ABSTRACT
Objective To evaluate the effect of urapidil on myocardial reperfusion and cardiac function during primary percutenons coronary intervention (PCI) in acute myocardial infarction (AMI) patients.Methods 54 AMI patients undergoing primary PCI were randomized to intracoronary urapidil (n=27) and nitroglycerin (n=27) group.When blood flow grade TIMI-l or more appeared in the infarct related artery (IRA) before or after percutenous transluminal coronary angioplasty (PTCA),urapidil (12.5 mg) or nitroglycerin (0.2 mg) was given intracoronary and then stents were implanted as needed.TIMI blood flow,no reflow/slow floW,corrected TIMl frame count (cTFC),myocardial blush grade (MBG),ST resolution (STR) on ECG, peak of creatine kinase (CK),cardiac troponin T (cTnT) were observed before and after PCI.Left ventricular ejection fraction (LVEF) was measured 24 hours and 30 days after PCI and MACE including death,reinfartion,revascularization in hospital were observed. Resuits Urapidil group compared to the nitroglycerin group,cTFC (18.38±3.30 vs.21.44±4.26,P=0.005) decreased and MBG (P=0.040) improved.STR in the urapidil group improved significantly compred to the nitroglycerin group (93% vs.70%,P=0.038).LVEF of 24 hours and 30 days after PCI in the urapidil group was higher than that ofthe nitroglycerin group (0.55±0.05 vs.0.52±0.06,P=0.021 and 0.58±0.06 vs 0.54±0.06,P=O.041,respectively).Peak CK (1895.26±1239.02 vs.1269.96±515.84,P=0.021) and peak TnT (5.81±5.27 vs 3.64±2.35,P=0.050) in the urapidil group decreased more significantly than that of the nitroglycerin group.No difference of MACE was found in the two groups.Conclusion Intracoronary urapidil administration adjunct to primary PCI in AMI ameliorates coronary blood flow and myocardial perfusion, improves ventricular function,and reduce the infarct size and does not incllase the incidence of complications during hospitalization.
ABSTRACT
BACKGROUND:Clinical trials have shown that oral administration of valsartan can decrease in-stent restenosis after stent implantation.But whether valsartan used locally also has the sanle effect and the possible mechanism should be validated.OBJECTIVE:To observe the effect of valsartan-eluting stents on collagen deposition in neointima and AT2 receptor expression after implanting valsartan-eluting stents into rabbit abdominal orta.DESIGN:Randomized and controlled animal experiment.SETTING:Beijing Friendship Hospital.MATERIALS:The experiment was performed at the Laboratory of Beijing Friendship Hospital between October 2004 and March 2006.Fifteen New Zealand white rabbits,irrespective of gender,weighing 2.75-3.25 kg were selected(Animal Laboratory of Beijing Friendship Hospital).The rabbits were adaptively fed for one week.All the operations of rabbits during the experiment were accorded with animal ethical standards.Valsartan powder was presented as a gift by Novartis.China;Reagent of MASSON was provided by Department of Pathology of Beijing Friendship Hospital;1%picrosirius solution was provided by the Department of Pathology of China-Japan Friendship Hospital:Mice-anti-rabbit monoclonal AT2 antibody was product of Santa Cruz Biotechnology (USA);Envision reagent was purphased from Dako;primers were synthesized by SBS Genetech(SBS).METHODS:①The animals were randomized into bare-metal stent group,carrier-eluting stent group and valsartan-eluting stent group with 5 animals in each group.All rabbits were implanted with corresponding types of above-mentioned stents into abdominal aortas down below renal artery.②Quantitative angiography before,immediately after and 3 months after stent implantation were performed to compare vascular diameters of the aortas.③Three months Iater,the rabbits were executed after anaesthesia.The vessels with stents were processed with HE staining.Indices of the vascular neointimal formation,I.e. iBrier and external elastic membrane luminal area,the maximal intimal thickness,neointimal area and stenosis area percent were measured.④The collagen deposition in neointima was observed through MASSON staining,and the type of collagen was identified through picrosirius stain.⑤The expressions of AT2R mRNA and proteins were also compared by RT-PCR and immunohistochemistry among three groups.MAIN OUTCOME MEASURES:①The diameters of aorta with stent at different time;②Inner and extemal elastic membrane luminal area,the maximal intimal thickness,neointimal area and stenosis area percent;③Collagen deposition and type of collagen of the aorta with stent;④AT2R mRNA and protein expressions.RESULTS:Of 15 rabbits selected in the experiment,1 rabbit of the bare-metal stent group died during stent implanting,and 1 of the carrier-eluting stent group died during breeding after stenting.Finally,13 rabbits were included in final analysis.