Skip to main content

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

Clinical Research in Cardiology volume 107, pages 338–346 (2018)Cite this article

Abstract

Background

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.

Methods and results

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).

Conclusions

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

ACS:

Acute coronary syndrome

AMIS:

Acute myocardial infarction in Switzerland

CK:

Creatine kinase

I/R:

Ischemia/reperfusion

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

PPCI:

Primary percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

TA:

Thrombus aspiration

TIMI:

Thrombolysis In myocardial infarction

References

  1. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  2. Noman A, Egred M, Bagnall A, Spyridopoulos I, Jamieson S, Ahmed J (2012) Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction. Eur Heart J 33:3054–3061

    Article  PubMed  Google Scholar 

  3. de Waha S, Desch S, Eitel I et al (2012) Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging. Clin Res Cardiol 101:487–495

    Article  PubMed  Google Scholar 

  4. Dong-bao L, Qi H, Zhi L, Shan W, Wei-ying J (2009) Predictors and short-term prognosis of angiographically detected distal embolization after emergency percutaneous coronary intervention for ST-elevation acute myocardial infarction. Clin Res Cardiol 98:773–779

    Article  PubMed  Google Scholar 

  5. Svilaas T, Vlaar PJ, van der Horst IC et al (2008) Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 358:557–567

    CAS  Article  PubMed  Google Scholar 

  6. Vlaar PJ, Svilaas T, van der Horst IC et al (2008) Cardiac death and reinfarction after 1 year in the thrombus aspiration during percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 371:1915–1920

    Article  PubMed  Google Scholar 

  7. Frobert O, Lagerqvist B, Olivecrona GK et al (2013) Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 369:1587–1597

    CAS  Article  PubMed  Google Scholar 

  8. Lagerqvist B, Frobert O, Olivecrona GK et al (2014) Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 371:1111–1120

    CAS  Article  PubMed  Google Scholar 

  9. Jolly SS, Cairns JA, Yusuf S et al (2015) Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 372:1389–1398

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Kumbhani DJ, Bavry AA, Desai MY, Bangalore S, Bhatt DL (2013) Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty: an updated meta-analysis of randomized trials. J Am Coll Cardiol 62:1409–1418

    Article  PubMed  Google Scholar 

  11. Elgendy IY, Huo T, Bhatt DL, Bavry AA (2015) Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials. Circ Cardiovasc Interv 8:e002258

    Article  PubMed  Google Scholar 

  12. Harle T, Zeymer U, Hochadel M et al (2015) Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry. Clin Res Cardiol 104:803–811

    Article  PubMed  Google Scholar 

  13. Virag JA, Lust RM (2014) Circadian influences on myocardial infarction. Front Physiol 5:422

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fournier S, Taffe P, Radovanovic D et al (2015) Myocardial infarct size and mortality depend on the time of day-a large multicenter study. PLoS One 10:e0119157

    Article  PubMed  PubMed Central  Google Scholar 

  15. Reiter R, Swingen C, Moore L, Henry TD, Traverse JH (2012) Circadian dependence of infarct size and left ventricular function after ST elevation myocardial infarction. Circ Res 110:105–110

    CAS  Article  PubMed  Google Scholar 

  16. Suarez-Barrientos A, Lopez-Romero P, Vivas D et al (2011) Circadian variations of infarct size in acute myocardial infarction. Heart 97:970–976

    Article  PubMed  Google Scholar 

  17. Fournier S, Eeckhout E, Mangiacapra F et al (2012) Circadian variations of ischemic burden among patients with myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J 163:208–213

    Article  PubMed  Google Scholar 

  18. Kurnik PB (1995) Circadian variation in the efficacy of tissue-type plasminogen activator. Circulation 91:1341–1346

    CAS  Article  PubMed  Google Scholar 

  19. Kono T, Morita H, Nishina T et al (1996) Circadian variations of onset of acute myocardial infarction and efficacy of thrombolytic therapy. J Am Coll Cardiol 27:774–778

    CAS  Article  PubMed  Google Scholar 

  20. Radovanovic D, Erne P (2010) AMIS plus: swiss registry of acute coronary syndrome. Heart 96:917–921

    Article  PubMed  Google Scholar 

  21. Muller JE, Stone PH, Turi ZG et al (1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322

    CAS  Article  PubMed  Google Scholar 

  22. Panza JA, Epstein SE, Quyyumi AA (1991) Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. N Engl J Med 325:986–990

    CAS  Article  PubMed  Google Scholar 

  23. Petralito A, Mangiafico RA, Gibiino S, Cuffari MA, Miano MF, Fiore CE (1982) Daily modifications of plasma fibrinogen platelets aggregation, Howell’s time, PTT, TT, and antithrombin II in normal subjects and in patients with vascular disease. Chronobiologia 9:195–201

    CAS  PubMed  Google Scholar 

  24. Rea MS, Figueiro MG, Sharkey KM, Carskadon MA (2012) Relationship of morning cortisol to circadian phase and rising time in young adults with delayed sleep times. Int J Endocrinol 2012:749460

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tofler GH, Brezinski D, Schafer AI et al (1987) Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 316:1514–1518

