Síndrome coronario agudo en el paciente joven / Acute coronary syndrome in the young patient

Resumen Las enfermedades del sistema circulatorio constituyen la primera causa de muerte en el mundo. En Colombia, la enfermedad cardíaca isquémica se ubica como la principal causa de muerte, tanto en hombres como en mujeres. En la población femenina es la causa de más de la mitad de las muertes, cercana al 53%. La enfermedad isquémica en jóvenes, definidos como aquellos menores de 45 años, se ha descrito en cohortes en hasta un 11,6%, con una menor tasa de mortalidad. La dificultad para el abordaje de estos pacientes es mayor, dado que, al consultar al servicio de urgencias, pocas veces se sospecha enfermedad cardíaca isquémica.

Abstract The diseases of the circulatory system constitute the leading cause of death in the world. In Colombia, ischemic heart disease is the main cause of death, both in men and women, being within the group of women the cause of more than half of the deaths, close to 53%. Ischemic disease in young people, defined as those under 45 years old, has been described in cohorts around to 11.6%, with a lower mortality rate. The difficulty in addressing these patients is higher, given that, when consulting the emergency department, ischemic heart disease is rarely suspected.

Coronary thrombo-embolic events after Covid-19 vaccination- a single centre study

Thrombo-embolic complications after Corona virus disease-19 (COVID-19) vaccination have been previously reported. We aimed to study the coronary thrombo-embolic complications (CTE) after COVID-19 vaccination in a single centre during the initial 3 months of vaccination drive in India. All patients admitted to our hospital between 1st March 2021 and 31st May 2021 with Acute coronary syndrome (ACS) were included. Of the 89 patients [Age 55 (47e64)y, 13f] with ACS and angiographic evidence of coronary thrombus, 37 (42%) had prior vaccination history. The timing from last vaccination dose to index event was <1, 1e2, 2e4 and >4 weeks in 9(24%), 4(11%), 15(41%) and 9 (24%) respectively. ChAdOx1 nCoV-19/AZD1222 (Covishield) was the most used vaccine- 28 (76%), while 9 (24%) had BBV152 (Covaxin). Baseline characteristics were similar in both vaccinated (VG) and non-vaccinated group (NVG), except for symptom to door time [8.5 (5.75e14) vs 14.5 (7.25e24) hrs, p ¼ 0.003]. Thrombocytopenia was not noted in any of the VG patients, while 2 (3.8%) of NVG patient had thrombocytopenia (p ¼ 0.51). The pre- Percutaneous Coronary Intervention (PCI) Thrombolysis in Myocardial Infarction (TIMI) flow was significantly lower [1 (0e3) vs2 (1e3), p ¼ 0.03) and thrombus grade were significantly higher [4 (2.5e5) vs 2 (1e3), p ¼ 0.0005] in VG. The in-hospital (2.7% vs 1.9%, p ¼ 1.0) and 30-day mortality were also similar (5.4% vs 5.8%, p ¼ 1.0). This is the first report of CTE after COVID-19 vaccination during the first 3 months of vaccination drive in India. We need further reports to identify the incidence of this rare but serious adverse events following COVID-19 vaccination.

Beyond Atherothrombotic Disease in Acute Coronary Syndrome

Abstract Half of the global population over 20 years of age will be affected by cardiovascular disease. Cardiovascular events in young people is challenging. Spontaneous coronary artery dissection is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an uncommon and underdiagnosed cause of acute myocardial infarction predominately found in young women. Medical management has been more widely accepted, with percutaneous and surgery treatment reserved for precise indications. Optimal control of individual risk factors is essential in order to avoid recurrences.

