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Hsueh SK, Hsieh YK, Fang CY, Youssef AA, Chen CJ, Chen SM, Yang CH, Yip HK, Chen MC, MorganFu, Cheng CI, Wu CJ. S35-6 DRUG-ELUTING STENTS VERSUS COBALT CHROMIUM ALLOY STENTS IN REAL WORLD PRACTICE. Int J Cardiol 2007. [DOI: 10.1016/s0167-5273(08)70506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cheng CI, Lee FY, Chang JP, Hsueh SK, Hsieh YK, Fang CY, Chen SM, Yang CH, Yip HK, Chen MC, Fu M, Wu CJ. S6-3 LONG-TERM OUTCOMES OF INTERVENTION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY STENOSES: CORONARY STENTING VS. CORONARY ARTERY BYPASS GRAFT SURGERY. Int J Cardiol 2007. [DOI: 10.1016/s0167-5273(08)70426-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bhasin A, Cheng CI, Wu CJ, Fang CY, Chen CJ, Chen SM, Yang CH, Hsieh YK. S45-3 PATENCY OF ENDOVASCULAR TREATED CENTRAL VEIN STENOSIS AND OCCLUSION IN PATIENTS WITH HEMODIALYSIS ACCESS. Int J Cardiol 2007. [DOI: 10.1016/s0167-5273(08)70524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen SM, Yuan YB, Lian JR, Zhou X. High-efficiency and high-contrast phosphorescent top-emitting organic light-emitting devices with p-type Si anodes. OPTICS EXPRESS 2007; 15:14644-14649. [PMID: 19550745 DOI: 10.1364/oe.15.014644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report high-efficiency and high-contrast phosphorescent topemitting organic light-emitting devices (OLEDs) by employing the low reflectance p-type Si bottom anodes and the high transmittance Cs(2)CO(3)/Ag top cathodes for effective hole and electron injection. With the green electrophosphorescent material fac tris (2-phenylpyridine) iridium [Ir(ppy)(3)] doped emitting layer, the devices exhibit peak external quantum and power efficiencies of 3.5% (12 cd/A) and 4.5 lm/W, which are the highest values reported for OLEDs using Si wafers as electrodes. Moreover, these devices exhibit significantly higher contrast compared to the conventional bottom-emitting and top-emitting OLEDs with the highly reflective back electrodes.
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Yager DR, Chen SM, Ward SI, Olutoye OO, Diegelmann RF, Kelman Cohen I. Ability of chronic wound fluids to degrade peptide growth factors is associated with increased levels of elastase activity and diminished levels of proteinase inhibitors. Wound Repair Regen 2007; 5:23-32. [PMID: 16984454 DOI: 10.1046/j.1524-475x.1997.50108.x] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The stability of peptide growth factors exposed to fluids from healing surgical wounds and from nonhealing chronic wounds was examined in vitro. (125)I-Labeled transforming growth factor-beta1 or platelet-derived growth factor-BB was incubated with fluids from healing surgical wounds and fluids from venous stasis or pressure ulcers. Fluids from healing surgical wounds had no appreciable effect on the level of (125)I corresponding to intact growth factor. In contrast, incubation with fluids from several venous stasis or pressure ulcers resulted in significant degradation of these growth factors. Degradation was blocked by broad-spectrum serine proteinase inhibitors and by specific inhibitors of neutrophil elastase. Levels of elastase activity in wound fluids correlated with the ability to degrade peptide growth factors. Further comparisons showed qualitative and quantitative differences in the endogenous proteinase inhibitors, alpha2-macroglobulin and alpha1-antiproteinase. These results could explain, in part, the variable growth factor levels which have been found in chronic wounds. More importantly, the ability of some chronic nonhealing wounds to rapidly degrade exogenously added growth factors has important implications with regard to past and future clinical attempts to use peptide growth factors to treat these types of problem wounds.
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Yip HK, Youssef AA, Chang WN, Lu CH, Yang CH, Chen SM, Wu CJ. Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting. Cardiovasc Intervent Radiol 2007; 30:840-6. [PMID: 17587084 DOI: 10.1007/s00270-007-9051-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 03/21/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. BACKGROUND The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. METHODS The study included 24 consecutive patients (22 male,2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. RESULTS A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. CONCLUSION We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access.
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Cheng CI, Wu CJ, Hsieh YK, Chen YH, Chen CJ, Chen SM, Yang CH, Hung WC, Yip HK, Chen MC, Fu M, Fang CY. Percutaneous coronary intervention for iatrogenic left main coronary artery dissection. Int J Cardiol 2007; 126:177-82. [PMID: 17490760 DOI: 10.1016/j.ijcard.2007.03.125] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 02/19/2007] [Accepted: 03/30/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although catheter-induced left main coronary artery (LMCA) dissection is a rare complication of coronary catheterization, it is a common cause of periprocedural mortality. Emergent coronary artery bypass surgery (CABG) is the mainstay for managing this acute complication. However, hemodynamic deterioration may progress while patients await emergent CABG; consequently, a high postoperative mortality rate has been reported. Although the number of cases was small, prompt bail-out stenting for iatrogenic LMCA dissection had reportedly reversed this complication with favorable clinical outcomes. METHODS This study included 13 cases of attempted stenting for iatrogenic LMCA dissection classified as grades C-F based on the National Heart, Lung and Blood Institute (NHLBI) classification system. Angiographic success, in-hospital mortality and long-term outcomes were analyzed. RESULTS The incidence of iatrogenic LM dissection was 0.071%. Most of the patients were initially asymptomatic. Angiographic success was achieved in 11 of 13 patients (84.6%). Including one patient who underwent emergent CABG after a failed wiring attempt, two mortalities occurred in this series. Mean follow-up duration of the ten patients discharged was 30.1+/-11.8 months, and no cardiac deaths occurred. Follow-up angiogram of eight patients with a mean interval of 5.2+/-2.3 months after initial event demonstrated restenosis in three patients occurring either at the ostiums of the left anterior descending artery or left circumflex artery. Revascularization was performed on two patients. CONCLUSIONS Successful bail-out stenting resulted in good long-term survival and should be considered for initial management of iatrogenic LMCA dissection.
