Antiplatelet Therapy, Clinical Characters and Long-term Outcomes of Patients With Angiography-documented Stent Thrombosis / 中国循环杂志

Objectives: To describe the differences between patients with angiography confirmed stent thrombosis in antiplatelet therapy and long term outcomes. Methods: We analyzed data from 1 204 patients with angiography – documented stent thrombosis between January 2008 to December 2016 in Beijing Anzhen Hospital. According to the timing of stent thrombosis post stent implantation, patients were divided into acute stent thrombosis (<24 h, n=106), subacute stent thrombosis(24 h~30 d, n=206), late stent thrombosis (>30 d~1y, n=268), and very late stent thrombosis (>1 y, n=624) groups. Death, recurrent stent thrombosis, recurrent myocardial infarction, target vessel revascularization, stroke and antiplatelet treatment during In-hospital or long-term clinical follow-up were compared among groups. Results: Prevalence of stent thrombosis was the highest in the left anterior descending artery (51.9%) in acute stent thrombosis group. Subjects with subacute stent thrombosis had a higher prevalence rate of LVEF<50% (28.2%), and subjects with very late stent thrombosis had a higher prevalence rate of diabetes (34.1%). All patients in acute stent thrombosis group received aspirin + clopidogrel, 96.5% patients in subacute stent thrombosis group and 94.5% patients in late stent thrombosis group were treated with double or triple antiplatelet therapy, while 95.2% patients in the very late stent thrombosis group were treated with double or mono antiplatelet therapy. During the follow up, mortality was 23.6%, 26.7%, 26.3% and 18.9% in acute stent thrombosis, subacute stent thrombosis, late stent thrombosis, and very late stent thrombosis groups, respectively. Conclusions: Most patients with angiography–documented stent thrombosis are treated with recommended antiplatelet therapy. Development of stent thrombosis is associated with poor outcomes.

Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery (IRA) bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction (STEMI). This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.</p><p><b>METHODS</b>This single center study included 108 matched control patients with STEMI, angioplasty after thrombus aspiration, and 108 study patients with STEMI plus intra-IRA administration of 500 microg of tirofiban. Both groups had subsequent 12-hour intravenous infusion of 0.1 microg x kg(-1) x min(-1) of tirofiban after angioplasty. The primary end points were Thrombolysis in Myocardial Infarction (TIMI) flow immediately after angioplasty, ST-segment elevation resolution (STR) (> 70%) at 90 minutes after angioplasty, and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at nine months follow-up, cardiac death, target vessel revascularization (TVR), re-infarction and the combination of these three as major adverse cardiac events (MACE) within nine months and any bleeding events.</p><p><b>RESULTS</b>Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group (97.22% vs. 87.04%, chi(2) = 7.863, P = 0.049). The peak of CK-MB (83.9 (68.9 - 310.5) U/L vs. 126.1 (74.7 - 356.7) U/L, P = 0.034) and TnI (42.7 (14.7 - 113.9) ng/ml vs. 72.5 (59.8 - 135.3) ng/ml, P = 0.029) were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, (45.7 +/- 8.3)% to (42.9 +/- 12.1)%, t = 1.98, P = 0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference (Log-rank chi(2) = 2.865, P = 0.09). There was no statistical difference in any bleeding events between the two groups.</p><p><b>CONCLUSIONS</b>Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.</p>

