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Myocardial reperfusion for acute myocardial infarction under an optimized antithrombotic medication: What can you

Samuel Pinelli1, Nelly Agrinier2, Nidhal Bouchahda1

  • 1CHU Nancy, Département de Cardiologie, Nancy F-54000, France.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|March 21, 2018
PubMed

Insights

Different antithrombotic strategies did not impact reperfusion in STEMI patients undergoing primary PCI. Optimal tissue reperfusion remains a challenge, achieved in only half of cases despite earlier interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • ST-elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
  • Primary percutaneous coronary intervention (pPCI) is the standard treatment for STEMI.
  • Optimizing both macrovascular and microvascular reperfusion is crucial for myocardial salvage.

Purpose of the Study:

  • To evaluate the impact of different intravenous antithrombotic strategies on epicardial, microvascular, and tissue reperfusion in STEMI patients prior to pPCI.
  • To identify if pre-admission antithrombotic choices influence reperfusion outcomes.

Main Methods:

  • A cohort of 488 STEMI patients undergoing pPCI were analyzed.
  • Patients received prehospital bivalirudin or heparin, with or without glycoprotein IIb/IIIa inhibitors (GPI).
  • Epicardial perfusion (TIMI flow), microvascular perfusion (corrected TIMI frame count [cTFC]), and ST resolution (STR) on ECG were assessed.

Main Results:

  • Overall, 85.2% achieved TIMI 3 flow, 37.2% had cTFC ≤23, and 42.5% showed STR >70%.
  • No significant differences in STR or cTFC were observed between the antithrombotic treatment groups.
  • Multivariate analysis did not identify any specific antithrombotic treatment as predictive of optimal reperfusion outcomes.

Conclusions:

  • While pPCI has improved, optimal tissue reperfusion is achieved in only about half of STEMI patients.
  • Pre-hospital antithrombotic strategies did not significantly alter macrovascular or microvascular reperfusion success rates.
  • Factors like pre-procedural TIMI 3 flow and symptom-to-balloon time are more predictive of ST resolution than the chosen antithrombotic agent.
Abstract

Keywords:
Microcirculatory perfusionMyocardial infarctionPercutaneous coronary intervention

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