Skip to main content
SpringerLink
Log in

Prevention of Iatrogenic CMD

  • Chapter
  • First Online:
Coronary Microvascular Dysfunction

  • 1075 Accesses

Abstract

Peri-procedural microvascular myocardial damage related to PCI can be prevented by some non pharmacological tools, including direct stenting and use of distal or proximal protection filters, which prevent coronary embolism, as well as ischemic preconditioning. Furthermore, several drugs have been proposed to this scope, including antiplatelet drugs, adenosine, statins, beta-blockers and trimetazidine. Similarly protection from microcirculatory and myocardial damage in patients undergoing CABG surgery have included ischemic conditioning and drugs, as adenosine and acadesine, diazoxide, volatile anesthetic agents, anti-inflammatory agents, statins and sodium–hydrogen exchange inhibitors. The results achieved with these forms of treatment are discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nageh T, Thomas MR, Sherwood RA, Harris BM, Jewitt DE, Wainwright RJ (2003) Direct stenting may limit myocardial injury during percutaneous coronary intervention. J Invasive Cardiol 15:115–118

    PubMed  Google Scholar 

  2. Cuisset T, Hamilos M, Melikian N et al (2008) Direct stenting for stable angina pectoris is associated with reduced periprocedural microcirculatory injury compared with stenting after pre-dilation. J Am Coll Cardiol 51:1060–1065

    Article  PubMed  Google Scholar 

  3. Burzotta F, Trani C, Prati F et al (2003) Comparison of outcomes (early and six month) of direct stenting with conventional stenting (a meta-analysis of ten randomized trials). Am J Cardiol 91:790–796

    Article  PubMed  Google Scholar 

  4. Baim DS, Wahr D, George B et al (2002) Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation 105:1285–1290

    Article  PubMed  Google Scholar 

  5. Mauri L, Cox D, Hermiller J et al (2007) The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System: a randomized, prospective, multicenter clinical trial. J Am Coll Cardiol 50:1442–1449

    Article  PubMed  Google Scholar 

  6. Babu GG, Walker JM, Yellon DM, Hausenloy DJ (2011) Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection. Eur Heart J 32:23–31

    Article  CAS  PubMed  Google Scholar 

  7. Laskey WK (1999) Beneficial impact of preconditioning during PTCA on creatine kinase release. Circulation 99:2085–2089

    Article  CAS  PubMed  Google Scholar 

  8. Hoole SP, Heck PM, Sharples L et al (2009) Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: a prospective, randomized control trial. Circulation 119:820–827

    Article  PubMed  Google Scholar 

  9. Schwartz L, Bourassa MG, Lesperance J et al (1988) Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med 318:1714–1719

    Article  CAS  PubMed  Google Scholar 

  10. Lembo NJ, Black AJ, Roubin GS et al (1990) Effect of pretreatment with aspirin versus aspirin plus dipyridamole on frequency and type of acute complications of percutaneous transluminal coronary angioplasty. Am J Cardiol 65:422–426

    Article  CAS  PubMed  Google Scholar 

  11. King SB III, Smith SC Jr, Hirshfeld JW Jr et al (2008) 2007 Focused update of the acc/aha/scai 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task force on practice guidelines. Circulation 117:261–295

    Article  PubMed  Google Scholar 

  12. Quinn MJ, Fitzgerald DJ (1999) Ticlopidine and clopidogrel. Circulation 100:1667–1672

    Article  CAS  PubMed  Google Scholar 

  13. Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G (2005) Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for reduction of myocardial damage during angioplasty) study. Circulation 111:2099–2106

    Article  CAS  PubMed  Google Scholar 

  14. Labinaz M, Ho C, Banerjee S, Martin J, Chen S, Mensinkai S (2007) Meta-analysis of clinical efficacy and bleeding risk with intravenous glycoprotein IIb/IIIa antagonists for percutaneous coronary intervention. Can J Cardiol 23:963–970

    Article  CAS  PubMed  Google Scholar 

  15. Hamm CW, Bassand JP, Agewall S et al (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32:2999–3054

    Article  PubMed  Google Scholar 

  16. Desmet WJ, Dens J, Coussement P, Van de Werf F (2002) Does adenosine prevent myocardial micronecrosis following percutaneous coronary intervention? The ADELINE pilot trial. Adenosine limit myocardial necrosis. Heart 88:293–295

    Article  CAS  PubMed  Google Scholar 

  17. Lee CH, Low A, Tai BC et al (2007) Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after nonurgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J 28:19–25

    Article  PubMed  Google Scholar 

  18. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G (2004) Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (atorvastatin for reduction of myocardial damage during angioplasty) study. Circulation 110:674–678

    Article  CAS  PubMed  Google Scholar 

  19. Briguori C, Visconti G, Focaccio A et al (2009) Novel approaches for preventing or limiting events (Naples) II trial impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol 54:2157–2163

