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Published in: Cardiovascular Ultrasound 1/2012

Open Access 01-12-2012 | Hypothesis

Detection of coronary microembolization by Doppler ultrasound in patients with stable angina pectoris during percutaneous coronary interventions under an adjunctive antithrombotic therapy with abciximab: design and rationale of the High Intensity Transient Signals ReoPro (HITS-RP) study

Authors: Daniel Kretzschmar, Christian Jung, Sylvia Otto, Stephan Utschig, Michael Hartmann, Thomas Lehmann, Atilla Yilmaz, Tudor C Pörner, Hans R Figulla, Markus Ferrari

Published in: Cardiovascular Ultrasound | Issue 1/2012

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Abstract

Background

Embolization of atherosclerotic debris from the rupture of a vulnerable atherosclerotic plaque occurs iatrogenically during percutaneous coronary interventions (PCI) and can induce myocardial necrosis. These microembolizations are detected as high intensity transient signals (HITS) using intracoronary Doppler technology.

Presentation of the hypothesis

In the presented study we will test if abciximab (ReoPro®) infusion reduces high intensity transient signals in patients with stable angina pectoris undergoing PCI in comparison to standard therapy alone.

Testing the hypothesis

The High Intensity Transient Signals ReoPro® (HITS-RP) study will enroll 60 patients. It is a prospective, single center, randomized, double-blinded, controlled trial. The study is designed to compare the efficacy of intravenous abciximab administration for reduction of microembolization during elective PCI. Patients will be randomized in a 1:1 fashion to abciximab or placebo infusion. The primary end point of the HITS-RP-Study is the number of HITS during PCI measured by intracoronary Doppler wire. Secondary endpoints are bleeding complications, elevation of cardiac biomarkers or ECG changes after percutaneous coronary interventions, changes in coronary flow velocity reserve, hs-CRP elevation, any major adverse cardio-vascular event during one month follow-up.

