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Jinnouchi H, Sakakura K, Fujita H. Peri-procedural myocardial infarction is all the same? J Thorac Dis 2018; 10:S3176-S3181. [PMID: 30430028 DOI: 10.21037/jtd.2018.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.,CV Path Institute, Gaithersburg, Maryland, USA
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Fujino A, Hao H, Shimodai S, Kawakami R, Matsuo K, Yasumura Y, Higuchi Y, Tsujimoto M, Ueda Y, Hirota S. Atherosclerotic Plaque Component as a Risk Factor for Distal Embolization During Percutaneous Coronary Intervention - Pathology of Tissue Obtained by Distal Protection Device. Circ J 2018; 82:2292-2298. [PMID: 29962392 DOI: 10.1253/circj.cj-18-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Embolism during percutaneous coronary intervention (PCI) causes microcirculation impairment. The aim of this study was to clarify the relationship between the pathological characteristics of tissue captured by distal protection device (DPD) and amount of tissue accumulated in DPD. Methods and Results: A total of 671 consecutive lesions in PCI using DPD were examined. The amount of necrotic debris, fibrous tissue, calcified particle, platelet thrombus and organized thrombus in the DPD baskets was histologically evaluated. The DPD tissue amount was assessed semi-quantitatively, and the relationship between the captured DPD tissue characteristics and tissue amount was investigated. On pathology, 40.7% of the lesions had necrotic debris, 41.4% had fibrous tissue, and 18.0% had calcified particle. The prevalence of lesions in patients with acute coronary syndrome (ACS) was 62.1%. Tissue amount score distribution was as follows: score 1 (tissue invisible), 3.9%; score 2 (tissue clinging to the basket), 52.0%; score 3 (tissue accumulated at the bottom of the basket), 38.5%; and score 4 (tissue accumulated in more than half of the basket), 5.7%. On multivariate analysis, necrotic debris and fibrous tissue were associated with greater tissue amount as well as clinical presentation of ACS. CONCLUSIONS The presence of atherosclerotic plaque component, such as necrotic debris and fibrous tissue, might be a risk for distal embolism during PCI.
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Affiliation(s)
- Akiko Fujino
- Department of Surgical Pathology, Hyogo College of Medicine
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine
| | - Sayaka Shimodai
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine
| | - Rika Kawakami
- Department of Surgical Pathology, Hyogo College of Medicine
| | | | | | | | | | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine
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Impact of paclitaxel-coated balloon versus newer-generation drug-eluting stent on periprocedural myocardial infarction in stable angina patients. Coron Artery Dis 2018; 29:403-408. [DOI: 10.1097/mca.0000000000000620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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54
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Coronary microembolization and microvascular dysfunction. Int J Cardiol 2018; 258:17-23. [PMID: 29429637 DOI: 10.1016/j.ijcard.2018.02.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 01/16/2023]
Abstract
Plaque erosion, fissuring or rupture occurs spontaneously or during coronary interventions. At some residual blood flow, the atherothrombotic debris is washed into the coronary microcirculation, causing physical obstruction, vasoconstriction, inflammation and ultimately microinfarction. Coronary microembolization also contributes to microvascular obstruction in reperfused acute myocardial infarction. Patients with microvascular obstruction after reperfused myocardial infarction have worse prognosis. Cardioprotective strategies to avoid acute coronary microembolization and rescue myocardium from microvascular obstruction have not yet been established in clinical practice. Subclinical coronary microembolization together with release of thrombogenic, vasoconstrictor and inflammatory substances from a culprit lesion can sensitize the coronary microcirculation and contribute to angina in the absence of major epicardial coronary obstruction. Repetitive coronary microembolization can induce progressive loss of functional cardiomyocytes and induce heart failure in the absence of overt myocardial infarction.
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Zeitouni M, Silvain J, Guedeney P, Kerneis M, Yan Y, Overtchouk P, Barthelemy O, Hauguel-Moreau M, Choussat R, Helft G, Le Feuvre C, Collet JP, Montalescot G. Periprocedural myocardial infarction and injury in elective coronary stenting. Eur Heart J 2018; 39:1100-1109. [DOI: 10.1093/eurheartj/ehx799] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michel Zeitouni
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Paul Guedeney
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Mathieu Kerneis
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Yan Yan
- Department of Cardiology, Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Anzhen Rd, Chaoyang Qu, 100029 Beijing, China
| | - Pavel Overtchouk
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Olivier Barthelemy
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Marie Hauguel-Moreau
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Rémi Choussat
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Gérard Helft
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Claude Le Feuvre
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 2-278, 47-83 bld de l'Hôpital, 75013 Paris, France
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Coenzyme Q10 Regulates Antioxidative Stress and Autophagy in Acute Myocardial Ischemia-Reperfusion Injury. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:9863181. [PMID: 29348792 PMCID: PMC5733971 DOI: 10.1155/2017/9863181] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022]
Abstract
Background Oxidative stress and autophagy both play key roles in continuous cardiomyocyte death and cardiac dysfunction after reperfusion therapy for acute myocardial ischemia-reperfusion injury. Coenzyme Q10 (CQ10), which is a fat-soluble quinone antioxidant, is involved in the pathophysiological processes of neurodegenerative diseases, cancer, diabetes, heart failure, and other diseases. Our objective was to determine if, and by what mechanism, CQ10 can ameliorate acute myocardial ischemia-reperfusion injury and improve heart function. Methods and Results Fat-soluble CQ10 in soybean oil solvent was preconditioned in rats with acute myocardial ischemia-reperfusion injury by intraperitoneal injection. Oxidant and antioxidant levels were compared between the preconditioned and control groups. Autophagy was measured by Western blotting analysis of autophagy proteins. Proapoptotic proteins and immunofluorescence were used to assess cell apoptosis. Infarct size was determined by triphenyl tetrazolium chloride (TTC) staining and Evans blue staining and visualized myocardial pathology by tissue staining. Finally, we assessed cardiac function by electrocardiography (ECG) and hemodynamics. Conclusions This study reveals that CQ10 preconditioning regulates antioxidant levels and the oxidant balance, enhances autophagy, reduces myocardial apoptosis and death, and improves cardiac function in rats with acute ischemia-reperfusion injury. These results imply that CQ10 protects against acute myocardial ischemia-reperfusion injury via the antioxidative stress and autophagy pathways.
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Ghosal S, Sinha B. Secondary cvd prevention-Lipid modification strategies: A critical analysis. Diabetes Metab Syndr 2017; 11 Suppl 1:S187-S193. [PMID: 28041920 DOI: 10.1016/j.dsx.2016.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
Lipid modification holds the key to effective secondary prevention of cardiovascular disease (CVD). However there is a controversy on whether it's all about targeting specific lipid sub fractions to a particular level or a direct effect of the agent(s) used or both. This review intends to look into these important issues from an evidence-based perspective. What is the appropriate timing of testing for lipid profile after a cardiovascular event? What is the rationale behind initiating with a high dose statin after an acute coronary event? What is the role of targeting lipid sub fractions beside LDL cholesterol? Is there any role for non-statin based therapy after an acute cardiovascular event? What constitutes a long-term lipid modification strategy in patients post CVD? These are very important questions, which needs to be addressed adequately as well as scientifically. The secondary CVD preventive strategies form a lipid perspective, which requires a thorough review.
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Affiliation(s)
- Samit Ghosal
- Nightingale Hospital, 11 Shakespeare Sarani, Kolkata, India.
| | - Binayak Sinha
- AMRI Hospitals, JC-16/17, Salt Lake City, Kolkata 700091, India
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Okuya Y, Saito Y, Kitahara H, Nakayama T, Fujimoto Y, Kobayashi Y. Intraluminal Intensity of Blood Speckle on Intravascular Ultrasound, a Novel Predictor of Periprocedural Myocardial Injury After Coronary Stenting. Am J Cardiol 2017; 120:1084-1089. [PMID: 28781024 DOI: 10.1016/j.amjcard.2017.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
The difference in the intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across a coronary artery stenosis (i.e., ΔIBS) has previously shown a negative correlation with fractional flow reserve, reflecting an impaired coronary blood flow. Periprocedural myocardial injury (PMI) after coronary stenting has also been associated with coronary circulatory dysfunction. The aim of this study was to investigate the relation between ΔIBS after coronary stenting and PMI. A total of 180 patients who underwent elective coronary stenting under IVUS guidance for a single lesion were included. Intraluminal IBS was measured using IB-IVUS in cross sections at the ostium of the target vessel and at the distal reference of the stent. ΔIBS was calculated as (distal IBS value) - (ostium IBS value). PMI was defined as an elevation of troponin I >5 times the 99th percentile upper reference limit (>0.45 ng/ml) within 24 hours after the procedure. The mean ΔIBS after coronary stenting was 6.52 ± 5.71. There was a significantly greater use of the rotational atherectomy, the number of stents, the total stent length, and ΔIBS in patients with PMI than those without. In the receiver operating characteristic curve analysis, ΔIBS significantly predicted PMI (area under the curve 0.64, best cut-off value 7.88, p = 0.001). Multiple logistic regression analysis determined that the total stent length, the use of rotational atherectomy, and ΔIBS were independent predictors of PMI. In conclusion, greater ΔIBS assessed by IB-IVUS was significantly associated with PMI after coronary stenting in patients with a stable coronary artery disease.
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Affiliation(s)
- Yoshiyuki Okuya
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Hashizume N, Miura T, Miyashita Y, Motoki H, Ebisawa S, Izawa A, Koyama J, Ikeda U, Kuwahara K. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry. Angiology 2017; 68:884-892. [PMID: 28956475 DOI: 10.1177/0003319717697883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.
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Affiliation(s)
- Naoto Hashizume
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- 2 Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hirohiko Motoki
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Izawa
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Koyama
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Stundl A, Schulte R, Lucht H, Weber M, Sedaghat A, Shamekhi J, Zur B, Grube E, Mellert F, Welz A, Fimmers R, Nickenig G, Werner N, Sinning JM. Periprocedural Myocardial Injury Depends on Transcatheter Heart Valve Type But Does Not Predict Mortality in Patients After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1550-1560. [DOI: 10.1016/j.jcin.2017.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/18/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
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Vieira de Melo RM, Hueb W, Nomura CH, Ribeiro da Silva EE, Villa AV, Oikawa FTC, da Costa LMA, Rezende PC, Garzillo CL, Lima EG, Franchini Ramires JA, Kalil Filho R. Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement. Catheter Cardiovasc Interv 2017; 90:87-93. [DOI: 10.1002/ccd.27125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Whady Hueb
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cesar Higa Nomura
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Alexandre Volney Villa
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | | | - Paulo Cury Rezende
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cibele Larrosa Garzillo
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Eduardo Gomes Lima
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Roberto Kalil Filho
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
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Kim Y, Gnanadesigan M, van Soest G, Johnson TW. A new technique for lipid core plaque detection by optical coherence tomography for prevention of peri-procedural myocardial infarction: A case report. Medicine (Baltimore) 2017; 96:e7125. [PMID: 28591063 PMCID: PMC5466241 DOI: 10.1097/md.0000000000007125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Percutaneous coronary intervention (PCI) provides effective revascularization of atherosclerotic coronary arteries but the invasive nature of treatment can result in complications. PATIENT CONCERNS A 53-year old man underwent coronary angiography due to chest pain with minimal ST-segment elevation in the inferior leads of the electrocardiogram. DIAGNOSIS We proceeded directly to coronary angiography and delineated a moderate stenosis with haziness in the mid right coronary artery (RCA). INTERVENTIONS Expert analysis of the pre-intervention OCT imaging demonstrated a large lipid core plaque (LCP), upstream of the culprit site, with minimal thrombus burden. Subsequent implantation of a bioresorbable vascular scaffold, protected with distal deployment of a filter protection device provided an excellent result with retrieval of plaque material. Post-hoc attenuation analysis confirmed the presence of large LCP. OUTCOMES A post-procedural transthoracic echocardiogram confirmed good left ventricular function with no regional wall motion abnormality. An excellent clinical outcome was achieved. LESSONS Optical coherence tomography (OCT) derived attenuation analysis can provide with qualitative and quantitative detailed evaluation of the underlying plaque substrate. Our case shows OCT can provide the interventionist with qualitative and qualitative assessment of large LCP for prevention of periprocedural complications, which may improve outcome for PCI.
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Affiliation(s)
| | - Muthukaruppan Gnanadesigan
- Department of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:39-46. [PMID: 28344616 PMCID: PMC5364281 DOI: 10.5114/aic.2017.66185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/17/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction Myocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results. Aim To assess the impact of a single episode of RIPC on myocardial injury after elective PCI. Material and methods One hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, ΔcTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups. Results Median cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184). Conclusions A single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.
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Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Sci Rep 2017; 7:44789. [PMID: 28303967 PMCID: PMC5356037 DOI: 10.1038/srep44789] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 02/14/2017] [Indexed: 12/22/2022] Open
Abstract
In this study, we assessed the effect of rehabilitation exercise after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). We performed a meta-analysis to determine the effects of exercise in patients after PCI. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, the Embase database, China National Knowledge Internet (CNKI), China Biology Medicine (CBM), and the Wanfang Database were searched for randomized controlled trials (RCTs). The key words used for the searches were PCI, exercise, walking, jogging, Tai Chi, and yoga. Six studies with 682 patients met our inclusion criteria; we chose the primary endpoint events of cardiac death, recurrence of myocardial infarction (MI), repeated PCI, coronary artery bypass grafting (CABG), and restenosis, and the secondary endpoint measures included recurrent angina, treadmill exercise (total exercise time, ST-segment decline, angina, and maximum exercise tolerance). The results showed that exercise was not clearly associated with reductions in cardiac death, recurrence of MI, repeated PCI, CABG, or restenosis. However, the exercise group exhibited greater improvements in recurrent angina, total exercise time, ST-segment decline, angina, and maximum exercise tolerance than did the control group. Future studies need to expand the sample size and improve the quality of reporting of RCTs.
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Cao YY, Chen ZW, Jia JG, Chen A, Zhou Y, Ye Y, Gao YH, Xia Y, Chang SF, Ma JY, Qian JY, Ge JB. Establishment of a Novel Mouse Model of Coronary Microembolization. Chin Med J (Engl) 2017; 129:2951-2957. [PMID: 27958227 PMCID: PMC5198530 DOI: 10.4103/0366-6999.195469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Coronary microembolization (CME) has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to severe prognosis. This study aimed to explore a new mouse model of CME. Methods: The mouse model of CME was established by injecting polystyrene microspheres into the left ventricular chamber during 15-s occlusion of the ascending aorta. Based on the average diameter and dosage used, 30 C57BL/6 male mice were randomly divided into five groups (n = 6 in each): 9 μm/500,000, 9 μm/800,000, 17 μm/200,000, 17 μm/500,000, and sham groups. The postoperative survival and performance of the mice were recorded. The mice were sacrificed 3 or 10 days after the surgery. The heart tissues were harvested for hematoxylin and eosin staining and Masson trichrome staining to compare the extent of inflammatory cellular infiltration and fibrin deposition among groups and for scanning transmission electron microscopic examinations to see the ultrastructural changes after CME. Results: Survival analysis demonstrated that the cumulative survival rate of the 17 μm/500,000 group was significantly lower than that of the sham group (0/6 vs. 6/6, P = 0.001). The cumulative survival rate of the 17 μm/200,000 group was lower than those of the sham and 9 μm groups with no statistical difference (cumulative survival rate of the 17 μm/200,000, 9 μm/800,000, 9 μm/500,000, and sham groups was 4/6, 5/6, 6/6, and 6/6, respectively). The pathological alterations were similar between the 9 μm/500,000 and 9 μm/800,000 groups. The extent of inflammatory cellular infiltration and fibrin deposition was more severe in the 17 μm/200,000 group than in the 9 μm/500,000 and 9 μm/800,000 groups 3 and 10 days after the surgery. Scanning transmission electron microscopic examinations revealed platelet aggregation and adhesion, microthrombi formation, and changes in cardiomyocytes. Conclusion: The injection of 500,000 polystyrene microspheres at an average diameter of 9 μm is proved to be appropriate for the mouse model of CME based on the general conditions, postoperative survival rates, and pathological changes.
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Affiliation(s)
- Yuan-Yuan Cao
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhang-Wei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Guo Jia
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ao Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Ye
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan-Hua Gao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan Xia
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shu-Fu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Ying Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ju-Ying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun-Bo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Kitagawa K, Amano T, Uetani T, Ishii H, Okumura T, Suzuki S, Takashima H, Kurita A, Ando H, Matsubara T, Murohara T. Association between plaque characteristics and the amount of debris captured by a filter-type distal protection device in patients with acute coronary syndrome. Atherosclerosis 2017; 258:72-78. [DOI: 10.1016/j.atherosclerosis.2017.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/28/2017] [Accepted: 02/02/2017] [Indexed: 11/28/2022]
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Zeng RX, Li S, Zhang MZ, Li XL, Zhu CG, Guo YL, Zhang Y, Li JJ. Remnant cholesterol predicts periprocedural myocardial injury following percutaneous coronary intervention in poorly-controlled type 2 diabetes. J Cardiol 2017; 70:113-120. [PMID: 28209463 DOI: 10.1016/j.jjcc.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/26/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Remnant cholesterol (RC) is receiving increasing attention regarding its relation to cardiovascular risk. Whether RC is associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in type 2 diabetes (T2D) is currently unknown. METHODS We prospectively enrolled 1182 consecutive T2D patients who were scheduled for PCI but with baseline normal preprocedural cardiac troponin I (cTnI). Patients were divided according to their glycemic control status: group A [glycated hemoglobin (HbA1c)<7%, n=563] and group B (HbA1c≥7%, n=619). PMI was evaluated by cTnI analysis within 24h. The associations of preprocedural RC and the RC to high-density lipoprotein cholesterol ratio (RC/HDL-C) with PMI were investigated. RESULTS The associations of RC and RC/HDL-C with PMI were observed in group B (both p<0.05) but not in group A (both p>0.05). Patients in group B, a 1-SD increase of RC produced 30% and 32% increased risk for postprocedural cTnI>3× upper limit of normal (ULN) and >5×ULN, respectively. The odds ratios for RC/HDL-C were the highest compared with any cholesterol fractions including total cholesterol (TC)/HDL-C, low density lipoprotein cholesterol (LDL-C)/HDL-C, nonHDL-C/HDL-C, and triglyceride/HDL-C with 1.43 [95% confidence interval (CI): 1.10-1.88] for >3× ULN and 1.49 (95% CI: 1.13-1.97) for >5× ULN. However, no such associations were found in group A. Furthermore, patients with RC >27.46mg/dL (third tertile) [RC≤14.15mg/dL (first tertile) as reference] were associated with a 1.57-fold and 2-fold increased risk for >3× ULN and >5× ULN in group B, respectively. CONCLUSIONS RC and RC/HDL-C might be valuable, independent predictors for PMI in poorly-controlled diabetic patients undergoing PCI.
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Affiliation(s)
- Rui-Xiang Zeng
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min-Zhou Zhang
- Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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68
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Her AY, Cho KI, Singh GB, Garg S, Kim YH, Koo BK, Shin ES. A Comparison of Peri-Procedural Myocardial Infarction between Paclitaxel-Coated Balloon and Drug-Eluting Stent on De Novo Coronary Lesions. Yonsei Med J 2017; 58:99-104. [PMID: 27873501 PMCID: PMC5122659 DOI: 10.3349/ymj.2017.58.1.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. MATERIALS AND METHODS In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). RESULTS One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44-533.87, p=0.004). CONCLUSION Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES.
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Affiliation(s)
- Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Gillian Balbir Singh
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Tsabedze N, McCutcheon K, Mkhwanazi L, Garda R, Vachiat A, Ramjee R, Moosa J, Maluleke T, Mukeshimana G, Karolia S, Mpanya D, Manga P. Periprocedural myocardial infarction during percutaneous coronary intervention in an academic tertiary centre in Johannesburg. Int J Cardiol 2016; 230:175-180. [PMID: 28062147 DOI: 10.1016/j.ijcard.2016.12.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 12/07/2016] [Accepted: 12/25/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is effective therapy for significant atherosclerotic coronary artery disease. Despite medical and technological advances in PCI, periprocedural myocardial infarction (PMI) remains a common complication. The frequency and factors associated with PMI have been well investigated in the developed world, yet there is a paucity of data from the developing world, especially Sub-Saharan Africa. METHODS We prospectively enrolled 153 adult patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB and hs-Troponin I were routinely measured before PCI and at 16-24h post-procedure. The third universal definition of myocardial infarction was used to define a PMI event. RESULTS 152 participants met the inclusion criteria and were analysed for PMI. 70.4% participants were male. The mean age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled the criteria for PMI. Side branch pinching with preserved TIMI III flow was noted in 62.5% of PMI cases. Duration of procedure (P=0.007), right coronary artery intervention (p=0.042) and total stent length (p=0.045) were independently associated with PMI. CONCLUSION PMI occurred in 10.5% of cases undergoing PCI. This is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes associated with PMI.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa.
| | - Keir McCutcheon
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Lancelot Mkhwanazi
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Riaz Garda
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Rohan Ramjee
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Jameel Moosa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Themba Maluleke
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Gloria Mukeshimana
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Saffiyyah Karolia
- Division of Diagnostic Radiography, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Dineo Mpanya
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
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Jin P, Zhou Q, Song S, Xu J, Zhang M, Zhu M, Kang M, Shi X, Shi J, Lu D, Li J. Elevated preoperative HMGB1 as predictor of myocardial injury post-percutaneous coronary intervention. Medicine (Baltimore) 2016; 95:e5149. [PMID: 27861339 PMCID: PMC5120896 DOI: 10.1097/md.0000000000005149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this study, we evaluated the impact of preoperative high mobility group box 1 (HMGB1) on myocardial injury post-percutaneous coronary intervention.We evaluated 302 consecutive patients who underwent percutaneous coronary intervention. They were divided into equal tertiles based on their preoperative HMGB1 levels. Creatine kinase-MB and troponin I levels were measured at baseline, 8- and 24-hours after the procedure, while clinical outcomes were followed up for 1 year.The occurrence of post-procedural myocardial injury was significantly higher in the tertile comprising of patients with elevated HMGB1 levels. Moreover, these patients showed significantly higher post-procedural peak values of creatine kinase-MB and troponin I in comparison to patients with lower HMGB1 levels. Event-free survival was significantly associated with HMGB1 levels, with worst event-free survival in patients with elevated HMGB1 levels.Elevated preoperative HMGB1 was a predictor of myocardial injury after percutaneous coronary intervention, and was associated with the worst clinical outcomes during 1-year follow up.
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Affiliation(s)
- Peng Jin
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Qi Zhou
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Shujiang Song
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Jinpeng Xu
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Minli Zhang
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Ming Zhu
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Meili Kang
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Xiangming Shi
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Junting Shi
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Di Lu
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, Hebei, China
| | - Jing Li
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
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71
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Guo LZ, Kim MH, Shin ES, Ann SH, De Jin C, Cho YR, Park JS, Park K, Park TH, Lee MS, Serebruany VL. Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study. Int J Cardiol 2016; 222:639-644. [DOI: 10.1016/j.ijcard.2016.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Topuz M, Oz F, Akkus O, Sen O, Topuz AN, Bulut A, Ozbicer S, Okar S, Koc M, Gur M. Plasma apelin-12 levels may predict in-hospital major adverse cardiac events in ST-elevation myocardial infarction and the relationship between apelin-12 and the neutrophil/lymphocyte ratio in patients undergoing primary coronary intervention. Perfusion 2016; 32:206-213. [PMID: 27770057 DOI: 10.1177/0267659116676335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. RESULTS Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). CONCLUSION We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.