    Article  CAS  PubMed  Google Scholar 

  20. Patti G, Pasceri V, Colonna G et al (2007) Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial. J Am Coll Cardiol 49:1272–1278

    Article  CAS  PubMed  Google Scholar 

  21. Yun KH, Jeong MH, Oh SK et al (2009) The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol 137:246–251

    Article  PubMed  Google Scholar 

  22. Merla R, Reddy NK, Wang FW, Uretsky BF, Barbagelata A, Birnbaum Y (2007) Meta-analysis of published reports on the effect of statin treatment before percutaneous coronary intervention on periprocedural myonecrosis. Am J Cardiol 100:770–776

    Article  CAS  PubMed  Google Scholar 

  23. Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A (2009) Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (atorvastatin for reduction of myocardial damage during angioplasty) randomized trial. J Am Coll Cardiol 54:558–565

    Article  PubMed  Google Scholar 

  24. Ludman A, Venugopal V, Yellon DM, Hausenloy DJ (2009) Statins and cardioprotection—more than just lipid lowering? Pharmacol Ther 122:30–43

    Article  CAS  PubMed  Google Scholar 

  25. Wang FW, Osman A, Otero J et al (2003) Distal myocardial protection during percutaneous coronary intervention with an intracoronary beta-blocker. Circulation 107:2914–2919

    Article  PubMed  Google Scholar 

  26. Uretsky BF, Birnbaum Y, Osman A et al (2008) Distal myocardial protection with intracoronary beta blocker when added to a GpIIb/IIIa platelet receptor blocker during percutaneous coronary intervention improves clinical outcome. Catheter Cardiovasc Interv 72:488–497

    Article  PubMed  Google Scholar 

  27. Leesar MA (2008) Myocardial protection with a beta blocker and glycoprotein IIb/IIIa inhibitor during PCI: attractive concept, but limited evidence of benefit. Catheter Cardiovasc Interv 72:498–499

    Article  PubMed  Google Scholar 

  28. Minners J, van den Bos EJ, Yellon DM, Schwalb H, Opie LH, Sack MN (2000) Dinitrophenol, cyclosporin A, and trimetazidine modulate preconditioning in the isolated rat heart: support for a mitochondrial role in cardioprotection. Cardiovasc Res 47:68–73

    Article  CAS  PubMed  Google Scholar 

  29. Bonello L, Sbragia P, Amabile N et al (2007) Protective effect of an acute oral loading dose of trimetazidine on myocardial injury following percutaneous coronary intervention. Heart 93:703–707

    Article  CAS  PubMed  Google Scholar 

  30. Yellon DM, Alkhulaifi AM, Pugsley WB (1993) Preconditioning the human myocardium. Lancet 342:276–277

    Article  CAS  PubMed  Google Scholar 

  31. Walsh SR, Tang TY, Kullar P, Jenkins DP, Dutka DP, Gaunt ME (2008) Ischemic preconditioning during cardiac surgery: systematic review and metanalysis of perioperative outcomes in randomized clinical trials. Eur J Cardiothorac Surg 34:985–994

    Article  PubMed  Google Scholar 

  32. Zhao ZQ, Corvera JS, Halkos ME et al (2003) Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 285:H579–H588

    CAS  PubMed  Google Scholar 

  33. Hausenloy DJ, Mwamure PK, Venugopal V et al (2007) Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet 370:575–579

    Article  PubMed  Google Scholar 

  34. Thielmann M, Kottenberg E, Boengler K et al (2010) Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest. Basic Res Cardiol 105:657–664

    Article  CAS  PubMed  Google Scholar 

  35. Karuppasamy P, Chaubey S, Dew T, Musto R, Sherwood R, Desai J et al (2011) Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation? Basic Res Cardiol 106:511–519

    Article  CAS  PubMed  Google Scholar 

  36. Lee HT, LaFaro RJ, Reed GE (1995) Pretreatment of human myocardium with adenosine during open heart surgery. J Card Surg 10:665–676

    Article  CAS  PubMed  Google Scholar 

  37. Mentzer RM Jr, Rahko PS, Molina-Viamonte V et al (1997) Safety, tolerance, and efficacy of adenosine as an additive to blood cardioplegia in humans during coronary artery bypass surgery. Am J Cardiol 79:38–43

    Article  CAS  PubMed  Google Scholar 

  38. Zarro DL, Palanzo DA, Sadr FS (1998) Myocardial preconditioning using adenosine: review and clinical experience. Perfusion 13:145–150

    Article  CAS  PubMed  Google Scholar 

  39. Belhomme D, Peynet J, Florens E, Tibourtine O, Kitakaze M, Menasche P (2000) Is adenosine preconditioning truly cardioprotective in coronary artery bypass surgery? Ann Thorac Surg 70:590–594

    Article  CAS  PubMed  Google Scholar 

  40. Rinne T, Laurikka J, Penttila I, Kaukinen S (2000) Adenosine with cold blood cardioplegia during coronary revascularization. J Cardiothorac Vasc Anesth 14:18–20

