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Suruga K, Shimokawahara H, Miyagi A, Sugiyama Y, Suetomi T, Ogawa A, Matsubara H. Flow Grade-Based Success Rates, Complication Rates, and Balloon Pulmonary Angioplasty Patency for Total Occlusions. Can J Cardiol 2024; 40:625-633. [PMID: 38081510 DOI: 10.1016/j.cjca.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The number of successfully recanalized total occlusions affects hemodynamic improvement after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to clarify the current efficacy, patency, and success rate of BPA for total occlusions. METHODS Between April 2016 and August 2021, 178 BPAs were performed in 100 patients with CTEPH and total occlusions. The primary success and subsequent patency rates immediately before the second BPA procedure (follow-up) were compared between the segmental and subsegmental groups, based on the flow grade, which was defined as follows: 0, no reperfusion; 1, minimal reperfusion; 2, partial reperfusion; and 3, complete reperfusion. RESULTS Total occlusions were mainly located in the right lung (70%) and lower lobes (48%). The primary success rate was 88%, with significant improvements in oxygenation, hemodynamic parameters, and 6-minute walk test. The primary flow grade did not differ between groups. However, the proportion of lesions with a flow grade of 2 or 3 at follow-up was significantly higher in the subsegmental group than in the segmental group (84% vs 45%, respectively; P < 0.01). In multivariate analysis, flow grade in the acute phase (odds ratio [OR], 46.9; 95% confidence interval [CI], 12.54-176.78; P < 0.01) and subsegmental lesions (OR, 13.8; 95% CI, 3.24-58.94; P < 0.01) were independently associated with better patency (flow grade of 2 or 3) at follow-up. CONCLUSIONS Total occlusions can be safely and effectively treated with BPA. BPA for total occlusions may be preferable for subsegmental over segmental lesions.
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Affiliation(s)
- Kazuki Suruga
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan.
| | - Ayane Miyagi
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Yoichi Sugiyama
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Takeshi Suetomi
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Aiko Ogawa
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Cardiology and Clinical Science, NHO Okayama Medical Center, Okayama, Japan
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Predictive Value of Cardiac Magnetic Resonance for Left Ventricular Remodeling of Patients with Acute Anterior Myocardial Infarction. Diagnostics (Basel) 2022; 12:diagnostics12112780. [PMID: 36428840 PMCID: PMC9689537 DOI: 10.3390/diagnostics12112780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Heart failure is a serious complication resulting from left ventricular remodeling (LVR), especially in patients experiencing acute anterior myocardial infarction (AAMI). It is crucial to explore the predictive parameters for LVR following primary percutaneous coronary intervention (PPCI) in patients with AAMI. Methods: A total of 128 AAMI patients who were reperfused successfully by PPCI were enrolled sequentially from June 2018 to December 2019. Cardiovascular magnetic resonance (CMR) was performed at the early stage (<7 days) and after the 6-month follow-up. The patients were divided into LVR and non-LVR groups according to the increase of left ventricular end diastolic volume (LVEDV) measured by the second cardiac magnetic resonance examination ≥20% from baseline. (3) Results: The left ventricular ejection fraction (LVEF), the global longitudinal strain (GLS), the peak circumferential strain in infarcted segments, and the infarct size (IS) remained significantly different in the multivariate logistic regression analysis (all p < 0.05). The area under the receiver operating characteristic curve of Model 1, wherein the GLS was added to the LVEF, was 0.832 (95% CI 0.758−0.907, p < 0.001). The C-statistics for Model 2, which included the infarct-related regional parameters (IS and the peak circumferential strain in infarcted segments)was 0.917 (95% CI 0.870−0.965, p < 0.001). Model 2 was statistically superior to Model 1 in predicting LVR (IDI: 0.190, p = 0.002). (4) Conclusions: Both the global and regional CMR parameters were valuable in predicting LVR in patients with AAMI following the PPCI. The local parameters of the infarct zones were superior to those of the global ones.
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Cimmino G, di Serafino L, Cirillo P. Pathophysiology and mechanisms of Acute Coronary Syndromes: athero-thrombosis, immune-inflammation and beyond. Expert Rev Cardiovasc Ther 2022; 20:351-362. [PMID: 35510629 DOI: 10.1080/14779072.2022.2074836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The pathophysiology of atherosclerosis and its acute complications, such as the Acute Coronary Syndromes (ACS), is continuously under investigation. Immunity and inflammation seem to play a pivotal role in promoting formation and grow of atherosclerotic plaques. At the same time, plaque rupture followed by both platelets' activation and coagulation cascade induction lead to intracoronary thrombus formation. Although these phenomena might be considered responsible of about 90% of ACS, in up to 5-10% of acute syndromes a non-obstructive coronary artery disease (MINOCA) might be documented. This paper gives an overview on athero-thrombosis and immuno-inflammation processes involved in ACS pathophysiology also emphasizing the pathological mechanisms potentially involved in MINOCA. AREAS COVERED The relationship between immuno-inflammation and atherothrombosis is continuously updated by recent findings. At the same time, pathophysiology of MINOCA still remains a partially unexplored field, stimulating the research of potential links between these two aspects of ACS pathophysiology. EXPERT OPINION Pathophysyiology of ACS has been extensively investigated; however, several grey areas still remain. MINOCA represents one of these areas. At the same time, many aspects of immune-inflammation processes are still unknown. Thus, research should be continued to shed a brighter light on both these sides of "ACS" moon.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Chen C, Ling C, Luo L, Yang Y, Huang T, Wei L, Wang H. Multimodal recanalization for subacute symptomatic internal carotid artery occlusion due to atherosclerosis: Outcomes and notes on hybrid techniques. Ann Vasc Surg 2022; 84:114-125. [PMID: 35247538 DOI: 10.1016/j.avsg.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Subacute internal carotid artery occlusion (ICAO) is associated with ipsilateral recurrent stroke, and successful recanalization of ICAO can improve cerebral blood perfusion (CBP) and prevent stroke. However, the optimal treatment remains controversial. METHODS We conducted a retrospective analysis of patients with subacute symptomatic ICAO due to atherosclerosis treated at our center. The hybrid surgical procedures included carotid endarterectomy, Fogarty balloon catheter embolectomy, aspiration thrombectomy and percutaneous transluminal angioplasty/stenting. Recanalization rates, CBP improvement, stroke recurrence and restenosis/reocclusion were investigated. RESULTS Fourteen symptomatic atherosclerotic ICAO patients (type A, 4; type C, 10; men, 11; women, 3; average age, 68.1 ± 7.9 years) in the subacute phase were treated with a multimodal recanalization technique. Symptoms included mild cerebral infarction, transient ischemic attack (TIA) and amaurosis fugax. The average onset-to-treatment time was 18.1 ± 4.8 days. The successful recanalization (thrombolysis in cerebral ischemia grade 2 or 3) rate was 100%. The ipsilateral-to-contralateral mean transit time ratio was significantly lower at the 1-year follow-up than preoperatively (1.01 ± 0.05 vs. 1.26 ± 0.09, P < 0.0001). There was one case of restenosis detected 1 year after surgery and no cases of reocclusion. During the 28.3 ± 10.0 months of follow-up, only 2 cases of TIA occurred. The average modified Rankin Scale score and National Institute of Health Stroke Scale score were significantly lower at themost recent follow-up than before recanalization (1.21 ± 0.89 vs. 1.86 ± 0.66, P = 0.0003; 1.36 ± 1.55 vs. 2.00 ± 1.88, P = 0.0066). CONCLUSION Multimodal recanalization techniques performed in a hybrid operation theater can safely achieve high recanalization rates in atherosclerotic ICAO patients in the subacute phase, which can be beneficial for recovering CBP and preventing stroke.
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Affiliation(s)
- Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Cong Ling
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Yang Yang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Tengchao Huang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Lei Wei
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong, PR China.
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Comparison of prognostic significance between serum fibrinogen and Global Registry of Acute Coronary Events score for prognosis of patients with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention. Coron Artery Dis 2021; 31:124-129. [PMID: 31833946 DOI: 10.1097/mca.0000000000000789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An elevated fibrinogen level has been demonstrated to be a predictor of adverse coronary heart disease outcome. This study aimed to assess whether fibrinogen is a useful marker to predict the prognosis of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Additionally, the prognostic accuracy of fibrinogen level was compared with that of the Global Registry of Acute Coronary Events (GRACE) score. METHODS A total of 1211 patients with NSTE-ACS undergoing PCI were analyzed in a prospective cohort study. The enrolled patients were divided into a low fibrinogen group (n = 826, fibrinogen ≤ 3.49 mg/dl) and a high fibrinogen group (n = 385, fibrinogen > 3.49 mg/dl) based on a receiver operating characteristic (ROC) curve. The clinical endpoints were death and death/nonfatal reinfarction. An ROC curve analysis was performed and the area under the curve with a 95% confidence interval (CI) was derived and compared with those for the GRACE score to determine the diagnostic value of the serum fibrinogen level. RESULTS Multivariate analysis showed that an elevated baseline fibrinogen level was an independent predictor of death/nonfatal reinfarction (hazard ratio = 1.498, 95% CI: 1.030-2.181, P = 0.035). The prognostic performance of fibrinogen was equivalent to that of the GRACE system in predicting clinical endpoints (C-statistic: z = 1.486, P = 0.14). CONCLUSION Fibrinogen is an independent predictor of death/nonfatal reinfarction in patients with NSTE-ACS undergoing PCI, and its accuracy is similar to that of the GRACE system.
