| Time-related impact of distal embolisation on myocardial perfusion and survival among patients undergoing primary angioplasty with glycoprotein IIb-IIIa inhibitors: insights from the EGYPT cooperation. | |
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MedLine Citation:
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PMID: 22917731 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Aims: Considerable interest has been focused in recent years on the role of distal embolisation as a major determinant of impaired reperfusion after primary angioplasty for STEMI. The aim of the current study was to evaluate in a large cohort of STEMI patients undergoing primary angioplasty with glycoprotein (Gp) IIb-IIIa inhibitors, whether the impact of distal embolisation on myocardial perfusion and survival may depend on time-to-treatment. Methods and results: Our population is represented by 1,182 patients undergoing primary angioplasty for STEMI included in the EGYPT database. Patients were grouped according to time-to-treatment (<3 hours, 3-6 hours, >6 hours). Distal embolisation was defined as an abrupt "cutoff" in the main vessel or one of the coronary branches of the infarct-related artery, distal to the angioplasty site. Myocardial perfusion was evaluated by angiography or ST-segment resolution, whereas infarct size was estimated by using peak creatine kinase (CK) and CK-MB. Follow-up data were collected between 30 days and one year after primary angioplasty. Distal embolisation was observed in 132 patients (11.1%) and tended to occur more frequently in late presenters (p=0.067). Patients with distal embolisation less often had post-procedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow (p<0.001), post-procedural myocardial blush grade (MBG) 2-3 (p<0.001), complete ST-segment resolution (p=0.021) and larger infarct size (p=0.012). Distal embolisation was associated with a significantly higher mortality (9.2% vs. 2.7%, heart rate [HR] [95% CI]=3.41 [1.73-6.71], p<0.0001). The impact of distal embolisation on myocardial perfusion and survival persisted for all time intervals. Conclusions: This study showed that among STEMI patients treated with Gp IIb-IIIa inhibitors, the negative impact of distal embolisation on myocardial perfusion and mortality is independent of the time from symptom onset to balloon angioplasty. |
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Authors:
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Giuseppe De Luca; C Michael Gibson; Kurt Huber; Dariusz Dudek; Donald Cutlip; Uwe Zeymer; Maryann Gyongyosi; Francesco Bellandi; Marko Noc; Hans-Richard Arntz; Mauro Maioli; Gioel Gabrio Secco; Simona Zorman; H Mesquita Gabriel; Ayse Emre; Tomasz Rakowski; Arnoud W J Van't Hof |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology Volume: 8 ISSN: 1969-6213 ISO Abbreviation: EuroIntervention Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-08-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101251040 Medline TA: EuroIntervention Country: France |
Other Details:
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Languages: eng Pagination: 470-6 Citation Subset: IM |
Affiliation:
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Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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