ABSTRACT
OBJECTIVE@#To evaluate the effect of Danhong Injection (, DH) on the index of microcirculatory resistance (IMR) and myocardial injury in patients with unstable angina undergoing elective percutaneous coronary intervention (PCI).@*METHODS@#Seventy-eight patients with unstable angina were randomly divided into DH group (39 cases) and the control group (39 cases) during elective PCI. Randomization was performed using a random-number table. The DH group received DH at a dosage of 40 mL (mixed with 250 mL saline, covered by a light-proof bag, intravenous drip) during PCI and daily for 7 consecutive days, while the control group only received the same dosage of saline. Both groups received standardized treatment. The IMR and fractional flow reserve (FFR) were measured at maximal hyperemia before and after PCI. Myocardial markers, including myoglobin, creatine kinase (CK), creatine kinase MB (CK-MB), and coronary troponin T (cTnT) values were measured at baseline and 24 h after PCI.@*RESULTS@#Among the 78 patients enrolled, the baseline and procedural characteristics were similar between the two groups. There was no significant difference in pre-PCI myocardial markers and coronary physiological indexes between the two groups. However, post-PCI CK and CK-MB levels in the DH group were significantly lower than those in the control group (111.97 ± 80.97 vs. 165.47 ± 102.99, P=0.013; 13.08 ± 6.90 vs. 19.75 ± 15.49, P=0.016). Post-PCI myoglobin and cTNT-positive tend to be lower in the DH group than in the control group but did not reach statistical significance (88.07 ± 52.36 vs. 108.13 ± 90.94, P=0.52; 2.56% vs.7.69%, P=0.065). Compared with the control group, the post-IMR levels of the DH group tended to decrease, but there was no statistical difference (20.73 ± 13.15 vs. 26.37 ± 12.31, P=0.05). There were no statistical differences in post-FFR in both groups. The peri-procedural myocardial injury of the DH group was significantly lower than that of the control group (2.56% vs. 15.38%, P=0.025). During the 30-d follow-up period, no major adverse cardiovascular events occurred in either group.@*CONCLUSION@#This study demonstrated benefit of DH in reducing myocardial injury and potential preserving microvascular function in patients with unstable angina undergoing elective PCI.
Subject(s)
Humans , Angina, Unstable/drug therapy , Drugs, Chinese Herbal , Fractional Flow Reserve, Myocardial , Microcirculation , Percutaneous Coronary Intervention , Pilot Projects , Treatment OutcomeABSTRACT
Objective: To analyze the risk factors for peri-procedural myocardial infarction (PMI) in patients with percutaneous coronary intervention (PCI) and to study the impact of CYP2C19 genotypes on PMI. Methods: A total of 283 coronary artery disease (CAD) patients received elective PCI were enrolled, the patients were with normal level of cTnI prior PCI, without adverse reaction post PCI and cTnI levels were re-examined at 24 hours after PCI. The patients were divided into 2 groups: PMI group,n=83 and Non-PMI group,n=200. CYP2C19 genotypes were detected by DNA microarray chip method and based on its result, the patients were classiifed into 3 genotypes: Extensive metabolism type, Intermediate metabolism type and Poor metabolism type. The patients with ADP inhibition rate ≤ 20% was deifned as heightened platelet reactivity (HPR) which was measured by thrombelastograph. Baseline clinical condition was compared between 2 groups and the impact of CYP2C19 genotypes with other risk factors for PMI occurrence were studied. Results: The occurrence rate of PMI was 29.3% (83/283); the age, gender, BMI, smoking, blood levels of TG, LDL-C and uric acid, history of hypertension and diabetes were similar between 2 groups,P>0.05. Compared with Non-PMI group, PMI group had more implanted stents (2.1 ± 0.9) vs (1.5 ± 0.6) and longer total length of stents 56 (36-71) mm vs 33 (23-51) mm, bothP<0.05; lower ADP inhibition rate (36.0 ± 29.8) % vs (43.9 ± 26.4) %,P=0.02 and higher HPR occurrence rate 39.8% vs 22.0%,P=0.01. The ratios of CYP2C19 genotypes of Extensive metabolism, Intermediate metabolism and Poor metabolism were 37.5%, 45.2% and 17.3% respectively, while PMI patients in each genotype were 21.7%, 29.7% and 44.9% respectively. Logistic regression analysis indicated that HPR (OR=2.18, 95% CI 1.19-4.01,P=0.02), total length of stents (OR=1.03, 95% CI 1.00-1.06,P=0.007) and CYP2C19 Poor metabolism genotype (OR=2.8, 95% CI 1.24-6.28,P=0.01) were the risk factors for PMI occurrence. Conclusion: HPR, total length of stents and CYP2C19 poor metabolism genotype were the risk factors of PMI occurrence, while poor metabolism genotype might be the most important endogenous reason for PMI occurrence.
ABSTRACT
Objective: To investigate the prognostic factor for small side branch (SB) occlusion during coronary bifurcation intervention with the incidence rate of peri-procedural myocardial injury (PMI) in relevant patients. Methods: A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions ≤ 2.0 mm conifrmed by quantitative coronary angiography (QCA). The patients were divided into 2 groups: SB occlusion group,n=85, including 86 bifurcation lesions and Non-SB occlusion group,n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results: The total SB occlusion rate was 9.1% (86/949). SB occlusion group had the higher incidence rate of PMI (26/83, 31.3%) vs (77/821, 9.4%) and peri-operative MI mortality(6/83, 7.2%) vs (11/821, 1.3%) than Non-SB occlusion group, both P Conclusion: Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.