Effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty / 药学实践杂志

Objective To evaluate the effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty. Methods A retrospective analysis was performed on 193 patients who underwent percutaneous transluminal coronary angioplasty and took antihypertensive drugs regularly. Those patients were admitted to Nanjing Drum Tower Hospital during January 2020 to December 2020. The patients were divided into ACEI/ARB group, β-blockers, calcium channel blockers and hydration control group. All patients received routine hydration during the perioperative period. The changes of serum creatinine (Scr), blood urea nitrogen (BUN), estimated glomerular filtration rate(eGFR) and endogenous creatinine clearance rate (Ccr) before and after operation were compared. Results The incidence of CIN was 0% in four groups. Compared with the preoperative, there was no significant change in Scr and Ccr in every group. Except for the hydration control group, the BUN levels in three treated groups were reduced after postoperative. Specifically, the BUN reduction in β-blockers group has statistically significant difference compared to the hydration control group and CCB group. In addition, eGFR levels were significantly reduced in the β-blockers group. Preoperative Scr and Ccr levels in patients with high blood pressure (SBP≥140 or DBP≥90) were significantly different from the patients with normal blood pressure (SBP<140 and DBP<90). Conclusion The use of ACEI/ARB and CCB before percutaneous transluminal coronary angioplasty had no effect on renal function in the short term. β-blockers can slightly reduce renal function, especially in patients with high blood pressure, who should receive special attention.

Infarto agudo de miocardio con elevación del segmento ST anterior extenso en joven deportista de alto rendimiento sin factores de riesgo coronario / Extensive anterior acute myocardial infarction in young high-performance athlete without coronary risk factors

RESUMEN El ejercicio físico evita las enfermedades cardiovasculares pero cuando es intenso debe tener planificación y dosificación correctas y, de ser posible, es muy útil contar con una prueba ergométrica previa y un especialista orientador; porque también puede producir accidentes cardiovasculares en deportistas de alto rendimiento, entre otras cosas, por no cumplir con una programación bien definida con un basamento científico. La complicación más temida es la muerte súbita cardíaca, habitualmente por arritmias malignas y enfermedad isquémica. Se presenta el caso de un deportista de alto rendimiento, de 34 años de edad, en fase desentrenamiento y sin factores de riesgo cardiovascular u otros antecedentes de interés, que sufrió un infarto agudo de miocardio anterior extenso, con angina postinfarto, debido a una estenosis suboclusiva de la descendente anterior proximal. Se realizó angioplastia de rescate, con implantación de un stent farmacoactivo y el paciente evolucionó favorablemente.

ABSTRACT Physical exercise avoids cardiovascular diseases but when it is intense, it must have correct planning and dosage and, if possible, a previous ergometric test and a guidance specialist could be very useful; because it can also cause cardiovascular events in high performance athletes, among other things, for not complying with a well-defined schedule with a scientific base. The most feared complication is sudden cardiac death, usually due to malignant arrhythmias and ischemic heart disease. Here is presented the case of a 34-year-old high-performance athlete, in the detraining phase and without cardiovascular risk factors or other history of interest, who suffered an extensive acute myocardial infarction, with post-infarction angina, due to a stricture suboclusive of the proximal left anterior descending artery. A rescue angioplasty was performed, with implantation of a drug-eluting stent and the patient evolved favorably.

Utilidad de la angiografía intracoronaria con microcatéter para evitar fenómeno de no reflujo en la angioplastia primaria / Utility of the intracoronary angiography with microcatheter to avoid no reflow phenomenon in primary angioplasty