Efficiency and safety of thrombus aspiration plus intra-infarct-related artery administration of tirofiban during primary angioplasty / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.</p><p><b>METHODS</b>In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 µg tirofiban administration, with subsequent 12-hour intravenous infusion of 0.1 µg×kg(-1)×min(-1) after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspiration group). The primary end points included thrombolysis in myocardial infarction (TIMI) flow immediately after angioplasty, complete ST-segment elevation resolution (> 70%) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events (MACE: cardiac death, target vessel revascularization, re-infarction) at 9 months and any bleeding events.</p><p><b>RESULTS</b>Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87.04%, P = 0.011) and the complete ST-segment resolution rate (66.67% vs. 50.91%, χ(2) = 6.129, P = 0.047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126.1 U/L, P = 0.034) and TnI (42.7 ng/ml vs. 72.5 ng/ml, P = 0.029) were significantly lower in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiration + tirofiban the group (45.7% ± 10.8%, 42.9% ± 9.9%, t = 1.99, P = 0.049). There was a tendency to decreased MACE rate at 9-month follow-up, which favored thrombus aspiration + tirofiban the group (logrank χ(2) = 2.865, P = 0.09). Bleeding events were similar between the two groups.</p><p><b>CONCLUSION</b>Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.</p>

Reasons for failed electrocardiographic identification of the infarct-related artery in patients with ST-elevation acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>The infarct-related artery (IRA) could not always be identified by electrocardiogram (ECG). In the present study, we attempted to explore the reason for failed IRA identification by ECG based on the comparison between ECG records and coronary angiographic findings.</p><p><b>METHODS</b>All 18-lead ECG records were compared with respective angiographic findings in 1024 consecutive patients with ST elevation myocardial infarction (STEMI) between October 2004 and July 2009. More than two continuous 18-lead ECG records were performed within 12 hours of the symptom onset in all patients. Patients with previous myocardial infarction, coronary artery bypass surgery, pacemaker implantation or ECG evidence of left bundle branch block and angiography was performed more than 12 hours time from symptom onset were excluded.</p><p><b>RESULTS</b>Of all 1024 patients enrolled, the IRA were correctly identified in 854 cases and identified wrong in 96 cases and could not be identified in 74 cases by ECG. Of the failed identification in these 170 cases, IRA was left circumflex coronary artery in 76 (44.7%)cases, right coronary artery in 66 (38.8%) cases, left anterior descending branch in 20 (11.8%) cases, ramus medianus branch in 7 (4.1%) cases, and left main in 1(0.6%) case. Double-vessel and triple-vessel diseases were recorded in 27(15.9%) patients and 47(27.6%) patients respectively. Early repolarization syndrome occurred in 8 (4.7%) patients, and dextrocardia in 1 patient (0.6%). Angiographic study showed acute occlusion of a small branch in 6 (3.5%) patients.</p><p><b>CONCLUSION</b>Coronary collateral vessel can mislead judgments of the IRA by ECG. When the IRA can not be determined by ECG, left circumflex coronary artery is most likely to be the culprit vessel. Occasionally, early repolarization syndrome and anatomic variation of the coronary artery or heart and a small branch occlusion could be causes of misjudgments of IRA by ECG.</p>

Comparison of Diver CE and ZEEK manual aspiration catheters for thrombectomy in ST-segment elevation myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.</p><p><b>METHODS</b>From September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).</p><p><b>RESULTS</b>Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P = 0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P = 0.74). Aspirated thrombi were categorized as small thrombi (< 3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (> 7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P = 0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P = 0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.</p><p><b>CONCLUSIONS</b>Both Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.</p>

Molecular characterization of vancomycin-resistant Enterococci / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the homology and resistant mechanism of vancomycin-resistant Enterococci (VRE) isolates.</p><p><b>METHODS</b>A total of 9 VRE isolates were collected from 2006 to 2007 at PUMC hospital. The susceptibility of these isolates to 10 different antibiotics including vancomycin was tested by E-test. These strains were processed by brain heart infusion agar screening in the presence of vancomycin (6 microg/ml), and were analyzed for genotypic characteristics using the multiplex PCR. The homology of the isolates was determined by pulsed-field gel electrophoresis (PFGE).</p><p><b>RESULTS</b>All the 9 VRE isolates were identified as Enterococci faecium. The visual analysis of PFGE patterns revealed 6 different PFGE types. The vanA gene was confirmed by PCR and sequencing in 9 VRE isolates, which were consistent between phenotype and genotype for glycopeptides resistance.</p><p><b>CONCLUSIONS</b>Only vanA genotype was detected in PUMC hospital. Clonal dissemination, horizontal gene transfer, and the selective pressure of antimicrobial agents may contribute to the increase of VRE.</p>