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Sabatine MS, Braunwald E. Thrombolysis In Myocardial Infarction (TIMI) Study Group: JACC Focus Seminar 2/8. J Am Coll Cardiol 2021; 77:2822-2845. [PMID: 34082913 DOI: 10.1016/j.jacc.2021.01.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/14/2023]
Abstract
In 1984, the National Heart, Lung, and Blood Institute (NHLBI) decided to study the efficacy and safety of the treatment of acute myocardial infarction with an emerging therapy, coronary thrombolysis, and thus the TIMI (Thrombolysis In Myocardial Infarction) Study Group was born. Following completion of 3 clinical trials of thrombolytic therapy supported by the NHLBI, TIMI became an academic research organization headquartered at Brigham and Women's Hospital and subsequently branched out to study a wide range of patients, including those with stable coronary, cerebrovascular, and peripheral arterial disease; dyslipidemia; heart failure; atrial fibrillation; diabetes; and obesity. TIMI also began to study a wide range of interventions including thrombolytic, antithrombotic, lipid-modifying, anti-inflammatory, heart failure, glucose-lowering, and weight loss agents. TIMI, now in its 37th year, has completed >70 trials. This review describes the origins of the TIMI Study Group, summarizes several of its completed trials and the major lessons learned from them, and discusses ongoing trials and future directions.
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Affiliation(s)
- Marc S Sabatine
- TIMI (Thrombolysis In Myocardial Infarction) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Eugene Braunwald
- TIMI (Thrombolysis In Myocardial Infarction) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Lai W, Jie H, Jian-Xun D, Ling-Cong K, Jun-Tong Z, Bo-Zhong S, Dong-Ao-Lei A, Bing-Hua C, Song D, Zheng L, Fan Y, Yi-Ning Y, Fu-Hua Y, Jian-Cheng X, Hu-Wen W, Jian-Rong X, Heng G, Jun P. Impact of Concomitant Impairments of the Left and Right Ventricular Myocardial Strain on the Prognoses of Patients With ST-Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:659364. [PMID: 34136542 PMCID: PMC8200389 DOI: 10.3389/fcvm.2021.659364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of concomitant impairments of left and right ventricular (LV and RV) strain on the long-term prognosis of acute ST-elevation myocardial infarction (STEMI) is not clear. Methods: We analyzed CMR images and followed up 420 first STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453). These patients received timely primary percutaneous coronary intervention (PCI) within 12 h and CMR examination within 1 week (median, 5 days; range, 2-7 days) after infarction. Global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) of both ventricles were measured based on CMR cine images. Conventional CMR indexes were also assessed. Primary clinical outcome was composite major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, re-hospitalization for heart failure and stroke. In addition, CMR data from 40 people without apparent heart disease were used as control group. Results: Compared to controls, both LV and RV strains were remarkably reduced in STEMI patients. During follow-up (median: 52 months, interquartile range: 29-68 months), 80 patients experienced major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, heart failure, and stroke. LV-GCS > -11.20% was an independent predictor of MACCEs (P < 0.001). RV-GRS was the only RV strain index that could effectively predict the risk of MACCEs (AUC = 0.604, 95% CI [0.533, 0.674], P = 0.004). Patient with RV-GRS ≤ 38.79% experienced more MACCEs than those with preserved RV-GRS (log rank P < 0.001). Moreover, patients with the concomitant decrease of LV-GCS and RV-GRS were more likely to experience MACCEs than patients with decreased LV-GCS alone (log rank P = 0.010). RV-GRS was incremental to LV-GCS for the predictive power of MACCEs (continuous NRI: 0.327; 95% CI: 0.095-0.558; P = 0.006). Finally, tobacco use (P = 0.003), right coronary artery involvement (P = 0.002), and LV-GCS > -11.20% (P = 0.012) was correlated with lower RV-GRS. Conclusions: The concomitant decrease of LV and RV strain is associated with a worse long-term prognosis than impaired LV strain alone. Combination assessment of both LV and RV strain indexes could improve risk stratification of patients with STEMI. Trial Registration: ClinicalTrials.gov, NCT03768453. Registered 7 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03768453.
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Affiliation(s)
- Wei Lai
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - He Jie
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Jian-Xun
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kong Ling-Cong
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zeng Jun-Tong
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shi Bo-Zhong
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - An Dong-Ao-Lei
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Bing-Hua
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ding Song
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Li Zheng
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Fan
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Yi-Ning
- The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, China
| | - Yan Fu-Hua
- Department of Radiology, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu Jian-Cheng
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wang Hu-Wen
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Xu Jian-Rong
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ge Heng
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Pu Jun
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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Comparison of direct stenting with conventional strategy on myocardial impairments in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 2020; 36:1167-1175. [PMID: 32166507 DOI: 10.1007/s10554-020-01812-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
Direct stenting (DS) without pre-dilatation of the culprit lesion might improve myocardial perfusion and prognosis in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI); however, some studies report conflicting results. We investigated whether DS provides incremental myocardial benefits over conventional stenting (CS) in STEMI patients based on cardiac magnetic resonance imaging (CMR) measures. Reperfused patients who underwent CMR examinations within 1 week of STEMI onset were selected from a multicenter CMR registry of STEMI (NCT: 03768453). Patients were stratified into either a DS or CS group. Each group comprised 137 patients after 1:1 propensity score matching. Major adverse events (MACEs), including death, myocardial re-infarction, re-admission for heart failure, and stroke were noted during a median period of 44 months (interquartile range 32-58 months). DS was associated with larger (p = 0.007) and shorter (p = 0.005) stent sizes than CS. DS and CS achieved comparable angiographic TIMI-3 flow grades (p = 0.86) and myocardial blush grades (p = 0.70). There were no group differences regarding the incidence of CMR manifestations of microvascular dysfunction, including microvascular obstruction (MVO) (p = 0.89) and intramyocardial hemorrhage (p = 0.47), the extent of MVO (p = 0.21), infarction size (p = 0.83), or left ventricular ejection fraction (p = 0.57). Kaplan-Meier analysis revealed similar risks of MACEs (log rank p = 0.909), which occurred in 23.4% of DS and 26.3% of CS patients (p = 0.576). DS did not show any incremental benefits over CS on myocardial impairments as evaluated using CMR.Clinical Trial Registration: Clinicaltrials.gov, NCT: 03768453.
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Heusch G. Coronary microvascular obstruction: the new frontier in cardioprotection. Basic Res Cardiol 2019; 114:45. [DOI: 10.1007/s00395-019-0756-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/16/2022]
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Haybar H, Parsa SA, Khaheshi I, Zayeri ZD. Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis. Cardiovasc Hematol Disord Drug Targets 2018; 19:160-168. [PMID: 30465517 DOI: 10.2174/1871529x19666181120161810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/08/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
AIMS To examine if pentraxin can help identify patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis. METHODS Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities. Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 days after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3). RESULTS The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF was attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 ng.ml-1 PTX3 level, achieved a clinically significant increase in the LVEF as compared to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing an LVEF <40%. CONCLUSION We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevance to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75% of patients with STEMI who have PTX3 levels ≤7 ng.ml-1 imply the need of PCI.
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Affiliation(s)
- Habib Haybar
- Atherosclerosis research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Alipour Parsa
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Deris Zayeri
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Tian C, Song J, He D, Wu J, Sun Z, Sun Z. Predictive Value of Mean Platelet Volume/Platelet Count for Prognosis in Acute Myocardial Infarction. Int Heart J 2018; 59:286-292. [PMID: 29563382 DOI: 10.1536/ihj.17-212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increased mean platelet volume (MPV) has been associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We aim to assess whether MPV/platelet count (MPV/PC) ratio is a useful marker to predict long-term prognosis in patients with STEMI undergoing PCI. Moreover, the prognostic accuracy of MPV/PC ratio is compared with MPV. 962 consecutive patients with STEMI treated with P-PCI were considered. According to the admission MPV/PC values, the population was divided into two groups: high MPV/PC group (n = 320, MPV/PC ≥ 0.055) and low MPV/PC group (n = 642, MPV/PC < 0.055). Multivariate analysis showed that high MPV/PC was an independent predictor of major adverse cardiovascular event (MACE; hazard ratio [HR]: 1.121, 95% confidence interval [CI]: 1.056-1.190, P < 0.01), all-cause mortality (HR: 1.109, 95% CI: 1.016-1.209, P = 0.020), cardiac mortality (HR: 1.141, 95% CI: 1.038-1.253, P = 0.006), nonfatal myocardial reinfarction (HR: 1.148, 95% CI: 1.044-1.262, P = 0.004), and unplanned repeat revascularization (HR: 1.073, 95% CI: 1.007-1.144, P = 0.030), respectively. MPV/PC ratio has good accuracy for predicting MACE (the area under the receiver-operating characteristic curve: 0.764), and the cut-off value was 0.054 with a sensitivity of 0.813 and a specificity of 0.662. The discriminatory performance of MPV/PC ratio was better than MPV for predicting MACE (MPV/PC ratio versus MPV: z = 2.285, P = 0.022), in patients with STEMI undergoing P-PCI. MPV/PC ratio is able to but better than MPV to predict long-term adverse outcomes in patients with STEMI undergoing P-PCI.
