Single center experience of primary percutaneous coronary intervention on left main disease complicated by acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the clinical effect of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) induced by left main artery total or subtotal occlusion.</p><p><b>METHODS</b>Between January 1995 and June 2010, there were 28 AMI patients [24 males, mean age (61.5 ± 2.3) years, 15 patients complicated with cardiac shock] with left main occlusion or severe stenosis who were treated with PCI in our center. The clinical features were compared between death group and survival group. All survival cases were prospectively followed up for the occurrence of major adverse cardiac events.</p><p><b>RESULTS</b>Totally 25 patients received stent implantation, 2 received balloon dilation followed by coronary artery bypass graft, and 1 patient died during PCI. Total in-hospital mortality was 35.7% (10/28), and mortality was 53.3% (8/15) in cardiac shock patients. Compared with survival group, ratio of cardiac shock [80.0% (8/10) vs.38.9% (7/18), P < 0.05] and poor collateral circulation flow [100% (10/10) vs. 33.3% (6/18), P < 0.01] were higher in death group, and there was no significant difference in TIMI 3 grade of forward flow post procedure (P > 0.05). Hospital stay was (22.1 ± 2.6) days and the cumulative survival was 64.3% during 3 months follow up for survival group.</p><p><b>CONCLUSIONS</b>Short-term clinical outcome is favorable for survived AMI patients with left main disease who underwent PCI. The ratio of cardiac shock and poor collateral circulation flow are risk factors for in-hospital death in AMI patients with left main disease who underwent PCI.</p>

Comparison of tirofiban combined with dalteparin or unfractionated heparin in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.</p><p><b>METHODS</b>From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2 ± 9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5 ± 10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.</p><p><b>RESULTS</b>There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.</p><p><b>CONCLUSIONS</b>Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.</p>

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>

Efficacy comparison of primary percutaneous coronary intervention with biodegradable polymer- and durable polymer-based sirolimus-eluting stents for patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>This prospective random control study was performed to compare the efficacy and safety of primary percutaneous coronary intervention (PCI) with biodegradable polymer (Excel) and with durable polymer (Cypher Select) sirolimus-eluting stents in patients with acute ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>Consecutive patients with STEMI underwent primary PCI were randomly divided into Cypher group (n = 113) and Excel group (n = 115). The primary endpoints were major adverse cardiac events (MACE, including death, reinfarction and target vessel revascularization) within 12 months. The second endpoints included late luminal loss and restenosis at 9 months.</p><p><b>RESULTS</b>Angiographic follow-up data at 9 months were available in 43 (38%) patients in Cypher group and 48 (42%) in Excel group. The rates of in-stent restenosis and in-segment restenosis were 2.3% vs. 2.1% (P = 0.937) and 4.7% vs. 6.3% (P = 0.738), respectively. The late luminal loss of in-stent and in-segment were (0.17 ± 0.26) mm vs. (0.18 ± 0.33) mm (P = 0.483) and (0.19 ± 0.36) mm vs. (0.20 ± 0.42) mm (P = 0.419), respectively. There were no significant differences in death (3.5% vs. 2.6%, P = 0.692), reinfarction (1.8% vs. 2.6%, P = 0.658), target vessel revascularization (1.8% vs. 2.6%, P = 0.658), MACE (5.3% vs. 6.1%, P = 0.788) or stent thrombosis (4.4% vs. 3.5%, P = 0.692) at 12 months between Cyper group and Excel group.</p><p><b>CONCLUSIONS</b>Excel and Cypher Select stents may have similar mid-term efficacy and safety in patients with STEMI treated with primary PCI.Further investigation is warranted to validate the long-term efficacy and safety.</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>

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical outcome of percutaneous coronary intervention (PCI) is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged > 55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis < 20% with thrombolysis in myocardial infarction flow grade > 2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events (MACE), including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.</p><p><b>RESULTS</b>Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups (94.4% vs 92.2%). The occurrence rate of MACE did not differ during the hospitalization (4.2% vs 6.0%, P = 0.50), but was significantly higher in the female group during follow-up (mean (16.0 +/- 11.2) months) than that in the male group (5.4% vs 0.7%, P = 0.02).</p><p><b>CONCLUSION</b>Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.</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>

Very late stent thrombosis after implantation of sirolimus eluting coronary stents / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical date of 4 patients who developed very late stent thrombosis after implantation of sirolimus eluting stents.</p><p><b>METHODS</b>From Oct. 2002 to Aug. 2006, 835 sirolimus eluting stents were implanted in 612 patients. From Jan. 2006 to Aug. 2006, very late thrombosis in sirolimus eluting stents occurred in 4 patients (0.65%), and which caused acute myocardial infarction in anterior wall. Emergency percutaneous coronary interventions (PCIs) were performed in 4 patients immediately after re-admission. The clinical date of the 4 cases were analyzed retrospectively.</p><p><b>RESULTS</b>These 4 patients were male with the age of 40-69 years. Very late stent thrombosis occurred 31-37 months after successful implantation of sirolimus eluting stents. Application of clopidogrel was stopped 7-12 months after first stents implantation. Aspirin was continued in 3 patients, while the other patient discontinued taking aspirin 18 moths before thrombosis occurred. Emergency coronary angiogram showed that sirolimus eluting stents in LADs were all occlude by thrombosis with TIMI 0 flow. All 4 patients survived after successfully primary PCIs.</p><p><b>CONCLUSIONS</b>Our report presents evidence of very late thrombosis in sirolimus eluting coronary stents, and more careful and prolonged flow-up was required in patients after implantation of drug eluting stents.</p>