Desfechos em Pacientes com Fenômeno de No-Reflow Coronário e a Relação entre a Molécula-1 de Lesão Renal e o Fenômeno de No-Reflow Coronário / Outcomes in Coronary No-Reflow Phenomenon Patients and the Relationship between Kidney Injury Molecule-1 and Coronary No-Reflow Phenomenon

Resumo Fundamento O fenômeno de no-reflow coronário (CNP, do inglês Coronary no-reflow phenomenon) está associado a um risco aumentado de eventos cardiovasculares adversos maiores (ECAM). Objetivo Este estudo teve como objetivo avaliar a relação entre os níveis séricos da Molécula-1 de lesão renal (KIM-1) e o CNP em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Métodos Este estudo incluiu um total de 160 pacientes (113 homens e 47 mulheres; média de idade: 61,65 ± 12,14 anos) com diagnóstico de IAMCSST. Os pacientes foram divididos em dois grupos, o grupo reflow (GR) (n = 140) e o grupo no-reflow (GNR) (n = 20). Os pacientes foram acompanhados durante um ano. Um valor de p<0,05 foi considerado significativo. Resultados O CNP foi observado em 12,50% dos pacientes. O nível de KIM-1 sérico foi significativamente maior no GNR do que no GR (20,26 ± 7,32 vs. 13,45 ± 6,40, p<0,001). O índice de massa corporal (IMC) foi significativamente maior no GNR do que no GR (29,41 (28,48-31,23) vs. 27,56 (25,44-31,03), p=0,047). A frequência cardíaca (FC) foi significativamente menor no GNR do que no GR (61,6 ± 8,04 vs. 80,37 ± 14,61, p<0,001). O escore do European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) foi significativamente maior no GNR do que no GR (3,06 ± 2,22 vs. 2,36 ± 2,85, p=0,016). A incidência de AVC foi significativamente maior no GNR do que no GR (15% vs. 2,90%, p=0,013). O nível basal de KIM-1 (OR = 1,19, IC 95%: 1,07-1,34, p=0,002) e HR (OR = 0,784, IC 95%: 0,69-0,88, p<0,001) foram os preditores independentes de CNP. Conclusão Em conclusão, os níveis séricos basais de KIM-1 e a FC mais baixa estão independentemente associados com CNP em pacientes com IAMCSST, e o acidente vascular cerebral foi significativamente maior no GNR em um ano de seguimento. (Arq Bras Cardiol. 2021; 116(2):238-247)

Abstract Background Coronary no-reflow phenomenon (CNP) is associated with an increased risk of major cardiovascular adverse events (MACE). Objective This study aimed to evaluate the relationship between serum Kidney Injury Molecule-1 (KIM-1) levels and CNP in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods This study included a total of 160 patients (113 males and 47 females; mean age: 61.65±12.14 years) who were diagnosed with STEMI. The patients were divided into two groups, the reflow group (RG) (n=140) and the no-reflow group (NRG) (n=20). Patients were followed during one year. A p-value of <0.05 was considered significant. Results CNP was observed in 12.50% of the patients. Serum KIM-1 was significantly higher in the NRG than in the RG (20.26±7,32 vs. 13.45±6.40, p<0.001). Body mass index (BMI) was significantly higher in the NRG than in the RG (29.41 (28.48-31.23) vs. 27.56 (25.44-31.03), p=0.047). Heart rate (HR) was significantly lower in the NRG than in the RG (61.6±8.04 vs. 80.37±14.61, p<0.001). The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was significantly higher in the NRG than in the RG (3.06±2.22 vs. 2.36±2.85, p=0.016). The incidence of stroke was significantly higher in the NRG than in the RG (15% vs. 2.90%, p=0.013). The baseline KIM-1 level (OR=1.19, 95% CI:1.07 to 1.34, p=0.002) and HR (OR=0.784, 95% CI:0.69 to 0.88, p<0.001) were the independent predictors of CNP. Conclusion In conclusion, baseline serum KIM-1 concentrations and lower HR are independently associated with CNP in STEMI patients and the incidence of stroke was significantly higher in the NRG in the one-year follow-up. (Arq Bras Cardiol. 2021; 116(2):238-247)

Blunt-chest-trauma-induced acute myocardial infarction

Blunt chest trauma (BCT) is one of the rarest causes of acute myocardial infarction (AMI). This paper reports the case of a young married man who suffered from AMI due to BCT sustained in a fight with his wife. The histopathology examination revealed a rupture of atherosclerotic plaque with superimposed thrombus in the proximal left anterior descending artery. This report also reviews previously reported BCT-induced AMI cases in the literature.