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Affiliation(s)
- Chunyang Tian
- Department of Cardiology, Shengjing Hospital of China Medical University
| | - Jia Song
- Department of Cardiology, Shengjing Hospital of China Medical University
| | - Dongxu He
- Department of Cardiology, Shengjing Hospital of China Medical University
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University
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Ajayi NO, Vanker EA, Satyapal KS. The role of coronary artery collaterals in the preservation of left ventricular function: a study to address a long-standing controversy. Cardiovasc J Afr 2017; 28:81-85. [PMID: 28470330 PMCID: PMC5488059 DOI: 10.5830/cvja-2016-054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 04/16/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction: The functional significance of coronary artery collateral (CAC) vasculature in humans has been debated for decades and this has been compounded by the lack of a standard, systematic, objective method of grading and documenting CAC flow in man. CACs serve as alternative conduits for blood in obstructive coronary artery disease. This study aimed to evaluate the impact of CACs on left ventricular function in the presence of total coronary arterial occlusion. Methods: The study group included the coronary angiographic records of 97 patients (mean age: 59 ± 8 years). CACs were graded from 0–3 based on the collateral connection between the donor and recipient arteries. Left ventricular function was computed from the ventriculogram and expressed as ejection fraction (EF). Results: The mean EF of the patients with grades 0, 1, 2 and 3 CACs were calculated as 50.4, 47, 60.5 and 70%, respectively. A significant difference was recorded in the mean EF calculated for the different CAC grades (p = 0.001). There was a significant positive correlation (p < 0.001; r = 0.478) between the mean EF and the CAC grades. Conclusion: The patients with better coronary collateral grades had a higher mean EF. Therefore, as the grade of CACs increased, there was an improvement in their ability to preserve left ventricular function.
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Affiliation(s)
- N O Ajayi
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - E A Vanker
- St Augustine's Hospital, Chelmsford Medical Centre, Durban, South Africa
| | - K S Satyapal
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
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Yang L, Wang H, Zhang Y, Han T, Wang W. The Prognostic Value of Lipoprotein-Associated Phospholipase A 2 in the Long-Term Care of Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2017; 24:822-827. [PMID: 29121808 PMCID: PMC6714881 DOI: 10.1177/1076029617737837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent risk factor for cardiovascular disease. Accordingly, studies from many countries around the world have shown an association between Lp-PLA2 and cardiovascular events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), but this association has not been documented among the Chinese. The aim of this study was to assess the use of Lp-PLA2 as a useful marker for predicting the long-term prognosis of Chinese patients with ACS undergoing PCI. A total of 651 consecutive patients undergoing PCI between September 2013 and January 2015 were divided into 2 groups: the high Lp-PLA2 group (n = 262, Lp-PLA2 > 138 nmol/L) and the low Lp-PLA2 group (n = 389, Lp-PLA2 ≤ 138 nmol/L). The end point was all-cause mortality and rehospitalization. The median follow-up was 24 months. Multivariate analysis showed that high Lp-PLA2 was an independent predictor of all-cause mortality and rehospitalization (hazard ratio: 1.429, 95% confidence interval [CI]: 1.411-1.448; P < .05). The Lp-PLA2 had good accuracy for predicting all-cause mortality and rehospitalization among patients with ACS undergoing PCI (area under the receiver-operating characteristic curve: 0.858, 95% CI: 0.819-0.898; P < .05), and a good correlation with the Global Registry of Acute Coronary Event score ( r = 0.525, P < .05). This study provided evidence that Lp-PLA2 could predict all-cause mortality and rehospitalization risk among patients with ACS undergoing PCI.
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Affiliation(s)
- Lijiao Yang
- 1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Hong Wang
- 1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Yida Zhang
- 1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Tingting Han
- 1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Wenfeng Wang
- 1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
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Yu T, Tian C, Song J, He D, Sun Z, Sun Z. ACTION (acute coronary treatment and intervention outcomes network) registry-GWTG (get with the guidelines) risk score predicts long-term mortality in acute myocardial infarction. Oncotarget 2017; 8:102559-102572. [PMID: 29254271 PMCID: PMC5731981 DOI: 10.18632/oncotarget.21741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023] Open
Abstract
This study aimed to test the predictive performance of the updated ACTION, GRACE, and CADILLAC risk scores (RS’s) for long-term mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The study included individuals from 2 independent cohorts: derivation cohort (N = 1901) and validation cohort (N = 728). From the derivation cohort, we used Cox regression analysis to determine that the updated ACTION, GRACE, and CADILLAC RS's were associated with long-term mortality. The concordance (C) statistics of the 3 RS's were 0.682, 0.703 and 0.734, respectively. We used the validation cohort to validate the results. Moreover, the discriminatory performance of the updated ACTION RS for predicting long-term mortality in both the respective derivation and validation cohorts was similar to the discriminatory performance of the GRACE and CADILLAC RS's (ACTION vs. GRACE: z = 0.684, p = 0.494; ACTION vs. CADILLAC: z = 1.638, p = 0.101) and (ACTION vs. GRACE: z = 0.460, p = 0.646; ACTION vs. CADILLAC: z = 0.290, p = 0.772). Despite their development over a decade ago, GRACE and CADILLAC RS's maintain good performance for predicting the long-term mortality of AMI patients undergoing PCI. As a new risk model, the updated ACTION RS also predicts long-term mortality, and its discriminatory performance is similar to that of the GRACE and CADILLAC RS’s.
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Affiliation(s)
- Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Chunyang Tian
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Jia Song
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Dongxu He
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R.China
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Derivation and Validation of Shock Index as a parameter for Predicting Long-term Prognosis in Patients with Acute Coronary Syndrome. Sci Rep 2017; 7:11929. [PMID: 28931945 PMCID: PMC5607331 DOI: 10.1038/s41598-017-12180-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023] Open
Abstract
The objective of this study was to examine whether shock index (SI), defined by ratio of heart rate and systolic blood pressure, can predict long-term prognosis of acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI) and to compare prognostic accuracy of SI with the Global Registry of Acute Coronary Events (GRACE) risk score. This study included individuals from 2 independent cohorts: derivation cohort (n = 2631) and validation cohort (n = 963). In the derivation cohort, we derived that higher admission SI was associated with a greater risk of long-term all-cause mortality [HR = 4.104, 95% CI 1.553 to 10.845, p = 0.004] after adjusting for covariates. We validated this finding in the validation cohort [HR = 10.091, 95% CI 2.205 to 46.187, p = 0.003]. Moreover, admission SI had similar performance to the GRACE score in determining all-cause mortality risk in both cohorts (derivation cohort, admission SI vs. GRACE, z = 1.919, p = 0.055; validation cohort, admission SI vs. GRACE, z = 1.039, p = 0.299). In conclusion, admission SI is an independent predictor of adverse outcome in ACS patients undergoing PCI, and can identify patients at high risk of death. SI and the GRACE score showed similar performance in predicting all-cause mortality, and SI is more readily obtained than the GRACE score.
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Simplifying contrast-induced acute kidney injury prediction after primary percutaneous coronary intervention: the age, creatinine and ejection fraction score. Cardiovasc Interv Ther 2017; 33:224-231. [DOI: 10.1007/s12928-017-0472-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/17/2017] [Indexed: 12/15/2022]
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Abstract
The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre- and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available.
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Affiliation(s)
- Gerd Heusch
- From the Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Essen, Essen, Germany.
