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Chen W, Hou CH, Chen YL, Shen HH, Lin CH, Wu CY, Lin MH, Liao CC, Huang JJ, Yang CY, Li YC, Yip HK. Safety and efficacy of intracoronary artery administration of human bone marrow-derived mesenchymal stem cells in STEMI of Lee-Sung pigs—A preclinical study for supporting the feasibility of the OmniMSC-AMI phase I clinical trial. Front Cardiovasc Med 2023; 10:1153428. [PMID: 37063964 PMCID: PMC10091140 DOI: 10.3389/fcvm.2023.1153428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundThis study tested whether early left intracoronary arterial (LAD) administration of human bone marrow-derived mesenchymal stem cells (hBMMSCs, called OmniMSCs) in acute ST-segment elevation myocardial infarction (STEMI) of Lee-Sung pigs induced by 90 min balloon-occluded LAD was safe and effective.Methods and resultsYoung male Lee-Sung pigs were categorized into SC (sham-operated control, n = 3), AMI-B (STEMI + buffer/21 cc/administered at 90 min after STEMI, n = 6), and AMI-M [acute myocardial infarction (AMI) + hBMMSCs/1.5 × 107/administered at 90 min after STEMI, n = 6] groups. By 2 and 5 months after STEMI, the cardiac magnetic resonance imaging demonstrated that the muscle scar score (MSS) and abnormal cardiac muscle exercise score in the infarct region were significantly increased in the AMI-B than in the SC group that were significantly reversed in the AMI-M group, whereas the left ventricular ejection function by each month (from 1 to 5) displayed an opposite pattern of MSS among the groups (all p < 0.001). By 5 months, histopathological findings of infarct and fibrosis areas and isolectin-B4 exhibited an identical pattern, whereas the cellular expressions of troponin-I/troponin-T/von Willebrand factor exhibited an opposite pattern of MSS among the groups (all p < 0.001). The ST-segment resolution (>80%) was significantly earlier (estimated after 6-h AMI) in the AMI-M group than in the AMI-B group (p < 0.001). The protein expressions of inflammation (IL-1β/TNF-α/NF-κB)/oxidative stress (NOX-1/NOX-2/oxidized protein)/apoptosis (cleaved caspase-3/cleaved PARP)/DNA damage (γ-H2AX) displayed an identical pattern to MSS among the groups, whereas the protein expressions of angiogenesis factors (SDF-1α/VEGF) were significantly and progressively increased from SC, AMI-B, to AMI-M groups (all p < 0.001).ConclusionEarly intra-LAD transfusion of OmniMSC treatment effectively reduced the infarct size and preserved LV function in porcine STEMI.
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Affiliation(s)
- Wannhsin Chen
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chun-Hsiang Hou
- Animal Technology Laboratories, Agricultural Technology Research Institute, Miaoli, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-Hsin Shen
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chen-Hsuan Lin
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Cheng-Yi Wu
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Meng-Hsueh Lin
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chih-Ching Liao
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Jun-Jae Huang
- Regeneration Medicine Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chi-Yu Yang
- Animal Technology Laboratories, Agricultural Technology Research Institute, Miaoli, Taiwan
| | - Yi-Chen Li
- Center of Cell Therapy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, China
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Sung PH, Wu CJ, Yip HK. Is Extracorporeal Membrane Oxygenator a New Weapon to Improve Prognosis in Patients With Profound Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention? Circ J 2016; 80:572-8. [PMID: 26853720 DOI: 10.1253/circj.cj-15-1398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite advancements in pharmacological therapy and refinement of the tools and technique of primary percutaneous coronary intervention (PCI) and coronary artery bypass surgery, patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock (CS) still have unacceptably high in-hospital mortality and unfavorable long-term outcome. Thus, there is an imminent need of a new and safe treatment modality in the management of AMI complicated by profound CS. Growing evidence suggests that extracorporeal membrane oxygenator (ECMO)-supported primary PCI is an effective therapeutic option for saving lives under such conditions. In this review, we describe and interpret the potential role of circulatory mechanical support by ECMO in the setting of AMI complicated by profound CS for improving clinical outcomes. (Circ J 2016; 80: 572-578).