Resumen Introducción La oclusión coronaria aguda, asociada a alta tasa de morbimortalidad en el infarto agudo del miocardio con elevación del segmento ST (IAMCEST), representa un desafío para el intervencionista cuando desconoce el importe de carga de trombo y las características distales a la oclusión (obstrucción microvascular (OMV), estenosis distal) que complican la angioplastia primaria (ACTP) y el fenómeno de no reflujo (FNR), el cual tiene una incidencia reportada de 20 a 40%. Objetivos Evaluar la eficacia de la angiografía distal con microcatéter al orientar una estrategia terapéutica individualizada con la finalidad de prevenir el FNR en oclusión coronaria aguda por IAMCEST en ACTP. Material y métodos Se incluyeron 70 pacientes con IAMCEST. Se realizó angiografía con microcatéter distal a la obstrucción y se eligió la estrategia terapéutica en la angioplastia de conformidad con hallazgos: estenosis, carga de trombo y OMV. Posteriormente se evaluó la incidencia de FNR al finalizar la ACTP. Resultados Reporte de 70 pacientes, la mayoría hombres (80%), clase Killip-Kimball I (95%), con afección de la arteria coronaria derecha en 57% de ellos y de la descendente anterior en 37%. Trombo distal presente en 47% de los pacientes estudiados, se observó en 21% de los casos que la longitud de obstrucción fue mayor de 30 mm, disección de las arterias también en 21%, OMV presente en 41% y 25% con estenosis distal. Estrategias terapéuticas utilizadas: se aplicó stent con fármaco en 81% de los pacientes, balón largo en 93% y trombolítico en 30%. Se observó una incidencia del FNR de 18.6%. Conclusiones En IAMCEST la técnica propuesta disminuye el FNR en comparación con lo reportado. La obstrucción > 30 mm es factor independiente de FNR, por lo que en estos casos recomendamos el uso de esta técnica y balón largo.

Abstract Introduction The acute coronary occlusion associated with a high valuation of morbimortalidad in the acute infarction of the myocardium with elevation of the ST segment (STEMI), represents a challenge for the interventionist, due the unknown amount of thrombus load and its characteristics beyond the occlusion (microvascular obstruction (MVO), distal stenosis), which leads to complicate the primary angioplasty (PTCA) and to the no reflow phenomenon (NFP), which has an overall incidence reported from 20 to 40%. Objectives To evaluate the efficacy of the distal coronary angiography with microcatheter, that leads to an individualized therapeutic strategy, with the purpose of prevent the NFP in the accute coronary occlusion in STEMI treated with PTCA. Material and methods 70 patients were included with STEMI. We performed coronary angiography with microcatheter distal to the obstruction, and the therapeutic strategy was chosen in accordance with findings: stenosis, thrombus amount or MVO. After the PTCA were performed, we evaluated the NFP incidence. Results Report of 70 patients, the majority men (80%), class Killip Kimbal I (95 %), with disease of the right coronary artery in 57%, and anterior descending coronary artery in 37%. Distal thrombus was present in 47% of the studied patients. An obstruction length of more than 30 mm was observed in 21% of the cases, also we observed dissection of the arteries in a 21%, MVO was presented in 41%, and distal stenosis in 25%. Used therapeutic strategies: It was applied medicated stent in 81% of the patients, long balloon in 93%, and thrombolytic therapy in 30%. We observed a NFP incidence of 18.6 %. Conclusions The diagnostic and therapeutic approach for STEMI that this study recommends, diminishes the NFP in comparison with reported. An obstruction > 30 mm is an independent factor for NFP, therefore in these cases we recommend use the described diagnostic approach and long balloon.

Application of drug-coated balloons in treatment of coronary small vessel diseases / 上海交通大学学报（医学版）

Drug-coated balloons (DCB) have emerged as a new application in percutaneous coronary intervention. It is developed to circumvent some of the limitations faced by drug-eluting stents (DES). DES has some limitations, as follows: it could not be implanted in some lesions; bleeding risks are associated with prolonged dual antiplatelet therapy; risks of late and very late stent thrombosis increase. Many clinical trials had confirmed the efficacy and safety of DCB, particularly, the application of DCB in coronary small vessel diseases. This review discussed the basic concept, development, evolution of DCB and some clinical studies associated with the application of DCB in coronary small vessel diseases.

Application of drug-coated balloons in treatment of coronary small vessel diseases / 上海交通大学学报（医学版）

Drug-coated balloons (DCB) have emerged as a new application in percutaneous coronary intervention. It is developed to circumvent some of the limitations faced by drug-eluting stents (DES). DES has some limitations, as follows: it could not be implanted in some lesions; bleeding risks are associated with prolonged dual antiplatelet therapy; risks of late and very late stent thrombosis increase. Many clinical trials had confirmed the efficacy and safety of DCB, particularly, the application of DCB in coronary small vessel diseases. This review discussed the basic concept, development, evolution of DCB and some clinical studies associated with the application of DCB in coronary small vessel diseases.