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Hung WC, Wu CJ, Yip HK, Fang CY, Hang CL, Chen SM, Chen MC, Yu TH, Wang CP, Hsieh YK. Percutaneous transluminal angioplasty to left internal mammary artery grafts: immediate and long-term clinical outcomes. CHANG GUNG MEDICAL JOURNAL 2007; 30:235-41. [PMID: 17760274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Increasing usage of the left internal mammary artery (LIMA) as the graft of choice in coronary artery bypass surgery has led to increased incidence of LIMA graft stenosis. METHODS Thirteen patients with LIMA graft stenosis were identified from a review of our institutional database, with intervention approach either from the femoral (n = 6) or radial artery (n = 7). There were no LIIMA orifice lesions and all patients presented with anastomosis site stenoses, except one individual who had combined LIMA shaft stenosis. Clinical outcomes were assessed. RESULTS The procedural success rate was 92% (12/13). Conventional balloon dilation was performed in seven cases and stenting in five. Two patients developed LIMA body dissection during the procedure, with one requiring bail-out stenting and the other prolonged balloon inflation. The in-hospital major adverse cardiac events included 1 non-Q wave myocardial infarction (7.7%) but no deaths, emergency coronary artery bypass surgery or target lesion revascularization. In the one failure case, the patient died 1 month later at home. Angiographic follow-up of ten patients (83%) revealed a restenosis rate of 20% (2/10). The mean clinical follow-up duration was 34.5 +/- 20.9 months. One patient expired 32 months later due to acute stroke with sepsis. CONCLUSION Percutaneous transluminal intervention of LIMA grafts can be performed safely from either the femoral or radial approach. High procedure success and low complication rates are achievable by an experienced cardiologist; long-term clinical results were excellent in our patients. It can be considered as an alternative therapeutic method for a stenosed LIMA graft.
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Chiu CA, Youssef AA, Wu CJ, Hsieh YK, Yang CH, Chen SM, Chen CJ, Cheng CI, Chen YH, Yip HK. Impact of PercuSurge GuardWire device on prevention and reduction of recovery time from complete heart block in patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention. Int Heart J 2007; 48:35-44. [PMID: 17379977 DOI: 10.1536/ihj.48.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Second-degree heart block or complete heart block (CHB) is a relatively frequent complication of acute inferior wall myocardial infarction (AIWMI). This study investigated whether the PercuSurge device can prevent procedure-related CHB or can shorten CHB recovery time in patients with AIWMI undergoing primary percutaneous coronary intervention (PCI). Between May 2002 and April 2005, a PercuSurge device was utilized in 113 patients (study population, group 1) with AIWMI due to obstruction of the right coronary artery (RCA) with a reference lumen diameter (RLD) > or = 3.5 mm. The control subjects (group 2) consisted of 119 patients who experienced AIWMI due to RCA obstruction with a RLD > or = 3.5 mm from May 2000 to April 2002. The combined incidence of new onset of CHB following the interventional procedure was significantly higher in group 2 than in group 1. Additionally, recovery time from CHB to first-degree heart block or normal sinus rhythm was remarkably longer in group 2 than in group 1. Furthermore, the duration of hospitalization in group 2 was significantly longer than in group 1. Multiple stepwise analyses demonstrated that the PercuSurge device was the only independent predictor of preventing new onset of CHB during the procedure. Additionally, this mechanical device along with final TIMI-3 flow and final myocardial blush grade > or = 2 was independently associated with reducing recovery time from CHB. In conclusion, the PercuSurge device can prevent procedure-related CHB and shorten the recovery time for CHB in patients with AIWMI undergoing primary PCI.
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Cheng CI, Wu CJ, Fang CY, Youssef AA, Chen CJ, Chen SM, Yang CH, Hsueh SK, Yip HK, Chen MC, Fu M, Hsieh YK. Feasibility and Safety of Transradial Stenting for Unprotected Left Main Coronary Artery Stenoses. Circ J 2007; 71:855-61. [PMID: 17526980 DOI: 10.1253/circj.71.855] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is considered an excellent alternative treatment for unprotected left main coronary artery (ULMCA) stenoses. Most PCIs for ULMCA stenoses are performed via the transfemoral approach. The feasibility and safety of the transradial approach for this particular entity are unknown. The present study assessed the feasibility, safety and 1-year outcomes of the transradial approach for stenting of ULMCA stenoses. METHODS AND RESULTS Of 131 consecutive patients who underwent coronary stenting for ULMCA stenoses, 113 patients (86.3%) received stenting using the transradial approach. All 113 procedures were performed with 6 or 7 French (Fr) catheters except 1 procedure requiring an 8 Fr guiding catheter for directional atherectomy. The technical success rate was 100%, and angiographic success was achieved in 96 patients (85.9%). Two patients had local hematoma (1.8%), and no procedure-related deaths, Q-wave myocardial infarction, repetitive PCI, stroke or emergent coronary artery bypass graft surgery during hospitalization were noted. One (0.9%) in-hospital cardiac death occurred due to ventricular tachyarrhythmia. More than half of our patients stayed in hospital by < or =3 days. The 1-year target lesion revascularization and cardiac death rate were 14.2% and 3.5%, respectively. CONCLUSIONS This investigation demonstrated the feasibility, safety and accepted short-term clinical outcomes of transradial stenting for ULMCA stenosis. This procedure may offer a feasible alternative to the transfemoral approach.
