Do myocardial perfusion markers predict clinical outcomes?
EXPERIA: MBG and outcomes
Sardella et al Am J Cardiol 2010
EXPERIA: STR and outcomes
Sardella et al Am J Cardiol 2010
Is there a thrombus in every STEMI patient? Certainly YES
Is angiography sensetive enough to pick all thrombi
Incidence of Angioscopic Thrombi in Unstable Versus Stable Angina Patients
White et al. Circulation 1996
Intracoronary Microparticles and Markers of Myocardial Perfusion
Porto et al, Eur H J 2012
Intracoronary Microparticles and Markers of Myocardial Perfusion
Porto et al, Eur H J 2012
Macroscopic thrombus retrieval and infarct size
Chopard et al. Am J Cardiol 2013
INFUSE-AMI 6318
patient were screened and only 452
were enrolled
Only anterior MI with proximal of mid LAD occlusion
Infarct size was measured only at one time point at 30 days
Only patients with symptom to device time < 5hrs
De Vita et al, Heart 2010
INFUSE-AMI
McNamara et al, JACC 2006
INFUSE-AMI
ClearWay catheter for intracoronary Abciximab
Not powered for clinical events
MUSTELA Trial No difference in infarct size at 3 months or 1 yr MACE
Only patients with large thrombi (>3) include
In those with thrombi of grade 5. reclassification after wire or balloon
Angiojet was used in 52%
MRI only at 3 months
Control group had shorter Pain To Balloon time (208 vs 230) and more TIMI-3 pre-PCI (16.3% vs 3.8%)
Yet, It showed better MBG-3 and STR and less MVO and more dyshomogenious scar
PASSION Trial 2 year MACE is the same Thrombectomy
Conventional PCI
P
â&#x20AC;˘ Post-hoc analysis â&#x20AC;˘ Important baseline angiographic findings favor conventional PCI Mink et al, Cath Cardiovasc Interv 2012
Kaltoft Study
TA patients had longer symptom onset to balloon time (242 vs 208 minutes)
TA patients had significantly longer procedures (39 vs 29 minutes)
They used bulky catheter (RESCUE cath 4.5 Fr)
Twice as many patients in TA arm didn’t have baseline scan (24 vs 12)
Kaltoft et al, Circulation 2006
Problems with Assessment of Therapeutic Effect: Is Infarct Size a valid endpoint?
Brodie et al. Am J Cardiol 2007
Problems with Assessment of Therapeutic Effect: Is Infarct Size a valid endpoint?
Stone et al. Am J Cardiol 2007
Thank You
Is there a room to improve STEMI outcomes?
??
Baseline Risk and Impact of ReoPro on Outcomes Death or MI at 30 days Placebo 20.0 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0
Abciximab 18.3
P=0.02
13.1
P=0.91
4.0 4.0
ISAR REACT 1 Stable patients Kastrati A, NEJM 2004, JAMA 2006
P=0.98
4.6 4.6
ISAR REACT 2 NSTEACS TnT -
ISAR REACT 2 NSTEACS TnT +