title: 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.
  
  
  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.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01374698.
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.). stefania.basili@uniroma1.it.
authors: Stefania
authors: S
authors: Basili
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Gaetano
authors: G
authors: Tanzilli
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Valeria
authors: V
authors: Raparelli
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Camilla
authors: C
authors: Calvieri
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Pasquale
authors: P
authors: Pignatelli
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Roberto
authors: R
authors: Carnevale
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Marcello
authors: M
authors: Dominici
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Attilio
authors: A
authors: Placanica
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Alessio
authors: A
authors: Arrivi
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Alessio
authors: A
authors: Farcomeni
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Francesco
authors: F
authors: Barillà
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Enrico
authors: E
authors: Mangieri
authors: From the I Clinica Medica (S.B., V.R., P.P., R.C., F.V.), Department of the Heart and Great Vessels Attilio Reale (G.T., C.C., F.B., E.M.), and Department of Public Health and Infectious Diseases (A.F.), Sapienza-University of Rome, Rome, Italy; and Division of Cardiology, Department of Interventional Cardiology, Santa Maria University Hospital, Terni, Italy (M.D., A.P., A.A.).
authors: Francesco
authors: F
authors: Violi
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013929:Thromboxane B2 / Q000097:blood*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D013929:Thromboxane B2; D001241:Aspirin
keywords: angioplasty; aspirin; microcirculation