    Article  CAS  PubMed  Google Scholar 

  41. Menasche P, Jamieson WR, Flameng W, Davies MK (1995) Acadesine: a new drug that may improve myocardial protection in coronary artery bypass grafting. Results of the first international multicenter study. Multinational Acadesine Study Group. J Thorac Cardiovasc Surg 110:1096–1106

    Article  CAS  PubMed  Google Scholar 

  42. Multicenter Study of Perioperative Ischemia (McSPI) Research Group (1995) Effects of acadesine on the incidence of myocardial infarction and adverse cardiac outcomes after coronary artery bypass graft surgery. Anesthesiology 83:658–673

    Google Scholar 

  43. Mangano DT, Miao Y, Tudor IC, Dietzel C (2006) Post-reperfusion myocardial infarction: long-term survival improvement using adenosine regulation with acadesine. J Am Coll Cardiol 48:206–214

    Article  PubMed  Google Scholar 

  44. Wei M, Wang X, Kuukasjarvi P et al (2004) Bradykinin preconditioning in coronary artery bypass grafting. Ann Thorac Surg 78:492–497

    Article  PubMed  Google Scholar 

  45. Wang X, Wei M, Kuukasjarvi P et al (2008) The antiinflammatory effect of bradykinin preconditioning in coronary artery bypass grafting (bradykinin and preconditioning). Scand Cardiovasc J 43:1–8

    Google Scholar 

  46. Wang X, Wei M, Laurikka J (2004) The antiinflammatory effect of diazoxide in coronary artery bypass grafting. Shock 22:23–28

    Article  CAS  PubMed  Google Scholar 

  47. Wang X, Wei M, Kuukasjarvi P et al (2003) Novel pharmacological preconditioning with diazoxide attenuates myocardial stunning in coronary artery bypass grafting. Eur J Cardiothorac Surg 24:967–973

    Article  PubMed  Google Scholar 

  48. Kato R, Foex P (2002) Myocardial protection by anesthetic agents against ischemia–reperfusion injury: an update for anesthesiologists. Can J Anaesth 49:777–791

    Article  PubMed  Google Scholar 

  49. Symons JA, Myles PS (2006) Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth 97:127–136

    Article  CAS  PubMed  Google Scholar 

  50. Yu CH, Beattie WS (2006) The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis. Can J Anaesth 53:906–918

    Article  PubMed  Google Scholar 

  51. Landoni G, Biondi-Zoccai GG, Zangrillo A et al (2007) Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth 21:502–511

    Article  CAS  PubMed  Google Scholar 

  52. Smith PK, Shernan SK, Chen JC et al (2011) Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: combined results from the PRIMO-CABG I and II trials. J Thorac Cardiovasc Surg 142:89–98

    Article  CAS  PubMed  Google Scholar 

  53. Pan W, Pintar T, Anton J, Lee VV, Vaughn WK, Collard CD (2004) Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation 110:II45−II49

    Google Scholar 

  54. Collard CD, Body SC, Shernan SK, Wang S, Mangano DT (2006) Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 132:392–400

    Article  CAS  PubMed  Google Scholar 

  55. Liakopoulos OJ, Choi YH, Haldenwang PL et al (2008) Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J 29:1548–1559

    Article  PubMed  Google Scholar 

  56. Avkiran M, Marber MS (2002) Na(+)/H(+) exchange inhibitors for cardioprotective therapy: progress, problems and prospects. J Am Coll Cardiol 39:747–753

    Article  CAS  PubMed  Google Scholar 

  57. Boyce SW, Bartels C, Bolli R et al (2003) Impact of sodium–hydrogen exchange inhibition by cariporide on death or myocardial infarction in high-risk CABG surgery patients: results of the CABG surgery cohort of the GUARDIAN study. J Thorac Cardiovasc Surg 126:420–427

    Article  CAS  PubMed  Google Scholar 

  58. Mentzer RM Jr, Bartels C, Bolli R et al (2008) Sodium–hydrogen exchange inhibition by cariporide to reduce the risk of ischemic cardiac events in patients undergoing coronary artery bypass grafting: results of the EXPEDITION study. Ann Thorac Surg 85:1261–1270

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy

    Filippo Crea & Gaetano A. Lanza

  2. Division of Cardiovascular Medicine, “Vita e Salute” University and Istituto Scientifico San Raffaele, Via Olgettina, 60, 20132, Milan, Italy

    Paolo G. Camici

Authors
  1. Filippo Crea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaetano A. Lanza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo G. Camici
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filippo Crea .

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Crea, F., Lanza, G.A., Camici, P.G. (2014). Prevention of Iatrogenic CMD. In: Coronary Microvascular Dysfunction. Springer, Milano. https://doi.org/10.1007/978-88-470-5367-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5367-0_11

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5366-3

  • Online ISBN: 978-88-470-5367-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation