Utilidad de la tomografía de coherencia óptica como guía en el tratamiento del síndrome coronario agudo: reporte de un caso / Utility of optical coherence tomography to guide treatment in acute coronary syndromes: case report / Utilidade da tomografia de coerência óptica como guia no tratamento da síndrome coronariana aguda: relato de um caso

La tomografía de coherencia óptica (OCT) es una técnica de imagen endovascular con elevada resolución espacial que permite evaluar las diferentes estructuras que componen la pared de las arterias coronarias, caracterizar morfológicamente la placa aterosclerótica y establecer el mecanismo fisiopatológico subyacente en los síndromes coronarios agudos (SCA). Se presenta el caso clínico de un paciente con infarto agudo de miocardio, donde la OCT evidenció que la reducción de la luz arterial estaba determinada principalmente por la presencia de trombo, a la vez que demostró una disrupción endotelial (ruptura de placa) como mecanismo fisiopatológico subyacente. Se adoptó una estrategia invasivo-conservadora, donde finalmente no se implantó stent. La información surgida de la OCT en este caso particular fue fundamental en la toma de decisiones.

Optical coherence tomography (OCT) is an endovascular imaging technique with high spatial resolution. It allows to evaluate the different structures that compose coronary arteries' wall, morphologically characterize atherosclerotic plaques and establish the underlying pathophysiological mechanism in acute coronary syndromes (ACS). The case of a patient with acute myocardial infarction is presented, in which OCT showed that the reduction of arterial lumen was determined mainly by the presence of thrombus, while also demonstrated endothelial disruption (plaque rupture) as the underlying pathophysiological mechanism. An invasive-conservative strategy was adopted and finally stent was not implanted. The information that emerged from the OCT in this particular case was fundamental in decision-making.

A tomografia de coerência óptica (OCT) é uma técnica de imagem endovascular com alta resolução espacial que permite a avaliação das diferentes estruturas que compõem a parede das artérias coronárias, a caracterização morfológica da placa aterosclerótica e o estabelecimento do mecanismo fisiopatológico subjacente de síndrome coronariana aguda (SCA). Apresentamos o caso clínico de um paciente com enfarte agudo do miocárdio, onde a OCT mostrou que a redução do lúmen arterial foi determinada principalmente pela presença de trombo, ao mesmo tempo que demonstrou uma ruptura endotelial (ruptura da placa) como causa fisiopatológica subjacente. Adotou-se uma estratégia invasiva-conservadora, onde finalmente o stent não foi implantado. As informações obtidas da OCT neste caso específico foram fundamentais na tomada de decisão.

Human pilot study of bare-metal stent: INC-01

ABSTRACT Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.

Intracoronary sarcoplasmic reticulum calcium-atpase gene therapy in advanced heart failure patients with reduced ejection fraction: a prospective cohort study

OBJECTIVE: Heart failure is a progressive and debilitating disease. Intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy may improve the function of cardiac muscle cells. This study aimed to test the hypothesis that intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy can improve outcomes and reduce the number of recurrent and terminal events in advanced heart failure patients with reduced ejection fraction. METHODS: A total of 768 heart failure patients with reduced ejection fraction and New York Heart Association classification II to IV were included in this prospective cohort study. Patients either underwent intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy (CA group, n=384) or received oral placebo (PA group; n=384). Data regarding recurrent and terminal event(s), treatment-emergent adverse effects, and outcome measures were collected and analyzed. RESULTS: After a follow-up period of 18 months, intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy reduced the number of hospital admissions (p=0.001), ambulatory treatments (p=0.0004), and deaths (p=0.024). Additionally, intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy improved the left ventricular ejection fraction (p<0.0001) and Kansas City Cardiomyopathy Questionnaire score (p<0.0001). The number of recurrent and terminal events/patients were higher in the PA group than in the CA group after the follow-up period of 18 months (p=0.015). The effect of the intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy was independent of the confounding variables. No new arrhythmias were reported in the CA group. CONCLUSIONS: Intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy reduces the number of recurrent and terminal events and improves the clinical course of advanced heart failure patients with reduced ejection fraction.