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Affiliation(s)
- Mustafa Topuz
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Fahrettin Oz
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Oguz Akkus
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Omer Sen
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Ayse Nur Topuz
- 2 Family Medicine, Cukurova Universty Medicine Faculty, Adana, Turkey
| | - Atilla Bulut
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Suleyman Ozbicer
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Sefa Okar
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Mevlut Koc
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Mustafa Gur
- 1 Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
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Novel risk factors for acute coronary syndromes and emerging therapies. Int J Cardiol 2016; 220:815-24. [DOI: 10.1016/j.ijcard.2016.06.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/04/2016] [Accepted: 06/24/2016] [Indexed: 02/04/2023]
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74
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Huang GY, Yang LJ, Wang XH, Wang YL, Xue YZ, Yang WB. Relationship between platelet-leukocyte aggregation and myocardial perfusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Heart Lung 2016; 45:429-33. [DOI: 10.1016/j.hrtlng.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 01/27/2023]
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75
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Lee BK, Koo BK, Nam CW, Doh JH, Chung WY, Cho BR, Fearon WF. Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome? Korean Circ J 2016; 46:472-80. [PMID: 27482255 PMCID: PMC4965425 DOI: 10.4070/kcj.2016.46.4.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/23/2015] [Accepted: 08/13/2015] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives There is controversy surrounding whether or not high dose statin administration before percutaneous coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing PCI. Subjects and Methods Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration 12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinase-myocardial band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI. Results The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40 ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to 0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001). Conclusion Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an immediate anti-inflammatory effect in patients with NSTE-ACS.
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Affiliation(s)
- Bong-Ki Lee
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bon-Kwon Koo
- Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Woo-Young Chung
- Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - William F Fearon
- Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
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Relationship of non-cardiac biomarkers with periprocedural myocardial injury in patients undergoing percutaneous coronary intervention. Int J Cardiol 2016; 221:726-33. [PMID: 27428312 DOI: 10.1016/j.ijcard.2016.07.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/08/2016] [Indexed: 01/05/2023]
Abstract
percutaneous coronary intervention (PCI) is one of the dominant methods for revascularization in patient with coronary artery disease (CAD), which accompanied with high incidence of periprocedural myocardial injury (PMI) evaluated by postprocedural cardiac biomarker elevation. For the convenience of risk stratification of PMI following PCI, the aim of present review provides a unique opportunity to summarize the relationship of non-cardiac biomarkers with PMI by extensively searching in the MEDLINE to identify all the relevant studies. In conclusion, we found that PCI related PMI might be correlated positively to those non-cardiac biomarkers such as low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol, total cholesterol, triglyceride, the ratios of LDL-C to high-density lipoprotein cholesterol (HDL-C), the ratios of HDL-C to apolipoprotein A-I, the ratio of eicosapentaenoic acid to arachidonic acid, lectin-like oxidized low-density lipoprotein receptor-1, C-reactive protein, high on-treatment platelet reactivity, platelet-monocyte aggregates, N-term pro-B-type natriuretic peptide, hemoglobin and albuminuria. Inversely, no relationships of PMI with those non-cardiac biomarkers such as mean platelet volume, platelet distribution width, platelet-larger cell ratio, uric acid, eosinophils count and the genetic variant of methylenetetrahydrofolate reductase (MTHFR) 677 C>T polymorphism. Moreover, there were controversial associations between PMI and those non-cardiac biomarkers such as high-density lipoprotein cholesterol, glycosylated hemoglobin, homocysteine and the polymorphism Leu33Pro of platelet glycoprotein IIbIIIa. However, almost all studies failed to provide definite mechanism of its findings, and further reaches are needed to focus on the potential mechanisms of association between non-cardiac biomarkers and PMI related to PCI.
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Xu LX, Chen KY, Liu T, Zheng XT, Jiao ZQ, Xu Y, Li G. Adjunctive loading dose of cilostazol in preventing periprocedural myocardial infarction. Cardiovasc Ther 2016; 34:225-33. [PMID: 27133311 DOI: 10.1111/1755-5922.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ling-Xia Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Kang-Yin Chen
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Tong Liu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Xin-Tian Zheng
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Zhan-Quan Jiao
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Yanmin Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Guangping Li
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
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Liu Z, Joerg H, Hao H, Xu J, Hu S, Li B, Sang C, Xia J, Chu Y, Xu D. Efficacy of High-Intensity Atorvastatin for Asian Patients Undergoing Percutaneous Coronary Intervention. Ann Pharmacother 2016; 50:725-33. [PMID: 27307415 DOI: 10.1177/1060028016654722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Statins have proven cardioprotective effects, but higher doses are accompanied by various concerns and may not lead to superior clinical outcomes in Chinese/Asian populations. OBJECTIVE We designed a trial to test the efficacy of high-intensity statin therapy for the reduction of periprocedural myocardial infarction (MI) and 1-year major adverse cardiovascular events (MACEs, including cardiovascular death, spontaneous MI, unplanned revascularization) in an Asian population. METHODS A total of 798 Chinese patients with stable angina or acute coronary syndrome (ACS) were randomized to high-intensity atorvastatin (80 mg/d before percutaneous coronary intervention [PCI] and 40 mg/d thereafter for 1 year, n = 400) or moderate-intensity atorvastatin (20 mg/d for 1 year, n = 398). The primary end point was 1-year incidence of MACEs. RESULT In patients with stable angina, 1-year MACE rates were not significantly different between moderate- and high-intensity groups (7.6% vs 5.7%, P = 0.53). In contrast, in patients with ACS, the 1-year MACE rate was significantly higher in the moderate- than in the high-intensity atorvastatin group (16.8% vs 10.1%, P = 0.021; adjusted hazard ratio = 1.71, 95% CI = 1.08 to 2.77, P = 0.021). CONCLUSIONS Whereas stable angina patients derive similar benefit from moderate- and high-intensity atorvastatin therapy over the duration of 1 year after PCI, high-intensity statin therapy is superior in ACS patients.
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Affiliation(s)
- Zhi Liu
- Xuanwu Hospital Capital Medical University, Beijing, China
| | | | - Hengjian Hao
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ji Xu
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shaodong Hu
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Boyu Li
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Cheng Sang
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jinggang Xia
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yanyan Chu
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dong Xu
- Xuanwu Hospital Capital Medical University, Beijing, China
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Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:41-8. [PMID: 26966448 PMCID: PMC4777705 DOI: 10.5114/pwki.2016.56948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI). AIM To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT). MATERIAL AND METHODS Three hundred and four patients (mean age: 60.8 ±8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively. RESULTS The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3% and 12.2% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340; p < 0.001) with the stent lengths. CONCLUSIONS High-sensitivite troponin measurements indicate a high incidence of PMI even though no clinical or procedural signs suggestive of myocardial ischemia exist. Multivessel PCI, overlapping stenting, predilatation, postdilatation and longer stent length are associated with PMI following elective PCI.
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Oosterwerff EFJ, Fagel ND, Slagboom T, Tijssen JGP, Herrman JP, Smits PC, Suttorp MJ, Ronner E, Laarman GJ, Patterson MS, Amoroso G, Vink MA, van der Schaaf RJ, Verheugt FWA, Riezebos RK. Impact of percutaneous coronary intervention timing on 5-year outcome in patients with non-ST-segment elevation acute coronary syndromes. The 'wait a day' approach might be safer. Neth Heart J 2016; 24:173-80. [PMID: 26860709 PMCID: PMC4771630 DOI: 10.1007/s12471-016-0803-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best treatment strategy for patients presenting with NSTE-ACS, long-term outcomes are essential. Methods Five-year follow-up data from 133 of the 142 patients could be retrieved (94 %). The primary endpoint was a composite of death and spontaneous myocardial infarction (MI). Spontaneous MI was defined as MI occurring more than 30 days after randomisation. Secondary endpoints were the individual outcomes of death, spontaneous MI or re-PCI. Results No significant difference with respect to the primary endpoint was observed (17.8 vs. 10.1 %; HR 1.55, 95 % CI: 0.73–4.22, p = 0.21). There was no significant difference in mortality rate. However, spontaneous MI was significantly more common in the group receiving immediate PCI (11.0 vs. 1.4 %; HR 4.46, 95 % CI: 1.21–16.50, p = 0.02). We did not find a significant difference between the groups with respect to re-PCI rate. Conclusion There was no difference in the composite of death and spontaneous MI. The trial suggests an increased long-term risk of spontaneous MI for patients treated with immediate PCI.