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Yamamoto S, Zalipska J, Aliu E, Andringa S, Aoki S, Argyriades J, Asakura K, Ashie R, Berghaus F, Berns H, Bhang H, Blondel A, Borghi S, Bouchez J, Burguet-Castell J, Casper D, Catala J, Cavata C, Cervera A, Chen SM, Cho KO, Choi JH, Dore U, Espinal X, Fechner M, Fernandez E, Fukuda Y, Gomez-Cadenas J, Gran R, Hara T, Hasegawa M, Hasegawa T, Hayashi K, Hayato Y, Helmer RL, Hiraide K, Hosaka J, Ichikawa AK, Iinuma M, Ikeda A, Inagaki T, Ishida T, Ishihara K, Ishii T, Ishitsuka M, Itow Y, Iwashita T, Jang HI, Jeon EJ, Jeong IS, Joo KK, Jover G, Jung CK, Kajita T, Kameda J, Kaneyuki K, Kato I, Kearns E, Kerr D, Kim CO, Khabibullin M, Khotjantsev A, Kielczewska D, Kim JY, Kim SB, Kitching P, Kobayashi K, Kobayashi T, Konaka A, Koshio Y, Kropp W, Kubota J, Kudenko Y, Kuno Y, Kurimoto Y, Kutter T, Learned J, Likhoded S, Lim IT, Loverre PF, Ludovici L, Maesaka H, Mallet J, Mariani C, Matsuno S, Matveev V, McConnel K, McGrew C, Mikheyev S, Minamino A, Mine S, Mineev O, Mitsuda C, Miura M, Moriguchi Y, Morita T, Moriyama S, Nakadaira T, Nakahata M, Nakamura K, Nakano I, Nakaya T, Nakayama S, Namba T, Nambu R, Nawang S, Nishikawa K, Nitta K, Nova F, Novella P, Obayashi Y, Okada A, Okumura K, Oser SM, Oyama Y, Pac MY, Pierre F, Rodriguez A, Saji C, Sakuda M, Sanchez F, Sarrat A, Sasaki T, Sato H, Scholberg K, Schroeter R, Sekiguchi M, Shiozawa M, Shiraishi K, Sitjes G, Smy M, Sobel H, Sorel M, Stone J, Sulak L, Suzuki A, Suzuki Y, Takahashi T, Takenaga Y, Takeuchi Y, Taki K, Takubo Y, Tamura N, Tanaka M, Terri R, T'jampens S, Tornero-Lopez A, Totsuka Y, Ueda S, Vagins M, Whitehead L, Walter CW, Wang W, Wilkes RJ, Yamada S, Yanagisawa C, Yershov N, Yokoyama H, Yokoyama M, Yoo J, Yoshida M. Improved search for nu(mu) --> nu(e) oscillation in a long-baseline accelerator experiment. PHYSICAL REVIEW LETTERS 2006; 96:181801. [PMID: 16712358 DOI: 10.1103/physrevlett.96.181801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Indexed: 05/09/2023]
Abstract
We performed an improved search for nu(mu) --> nu(e) oscillation with the KEK to Kamioka (K2K) long-baseline neutrino oscillation experiment, using the full data sample of 9.2 x 10(19) protons on target. No evidence for a nu(e) appearance signal was found, and we set bounds on the nu(mu) --> nu(e) oscillation parameters. At Deltam(2)=2.8 x 10(-3) eV(2), the best-fit value of the K2Knu(mu) disappearance analysis, we set an upper limit of sin(2)2theta(mue) < 0.13 at a 90% confidence level.
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Chen SM, Hsieh YK, Guo GBF, Fang CY, Yip HK, Wu CJ, Fu M. Angiographic and clinical outcome in ST-segment elevation myocardial infarction patients receiving an adjunctive double bolus regimen of tirofiban for primary percutaneous coronary intervention. Circ J 2006; 70:536-41. [PMID: 16636486 DOI: 10.1253/circj.70.536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because of different dosages, the efficacy of adjunctive tirofiban therapy for primary percutaneous coronary intervention (PCI) is currently unclear. The hypothesis that a double bolus regimen of tirofiban will improve angiographic and clinical outcomes in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing PCI was tested in the present study. METHODS AND RESULTS Primary PCI was performed in 217 STEMI patients: 80 received standard PCI (control group) and 137 received tirofiban (tirofiban group). Tirofiban was given as a bolus (10 mg/kg) in the emergency room and again upon arrival at the cardiac catheterization laboratory, followed by infusion of 0.15 mg . kg(-1) . min (-1) until the total dose reached 12.5 mg. The primary endpoint was emergency target vessel revascularization, recurrent myocardial infarction, or cardiovascular mortality at 30 days and 1 year. Baseline clinical and angiographic variables of the 2 groups were similar, as were angiographic results after PCI and bleeding complications at 30 days. The primary 30-day and 1-year endpoints were 5.1% and 11.7% in the tirofiban group, respectively, vs 10.0% (p = 0.171) and 18.8% (p = 0.151) in the control group. CONCLUSION Although angiographic and clinical benefits were not demonstrated, the results suggest that research into an effective and uniform dosing regimen of adjunctive tirofiban therapy for PCI is warranted.