Thrombus Aspiration Plus Intracoronary Abciximab vs Intracoronary Abciximab Alone in Patients with STEMI Undergoing Primary PCI

Background: Thrombus embolization during the Percutaneous Coronary Intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI is bolus intracoronary Abciximab and manual aspiration thrombectomy. There are several factors which influence the decision of primary PCI in a patient with AMI in developing countries. Cost of therapy and affordability is probably the most important factor. The additional cost for thrombus aspiration needs to be considered against the additional advantages in terms of better clinical outcome. Objectives: To compare the use of a combination of intracoronary Abciximab with manual thrombus aspiration to intracoronary Abciximab alone, in patients with STEMI undergoing primary PCI. Patients and Methods: This is a prospective observational study of patients with STEMI who underwent primary PCI between June 2018 to May 2019. A pre-approved study protocol was designed to determine the eligibility of STEMI patients to be included in the study. Patients with The patients have analysed in two groups: 84 patients received a combination of intracoronary Abciximab with manual thrombus aspiration & 80 patients received intracoronary Abciximab alone. The primary endpoint was the assessment of myocardial perfusion parameters namely Myocardial Blush Grade (MBG) in the culprit vessel & ST-segment resolution of >70% on ECG at 90 min after PCI. Secondary endpoints were the improvement in LV ejection fraction, cardiovascular mortality & recurrent MI at one-month post-procedure. Results: Result of the 84 patients who received combination of intracoronary Abciximab with manual thrombus aspiration, the primary endpoints namely the myocardial blush grade (MBG) of 2/3 was achieved in 72 patients (90.74%) & ST-segment resolution of >70% at 90 min was seen in 66 patients (78.57%) (p<0.001). Of the 80 patients who received only intracoronary Abciximab without thrombus aspiration, MBG 2/3 was achieved in 38 patients (47.5%) & ST-segment resolution of >70% at 90 min was seen in 28 patients (35%). At one month of follow up the secondary endpoints namely the LVEF in the combination group improved from 43.42±3.73 to 47.88±4.16% (p=0.12)and in the Abciximab group improved from 44.78±3.34 to 46.20±3.63%. Recurrent MI was seen in one patient in the combination group (p<0.001) & two patients in the ic Abciximab group. There was no cardiovascular mortality noted in the present study (p<0.001). Conclusion: Intracoronary Abciximab + manual thrombus aspiration reduces thrombus burden with better results in microvascular perfusion assessed by ST-segment resolution of >70% at 90 min & higher Myocardial Blush Grade compared to intracoronary Abciximab alone in patients with STEMI undergoing primary PCI.

Evaluation of intracoronary blood from obstructive vessel in patients of ST-elevation myocardial infarction undergoing PPCI

Objective Information available on acid–base imbalance in ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous intervention is limited and no data were present on intracoronary blood analysis, extracted from obstructed artery. Methods This was a prospective study conducted over 12 months in which STEMI patients presenting in emergency and undergoing primary percutaneous coronary intervention were included. Blood gas analysis of intracoronary arterial blood from obstructed vessel and peripheral arterial blood was performed. Patients in whom adequate intracoronary sample could not be obtained were excluded. Intracoronary and peripheral arterial blood gas measurements were correlated and relationship of intracoronary parameters were compared with clinical parameters, investigational markers and short-term outcome. Results The mean age of study population was 54.8 years and average symptom onset to door time was 162 min. On comparing intracoronary blood with peripheral blood arterial obtained, pH (95% confidence interval [CI] −0.01 to 0.02;p = 0.44), lactate (95% CI 0.03–0.1;p = 0.28), bicarbonate (95% CI 0.6–1.5;p = 0.64), pCO2 (95% CI 1.1–2.4;p = 0.79) and pO2 (95% CI 3.2–47.5; p = 0.06) were all found to be statistically insignificant. Intracoronary hyperlactatemia was present in patients presenting with higher symptom onset to door time (p = 0.025). Systolic blood pressure (SBP) (p = 0.03) was also significantly lower in patients who had high intracoronary lactate levels. Conclusion The evaluation of intracoronary blood provides no additional information regarding the prognosis and short-term (30-day) outcome of the patients when compared with peripheral blood. However, there was a significant intracoronary hyperlactatemia in patients presenting late after symptom onset. SBP was also significantly less in patients with high intracoronary lactate, which signifies that predominant cause of hyperlactatemia was systemic hypoperfusion rather than local increase in lactate levels.

