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Objective To investigate the impact of optical coherence tomography(OCT) imaging on physician decision-making during primary percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods From January 2016 to May 2017, OCT was performed in 100 cases pre- and post- primary PCI. The pathogenesis of myocardial infarction was determined and immediate effect of PCI evaluated by OCT. Clinical outcome during a 12-months follow up was analyzed. Results The data from 17 patients were excluded for further study due to poor OCT images quality. The rates of plaque rupture, plaque erosion, calcification nodules, stent malapposition and coronary spasm were 65.1％(54/83), 26.5％(22/83), 3.6％(3/83), 2.4％(2/83) respectively among the remaining 83 patients with sufficient OCT quality images. of the overall rate of stent malposition, tissue prolapse and incomplete stent expansion was 21.7％(18/83). The incidence of edge dissection was 19.3％(16/83), and among them 2 patients required treatment with stent implantation. Among the 17 patients without stenting:coronary spasm were found in 2 cases, thrombus overload in 1 case after thrombus aspiration, plaque rupture in 7 cases , plaque erosion in 4 cases and stent malposition in 3 cases. One patient died in hospital for cardiogenic shock and one patient had subacute stent thrombosis . There were no major adverse cardiac events occurred in the remaining patients during the (11.0±4.0) months of follow-up. Conclusions OCT can identify nonoptimal stent deployment in approximately one-fourth of STEMI patients undergoing primary PCI, thus providing preliminary guidance to the physician for further mangement.
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Objective To investigate the first medical contact to balloon ( FMC2B) time in our center and to identify the influencing factors .Methods This is a retrospective study conducted in the heart center of Beijing Luhe Hospital . A total of 140 patients undergoing primary percutaneous coronary intervention ( PCI) were enrolled between July 2013 to September 2014.Demographic data , clinical risk factors and the emergency process were evaluated .All the patients were categorized into 2 groups including:the conformed group ( patients with FMC2B<120 min for non-PCI-capable hospital and <90 min for direct arrival at Luhe hospital, n=59) and the unconformed group (n=81).Multivariant regression aralysis was done to analyse factors influencing FMC 2B time.Results Among the enrolled 140 patients, 58 patients were initially seen in a non-PCI-capable hospital , 31 patients were directly sent to Luhe hospital by ambulance and 51 patients arrived by themselves.The median FMC2B time was 106.16 min (interquartile range [ IQR ]: 77.37 -165.52 min ) and 42.1% ( 59/140 ) of the patients achieved the current recommended FMC2B time.In a multivariate logistic analysis , FMC to electrocardiographic ( ECG) within 10 min ( OR=5.61 , 95% CI 1.91-16.88 ) , admission during normal working hours ( OR=5.11 , 95%CI 1.88-13.85 ) , patient′s education level of high school or above ( OR=4.16 , 95%CI 1.53-11.34 ) , awareness of heart diseases ( OR =2.58, 95% CI 1.13 -5.91 ) were predictors of improving FMC2B. Transfer for primary PCI (OR=0.37, 95% CI 0.15-0.92) increased FMC2B.Conclusions Less than half of the patients with primary PCI achieved the goal of guidelines′recommended FMC2B time.Initial ECG, admission during normal working hours , patient′s education level and awareness of heart diseases and transfer for primary PCI are the independent predictors of FMC 2B time.
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Objective To investigate the therapeutic effect of self made balloon with side hole on no reflow ( NR) after emergency percutaneous coronary intervention ( PCI ) .Methods 48 patients with NR after PCI in our hospital were randomized into two groups , which were group A ( n=24 , patients received self made perfusion balloons with holes ) and group B ( n=24 , patients using direct guiding catheter ) and through respective devices intravascular tirofiban and verapamil were given .TIMI flow grade, recovery of myocardial enzymes and ST-segment elevation , LVEF and the incidence of MACE were compared between the 2 groups.Results Among patients in group A , the percentage of immediate postoperative TIMI Ⅲflow (79.2%vs.45.8%,P=0.032), ST segment resolution of more than 50% (83.3% vs.54.2%,P =0.029 ) and LVEF after 1 months [ ( 54.92 ±12.32 )% vs. ( 47.67 ±12.15 )%, P =0.046 ] were significantly higher than patients in group B .The CK peak value of patients in group A [ ( 1018.62 ± 732.34)mmol/L vs.(1497.75 ±858.63)mmol/L, P =0.043], CK-MB peak values [(113.84 ± 76.53 ) mmol/L vs.( 172.74 ±93.56 ) mmol/L, P=0.021 ] and MACE rates ( 0 vs.16.7%, P=0.037 ) were lower than those of patients in group B .Conclusions The use of self-made perfusion balloon with side hole for the treatment of NR patients after emergency PCI is convenient , easy and effective.
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Objective:To explore the impact of domestic bivalirudin on platelet function during emergency percutane-ous coronary intervention (PCI) .Methods :A total of 100 patients with acute ST segment elevation myocardial in-farction who recieved emergency PCI were randomly divided into unfractionated heparin group (UFH group ,n=53) and bivalirudin group (n=47) .Adenyl diphosphoric acid (ADP)-induced platelet aggregation rate was meas-ured and statistically compared between two groups before and after PCI .Results:Before emergency PCI ,there was no significant difference in ADP-induced platelet aggregation rate between two groups (P=0.99) .After emergency PCI ,ADP-induced platelet aggregation rate in bivalirudin group was significantly lower than that of UFH group [ (16.46 ± 10.23)% vs .(25.21 ± 15.91) % , P<0.01] .Conclusion:During percutaneous coronary intervention , compared with routine heparin anticoagulation , bivalirudin , as an anticoagulant , can more significantly inhibit platelet aggregation and possess antiplatelet effect .