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Aspirin reload before elective percutaneous coronary intervention: impact on serum thromboxane b2 and myocardial reperfusion indexes.

AbstractBACKGROUND:
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.
AuthorsStefania Basili, Gaetano Tanzilli, Valeria Raparelli, Camilla Calvieri, Pasquale Pignatelli, Roberto Carnevale, Marcello Dominici, Attilio Placanica, Alessio Arrivi, Alessio Farcomeni, Francesco Barillà, Enrico Mangieri, Francesco Violi
JournalCirculation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 7 Issue 4 Pg. 577-84 (Aug 2014) ISSN: 1941-7632 [Electronic] United States
PMID25074252 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Copyright© 2014 American Heart Association, Inc.
Chemical References
  • Troponin I
  • Thromboxane B2
  • Aspirin
Topics
  • Aged
  • Aspirin (administration & dosage, adverse effects)
  • Female
  • Humans
  • Male
  • Microvessels (pathology, surgery)
  • Middle Aged
  • Myocardial Reperfusion Injury (etiology, prevention & control)
  • Percutaneous Coronary Intervention
  • Postoperative Complications (prevention & control)
  • Preoperative Period
  • Thrombosis (etiology, prevention & control)
  • Thromboxane B2 (blood)
  • Treatment Outcome
  • Troponin I (blood)

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