Prognosis comparison of vascular in situ and bridge vessel percutaneous coronary intervention in patients with recurrent angina after coronary artery bypass grafting / 中国综合临床

Objective To compare the prognosis of vascular in situ and bridge vessel percutaneous coronary intervention ( PCI) therapy strategies in patients with recurrent angina after coronary artery bypass grafting ( CABG) . Methods A total of one hundred and two patients with recurrent angina after CABG from January 2008 to January 2016 were involved in this study and were divided into two groups according to interventional therapy strategy:74 patients in the vascular in situ PCI group ( in situ group,74 cases) and 28 patients for bridge vessel PCI group ( bridge vessel group,28 cases) . The patients have been followed up for (33. 6± 10. 2) months. The major adverse cardiovascular events ( MACE) of the two groups were recorded, including non?fatal acute myocardial infarction ( AMI) ,target vessel revascularization ( TVR) and cardiac death, and multivariate logistic regression analysis was used to analyze the related factors of MACE. Results Compared with the bridge vessel group,the non?MACE survival rate,non?AMI survival rate and non?TVR survival rate of the in situ group were significantly increased ( ( 71. 6% ( 53/74 ) vs. 57. 1% ( 16/28 ) , 93. 2% ( 69/74 ) vs. 82. 1% (23/28),81. 1% (60/74) vs. 67. 9% (19/28) ),the differences were statistically significant (χ2=8. 141,4. 219,5. 436, P<0. 05) . Multivariable logistic regression analysis showed that age of bridge ( OR=1. 023,95%CI 1. 005-1. 026,P=0. 019) ,diabetes mellitus ( OR=2. 386,95%CI 1. 425-3. 991,P=0. 003) and bridge vessel PCI (OR=1. 884,95%CI 1. 093-3. 220,P=0. 025) were factors that affect the clinical prognosis in patients with recurrent angina pectoris after CABG. Conclusion The clinical prognosis of the in situ PCI is better than bridge vascular PCI in patients with recurrent angina after CABG,while the age of bridge, diabetes mellitus, vascular interventional treatment are factors for the effect of interventional therapy patients prognosis. The clinical prognosis is much better in native vessel PCI than that of bridge vessel PCI in patients with recurrent angina after CABG. The age of bridge,diabetes mellitus and bridge vessel PCI are the factors that affect the clinical prognosis in the patients.

The comparison of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute ST elevated myocardial infarction / 中国基层医药

Objective To compare the effects of ticagrelor and clopidogrel on patients undergoing percutane-ous coronary intervention(PCI)with acute ST elevated myocardial infarction (STEMI).Methods 120 patients with STEMI received PCI within 12h of symptom onset in our hospital were randomly divided into clopidogrel treated group (n=60)and ticagrelor treated group (n=60).Serum was collected before surgery and 36 hours after PCI for ALT, Cr,CK-MB,and MA.Cardiac ultrasound was examined,too.All patients were followed 6 months post-PCI for main adverse cardiovascular and cerebrovascular events (MACCE)and medicine side effect.Results No significantly difference was noted in baseline between the two groups.The level of CK-MB and MA in the ticagrelor treated group [CK-MB(56.5 ±8.3)U/L,MA (45.9 ±6.4)mm[and clopidogrel treated group[CK-MB(74.3 ±9.6)U/L,MA (35.6 ±7.3)mm]were significant difference (CK-MB,P=0.043;MA,P=0.038).The MACCE of patients in ticagrelor treated group were significantly lower than patients in clopidogrel treated group during post-PCI 6 months follow-up(The ratio of angina in ticagrelor group was 1.7%,while in clopidogrel group was 6.7%,P=0.042). Conclusion Ticagrelor is more effective in suppress the function of platelet,decrease MACCE in patients with STE-MI undergoing PCI.

