 2Unknown, Valencia, Spain; 3General Hospital Valencia, Valencia, Spain; 4Hospital General Valencia, Valencia, Spain; 5Hospital General Universitario de Valencia; 6 Hospital General Universitario de Valencia; 7Hospital General Universitario de Valencia; 8Hospital Clínico Universitario de Valencia; 9 Hospital General Universitario de Valencia BACKGROUND Recent studies have shown that complete revascularization of patients with multivessel disease undergoing primary angioplasty (primary PCI) reduces long-term mortality. However, these studies do not include patients with chronic total occlusions (CTO). The aim of this study was to evaluate the prognostic role of CTO in a non culprit vessel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary / rescue PCI. METHODS We prospectively included 554 consecutive patients admitted for a STEMI who underwent primary / rescue PCI from 01/ 06/2009 to 01/12/2014. In order to evaluate the effect of the interaction of a CTO in mortality and readmission we used the Cox regression and binomial models respectively. RESULTS The patient mean age was 6524 years old and 64.1% of the patients underwent primary PCI. 50 patients (9%) showed a CTO in a non culprit vessel. Patients with a CTO showed a higher percentage of severe systolic dysfunction (<35%), with a higher incidence of cardiogenic shock at the time of infarction. During a median follow-up of 57 months (interquartile range: 17-101), no significant differences in reinfarction or rehospitalization for heart failure were observed in both groups. Nevertheless, we observed an increase in inhospital mortality (20.5% vs 6.2%, p <0.001) and during outpatient follow-up (38.8% vs 12.4%, p <0.001) in patients with a CTO. In multivariate analysis, and after adjusting for clinical and haemodynamic variables, we observed that the presence of a CTO is independently associated with an increased risk of death (HR 3.16, 95% CI 1.1-8.70). CONCLUSION The presence of a CTO triples the risk of long-term death in patients with a STEMI undergoing primary / rescue PCI, constituting a high-risk subgroup that could also benefit of a complete preventive revascularization. CATEGORIES CORONARY: Acute Myocardial Infarction