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Affiliation(s)
- Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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Adenosine as an Adjunct Therapy in ST Elevation Myocardial Infarction Patients: Myth or Truth? Cardiovasc Drugs Ther 2015; 29:481-93. [DOI: 10.1007/s10557-015-6606-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Nazir SA, Khan JN, Mahmoud IZ, Greenwood JP, Blackman DJ, Kunadian V, Been M, Abrams KR, Wilcox R, Adgey AAJ, McCann GP, Gershlick AH. The REFLO-STEMI trial comparing intracoronary adenosine, sodium nitroprusside and standard therapy for the attenuation of infarct size and microvascular obstruction during primary percutaneous coronary intervention: study protocol for a randomised controlled trial. Trials 2014; 15:371. [PMID: 25252600 PMCID: PMC4189551 DOI: 10.1186/1745-6215-15-371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/10/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Microvascular obstruction (MVO) secondary to ischaemic-reperfusion injury is an important but underappreciated determinant of short- and longer-term outcome following percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). Several small studies have demonstrated a reduction in the degree of MVO utilising a variety of vasoactive agents, with adenosine and sodium nitroprusside (SNP) being most evaluated. However, the evidence base remains weak as the trials have had variable endpoints, differing drug doses and delivery. As such, the results regarding benefit are conflicting. METHODS The REperfusion Facilitated by LOcal adjunctive therapy in STEMI (REFLO-STEMI) trial is a multicentre, prospective, randomised, controlled, open label, study with blinded endpoint analysis: Patients presenting within 6 h of onset of STEMI and undergoing planned primary PCI (P-PCI) with TIMI 0/1 flow in the infarct-related artery (IRA) and no significant bystander coronary artery disease on angiography, are randomised into one of three groups: PCI with adjunctive pharmacotherapy (intracoronary adenosine or SNP) or control (standard PCI). All receive Bivalirudin anticoagulation and thrombus aspiration. The primary outcome is infarct size (IS) (determined as a percentage of total left ventricular mass) measured by cardiac magnetic resonance imaging (CMRI) undertaken at 48 to 72 h post P-PCI. Secondary outcome measures include MVO (hypoenhancement within infarct core) on CMRI, angiographic markers of microvascular perfusion and MACE during 1-month follow-up. The study aims to recruit 240 patients (powered at 80% to detect a 5% absolute reduction in IS). DISCUSSION The REFLO-STEMI study has been designed to address the weaknesses of previous trials, which have collectively failed to demonstrate whether adjunctive pharmacotherapy with adenosine and/or SNP can reduce measures of myocardial injury (infarct size and MVO) and improve clinical outcome, despite good basic evidence that they have the potential to attenuate this process. The REFLO-STEMI study will be the most scientifically robust trial to date evaluating whether adjunctive therapy (intracoronary adenosine or SNP following thrombus aspiration) reduces CMRI measured IS and MVO in patients undergoing P-PCI within 6 h of onset of STEMI. TRIAL REGISTRATION Trial registered 20th November 2012: ClinicalTrials.gov Identifier NCT01747174.
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Affiliation(s)
- Sheraz A Nazir
- />Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, LE3 9QP Leicester, UK
| | - Jamal N Khan
- />Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, LE3 9QP Leicester, UK
| | - Islam Z Mahmoud
- />Department of Cardiovascular Imaging, Division of Imaging Sciences & Biomedical Engineering, Rayne Institute, BHF Excellence Centre, St Thomas’ Hospital, King’s College London, London, UK
| | - John P Greenwood
- />Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Daniel J Blackman
- />Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Vijay Kunadian
- />Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Martin Been
- />Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Keith R Abrams
- />Centre for Biostatistics & Genetic Epidemiology, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Robert Wilcox
- />Faculty of Medicine & Health Sciences, Queen’s Medical Centre, Nottingham, UK
| | - AA Jennifer Adgey
- />Heart Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Gerry P McCann
- />Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, LE3 9QP Leicester, UK
| | - Anthony H Gershlick
- />Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, LE3 9QP Leicester, UK
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Zhao YJ, Fu XH, Ma XX, Wang DY, Dong QL, Wang YB, Li W, Xing K, Gu XS, Jiang YF. Intracoronary fixed dose of nitroprusside via thrombus aspiration catheter for the prevention of the no-reflow phenomenon following primary percutaneous coronary intervention in acute myocardial infarction. Exp Ther Med 2013; 6:479-484. [PMID: 24137212 PMCID: PMC3786843 DOI: 10.3892/etm.2013.1139] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/23/2013] [Indexed: 12/13/2022] Open