Terapia de restauración vascular con plataformas biorreabsorbibles. La cuarta revolución / Vascular restoration therapy using bioresorbable scaffolds. The fourth revolution

Con la aprobación y concesión del Registro Sanitario 201300 4713 del 25 de febrero de 2013, con vigencia hasta el año 2023, por parte del Instituto Nacional de Vigilancia de Medicamentos y Alimentos como órgano oficial del Ministerio de Salud y Protección Social de Colombia, a la plataforma biorreabsorbible Absorb BVS®, con el nombre de stent medicado biorreabsorbible, la introducción de estas plataformas al portafolio terapéutico del cardiólogo intervencionista para el tratamiento de pacientes seleccionados con enfermedad coronaria, ha generado gran expectativa gracias a la seguridad y eficacia que han demostrado en comparación con los stents liberadores de medicamento, con resultados de no inferioridad y con el ofrecimiento de una serie de ventajas por las cuales ha sido considerado la «cuarta revolución¼. En este artículo se hace una revisión acerca de las plataformas existentes, de su mecanismo de acción, así como de sus potenciales ventajas y limitaciones.

The approval and the concession of the Health Registration 201300 4713 dated February 25th 2013, in force until 2013, by the National Institute of Food and Drug Monitoring as a body of the Colombian Ministry of Health and Social Protection, in favor of the Absorb BVS® bioresorbable scaffold, under the name of bioresorbable medicated stent, has created high expectations regarding the introduction of these scaffolds in the therapeutic repertoire of the interventional cardiologist for treatment of selected patients with coronary disease. The security and efficiency that they have shown in comparison to the drug-eluting stents, with results of non-inferiority and offering various advantages, have been the reasons why they have been called the fourth revolution. This article reviews the existing scaffolds and their operating methods, as well as their advantages and limitations.

Angina inestable secundaria a disección coronaria espontánea / Unstable angina secondary to spontaneous coronary dissection

La disección coronaria espontánea es una causa rara de infarto agudo del miocardio y puede debutar además como angina estable o síndrome de falla cardiaca. Se presenta el caso de una mujer de 35 años quien tuvo eventos recurrentes de dolor torácico en el primer mes de posparto y en quien se diagnosticó disección coronaria de la arteria circunfleja, la cual fue intervenida con stents medicados. Veinte meses después permanecía libre de síntomas y sin evidencia de isquemia miocárdica inducible.

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction which may also occur as stable angina or heart failure syndrome. Here reported the case of a 35 years old woman who presented recurrent chest pain events in the first month of postpartum and in whom coronary dissection of the circumflex artery was diagnosed, which was intervened with drug eluting stents. Twenty months later she remained free of symptoms and with no evidence of inducible myocardial ischemia.

Adequação das indicações da intervenção percutânea na doença coronariana estável e preditores do seu emprego inapropriado em um hospital de ensino / Appropriateness of percutaneous intervention indications in stble coronary disease and inappropriate use predictors at a teaching hospital

Fundamentos: A intervenção coronariana percutânea(ICP) promove melhora sintomática e menor necessidade de antianginosos na doença coronariana estável, masnão reduz a incidência de infarto do miocárdio e morte. Objetivo: Avaliar a adequação das indicações de ICPem pacientes com doença coronariana estável em um hospital universitário.Métodos: Foram estudados 102 pacientes com doença coronariana estável submetidos consecutivamentea ICP em um hospital universitário, com média de idade de 65,9±10,7 anos, sendo 67,3 % homens. Coletaram-se informações referentes ao paciente(dados clínico-epidemiológicos, resultados de testes provocativos de isquemia e uso de antianginosos) e aomédico solicitante (tempo de formação e especialidade). Considerou-se adequada a indicação de ICP a pacientes com angina do peito refratária ao tratamento clínico ou a pacientes assintomáticos apresentando grande área de isquemia miocárdica em testes provocativos.Resultados: A indicação de ICP foi considerada adequada em 34 (33,3 %) pacientes, inadequada em 2 e incerta nos 66 restantes. À análise univariada,mostraram-se significativamente associadas à indicação de ICP inadequada/incerta as variáveis: idade mais elevada (p=0,001), aposentadoria (p=0,006) e ausência de tabagismo (p=0,041) e de dislipidemia(p=0,039), observando-se tendência à significância em relação a sedentarismo (p=0,094), renda mais baixa(p=0,013) e tempo de formação do médico solicitante ≥10 anos (p=0,094). Após análise de regressão logística,apenas idade mais elevada (OR=1,10 [1,06-11,1]; p=0,048), renda mais baixa (OR=2,84 [1,5-7,6]; p=0,039)e maior tempo de formação do médico solicitante...

