Role of Combination Therapy on no-reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.
Abstract
Background: No-reflow is a complex process with multiple pathogenetic components that may lead to major complications and higher mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) after performing percutaneous coronary intervention (PCI).This study aims to evaluate the role of combination treatment in the prevention of occurrence of no- reflow and major cardiac adverse effects in patients with STEMI undergoing primary PCI. Subjects and methods:This is an interventional study including 100 patients with STEMI who underwent emergency primary PCI and had a high risk of no-reflow (no-flow score ≥ 8), patient were randomly divided into a controlled group (n = 50) received conventional treatment, and a combination therapy group (n = 50) received high dose 80mg atorvastatin pre-intervention, platelet membrane glycoprotein IIb/IIIa receptor antagonist (tirofiban, 10μg/kg bolus followed by 0.15 μg/kg per minute) and thrombus aspiration. Six months follow up recording of major adverse cardiac events.
Results: No-reflow was detected in3/50 cases (2.8%) in the combination therapy group versus 38/50 cases (35.2%) in the control group. TIMI grade 3 was found in 46 patients (92%) versus in 32 patients (64%) p=0.008. While MBG ≤ 1 was (14/50) 28% vs (15/50) 30% p=0.18 in the combination therapy group versus control group respectively. MACE at six months 9 events (18%) in the combination therapy group, versus 19 events (38%) in the control group p= 0.03. Conclusion: combination therapy with thrombus aspiration, high-dose statin and platelet membrane glycoprotein IIb/IIIa receptor antagonist prior to pPCI reduces the incidence of no- reflow, and major cardiac adverse events in patients with acute ST-elevation myocardial infarction.
References
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15. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American college of cardiology. 2013 Jan 29;61(4):e78-140. 16. HASSAN, Ayman KM, et al. Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective. The Egyptian Heart Journal, 2018, 70.4: 421.
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18. QI, Kang, et al. Cardiac microvascular barrier function mediates the protection of Tongxinluo against myocardial ischemia/reperfusion injury. PloS one, 2015, 10.3: e0119846. 19. Uitterdijk A, Yetgin T, te Lintel Hekkert M, Sneep S, Krabbendam-Peters I, van Beusekom HMM, et al. Vagal nerve
Corresponding author: albashierkondy@gmail.com Vol. 7 (Dec., 2021)
stimulation started just prior to reperfusion limits infarct size and no-reflow. Basic Res Cardiol. 2015 Sep 28;110(5):508– 508.
20. MaÅ‚ek ÅA, SÌpiewak M, KÅ‚opotowski M, MisÌko J, RuyÅ‚Å‚o W, Witkowski A. The size does not matter - The presence of microvascular obstruction but not its extent corresponds to larger infarct size in reperfused STEMI. Eur J Radiol. 2012 Oct 1;81(10):2839–43.
21. KimJS,KimJ,ChoiD,LeeCJ,LeeSH,KoYG,etal. Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. The STATIN STEMI Trial. JACC Cardiovasc Interv. 2010;3(3):332–9.
22. Liu W, Zou Z, Jiang H, Li Q, Guo F, Wang Z, et al. Clinical effect of preoperative high-dose atorvastatin against no-reflow after pci. Exp Ther Med. 2017;13(1):97–102.
23. Zhou SS, Tian F, Chen YD, Wang J, Sun ZJ, Guo J, et al. Combination of thrombus aspiration, high-dose statin, adenosine and platelet membrane glycoprotein IIb/IIIa receptor antagonist reduce the incidence of no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation acute . J Geriatr Cardiol. 2015;12(2):135–42.
24. Li XD, Yang YJ, Hao YC, Yang Y, Zhao JL, Dou KF, et al. Effect of pre-procedural statin therapy on myocardial no- reflow following percutaneous coronary intervention: A meta analysis. Chin Med J(Engl).2013;126(9):175560
25. Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A. Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention. Results of the ARMYDA- RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol. 2009 Aug 4;54(6):558–65.
26. ROCHON, Brent, et al. Manual aspiration thrombectomy in acute ST elevation myocardial infarction: New gold standard. World Journal of cardiology, 2011, 3.2: 43. 27. Galiuto L, Garramone B, Burzotta F, Lombardo A, Barchetta S, Rebuzzi AG, et al. Thrombus Aspiration Reduces Microvascular Obstruction After Primary Coronary Intervention. A Myocardial Contrast Echocardiography Substudy of the REMEDIA Trial. J Am Coll Cardiol. 2006 Oct 3;48(7):1355–60.
28. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011 Dec 6;124(23):574–651.
29. Magro M, Springeling T, Jan van Geuns R, Zijlstra F. Myocardial ‘No-Reflow’ Prevention. Curr Vasc Pharmacol. 2013 Mar 3;11(2):263–77. 16. Seibert K, Zhang Y, Leahy K, et al. Pharmacological and biochemical demonstration of the role of cyclooxygenase 2 in inflammation and pain. Proc Nat Acad Sci. 1994; 91 (21):12013-12017.
2. BONNEFOY, Eric, et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. European heart journal, 2009, 30.13: 1598-1606.
3. CHOUDHURY, Tawfiq; WEST, Nick EJ; EL-OMAR, Magdi. ST elevation myocardial infarction. Clinical Medicine, 2016, 16.3: 277.
4. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. Journal of the American College of Cardiology. 2009 Jul 21;54(4):281-92.
5. Brosh D, Assali AR, Mager A, Porter A, Hasdai D, Teplitsky I, et al. Effect of No-Reflow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction on Six-Month Mortality. Am J Cardiol. 2007;99(4):442–5.
6. BERG, Ryan; BUHARI, Cyrus. Treating and preventing no reflow in the cardiac catheterization laboratory. Current Cardiology Reviews, 2012, 8.3: 209-214.
