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 […]
Tag: PPCI
Temporal trends towards increased mortality despite Improved door-to-balloon times in ST-elevation myocardial infarction
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 […]
Thrombus aspiration in STEMI fails to demonstrate benefit
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 […]
Bivalirudin in contemporary STEMI treatment
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, […]
How appropriate is coronary intervention?
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 […]
PPCI less effective in the elderly
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 […]