①There were no significant differences in the mean aortic diameters between any two of the three groups before,immediately after and 3 months after stent implantation(P＞0.05).②A larger 1uminal area and a less neointimal hyperplasia in valsartan eluting-stents group were found compared with the other two groups(P＜0.01).③MASSON staining showed that collagen deposition was rich in neointima of bare-metal stent group and carrier-eluting stent group while rare in neointima of valsartan eluting stent group.Pierosirius staining suggested that the deposited collagen was type Ⅲ collagen predominantly accompanied by type Ⅰ collagen around stents struts;the type Ⅲcollagen deposition was obviously decreased in valsartan eluting stent group.④AT2R protein only expressed in adventitia of bare-metal stet group and arrier-eluting stent group while expressed in all layers of valsartan eluting-stents group.The AT2R mRNA/a-Actin mRNA of valsartan eluting stent group was significantly higher than that in the other two groups(P＜0.01).CONCLUSION:Valsartan eluting-stents inhibits neointimal hyperplasia after stenting by decreasing collagen deposition.especially collagen Ⅲ.The mechanism may be related with the upregulation of AT2R mRNA and protein expressions by valsartan-eluting stent.
ABSTRACT
BACKGROUND: Valsartan is an antagonist of angiotensin Ⅱ (Ang Ⅱ ) receptor. Many researches have proved that it can protect heart tissue. Val-PREST suggests that valsartan with a long-term administration can decrease restenosis rate in stent; however, effect of valsartan on restenosis rate of Chinese population is still unclear presently.OBJECTIVE: To evaluate the effect of oral valsartan for 6 months on patients with coronary heart disease (CHD) who undertook successful intervention therapy.DESIGN: Multicenter, double blind, randomized, and controlled evaluation and prospective design.SETTING: Beijing Friendship Hospital Affiliated to Capital Medical University; Beijing Anzhen Hospital Affiliated to Capital Medical University; Peking Union Hospital; People's Hospital of Peking University; Beijing Tongren Hospital Affiliated to Capital Medical University; Beijing Shijingshan Hospital; Beijing Fuxing Hospital Affiliated to Capital Medical University;Beijing Chuiyangliu Hospital.PARTICIPANTS: Eight three-grade A hospitals in Beijing participated in the study. Since December 2002 to October 2003, a total of 200 patients who underwent bare mental stent implantation were consented, but 196 patients were recruited in the end. All 196 patients were randomized into valsartan group (100 cases) and control group (96 cases).METHODS: Basic medicines in the two group included aspirin, clopidogrel, nitrides, statins, β-receptor antagonists, calcium channel antagonists, etc. Additionally, Patients in valsartan group were also given valsartan (Beijing Nuohua Pharmaceutical Co. Ltd., batch number: SD 34004) in a dosage of 80 mg a day. Both groups were followed-up once a month for total 6 months.MAIN OUTCOME MEASURES: ① Major adverse cardiac events within 6 months on clinics (death, non-fatal myocardial infarction, hospitalisation once more due to recurrent myocardial ischemia, and target vessel revascularization); ② Results of duplicated coronary angiography or exercise treadmill test (ETT) of partial patients within 6 months.RESULTS: ① Two patients (2%) in valsartan group were excluded in this study because of intolerance, so 194 patients were involved in the final analysis. ② No significant differences of baseline characteristics in terms of lesion type, the number of diseased vessels and the cardiac function were found between the two groups (P ＜ 0.05). ③ During the period of 6-month follow-up, one case died in control group. One acute myocardial infarction occurred in each group, whilst one case undertook target vessel revascularization in valsartan group. It was found that the proportion of recurrent cardiac events was lower in valsartan group than that in control group (11.2% vs. 15.6%). However, this difference did not reach the statistic significance. ④ During the period of 6-month duplicated contrast examination, one case had restenosis of in-stent in valsartan group. ⑤ The positive rate of exercise treadmill test (ETT) was lower in valsartan group (25.7%) than that in control group (36.4%), but there was no statistic difference.CONCLUSION: Six-month oral valsartan on patients with coronary heart disease who undertook successful intervention therapy can decrease the trend of recurrent cardiac events and positive rate of ETT.