7. Mensah K, Mocanu MM, Yellon DM. Failure to protect the myocardium against ischemia/reperfusion injury after chronic atorvastatin treatment is recaptured by acute atorvastatin treatment: A potential role for phosphatase and
290 tensin homolog deleted on chromosome ten? J Am Coll Cardiol. 2005 Apr 19;45(8):1287–91.
8. Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, et al. Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction. Eur Heart J .2006 Mar 1;27(5):534–9.
9. Mood GR, Bavry AA, Roukoz H, Bhatt DL. Meta- Analysis of the Role of Statin Therapy in Reducing Myocardial Infarction Following Elective Percutaneous Coronary Intervention. Am J Cardiol. 2007 Sep 15;100(6):919–23. 10.Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention. Results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol. 2009 Aug 4;54(6):558– 65.
11. ZODDA, Donatella; GIAMMONA, Rosario; SCHIFILLITI, Silvia. Treatment strategy for dyslipidemia in cardiovascular disease prevention: Focus on old and new drugs. Pharmacy, 2018, 6.1: 10.
12. DA VIGNON, Jean. Pleiotropic effects of pitavastatin. British journal of clinical pharmacology, 2012, 73.4: 518-535. 13. Ostadal P . Statins as first-line therapy for acute coronary syndrome? [Internet]. Vol. 17, Experimental and Clinical Cardiology. Cardiology Academic Press; 2012. p. 227– 36.
14. Wang J-W, Chen Y-D, Wang C-H, Yang X-C, Zhu X- L, Zhou Z-Q. Development and Validation of a Clinical Risk Score Predicting the No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Cardiology. 2013;124(3):153–60.
15. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American college of cardiology. 2013 Jan 29;61(4):e78-140. 16. HASSAN, Ayman KM, et al. Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective. The Egyptian Heart Journal, 2018, 70.4: 421.
17. GarciÌa-MeÌndez RC, Almeida-Gutierrez E, Serrano- Cuevas L, SaÌnchez-DiÌaz JS, Rosas-Peralta M, Ortega-Ramirez JA, et al. Reduction of No Reflow with a Loading Dose of Atorvastatin before Primary Angioplasty in Patients with Acute ST Myocardial Infarction. Arch Med Res. 2018 Nov 1;49(8):620–9.
18. QI, Kang, et al. Cardiac microvascular barrier function mediates the protection of Tongxinluo against myocardial ischemia/reperfusion injury. PloS one, 2015, 10.3: e0119846. 19. Uitterdijk A, Yetgin T, te Lintel Hekkert M, Sneep S, Krabbendam-Peters I, van Beusekom HMM, et al. Vagal nerve
Corresponding author: albashierkondy@gmail.com Vol. 7 (Dec., 2021)
stimulation started just prior to reperfusion limits infarct size and no-reflow. Basic Res Cardiol. 2015 Sep 28;110(5):508– 508.
20. MaÅ‚ek ÅA, SÌpiewak M, KÅ‚opotowski M, MisÌko J, RuyÅ‚Å‚o W, Witkowski A. The size does not matter - The presence of microvascular obstruction but not its extent corresponds to larger infarct size in reperfused STEMI. Eur J Radiol. 2012 Oct 1;81(10):2839–43.
21. KimJS,KimJ,ChoiD,LeeCJ,LeeSH,KoYG,etal. Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. The STATIN STEMI Trial. JACC Cardiovasc Interv. 2010;3(3):332–9.
22. Liu W, Zou Z, Jiang H, Li Q, Guo F, Wang Z, et al. Clinical effect of preoperative high-dose atorvastatin against no-reflow after pci. Exp Ther Med. 2017;13(1):97–102.
23. Zhou SS, Tian F, Chen YD, Wang J, Sun ZJ, Guo J, et al. Combination of thrombus aspiration, high-dose statin, adenosine and platelet membrane glycoprotein IIb/IIIa receptor antagonist reduce the incidence of no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation acute . J Geriatr Cardiol. 2015;12(2):135–42.
24. Li XD, Yang YJ, Hao YC, Yang Y, Zhao JL, Dou KF, et al. Effect of pre-procedural statin therapy on myocardial no- reflow following percutaneous coronary intervention: A meta analysis. Chin Med J(Engl).2013;126(9):175560
25. Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A. Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention. Results of the ARMYDA- RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol. 2009 Aug 4;54(6):558–65.
26. ROCHON, Brent, et al. Manual aspiration thrombectomy in acute ST elevation myocardial infarction: New gold standard. World Journal of cardiology, 2011, 3.2: 43. 27. Galiuto L, Garramone B, Burzotta F, Lombardo A, Barchetta S, Rebuzzi AG, et al. Thrombus Aspiration Reduces Microvascular Obstruction After Primary Coronary Intervention. A Myocardial Contrast Echocardiography Substudy of the REMEDIA Trial. J Am Coll Cardiol. 2006 Oct 3;48(7):1355–60.
28. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011 Dec 6;124(23):574–651.
29. Magro M, Springeling T, Jan van Geuns R, Zijlstra F. Myocardial ‘No-Reflow’ Prevention. Curr Vasc Pharmacol. 2013 Mar 3;11(2):263–77. 16. Seibert K, Zhang Y, Leahy K, et al. Pharmacological and biochemical demonstration of the role of cyclooxygenase 2 in inflammation and pain. Proc Nat Acad Sci. 1994; 91 (21):12013-12017.
Additional Files
Published
2021-12-12
How to Cite
Role of Combination Therapy on no-reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. (2021). Lebda Medical Journal, 8(1), 283–291. Retrieved from https://lebmedj.elmergib.edu.ly/index.php/LMJ/article/view/161
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Medicine