Red cell distribution width predicts the severity of non-ST-elevation myocardial infarction in patients / 中国基层医药

Objective:To analyze the relationship between red cell distribution width (RDW) and disease severity in patients with non-ST-elevation myocardial infarction.Methods:Seventy patients with non-ST-elevation myocardial infarction who received treatment in Chaozhou People's Hospital from June 2019 to June 2020 were included in the observation group. An additional 70 patients with ST-elevation myocardial infarction who concurrently received treatment in the same hospital were included in the control group. All patients underwent electrocardiography and blood biochemical index examination. RDW was compared between the observation and control groups. The relationship between RDW and the severity of non-ST-elevation myocardial infarction was analyzed.Results:RDW in the observation group was significantly higher than that in the control group [(14.60 ± 1.00) % vs. (13.06 ± 1.70) %, t = 5.884, P = 0.012). The detection rate of coronary artery thrombosis in the observation group was significantly higher than that in the control group [70.00% (49/70) vs. 50.00% (35/70), χ2 = 7.563, P = 0.002]. In the observation group, the area under the receiver operating characteristic (ROC) curve plotted taking RDW as the variable was 0.649 (95% CI 0.546-0.753, P = 0.006). When the critical value of RDW was 14%, the sensitivity and specificity of RDW in the prediction of non-ST-elevation myocardial infarction were 73% and 59% respectively. RDW was positively correlated with cardiac troponin I level ( r = 0.19, P = 0.006). Conclusion:In patients with non-ST-elevation myocardial infarction, the increase in RDW is related to myocardial injury and the increase in cardiac troponin I level. RDW can be used as an effective index to predict the severity of non-ST-elevation myocardial infarction.

Epidemiología del síndrome coronario agudo / Epidemiology of the acute coronary syndrome / Epidemiologia da síndrome coronária aguda

Las enfermedades cardiovasculares son la principal causa de muerte en el mundo. Su incidencia y prevalencia aumentan con la edad y con los diferentes factores de riesgo. La mayoría de estos factores tienen una relación estrecha con el estilo de vida; factores como la dislipidemia, el tabaquismo, la hipertensión, la diabetes mellitus, la obesidad y el estrés son cada vez más prevalentes y varían según la población y localización geográfica. Por eso se realiza una revisión de la epidemiología mundial y nacional del síndrome coronario agudo, y de cómo este ha variado a través de los años. Se buscó literatura en inglés y español en diferentes bases de datos, fueron seleccionados 50 artículos que se presentan haciendo énfasis en el impacto epidemiológico del síndrome coronario agudo. Luego de realizar la revisión detallada se concluye que la enfermedad cardiovascular persiste como primera causa mundial de morbimortalidad, con aumento en su frecuencia durante los últimos años. El síndrome coronario agudo es la afección que provoca más muertes entre todos los eventos, con incidencia, edad de presentación, impacto económico y factores de riesgo diferentes de acuerdo con cada región. Los factores de riesgo modificables siguen siendo muy importantes en el desarrollo de enfermedades cardiovasculares.

Cardiovascular diseases are the main cause of mortality all over the world. Their incidence and prevalence increase with age and different risk factors. The majority of factors are closely related to the lifestyle; aspects such as hypertension, diabetes mellitus, obesity, and stress are more prevalent day by day and vary according to the population and its geographical location. The researchers made a revision on international and national epidemiology of the acute coronary syndrome and it has changed over the years. The study included literature published in both English and Spanish retrieved from different databases. For this particular case, 50 articles focused on the epidemiologic impact of the acute coronary syndrome were reviewed. After a detailed revision, it can be said that the cardiovascular disease, which has been increasing during the past years, remains as the first cause of morbidity and mortality at the worldwide level. This syndrome causes more deaths in all events, with different incidence, age in which it takes place, economic impact and risk factors, depending on each region. The modifiable risk factors are still very important in the development of cardiovascular diseases.