ABSTRACT
Background and Objective Previous study showed tenecteplase and alteplaxe were equovalent for 30-day mortality in the treatment of acute myocardial infarction. The purpose of this open-label, randomized, multi-center, angiographic trial was to assess the efficacy and safety of tenecteplase compared with alteplase in Chinese patients with acute myocardial infarction. Methods We recruited patients with acute ST-elevation myocardial infarction presenting within 6 hours of symptom onset from October, 2002 to March,2004, in 5 hospitals in Beijing. After giving informed consent, patients were randomly assigned a single-bolus injection of tenecteplase (30-50 mg according to body weight) or front loaded alteplase (100 mg), and underwent coronary angiography at 90 min after starting the study drug. All patients received aspirin and heparin (target activated partial thromboplastin time 50-70 s). The primary efficacy end point was the rate of TIMI grade 3 flow at 90 minutes. Other efficacy end points included TIMI grade 2/3 flow at 90 minutes. Safety end points included all stroke, intracranial hemorrhage (ICH), moderate/severe hemorrhage (except for ICH), all-cause mortality at 30-days, and major non-fatal cardiac events at 30 days. Results Overall 110 patients were eligible for statistical analysis, with 58 patients assigned to receive tenecteplase and 52 patients to alteplase. Tenecteplase produced a rate of TIMI grade 3 flow at 90 minutes after the start of thrombolysis(68.4%) similar to that of alteplase (66.7%, P=1.0); the rates of TIMI grade 2 or 3 were similar for patients treated with tenecteplase versus alteplase (89.5% versus 80.4%, respectively, P=0.278). At 30 days, rates for all strokes were similar for the two groups (5.17% for tenecteplase and 1.92% for alteplase, P=0.62); rates of ICH were 3.45% and 1.92% (tenecteplase and rt-PA,P=1.00) respectively. The rate of moderate/severe hemorrhage was 8.62% with tenecteplase and 5.77% with alteplase (P=0.72); total mortality was almost identical in the two groups (13.8% versus 9.6%, respectively, P=0.565) while the rates of non-fatal cardiac complications were 10.35% and 11.54% (tenecteplase and alteplase, P=1.0). Conclusions The efficacy of a single-bolus, weightadjusted tenecteplase fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow, and TIMI 2 or 3 flow, but the 30-day mortality and ICH in both groups was so high that the use of tenecteplase is not permitted in China. These negative safety results might be due to the high rate of percutaneous coronary intervention (PCI) and high dose of bolus heparin and suboptimal concomitant medical therapy during hospitalization, so further studies are needed to confirm the safety for tenecteplase in Chinese patients.
ABSTRACT
Cardiovascular fibrosis is the common pathological manifestation of many heart diseases.Relaxin inhibits fibrosis through several mechanisms as follows relaxin inhibits fibroblast function,collagen synthesis/secretion and the influence of several profibrotic factors.Relaxin stimulates MMP expression.Relaxin rapidly inhibits cardiovascular fibrosis and has no effect on normal tissue.It is a potential and selective antifibrotic target of cardiovascular diseases.
ABSTRACT
0.05). Multivariate analysis revealed that risk factors for vascular complications included the difference in radial artery diameter and sheath size; prolonged procedure time and comorbidity of diabetes mellitus. Conclusion Transradial access is a safe and practical alternative approach for intervention procedure. Vascular ultrasonic examination is valuable for selection sheath before invention procedure especially in patients with diabetes mellitus and in assessment vascular complications after the procedure.
