Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Détails

ID Serval
serval:BIB_311E7ADB8A0A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Périodique
Clinical research in cardiology
Auteur(s)
Fournier S., Muller O., Benedetto U., Roffi M., Pilgrim T., Eberli F.R., Rickli H., Radovanovic D., Erne P., Cook S., Noble S., Fesselet R., Zuffi A., Degrauwe S., Masci P., Windecker S., Eeckhout E., Iglesias J.F.
Collaborateur(s)
on behalf on the AMIS Plus Investigators
ISSN
1861-0692 (Electronic)
ISSN-L
1861-0684
Statut éditorial
Publié
Date de publication
04/2018
Peer-reviewed
Oui
Volume
107
Numéro
4
Pages
338-346
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
The clinical benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. This study assessed the impact of circadian rhythms on the effectiveness of manual TA.
We conducted an observational study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing PPCI with (TA group) or without (PCI-alone group) manual TA were divided based on time-of-day symptom onset: group 1 (00:00-05:59), group 2 (06:00-11:59), group 3 (12:00-17:59) and group 4 (18:00-23:59). The primary endpoint was circadian variation of myocardial infarction (MI) size. The secondary endpoint was in-hospital all-cause mortality. Between 2009 and 2014, 3648 patients underwent PPCI (TA, 49%). After propensity-score matching, 2860 patients were included. Minimal myocardial Injury was observed in groups 2 and 3 (peak creatine kinase level group 1, 2723 ± 148 U/l; group 2, 2493 ± 105 U/l; group 3, 2550 ± 106 U/l; group 4, 2952 ± 144 U/l; p = 0.044) in the TA group, whereas no time-of-day dependence was found in PCI-alone group. After periodic sinusoidal regression analysis, a circadian relationship between time-of-day symptom onset and MI size was demonstrated in the TA group (p < 0.001). In-hospital all-cause mortality was 3.4% in the TA group and 4.3% in the PCI-alone group (p = 0.20).
In this large registry of STEMI patients, manual TA did not reduce in-hospital all-cause mortality. Nonetheless, there was a circadian dependence of TA effectiveness with greatest myocardial salvage for patients with symptom onset between 06:00 and 17:59.

Mots-clé
Circadian rhythms, Manual thrombus aspiration, Myocardial infarct size, Primary percutaneous coronary intervention
Pubmed
Web of science
Création de la notice
14/12/2017 18:57
Dernière modification de la notice
20/08/2019 14:16
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