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Wu CJ, Hung WC, Chen SM, Yang CH, Chen CJ, Cheng CI, Chen YH, Yip HK. Feasibility and safety of transradial artery approach for selective cerebral angiography. Catheter Cardiovasc Interv 2006; 66:21-6. [PMID: 16082678 DOI: 10.1002/ccd.20396] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The transradial artery (TRA) approach is a conventional means of diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of cerebrovascular angiographic studies using the TRA approach for patients with brain ischemia has not been reported. This study investigated whether the TRA approach using 6 Fr Kimny guiding catheter for both extracranial and intracranial angiographies is safe and effective for patients with a history of stroke, transient ischemic attack, or significant carotid stenosis. From February 2003 to June 2004, a total of 46 consecutive patients with an age range from 50 to 83 years were enrolled into the study. The retrograde engagement technique that involved lopping the guiding catheter was utilized. Outpatient carotid angiography was performed in 40% of the study patients. The overall procedural success (defined as completely evaluating both carotid and vertebral arteries and intracranial vessels) was 93.5% (n = 43) using the Kimny guiding catheter. Significant cerebrovascular stenosis (> 50%), including carotid artery in 52.2% (n = 24), vertebral artery in 15.2% (n = 7), and intracranial major artery in 15.2% (n = 7), was found in 82.6% of the patients. Notably, 17 (37.0%) of these patients with severe carotid stenosis (> or = 70%) required staged carotid stenting. Concomitant vertebral artery stenting was performed in four (8.7%) patients because of severe stenosis (> or = 70%) of these vessels. Two patients experienced transient dizziness (duration < 30 min) following the procedure. TRA approach for selective cerebral angiography is safe and feasible in patients with a history of brain ischemia.
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Hsieh SL, Chen SM, Yang YH, Kuo CM. Involvement of norepinephrine in the hyperglycemic responses of the freshwater giant prawn, Macrobrachium rosenbergii, under cold shock. Comp Biochem Physiol A Mol Integr Physiol 2006; 143:254-63. [PMID: 16423547 DOI: 10.1016/j.cbpa.2005.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 11/30/2005] [Accepted: 12/02/2005] [Indexed: 10/25/2022]
Abstract
Hyperglycemic response of freshwater giant prawn, Macrobrachium rosenbergii, under acute cold shock was investigated, and the involvement and stimulatory pathways of norepinephrine (NE) on induced-glycemia were further examined. Remarkable elevations in hemolymph glucose at comparable magnitude were observed in both intact and eyestalkless prawn under cold treatments, suggesting that hyperglycemic response of this species is not solely mediated through the actions of crustacean hyperglycemic hormone released from X-organ sinus gland complex on the target tissues, but NE is involved. Positive and significant correlations were noted between the hemolymph glucose titers and NE contents in both thoracic ganglia and the hemolymph, suggesting that NE plays a significant role in the hyperglycemic responses of this species under cold. Depressive effects of various adrenoceptor antagonists monitored in vivo and in vitro further suggest that the action of NE is primarily mediated through both alpha1- and beta1-adrenoceptors.
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Wu CJ, Cheng CI, Hung WC, Fang CY, Yang CH, Chen CJ, Chen YH, Hang CL, Hsieh YK, Chen SM, Yip HK. Feasibility and safety of transbrachial approach for patients with severe carotid artery stenosis undergoing stenting. Catheter Cardiovasc Interv 2006; 67:967-71. [PMID: 16649240 DOI: 10.1002/ccd.20738] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although sporadic successful cases using the transradial approach (TRA) for carotid stenting have been reported, the safety and feasibility of carotid stenting using either TRA or a transbrachial approach (TBA) have not been fully investigated. Recently, we have developed a safe and feasible method of TRA for cerebrovascular angiographic studies. This study investigated whether a TBA approach using a 7-French (F) Kimny guiding catheter for carotid stenting is safe and feasible for patients with severe carotid stenosis. Thirteen patients were enrolled into this study (age range, 63-78 years). Seven of these 13 patients had severe peripheral vascular disease. A retrograde-engagement technique, involving looping 6-F Kimny guiding catheter, was utilized for carotid angiographic study. For carotid stenting, the 6-F Kimny guiding catheter was replaced with a 7-F Kimny guiding catheter, and the procedure was performed as the follows. First, an extra-support wire was inserted into the middle portion of external carotid artery (ECA). Second, a 0.035-inch Teflon wire was advanced into the common carotid artery. Then, the 6-F guiding catheter was exchanged for a 7-F Kimny guiding catheter. Third, if the first and second steps did not provide adequate support for exchanging the guiding catheter, a PercuSurge GuardWire was inserted into the ECA, followed by distal balloon inflation for an anchoring support. FilterWire EX was used in 9 patients and PercuSurge GuardWire in 4 patients to protect from distal embolization during the procedure. The procedure was successful in all patients. No neurological or vascular bleeding complications were observed and all patients were discharged uneventfully. The TBA for carotid stenting was safe and effective, providing a last resort for patients unsuited to femoral arterial access and surgical intervention.