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18
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Comparison of prognostic significance of mean platelet volume/platelet count with GRACE for long-term prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Int J Cardiol 2017; 228:335-340. [DOI: 10.1016/j.ijcard.2016.11.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/05/2016] [Indexed: 11/20/2022]
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Yu T, Dong Y, Zhu J, Tian C, Sun Z, Sun Z. Culprit-only versus staged complete revascularization for patients with ST-segment elevation myocardial infarction and Multivessel disease: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:189. [PMID: 27716075 PMCID: PMC5053086 DOI: 10.1186/s12872-016-0365-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multivessel disease (MVD) is common in patients with ST-segment elevation myocardial infarction (STEMI), but optimal treatment management remains undetermined. METHODS In this retrospective cohort study, 602 consecutive STEMI patients with MVD were enrolled between January 1, 2010 and October 1, 2014. Three hundred and eighty-two patients underwent culprit-only revascularization and 220 underwent staged complete revascularization. Primary end points were a composite of cardiac mortality or nonfatal reinfarction. RESULTS The mean duration of follow-up was 35 months (12-71 months). Following multivariate analysis, staged complete revascularization was associated with a lower rate of the composite of cardiac mortality or nonfatal reinfarction [HR: 0.430, 95 % CI: 0.197-0.940, P = 0.034] and unplanned repeat revascularization [HR: 0.343, 95 % CI: 0.166-0.708, P = 0.004] compared with culprit-only revascularization. CONCLUSIONS Compared with culprit-only revascularization, staged complete revascularization significantly reduced the rate of the composite of cardiac mortality or nonfatal reinfarction, and the need for unplanned repeat revascularization.
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Affiliation(s)
- Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Yuanyuan Dong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Jiahe Zhu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Chunyang Tian
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
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Esfandi A, Fotouhi M, Allami A, Ebrahimi M. Comparison between the Outcomes of Intracoronary and Intravenous Administration of Eptifibatide during Primary Percutaneous Coronary Intervention in Patients with Acute ST-Elevation Myocardial Infarction. J Atheroscler Thromb 2015; 23:465-76. [PMID: 26632161 DOI: 10.5551/jat.30965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM To compare the outcomes of intracoronary (IC) and intravenous (IV) administration of eptifibatide during primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). METHODS In this prospective double-blind randomized clinical trial, 76 patients with STEMI selected for PPCI were randomly assigned in two groups to receive either IC or IV bolus of eptifibatide. The primary end point was coronary perfusion assessment by thrombolysis in myocardial infarction (TIMI) flow grade (TFG), TIMI perfusion grade (TPG), and corrected TIMI frame count (cTFC). Secondary end points were left ventricular ejection fraction (LVEF) restoration, ST-segment elevation resolution, and in-hospital major cardiovascular adverse events (MACEs) (including recurrent MI, need for target vessel revascularization (TVR), stroke, and death resulting from any cause) until discharge. RESULTS Assessment revealed significantly better TFG (95% CI: 1.01-10.26, OR=3.224, P=0.042), more TFG 3 (65.79% vs. 86.11% in IV and IC groups, respectively), better TPG (P=0.024), more achieved TPG 3 and TPG 2+3 (TPG 3: 44.74% vs. 72.22% and TPG 2+3: 78.95% vs. 94.44% in the IV and IC groups, respectively) with better cTFC in the IC group (37.33±15.84 vs. 32.53± 20.71 in the IV and IC groups, respectively; P=0.034). LVEF was better restored in the IC group (6.21±8.61% vs. 14.72±5.34% in the IV and IC groups, respectively; P<0.001) and the ST-segment elevation resolution was better achieved in the IC administration (95% CI: -22.55 to -6.23, P=0.001). There were no recurrent MI, stroke, or need for TVR among patients during the in-hospital stay. CONCLUSIONS IC administration of eptifibatide during PPCI in patients with STEMI in comparison with IV administration of eptifibatide is associated with significantly better coronary reperfusion and improved clinical outcomes (IRCT2012090510751N1).
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Affiliation(s)
- Amir Esfandi
- Department of Cardiology, Bu-Ali Sina Hospital, Qazvin University of Medical Sciences
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Ge H, Ding S, An D, Li Z, Ding H, Yang F, Kong L, Xu J, Pu J, He B. Frame counting improves the assessment of post-reperfusion microvascular patency by TIMI myocardial perfusion grade: Evidence from cardiac magnetic resonance imaging. Int J Cardiol 2015; 203:360-6. [PMID: 26539957 DOI: 10.1016/j.ijcard.2015.10.194] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/30/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Quantitative modification of TIMI myocardial perfusion grade (TMPG) by the method of frame counting may improve its sensitivity and the false negative rate for post-reperfusion microvascular dysfunction (MVD) in ST segment-elevated myocardial infarction (STEMI) patients. METHODS The durations of contrast-washout from infarction area of 139 patients were measured by counting the cine-frame numbers between the appearance and disappearance of myocardial blush. The achieved new index, TMP Frame Counting (TMP-FC) was referenced by cardiac magnetic resonance, by which MVD was defined as microvascular obstruction on gadolinium late-enhancement imaging. RESULTS Median TMP-FC differed significantly between patients with and without MVD (126 frames, IQR 105-160 vs. 86 frames, IQR 75-100, p<0.001). By receiver-operating characteristic analysis, the cutoff of TMP-FC at ≥ 95.5 frames represented an independent predictor of MVD (OR=11.61, p<0.001). TMP-FC had similar specificity (75%) and positive predictive value (88%), but significantly improved sensitivity (85.3%) and negative predictive value (70.2%) for MVD compared with TMPG (88.6%, 86.5%, 33.7% and 38.2%, respectively) and other traditional angiographic assessments, leading to a better overall accuracy (area under the curve: 0.801 compared with 0.612 from TMPG, p<0.001) for the evaluation of microvascular patency. TMP-FC was positively correlated with MVD extent (r=0.5, p<0.001). Abnormal TMP-FC was associated with larger infarction size (28.67 ± 13.72% vs. 16.51 ± 10.68% of left ventricular mass, p<0.001) and lower LVEF (49.37 ± 11.06% vs. 56.84 ± 9.72%, p<0.001). CONCLUSION Frame counting can improve the accuracy of TMPG for MVD. Moreover, TMP-FC is correlated with the degree of MVD and cardiac detriments, which is useful for risk stratification.
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Affiliation(s)
- Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Dongaolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Haiyan Ding
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Lingcong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China.
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China.
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Yıldız A, Yıldız C. Long-term clinical results of saphenous vein bypass graft lesions treated with bare-metal stents and drug eluting stents. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2015. [DOI: 10.1016/j.ijcac.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Oxidized Low Density Lipoprotein and High Sensitive C-Reactive Protein in Non-Diabetic, Pre-Diabetic and Diabetic Patients in the Acute Phase of the First Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. J Med Biochem 2015; 34:160-169. [PMID: 28356828 PMCID: PMC4922321 DOI: 10.2478/jomb-2014-0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/17/2014] [Indexed: 12/25/2022] Open
Abstract
Background Oxidized low density lipoprotein (ox-LDL) and high-sensitive C-reactive protein (hs-CRP) are elevated in diabetes mellitus (DM) and associated with accelerated atherosclerosis. Little is known about their dynamics in the acute phase of ST segment elevation myocardial infarction (STEMI), especially in relation to the presence of DM and pre-diabetes (pre-DM). This study aimed to analyze time-dependent changes in ox-LDL and hs-CRP regarding the presence of pre-DM and DM in STEMI patients treated by primary percutaneous coronary intervention (pPCI). Methods In 103 consecutive patients with the first anterior STEMI ox-LDL and hs-CRP were measured before pPCI, on day 2 and day 7 after pPCI. Results Patients were classified into: non-diabetics, pre-diabetics and diabetics. In each group the maximal ox-LDL concentration was found on admission, decreased on day 2 and reached the lowest values on day 7 (p<0.001). Diabetics had the highest ox-LDL concentrations compared to pre-diabetics and non-diabetics (on admission: p=0.028, on day 2: p=0.056, on day 7: p=0.004). hs-CRP concentration rose from admission, reached its peak on day 2 and decreased on day 7, in each group (p<0.001). Significant differences in hs-CRP concentrations were found between non-diabetics and pre-diabetics on admission (p=0.018) and day 2 (p=0.026). In a multivariate analysis DM was an independent determinant of high ox-LDL concentrations. Both ox-LDL and hs-CRP significantly correlated with Killip class, left ventricular ejection fraction, NT-proBNP and peak troponin I. Conclusions In patients with the first STEMI treated by pPCI there were significant differences in ox-LDL and hs-CRP concentrations between non-diabetics, pre-diabetics and diabetics. Ox-LDL and hs-CRP concentrations were related to heart failure parameters.