Evaluation of Vitek 2 Compact for antimicrobial susceptibility testing of clinically relevant bacteria / 中华检验医学杂志

Objective To evaluate a new system,Vitek 2 Compact,for antimicrobial susceptibility testing(AST)of gram-negative and gram-positive bacteria.Methods Eighty-nine clinical isolates of Peking Union Medical College Hospital,including 48 gram-negative strains and 41 gram-positive strains,and 66 reference strains kept in our laboratory,including 41 gram-negative strains and 25 gram-positive strains, were studied.The antimicrobial susceptibility of these strains were tested by Vitek 2 Compact with AST- GN09(for gram-negative bacteria),AST-P536(for Staphylococci),AST-P534(for Enterococci and S.agalactiae),and AST-P533(for S.pneumoniae)susceptibility cards.The Etest was used as the reference method for comparision.Thirty-two ESBL-producing strains assessed with the confirmatory tests for ESBLs of CLSI(16 strains of them had been confirmed by PCR amplified and sequencing)were detected for ESBLs by Vitek 2 Compact.Results According to the breakpoints of Clinical and Laboratory Standards Institute (CLSI),for the 1 626 microorganism-antibiotic combinations,Vitek 2 Compact gave 90.83% strains with category agreement(CA),4.91% strains with very major errors(VME),2.09% strains with major errors (ME),6.40% minor errors(MIE).The AST for more than 90% of Enterobacteriaceae,nonfermenting bacteria,micrococci and streptococci were completed within 11h,13h,11h and 12h,respectively.The ESBLs tests for thirty-two strains by V-itek 2 Compact are all positive.Conclusions Vitek 2 Compact system can give rapid,reliable and reproducible result with high sensitivity and specificity in assessment of antimicrobial susceptibility testing for clinically relevant gram-negative and gram-positive bacteria,and would become a powerful tool in clinical microbiology laboratory.

Evaluation of Vitek 2 Compact for identification of clinically relevant bacteria and yeasts / 中华检验医学杂志

Objective To evaluate a new system,Vitek 2 Compact,for identification of bacteria and yeasts.Methods 185 clinical isolates of Peking Union Medical College Hospital,including 69 gram- positive strains,66 gram-negative strains and 50 yeasts,and 50 reference strains in our laboratory,including 25 gram-positive and gram-negative strains respectively,were studied.All the strains were identified by Vitek 2 Compact with GP,GN or YST identification cards.The API method was used as the reference method.Results Among the 93 gram-positive strains,85 strains(91.40%)were correctly identified, including 5 low discrimination identified strains,and 8 strains(8.60%)were correctly identified to the genus level,but misidentified to the species level.About 90% of gram-positive strains were identified within 7 h.Out of 91 gram-negative strains,90 strains(98.90%)were correctly identified,with 5 low discrimination identified strains,only 1 strain(1.1%)was correctly identified to the genus level,but misidentified to the species level.Above 90% of Enterobacteriaceae were identified within 5 h,and over 90% of nonfermenting bacteria were identified within 10 h.In the 50 strains of yeasts,46 strains(92%) were correctly identified,including 8 low discrimination identified strains,and 4 strains(8%)were correctly identified to the genus level,but misidentified to the species level.In all the yeasts,45 strains (90%)were identified in 18.25 h,and another 5 strains(10%)were identified in 18.50 h.Conclusions As Vitek 2 Compact system can give us reliable identification results of clinically relevant bacteria and yeasts,together with its significant reduction of handling time,it will definitely become a powerful tool in clinical microbiology laboratory.