Abstract
Previous studies have shown that intracoronary (IC) nitroprusside (NTP) injection is a safe and effective strategy for the treatment of no-reflow (NR) during percutaneous coronary intervention (PCI). The present study tested the hypothesis that, on the basis of thrombus aspiration for the treatment of ST-segment elevation myocardial infarction (STEMI), the selective IC administration of a fixed dose of NTP (100 μg) plus tirofiban is a safe and superior treatment method compared with the IC administration of tirofiban alone for the prevention of NR during primary PCI. A total of 162 consecutive patients with STEMI, who underwent primary PCI within 12 h of onset, were randomly assigned to two groups: Group A, IC administration of a fixed dose of NTP (100 μg) plus tirofiban (10 μg/kg) and group B, IC administration of tirofiban (10 μg/kg) alone (n=80 and n=82, respectively). The drugs were selectively injected into the infarct-related artery (IRA) via a thrombus aspiration catheter advanced into the IRA. The primary end-point was post-procedural corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). The proportion of complete (>70%) ST-segment resolution (STR); the TIMI myocardial perfusion grade (TMPG) 2–3 ratio following PCI; the peak value of creatine kinase (CK)-MB; the TIMI flow grade; the incidence of major adverse cardiac events (MACEs) and the left ventricular ejection fraction (LVEF) after 6 months of follow-up were observed as the secondary end-points. There were no significant differences in the baseline clinical and angiographic characteristics between the two groups. Compared with group B, group A had i) a lower CTFC (23±7 versus 29±11, P=0.000); ii) a higher proportion of complete STR (72.5 versus 55.9%, P=0.040); iii) an enhanced TMPG 2–3 ratio (71.3 versus 53.7%, P=0.030) and iv) a lower peak CK-MB value (170±56 versus 210±48 U/l, P=0.010). There were no statistically significant differences in the final TIMI grade-3 flow between the two groups (92.5 versus 91.5% for groups A and B, respectively; P=0.956). The LVEF at 6 months was higher in group A than group B (63±9 versus 53±11%, respectively; P=0.001); however, the incidence of MACEs was not statistically different between the two groups, although there was a trend indicating improvement in group A (log rank χ2=0.953, P=0.489). The selective IC administration of a fixed dose of NTP (100 μg) plus tirofiban via a thrombus aspiration catheter advanced into the IRA is a safe and superior treatment method compared with tirofiban alone in patients with STEMI undergoing primary PCI. This novel therapeutic strategy improves the myocardial level perfusion, in addition to reducing the infarct size. Furthermore, it may improve the postoperative clinical prognosis following PCI.
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Affiliation(s)
- Yu-Jun Zhao
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000
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Utsunomiya M, Hara H, Sugi K, Nakamura M. Relationship between tissue characterisations with 40 MHz intravascular ultrasound imaging and slow flow during coronary intervention. EUROINTERVENTION 2011; 7:340-6. [DOI: 10.4244/eijv7i3a58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chang HW, Leu S, Sun CK, Hang CL, Youssef AA, Hsieh YK, Yang CH, Cheng CI, Chen SM, Chen CJ, Chua S, Chang LT, Wu CJ, Yip HK. Level and value of circulating endothelial progenitor cells in patients with acute myocardial infarction undergoing primary coronary angioplasty: in vivo and in vitro studies. Transl Res 2010; 156:251-63. [PMID: 20875902 DOI: 10.1016/j.trsl.2010.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/13/2010] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
Abstract
Levels of circulating endothelial progenitor cells (EPCs) in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI) were investigated in this study. Flow cytometric analysis of the circulating EPC level (CD31/CD34 [E(1)], CD62E/CD34 [E(2)], and KDR/CD34 [E(3)]) was determined from blood samples of 161 consecutive patients with STEMI undergoing primary PCI. Angiogenesis was evaluated using mononuclear cell-derived EPCs on Matrigel. The EPC number (E(1-3)) was lower in STEMI patients than in normal subjects (n = 25) (P < 0.005). Patients with high EPCs (E(1-3)) (≥1.2%) had a lower left ventricular ejection fraction, elevated white blood cell count and creatinine level, advanced Killip score (≥class 3), more advanced congestive heart failure (CHF) (≥class 3), and increased 30-day mortality than those with a low EPC (E(1-3)) level (<1.2%) (P < 0.0001). Angiogenesis was lower in patients with a high EPC level than those with a low EPC level and normal controls (P < 0.001). Both the advanced Killip score and the CHF were independent predictors of increased EPC levels (P < 0.05). Multivariate analysis identified a high EPC (E(3)) level to be the most important predictor of increased 30-day major adverse clinical outcome (MACO) (P < 0.0001). In conclusion, the circulating EPC level is a major independent predictor of 30-day MACO in patients with STEMI undergoing primary PCI.