ABSTRACT
Objective To observe the security, major cardiac adverse events and target lesion revascularization (TLR) in patients underwent Sirolimus Eluting Stents and Paclitaxel Eluting Stents implantation. Methods A total of 224 consecutive patients from Dec, 2002 to Dec, 2004 who randomized to receive SES and PES implantation were enrolled with 168 male cases and 56 female cases. The average age was 60.9?11.1 years (35-86 yrs) and the median follow-up period was 13.4?6.7 months (3-27 ms). Results There was no difference in baseline characteristics between both groups. No acute and subacute thrombosis events occurred in both groups but two delayed thrombosis occurred in the PES group. There were six MACEs in the PES group, and among them two patients occurred delayed thrombosis and four patients underwent target lesion revascularization. There was one patient underwent TLR in the SES group. Conclusion Both drug eluting stents reduced MACEs and TLR, but the rate of delayed thrombosis, MACEs and TLR was lower in the SES group than in the PES group.
ABSTRACT
Objective To study the effect of valsartan eluting-stent on vascular neointimal formation and angiotensin Ⅱ type 2 receptor (AT2R) expression and to access its feasibility to prevent in-stent restenosis and the mechanism. Methods Both the valsartan eluting-stents and the carrier eluting-stents were made with multi-layers coated methods. Bare stents, carrier eluting-stents and valsartan eluting-stents were implanted into the rabbits' abdominal aortias respectively. Abdominal aorta angiography was performed before and right after the operation and at 3 months after stent inplantation. The mean diameter of aortas in different groups were measured by Quantitative coronary angiography software. All the rabbits were killed 3 months after the procedure and the cross section of the stented vessel were analysed for neointimal formation. The luminal area, neointimal area, inner elastic membrane luminal area and the maximal inner-membrane thickness were compared between the 3 groups. The expressions of AT2R mRNA and the protein were determined by RT-PCR and histomorphometry. Results There were no significant differences in the mean aortic diameters among the 3 groups.The greatest luminal area and the minimal neointimal hyperplasia was found in the valsartan eluting-stents group compared with the other two groups. The mean luminal areas of the bare stents, carrier eluting stents and the valsartan eluting-stents were 4 345 548?1 258 22 ?m2, 4 302 061?167 952 ?m2 and 5 016 269?207 934 ?m2; the mean neointimal areas were 1 119 635?163 503 ?m2, 1 135 636?136 555 ?m2 and 441 577?74 099 ?m2 and the mean maximal inner-membrane thickness were 210?30 ?m, 192?21 ?m and 116?12 ?m respectively.The level of AT2R mRNA expression in the valsartan eluting-stents group was higher than that in the other two groups. The transcription of AT2R protein showed similar trend. Conclusion Valsartan eluting-stents enhanced AT2R mRNA and protein expression and inhibited neointimal hyperplasia which might play an important role in preventing restenosis.
ABSTRACT
AIM:To investigate the changes in parameters related to myocardial fibrosis of H2 relaxin (H2RLX) and procollagen type I C-terminal peptide (PICP),transforming growth factor-?1 (TGF-?1) level in the plasma after acute anterior myocardial infarction. METHODS:Forty-one patients with anterior myocardial infarction (MI) and 10 controls with normal coronary vessels were selected. Plasma H2RLX,PICP,and TGF-?1 levels were determined by enzyme linked immunosorbent assay (ELISA) in 10 control subjects and 41 post-MI patients at day 3 and 7 post-MI. RESULTS:(1) H2RLX level at day 3 post-infarct had no difference between the patients and the controls. No marked change in H2RLX at day 3 versus day 7 post-infarct was observed. (2)The level of PICP at day 3 post-infarct was markedly increased followed by a fall at day 7 post-infarct,but was still higher than that in control. (3) TGF-?1 level,which was similar at day 3 and 7 post-infarct,was higher than that in control. (4) At day 7 post-infarct,the level of H2RLX was positively correlated with the fasting blood glucose in MI group. CONCLUSION:In early period of acute MI,profibrotic factors such as TGF-?1 expression and collagen expression increase. However,antifibrotic relaxin has no change.