As doenças cardiovasculares são as principais causas de morte no mundo. Sua incidência e prevalência aumentam com a idade e com os diferentes fatores de risco. A maioria destes fatores têm uma relação estreita com o estilo de vida; fatores como a dislipidemia, o tabaquismo, a hipertensão, a diabetes mellitus, a obesidade e o estresse são cada vez mais prevalentes e variam segundo a população e localização geográfica. Por isso se realiza uma revisão da epidemiologia mundial e nacional da síndrome coronária aguda, e de como este há variado através dos anos. Se buscou literatura em inglês e espanhol em diferentes bases de dados, foram selecionados 50 artigos que se apresentam fazendo ênfase no impacto epidemiológico da síndrome coronária aguda. Logo de realizar a revisão detalhada se conclui que a doença cardiovascular persiste como primeira causa mundial de morbimortalidade, com aumento na sua frequência durante os últimos anos. A síndrome coronária aguda é a afecção que provoca mais mortes entre todos os eventos, com incidência, idade de apresentação, impacto econômico e fatores de risco diferentes de acordo com cada região. Os fatores de risco modificáveis seguem sendo muito importantes no desenvolvimento de doenças cardiovasculares.

Clinical Significance of Platelet Volume and Other Platelet Parameters in Acute Myocardial Infarction and Stable Coronary Artery Disease / Significado Clínico do Volume Plaquetário e Outros Parâmetros Plaquetários no Infarto Agudo do Miocárdio e Doença Arterial Coronariana Estável

Abstract Background: Platelets are important in the initiation of thrombosis, and their morphological and functional changes are closely related with the occurrence and development of coronary artery thrombosis. Platelet parameters might be valuable in distinguishing between acute myocardial infarction (AMI) and stable coronary artery disease (SCAD). Objective: This study was designed to detect and compare changes in platelet parameters, such as mean platelet volume (MPV) in patients with acute myocardial infarction (AMI) and stable coronary artery disease (SCAD) and to investigate their roles in these diseases. Methods: Specimen collection: Between January 2011 and December 2013, 2 mL of elbow vein blood was drawn from each of 31 patients primarily diagnosed with AMI, 34 SCAD patients and 50 healthy subjects; and placed in EDTA-K2 anticoagulant tubes. Platelet count (PLT), MPV, plateletcrit (PCT), platelet distribution width (PDW), white blood cell (WBC) and neutrophil (NEU) counts were determined using an STKS automated hematology analyzer (Beckman Courter). Results: Compared with the control group, MPV levels were significantly higher in the AMI and SCAD groups (p < 0.05), while PLT was significantly lower (p < 0.05). Conclusion: These results suggest that MPV and other related parameters have a certain value in the diagnosis of SCAD and AMI.

Resumo Fundamento: As plaquetas são importantes no início da trombose e suas alterações morfológicas e funcionais estão intimamente relacionadas com a ocorrência e o desenvolvimento de trombose da artéria coronária. Os parâmetros plaquetários podem ser valiosos na distinção entre infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE). Objetivo: O objetivo desse estudo foi detectar e comparar alterações nos parâmetros plaquetários, como o volume plaquetário médio (VPM) em pacientes com infarto agudo do miocárdio (IAM) e doença arterial coronariana estável (DACE) e investigar seu papel nessas doenças. Métodos: Coleta de amostras: Entre janeiro de 2011 e dezembro de 2013, foram retirados 2 mL de sangue da veia do antebraço de cada um dos 31 pacientes diagnosticados principalmente com IAM, 34 pacientes com DACE e 50 indivíduos saudáveis; e colocado em tubos com anticoagulante EDTA-K2. As contagens de plaquetas (PQT), VPM, massa total de plaquetas (MTP), Amplitude de Distribuição de Plaquetas (PDW, do inglês platelet distribution width), contagem de glóbulos brancos (WBC, do inglês white blood cells) e neutrófilos (NEU) foram determinadas utilizando-se um analisador de hematologia automatizado STKS (Beckman Courter). Resultados: Comparado com o grupo controle, os níveis de VPM foram significativamente maiores nos grupos IAM e DACE (p < 0,05), enquanto os níveis de PQT foram significativamente menores (p < 0,05). Conclusão: Esses resultados sugerem que o VPM e outros parâmetros associados têm um certo valor no diagnóstico de DACE e IAM.