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Affiliation(s)
- Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Niccoli G, Dʼamario D, Spaziani C, Cosentino N, Marino M, Rigattieri S, Schiavo PL, De Vita MR, Tarantino F, Bartorelli A, Fabbiocchi F, Prati F, Imola F, Valgimigli M, Ferrari R, Crea F. Randomized evaluation of intracoronary nitroprusside vs. adenosine after thrombus aspiration during primary percutaneous coronary intervention for the prevention of no-reflow in acute myocardial infarction: the REOPEN-AMI study protocol. J Cardiovasc Med (Hagerstown) 2009; 10:585-92. [DOI: 10.2459/jcm.0b013e32832b3571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chang LT, Yuen CM, Sun CK, Wu CJ, Sheu JJ, Chua S, Yeh KH, Yang CH, Youssef AA, Yip HK. Role of stromal cell-derived factor-1alpha, level and value of circulating interleukin-10 and endothelial progenitor cells in patients with acute myocardial infarction undergoing primary coronary angioplasty. Circ J 2009; 73:1097-104. [PMID: 19372622 DOI: 10.1253/circj.cj-08-0497] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationships among the circulating levels of endothelial progenitor cells (EPC), stromal cell-derived factor (SDF)-1alpha, interleukin (IL)-10 and outcome were examined in patients with ST-segment elevation acute myocardial infarction (ST-se AMI) undergoing primary coronary angioplasty. METHODS AND RESULTS Circulating levels of IL-10, SDF-1alpha, and EPCs [defined by staining markers: CD31/CD34 (E(1)) and KDR/CD34 (E(2))] were examined by ELISA and flow cytometry, respectively. The IL-10 level was higher, whereas the circulating level of EPCs (E(1-2)) was lower (all P<0.05) in AMI patients than in normal subjects. Additionally, the SDF-1alpha level was significantly and independently predictive of an increased level of circulating EPCs (E(1-2)) (P<0.0001). Furthermore, patients with a high SDF-1alpha level (>1,500 pg/ml) had lower left ventricular performance, higher Killip score (defined as >or=3), and increased 30-day mortality than those with low SDF-1alpha level (<or=1,500 pg/ml) (all P<0.007). Moreover, high circulating levels of E(2) and IL-10 were the most significant independent predictors of increased 30-day major adverse clinical outcome (MACO) (defined as advanced Killip score >or=3 or 30-day mortality) (P<0.01). CONCLUSIONS The serum SDF-1alpha level is independently predictive of an increased level of circulating EPCs (E(1-2)). E(2) and IL-10 are major independent predictors of 30-day MACO in ST-se AMI patients undergoing primary coronary angioplasty.
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Affiliation(s)
- Li-Teh Chang
- Basic Science, Nursing Department, Meiho Institute of Technology, Pingtung, Taiwan, ROC
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Chen YL, Bhasin A, Youssef AA, Wu CJ, Yang CH, Hsieh YK, Fang CY, Hang CL, Yip HK. Prognostic factors and outcomes in young chinese patients with acute myocardial infarction undergoing primary coronary angioplasty. Int Heart J 2009; 50:1-11. [PMID: 19246842 DOI: 10.1536/ihj.50.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the prognostic risk and the clinical outcome of young-adult patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Between May 1999 and September 2007, primary PCI was performed in 1680 consecutive patients with AMI of onset < 12 hours (cardiogenic shock within 18 hours) at Kaohsiung Chang Gung Memorial Hospital. Of these patients, 163 (9.7%) young-age patients (defined as male of < 45 years old and female of < 55 years old) were enrolled into this study. A comparable number (n = 175) of patients > or = 55 years old, who presented with AMI of < 12 hours duration having undergone primary PCI between November 2004 and May 2006, were retrospectively reviewed and enrolled as control subjects. The procedural success (defined as normal blood flow achieved in the infract-related artery) was similar between the young-age and old-age patients (P = 1.0). Additionally, the incidence of an advanced Killip score (defined as > or = score 3 upon presentation), 30-day and 6-month cumulative mortality did not differ between these two groups of patients (P > 0.1). However, the 30-day major adverse clinical outcome (MACO) (defined as New York Heart Association Functional Classification > or = 3 or 30-day mortality) was significantly lower in the young-age than in the old-age patients (P < 0.001). Further, multiple stepwise logistic regression analysis showed that an advanced Killip score along with the peak level of CK-MB was independently predictive of 30-day MACO (P < 0.05) in young-age patients. In conclusion, the prognostic outcome is favorable in young-adult ST-se AMI undergoing primary PCI. Traditional risk factors remain effective for stratification of young-adult AMI patients into high- or low-risk subgroups.