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Miura K, Kato M, Dote K, Kagawa E, Nakano Y, Oda N, Sasaki S. Association of nonculprit plaque characteristics with transient slow flow phenomenon during percutaneous coronary intervention. Int J Cardiol 2015; 181:108-13. [DOI: 10.1016/j.ijcard.2014.11.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/29/2014] [Accepted: 11/26/2014] [Indexed: 01/02/2023]
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Chaudhary S, Godatwar PK, Sharma R. In vitro thrombolytic activity of Dhamasa ( Fagonia arabica Linn.), Kushta ( Saussurea lappa Decne.), and Guduchi ( Tinospora cordifolia Thunb.). Ayu 2015; 36:421-424. [PMID: 27833372 PMCID: PMC5041392 DOI: 10.4103/0974-8520.190697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Thrombotic disorders are among the major fatal conditions affecting the society. Treatment modalities used for such disorders are either surgical interventions or use of drugs such as urokinase, streptokinase (SK), or tissue plasminogen activators to dissolve the blood clots. These modalities have their own limitations and side effects apart from being expensive. There is a need for safer and cost effective antithrombolytic agents. Aim: To evaluate in vitro thrombolytic property of Dhamasa (Fagonia arabica Linn.), Kushta (Saussurea lappa Decne.), and Guduchi (Tinospora cordifolia Thunb.) plant extract. Materials and Methods: Venous blood drawn from 20 healthy volunteers was allowed to form clots which was weighed and treated with the extract of test plant materials to disrupt the clots. Weight of clot after and before treatment provided a percentage of clot lysis. SK was used as a positive and water as a negative control. Statistical Analysis Used: The significance between % clot lysis of five groups by means of weight difference was tested by the one-way ANOVA. Results: Clot lysis observed were 68.06%, 14.85%, 25.01%, 92.54%, and 3.00% for Dhamasa, Kushta, Guduchi, SK, and distilled water, respectively. Conclusion: Herbal extracts possess thrombolytic properties and lyse blood clots in vitro.
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Affiliation(s)
- Shweta Chaudhary
- Lecturer, Department of Roga Nidana and Vikriti Vijnana, Aligarh Unani and Ayurvedic Medical College, Aligarh, UP, India
| | - Pawan Kumar Godatwar
- Department of Roga Nidana and Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India
| | - Reetu Sharma
- Department of Roga Nidana and Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India
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Shimonaga T, Kurisu S, Watanabe N, Ikenaga H, Higaki T, Iwasaki T, Ishibashi K, Dohi Y, Fukuda Y, Kihara Y. Myocardial Injury after Percutaneous Coronary Intervention for In-Stent Restenosis Versus de novo Stenosis. Intern Med 2015; 54:2299-305. [PMID: 26370852 DOI: 10.2169/internalmedicine.54.5003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Periprocedural myocardial injury (PMI) remains a relatively common complication even after successful procedures. In-stent restenosis (ISR) may be involved in lesion-related factors for PMI. We compared the incidence of PMI between patients with ISR and those with de novo stenosis. METHODS The study population consisted of 121 patients with coronary artery disease who had been treated with statins and subsequently underwent angiographically successful percutaneous coronary intervention (PCI). Blood samples for troponin I were collected 18 to 24 hours after PCI. PMI was defined as an increase in the troponin I levels greater than 0.15 ng/mL. Major PMI was defined as an increase in the troponin I levels greater than 0.75 ng/mL. RESULTS There were 34 patients with ISR and 87 patients with de novo stenosis. The incidence of PMI was similar between the two groups (47.1 % vs. 55.2 %, p=0.42). Among the patients with ISR, the incidences of PMI were 33.3 %, 60.0 % and 66.7 % in patients with focal ISR, diffuse ISR and diffuse proliferative ISR, respectively, although these differences were not statistically significant. The incidence of major PMI was significantly less frequent in patients with ISR than those with de novo stenosis (5.9 % vs. 25.3 %, p=0.03). A multivariate logistic regression analysis showed that ISR [odds ratio (OR) 0.22, 95% confidence interval (CI) 0.03-0.90; p=0.03] and the maximum inflation pressure (OR 1.15, 95% CI 1.04-1.30; p=0.009) were independent predictors of major PMI. CONCLUSION Our results suggest that while PMI occurs in patients with ISR as commonly as those with de novo stenosis, major PMI occurs less frequently in patients with ISR.
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Affiliation(s)
- Takashi Shimonaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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Soto ME, Reyes-Villatoro MA, Márquez R, Cardoso G, Posadas-Sánchez R, Juárez-Orozco LE. Evaluation and Analysis of Plasma Soluble Adhesion Molecules in Patients With Coronary Ectasia and Atherosclerotic Coronary Artery Disease. Arch Med Res 2014; 45:478-83. [DOI: 10.1016/j.arcmed.2014.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/27/2014] [Indexed: 11/30/2022]
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Trifunovic D, Stankovic S, Marinkovic J, Beleslin B, Banovic M, Djukanovic N, Orlic D, Tesic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Stepanovic J, Djordjevic-Dikic A, Giga V, Ostojic M. Time-dependent changes of plasma adiponectin concentration in relation to coronary microcirculatory function in patients with acute myocardial infarction treated by primary percutaneous coronary intervention. J Cardiol 2014; 65:208-15. [PMID: 25012060 DOI: 10.1016/j.jjcc.2014.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE To analyze plasma adiponectin kinetics in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI) and its association with coronary flow reserve (CFR), an index of coronary microcirculatory function. METHODS A total of 96 consecutive patients with the first anterior STEMI treated by pPCI without heart failure were included. CFR was assessed on the 7th day after pPCI. Plasma adiponectin was measured on admission before pPCI, and on the 2nd and 7th day after pPCI. RESULTS Adiponectin concentration was the highest on admission, declined to the lowest level on the 2nd day, and rose on the 7th day remaining below admission values. Impaired coronary microcirculatory function (CFR<2) was observed in 41% of the patients. Adiponectin concentrations significantly positively correlated with CFR, and the strongest correlation was with the 2nd day adiponectin (r=0.489, p<0.001). In multivariate models, adiponectin concentrations were independent predictors of impaired CFR [on admission: odds ratio (OR) 0.175, confidence interval (CI): 0.047-0.654, p=0.010; 2nd day: OR 0.146, 95% CI: 0.044-0.485, p=0.002; 7th day: OR 0.198, CI: 0.064-0.611, p=0.005]. The best power to predict impaired CFR was the 2nd day adiponectin. Delta values of adiponectin (differences between adiponectin concentrations) did not correlate with CFR. CONCLUSIONS In patients with the first anterior STEMI treated by pPCI plasma adiponectin concentrations before and after pPCI are strongly associated with CFR. Our results support the hypothesis that low adiponectin, especially during the early post-pPCI period, carries the risk for impaired coronary microcirculatory function in STEMI patients.
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Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Centre of Serbia, School of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Banovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nina Djukanovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Dejan Orlic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic-Tesic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Petrovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Stepanovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Giga
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miodrag Ostojic
- School of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia
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Engblom H, Aletras AH, Heiberg E, Arheden H, Carlsson M. Quantification of myocardial salvage by myocardial perfusion SPECT and cardiac magnetic resonance — reference standards for ECG development. J Electrocardiol 2014; 47:525-34. [DOI: 10.1016/j.jelectrocard.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Indexed: 01/08/2023]
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Door-to-balloon time in radial versus femoral approach for primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Torabi A, Cleland JG, Rigby AS, Sherwi N. Development and course of heart failure after a myocardial infarction in younger and older people. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:1-12. [PMID: 24748875 PMCID: PMC3981977 DOI: 10.3969/j.issn.1671-5411.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/11/2014] [Accepted: 03/18/2014] [Indexed: 12/02/2022]
Abstract
Background Acute myocardial infarction (AMI) is a common cause of heart failure (HF), which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were categorised into those aged < 65 years, 65–75 years, and > 75 years. Results Of 896 patients, 311, 297 and 288 were aged < 65, 65–75 and >75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 (8%), 68 (23%) and 107 (37%) occurred during the index admission, many associated with acute HF. A further 37 (12%), 63 (21%) and 82 (29%) developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 (24%), 55 (40%) and 37 (47%) patients developed HF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 (70%), 93 (91%) and 107 (85%) in aged < 65 years, 65–75 years and >75 years, respectively. Conclusions The risk of developing HF and of dying after an MI increases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.
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Affiliation(s)
- Azam Torabi
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - John Gf Cleland
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alan S Rigby
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Nasser Sherwi
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull, HU16 5JQ, United Kingdom
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Trifunovic D, Stankovic S, Sobic-Saranovic D, Marinkovic J, Petrovic M, Orlic D, Beleslin B, Banovic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Stepanovic J, Djordjevic-Dikic A, Tesic M, Djukanovic N, Petrovic O, Vasovic O, Nestorovic E, Kostic J, Ristic A, Ostojic M. Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function. Cardiovasc Diabetol 2014; 13:73. [PMID: 24708817 PMCID: PMC4234386 DOI: 10.1186/1475-2840-13-73] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 12/13/2022] Open
Abstract
Background Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Methods In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. Results IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). Conclusion IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.
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Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, Clinical Centre of Serbia, Ul, Koste Todorovica 8, 11000 Belgrade, Serbia.
