Association between post primary percutaneous coronary intervention myocardium reperfusion and prognosis in patients with acute ST-elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the prognostic impact of post primary percutaneous coronary intervention (PCI) reperfusion status on outcome in patients with acute ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>A retrospective analysis was performed in 964 patients undergoing primary PCI for STEMI. Electrocardiogram and TIMI myocardial perfusion grade (TMPG) were analyzed by reader blinded to the clinical course. Patients were divided to four groups according to ST segment resolution (STR) and TMPG: group A were patients with good STR and TMPG(425/964), group B were patients with poor STR and good TMPG (239/964), group C were patients with good STR and poor TMPG (113/964) and group D were patients with poor STR and TMPG (113/964).</p><p><b>RESULTS</b>Although TIMI grade III flow was achieved after mechanical reperfusion, abnormal reperfusion was still present in about 1/3 patients as shown by poor STR or TMPG. Older age, cardiac dysfunction and diabetes, prolonged time of pain to balloon/emergency room are independent risk factors for abnormal reperfusion post PCI. Major adverse cardiac events events in hospital (RR = 64. 63, P < 0.01) and during follow up (RR = 11.69, P < 0.01) were significantly higher in group D than in group A.</p><p><b>CONCLUSION</b>Poor post PCI reperfusion status is associated with higher in hospital and during follow up major adverse cardiac events event in STEMI patients.</p>

Long-term efficacy of sirolimus-eluting stents (Cypher) versus bare metal stents for patients with ST-segment elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the safety and long-term efficacy of Cypher stent versus bare metal stents (BMS) in patients with STEMI.</p><p><b>METHODS</b>From Dec 2002 to Mar 2005, clinical and angiographic data of 407 consecutive patients with STEMI treated with Cypher stent (n = 131) or BMS (n = 276) were analyzed and followed up for a mean period of 28.7 +/- 11.7 months. Major adverse cardiac events (MACE): death, nonfatal reinfarction and target lesion revascularization (TLR) during follow up was compared between two groups.</p><p><b>RESULTS</b>Compared with the BMS group, diameter of vessels were significantly smaller (3.0mm vs. 3.2mm, P = 0.00), the incidence of MACE (6.1% vs. 12.7%, P = 0.04) and total mortality (1.5% vs. 6.9%, P = 0.02) were significantly lower in the Cypher group. The relative risk for MACE in Cypher group was 0.61 (P < 0.05), while there was no significant difference in the rate of stent thrombosis, rate of target lesion revascularization and restenosis.</p><p><b>CONCLUSION</b>Utilization of Cypher in the setting of primary PCI for STEMI was safe and improved the long-term clinical outcomes compared to BMS.</p>

Clinical and angiographic predicting factors leading to unfavorable myocardial reperfusion in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the clinical and angiographic morphologic features leading to worse myocardial reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Clinical and angiographic data were collected and logistic regression analysis performed in 964 STEMI patients undergoing primary PCI.</p><p><b>RESULTS</b>Logistic regression analysis showed that non-anterior myocardial infarction, pain to balloon time and degree of cardiac dysfunction were clinical predictive factors while fade-out type of angiographic morphology, ie, presence of accumulated thrombus proximal to the occlusion was angiographic predictive factor of worse reperfusion for STEMI patients post PCI.</p><p><b>CONCLUSION</b>These predictive clinical and angiographic morphologic factors in STEMI patients for worse myocardial reperfusion post PCI could help to identify patients at high risk post PCI.</p>

Effects of intracoronary or intravenous tirofiban administration in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the effects on MACE of intracoronary or intravenous tirofiban bolus administration in patients with acute ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>A total of 60 consecutive STEMI patients ready to receive primary PCI were randomly assigned to intracoronary tirofiban bolus (10 microg/kg) prior to the first balloon inflation (Group IC) or to intravenous tirofiban bolus at the same dose prior to coronary angiography (Group IV), followed by a 36-hours IV tirofiban (0.15 microg . kg(-1) . min(-1)) infusion for all patients. Clinical and angiographic features between 2 groups before and after PCI were analyzed.</p><p><b>RESULTS</b>Fifty-four out of 60 STEMI patients accomplished the study. Group IC was superior to Group IV in terms of TIMI flow grade, TIMI myocardial perfusion grade, ST-segment resolution, the distal embolism of IRA immediately after PCI and ejection fraction at 5 - 7 days after the PCI. The in-hospital MACE rate and bleeding complications were similar between the groups while, the combined incidence of MACE during follow-up was significantly lower in the Group IC compared with Group IV (7.1% versus 30.8%; P = 0.02).</p><p><b>CONCLUSION</b>Intracoronary bolus application of tirofiban is associated with superior clinical prognosis compared with the standard intravenous bolus application of tirofiban in patients with STEMI undergoing primary PCI.</p>

Single lead ST-segment resolution in acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: prognostic impact and associated factors / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic value of ST resolution (STR) measured in a single ECG lead obtained early after primary PCI in patients with ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>In this retrospective study, STR, MACE and factors contributed to STR were analyzed in 964 patients underwent primary PCI post STEMI. The ECGs analysis was made by technicians blinded to the clinical data. MACE was compared between the STR (n = 662) and the non-STR (n = 302) groups. Factors associated with non-STR were analyzed by logistic regression method.</p><p><b>RESULTS</b>Although TIMI grade III flow was achieved after PCI, non-STR was shown in nearly 1/3 patients and these patients were older, dominant with anterior myocardial infarction, cardiac dysfunction, diabetes and was associated with a higher MACE ratio (25.5% vs. 4.4%, P < 0.001). Cox regression showed that non-STR was one of the independent predictors of in-hospital MACE (RR = 3.33, P < 0.001). Logistic regression showed that anterior myocardial infarction, the pain to balloon time, cardiac dysfunction and white blood cell count on admission were predictive factors of non-STR.</p><p><b>CONCLUSIONS</b>STR obtained in a single ECG lead is an easy and important prognosticator of MACE post PCI in patients with STEMI. It could therefore be used to identify low- and high-risk STEMI patients post primary PCI.</p>

Impacts of coronary artery calcium on the diagnostic accuracy in detecting stenoses using 64-slice spiral CT / 中华放射学杂志

Objective To investigate the diagnostic accuracy of 64-slice spiral computed tomography(MSCT)in detecting coronary artery lesions and to analyze the impacts of coronary artery calcium on its diagnostic accuracy.Methods Sixty patients underwent 64-MSCT coronary angiography and conventional coronary angiography(CCA).Calcium scoring was estimated on plain scans.The diagnostic accuracy of MSCT to detect significant lesions(≥50%)was evaluated referring to quantitative coronary angiography(QCA).The impacts of coronary artery calcium on the diagnostic accuracy was analyzed.Results A total of 797 segments were diagnositc.The overall sensitivity,specificity,positive predictive value and negative predictive value of 64-MSCT were 96%(174/182),98%(601/615),93% (174/188),and 99%(601/609),respectively.When calcium score ≥100(Agatston score),the specificity and positive predictive value of 64-MSCT was 63%(12/19)and 81%(30/37), respectively.Conclusion In patients with no or mild coronary calcification,the 64-MSCT coronary angiography had a reliable detection of coronary artery stenoses.But severe calcification in coronary artery may degrade diagnostic specificity and positive predictive value of MSCT coronary angiography.