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Affiliation(s)
- Erik F J Oosterwerff
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands.
| | - N D Fagel
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - T Slagboom
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - J G P Tijssen
- Heart Centre, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J P Herrman
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - P C Smits
- Heart Centre, Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - M J Suttorp
- Heart Centre, Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - E Ronner
- Heart Centre, Department of Cardiology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - G J Laarman
- Heart Centre, Department of Cardiology, TweeSteden Hospital, Tilburg, The Netherlands
| | - M S Patterson
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - G Amoroso
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - M A Vink
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - R J van der Schaaf
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - F W A Verheugt
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
| | - R K Riezebos
- Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1090 HM, PO Box 95500, Amsterdam, The Netherlands
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Zhang Q, Hu J, Yang ZK, Ding FH, Zhang JS, Du R, Zhu TQ, Shen WF, Kirtane AJ, Zhang RY. Correlates and outcomes related to periprocedural myocardial injury during percutaneous coronary intervention for chronic total occlusion: Results from a prospective, single center PCI registry. Catheter Cardiovasc Interv 2016; 87 Suppl 1:616-23. [PMID: 26864270 DOI: 10.1002/ccd.26406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Qi Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Jian Hu
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Zhen Kun Yang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Feng Hua Ding
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Jian Sheng Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Run Du
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Tian Qi Zhu
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Wei Feng Shen
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Ajay J. Kirtane
- Columbia University/New York-Presbyterian Hospital; New York New York
| | - Rui Yan Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
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Liou K, Jepson N, Buckley N, Chen V, Thomas S, Russell EA, Ooi SY. Design and Rationale for the Endothelin-1 Receptor Antagonism in the Prevention of Microvascular Injury in Patients with non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (ENDORA-PCI) Trial. Cardiovasc Drugs Ther 2016; 30:169-75. [DOI: 10.1007/s10557-016-6641-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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83
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Kashlov JK, Donev IS, Doneva JG, Valkov VD, Kirkorova AD, Ghenev PI, Conev NV, Radeva TR, Ivanov BD, Georgieva ZT. Serum levels of RIPK3 and troponin I as potential biomarkers for predicting impaired left ventricular function in patients with myocardial infarction with ST segment elevation and normal troponin I levels prior percutaneous coronary intervention. Biosci Trends 2016; 10:294-9. [DOI: 10.5582/bst.2016.01077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Javor K Kashlov
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Department of Internal Medicine, St. Marina UMHAT
| | - Ivan S Donev
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Clinic of Medical Oncology, St. Marina UMHAT
| | - Jordanka G Doneva
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Department of Internal Medicine, St. Marina UMHAT
| | - Veselin D Valkov
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Department of Cardiology, St. Marina UMHAT
| | - Arpine D Kirkorova
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Department of Internal Medicine, St. Marina UMHAT
| | - Peter I Ghenev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University of Varna, St. Marina UMHAT
- Center of Clinical Pathology, St. Marina UMHAT
| | - Nikolay V Conev
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Clinic of Medical Oncology, St. Marina UMHAT
| | | | - Borislav D Ivanov
- Department of Clinical Medical Sciences, Medical University of Varna
| | - Zhaneta T Georgieva
- Department of Propedeutics of Internal Medicine, Medical University of Varna
- Department of Internal Medicine, St. Marina UMHAT
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Effects of liposomal prostaglandin E1 on periprocedural myocardial injury in patients with unstable angina undergoing an elective percutaneous coronary intervention. Coron Artery Dis 2015; 26:671-7. [DOI: 10.1097/mca.0000000000000294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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85
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Zhai C, Cong H, Liu Y, Zhang Y, Liu X, Zhang H, Ren Z. Effect of High-Dose Statin Pretreatment on the Incidence of Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention: Grading the Evidence Through a Cumulative Meta-analysis. Clin Cardiol 2015; 38:668-78. [PMID: 26442621 DOI: 10.1002/clc.22471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/30/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Previous studies have showed that high-dose statin pretreatment could reduce the incidence of periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI). However, previous analyses have not performed reliable grading of evidence. HYPOTHESIS In previous analyses, it supposed that the high-dose statin pretreatment was effective in reduction of the rate of PMI. In this analysis, we evaluated the effect of high-dose statin pretreatment on the reduction of rate of PMI based on a cumulative meta-analysis and grading of evidence. METHODS We assembled the relevant published randomized controlled trials that compared the efficacy of high-dose statin pretreatment prior to PCI. We evaluated the risk of PMI by a cumulative meta-analysis, with subgroups stratified by clinical classifications and different statin histories, and we conducted explicit grading of evidence. RESULTS High-dose statin pretreatment caused a 55% reduction in PMI through this cumulative meta-analysis of 23 RCTs (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.37-0.54). The effect of high-dose statin pretreatment was significant for the stable angina subgroup (OR: 0.42, 95% CI: 0.32-0.56), ACS subgroup (OR: 0.43, 95% CI: 0.29-0.64), and the mixed presentation subgroup (OR: 0.50, 95% CI: 0.36-0.70). In different statin therapy histories, high-dose statin pretreatment reduced incidence of PMI 55% in the statin-naive subgroup (OR: 0.45, 95% CI: 0.36-0.56) and 54% in the low-dose statin subgroup (OR: 0.46, 95% CI: 0.32-0.66). The GRADE system indicated that the overall evidence quality was moderate. This finding may strengthen the confidence in any recommendations. CONCLUSIONS High-dose statin pretreatment can reduce the rate of PMI, irrespective of either the clinical presentation or previous statin-treatment history. Importantly, the overall GRADE evidence quality was moderate.
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Affiliation(s)
- ChuanNan Zhai
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.,Department of Cardiology, Tianjin Gongan Hospital, Tianjin, China
| | - HongLiang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - YuJie Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ying Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - XianFeng Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - ZhiJing Ren
- Graduate School, Tianjin Medical University, Tianjin, China
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Zhang Y, Ma XJ, Shi DZ. Effect of Trimetazidine in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis. PLoS One 2015; 10:e0137775. [PMID: 26367001 PMCID: PMC4569304 DOI: 10.1371/journal.pone.0137775] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/20/2015] [Indexed: 12/03/2022] Open
Abstract
Optimizing the metabolism of the myocardium is a new strategy for patients with ischemic heart disease. Many studies have reported beneficial effects of trimetazidine (TMZ) on the clinical prognosis of patients with ischemic heart disease, but whether these beneficial effects are extended to patients undergoing percutaneous coronary intervention (PCI) remains uncertain. A meta-analysis was performed to evaluate the effect of TMZ on patients undergoing PCI. We conducted an electronic search of PubMed, Cochrane databases, the China National Knowledge Infrastructure, and Chinese Biological Medicine Database to identify randomized controlled trials. Methodological quality was assessed according to the Jadad scale score, and the meta-analysis was performed using Cochrane Collaboration RevMan 5.2 and Comprehensive Meta-Analysis. Dichotomous data were analyzed using relative risk (RR) or odds ratio (OR) with effect size indicated by the 95% confidence interval (CI), and continuous variables were analyzed using weighted mean differences (WMD) with effect size indicated by the 95% CI. Sensitivity analysis was performed by changing the statistical methods and effect model. Nine studies involving a total of 778 patients were included in this meta-analysis. Additional use of TMZ significantly improved the left ventricular ejection fraction (WMD: 3.11, 95% CI: [2.26, 3.96]) and reduced elevated cardiac troponin Ic level (RR: 0.69, 95% CI: [0.48, 0.99]), angina attacks during PCI (OR: 0.16, 95% CI: [0.07, 0.38]), and ischemic ST-T changes on the echocardiogram during PCI (RR: 0.76, 95% CI: [0.59, 0.98]). However, no significant difference was observed in serum BNP level 30 days after PCI between the experimental and control group. Additional use of TMZ for patients undergoing PCI may reduce myocardial injury during the procedure and improve cardiac function.