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Yang CH, Guo GBF, Yip HK, Hsieh K, Fang CY, Chen SM, Cheng CI, Hang CL, Chen MC, Wu CJ. Bilateral Cardiac Catheterizations The Safety and Feasibility of a Superficial Forearm Venous and Transradial Arterial Approach. Int Heart J 2006; 47:21-7. [PMID: 16479037 DOI: 10.1536/ihj.47.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The transradial approach for left heart catheterization has become increasingly popular recently because of its clinical benefits. We examined the safety and feasibility of a transforearm approach for bilateral cardiac catheterizations, using the radial artery and a superficial forearm vein (the cephalic, basilic, or median antecubital vein). Between August 2002 and October 2003, 296 right heart catheterizations were performed in our hospital. A superficial forearm vein was used in one group of 101 patients, of which 98 had a concomitant left heart catheterization through the radial artery. The femoral vein was used for right heart catheterization in the second group of 195 patients. Of these patients, 37 underwent left heart catheterization through the radial artery and 157 through the femoral artery. All instances of bilateral catheterizations were successful except for one complication of pseudoaneurysm occurring in the transfemoral group. The procedure time for right heart catheterization was significantly less in the forearm group than the femoral group. The transforearm group had a larger proportion of males and of patients undergoing diagnostic right heart catheterization for congestive heart failure, dilated cardiomyopathy, and ischemic cardiomyopathy. Patients with aortic stenosis (AS), atrial septal defect (ASD), and mitral stenosis (MS) were mainly restricted to the transfemoral approach. We conclude that the transradial artery and superficial forearm venous approach for bilateral cardiac catheterizations is a safe and feasible alternative to the femoral approach in a wide range of patients, with the exception of patients with AS, ASD, or MS.
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Hasegawa M, Aliu E, Andringa S, Aoki S, Argyriades J, Asakura K, Ashie R, Berns H, Bhang H, Blondel A, Borghi S, Bouchez J, Burguet-Castell J, Casper D, Cavata C, Cervera A, Chen SM, Cho KO, Choi JH, Dore U, Espinal X, Fechner M, Fernandez E, Fukuda Y, Gomez-Cadenas J, Gran R, Hara T, Hasegawa T, Hayashi K, Hayato Y, Helmer RL, Hill J, Hiraide K, Hosaka J, Ichikawa AK, Iinuma M, Ikeda A, Inagaki T, Ishida T, Ishihara K, Ishii T, Ishitsuka M, Itow Y, Iwashita T, Jang HI, Jeon EJ, Jeong IS, Joo KK, Jover G, Jung CK, Kajita T, Kameda J, Kaneyuki K, Kato I, Kearns E, Kerr D, Kim CO, Khabibullin M, Khotjantsev A, Kielczewska D, Kim JY, Kim SB, Kitching P, Kobayashi K, Kobayashi T, Konaka A, Koshio Y, Kropp W, Kubota J, Kudenko Y, Kuno Y, Kutter T, Learned J, Likhoded S, Lim IT, Loverre PF, Ludovici L, Maesaka H, Mallet J, Mariani C, Maruyama T, Matsuno S, Matveev V, Mauger C, McConnel K, McGrew C, Mikheyev S, Minamino A, Mine S, Mineev O, Mitsuda C, Miura M, Moriguchi Y, Morita T, Moriyama S, Nakadaira T, Nakahata M, Nakamura K, Nakano I, Nakaya T, Nakayama S, Namba T, Nambu R, Nawang S, Nishikawa K, Nitta K, Nova F, Novella P, Obayashi Y, Okada A, Okumura K, Oser SM, Oyama Y, Pac MY, Pierre F, Rodriguez A, Saji C, Sakuda M, Sanchez F, Sarrat A, Sasaki T, Sato H, Scholberg K, Schroeter R, Sekiguchi M, Sharkey E, Shiozawa M, Shiraishi K, Sitjes G, Smy M, Sobel H, Stone J, Sulak L, Suzuki A, Suzuki Y, Takahashi T, Takenaga Y, Takeuchi Y, Taki K, Takubo Y, Tamura N, Tanaka M, Terri R, T'jampens S, Tornero-Lopez A, Totsuka Y, Ueda S, Vagins M, Whitehead L, Walter CW, Wang W, Wilkes RJ, Yamada S, Yamamoto S, Yanagisawa C, Yershov N, Yokoyama H, Yokoyama M, Yoo J, Yoshida M, Zalipska J. Search for coherent charged pion production in neutrino-carbon interactions. PHYSICAL REVIEW LETTERS 2005; 95:252301. [PMID: 16384451 DOI: 10.1103/physrevlett.95.252301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Indexed: 05/05/2023]
Abstract
We report the result from a search for charged-current coherent pion production induced by muon neutrinos with a mean energy of 1.3 GeV. The data are collected with a fully active scintillator detector in the K2K long-baseline neutrino oscillation experiment. No evidence for coherent pion production is observed, and an upper limit of is set on the cross section ratio of coherent pion production to the total charged-current interaction at 90% confidence level. This is the first experimental limit for coherent charged pion production in the energy region of a few GeV.
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Yip HK, Hung WC, Yang CH, Chen YH, Cheng CI, Chen SM, Yeh KH. Serum concentrations of high-sensitivity C-reactive protein predict progressively obstructive lesions rather than late restenosis in patients with unstable angina undergoing coronary artery stenting. Circ J 2005; 69:1202-7. [PMID: 16195617 DOI: 10.1253/circj.69.1202] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The present study tested the hypothesis that high-sensitivity C-reactive protein (hs-CRP) concentrations might show significant serial changes in patients with unstable angina (UAP), and that elevation of hs-CRP might indicate a progressively obstructive lesion, rather than late restenosis in such patients undergoing coronary stenting. METHODS AND RESULTS Serum concentrations of hs-CRP in 168 patients with UAP undergoing coronary stenting for a new obstructive lesion were prospectively measured (pre-procedure, and on days 21, 90, and 180 post-procedure). The hs-CRP concentrations were also evaluated in 30 at-risk controls and 50 healthy volunteers. Moderately obstructive lesions of non-culprit vessels (defined as > or =50-69% stenosis) that were not treated by coronary angioplasty were found in 107 (63.7%) patients. The hs-CRP concentration was significantly higher at pre-procedure in the study patients than in the controls and healthy volunteers (all p-values <0.0001) and markedly declined after the procedure (p<0.0001). Pre-procedure (p=0.799) and post-procedure hs-CRP concentrations (all p-values >0.1) did not differ between restenotic and non-restenotic patients. However, at pre-procedure or on day 180, the concentration of hs-CRP was independently associated with progressively obstructive lesions of non-culprit vessels that required coronary angioplasty (both p-values <0.05). CONCLUSION The hs-CRP concentration was significantly higher at pre-procedure and declined substantially thereafter in patients with UAP following coronary stenting. There was no evidence of a positive association between an elevated hs-CRP concentration and late restenosis. However, both the pre-procedure and day 180 concentrations of hs-CRP were strongly associated with the progression of moderately obstructive lesions in non-culprit vessels.