Dolor torácico, electrocardiograma y enzimas cardiacas: una propuesta práctica de manejo hospitalario

La presentación clínica de la enfermedad arterioesclerótica coronaria abarca un espectro amplio: desde el paciente totalmente asintomático, a pesar de la existencia de lesiones obstructivas de grado variable en el árbol coronario, o bien, el paciente que refiere opresión precordial relacionada de manera exclusiva a esfuerzo físico, hasta el paciente que aqueja dolor precordial opresivo intenso de reposo, y acude a la sala de urgencias. En cada uno de estos contextos, existe una secuencia fisiopatológica distinta, a pesar de su origen común. Se presenta una propuesta práctica para el manejo del paciente con dolor torácico en la sala de urgencias, en diferentes contextos clínicos cuyo origen fisiopatológico es distinto; se comenta la utilidad y forma de interpretación del dosaje de las "enzimas cardiacas".

The clinical presentation of coronary arteriosclerotic disease covers a broad spectrum: from the patient totally asymptomatic, despite the existence of obstructive lesions of variable degree in the coronary tree, or the patient who refers precordial oppression related exclusively to physical activity, even the patient who suffers severe oppressive precordial pain at rest, and goes to the emergency room. In each of these contexts, there is a distinct physiopathological sequence, despite its common origin. A practical proposal for the management of patients with chest pain in the emergency room, in different clinical contexts with a different pathophysiology is presented. The usefulness and interpretation of the dosage of the "cardiac enzymes" is discussed.

Relationship between human galectin 3 and myocardial infarction range, coronary thrombosis load and ventricular remodeling in patients with acute myocardial infarction / 中国实用内科杂志

OBJECTIVE: To investigate the expression changes of human galectin 3(Gal-3)in patients with acute myocardial infarction undergoing emergency PCI and to assess the relationship between Gal-3 level and myocardial infarction range,coronary thrombotic load and ventricular remodeling.METHODS: Totally 62 patients with AMI who underwent emergency PCI in the department of cardiology of our hospital from January to August of 2018 were selected. Blood samples were taken for Gal-3 determination immediately after admission, 3 and 5 days after PCI. Troponin I was measured in 24 hours after PCI.Echocardiography was completed 24 hours after PCI. The patients were divided into three groups according to the results of coronary angiography: the single-vessel disease group, the two-vessel disease group and the three-vessel disease or the left main disease group.Gensini cumulative index was calculated. According to the imaging of coronary angiography, the coronary thrombus load was divided into 0-5 grades. The changes of Gal-3 level on admission to hospital,and at 3 and 5 days after PCI were analyzed and their relationship with troponin, coronary artery diseaseand thrombus load was analyzed.RESULTS: 1. Gal-3 levels were gradually reduced on admission, at 3 days after PCI and 5 days after PCI,which were respectively(93.38 ± 9.37)ng/L,(82.76 ± 7.43)ng/L and(72.71 ± 7.58)ng/L, and there were statistically significant differences among the three groups(F=99.17,P0.05). No correlation was found between Gal-3 levels and Gensini cumulative index(P>0.05). 3. The patients were divided into the group with thrombus level 0(T0 group)and the group with thrombus level 1-5(T1-5 group). Compared to the T0 group,the admission level of Gal-3 was significantly higher in the T1-5 group,which was(95.6±7.31)g/L vs.(89.62±11.3)ng/L,and the difference between the two groups was statistically significant(P=0.014). Similarly, the Gal-3 level of the T1-5 group was significantly higher than that of the T0 group on the 3 days after PCI and 5 days after PCI(P=0.017,P=0.006). Pearson correlation analysis showed that the level of Gal-3 on admission, 3 days after PCI and 5 days after PCI were all positively correlated with troponin I(CTNI)at 24 hours after PCI;there was a negative correlation with left ventricular ejection fraction(LVEF).CONCLUSION: Gal-3 is released in the acute phase of AMI,and decreases gradually within 5 days after emergency PCI. The level of Gal-3 is associated with the coronary thrombus load in patients with acute myocardial infarction. The heavier the thrombus load, the higher level the Gal-3. Gal-3 level is positively correlated with the extent of myocardial infarction, and negatively correlated with LVEF, reflecting that Gal-3 is involved in ventricular remodeling after actue myocardial infarction.