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Affiliation(s)
- Ying Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-juan Ma
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Da-zhuo Shi
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail:
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Strom J, Xu B, Tian X, Chen QM. Nrf2 protects mitochondrial decay by oxidative stress. FASEB J 2015; 30:66-80. [PMID: 26340923 DOI: 10.1096/fj.14-268904] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
Sublethal levels of oxidative stress are commonly associated with various pathophysiological conditions. Cardiomyocytes have the highest content of mitochondria among all cell types, allowing the study of mitochondria in cells surviving oxidative stress and address whether nuclear factor-erythroid-derived 2-related factor 2 (Nrf2) can reverse these changes. Mitochondria normally exist in elaborated networks, which were replaced by predominately individual punctuate mitochondria 24 h after exposure to a nonlethal dose of H2O2. Electron microscopy revealed that cells surviving H2O2 show swelling of mitochondria with disorganized cristae and areas of condensation. Measurements of functional mitochondria showed a H2O2 dose-dependent decrease over a course of 5 d. At the protein and mRNA levels, cells surviving H2O2 treatment show a reduction of mitochondrial components, cytochrome c, and cytochrome b. Nrf2 overexpression prevented H2O2 from inducing mitochondria morphologic changes and reduction of cytochrome b/c. Although Nrf2 is known as a transcription factor regulating antioxidant and detoxification genes, Nrf2 overexpression did not significantly reduce the level of protein oxidation. Instead, Nrf2 was found to associate with the outer mitochondrial membrane. Mitochondria prepared from the myocardium of Nrf2 knockout mice are more sensitive to permeability transition. Our data suggest that Nrf2 protects mitochondria from oxidant injury likely through direct interaction with mitochondria.
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Affiliation(s)
- Joshua Strom
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Beibei Xu
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Xiuqing Tian
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Qin M Chen
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Paradis JM, Maniar HS, Lasala JM, Kodali S, Williams M, Lindman BR, Damiano RJ, Moon MR, Makkar RR, Thourani VH, Babaliaros V, Xu K, Ayele GM, Svensson L, Leon MB, Zajarias A. Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement: A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves). JACC Cardiovasc Interv 2015; 8:1468-1479. [PMID: 26404200 PMCID: PMC4624400 DOI: 10.1016/j.jcin.2015.06.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR). BACKGROUND The clinical significance of cardiac biomarker elevation after TAVR remains unclear. METHODS Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (ΔcTnI); and creatine kinase-myocardial band (ΔCK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173). RESULTS At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (ΔcTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; ΔCK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (ΔcTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; ΔCK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year. CONCLUSIONS After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of ΔCK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes.
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Affiliation(s)
- Jean-Michel Paradis
- Quebec Heart and Lung Institute, Quebec, Canada; Cardiovascular Research Foundation, New York, New York.
| | - Hersh S Maniar
- Washington University School of Medicine, St Louis, Missouri
| | - John M Lasala
- Washington University School of Medicine, St Louis, Missouri
| | - Susheel Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Mathew Williams
- New York University Langone Medical Center, New York, New York
| | - Brian R Lindman
- Washington University School of Medicine, St Louis, Missouri
| | - Ralph J Damiano
- Washington University School of Medicine, St Louis, Missouri
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri
| | - Raj R Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, New York
| | | | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Alan Zajarias
- Washington University School of Medicine, St Louis, Missouri
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Pan Y, Tan Y, Li B, Li X. Efficacy of high-dose rosuvastatin preloading in patients undergoing percutaneous coronary intervention: a meta-analysis of fourteen randomized controlled trials. Lipids Health Dis 2015; 14:97. [PMID: 26306625 PMCID: PMC4549857 DOI: 10.1186/s12944-015-0095-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/16/2015] [Indexed: 12/17/2022] Open
Abstract
Background Numerous studies have evidenced that statins can reduce the incidence of cardiovascular disease. However, the effects of high-dose rosuvastatin (RSV) preloading in patients undergoing percutaneous coronary intervention (PCI) are controversial. Objective We attempted to identify and quantify the potential cardioprotective benefits of high-dose RSV preloading on final thrombolysis in myocardial infarction (TIMI) flow grade, major adverse cardiac events (MACE), and peri-procedural myocardial injury (PMI) in patients undergoing PCI. Methods Pubmed, EMBASE, Cochrane Central Register of Controlled Trials and ISI Web of Science databases were systematically searched for randomized controlled trials (RCTs) up to June 2015. We assessed the incidence of MACE and PMI in all enrolled patients for subgroups stratified by clinical presentation and previous statin therapy during the follow-up period. Results Fourteen trials with 3368 individuals were included in our meta-analysis. High-dose RSV preloading before PCI lead to a 58 % reduction in MACE (odds ratio [OR] = 0.42, 95 % confidence intervals [CI]: 0.29-0.61, P < 0.00001) and a 60 % reduction in PMI (OR = 0.40, 95 % CI: 0.25–0.63, P < 0.0001). This procedure also improved the final TIMI flow grade in patients undergoing PCI (OR = 1.61, 95 % CI: 1.09–2.38, P = 0.02). The benefits on MACE were significant for both stable angina patients (OR = 0.42, 95 % CI: 0.21-0.87, P = 0.02) and acute coronary syndrome (ACS) patients (OR = 0.42, 95 % CI: 0.27-0.65, P < 0.0001); and for both statin naïve patients (OR = 0.42, 95 % CI: 0.28-0.64, P < 0.0001) and previous statin therapy patients (OR = 0.28, 95 % CI: 0.10-0.73, P = 0.01). Conclusion High-dose RSV preloading can significantly improve myocardial perfusion and reduce both MACE and PMI in patients undergoing PCI. The cardioprotective benefits of RSV preloading were significant in not only stable angina and ACS patients but also statin naïve and previous statin therapy patients. The cardioprotective benefits of RSV preloading in the follow-up period mainly resulted from a reduction in spontaneous MI and TVR, especially for ACS and statin naïve patients.
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Affiliation(s)
- Yilong Pan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuan Tan
- Department of Anesthsia, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaodong Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Liang S, Aiqun M, Figtree G, Ping Z. GAPDH-silence preserves H9C2 cells from acute hypoxia and reoxygenation injury. Int J Biol Macromol 2015; 81:375-86. [PMID: 26279122 DOI: 10.1016/j.ijbiomac.2015.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute hypoxia and reoxygenation injury, as a common environmental stress condition, is a basic condition of most pathophysiological processes. It has been approve that autophagy and oxidant stress could contribute to acute hypoxia and reoxygenation injury. This study is aimed to examine the effect of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) silence on cell injury with acute hypoxia and reoxygenation injury by autophagy and antioxidant stress pathway. METHODS GAPDH expression was silenced by siRNA in H9C2 cardiomyoblasts with acute hypoxia and reoxygenation injury. Autophagy was detected by western blot for autophagy proteins and monodansylcadaverine (MDC) staining for acidic substances. Pro-apoptosis protein and flow cytometry were used to assess cell apoptosis and death and intracellular adenosine triphosphate (ATP) relative concentration was measured. Oxidant stress was assessed by measuring 2'-7'-dichlorodihydrofluorescein diacetate (DCFH-DA), thiobarbituric acid reactive substances (TBARS), glutathione (GSH) and super oxide dismutase (SOD). RESULTS In this study, GAPDH-silence enhanced autophagy in H9C2 cells with acute hypoxia and reoxygenation injury, decreased oxidant stress and increased antioxidant pathways; and reduced cell apoptosis and death. However, GAPDH-silence had no significant effect on cell energy. CONCLUSION GAPDH pre-silence by siRNA reduces H9C2 cell death occurring via autophagy and anti-oxidative stress pathway in acute hypoxia and reoxygenation injury. This study enriches the understanding of GAPDH pathophysiology role, and provides potential new therapeutic targets for cardiac disease states characterized by oxidative stress.
