Serum sP-selectin level and brachial artery flow mediated dilation as predictors of no reflow in patients with ST segment elevation myocardial infarction undergoing primary PCI

Background: No reflow phenomenon is associated with major adverse cardiac events, prediction of no reflow using laboratory and noninvasive imaging techniques can help in early prevention and management of this phenomenon

Objectives: To investigate the predictive value of serum sP-selectin and endothelial dysfunction assessed by using brachial artery flow mediated dilation [FMD] in patients with STEMI undergoing primary PCI to address patients with high incidence of no reflow

Methods: The prognostic performance, clinical and angiographic correlates of sP-selectin and FMD was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to [history taking, clinical examination, laboratory investigations including withdrawal of serum samples for detection of sP-selectin levels, echocardio-graphy, assessment of endothelial dysfunction by measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial blush grade. Follow up of the patients during hospital stay and after one month for the incidence of MACE

Results: A significant correlation between patients with high serum sP-selectin and TIMI flow

Conclusions: Serum sP-selectin level in patients with STEMI treated by primary PCI can predict the patients who will develop no reflow phenomenon after PCI, FMD could not predict the incidence of no reflow among those patients

Guard wire use during percutaneous intervention of saphenous vein bypass grafts in non-MI patients is associated with a reduction of in-hospital and 30-day major adverse cardiac events- a small scale randomized study

Distal embolization is known to be an awful complication of vein graft intervention, especially so in old friable and degenerated vein grafts. Distal protection offers an attractive option to prevent embolization, and hence preserve the myocardium. Fifty- three patients [with chronic stable angina, unstable angina, or myocardial infarction [MI] with the cardiac enzymes back to normal] were randomized to two treatment modalities. Thirty-one patients were randomized to conventional angioplasty and/or stenting of vein grafts, as opposed to 22 patients who were randomized to distal protection utilizing the Guard Wire treatment. Major Adverse Cardiac Events [MACE] during index hospitalization and at thirty days were recorded for both groups. There was a 19.4% absolute [100% relative] reduction in the Major Adverse Cardiac Events [MACE] during index hospitalization [19.4% of the patients in the control group versus zero percent of the patients in the guard wire group, P= 0.032]. Major Adverse Cardiac Events [MACE] during the first 30 days following the index procedure were seen in 25.8% [n=8] of the patients in the control group, as opposed to zero percent of the patients in the control group [P= 0.009]. The results of the current study suggest that distal protection might be superior to the current conventional PTCA and/or stenting techniques when percutaneous treatment of saphenous vein grafts is to be attempted. Distal protection needs to be the "standard" procedure during SVG interventions, especially in light of the accumulating evidence of its superiority over stand-alone PTCA and stenting