Background: Percutaneous coronary intervention (PCI) results in improved symptoms and less need forantianginal medications for stable coronary artery disease, but does not reduce myocardial infarction and death rates. Objective: To assess the appropriateness of PCIindications in patients with stable coronary artery disease at a university hospital. Methods: The study involved 102 patients with stable coronary artery disease consecutively undergoing PCIat a university hospital, with a mean age of 65.9 ± 10.7 years and 67.3% male. Information was collected on the patient (clinical and epidemiological data,ischemia provocation test results and antianginal drug use) and the requesting physician (time since graduation and speciality). PCI indications wereconsidered appropriate for patients with angina pectoris to clinical treatment, or for asymptomatic patients presenting large areas of myocardial ischemia in provocation tests. Results: PCI indications were consideredappropriate for 34 (33.3%) patients, inappropriate for two others, and uncertain for the remaining 66.In the univariate analysis, the following variables were significantly associated with inappropriate/uncertain ICP indications: older (p=0.001), retired(p=0.006), non-smoker (p=0.041) and dyslipidemia (p=0.039), noting a trend towards sedentary lifestyles (p=0.094), lower income (p=0.013) and≥10 years time since graduation (p=0.094). After the logistic regression analysis, only the older (OR=1.10 [1.06-11.1]; p=0.048), lower income(OR=2.84[1.5-7.6]; p=0.039) and longer time since...

Effects of Low Dose Pioglitazone on Restenosis and Coronary Atherosclerosis in Diabetic Patients Undergoing Drug Eluting Stent Implantation

PURPOSE: Thiazolidinediones are insulin-sensitizing agents that reduce neointimal proliferation and the adverse clinical outcomes associated with percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). There is little data on whether or not low dose pioglitazone reduces adverse clinical outcomes. MATERIALS AND METHODS: The study population included 121 DM patients with coronary artery disease and they were randomly assigned to 60 patients taking 15 mg of pioglitazone daily in addition to their diabetic medications and 61 patients with placebo after the index procedure with drug-eluting stents (DESs). The primary end points were rate of in-stent restenosis (ISR) and change in atheroma volume and in-stent neointimal volume. The secondary end points were all-cause death, myocardial infarction (MI), stent thrombosis and re-PCI. RESULTS: There were no statistical differences in the clinical outcomes and the rate of ISR between the two groups [all-cause death; n=0 (0%) in the pioglitazone group vs. n=1 (1.6%) in the control group, p=0.504, MI; n=2 (3.3%) vs. n=1 (1.6%), p=0.465, re-PCI; n=6 (10.0%) vs. n=6 (9.8%), p=0.652, ISR; n=4 (9.3%) vs. n=4 (7.5%), p=1.000, respectively]. There were no differences in changes in neointimal volume, percent neointimal volume, total plaque volume and percent plaque volume between the two groups on intravascular ultrasonography (IVUS) study. CONCLUSION: Our study demonstrated that low dose pioglitazone does not reduce rate of ISR, neointimal volume nor atheroma volume in DM patients who have undergone PCI with DESs, despite the limitations of the study.

Simultaneously Presented Acute Ischemic Stroke and Non-ST Elevation Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.

Simultaneously Presented Acute Ischemic Stroke and Non-ST Elevation Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.

Survey on sexual health for male patients with acute myocardial infarction and percutaneous transluminal coronary angioplasty plus stent implantation / 中国实用护理杂志

Objective The survey is based on status of sexual health and sexual needs for male patients with acute myocardial infarction and Percutaneous Transluminal Coronary Angioplasty (PTCA) plus stent implantation.The survey data provides the basis for guiding patients' health education.Methods General questionnaire,sexual knowledge status questionnaire and sexual health knowledge demand questionnaire were used to carried out the investigation in 214 cases of patients with PTCA plus stent implantation.Collected data entered into a database for statistical analysis.Results The overall score of sexual health of 214 patients was (8.79±2.52) points.There was a statistically significant difference in different education levels,occupation and monthly income.There was no statistically significant difference in different ages.The overall score of knowledge of sexual health demand was (29.40 ± 6.47) points.There was a statistically significant difference in different ages,education levels and occupations.There was no statistically significant difference in different monthly income.Conclusions The sexual knowledge cognitive level of patients with PTCA plus stent implantation is low,but they have higher demand of sexual health knowledge,the medical personnel should strengthen the knowledge of sex education for patients to improve the quality of sex.