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Chiu CA, Wu CJ, Yang CH, Fang CY, Hsieh YK, Hang CL, Hung WC, Chen CJ, Chen SM, Yu TH, Yeh KH, Fu M, Yip HK. Levels and value of soluble P-selectin following acute myocardial infarction: evaluating the link between soluble P-selectin levels and recruitment of circulating white blood cells and the marker for the rapid diagnosis of chest pain. CHANG GUNG MEDICAL JOURNAL 2005; 28:699-707. [PMID: 16382754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Platelet activation that results from coronary plaque rupture is important in the pathogenesis of acute myocardial infarction (AMI). Soluble p-selectin (sP-selectin) is crucial in modulating leukocyte adhesion to both platelets and endothelial cells during inflammatory response and thrombus formation. We hypothesized that sP-selectin, an index of both platelet activation and acute inflammation, rapidly increases and modulates the recruitment of circulating white blood cells (WBC) in patients following AMI. METHODS We conducted a prospective cohort study of 142 consecutive patients with ST-segment elevated AMI of onset < 12 h who were undergoing primary percutaneous coronary intervention. Blood samples for plasma levels of sP-selectin were obtained in the catheterization laboratory before coronary angiography was performed. The plasma levels of sP-selectin were also measured in 30 risk control subjects and 20 healthy control subjects. RESULTS The plasma level of sP-selectin and the circulating WBC count were significantly higher in patients with AMI than in either the risk control or healthy subjects (all of p values < 0.0001). Additionally, repeated measures of ANOVA demonstrated that there were no significant differences in plasma levels of sP-selectin (p > 0.10) in three intervals from the start of chest pain to blood sample collection (< 180 min, > or = 180 < 360, and > or = 360 < 720) following AMI. Correlation analysis demonstrated that the increase in the plasma level of sP-selectin was significantly related to the circulating WBC count (r = 0.248, p = 0.003). CONCLUSIONS sP-selectin was markedly elevated in an early phase of AMI. sP-selectin may be involved in modulating the recruitment of circulating WBC during AMI. These findings raise the need for a prospective investigation of sP-selectin as a potential reliable clinical tool for rapidly diagnosing AMI.
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Hang CL, Wang CP, Yip HK, Yang CH, Guo GBF, Wu CJ, Chen SM. Early Administration of Intracoronary Verapamil Improves Myocardial Perfusion During Percutaneous Coronary Interventions for Acute Myocardial Infarction. Chest 2005; 128:2593-8. [PMID: 16236929 DOI: 10.1378/chest.128.4.2593] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Intracoronary calcium-channel blockers administered in the event of no reflow during percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) have been shown to improve myocardial perfusion. STUDY OBJECTIVE To evaluate the effects of the administration of intracoronary verapamil before the occurrence of no reflow during direct PCI. DESIGN AND SETTING Single-center, nonrandomized, prospective study with a retrospective control group. PATIENTS AND METHODS From September 2001 to December 2003, 50 consecutive patients with AMI were prospectively enrolled for intracoronary verapamil treatment. Intracoronary verapamil was administered immediately prior to balloon inflation and at short intervals during the procedure thereafter. Retrospectively, 50 consecutive AMI patients who had undergone direct PCI and had not received intracoronary calcium-channel blockers were enrolled as control subjects. Patients with cardiogenic shock or platelet glycoprotein IIb/IIIa inhibitor were excluded. Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), and TIMI myocardial perfusion grade (TMPG) were assessed prior to and following PCI by two independent cardiologists blinded to the procedures. RESULTS The two groups had similar baseline and post-procedural angiographic characteristics, although the patients who been administered verapamil received more stent implantations than the control subjects (84% vs 60%, p = 0.008). Post-procedural TIMI flow < 3 (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.12 to 1.30; p = 0.18) and TMPG (OR, 1.24; 95% CI, 0.46 to 3.34; p = 0.68) were not associated with the implantation of the stents. There were no significant difference in post-PCI TIMI flow (p = 0.68) and CTFC (p = 0.36) between patients treated with verapamil and the control subjects. Post-PCI TMPG was significantly better in patients treated with intracoronary verapamil (p = 0.003). Forty-two percent of the patients treated with verapamil were found to have TMPG-3, while only 14% of the control subjects were found to have the same degree of TMPG (p = 0.004). Treatment with intracoronary verapamil (OR, 0.26; 95% CI, 0.12 to 0.58; p = 0.001) and pre-PCI TIMI flow (OR, 0.54; 95% CI, 0.35 to 0.84; p = 0.006) were found by multiple logistic regression to be independent predictors of TMPG. CONCLUSIONS Early administration of intracoronary verapamil during direct PCI improves post-procedural myocardial perfusion, as evaluated by TMPG.