Intracoronary tenecteplase in STEMI with massive thrombus

Primary percutaneous coronary intervention is the current standard of care in ST elevation myocardial infarction (STEMI). However, large thrombus is an independent predictor for stent thrombosis and major adverse cardiac events in patients undergoing primary angioplasty for STEMI. Here we report a series of STEMI patients with large thrombus burden treated successfully with low dose intracoronary thrombolysis. There was prompt and early ST resolution. There was improvement in thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade postlysis in all patients. Majority had recanalised infarct related coronary artery thus obviating the need for stenting. There was no inhospital or 1 month mortality or bleeding events. Hence intracoronary thrombolysis is an option in patients with large thrombus burden.

Experience of Treatment Cases According to Syndrome Differentiation of Intracoronary Stenting Postoperatively / 中国中医药信息杂志

Through three treatment cases according to syndrome differentiation of intracoronary stenting postoperatively by warming the spleen and stomach for dispelling cold, replenishing qi to invigorate the spleen, eliminating phlegm and dredging channel blockade, invigorating vital energy, soothing the liver and regulating the spleen, and relieving mental stress, this article discussed the application of treatment according to syndrome differentiation in intracoronary stenting postoperatively.

Adenosina intracoronaria durante la angioplastía primaria para la preservación del flujo coronario / Intracoronary adenosine during primary angioplasty and coronary flow preservation

Introducción: El uso de adenosina intracoronario durante la angioplastía coronaria ha sido controversial en los últimos años. El beneficio teórico en el flujo epi-cárdico y microcirculatorio (MC) no se ha demostrado categóricamente en estudios clínicos. Objetivo: Evaluar el efecto de protección de la MC y del flujo epicárdico al utilizar adenosina intracoronaria durante la AP. Métodos: Estudio clínico randomizado multicéntrico, caso-control con análisis post hoc ciego, en pacientes portadores de SCA con SDST. Un total de 122 pacientes aleatorizados 1:1, se consideró caso (A(+)) aquel que se administró adenosina en dosis de 120 microgramos intracoronario en bolo y luego infusión periférica de 6mg en 33ml de suero fisiológico a pasar en 2-3 minutos Se evaluaron criterios clínicos, angiográficos y electrocar-diográficos de reperfusión epicárdica y microvascular. Observadores ciegos evaluaron el conteo de cuadros TIMI (cTFC) y "blush" miocárdico (BM). Se compararon las características clínicas, angiográficas basales y los resultados angiográficos finales entre ambos grupos, usando t-Student, prueba de Mann-Whitney, Chi cuadrado y test exacto de Fisher según correspondiera. En todos los pacientes se evaluó la resolución del SDST con el score de ST. Además, se evaluó las posibles complicaciones por uso de adenosina intracoronaria. Resultados: Entre 2012-2014 se reclutaron 122 pacientes. Al comparar las características basales entre el grupo A(+) vs los A(-) no hubo diferencias significativas en la edad (59+/-10 años para A(+) vs 58+/-10 años para A(-), p:0,97), ni en las comorbilidades. Al comparar las características angiográficas basales, no se encontró diferencias en los vasos culpables (ADA 44% en A(+) vs 43% en A(-), p:0.57), en las cargas trombóticas (Alta carga: 69% para A(+) vs 74% para A(-), p:0.53), en el flujo TIMI pre (TIMI 0-1 86% para ambos grupos, p:0,69), cTFC pre (87+/-23 cuadros en A(+) vs 88+/-25 cuadros en A(-), p:0.99), Killip de ingreso (Killip I, 86% para A(+) vs 76% para A(-), p:0,11) y fracción de eyección (51+/-8% para A(+) vs 48+/-9% para (-), p:0,61). Al evaluar los resultados angiográficos finales encontramos diferencias significativas en el flujo TIMI (TIMI 3 96% para grupo A(+) vs 74% para grupo A(-), p:0,002). No encontramos diferencias significativas en el BM (Blush 3 73% para ambos grupos, p:0.74), el cTFC final (24+/-11 cuadros en A(+) vs 26+/-12 cuadros en A(-), p:0,85). Si consideramos cTFC <23cuadros como éxito angiográficos, tampoco encontramos diferencias significativas (56% para A(+) vs 53% para A(-), p:0,45). Por último tampoco hubo diferencias significativas con la resolución del segmento ST (44% para A(+) vs 58% para A(-), p:0,126). Conclusión: De acuerdo a los resultados obtenidos podemos inferir que la adenosina intracoronaria cumple un rol en la conservación óptima del flujo epicárdico coronario, pero sin influir en la microcirculación. Mayores estudios se requieren para determinar si se traduce en algún beneficio clínico.

