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Aspirin Reload Before Elective Percutaneous Coronary Intervention

2014; Lippincott Williams & Wilkins; Volume: 7; Issue: 4 Linguagem: Inglês

10.1161/circinterventions.113.001197

1941-7632

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,

Coronary Interventions and Diagnostics

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 B 2 , a stable metabolite of thromboxane A 2 , 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 B 2 , 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 B 2 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 B 2 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 B 2 (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 A 2 in microvascular occlusion. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01374698.