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Liu WH, Yang CH, Yeh KH, Chang HW, Chen YH, Chen SM, Cheng CI, Chen CJ, Yu TH, Hung WC, Hang CL, Wu CJ, Yip HK. Circulating levels of soluble P-selectin in patients in the early and recent phases of myocardial infarction. CHANG GUNG MEDICAL JOURNAL 2005; 28:613-20. [PMID: 16323552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Circulating soluble P-selectin (sP-selectin), a biomarker of platelet activation is substantially increased in patients with acute myocardial infarction (AMI). However, the circulating level of sP-selectin in patients in the early (onset of AMI > 12 h but < 7 d) or recent (onset of AMI > 8 d but < 21 d) phase after AMI remains unclear. The purpose of this study was to prospectively evaluate whether the circulating level of sP-selectin remains elevated in these two consecutive phases after an AMI. METHODS Blood samples were collected in the catherization room before coronary angiography to assess the circulating level of sP-selectin. A total of 53 consecutive patients, 34 with early MI (group 1) and 19 with recent MI (group 2), who had had no prior thrombolytic therapy were included. Circulating levels of sP-selectin were also measured in 30 risk control (stable angina) subjects undergoing elective percutaneous coronary intervention and in 20 healthy subjects who comprised the healthy control group. RESULTS The circulating level of sP-selectin did not differ between patients with early AMI and those with recent MI (p = 0.632). However, the plasma level of sP-selectin was significantly higher in group 1 and 2 patients than in the risk control and healthy control subjects (all p values < 0.0001). CONCLUSIONS Circulating sP-selectin was elevated in patients 12 hours to 7 days after AMI and the elevation was maintained until 21 days after AMI. Therefore, investigation of longer utilization of anti-platelet and anti-inflammatory agents for patients following AMI might be worthwhile.
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Chen SM, Li YG, Wang DM. Study on changes of heme oxygenase-1 expression in patients with coronary heart disease. Clin Cardiol 2005; 28:197-201. [PMID: 15869055 PMCID: PMC6654511 DOI: 10.1002/clc.4960280410] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Heme oxygenase (HO) is a rate-limiting enzyme of endogenetic carbon monoxide (CO) that degrades heme into carbon monoxide, bilirubin, and iron. These products have important physiologic effects: bilirubin is a potent antioxidant that can act against ischemia/reperfusion injury; there is a negative correlation between the content of HO-1 and the incidence of coronary heart disease (CHD). HYPOTHESIS This study was undertaken to investigate the changes of HO-1 in patients with CHD. METHODS Thirty-five patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP, diagnosed by coronary angiography), and 30 patients with stable angina pectoris (AP, diagnosed by coronary angiography) were selected for the study; another 30 patients with normal coronary artery (diagnosed by coronary angiography) were selected as controls. The levels of HO-1 protein expression in monocyte and lymphocyte in the subjects were tested by immunohistochemistry and western blot. Computer picture analyzing systems were also used to measure the levels of HO-1 protein expression. RESULTS Heme oxygenase-1 protein is located in cell plasma. The levels of HO-1 protein expression in patients with CHD were significantly higher than in those without CHD (p < 0.01). There were significant differences of HO-1 expression among the three groups of patients with CHD. The group with AMI was the highest, followed by the group with UAP and finally by the group with AP. CONCLUSIONS There is a higher expression of HO-1 in patients with CHD. The levels of HO-1 protein are associated with the severity of CHD.
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Chai HT, Yang CH, Wu CJ, Hang CL, Hsieh YK, Fang CY, Chen SM, Yu TH, Hung WC, Chen YH, Cheng CI, Yip HK. Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms. Int Heart J 2005; 46:35-44. [PMID: 15858935 DOI: 10.1536/ihj.46.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While coronary artery dissection caused by a guiding catheter, which is one of the most commonly occurring complications during diagnostic cardiac catheterization or coronary intervention, has various forms, extensive antegrade and retrograde dissections of the right coronary artery (RCA) are rarely observed during these procedures. Within the last three years, we retrospectively reviewed our experience with 12,600 consecutive patients who underwent either diagnostic cardiac catheterization or coronary angioplasty, and found that 17 (0.14%) of the patients displayed extensive antegrade and retrograde RCA dissection. The antegrade dissection always propagated to the distal RCA either on bifurcation of the posterior descending artery and posterolateral artery (PLA) or to the proximal PLA. The retrograde dissection was always observed close to the ostium of the RCA or extending to the ostium of the RCA. TIMI-0 flow in the RCA was immediately observed in all the patients. Chest pain associated with an electrocardiogram showing ST-segment elevation was soon observed in most of the patients. The true lumen could be entered successfully using a single wire in 8 of 17 patients. However, a double-wire technique was required for 7 patients. This technique involved first advancing a wire along to the false lumen and then pulling back the guiding catheter away from the ostium of the RCA for a few millimeters followed by anchoring with the wire. Another wire was then gently inserted into the true lumen from the dissection entrance point, which was located near or at the ostium of RCA, and carefully advanced to the distal RCA. Coronary stenting was successfully deployed in 15 patients. However, the procedure failed in 2 patients. Furthermore, this complication caused 7 patients to have acute myocardial infarctions, 2 patients to develop atrial fibrillation, and I to die from ischemic enterocolitis due to cardiac embolism after 7 months of follow-up. In conclusion, with an increase in experience, we now better understand this complication. However, this complication, which is a formidable challenge for coronary intervention, may be a life-threatening complication, and patients with this complication may face the potential risk of a nonfatal myocardial infarction, or even a long-term fatal outcome in the long-term. Accordingly, it is important to learn how to promptly manage this complication.