Background: The effect of Intracoronary adenosine for coronary flow preservation during primary PTCA is debatable. Clinical studies have not established a benefit of adenosine administration upon epicar-dic or microcirculatory flows. Aim: to evaluate micro circulatory flow preservation after administration of intracoronary adenosine during primary PTCA. Method: From 2012 to 2014, 122 patients with ST elevation myocardial infarction randomized to either adenosine of control (2:1) were included in a controlled clinical trial. Adenosine was administered in a 120 mg bolus followed by 6mg solution during 2 to 3 min. Epicardic and micro vascular flows were evaluated through clinical, angiographic, electrocardiographic and reperfusion variables. TIMI (cTFC) and myocardial "blush" were measured by blind observers. Results: Basal characteristics, namely age and co-morbidities were similar between groups. Also, the distribution of coronary vessels involved in MI was similar with a preponderance of the LAD artery. There was an high proportion of patients with an elevated thrombus load (Adenosine 69%, controls 74%) ; TIMI flow 0-1 was 86% in both groups and TIMI cTFC was not different (adenosine: 87±23 , controls 88±25 ). Over 75% of patients were Killip I, and the ejection fraction was slightly decreased (adenosine 51±8% , controls 48±9% , NS). In contrast, TIMI flow was significantly greater for adenosine (TIMI 3 96% for adenosine and 74% for controls, p=0.002). No difference was observed in myocardial blush (B 3 73% in both groups) nor cTFC (24±11 vs. 26±12, respectively). Finally, regression of ST elevation was similar in both groups. Conclusion: Intracoronary adenosine during PTCA in ST elevation MI was associated to a better epicardial but not microvascular flow. Further study is needed to evaluate the eventual clinical benefit of these effects.

Blanqueamiento dental intrínseco utilizando técnica termo-catalítica: Presentación de un caso clínico / Intrinsic tooth whitening using thermo-catalytic technique: Clinical case report

Paciente femenino de 20 años de edad, quien acudió al Servicio de Odontología del Hospital Militar Regional de Guadalajara, Jalisco, por cambio de color en sus dientes. A la exploración, se observó discromía en el incisivo central superior derecho, las pruebas de sensibilidad negativas, radiográficamente ausencia de zona radio-lúcida, diagnosticándose necrosis pulpar, lo cual condujo al tratamiento de conductos en sesión única, para posteriormente realizar blanqueamiento intracoronario con técnica termocatalítica. Se llevó a cabo control clínico-radiográfico a uno, tres, seis y 12 meses, observándose en estos periodos, una adecuada evolución clínica, ausencia de sintomatología, zona radiolúcida y coloración adecuada de los tejidos dentales.