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Tayeh O, Ettori F. Vascular access and angiographic lesion morphology in elective percutaneous coronary intervention. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dembo T, Deguchi I, Fukuoka T, Nagoya H, Maruyama H, Kato Y, Horiuchi Y, Ohe Y, Tanahashi N. Additional Endovascular Therapy in Patients with Acute Ischemic Stroke Who Are Nonresponsive to Intravenous Tissue Plasminogen Activator: Usefulness of Magnetic Resonance Angiography–Diffusion Mismatch. J Stroke Cerebrovasc Dis 2013; 22:1056-63. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 06/27/2012] [Accepted: 07/03/2012] [Indexed: 11/15/2022] Open
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Inami T, Kataoka M, Shimura N, Ishiguro H, Yanagisawa R, Taguchi H, Fukuda K, Yoshino H, Satoh T. Pulmonary edema predictive scoring index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty. JACC Cardiovasc Interv 2013; 6:725-36. [PMID: 23769649 DOI: 10.1016/j.jcin.2013.03.009] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/06/2013] [Accepted: 03/14/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to identify useful predictors for hemodynamic improvement and risk of reperfusion pulmonary edema (RPE), a major complication of this procedure. BACKGROUND Percutaneous transluminal pulmonary angioplasty (PTPA) has been reported to be effective for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). PTPA has not been widespread because RPE has not been well predicted. METHODS We included 140 consecutive procedures in 54 patients with CTEPH. The flow appearance of the target vessels was graded into 4 groups (Pulmonary Flow Grade), and we proposed PEPSI (Pulmonary Edema Predictive Scoring Index) = (sum total change of Pulmonary Flow Grade scores) × (baseline pulmonary vascular resistance). Correlations between occurrence of RPE and 11 variables, including hemodynamic parameters, number of target vessels, and PEPSI, were analyzed. RESULTS Hemodynamic parameters significantly improved after median observation period of 6.4 months, and the sum total changes in Pulmonary Flow Grade scores were significantly correlated with the improvement in hemodynamics. Multivariate analysis revealed that PEPSI was the strongest factor correlated with the occurrence of RPE (p < 0.0001). Receiver-operating characteristic curve analysis demonstrated PEPSI to be a useful marker of the risk of RPE (cutoff value 35.4, negative predictive value 92.3%). CONCLUSIONS Pulmonary Flow Grade score is useful in determining therapeutic efficacy, and PEPSI is highly supportive to reduce the risk of RPE after PTPA. Using these 2 indexes, PTPA could become a safe and common therapeutic strategy for CTEPH.
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Affiliation(s)
- Takumi Inami
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Maluenda G, Sizemore BC, Revtyak G, Cavros N, McElroy BB, Arora DS, Deibele A, Makam S, Ben-Dor I, Torguson R, Waksman R. Intracoronary glycoprotein IIb/IIIa inhibitor infusion via a perfusion coronary catheter to decrease thrombus burden: results from the ClearWay™ Multicenter Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:280-3. [PMID: 23375788 DOI: 10.1016/j.carrev.2012.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This multicenter registry aimed to assess the ClearWay™ (CW) perfusion catheter in reduction of thrombus burden and improvement of the coronary flow during percutaneous coronary intervention (PCI). BACKGROUND The presence or development of thrombus during PCI is associated with poor prognosis. METHODS The utility of the CW perfusion catheter was assessed in patients who presented with intracoronary thrombus and were subjected to PCI. Data were collected by online survey from 15 US sites. Angiographic assessment of the coronary thrombus burden and the coronary flow after intracoronary infusion of glycoprotein (GP) IIb/IIIa inhibitors via the CW catheter was evaluated at baseline, immediately after infusion, and at the end of the procedure. The cohort included 102 patients; 71.6% presented with ST-elevation myocardial infarction (MI), 21.6% with non-ST-elevation MI, 5.9% with stable angina pectoris, and 2.9% with silent ischemia. The mean cohort age was 59.9±14.5years and comprised mostly of men (72.5%). RESULTS GP IIb/IIIa inhibitors were infused via the CW catheter on average 1.1±0.3 times, with a mean pressure of 4.2±2.7atm and a mean infusion time of 55±55s. Following the infusion, Thrombolysis In Myocardial Infarction (TIMI) flow improved by 1° in 71 patients (69.6%) and by 2° in 51 patients (50%), while visible thrombus was reduced by 52% (p<0.001). In the final angiogram, TIMI flow was restored in 90.2% and clearance of a visible thrombus was obtained in 91.8% of the lesions. CONCLUSION Intracoronary infusion of GP IIb/IIIa inhibitors via the perfusion CW catheter is associated with significant reduction in thrombus burden and with improvement of the coronary flow in patients presenting or developing thrombus burden during PCI.
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Development of endovascular vibrating polymer actuator probe for mechanical thrombolysis: in vivo study. ASAIO J 2013; 58:503-8. [PMID: 22820916 DOI: 10.1097/mat.0b013e31825f341c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, we propose a new method for the enhancement of intraarterial thrombolysis by use of an endovascular vibrating polymer actuator probe (VPAP), which is fabricated from an ionic polymer metal composite (IPMC) actuator. The endovascular VPAP was fabricated by combining 0.8 × 0.8 × 10 mm3 IPMC samples, 0.22 mm × 50 cm copper wires, and 40 cm of Teflon tube. The purpose of this study was to evaluate the thrombolysis efficiency of an endovascular VPAP in a dog model. Both renal arteries of the enrolled dogs (n = 5) were used in the current study. A distal portion of the renal artery in a mongrel dog was occluded by a blood clot from autologous venous whole blood. Intraarterial thrombolysis was performed by use of a VPAP without the actuation force (control group), by a VPAP-only (VPAP-only group), or with a combination of recombinant tissue plasminogen activator (rtPA) and a VPAP (VPAP + rtPA group). The thrombolysis efficiency was evaluated by the modified Thrombolysis in Myocardial Infarction (TIMI) grading system based on the consensus between two radiologists. The grading scales were compared according to each intraarterial thrombolysis method. The VPAP + rtPA and VPAP-only groups showed a significantly higher thrombolysis efficiency than did the control group (p < 0.05). The VPAP-only group also showed a significantly higher thrombolysis efficiency than did the control group (p < 0.05). The VPAP+ rtPA group showed a significantly higher thrombolysis efficiency than did the VPAP-only group (p < 0.05). The use of an endovascular VPAP was a feasible and useful method for intraarterial thrombolysis, and it enhanced the thrombolysis efficiency when combined with the thrombolytic agent rtPA.
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Computed tomographic angiography-verified plaque characteristics and slow-flow phenomenon during percutaneous coronary intervention. JACC Cardiovasc Interv 2012; 5:636-43. [PMID: 22721658 DOI: 10.1016/j.jcin.2012.02.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 02/13/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to identify whether computed tomographic angiographic (CTA) plaque characteristics are associated with slow-flow phenomenon (SF) during percutaneous coronary intervention (PCI). BACKGROUND SF during PCI is associated with myocardial damage and prolonged hospitalization. Intracoronary ultrasound-verified large echolucent lesions have been reported to predict SF. METHODS The authors evaluated pre-PCI CTA plaque characteristics in 40 consecutive patients (male/female, 31/9; age, 69 ± 10 years) with stable angina pectoris who developed SF during PCI; patients with ≥ 600 Agatston coronary artery calcium score were not included. They were compared with 40 age-, sex-, and culprit coronary artery-matched patients (male/female, 31/9; age, 69 ± 9 years) who underwent PCI during the same period and did not develop SF. Plaque characteristics, including vascular remodeling, plaque consistency, including low-attenuation plaques representing lipid-rich lesions and high-attenuation plaque patterns of calcium deposition, were analyzed. RESULTS Calcium deposition in the perimeter of a plaque, or circumferential plaque calcification (CPC), was significantly more frequent in the SF group (25 of 40, 63%) than the no-SF group (2 of 40, 5.0%) (p < 0.001). Presence of CPC on CTA was confirmed at the same location in the nonenhanced CT during Agatston coronary artery calcium score calculation. The positive remodeling index was significantly higher (1.5 [1.3 to 1.8] vs. 1.2 [1.0 to 1.5]; p < 0.001) and plaque density significantly lower (23.5 [9.5 to 40] HU vs. 45 [29 to 86] HU; p = 0.001) in the SF group. The conditional logistic regression analysis revealed that CPC, plaque density, and dyslipidemia were the predictors of SF, with CPC being the strongest (odds ratio: 79; 95% confidence interval: 8 to 783, p < 0.0001). CONCLUSIONS CTA-verified CPC with low-attenuation plaque and positive remodeling were determinants of SF during PCI. If CTA findings are available in patients undergoing PCI, the interventionists should be aware of the likelihood of SF.