Implications of the hypothesis

The HITS-RP-Study addresses important questions regarding the efficacy of intravenous abciximab administration in reducing microembolization and periprocedural complications in stable angina pectoris patients undergoing PCI.
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Literature
1.
go back to reference Herrmann J, Haude M, Lerman A, Schulz R, Volbracht L, Ge J, Schmermund A, Wienecke A, von Birgelen C, Eggebrecht H, Baumgart D, Heusch G, Erbel R: Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation. Circulation. 2001, 103: 2339-2345. 10.1161/01.CIR.103.19.2339CrossRefPubMed Herrmann J, Haude M, Lerman A, Schulz R, Volbracht L, Ge J, Schmermund A, Wienecke A, von Birgelen C, Eggebrecht H, Baumgart D, Heusch G, Erbel R: Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation. Circulation. 2001, 103: 2339-2345. 10.1161/01.CIR.103.19.2339CrossRefPubMed
2.
go back to reference Johansen O, Brekke M, Stromme JH, Valen V, Seljeflot I, Skjaeggestad O, Arnesen H: Myocardial damage during percutaneous transluminal coronary angioplasty as evidenced by troponin T measurements. Eur Heart J. 1998, 19: 112-117. 10.1053/euhj.1997.0732CrossRefPubMed Johansen O, Brekke M, Stromme JH, Valen V, Seljeflot I, Skjaeggestad O, Arnesen H: Myocardial damage during percutaneous transluminal coronary angioplasty as evidenced by troponin T measurements. Eur Heart J. 1998, 19: 112-117. 10.1053/euhj.1997.0732CrossRefPubMed
3.
go back to reference Erbel R, Heusch G: Coronary microembolization. J Am Coll Cardiol. 2000, 36: 22-24. 10.1016/S0735-1097(00)00708-7CrossRefPubMed Erbel R, Heusch G: Coronary microembolization. J Am Coll Cardiol. 2000, 36: 22-24. 10.1016/S0735-1097(00)00708-7CrossRefPubMed
4.
go back to reference Brener SJ, Topol EJ: Troponin, embolization and restoration of micro-vascular integrity. Eur Heart J. 2000, 21: 1117-1119. 10.1053/euhj.2000.2119CrossRefPubMed Brener SJ, Topol EJ: Troponin, embolization and restoration of micro-vascular integrity. Eur Heart J. 2000, 21: 1117-1119. 10.1053/euhj.2000.2119CrossRefPubMed
5.
go back to reference Prasad A, Singh M, Lerman A, Lennon RJ, Holmes DR, Rihal CS: Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality. J Am Coll Cardiol. 2006, 48: 1765-1770. 10.1016/j.jacc.2006.04.102CrossRefPubMed Prasad A, Singh M, Lerman A, Lennon RJ, Holmes DR, Rihal CS: Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality. J Am Coll Cardiol. 2006, 48: 1765-1770. 10.1016/j.jacc.2006.04.102CrossRefPubMed
6.
go back to reference Herrmann J: Peri-procedural myocardial injury: 2005 update. Eur Heart J. 2005, 26: 2493-2519. 10.1093/eurheartj/ehi455CrossRefPubMed Herrmann J: Peri-procedural myocardial injury: 2005 update. Eur Heart J. 2005, 26: 2493-2519. 10.1093/eurheartj/ehi455CrossRefPubMed
7.
go back to reference Bahrmann P, Werner GS, Heusch G, Ferrari M, Poerner TC, Voss A, Figulla HR: Detection of coronary microembolization by doppler ultrasound in patients with stable angina pectoris undergoing elective percutaneous coronary interventions. Circulation. 2007, 115: 600-608. 10.1161/CIRCULATIONAHA.106.660779CrossRefPubMed Bahrmann P, Werner GS, Heusch G, Ferrari M, Poerner TC, Voss A, Figulla HR: Detection of coronary microembolization by doppler ultrasound in patients with stable angina pectoris undergoing elective percutaneous coronary interventions. Circulation. 2007, 115: 600-608. 10.1161/CIRCULATIONAHA.106.660779CrossRefPubMed
8.
go back to reference Heusch G, Kleinbongard P, Böse D, Levkau B, Haude M, Schul R, Erbel R: Coronary microembolization: from bedside to bench and back to bedside. Circulation. 2009, 120: 1822-1836. 10.1161/CIRCULATIONAHA.109.888784CrossRefPubMed Heusch G, Kleinbongard P, Böse D, Levkau B, Haude M, Schul R, Erbel R: Coronary microembolization: from bedside to bench and back to bedside. Circulation. 2009, 120: 1822-1836. 10.1161/CIRCULATIONAHA.109.888784CrossRefPubMed
9.
go back to reference Jung C, Sörensson P, Saleh N, Arheden H, Ryden L, Pernow J: Circulating endothelial and platelet derived microparticles reflect the size of myocardium at risk in patients with ST-elevation myocardial infarction. Atherosclerosis. 2012, 221: 226-231. 10.1016/j.atherosclerosis.2011.12.025CrossRefPubMed Jung C, Sörensson P, Saleh N, Arheden H, Ryden L, Pernow J: Circulating endothelial and platelet derived microparticles reflect the size of myocardium at risk in patients with ST-elevation myocardial infarction. Atherosclerosis. 2012, 221: 226-231. 10.1016/j.atherosclerosis.2011.12.025CrossRefPubMed
10.
go back to reference Bahrmann P, Figulla HR, Wagner M, Ferrari M, Voss A, Werner GS: Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions. Heart. 2005, 91: 1886-1192.CrossRef Bahrmann P, Figulla HR, Wagner M, Ferrari M, Voss A, Werner GS: Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions. Heart. 2005, 91: 1886-1192.CrossRef
11.
go back to reference Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ: Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001, 103: 2780-2783. 10.1161/hc2301.092121CrossRefPubMed Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ: Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001, 103: 2780-2783. 10.1161/hc2301.092121CrossRefPubMed
12.
go back to reference Selvanayagam JB, Poro I, Channon K, Petersen SE, Francis JM, Neubauer S, Banning AP: Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury. Circulation. 2005, 111: 1027-1032. 10.1161/01.CIR.0000156328.28485.ADCrossRefPubMed Selvanayagam JB, Poro I, Channon K, Petersen SE, Francis JM, Neubauer S, Banning AP: Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury. Circulation. 2005, 111: 1027-1032. 10.1161/01.CIR.0000156328.28485.ADCrossRefPubMed
13.
go back to reference Bassuk SS, Rifai N, Ridker PM: High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol. 2002, 29: 439-493. Bassuk SS, Rifai N, Ridker PM: High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol. 2002, 29: 439-493.