Diabetes Mellitus and Coronary Angiography / 임상당뇨병

Diabetes mellitus is one of the major causes of cardiovascular morbidity and mortality, and its prevalence is increasing. Although there have been great efforts regarding the early diagnosis and treatment of coronary artery disease in diabetic patients with the development of non-invasive imaging modalities, many diabetic patients are still managed with invasive coronary therapies such as percutaneous coronary intervention or coronary artery bypass graft in clinical practice. Coronary angiography is a gold standard method for detecting and treating coronary artery disease; however, this method is invasive and thus can elicit a relatively higher prevalence of procedure-related complications than non-invasive diagnostic methods. Accordingly, the appropriate use of coronary angiography could play an important role in the reduction of unnecessary complications as well as physician decision making. Recently, appropriate use criteria for coronary angiography in many types of patients with suspected or known coronary artery disease have been documented. This article demonstrates several aspects to be considered when performing coronary angiography and the appropriate use criteria of coronary angiography in diabetic patients.

Fatal Delayed Coronary Artery Perforation After Coronary Stent Implantation

Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

Successful Percutaneous Coronary Intervention in a Centenarian Patient With Acute Myocardial Infarction

Despite an increasing prevalence and burden of disease in the elderly, little is known about the management and outcomes of acute coronary syndromes in this group. We report the case of a 101-year-old female patient with a non-ST segment elevation myocardial infarction. Coronary angiography showed a total occlusion of the proximal right coronary artery (RCA), and a significant stenosis in the proximal to mid left anterior descending artery (LAD). Despite a very poor initial clinical status, a percutaneous coronary intervention was successfully performed for the total occlusion in the RCA. The LAD lesion was treated with medical therapy only, on account of the age and general condition of the patient. She was discharged after recovering to a good health status, free of chest pain or dyspnea.

Effects of 600 mg versus 300 mg Loading Dose of Clopidogrel in Asian Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Long-Term Follow-Up Study

PURPOSE: The optimum loading dose of clopidogrel has not been established in Asian patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Our aim was to evaluate the impact of different clopidogrel loading doses on short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI. MATERIALS AND METHODS: We studied 691 STEMI patients undergoing primary PCI, loaded with 600 mg (n=381) or 300 mg (n=310) of clopidogrel. The primary outcome was major adverse cardiac events (MACEs), defined as a composite of all-cause death, reinfarction, or target vessel revascularization (TVR). RESULTS: Baseline clinical and peri-procedural characteristics were mostly comparable between the 600 mg and 300 mg groups. There were no differences in 1 month MACEs as well as all-cause death, reinfarction, TVR, and stent thrombosis between the two groups. After a median follow-up of 921 days, MACEs [adjusted hazard ratio (HR) for the 600 mg group 1.79, 95% confidence interval (CI): 0.80-3.97, p=0.153], all-cause death (adjusted HR for the 600 mg group 0.97, 95% CI: 0.50-1.88, p=0.928), reinfarction (adjusted HR for the 600 mg group 1.03, 95% CI: 0.55-1.91, p=0.937), and TVR (adjusted HR for the 600 mg group 1.36, 95% CI: 0.68-2.69, p=0.388) did not differ between the two groups. These results were reliable even after analysis of propensity score-matched population, and were also constant among various subgroups. CONCLUSION: A 600 mg loading dose of clopidogrel did not result in better short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI.

Successful Retrieval of Intravascular Stent Remnants With a Combination of Rotational Atherectomy and a Gooseneck Snare

Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.

An Iatrogenic Coronary Arteriovenous Fistula Caused by Guidewire Trauma during Percutaneous Coronary Intervention / 대한내과학회지

We report the case of a 51-year-old man who presented with worsening exertional chest pain in whom subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Fortunately, the patient was stable and coronary angiography revealed resolution of the fistula 20 minutes later. This case study emphasizes the management of iatrogenic coronary perforations, depending on the type and severity of perforation, which generally involves initial conservative management.