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Aspirin reload before elective percutaneous coronary intervention: impact on serum thromboxane b2 and myocardial
Stefania Basili1, Gaetano Tanzilli2, Valeria Raparelli2
1From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.). stefania.basili@uniroma1.it.
Background:
Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B2, a stable metabolite of thromboxane A2, may be implicated in post-PCI microvascular obstruction.
Methods And Results:
We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B2, reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005).
Conclusions:
Aspirin loading dose before elective PCI improves myocardial reperfusion and injury indexes, suggesting a possible role of platelet thromboxane A2 in microvascular occlusion.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT01374698.
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