Clinical analysis of patients with acute myocardial infarction induced by left main artery occlusion / 中华急诊医学杂志

Objective To study clinical data of patients with acute myocardial infarction (AMI) induced by left main (LM) artery occlusion,and to find out the clinical characteristics.Method From Janurany 1995 to May 2006,there were 15 patients with AMI related with LM obstruction from 1793 AMI patients,in whom primary PCls were performed.All patients were male with a mean age of (60.6?10.4) years old (ranging from 43 to 85 years old).The clinical and interventional data were retrospectively analyzed.Results Cardiogenic shock occurred in 10 patients at admission.Primary PCls were performed with intraaortic balloon pump (IABP) in all patients.Nine patients died during short follow-up,and the mortality was 60%.Three-month follow-up was made in the all survival patients,and one patient died after 4 years.Analysis showed good collateral circulation flow from right coronary artery to left coronary artery before operation affected the short-term prognosis.Conclusions AMI related with left main artery obstruction was critically fatal with high occurrence of cardiogenic shock and high mortality.Prognosis differs at,cording to different degree of collateral circulation.Primary PCI with IABP provides a promising strategy to improve clinical outcomes.

Primary percutaneous coronary intervention in patients with acute myocardial infarction induced by left main artery occlusion or severe stenosis / 中华心血管病杂志

<p><b>OBJECTIVE</b>The effects of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) induced by left main (LM) artery occlusion were analyzed retrospectively in this study.</p><p><b>METHODS</b>A total of 1343 consecutive AMI patients who underwent primary PCI between January 1995 and December 2004 were retrospectively studied.</p><p><b>RESULTS</b>LM occlusion or severe stenosis were found in 11 patients [all male, mean age (56.4 +/- 9.2) years (range 43-70 years)], cardiogenic shock was overt in 6 patients. Primary PCI were performed under the assistance of intra-aortic balloon pump (IABP) in these patients [8 stent implantation, 3 balloon dilation and 2 necessitating emergency CABG after balloon dilation]. In-hospital mortality was 45.5% (5/11). Three-month follow-up were made in all survivals (6/11). Analysis showed good collateral circulation flow from right coronary artery to left coronary artery was existed in all survival cases before PCI.</p><p><b>CONCLUSION</b>Prognosis of AMI patients with LM artery obstruction or severe stenosis was poor. Patients with pre-existed collateral circulation before primary PCI and IABP had a better clinical outcomes.</p>

Effect of pre-angiography use of tirofiban in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the safety and efficiency of ultra-early glycoprotein IIb/IIIa receptor blockade tirofiban use in patients with acute ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>From April 2005 to April 2006, 158 consecutive AMI patients (117 males, mean age of 58.8 +/- 25.2 years) were randomly received tirofiban (10 microg/kg bolus i.v. followed by 0.15 microgxkg(-1)xmin(-1) for 36 hours) before PCI in emergency room (early, n = 78) or immediately before PCI in catheterization lab (late, n = 80). Clinical and angiographic features between 2 groups before and after PCI were analyzed.</p><p><b>RESULTS</b>Baseline clinical characteristics before PCI were similar between the two groups. Tirofiban was administered 39.8 minutes earlier in early group than that in the late group. The TIMI 3 flow rate (23.1% vs. 10.0%, P = 0.032) and the combined TIMI 2 or 3 flow rate (39.7% vs. 23.8%, P = 0.040) at initial angiography before PCI were significantly higher in early group than that in late group. However, TIMI 3 flow rate, myocardial Blush grade or corrected TIMI frames immediately after PCI were similar between the groups. The combined incidence of death or recurrent MI as well as bleeding complications or thrombocytopenia rate during early follow-up were similar between the groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Early initiation of tirofiban in patients with acute STEMI treated by primary PCI was safe. A better patency (TIMI 3 and TIMI 2-3 flow) in infarct related artery was obtained in patients with early tirofiban administration.</p>

The safety and efficacy of Cypher drug-eluting stent: results from a six months follow-up study in patients with ST-segment elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the feasibility, safety and efficacy of Cypher drug-eluting stent implanted after the emergency percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>From Nov. 2002 to Dec. 2004, 186 patients with STEMI treated by emergency PCI were included into this study. The incidence of major adverse cardiovascular event (MACE), stent thrombosis and restenosis were evaluated during 6 months follow-up after PCI.</p><p><b>RESULTS</b>One hundred and sixty-eight patients were successfully treated by emergency PCI and there were no complication during the procedure. The rates of successful treatment were 100%. One hundred and seventy-five Cypher drug-eluting stents were successfully implanted into 171 target lesions. There was one case with acute stent thrombosis among 186 patients, and the MACE and mortality were 2.4% and 1.8%, respectively, during the first one month follow up. Six months later, the MACE was 4.2% and the mortality was 2.4%. The in-stent thrombosis and restenosis rates were 1.2% and 1.8%, respectively, when evaluated by angiography and clinic follow up at six months after PCI.</p><p><b>CONCLUSION</b>Implanting a Cypher drug-eluting stent in STEMI patients during emergency PCI is as safe and effective as a conventional bare stent. Cypher drug-eluting stent can reduce restenosis rate and MACE in STEMI patients treated with emergency PCI.</p>