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Kang DW, Sohn SI, Hong KS, Yu KH, Hwang YH, Han MK, Lee J, Park JM, Cho AH, Kim HJ, Kim DE, Cho YJ, Koo J, Yun SC, Kwon SU, Bae HJ, Kim JS. Reperfusion therapy in unclear-onset stroke based on MRI evaluation (RESTORE): a prospective multicenter study. Stroke 2012; 43:3278-83. [PMID: 23093613 DOI: 10.1161/strokeaha.112.675926] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Unclear-onset strokes are generally excluded from time-based thrombolytic therapy. We examined the safety and feasibility of magnetic resonance imaging-based reperfusion therapy in unclear-onset stroke. METHODS This prospective, multicenter, single-arm study screened consecutive unclear-onset stroke patients within 6 hours of symptom detection. Patients with perfusion-diffusion mismatch>20% and negative or subtle fluid-attenuated inversion recovery changes were treated with intravenous tissue plasminogen activator, intra-arterial therapy, or a combination. The safety outcome was symptomatic intracranial hemorrhage within 48 hours after treatment. The primary efficacy outcome was a 3-month modified Rankin Scale score of 0 to 2. Controls were untreated unclear-onset stroke patients prospectively captured in stroke registries. RESULTS Of 430 unclear-onset stroke patients, 83 (19.3%) received reperfusion therapy (mean age, 67.5±10.4 years; males, 66.3%; median baseline National Institutes of Health Stroke Scale, 14). Symptomatic intracranial hemorrhage with any neurological decline developed in 5 patients (6.0%). Symptomatic intracranial hemorrhage with National Institutes of Health Stroke Scale worsening ≥4 developed in 3 patients (3.6%). Thirty-seven patients (44.6%) achieved modified Rankin Scale score of 0 to 2, and 24 (28.9%) had modified Rankin Scale score of 0 to 1. Female, baseline National Institutes of Health Stroke Scale score, no immediate or early recanalization, and more white blood cells were independent predictors of poor outcome. Compared with untreated controls, the treated group was significantly associated with good outcomes of modified Rankin Scale score of 0 to 2 after adjusting for age, sex, and baseline National Institutes of Health Stroke Scale in logistic regression analysis (odds ratio, 2.25; 95% CI, 1.14-4.49). CONCLUSIONS In unclear-onset stroke patients, magnetic resonance imaging-based reperfusion therapy was feasible and safe. Randomized controlled trials are warranted to confirm the benefit of reperfusion therapy for unclear-onset stroke.
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Affiliation(s)
- Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, and Eulji General Hospital, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, South Korea.
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Shim YK, Kim JT, Seong MH, Kim YJ, Shim TJ, Kim SM, Lee SY, Bae JW, Kim KS, Hwang KK, Kim DW, Cho MC. Serum thioredoxin 1 level has close relation with myocardial damage amount in acute myocardial infarction patients. J Korean Med Sci 2012; 27:1162-9. [PMID: 23091312 PMCID: PMC3468751 DOI: 10.3346/jkms.2012.27.10.1162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/05/2012] [Indexed: 01/21/2023] Open
Abstract
Thioredoxin-1 (Trx-1) is one of important anti-oxidative molecules to overcome the oxidative stress. The aim of the present study is to investigate the clinical relationship between serum concentration of Trx-1 on the pre-percutaneous coronary intervention (prePCI) and myocardial damage amount in the patients with acute myocardial infarction with the culprit lesion in only the left anterior descending artery on coronary angiography (n = 100). Initial value of creatine kinase (CK) was 368.3 ± 531.4 U/L, and MB isoenzyme of CK (CK-MB) level was 22.92 ± 33.8 ng/mL, and cardiac specific troponin T (cTnT) level was 0.61 ± 1.6 ng/mL. Positive correlations were observed between prePCI Trx-1 level and initial CK (P = 0.005, r = 0.281), and cTnT (P < 0.001, r = 0.453), peak CK (P = 0.001, r = 0.316) in all patients, but the statistical relation was observed only in ST segment elevation myocardial infarction (STEMI) patients (P = 0.008, r = 0.329 for initial CK, P = 0.001, r = 0.498 for initial cTnT, P = 0.005, r = 0.349 for peak CK), not in Non-STEMI patients. Conclusively, we consider prePCI serum Trx-1 as a predictor for myocardial damage amount in patients with STEMI.
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Affiliation(s)
- Young Kwang Shim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jeong-Tae Kim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Mun-Hyuk Seong
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yeon-Jeong Kim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Tae-Jin Shim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Min Kim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ki-Seok Kim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Kyung-Kuk Hwang
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Dong-Woon Kim
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Myeong-Chan Cho
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
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Cho KH, Lee DH, Kwon SU, Choi CG, Kim SJ, Suh DC, Kim JS, Kang DW. Factors and outcomes associated with recanalization timing after thrombolysis. Cerebrovasc Dis 2012; 33:255-61. [PMID: 22261742 DOI: 10.1159/000334666] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A substantial number of acute stroke patients do not respond immediately to aggressive intra-arterial (IA) recanalization therapy. The factors and outcomes associated with timing of recanalization after IA thrombolysis, however, have not yet been determined. METHODS Factors and outcomes in 75 acute ischemic stroke patients treated with IA urokinase (± intravenous tissue plasminogen activator) within 6 h of onset were retrospectively assessed. Immediate recanalization (IR) was assessed by the angiogram at the end of the IA procedure, and delayed (DR) and no (NR) recanalization were assessed by 5-day MR angiography. Modified Rankin Scale (mRS) scores were determined at 7 days and 3 months. RESULTS Of the 75 patients, 32 (42.7%) achieved IR, 21 (28%) achieved DR, and 22 (29.3%) showed NR. Good functional outcomes (mRS score ≤2) at 7 days and 3 months were observed in 59.4 and 62.5%, respectively, of the IR group, 14.3 and 38.1% of the DR group, and 22.7 and 27.3% of the NR group (p = 0.001 for 7 days, p = 0.028 for 3 months). Multivariate analysis showed that cardioembolism [odds ratio (OR), 3.74; 95% confidence interval (CI), 1.15-12.19] and middle cerebral artery occlusion (OR, 3.23; 95% CI, 1.04-10.04) were independent predictors of IR or DR compared with NR. Age (OR, 0.86; 95% CI, 0.77-0.95) and initial NIHSS score (OR, 1.20; 95% CI, 1.04-1.37) were independent predictors of DR compared with IR. CONCLUSIONS Patients receiving IA thrombolysis show different clinical and radiological characteristics according to the timing of recanalization. Earlier identification of DR patients and their more efficient recanalization may improve overall clinical outcomes after IA thrombolysis.
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Affiliation(s)
- Kyung-Hee Cho
- Stroke Center and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hauck EF, Natarajan SK, Ohta H, Ogilvy CS, Hopkins LN, Siddiqui AH, Levy EI. Emergent endovascular recanalization for cervical internal carotid artery occlusion in patients presenting with acute stroke. Neurosurgery 2011; 69:899-907; discussion 907. [PMID: 21499144 DOI: 10.1227/neu.0b013e31821cfa52] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute proximal (cervical) internal carotid artery (ICA) occlusion may cause ischemia of an entire hemisphere or no ischemia at all, depending on the presence of intracranial collaterals. OBJECTIVE To retrospectively analyze the clinical results for emergent endovascular carotid recanalization in patients with acute proximal (cervical) ICA occlusion and to assess predictors of recanalization and clinical, neurological, and functional outcome. METHODS Emergent endovascular revascularization was attempted in 22 patients presenting with acute stroke secondary to complete cervical ICA occlusion. Patients with pseudo-occlusion were excluded. Recanalization was assessed with the Thrombolysis in Myocardial Ischemia (TIMI) system: grade 0 (no flow) to grade 3 (normal flow). RESULTS The median age of the patients was 65 years; mean admission National Institutes of Health Stroke Scale (NIHSS) score was 14. Recanalization (TIMI grade 2/3) occurred in 17 patients (77.3%). Ten patients (45.5%) demonstrated significant clinical improvement during hospitalization (NIHSS improved ≥4 points). Fifty percent of patients had good outcomes (modified Rankin Scale ≤2) after a median follow-up of 3 months. Patient age <70 years and successful recanalization (TIMI grade 2/3) predicted a good outcome (P ≤ .01). Presence of atrial fibrillation, admission NIHSS score ≥20, and complete ICA occlusion at all levels (cervical, petrocavernous, and intracranial) were associated with poor outcomes (P ≤ .05). Patients with complete cervical ICA occlusion but partial distal preservation of the vessel were most likely to benefit from the intervention (recanalization in 88.2%; good outcome in 64.7%). CONCLUSION Attempts at emergent endovascular carotid recanalization for acute stroke are encouraged, particularly in younger patients with partial distal preservation of the ICA.