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Affiliation(s)
- Shao Liang
- Department of Cardiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - Ma Aiqun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Gemma Figtree
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Zhang Ping
- Department of Geriatrics & Neurology, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Fujita J, Kohsaka S, Ueda I, Inohara T, Maekawa Y, Kawamura A, Kanazawa H, Hayashida K, Tabei R, Tohyama S, Seki T, Suzuki M, Sano M, Fukuda K. The Prevalence of Clinically Significant Ischemia in Patients Undergoing Percutaneous Coronary Intervention: A Report from the Multicenter Registry. PLoS One 2015; 10:e0133568. [PMID: 26231033 PMCID: PMC4521937 DOI: 10.1371/journal.pone.0133568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Myocardial perfusion scintigraphy (MPS) plays an important role in the evaluation and quantification of myocardial ischemia, and those with significant ischemia (SI) benefit most from revascularization procedures. This study aimed to identify the clinical factors and anatomical features associated with SI in patients with stable ischemic heart disease (SIHD). Methods and Results Data were analyzed from 4197 SIHD patients undergoing percutaneous coronary intervention (PCI). Ischemia was based on MPS findings prior to PCI, with SI defined as an ischemic region of more than 10% of the total left ventricular area. Logistic regression analysis was performed to identify any clinical factors associated with SI. MPS was used to evaluate 1070 (25.5%) patients pre-procedurally. Patients with a history of heart failure, stroke, or anginal symptoms with Canadian Cardiovascular Society class 2 or more were more likely to have SI (odds ratio [OR] 1.63, p = 0.025, OR: 1.85, p = 0.009, and OR: 1.49, p = 0.003, respectively). When angiographic variables were considered, a proximal left anterior descending artery (pLAD) lesion was the sole factor associated with SI (OR: 1.45, p = 0.012). Importantly, those with SI had more in-hospital complications (p = 0.006), most notably post-PCI infarcts (p = 0.008). Conclusions Patients’ background data, such as stronger anginal symptoms or a pLAD lesion, were associated with SI. Patients with SI must be treated with PCI to improve their long-term prognosis; however, procedure-related complications happen more frequently in SI patients than in non-SI patients. Physicians must give their full attention when performing the PCI procedure in SI patients to minimize their complication rate.
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Affiliation(s)
- Jun Fujita
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
- * E-mail: (JF); (SK)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
- * E-mail: (JF); (SK)
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Ryota Tabei
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Shugo Tohyama
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Tomohisa Seki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Masahiro Suzuki
- National Hospital Organization Saitama National Hospital, 2–1 Suwa, Wako-shi, Saitama, 351–0102, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan
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Kurita A, Takashima H, Ando H, Kumagai S, Waseda K, Gosho M, Amano T. Effects of eicosapentaenoic acid on peri-procedural (type IVa) myocardial infarction following elective coronary stenting. J Cardiol 2015; 66:114-9. [DOI: 10.1016/j.jjcc.2014.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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Zeng RX, Li XL, Zhang MZ, Wang XW, Guo YL, Zhu CG, Ren Y, Li S, Zhang Y, Liu G, Xu RX, Dong Q, Li JJ. Preprocedural N-terminal pro-B-type natriuretic peptide as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients without cardiac dysfunction. Scandinavian Journal of Clinical and Laboratory Investigation 2015. [PMID: 26203960 DOI: 10.3109/00365513.2015.1060518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Elevated preprocedural N-term pro-B-type natriuretic peptide (NT-pro-BNP) and postprocedural cardiac troponin I (cTnI) are related to a poor cardiac outcome in the non-diabetic population. We hypothesized that preprocedural NT-pro-BNP might be a useful marker in predicting periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) in type 2 diabetes (T2D). METHODS We prospectively enrolled 1194 consecutive diabetic patients with normal cardiac function and preprocedural cTnI who were successfully undergoing elective PCI. Preprocedural NT-pro-BNP levels were assessed at admission, and PMI was evaluated by analysis of cTnI within 24 hours. The relationship between preprocedural NT-pro-BNP levels and the peak values of cTnI after PCI was examined. RESULTS Patients with high baseline NT-pro-BNP levels had higher postprocedural cTnI levels (β = 0.123, p < 0.001). In the multivariable model, NT-pro-BNP was associated with higher risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN, OR, 3.13; 95% CI, 1.51-6.50; p = 0.002), 3 × ULN (OR, 2.44; 95% CI, 1.17-5.08; p = 0.018), 5 × ULN (OR, 3.18; 95% CI, 1.44-7.0; p = 0.004), respectively. Moreover, the incidence of cTnI elevation was higher in patients with the upper tertile of NT-pro-BNP levels than that in ones with the lower tertile of NT-pro-BNP levels (> 1 × ULN: 63.1% vs. 50.0%, p < 0.001; > 3 × ULN: 39.2% vs. 31.9%, p = 0.032; > 5 × ULN: 30.4% vs. 21.9%, p < 0.006; respectively). CONCLUSIONS Our data, for the first time, demonstrated that increased preprocedural NT-pro-BNP levels were strongly and independently associated with a higher risk of PMI, suggesting that baseline NT-pro-BNP level might be a useful marker for predicting PMI following PCI in diabetic patients without cardiac dysfunction.
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Affiliation(s)
- Rui-Xiang Zeng
- a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Ishibashi Y, Muramatsu T, Nakatani S, Sotomi Y, Suwannasom P, Grundeken MJ, Cho YK, Garcia-Garcia HM, van Boven AJ, Piek JJ, Sabaté M, Helqvist S, Baumbach A, McClean D, de Sousa Almeida M, Wasungu L, Miquel-Hebert K, Dudek D, Chevalier B, Onuma Y, Serruys PW. Incidence and Potential Mechanism(s) of Post-Procedural Rise of Cardiac Biomarker in Patients With Coronary Artery Narrowing After Implantation of an Everolimus-Eluting Bioresorbable Vascular Scaffold or Everolimus-Eluting Metallic Stent. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Firoz CK, Jabir NR, Kamal MA, Alama MN, Damanhouri GA, Khan W, Alzahrani AS, Almehdar HA, Tabrez S. Neopterin: An immune biomarker of coronary artery disease and its association with other CAD markers. IUBMB Life 2015; 67:453-9. [DOI: 10.1002/iub.1390] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/16/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Chelapram Kandy Firoz
- King Fahd Medical Research Center; King Abdulaziz University; Jeddah 21589 Saudi Arabia
| | - Nasimudeen R. Jabir
- King Fahd Medical Research Center; King Abdulaziz University; Jeddah 21589 Saudi Arabia
| | - Mohammad A. Kamal
- King Fahd Medical Research Center; King Abdulaziz University; Jeddah 21589 Saudi Arabia
| | - Mohammed Nabil Alama
- Department of Cardiology, Faculty of Medicine; King Abdulaziz University Hospital; Jeddah Saudi Arabia
| | - Ghazi A. Damanhouri
- King Fahd Medical Research Center; King Abdulaziz University; Jeddah 21589 Saudi Arabia
| | - Waseem Khan
- Department of Radiology, Faculty of Medicine; King Abdulaziz University Hospital; Jeddah Saudi Arabia
| | - Anas S. Alzahrani
- Department of Cardiology; King Saud Bin Abdulaziz University for Health Sciences; Jeddah Saudi Arabia
| | - Hussein A. Almehdar
- Department of Biology, Faculty of Science; King Abdulaziz University; Jeddah Saudi Arabia
| | - Shams Tabrez
- King Fahd Medical Research Center; King Abdulaziz University; Jeddah 21589 Saudi Arabia
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Reddy K, Khaliq A, Henning RJ. Recent advances in the diagnosis and treatment of acute myocardial infarction. World J Cardiol 2015; 7:243-276. [PMID: 26015857 PMCID: PMC4438466 DOI: 10.4330/wjc.v7.i5.243] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/28/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
The Third Universal Definition of Myocardial Infarction (MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient’s plasma of cardiac troponin (cTn) with at least one cTn measurement greater than the 99th percentile of the upper normal reference limit during: (1) symptoms of myocardial ischemia; (2) new significant electrocardiogram (ECG) ST-segment/T-wave changes or left bundle branch block; (3) the development of pathological ECG Q waves; (4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or (5) identification of intracoronary thrombus by angiography or autopsy. Myocardial infarction, when diagnosed, is now classified into five types. Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI. However, high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis. The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated, especially if the initial ECG is not diagnostic of MI.