Association of Monocyte Count on Admission with the Angiographic Thrombus Burden in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention / Associação da Contagem de Monócitos na Internação com a Carga Trombótica Angiográfica em Pacientes com Infarto com Supradesnivelamento do Segmento ST Submetidos à Intervenção Coronária Percutânea Primária

Abstract Background: The intracoronary high-thrombus burden during the primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) can lead to poor outcomes. Monocytes have been described to play an important role in thrombotic disorders. Objectives: This study aimed to investigate the relationship between admission monocyte count and angiographic intracoronary thrombus burden in patients receiving primary percutaneous coronary intervention (PPCI). Methods: A total of 273 patients with acute STEMI who underwent PPCI were enrolled. The patients were divided into two groups according to the thrombolysis in myocardial infarction (TIMI) thrombus grade: low-thrombus burden group with a grade of 0-2 and high-thrombus burden group with a grade of 3-4. The monocyte count and other laboratory parameters were measured on admission before PPCI. P-value < 0.05 was considered significant. Results: There were 95 patients (34.8%) in the high-thrombus burden group, and 178 patients (65.2%) in the low-thrombus burden group. Patients with high-thrombus burden had significantly higher admission monocyte count (0.61 ± 0.29×109/L vs. 0.53 ± 0.24×109/L, p = 0.021). In multivariate analysis, monocyte count was the independent predictor of angiographic high-thrombus burden (odds ratio 3.107, 95% confidence interval [CI] 1.199-7.052, p = 0.020). For the prediction of angiographic high-thrombus burden, admission monocyte count at a cut-off value of 0.48×109/L yielded 0.59 ROC-AUC (71.9% sensitivity, 46.9% specificity). Conclusions: Monocyte count on admission was an independent clinical predictor of high-thrombus burden in patients with STEMI undergoing PPCI. Our findings suggest that admission monocyte count may be available for early risk stratification of high-thrombus burden in acute STEMI patients and might allow the optimization of antithrombotic therapy to improve the outcomes of PPCI.

Resumo Fundamento: A carga trombótica intracoronária durante a intervenção coronária percutânea primária em pacientes com Infarto com Supradesnivelamento do Segmento ST (STEMI) pode levar a resultados negativos.Os monócitos foram descritos para desempenhar um papel importante nos distúrbios trombóticos. Objetivos: Este estudo investigou a relação entre a contagem de monócitos no momento da internação e a carga trombótica angiográfica intracoronária em pacientes submetidos à intervenção coronária percutânea primária (ICPP). Métodos: Um total de 273 pacientes com STEMI agudo submetidos à ICPP participaram. Os pacientes se dividiram em dois grupos de acordo com o grau trombótico na trombólise do infarto do miocárdio (TIMI): grupo baixa carga trombótica, com graus de 0-2, e grupo alta carga trombótica, com graus de 3-4. A contagem de monócitos e outros parâmetros laboratoriais foram medidos na internação antes da ICPP. Consideramos o valor de p < 0,05 significativo. Resultados: Havia 95 pacientes (34,8%) no grupo alta carga trombótica, e 178 pacientes (65,2%) no grupo baixa carga trombótica. Pacientes com alta carga trombótica apresentaram contagem de monócitos no momento da internação mais alta (0,61 ± 0,29×109/L vs. 0,53 ± 0,24×109/L, p = 0,021). Na análise multivariada, a contagem de monócitos foi o indicador independente da alta carga trombótica angiográfica (odds ratio 3,107, intervalo de confiança de 95% [IC] 1,199-7,052, p = 0,020). Para a previsão da alta carga trombótica angiográfica, a contagem de monócitos na internação tinha ponto de corte de 0,48×109/L, chegou a 0.59 ROC-AUC (71,9% sensibilidade, 46,9% especificidade). Conclusões: a contagem de monócitos na internação foi um indicador clínico independente da alta carga trombótica em pacientes com STEMI submetidos à ICPP. Nossos achados sugerem que a contagem de monócitos na internação pode estar disponível para a estratificação de risco precoce da alta carga trombótica em pacientes com STEMI agudo, e podem levar à otimização da terapia antitrombótica para melhorar os resultados da ICPP.