A 20 year old female patient attended the dental hospital of the Regional Military Hospital, Guadalajara, Jalisco. The patient's complaint was tooth discoloration. Exploration revealed dyschromia in the upper central right incisor. Sensitivity tests elicited negative results, radiographic examination revealed lack of radio-lucid areas. Emitted diagnosis was pulp necrosis. Root canal treatment was conducted in one single visit. Intra-coronary whitening with thermo-catalytic technique was achieved at a later date. Clinical and radiographic follow-up were conducted 3, 6 and 12 months after procedure. At these sessions the following traits were observed: suitable clinical evolution, absence of symptomatology, radio-lucid area and suitable coloring of dental tissues.

The quantitative assessment of left ventricular regional diastolic function after intracoronary stent implantation by strain rate imaging / 中国医师进修杂志

Objective To investigate the application of strain rate imaging in quantitative assessment of left ventricular regional diastolic function after intracoronary stent implantation.Methods Fifty-six healthy person and 60 patients with coronary artery disease were performed quantitative assessment of left ventricular regional diastolic function by apical four chamber view,apical two chamber view and left ventricular long axis view before and after intracoronary stent implantation using strain rate imaging.Results Compared with those of normal myocardium,the peaks of strain rate curve at diastole of ischemic myocardium were reduced,and were increased after operation (P ＜ 0.05).Conclusions Intracoronary stent implantation can significantly improve the blood supply to the ischemia myocardium.Strain rate imaging can quantitatively analyze the changes of left ventricular regional diastolic function.

Analysis of radiation dose to patients during coronary angiography and intracoronary stenting using radial and femoral artery access / 重庆医学

Objective To evaluate the radiation dose to patients using radial and femoral artery access in coronary angiography (CAG) and intracoronary stenting (IS) ,provide basis for clinical intervention path .Methods The data of 190 samples (43 by femo-ral and 147 by radial) underwent CAG and 54 samples (17 by femoral and 37 by radial) underwent CAG+IS were analyzed retro-spectively .All samples were divided into two groups (radial group and femoral group) by different approach ,and radiation dose in different approach were analyzed .Results There was no significant difference of Dose Area Product (DAP) and Cumulative Dose (CD) using femoral and radial access in CAG (P>0 .05) .Separating two samples which CD were much higher than others ,the mean DAP was 23 .93 Gy · cm2 and the mean CD was 358 .85 mGy using radial vs .27 .06 Gy · cm2 and 369 .57 mGy using femoral , not distinctive either(P=0 .734 ,P=0 .834) .In CAG+IS ,the mean DAP was 82 .64 Gy · cm2 using radial and it was 78 .11 Gy · cm2 using femoral ,and the mean CD was 1 286 .41 mGy using radial and it was 1 267 .76 mGy using femoral .There were no signifi-cant difference in both DAP and CD (P=0 .705 ,P= 0 .919) .Conclusion The radiation dose of DAP and CD were not different when using radial access and using femoral access in CAG and CAG +IS .

The efficacy of intracoronary administration of tirofiban for acute coronary syndrome patients ;during percutaneous coronary intervention：a meta-analysis / 中国介入心脏病学杂志