14.
go back to reference Heusch G, Schulz R, Erbel R, Pearson TA, Mensag GA, Alexander RW, Anderson JL, Cannon RO, Criqiu MH, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC, Taubert K, Tracy RP, Vinicor F: Inflammatory markers in coronary heart disease: coronary vascular versus myocardial origin?. Circulation. 2003, 108: e4- 10.1161/01.CIR.0000079055.99427.3FCrossRefPubMed Heusch G, Schulz R, Erbel R, Pearson TA, Mensag GA, Alexander RW, Anderson JL, Cannon RO, Criqiu MH, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC, Taubert K, Tracy RP, Vinicor F: Inflammatory markers in coronary heart disease: coronary vascular versus myocardial origin?. Circulation. 2003, 108: e4- 10.1161/01.CIR.0000079055.99427.3FCrossRefPubMed
15.
go back to reference Chew DP, Bhatt DL, Robbins MA, Penn MS, Schneider JP, Lauer MS, Topol EJ, Ellis SG: Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation. 2001, 104: 992-997. 10.1161/hc3401.095074CrossRefPubMed Chew DP, Bhatt DL, Robbins MA, Penn MS, Schneider JP, Lauer MS, Topol EJ, Ellis SG: Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation. 2001, 104: 992-997. 10.1161/hc3401.095074CrossRefPubMed
16.
go back to reference , The EPIC Investigators: Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med. 1994, 330: 956-961.CrossRef , The EPIC Investigators: Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med. 1994, 330: 956-961.CrossRef
17.
go back to reference Bellandi F, Maioli M, Gallopin M, Toso A, Dabizzi RP: Increase of myocardial salvage and left ventricular function recovery with intracoronary abciximab downstream of the coronary occlusion in patienst with acute myocardial infarction treated with primary coronary intervention. Catheter Cardiovasc Interv. 2004, 62: 186-192. 10.1002/ccd.20041CrossRefPubMed Bellandi F, Maioli M, Gallopin M, Toso A, Dabizzi RP: Increase of myocardial salvage and left ventricular function recovery with intracoronary abciximab downstream of the coronary occlusion in patienst with acute myocardial infarction treated with primary coronary intervention. Catheter Cardiovasc Interv. 2004, 62: 186-192. 10.1002/ccd.20041CrossRefPubMed
18.
go back to reference , The EPIC Investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993, 329: 673-682.CrossRef , The EPIC Investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993, 329: 673-682.CrossRef
19.
go back to reference Kunadian B, Dunning J, Vijayalakshmi K, Thornley AR, de Belder MA: Meta-analysis of randomized trials comparing anti-embolic devices with standard PCI for improving myocardial reperfusion in patients with acute myocardial infarction. Catheter Cardiovasc Interv. 2007, 69: 488-496. 10.1002/ccd.20990CrossRefPubMed Kunadian B, Dunning J, Vijayalakshmi K, Thornley AR, de Belder MA: Meta-analysis of randomized trials comparing anti-embolic devices with standard PCI for improving myocardial reperfusion in patients with acute myocardial infarction. Catheter Cardiovasc Interv. 2007, 69: 488-496. 10.1002/ccd.20990CrossRefPubMed
20.
go back to reference Cura FA, Bhatt DL, Lincoff AM, Kapadia SR, L’Allier PL, Ziada KM, Wolski KE, Moliterno DJ, Brener SJ, Ellis SG, Topol EJ: Pronounced benefit of coronary stenting and adjunctive platelet glycoprotein IIb/IIIa inhibition in complex atherosclerotic lesions. Circulation. 2000, 102: 28-34. 10.1161/01.CIR.102.1.28CrossRefPubMed Cura FA, Bhatt DL, Lincoff AM, Kapadia SR, L’Allier PL, Ziada KM, Wolski KE, Moliterno DJ, Brener SJ, Ellis SG, Topol EJ: Pronounced benefit of coronary stenting and adjunctive platelet glycoprotein IIb/IIIa inhibition in complex atherosclerotic lesions. Circulation. 2000, 102: 28-34. 10.1161/01.CIR.102.1.28CrossRefPubMed
21.
go back to reference Shen J, Zhang Q, Zhang RY, Zhang JS, Hu J, Yang ZK, Zheng AF, Zhang X, Shen WF: Clinical benefits of adjunctive tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis. 2008, 19: 271-277. 10.1097/MCA.0b013e3282f487e0CrossRefPubMed Shen J, Zhang Q, Zhang RY, Zhang JS, Hu J, Yang ZK, Zheng AF, Zhang X, Shen WF: Clinical benefits of adjunctive tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis. 2008, 19: 271-277. 10.1097/MCA.0b013e3282f487e0CrossRefPubMed
22.
go back to reference Junghans U, Siebler M: Cerebral microembolism is blocked by tirofiban, a selective nonpeptide platelet glycoprotein IIb/IIIa receptor antagonist. Circulation. 2003, 107: 2717-2721. 10.1161/01.CIR.0000070544.15890.0ECrossRefPubMed Junghans U, Siebler M: Cerebral microembolism is blocked by tirofiban, a selective nonpeptide platelet glycoprotein IIb/IIIa receptor antagonist. Circulation. 2003, 107: 2717-2721. 10.1161/01.CIR.0000070544.15890.0ECrossRefPubMed
23.
go back to reference Stygall J, Kong R, Walker M, Hardman SMC, Harrison MJG, Newman SP: Cerebral microembolism detected by transcranial Doppler during cardiac procedures. Stroke. 2000, 31: 2508-2510. 10.1161/01.STR.31.10.2508CrossRefPubMed Stygall J, Kong R, Walker M, Hardman SMC, Harrison MJG, Newman SP: Cerebral microembolism detected by transcranial Doppler during cardiac procedures. Stroke. 2000, 31: 2508-2510. 10.1161/01.STR.31.10.2508CrossRefPubMed
Metadata
Title
Detection of coronary microembolization by Doppler ultrasound in patients with stable angina pectoris during percutaneous coronary interventions under an adjunctive antithrombotic therapy with abciximab: design and rationale of the High Intensity Transient Signals ReoPro (HITS-RP) study
Authors
Daniel Kretzschmar
Christian Jung
Sylvia Otto
Stephan Utschig
Michael Hartmann
Thomas Lehmann
Atilla Yilmaz
Tudor C Pörner
Hans R Figulla
Markus Ferrari
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2012
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-10-21

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