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Aspiration thrombectomy fails to demonstrate benefit in primary PCI  

16 Apr, 15 | by Alistair Lindsay

Although primary percutaneous coronary intervention (PPCI) restores epicardial coronary flow in the majority of patients with ST-segment myocardial infarction, this approach can lead to microvascular obstruction resulting from distal embolization of thrombus.  Manual thrombectomy (i.e. aspiration thrombectomy) prior to PPCI has been proposed as a method to reduce thrombus burden and resultant distal embolization with PPCI.  Although results from early studies of aspiration thrombectomy suggested improvements in patient outcomes, subsequent trials have failed to demonstrate a clinical benefit of aspiration thrombectomy prior to PPCI.  more…

Temporal trends towards increased mortality despite Improved door-to-balloon times in ST-elevation myocardial infarction  

20 Dec, 14 | by Alistair Lindsay

A short door-to-balloon time (D2B) is considered a quality of care measure for patients of ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (pPCI). However, recent literature has documented reductions in D2B that were not associated with improved STEMI mortality. Using the National Cardiovascular Data Registry (NCDR) CathPCI Registry, Nallamothu et al. assessed this apparent contradiction at the individual and population levels. The authors examined 150,116 pPCI procedures performed on 146,940 patients at 423 US hospitals over the course of six years. They assessed both in-hospitality (in the entire cohort) and 6-month mortality (in Medicare beneficiaries ≥ 65 years old) using models that incorporated patient and population-level components relevant to the association between D2B time and outcomes. more…

Thrombus aspiration in STEMI fails to demonstrate benefit

29 Dec, 13 | by Alistair Lindsay

Thrombus aspiration during primary PCI for patients presenting with ST elevation myocardial infarction (STEMI) is an intuitively attractive manoeuvre to aid rapid reperfusion, reduce distal embolization and improve microvascular perfusion.  Despite limited trial evidence of clinical benefit, the procedure has quickly taken hold in many PCI centres with European and US guidelines agreeing on a IIa recommendation for its use. more…

Bivalirudin in contemporary STEMI treatment

29 Dec, 13 | by Alistair Lindsay

The novel direct thrombin inhibitor bivalirudin is now widely used as an adjunctive therapy in patients undergoing primary PCI for ST elevation myocardial infarction (STEMI). This stems from trial data demonstrating bivalirudin results in lower bleeding rates and better long term survival as compared with the combination of heparin and a GP IIb/IIIa inhibitor. However, clinical practice has subsequently changed, including greater use of radial access with resultant lower bleeding risk and expanded use of newer generation P2Y­12 inhibitors.  The EUROMAX trial sought to understand whether use of bivalirudin benefits patients in light of these changes in clinical practices. more…

How appropriate is coronary intervention?

11 Jul, 11 | by Alistair Lindsay

When is a PCI procedure “appropriate” and when is it not?  The answer depends on how you define “appropriate”, and recently appropriate use criteria for coronary revascularisations have been jointly developed by six professional organisations, including the AHA and ACC.  The aim of this study, therefore, was to assess the appropriateness of PCI in the Unites States according to these new criteria. more…

PPCI less effective in the elderly

2 May, 11 | by Alistair Lindsay

In the Apex-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial, the novel anti-inflammatory agent Pexelizumab was not found to improve outcomes when given during PPCI.  However, the study did enrol the largest group of patients 75 years or older with ST-segment elevation myocardial infarction to be treated with primary percutaneous coronary intervention (PPCI) in a clinical trial.  As outcome data for elderly patients undergoing PPCI are limited, the authors performed a post-hoc analysis on this subgroup. more…

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