Objective To compare the effect of intracoronary versus intravenous administration of tiroifban for acute coronary syndrome (ACS) patients during percutaneous coronary intervention (PCI). Methods A search was retrieved from Pubmed, EMbase, Chinese Biomedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese Science and Technology Periodical Database (VIP), Cochrane Library to systematically collect the randomized controlled trials of intracoronary versus intravenous administration of tirofiban for the patients with ACS undergoing PCI. The data was extracted from the included studies and analyzed by Cochrane Collaboration's RevMan5.2 software. Results Twenty-five studies involving 2516 patients met the inclusion criteria. The results of meta-analysis showed that thrombolysis in myocardial infarction (TIMI) grade 3 lfow (RR 1.15, 95%CI 1.07-1.23, P=0.0001) were signiifcantly more often achieved in the patients by intracoronary administration of tiroifban (IC group) than those by intravenous strategy (IV group). Left ventricular ejection fraction (LVEF) values in a week after PCI which were evaluated by Cardiac Ultrasound were statistically significant between the two groups (WMD 2.69, 95%CI 0.14-5.25, P=0.04). LVEF values in IC group were increased by an average of 2.69% compared with group IV. Intracoronary administration resulted in a reduced incidence of major adverse cardiovascular events (MACE) at 30-day follow-up (RR 0.51, 95%CI 0.38-0.69, P < 0.0001). However, the incidence of bleeding complications was not statistically signiifcant between the two groups (RR 0.95, 95% CI 0.76-1.19, P=0.64). Conclusions Compared with intravenous strategy, intracoronary administration of tiroifban can be more effective in increasing coronary blood lfow and microvascular perfusion, more signiifcantly in reducing the incidence of MACE at 30-day follow-up and improving the prognosis after PCI without increasing the risk of bleeding.

Aplicación intracoronaria de levosimendán en la prueba de fracción de flujo de reserva coronaria (Simdax) / Intracoronary administration of levosimendan in the coronary fractional flow reserve test

Introducción: El estudio hemodinámico de una estenosis coronaria de severidad intermedia mediante la prueba de fracción de flujo de reserva (FFR) coronaria es fundamental en términos de eventos cardiovasculares principales a corto y largo plazo. Actualmente, no se ha publicado en este contexto la aplicación intracoronaria de levosimendán. Objetivos: Determinar los efectos hemodinámicos de la administración intracoronaria de levosimendán como vasodilatador en la prueba FFR, comparado contra adenosina intracoronaria. Material y métodos: Se estudiaron mediante FFR 48 lesiones intermedias en las coronarias epicárdicas principales. Resultados: De las 48 lesiones valoradas con FFR en relación con la aplicación de adenosina versus levosimendán intracoronarios, el porcentaje de estenosis coronaria fue del 55.83 (± 11.64), FFR adenosina intracoronaria 0.8633 (± 0.1130) y FFR levosimendán intracoronario 0.8652 (± 0.1090); coeficiente de correlación 0.9859 y correlación cuadrática 0.9720. Demostrando que la inducción de vasodilatación es semejante, incluyendo casos positivos para revascularización con relación FFR < 0.80. Conclusiones: El levosimendán intracoronario en la prueba FFR presentó semejanza en la valoración de las estenosis coronarias intermedias, comparado con adenosina intracoronaria. El levosimendán representa una alternativa favorable en la inducción de hiperemia coronaria, para normar decisiones de revascularización mediante asistencia fisiológica.

Aims: The hemodynamic study of a coronary stenosis of intermediate severity, by testing fraction flow reserve (FFR) is essential in terms of major cardiovascular events in the short and long term. Currently not published in this context the intracoronary application of levosimendan. Objectives: To determine the hemodynamic effects of intracoronary administration of levosimendan, a vasodilator in the FFR test, compared with intracoronary adenosine. Material and methods: Were evaluated by FFR, 48 intermediate lesions in major epicardial coronary arteries. Results: Of the 48 lesions with FFR assessed, the application of adenosine versus intracoronary levosimendan, the percentage of coronary stenosis was 55.83 (± 11.64), intracoronary adenosine FFR 0.8633 (± 0.1130) and 0.8652 FFR intracoronary levosimendan (± 0.1090) correlation coefficient of 0.9859 and 0.9720 quadratic correlation. Demonstrating that induction of vasodilatation is similar, including revascularization positive cases compared FFR < 0.80. Conclusions: Intracoronary levosimendan in the FFR test showed similarity in the assessment of intermediate coronary stenosis compared with intracoronary adenosine. Levosimendan is an excellent alternative in the induction of coronary hyperemia decisions to regulate physiological revascularization with assistance.

