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Thrombus Composition in Sudden Cardiac Death from Acute ଝ G Model 1 RESUS 7068 1–7 ARTICLE IN PRESS Resuscitation xxx (2017) xxx–xxx Contents lists available at ScienceDirect Resuscitation jo urnal homepage: www.elsevier.com/locate/resuscitation 2 Clinical paper 3 Thrombus composition in sudden cardiac death from acute ଝ 4 myocardial infarction a,∗ a a b 5 Q2 Johanne Silvain , Jean-Philippe Collet , Paul Guedeney , Olivier Varenne , c a d 6 Chandrasekaran Nagaswami , Carole Maupain , Jean-Philippe Empana , d d e a 7 Chantal Boulanger , Muriel Tafflet , Stephane Manzo-Silberman , Mathieu Kerneis , a a c d 8 Delphine Brugier , Nicolas Vignolles , John W. Weisel , Xavier Jouven , a d 9 Gilles Montalescot , Christian Spaulding a 10 Q3 Sorbonne Université – Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, 11 France b 12 Cardiology Department, Cochin Hospital, Paris 5 School of Medicine, Rene Descartes University, Paris, France c 13 Q4 Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, United States d 14 Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM 15 UMRS 970, Paris Sudden Death Expertise Centre, Paris, France e 16 Cardiology Department, Inserm U942, Lariboisiere Hospital, Paris Diderot University, Paris, France 17 2918 a r t i c l e i n f o a b s t r a c t 19 20 Article history: Q6 Background and aim: It was hypothesized that the pattern of coronary occlusion (thrombus composition) 21 Received 29 October 2016 might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial 22 Received in revised form 11 January 2017 infarction (MI). 23 Accepted 20 January 2017 Q7 Methods: The TIDE (Thrombus and Inflammation in sudden DEath) study included patients with 24 angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated 25 Keywords: by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo- 26 Sudden cardiac death aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method 27 ST elevated myocardial infarction using scanning electron microscopy. We compared the composition of the thrombi responsible for the 28 Coronary thrombus coronary occlusion between the two groups and evaluated factors influencing its composition. Results: We included 121 patients and found that thrombus composition was not different between the SCD group (n = 23) and the STEMI group (n = 98) regarding content of fibrin fibers (60.3 ± 18.4% vs. 62.4 ± 18.4% respectively, p = 0.68), platelets (16.3 ± 19.2% vs. 15.616.7 ±%, p = 0.76), erythrocytes (14.6 ± 12.5% vs. 13 ± 12.1%, p = 0.73) and leukocytes (0.6 ± 0.9% vs. 0.8 ± 1.5%, p = 0.93). Thrombus com- position did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8 ± 18.5% vs. 71.9 ± 10.1%, p = 0.0008) and a higher platelet content (19.2 ± 19.1% vs. 7.9 ± 5.7% p = 0.014) in early presenters (<3 h of ischemic time) vs. late presenters (>6 h of ischemic time). Conclusion: Composition of intracoronary thrombi in STEMI patients does not differ between those pre- Q8 senting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in MI. © 2017 Published by Elsevier Ireland Ltd. Introduction 30 Abbreviations: STEMI, ST-elevated myocardial infarction; SCD, sudden cardiac Sudden cardiac death (SCD) accounts for 4 million deaths every 31 1 death; TIDE study, Thrombus and Inflammation in sudden DEath study; GPI, glyco- year worldwide. A frequent cause of SCDs is ventricular fibrillation 32 protein IIb/IIIa inhibitors; IQR, interquartile range. ଝ or fast ventricular tachycardia in the setting of an acute coronary 33 A Spanish translated version of the abstract of this article appears as Appendix 2,3 artery occlusion. Several risk factors of SCD have been identified 34 in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.01.030. ∗ in previous studies, however the relationship between an acute 35 Q5 Corresponding author at: Institut de Cardiologie, Bureau 278, Pitié- 36 Salpêtrière University Hospital, 47 Blvd de l’Hôpital, 75013 Paris, France. coronary artery occlusion and the onset of ventricular arrhythmia 4–9 Fax: +33 01 42 16 29 31. is unknown. 37 E-mail address: [email protected] (J. Silvain). http://dx.doi.org/10.1016/j.resuscitation.2017.01.030 0300-9572/© 2017 Published by Elsevier Ireland Ltd. Please cite this article in press as: Silvain J, et al. Thrombus composition in sudden cardiac death from acute myocardial infarction. Resuscitation (2017), http://dx.doi.org/10.1016/j.resuscitation.2017.01.030 G Model RESUS 7068 1–7 ARTICLE IN PRESS 2 J. Silvain et al. / Resuscitation xxx (2017) xxx–xxx Fig. 1. Flow chart of the study. STEMI: ST-segment elevated myocardial infarction; SCD: sudden cardiac death; PCI: percutaneous coronary intervention. 