    CAS  Article  PubMed  Google Scholar 

  26. Scheer FA, Michelson AD, Frelinger AL 3rd et al (2011) The human endogenous circadian system causes greatest platelet activation during the biological morning independent of behaviors. PLoS One 6:e24549

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Grimaudo V, Hauert J, Bachmann F, Kruithof EK (1988) Diurnal variation of the fibrinolytic system. Thromb Haemost 59:495–499

    CAS  PubMed  Google Scholar 

  28. Goldhammer E, Kharash L, Abinader EG (1999) Circadian fluctuations in the efficacy of thrombolysis with streptokinase. Postgrad Med J 75:667–671

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. De Luca G, Suryapranata H, Ottervanger JP et al (2005) Circadian variation in myocardial perfusion and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Am Heart J 150:1185–1189

    Article  PubMed  Google Scholar 

  30. Durgan DJ, Pulinilkunnil T, Villegas-Montoya C et al (2010) Short communication: ischemia/reperfusion tolerance is time-of-day-dependent: mediation by the cardiomyocyte circadian clock. Circ Res 106:546–550

    CAS  Article  PubMed  Google Scholar 

  31. Wieringa WG, Lexis CP, Mahmoud KD et al (2014) Time of symptom onset and value of myocardial blush and infarct size on prognosis in patients with ST-elevation myocardial infarction. Chronobiol Int 31:797–806

    Article  PubMed  Google Scholar 

  32. Leibundgut G, Gick M, Morel O et al (2016) Discordant cardiac biomarker levels independently predict outcome in ST-segment elevation myocardial infarction. Clin Res Cardiol 105:432–440

    CAS  Article  PubMed  Google Scholar 

  33. Fournier S, Iten L, Marques-Vidal P et al (2017) Circadian rhythm of blood cardiac troponin T concentration. Clin Res Cardiol 106(12):1026–1032

    CAS  Article  PubMed  Google Scholar 

  34. Bouma W, Willemsen HM, Lexis CP et al (2016) Chronic ischemic mitral regurgitation and papillary muscle infarction detected by late gadolinium-enhanced cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction. Clin Res Cardiol 105:981–991

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chia S, Senatore F, Raffel OC, Lee H, Wackers FJ, Jang IK (2008) Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 1:415–423

    Article  PubMed  Google Scholar 

  36. Kleber FX, Rittger H, Ludwig J et al (2016) Drug eluting balloons as stand alone procedure for coronary bifurcational lesions: results of the randomized multicenter PEPCAD-BIF trial. Clin Res Cardiol 105:613–621

    CAS  Article  PubMed  Google Scholar 

  37. Ferenc M, Buettner HJ, Gick M et al (2016) Clinical outcome after percutaneous treatment of de novo coronary bifurcation lesions using first or second generation of drug-eluting stents. Clin Res Cardiol 105:230–238

    CAS  Article  PubMed  Google Scholar 

  38. van der Heijden LC, Kok MM, Lam MK et al (2016) Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. Clin Res Cardiol 105:206–215

    Article  PubMed  Google Scholar 

  39. Ong P, Sechtem U (2016) Controversies in the treatment of patients with STEMI and multivessel disease: is it time for PCI of all lesions? Clin Res Cardiol 105:467–470

    Article  PubMed  Google Scholar 

  40. de Waha S, Eitel I, Desch S et al (2015) Intravenous morphine administration and reperfusion success in ST-elevation myocardial infarction: insights from cardiac magnetic resonance imaging. Clin Res Cardiol 104:727–734

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Stephane Fournier, Olivier Muller, Rachel Fesselet, Andrea Zuffi, Sophie Degrauwe, PierGiorgio Masci, Eric Eeckhout & Juan F. Iglesias

  2. Bristol Heart Institute, University of Bristol, Bristol, UK

    Umberto Benedetto

  3. Division of Cardiology, University Hospital, Geneva, Switzerland

    Marco Roffi & Stéphane Noble

  4. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Thomas Pilgrim & Stephan Windecker

  5. Department of Cardiology, Triemli Hospital, Zurich, Switzerland

    Franz R. Eberli

  6. Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Hans Rickli

  7. AMIS Plus Data Center, University of Zurich, Zurich, Switzerland

    Dragana Radovanovic

  8. Laboratory of Signal Transduction, Department of Biomedicine, Basel University Hospital, Basel, Switzerland

    Paul Erne

  9. Department of Cardiology, University Hospital, Fribourg, Switzerland

    Stéphane Cook

Authors
  1. Stephane Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olivier Muller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Umberto Benedetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Roffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Pilgrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franz R. Eberli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hans Rickli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dragana Radovanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paul Erne
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stéphane Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stéphane Noble
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rachel Fesselet
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Andrea Zuffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sophie Degrauwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. PierGiorgio Masci
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Stephan Windecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Eric Eeckhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Juan F. Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf on the AMIS Plus Investigators

Corresponding author

Correspondence to Juan F. Iglesias.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fournier, S., Muller, O., Benedetto, U. et al. Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Res Cardiol 107, 338–346 (2018). https://doi.org/10.1007/s00392-017-1189-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-017-1189-8

Keywords

  • Circadian rhythms
  • Primary percutaneous coronary intervention
  • Manual thrombus aspiration
  • Myocardial infarct size