OBJECTIVE: We assessed the relationship between fibrin clot properties and the no-reflow phenomenon after primary coronary intervention (PCI). METHODS AND RESULTS: Epicardial blood flow was assessed by TIMI scale and corrected TIMI frame count (cTFC), and perfusion by TIMI Myocardial Perfusion Grade (TMPG) after PCI during ST-segment elevation myocardial infarction (STEMI). Fibrin clot permeability (K(s)) and susceptibility to lysis in assays using exogenous thrombin (t(50%)) and without thrombin (t(TF)) were determined in 30 no-reflow patients (TIMI < or = 2) and in 31 controls (TIMI-3) after uneventful 6 to 14 months from PCI. Patients with TIMI < or = 2 had lower K(s) by 18% (P<0.0001) and prolonged fibrinolysis by 33% for t(50%) (P<0.0001) and by 45% for t(TF) (P<0.0001). cTFC was correlated with K(s) (r=-0.56, P<0.0001), t(50%) (r=0.49, P<0.001), and t(TF) (r=0.54, P<0.001). K(s) increased in a stepwise fashion with TIMI flow (P<0.0001) and TMPG (P<0.0001), whereas both fibrinolysis times decreased with TIMI flow (P<0.0001 for both) and TMPG (P<0.01 for both). Multiple regression models showed that only K(s) and fibrinogen were independent predictors of cTFC (P<0.05 for both), TIMI < or = 2 flow (P<0.05 for both) and TMPG-0/1 (P<0.05 for both). CONCLUSIONS: Survivors of myocardial infarction with a history of the no-reflow after PCI are characterized with more compact fibrin network and its resistance to lysis.
OBJECTIVE: We assessed the relationship between fibrin clot properties and the no-reflow phenomenon after primary coronary intervention (PCI). METHODS AND RESULTS: Epicardial blood flow was assessed by TIMI scale and corrected TIMI frame count (cTFC), and perfusion by TIMI Myocardial Perfusion Grade (TMPG) after PCI during ST-segment elevation myocardial infarction (STEMI). Fibrin clot permeability (K(s)) and susceptibility to lysis in assays using exogenous thrombin (t(50%)) and without thrombin (t(TF)) were determined in 30 no-reflow patients (TIMI < or = 2) and in 31 controls (TIMI-3) after uneventful 6 to 14 months from PCI. Patients with TIMI < or = 2 had lower K(s) by 18% (P<0.0001) and prolonged fibrinolysis by 33% for t(50%) (P<0.0001) and by 45% for t(TF) (P<0.0001). cTFC was correlated with K(s) (r=-0.56, P<0.0001), t(50%) (r=0.49, P<0.001), and t(TF) (r=0.54, P<0.001). K(s) increased in a stepwise fashion with TIMI flow (P<0.0001) and TMPG (P<0.0001), whereas both fibrinolysis times decreased with TIMI flow (P<0.0001 for both) and TMPG (P<0.01 for both). Multiple regression models showed that only K(s) and fibrinogen were independent predictors of cTFC (P<0.05 for both), TIMI < or = 2 flow (P<0.05 for both) and TMPG-0/1 (P<0.05 for both). CONCLUSIONS: Survivors of myocardial infarction with a history of the no-reflow after PCI are characterized with more compact fibrin network and its resistance to lysis.
Authors: Peter J McCartney; Hany Eteiba; Annette M Maznyczka; Margaret McEntegart; John P Greenwood; Douglas F Muir; Saqib Chowdhary; Anthony H Gershlick; Clare Appleby; James M Cotton; Andrew Wragg; Nick Curzen; Keith G Oldroyd; Mitchell Lindsay; J Paul Rocchiccioli; Aadil Shaukat; Richard Good; Stuart Watkins; Keith Robertson; Christopher Malkin; Lynn Martin; Lynsey Gillespie; Thomas J Ford; Mark C Petrie; Peter W Macfarlane; R Campbell Tait; Paul Welsh; Naveed Sattar; Robin A Weir; Keith A Fox; Ian Ford; Alex McConnachie; Colin Berry Journal: JAMA Date: 2019-01-01 Impact factor: 56.272
Authors: Peter J McCartney; Annette M Maznyczka; Hany Eteiba; Margaret McEntegart; Keith G Oldroyd; John P Greenwood; Neil Maredia; Matthias Schmitt; Gerry P McCann; Timothy Fairbairn; Elisa McAlindon; Campbell Tait; Paul Welsh; Naveed Sattar; Vanessa Orchard; David Corcoran; Thomas J Ford; Aleksandra Radjenovic; Ian Ford; Alex McConnachie; Colin Berry Journal: J Am Coll Cardiol Date: 2020-03-31 Impact factor: 24.094