11 38 In ST-elevation myocardial infarction (STEMI) patients, a formed due to the lack of available data. Recruitment of the TIDE 73 39 hypothesis is that differences in patterns of STEMI development study was slower than expected and patients with STEMI from the 74 40 leading to more rapid coronary occlusion could trigger SCD. In the thrombus registry of the Pitié-Salpêtrière hospital who matched 75 41 TIDE (Thrombus and Inflammation in sudden DEath) micropar- the inclusion criteria of the TIDE study were included in the present 76 42 ticle study, we reported higher concentrations of intracoronary analysis as explained in Fig. 1. 77 43 endothelial microparticles in STEMI with SCD at presentation 44 versus those without SCD, suggesting that ventricular arrhythmia Thrombus collection 78 45 in the setting of acute myocardial ischemia is not entirely explained 10 46 by rhythmic vulnerability. A vascular vulnerability related to a Thrombo-aspiration during primary PCI was performed by a 79 47 specific pattern of abrupt coronary occlusion may also be involved. low-profile catheter (Export 6F, Medtronic, Santa Rosa, Califor- 80 48 The TIDE Thrombus study (NCT00748111) was designed to inves- nia). Collected thrombi were immediately washed with saline and 81 49 tigate this hypothesis. Our aim was to assess whether thrombus fixed with 2% glutaraldehyde in 50 mmol/l Na Cacodylate buffer 82 50 architecture per se could affect the occurrence of SCD in myocardial (pH 7.3). Patients received 250 mg of aspirin intravenously; 600 mg 83 51 infarction and characterize the independent correlates of thrombus of clopidogrel (crushed and administrated in the nasogastric tube 84 52 composition. if necessary for SCD patients) and the use of glycoprotein IIb/IIIa 85 platelet receptor inhibitors (GPI) were administered before and/or 86 53 Methods during the procedure at the discretion of the physicians. 87 54 Study design Study oversight 88 55 We prospectively screened all the STEMI and SCD patients The study was reviewed and accepted by the ethics committee of 89 56 referred to the catheterization laboratory of the Pitié-Salpêtrière the Institutional Review Board of the Cochin Hospital, Paris, France 90 57 and Cochin Hospital in Paris France for primary percutaneous and the thrombus registry of the Pitié-Salpêtrière is declared as part 91 58 coronary intervention (PCI). In the thrombus analysis of the TIDE of the ePARIS STEMI registry which was reviewed and accepted 92 59 study, we included SCD patients with documented STEMI (SCD by the ethics committee of the Institutional Review Board of the 93 60 group) and STEMI patients without ventricular arrhythmias (STEMI Pitié-Salpêtrière Hospital. Informed consent was obtained before 94 61 group) meeting the following inclusion criteria: age >18 years; the procedure in all STEMI patients without SCD. The ethics com- 95 62 documented acute coronary artery occlusion with thrombolysis mittee allowed blood sampling and thrombus collection without 96 63 in myocardial infarction (TIMI) flow of 0, 1, or 2; coronary blood consent during PCI procedures in case of SCD. However, the data 97 64 sampling using an aspiration catheter available; a time delay from could be used only if informed consent was obtained from the next 98 65 symptom onset to ventricular arrhythmia or pulseless condition of of kin before or after the procedure and from the patient if s/he 99 66 less than 1 h; successful out-of-hospital resuscitation with Return survived. 100 67 Of Spontaneous Circulation (ROSC) after SCD. Due to logistical con- 68 straints, we evaluated only patients presenting during ‘on hours’. Scanning electron microscope analysis 101 69 Our aim was to include 4 STEMI for each SCD. Based on our previ- 70 ous experience in the analysis of thrombus composition in STEMI Sample fixation, dehydration, and preparation were performed 102 12 71 presenters, we estimated a sample size of 100 STEMI and 25 SCD according to a previously published method. High-definition 103 72 to be reasonable although no sample size calculation could be per- photographs (×3000 magnification) were obtained using a 104 Please cite this article in press as: Silvain J, et al. Thrombus composition in sudden cardiac death from acute myocardial infarction. Resuscitation (2017), http://dx.doi.org/10.1016/j.resuscitation.2017.01.030 Download English Version: https://daneshyari.com/en/article/5620051 Download Persian Version: https://daneshyari.com/article/5620051 Daneshyari.com.
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