Stefania Basili1, Gaetano Tanzilli2, Valeria Raparelli2, Camilla Calvieri2, Pasquale Pignatelli2, Roberto Carnevale2, Marcello Dominici2, Attilio Placanica2, Alessio Arrivi2, Alessio Farcomeni2, Francesco Barillà2, Enrico Mangieri2, Francesco Violi2. 1. From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.). stefania.basili@uniroma1.it. 2. From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
Abstract
BACKGROUND: Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B2, a stable metabolite of thromboxane A2, may be implicated in post-PCI microvascular obstruction. METHODS AND RESULTS: We enrolled 91 patients (74 males, 66±10 years) on chronic low-doseaspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (controlgroup, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B2, reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005). CONCLUSIONS:Aspirin loading dose before elective PCI improves myocardial reperfusion and injury indexes, suggesting a possible role of platelet thromboxane A2 in microvascular occlusion. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01374698.
RCT Entities:
BACKGROUND:Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B2, a stable metabolite of thromboxane A2, may be implicated in post-PCI microvascular obstruction. METHODS AND RESULTS: We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B2, reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005). CONCLUSIONS:Aspirin loading dose before elective PCI improves myocardial reperfusion and injury indexes, suggesting a possible role of platelet thromboxane A2 in microvascular occlusion. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01374698.
Authors: Camilla Calvieri; Nicola Galea; Francesco Cilia; Giacomo Pambianchi; Giuseppe Mancuso; Domenico Filomena; Sara Cimino; Iacopo Carbone; Marco Francone; Luciano Agati; Carlo Catalano Journal: Front Cardiovasc Med Date: 2022-03-16
Authors: Ciro Indolfi; Francesco Passafaro; Annalisa Mongiardo; Carmen Spaccarotella; Daniele Torella; Sabato Sorrentino; Alberto Polimeni; Vittorio Emanuele; Antonio Curcio; Salvatore De Rosa Journal: Medicine (Baltimore) Date: 2015-03 Impact factor: 1.889