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Affiliation(s)
- Erik F Hauck
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA
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Topaz O, Topaz A, Owen K. Thrombus grading for coronary interventions: the role of contemporary classifications. Interv Cardiol 2011. [DOI: 10.2217/ica.11.76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kim JT, Heo SH, Cho BH, Choi SM, Lee SH, Park MS, Yoon W, Cho KH. Hyperdensity on non-contrast CT immediately after intra-arterial revascularization. J Neurol 2011; 259:936-43. [PMID: 22015965 DOI: 10.1007/s00415-011-6281-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/01/2011] [Accepted: 10/04/2011] [Indexed: 01/20/2023]
Abstract
Non-contrast enhanced computed tomography (NCCT) is usually performed to estimate bleeding complications immediately after procedures. However, hyperdense areas on NCCT have not yet been understood; different interpretations have been reported in the literature. It remains unclear whether NCCT performed immediately after intra-arterial revascularization (IAR) could be useful for predicting hemorrhagic transformation (HT) or clinical outcomes. Therefore, we investigated the diagnostic values of hyperdense areas on NCCT images obtained immediately after IAR. This was a retrospective study of acute ischemic stroke patients who underwent IAR between October 2007 and December 2010. NCCT scans were routinely obtained immediately after IAR and additional follow-up imaging protocols included diffusion weighted imaging (DWI)/gradient echo imaging (GRE) 24 h after IAR. HT was assessed by means of GRE obtained 24 h after IAR. Hounsfield Unit (HU) of the hyperdensity was measured in the manually drawn regions of interest. A total of 68 patients were analyzed in this study. Twenty-nine patients (42.6%) developed HT on follow-up images. Thirty-eight patients had hyperdense areas on NCCT immediately after IAR. Hyperdensity on NCCT performed immediately after IAR revealed 23 (60.5%) of the 38 patients with six false negative areas. NCCT performed immediately after IAR showed a sensitivity of 79.3%, a specificity of 61.5%, a positive predictive value of 60.5% and a negative predictive value of 80% for HT. The HU value was a predictor of HT without statistical significance (area under curve of 0.629; 95% CI: 0.49-0.76; p = 0.068). In addition, an HU of >90 poorly predicted HT with a low sensitivity (23%) and a high specificity (94%). In conclusion, our results showed that although hyperdensity on NCCT images obtained immediately after IAR had a moderate predictive value for HT, there were limitations to the prediction of subsequent parenchymal hematoma and symptomatic intracranial hemorrhage, with a low specificity and a low positive predictive value.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
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Kim JT, Park MS, Nam TS, Choi SM, Kim BC, Kim MK, Cho KH. Thrombolysis as a factor associated with favorable outcomes in patients with unclear-onset stroke. Eur J Neurol 2011; 18:988-94. [PMID: 21299733 DOI: 10.1111/j.1468-1331.2011.03351.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Clinical and radiological features of patients with unclear-onset stroke do not differ significantly from those with known-onset stroke. There is a lack of evidence for the safety and efficacy of thrombolysis in patients with unclear-onset stroke. We sought to provide supportive data on the safety and efficiency of thrombolysis in patients with unclear-onset stroke. METHODS We retrospectively identified patients with unclear-onset stroke (<3 h of first found abnormal time) from our stroke registry. We performed following protocols for thrombolysis in patients with unclear-onset stroke; initial conventional CT-based intravenous thrombolysis (IVT), repeat MRI during IVT, and then decision to maintain IVT or to perform combined intra-arterial thrombolysis. In addition, we compared clinical outcomes and safety between thrombolyzed and non-thrombolyzed patients. RESULTS A total of 78 patients with unclear-onset stroke were included. Twenty-nine patients underwent thrombolysis. Thrombolysis (OR, 6.842; 95% CI, 1.950-24.004; P = 0.003) and baseline NIHSS (OR, 0.769; 95% CI, 0.645-0.917; P = 0.003) were associated with favorable outcomes at 3 months in multivariate logistic regression analysis. The frequency of hemorrhagic transformation and symptomatic ICH was not significantly different between the thrombolyzed and non-thrombolyzed patients (34.4% vs. 40.7% and 10.3% vs. 8.2%, respectively). CONCLUSION The results of this study suggest that thrombolysis in unclear-onset stroke could be independently associated with favorable outcomes at 3 months and that thrombolysis based on repeat imaging appears to be safely applied to patients with unclear-onset stroke.
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Affiliation(s)
- J-T Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
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Kim JT, Park MS, Kim MK, Cho KH. Minor stroke with total mismatch after acute MCA occlusion. J Neuroimaging 2011; 21:399-402. [PMID: 21223430 DOI: 10.1111/j.1552-6569.2010.00564.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Recently, "total mismatch," negative diffusion-weighted imaging (DWI) and extensive perfusion defects were introduced and described as having a favorable outcome after intravenous thrombolysis. We sought to determine the clinical characteristics of patients with total mismatch and describe their clinical courses. METHODS We retrospectively analyzed subjects from the stroke registry of acute ischemic stroke patients between August 2008 and October 2009. The patients with the following characteristics were included: acute ischemic stroke within 6 hours of symptom onset, a large artery occlusion in the anterior circulation and a negative DWI but large perfusion-weighted imaging (PWI) lesion on mean transit time maps. According to our stroke imaging protocol, the patients underwent emergent MR imaging immediately after admission and follow-up imaging within 96 hours of symptom onset. RESULTS Four patients were identified as suitable for the imaging criteria (negative DWI and MTT delay) of this study. All patients presented with a spontaneous recovery of ischemic symptoms related to the middle cerebral artery occlusion had a potential source of cardioembolism and eventually developed new lesions on follow-up DWI and recanalization without thrombolysis. CONCLUSION In our study, total mismatch seems to suggest favorable outcome after recanalization, regardless of thrombolysis. Further attention should be focused on the considerable variations in PWI and DWI findings in acute stroke.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
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Interventional Neuroradiologic Therapy of Atherosclerotic Disease and Vascular Malformations. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Teis A, Teis-Soley A, Fernández-Nofrerías E, Rodríguez-Leor O, Tizón H, Salvatella N, Valle V, Mauri J. Coronary artery perforation by intracoronary guide wires: risk factors and clinical outcomes. Rev Esp Cardiol 2010; 63:730-4. [PMID: 20515631 DOI: 10.1016/s1885-5857(10)70148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aims of this study were to determine the incidence of coronary artery perforation by intracoronary guide wires during angioplasty, to identify associated factors, and to assess outcomes. The retrospective analysis covered 4,353 consecutive procedures, corresponding to a total 6,994 lesions treated over a period of 8 years. Coronary artery perforation by guide wires occurred in 15 cases (0.35%). Perforation was associated with the number of hydrophilic wires used (odds ratio=2.33; 95% confidence interval, 1.34-4.05) and treatment of chronic occlusions (odds ratio=3.31; 95% confidence interval, 1.05-10.46). Cardiac tamponade occurred in seven cases (46.7%), six of which were subacute. Three cases were resolved by pericardiocentesis, while four required surgical drainage. Cardiac tamponade was associated with the number of guide wires used (P=.039) and the use of abciximab (P=.016). No death occurred.
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Affiliation(s)
- Albert Teis
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
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Mini-crush versus T-provisional techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. JACC Cardiovasc Interv 2010; 2:185-94. [PMID: 19463424 DOI: 10.1016/j.jcin.2008.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 11/24/2008] [Accepted: 12/17/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This retrospective study sought to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in bifurcation lesions with the T-provisional (T-prov) technique and mini-crush (MC) technique. BACKGROUND The best option on the treatment of coronary bifurcation lesions is a subject of considerable debate. However, recent evidence suggests that bifurcation lesions might be treated by drug-eluting stent on both branches using the MC technique with a low rate of major adverse cardiac event and restenosis. METHODS From April 2004 to July 2006, 457 patients were consecutively treated with either MC technique (n = 199) or T-prov technique (n = 258). Of these latter, 170 patients were treated with 1 stent and 88 patients with 2 stents. The 9-month angiographic follow-up was completed in 188 of 229 (82.1%) bifurcation lesions of MC patients and in 207 of 266 lesions (77.8%) of T-prov patients. RESULTS After a propensity score adjustment, 2-year cumulative major adverse cardiac events were similar between groups (p = 0.16). The MC group compared with the T-prov 1-stent group had significantly lower main and side branches restenosis (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.27 to 0.99; p = 0.047; and HR: 0.41, 95% CI: 0.20 to 0.85; p = 0.016, respectively). However, the MC group compared with the T-prov-only group had significantly lower side branch restenosis (HR: 0.55, 95% CI: 0.37 to 0.82; p = 0.004). CONCLUSIONS Both techniques of bifurcation treatment met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the MC technique yields a lower restenosis rate at both main and side branches. These results may confirm the advantage of using prescheduled 2-stent technique to give a complete coverage of the side branches' ostium.
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Teis-Soley A, Fernández-Nofrerías E, Rodríguez-Leor O, Tizón H, Salvatella N, Valle V, Mauri J. Perforación coronaria causada por guías intracoronarias: factores de riesgo y evolución clínica. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70166-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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