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Affiliation(s)
- Yung-Lung Chen
- Department of Internal Medicine, Chang Gung University College of Medicine, Taiwan, Republic of China
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Montarella KE, Gales MA. Intracoronary Vasodilators for the No-Reflow Phenomenon. J Pharm Technol 2008. [DOI: 10.1177/875512250802400403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the literature relating to the use of intracoronary vasodilators to prevent and/or treat the no-reflow phenomenon in patients undergoing percutaneous coronary intervention (PCI). Data Sources: A literature search was conducted using MEDLINE (1966–March 2008) and Science Citation Index (1945–March 2008) using the search terms vasodilators, no-reflow, and intracoronary. Study Selection and Data Extraction: English-language clinical trials and case series were selected from articles retrieved. References of reviewed articles were examined for additional sources. Studies relating to the use of intracoronary vasodilators in the prevention and/or treatment of no-reflow in PCI were evaluated for safety and efficacy data. Articles relating to agents not available in the US were excluded. Data Synthesis: Evidence of intracoronary adenosine's utility in no-reflow treatment is limited. Its use in no-reflow prevention was associated with outcomes ranging from no difference to nearly an 88% reduction in no-reflow development; the drug was generally well tolerated. No-reflow treatment with intracoronary verapamil improved flow in 87–100% of cases. Preventive trials with verapamil failed to demonstrate efficacy. Atrioventricular block requiring treatment was the most commonly reported adverse event with intracoronary verapamil. Literature on intracoronary diltiazem and intracoronary nicardipine is limited. Both agents produced greater than 95% efficacy in no-reflow treatment, while prevention studies found no-reflow developing in less than 4% of patients. Although adverse event reporting was limited, hemodynamic instability was noted in patients receiving diltiazem. Response rates ranged from 73% to 100% when intracoronary nitroprusside was studied as treatment for no-reflow associated with acute myocardial infarction (AMI). Systemic hypotension was noted with nitroprusside administration. Conclusions: The available data are predominately from case series and retrospective reviews. Prevention of no-reflow with intracoronary vasodilators in elective PCI is not warranted. Nitroprusside should be considered first-line treatment in no-reflow associated with AMI.
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Affiliation(s)
- Kristin E Montarella
- KRISTIN E MONTARELLA PharmD BCPS, Assistant Professor of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Oklahoma City, OK; Clinical Specialist, Department of Pharmacy, Integris Southwest Medical Center, Oklahoma City
| | - Mark A Gales
- MARK A GALES PharmD BCPS, Professor of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University; Clinical Specialist, Department of Pharmacy, Integris Southwest Medical Center
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Seth A. Another "nail in the coffin" for protection devices in acute MI? Catheter Cardiovasc Interv 2008; 71:E3-4. [PMID: 18412090 DOI: 10.1002/ccd.21603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yip HK, Youssef AA, Chang WN, Lu CH, Yang CH, Chen SM, Wu CJ. Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting. Cardiovasc Intervent Radiol 2007; 30:840-6. [PMID: 17587084 DOI: 10.1007/s00270-007-9051-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 03/21/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. BACKGROUND The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. METHODS The study included 24 consecutive patients (22 male,2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. RESULTS A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. CONCLUSION We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access.
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Affiliation(s)
- Hon-Kan Yip
- Division of Cardiology, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University Collage of Medicine, Kaohsiung, Taiwan, ROC
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