There have been significant advances in adjunctive pharmacotherapy, procedural techniques and stent technology in the treatment of patients with MIs. The routine use of antiplatelet agents such as clopidogrel, prasugrel or ticagrelor, in addition to aspirin, reduces patient morbidity and mortality. Percutaneous coronary intervention (PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI. Drug eluting coronary stents are safe and beneficial with primary coronary intervention. Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein IIb/IIIa receptor antagonists and is associated with a significant reduction in bleeding. The intra-coronary use of a glycoprotein IIb/IIIa antagonist can reduce infarct size. Pre- and post-conditioning techniques can provide additional cardioprotection. However, the incidence and mortality due to MI continues to be high despite all these recent advances. The initial ten year experience with autologous human bone marrow mononuclear cells (BMCs) in patients with MI showed modest but significant increases in left ventricular (LV) ejection fraction, decreases in LV end-systolic volume and reductions in MI size. These studies established that the intramyocardial or intracoronary administration of stem cells is safe. However, many of these studies consisted of small numbers of patients who were not randomized to BMCs or placebo. The recent LateTime, Time, and Swiss Multicenter Trials in patients with MI did not demonstrate significant improvement in patient LV ejection fraction with BMCs in comparison with placebo. Possible explanations include the early use of PCI in these patients, heterogeneous BMC populations which died prematurely from patients with chronic ischemic disease, red blood cell contamination which decreases BMC renewal, and heparin which decreases BMC migration. In contrast, cardiac stem cells from the right atrial appendage and ventricular septum and apex in the SCIPIO and CADUCEUS Trials appear to reduce patient MI size and increase viable myocardium. Additional clinical studies with cardiac stem cells are in progress.
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Zhang Q, Long Wang X, Lei Liao M, Hu J, Kun Yang Z, Hua Ding F, Sheng Zhang J, Du R, Qi Zhu T, Feng Shen W, Yan Zhang R. Periprocedural use of tirofiban in elective percutaneous coronary intervention for long coronary lesions in stable patients with overlapping drug-eluting stents-the PETITION study: A prospective, randomized, multicenter study. Catheter Cardiovasc Interv 2015; 85 Suppl 1:762-9. [PMID: 25630513 DOI: 10.1002/ccd.25864] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/07/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Qi Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Xiao Long Wang
- Department of Cardiology; Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; Shanghai 201203 China
| | - Min Lei Liao
- Department of Cardiology; Wusong Hospital; Shanghai 200940 China
| | - Jian Hu
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Zhen Kun Yang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Feng Hua Ding
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Jian Sheng Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Run Du
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Tian Qi Zhu
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Wei Feng Shen
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
| | - Rui Yan Zhang
- Department of Cardiology; Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai 200025 China
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Legrand V, Cuisset T, Chenu P, Vrolix M, Martinez C, Dens J, Gach O, Boland J, Claeys MJ, Magne J, Barbato E, Wijns W. Platelet reactivity and cardiovascular events after percutaneous coronary intervention in patients with stable coronary artery disease: the Stent Thrombosis In Belgium (STIB) trial. EUROINTERVENTION 2015; 10:204-11. [PMID: 24952058 DOI: 10.4244/eijv10i2a34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The Stent Thrombosis In Belgium (STIB) trial aimed to determine whether assessing platelet reactivity (PR) in patients with stable coronary artery disease undergoing elective percutaneous coronary intervention (PCI) could predict the risk of ischaemic complications and adverse clinical events up to 30 days post PCI. METHODS AND RESULTS PR before intervention was determined in 891 patients undergoing PCI for stable angina pectoris. Twelve to 24 hours before PCI, all patients received a 600 mg clopidogrel dose followed by 75 mg daily, and 500 mg of aspirin followed by 80-100 mg daily. Residual PR was assessed by VerifyNow point-of-care aspirin and P2Y12 assay before PCI. "Non-responders" to antiplatelet therapy were defined as aspirin reaction unit (ARU) >550 and as P2Y12 reaction unit (PRU) >230. The endpoint of the study was the composite of periprocedural myonecrosis, stent thrombosis, non-fatal myocardial infarction (MI), stroke and death at 30 days in patients with or without high PR. The endpoint was observed in 180 patients: four deaths, one stroke, 11 Q-wave MI, three non-Q-wave MI and 161 periprocedural myonecroses. At multivariate analysis, the endpoint was predicted by total stent length (OR: 1.020), GFR <60 ml/min (OR: 1.87), history of PCI (OR: 0.58), white blood cell count (OR: 1.95) and diabetes (OR: 1.83). No significant association was found between residual PR and the primary endpoint or any of its components. CONCLUSIONS PR measured before PCI in stable patients undergoing elective PCI who are preloaded with 500 mg of aspirin and 600 mg of clopidogrel is not predictive of periprocedural myocardial injury or adverse ischaemic complications up to 30 days.
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Liou K, Jepson N, Kellar P, Ng B, Isbister J, Giles R, Friedman D, Allan R, Lau A, Pitney M, Ooi SY. Prognostic Significance of Peri-procedural Myocardial Infarction in the Era of High Sensitivity Troponin: A Validation of the Joint ACCF/AHA/ESC/WHF Universal Definition of Type 4a Myocardial Infarction with High Sensitivity Troponin T. Heart Lung Circ 2015; 24:673-81. [PMID: 25697382 DOI: 10.1016/j.hlc.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/01/2015] [Accepted: 01/05/2015] [Indexed: 11/18/2022]
Abstract
AIMS This study aims to validate the joint ACCF/AHA/ESC/WHF Universal Definition of peri-procedural myocardial infarction (PMI) with high sensitivity troponin T (hsTnT). METHODS A retrospective cohort study encompassing patients admitted to our institution between May 2012 and April 2013 was performed. RESULTS 630 patients underwent percutaneous coronary interventions during the study period. Among them, 459 patients met the inclusion criteria and were eligible for analyses. 76.9% of these patients were male, while the mean age was 68.6. PMI was observed in 4.3% of the patients based on the Universal Definition. The predictors of PMI were chronic kidney disease (OR: 3.0, p=0.026), family history of cardiovascular disease (OR: 2.7, p=0.043) and use of IIb/IIIa inhibitors (OR 4.2, p=0.01). MACE was reported in 4.4% of the patients at 12 months, and was significantly and independently associated with PMI (OR 7.3, p=0.003) in a multivariate model which accounted for lesion complexity, patients' baseline clinical information, dual-antiplatelet status at follow-up and various procedural characteristics. The post-procedural hsTnT was much higher in those who suffered MACE than those who did not (156 v.s. 43 ng/L, p<0.001). CONCLUSION PMI as defined by the current Universal Definition using hsTnT is an independent predictor of adverse clinical outcome at 12 months in patients undergoing PCI. Accordingly, PMI remains a clinically relevant factor in current practice and should be considered a key outcome measure in clinical trials and a potential target for therapy.
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Affiliation(s)
- Kevin Liou
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Nigel Jepson
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Petrina Kellar
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Ben Ng
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Julia Isbister
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Robert Giles
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Daniel Friedman
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Roger Allan
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Antony Lau
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Mark Pitney
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Sze-Yuan Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
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