Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: Insights from INFUSE-AMI

Sorin J. Brener, Jan Henk Dambrink, Akiko Maehara, Saqib Chowdhary, Anthony H. Gershlick, Philippe Genereux, Jacques Koolen, Roxana Mehran, Martin Fahy, C. Michael Gibson, Gregg W. Stone

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis In Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% [4.6, 21.8] vs. 22.6% [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.

Original languageEnglish (US)
Pages (from-to)1195-1201
Number of pages7
JournalEuroIntervention
Volume9
Issue number10
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

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Percutaneous Coronary Intervention
Myocardial Infarction
Stents
Thrombosis
ST Elevation Myocardial Infarction
abciximab

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Brener, Sorin J. ; Dambrink, Jan Henk ; Maehara, Akiko ; Chowdhary, Saqib ; Gershlick, Anthony H. ; Genereux, Philippe ; Koolen, Jacques ; Mehran, Roxana ; Fahy, Martin ; Gibson, C. Michael ; Stone, Gregg W. / Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction : Insights from INFUSE-AMI. In: EuroIntervention. 2014 ; Vol. 9, No. 10. pp. 1195-1201.
@article{f868520c95f3419195943aa018b2bbd5,
title = "Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: Insights from INFUSE-AMI",
abstract = "Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis In Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2{\%}) with pre-stent TIMI 0/1 flow, 47 (17.4{\%}) with TIMI 2 flow and 175 (57.4{\%}) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5{\%} [4.6, 21.8] vs. 22.6{\%} [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7{\%} vs. 17.3{\%} for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.",
author = "Brener, {Sorin J.} and Dambrink, {Jan Henk} and Akiko Maehara and Saqib Chowdhary and Gershlick, {Anthony H.} and Philippe Genereux and Jacques Koolen and Roxana Mehran and Martin Fahy and Gibson, {C. Michael} and Stone, {Gregg W.}",
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Brener, SJ, Dambrink, JH, Maehara, A, Chowdhary, S, Gershlick, AH, Genereux, P, Koolen, J, Mehran, R, Fahy, M, Gibson, CM & Stone, GW 2014, 'Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: Insights from INFUSE-AMI', EuroIntervention, vol. 9, no. 10, pp. 1195-1201. https://doi.org/10.4244/EIJV9I10A201

Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction : Insights from INFUSE-AMI. / Brener, Sorin J.; Dambrink, Jan Henk; Maehara, Akiko; Chowdhary, Saqib; Gershlick, Anthony H.; Genereux, Philippe; Koolen, Jacques; Mehran, Roxana; Fahy, Martin; Gibson, C. Michael; Stone, Gregg W.

In: EuroIntervention, Vol. 9, No. 10, 01.02.2014, p. 1195-1201.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction

T2 - Insights from INFUSE-AMI

AU - Brener, Sorin J.

AU - Dambrink, Jan Henk

AU - Maehara, Akiko

AU - Chowdhary, Saqib

AU - Gershlick, Anthony H.

AU - Genereux, Philippe

AU - Koolen, Jacques

AU - Mehran, Roxana

AU - Fahy, Martin

AU - Gibson, C. Michael

AU - Stone, Gregg W.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis In Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% [4.6, 21.8] vs. 22.6% [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.

AB - Aims: To determine the relation between thrombus aspiration (TA) and/or intra-lesion (IL) abciximab with pre-stent Thrombolysis In Myocardial Infarction (TIMI) flow grade and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results: The INFUSE-AMI trial randomised 452 patients with anterior STEMI to IL abciximab vs. no abciximab, and to manual TA vs. no TA. The primary endpoint was cMRI-determined IS at 30 days. Patients were classified according to pre-stent TIMI flow. Complete data were available in 290 patients - 68 (25.2%) with pre-stent TIMI 0/1 flow, 47 (17.4%) with TIMI 2 flow and 175 (57.4%) with TIMI 3 flow. Patients with pre-stent TIMI 3 flow had significantly lower IS (15.5% [4.6, 21.8] vs. 22.6% [14.7, 28.0] for TIMI 2 vs. 19.5 [14.4, 27.8] for TIMI 0/1, p<0.0001) and fewer 30-day clinical events (p=0.03). Patients receiving TA with or without IL abciximab had the highest rate of pre-stent TIMI 3 flow (p<0.0001) and patients receiving both had the smallest IS (14.7% vs. 17.3% for the other three groups, p=0.03). Conclusions: Optimisation of coronary flow prior to stent implantation may reduce infarct size and clinical events in STEMI patients undergoing primary PCI.

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U2 - 10.4244/EIJV9I10A201

DO - 10.4244/EIJV9I10A201

M3 - Article

C2 - 24561570

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VL - 9

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JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 10

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