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Chen YH, Wu CJ, Chang HW, Fang CY, Chen CJ, Yu TH, Chen SM, Hung WC, Cheng CI, Yip HK. Effects and Safety of Intracoronary Thrombectomy Using Transradial Application of the PercuSurge Distal Balloon Protection System in Patients with Early or Recent Myocardial Infarction. Cardiology 2004; 102:206-14. [PMID: 15452393 DOI: 10.1159/000081012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2003] [Accepted: 02/12/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Distal embolization and no reflow are likely during primary percutaneous coronary intervention (PCI) on the large infarct-related artery (IRA), which mostly contains high-burden thrombus formation (HBTF) and plaque burden. Mechanical devices to prevent distal atheroembolism may be of importance for preserving reperfusion and microvascular integrity in IRA. METHODS AND RESULTS Between May 2002 and December 2002, transradial application (TRA) of the PercuSurge GuardWire device with 7-french arterial sheath was performed in 39 consecutive patients who experienced early (>12 h and </=7 days) or recent (>7 days and <14 days) myocardial infarction (MI) associated with large IRA (vessel size >/=3.5 mm with HBTF; group 1). Between January 2001 and April 2002, 64 consecutive patients who had early or recent MI associated with HBTF in IRA of a vessel size >/=3.5 mm received TRA of PCI with adjunctive tirofiban therapy but without using the adjunctive PercuSurge GuardWire device (group 2). The angiographic and clinical outcomes of both groups were compared in a chronologically consecutive manner. The procedural success rate and post-PCI myocardial blush grades were significantly higher in group 1 than in group 2 patients (all p values <0.05), whereas a combined incidence of vascular and bleeding complications and 30-day major adverse cardiac events (defined as death, reinfarction and repeated PCI of IRA) were significantly higher in group 2 than in group 1 patients (all p values <0.05). CONCLUSIONS Our data suggested that TRA using the PercuSurge GuardWire device during PCI for patients with early or recent MI and HBTF in IRA was safe and feasible. This mechanical device provided more additional benefit to patients in this clinical setting than a combination of conventional PCI and tirofiban therapy.
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Yip HK, Wu CJ, Yang CH, Chang HW, Chen SM, Hung WC, Hang CL. Delayed Post-Myocardial Infarction Invasive Measures, Helpful or Harmful? Chest 2004; 126:38-46. [PMID: 15249440 DOI: 10.1378/chest.126.1.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In patients who have experienced acute myocardial infarction (MI), primary percutaneous coronary intervention (PCI) has been shown to be of benefit in terms of clinical outcomes. However, the value of performing routine PCI in patients with early MI (ie, an MI occurring > 12 h to < or = 7 days before patient presentation) or recent MI (ie, an MI occurring > or = 8 days to < 30 days before patient presentation) has not been established. The purposes of this prospective observational study were to evaluate the impact of PCI on outcomes, and to delineate the predictors of lack of response to reperfusion and the prognostic determinants in patients with this clinical condition. METHODS AND RESULTS A total of 377 consecutive unselected patients who had experienced early or recent MI underwent PCI. Successful reperfusion (ie, Thrombolysis in Myocardial Infarction flow grade 3 of the infarct-related artery [IRA]) was achieved in 90.2% of patients. By multiple stepwise logistic regression analysis, high-burden thrombus formation (odds ratio [OR], 15.53; 95% confidence interval [CI], 6.09 to 39.60; p < 0.0001) in the IRA, early PCI (ie, < or = 3 days) [OR, 4.10; 95% CI, 1.79 to 7.36; p = 0.0008], advanced congestive heart failure (CHF) [OR, 4.10; 95% CI, 1.70 to 9.91; p = 0.002], and diabetes (OR, 3.03; 95% CI, 1.03 to 7.06; p = 0.010) were independent predictors for lack of response to reperfusion. The 30-day mortality rate was 6.8%. The only variables that were independently related to the 30-day mortality rate were advanced CHF (OR, 29.85; 95% CI, 7.84 to 113.7; p < 0.0001), lack of response to reperfusion (OR, 7.57; 95% CI, 2.29 to 25.07; p = 0.0009), early PCI (OR, 4.81; 95% CI, 1.60 to 14.41; p = 0.005), and multivessel disease (OR, 9.22; 95% CI, 1.63 to 52.04; p = 0.0119). The surviving 351 patients were discharged from the hospital and followed-up for a mean (+/- SD) 38.9 +/- 14.2 months. Coronary angiographic follow-up was performed in 285 patients (81.2%). Restenosis of the IRA was found in 101 patients (35.4%). Reinterventions of the IRA were required in 69 patients (24.2%). Follow-up measurements of left ventricular ejection fraction (LVEF) showed significantly more improvement than the initial LVEF (59.3 +/- 13.8% vs 50.4 +/- 13%; p < 0.0001). The total cumulative mortality rate after hospital discharge was 6.5% for the entire group. Only advanced CHF (OR, 3.46; 95% CI, 1.26 to 9.52; p = 0.016) and old age (ie, > or = 70 years of age) [OR, 4.41; 95% CI, 1.59 to 12.24; p = 0.004] were independent predictors of long-term mortality. CONCLUSION The performance of PCI on > or = day 4 in patients after they had experienced an MI was safe and had a high rate of success. The clinical benefits of a relative low mortality rate associated with successful PCI for patients with early and recent MI was maintained during the long-term follow-up. However, patients with advanced CHF along with old age continued to have a poor prognosis.
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