Validation of Predictive Value of Patterns of Nonadherence to Antiplatelet Regimen in Stented Patients Thrombotic Risk Score in Chinese Population Undergoing Percutaneous Coronary Intervention: A Prospective Observational Study / 中华医学杂志(英文版)

Background@#The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS) thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs) after percutaneous coronary intervention (PCI) with drug-eluting stents. However, the prognostic value of this score has not been fully evaluated in non-Euro-American PCI populations.@*Methods@#We performed a prospective, observational study of 10,724 patients who underwent PCI in Fuwai hospital, China and evaluated the PARIS thrombotic risk score's predictive value of CTEs in the PCI population. The area under the receiver operating characteristic curve (AUROC) was used to assess the predictive value of the PARIS score for CTE.@*Results@#Among 9782 patients without in-hospital events, a total of 95 CTEs occurred during the 2-year follow-up. The PARIS score was significantly higher in patients with CTEs (3.38 ± 2.04) compared with patients without events (2.53 ± 1.70, P < 0.001). According to the risk stratification of the PARIS thrombotic score, the risk of CTEs in the high-risk group was 3.14 times higher than that in the low-risk group (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.92-5.13; P < 0.001). However, the risk of CTEs in the intermediate-risk and low-risk groups was not significant (HR, 1.39; 95% CI, [0.86-2.24]; P = 0.184). The PARIS score showed prognostic value in evaluating CTEs in the overall population (AUROC, 0.621; 95% CI, 0.561-0.681), the acute coronary syndrome (ACS) population (AUROC, 0.617; 95% CI, 0.534-0.700; P = 0.003), and the non-ACS population (AUROC, 0.647; 95% CI, 0.558-0.736; P = 0.001).@*Conclusions@#In a real-world Chinese population, the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI. This score also has a predictive value for CTEs in the ACS and non-ACS subgroup populations.

Acute left main coronary artery thrombosis as an initial presentation of systemic lupus erythematosus / 영남의대학술지

Left main coronary artery (LMCA) thrombosis is rare and the cause should be determined. A previously healthy young man presented with severe chest pain and dyspnea. The electrocardiogram showed typical ST-segment elevation myocardial infarction with clinical instability. Emergency coronary angiography revealed complete LMCA occlusion by thrombosis. After reperfusion, the patient was admitted to the cardiac care unit. He was diagnosed with hemolytic anemia and tested positive for antinuclear antibodies. Systemic lupus erythematosus (SLE) and LMCA disease due to systemic thrombosis were diagnosed. Steroids were started and the patient was discharged without complications. We report this rare case of LMCA thrombosis as an initial presentation of SLE.

Drug-Coated Balloon Treatment of Very Late Stent Thrombosis Due to Complicated Neoatherosclerosis / Tratamento por Balão Farmacológico de Trombose de Stent Muito Tardia Causada por Neoaterosclerose Complicada

Abstract We describe the treatment of a patient presenting with very-late stent thrombosis with the use of a drug-coated balloon. In this patient, optical coherence tomography disclosed that ruptured and complicated neoatherosclerosis was the underlying substrate responsible for the episode of very-late stent thrombosis. The potential use of drug-coated balloons in this unique scenario is discussed.

Resumo Descrevemos o tratamento de um paciente apresentando trombose de stent muito tardia com a utilização de um balão farmacológico. Nesse paciente, a tomografia de coerência ótica revelou que a neoaterosclerose apresentava-se complicada e com ruptura, sendo portanto o substrato subjacente responsável pelo episódio de trombose de stent muito tardia. O uso potencial de balões farmacológicos nesse cenário especial é discutido.

