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

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-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: Stefania 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
• Journal: Circulation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 7 Issue 4 Pg. 577-84 (Aug 2014) ISSN: 1941-7632 [Electronic] United States
• PMID: 25074252 (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)