Search

Background: There is great variability among individual patients in platelet inhibition after aspirin intake. Aspirin resistance has been associated with a higher incidence of ischemic events after percutaneous coronary intervention (PCI). The optimal antiplatelet therapy in aspirin-resistant patients undergoing PCI is unknown. The objective of this study was to evaluate whether aggressive antiplatelet therapy would reduce ischemic events in aspirin-resistant patients after PCI., Methods: A total of 330 patients undergoing PCI (with bivalirudin) were screened for aspirin responsiveness. The resulting 36 aspirin-resistant patients were randomized into two arms: 1) conventional strategy patients received 325 mg aspirin orally and a loading dose of 600 mg clopidogrel at the time of the procedure; and 2) aggressive strategy patients received similar amounts of aspirin and clopidogrel, with the addition of an intravenous glycoprotein IIb/IIIa inhibitor bolus intraprocedurally. The primary outcome was an elevation of cardiac enzymes within 24 hours post procedure. The secondary outcome was a composite of major adverse cardiac events including death, myocardial infarction, stent thrombosis and urgent revascularization, and bleeding up to 30 days., Results: Primary outcome occurred in 22% of the conventional strategy group and 11% of the aggressive strategy group (p = 0.36). The secondary outcome was reached in 27.8% of the conventional group and 5.5% of the aggressive strategy group (p = 0.17), which is suggestive of a statistical trend toward more ischemic events with conventional therapy. Importantly, there were 2 cases of definite stent thrombosis in the conventional strategy group., Conclusion: In aspirin-resistant patients, aggressive antiplatelet therapy tended to show better outcomes after PCI, without an increase in bleeding. These findings need validation in a large, randomized study.

Background: Primary stenting during acute myocardial infarction (MI) is often complicated by slow-flow/no-reflow due to distal embolization of intracoronary thrombus. The AngioJet thrombectomy catheter has been utilized in this setting in order to limit distal embolization and improve flow. The effect of AngioJet during primary stenting in acute MI with high-grade thrombus (greater than or equal to grade 3, as per thrombolysis in MI [TIMI] classification) is not known., Methods: We analyzed 95 consecutive acute MI patients with thrombus grade > or = 3 who underwent primary stenting with AngioJet (n = 52) and without AngioJet (n = 43) for epicardial and microvascular flow, and followed for 30-day major adverse cardiac events (MACE) and 1-year survival. Baseline characteristics and in-hospital events were obtained from the interventional database. Two independent operators analyzed pre- and post-procedure TIMI flow rates, corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG)., Results: Baseline clinical and angiographic characteristics were comparable between the two groups. AngioJet use was associated with better TIMI flow, TMP grade, CTFC and a trend towards lower 30-day and 1-year MACE. Use of AngioJet thrombectomy prior to stenting of acute MI patients with high-grade thrombus improves epicardial and microvascular flow, with a trend toward better short- and long-term outcome.