Revascularización del vaso culpable versus completa en enfermedad de múltiples vasos en infarto agudo de miocardio con elevación del segmento ST Metaanálisis de ensayos clínicos / Culprit vessel revascularization versus complete revascularization in multivessel disease in acute myocardial infarction with ST-segment elevation Meta-analysis of clinical trials

Resumen Revascularización del vaso culpable versus completa en enfermedad de múltiples vasos en infarto agudo de miocardio con elevación del segmento ST: metaanálisis de ensayos clínicos. Introducción: se ha recomendado que en los pacientes con infarto agudo de miocardio con elevación del segmento ST se realice revascularización percutánea sólo del vaso culpable. Objetivos: evaluar el efecto de la revascularización percutánea sólo del vaso culpable en comparación a la completa, en pacientes con infarto agudo de miocardio con elevación del segmento ST de menos de 12 horas de evolución para disminuir desenlaces críticos. Material y métodos: se realizó una búsqueda sistemática en las bases de datos bibliográficas, resúmenes de congresos de cardiología y búsqueda manual de los estudios primarios incluidos en otros metaanálisis, de ensayos clínicos con asignación aleatoria de pacientes con infarto agudo de miocardio con elevación del segmento ST de menos de 12 horas de evolución. Resultados: la estrategia de revascularización percutánea completa no aumenta la mortalidad de cualquier causa RR 0.78 (IC 95% 0.44-1.39); ni la de origen cardiovascular RR 0,62 (IC 95% 0.27-1.44), y reduce la frecuencia de reinfartos RR 0.39 (IC 95% 0.2-0.76) y la frecuencia de reintervenciones RR 0.45 (IC 95% 0.31-0.65) en los pacientes con infarto agudo de miocardio con elevación del segmento ST, que se presentan durante las primeras 12 horas de evolución Conclusiones: en pacientes con infarto agudo de miocardio con elevación del segmento ST, quienes se presentan en las primeras 12 horas, la revascularización competa en enfermedad multi-vaso es segura y disminuye la frecuencia de eventos como reinfarto y necesidad de reintervención. (Acta Med Colomb 2016; 41: 116-124).

Abstract Culprit vessel revascularization versus complete revascularization in multivessel disease in acute myocardial infarction with ST segment elevation: meta-analysis of clinical trials. Introduction: it has been recommended to perform only culprit vessel revascularization in patients with acute myocardial infarction with ST-segment elevation. Objectives: to evaluate the effect of percutaneous revascularization of only the culprit vessel compared to the complete in patients with acute myocardial infarction with ST-segment elevation of less than 12 hours of evolution to reduce critical outcomes. Materials and Methods: a systematic search of the literature databases, abstracts of cardiology congress and manual search of primary studies included in other meta-analyzes of clinical randomized trials of patients with acute myocardial infarction with ST-segment elevation of less than 12 hours of evolution, was performed. Results: complete percutaneous revascularization strategy does not increase mortality from any cause RR 0.78 (95% CI 0.44-1.39); nor that of cardiovascular origin RR 0.62 (95% CI 0.27-1.44), and reduces the frequency of reinfarction RR 0.39 (95% CI 0.2-0.76), and the frequency of reoperations RR 0.45 (95% CI 0.31 -0.65) in patients with acute myocardial infarction with ST segment elevation, occurring during the first 12 hours of evolution. Conclusions: in patients with acute myocardial infarction with ST segment elevation who consult in the first 12 hours, complete revascularization in multivessel disease is safe and decreases the frequency of events such as reinfarction and need for reoperation. (Acta Med Colomb 2016; 41: 116-124).

Observation on therapeutic effect of balloon dilation in acute thrombus disease / 中国医师进修杂志

Objective To observe the therapeutic effect of balloon dilation in acute thrombus disease. Methods After coronary angiography, 137 patients with acute thrombus disease who were performed percutaneous coronary artery interventional therapy (PCI) from August 2010 to August 2012 were enrolled. In them, 53 patients (control group) didn′t undergo balloon dilation after PCI, and 84 patients(observation group)underwent balloon dilation after PCI. The intraoperative complications and the major adverse cardiac events (MACE) rate were observed. Results The rate of residue stenosis in observation group was lower than that in control group:(6.7 ± 1.3)% vs. (17.1 ± 1.8)%, and there was significant difference (P0.05). The follow-up time was (0.9 ± 0.2) years. In control group, myocardial infarction occurred in 2 patients, 7 patients reviewed coronary angiography, and 2 patients underwent revascularization. In observation group, there was no MACE. Five patients reviewed coronary angiography, and no patient underwent revascularization. Conclusions The method of balloon dilation after PCI in acute thrombus disease is safe and feasible. It can reduce the incidence of MACE, and did not increase the rate of no-reflow or slow flow.