Effect of intracoronary tirofiban on coronary slow flow patients with acute myocardial infarction during primary percutaneous coronary intervention / 中华急诊医学杂志

Objective To investigate the effect of intracoronary application of tirofiban on coronary slow flow patients with acute myocardial infarction during primary percutaneous coronary intervention (PPC1).Method It was a retrospective analysis of 187 patients with acute myocardial infarction treated with PPCI in the emergency department of Beijing Anzhen Hospital enrolled in this study from January,2008 through January,2011.The patients divided into 2 groups in terms of intra-coronary administration of tirofiban (tirofiban group) and intra-coronary use of nitroglycerol (control group).Data were statistically analyzed by using SPSS 13.0 software.Categorical variables were analyzed using x2 test and continuous variables were compared by t test.Results Between two groups,there were no differences in preoperative systolic pressure (P =0.245),the rate of TIMI flow 3 (P =0.568) after PPCI and ST segment resolution (P =0.824),LVEF (P =0.275) and in-hospital mortality (P =0.502).Compared with tirofiban group,the systolic pressure was lower and the rate of using intra-aortic counter-pulsation was higher in control group.Although the incidence of slight bleeding in the control group was lower than that in the tirofiban group,no severe bleeding was observed in both groups.Conclusions The effect of intracoronary use of tirofiban was similar to that of nitroglycerol in terms of improving slow flow of coronary artery.It could safely and effectively reduce the incidence of the coronary slow flow in the patients after PPCI,but it produced a little impact on systolic pressure.It may be a better method of choice for AMI patient with low blood pressure.

Risk assessment of acute kidney injury after intracoronary stent implantation / 中国综合临床

Objective To investigate the risk factors of acute kidney injury(AKI) after intracoronary stent implantation in order to provide the basis for clinical prophylaxis and treatment.Methods Retrospectively analyzed 626 consecutive patients who underwent isolated intracoronary stent implantation in our institution from January 2007 to July 2011.Multivariate logistic regression model was constructed to identify the risk factors for the development of AKI defined as a serum creatinine (SCr) 130 to 199 μ mol/L or estimated creatinine clearance(Ccr) 30 to 60 ml/min per 1.73 m2.Results Ninety-three patients of 626 (14.9％) underwent isolated intracoronary stent implantation developed AKI.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of AKI following isolated intra-coronary stent implantation was associated with age (OR =1.570,95％ CI 1.308-1.885),ejection fraction (EF) ≤ 30％(OR =11.526,95％ CI 2.452-54.177),hypotension during perioperative and postoperation (OR =11.074,95％ CI 2.439-50.282),operation duration(OR =1.032,95％ CI 1.012-1.051),sex (OR =0.010,95％ CI 0.001-0.086),NYHA class Ⅲ & Ⅳ (OR =0.209,95％ CI 0.059-0.737),peripheral vascular disease (OR =0.528,95％ CI 0.286-0.973),chronic obstructive pulmonary diseases (OR =0.546,95％ CI 0.304-0.982),preoperation Cr (OR=1.418,95％CI 1.216-1.654) (and all P＜0.05).Conclusion AKI is the common complications after intracoronary stent implantation,especially age,EF ≤ 30％,hypotension during perioperative and postoperation,operation duration are independent risk factors.

Effect of bone marrow mononuclear cell transplantation on angiogenesis and expression of cytokines following myocardial infarction / 中国组织工程研究

BACKGROUND:Cel transplantation offers a new promise of rebuilding the damaged myocardium. But the results of them are not consistent. It is not clear if the transplanted cel s can permanently improve heart function and the mechanism underlying this therapeutic effect. OBJECTIVE:To study the effect of intracoronary autologous bone marrow mononuclear cel transplantation on cardiac function, and angiogenesis and cytokine production in canines with acute myocardial infarction. METHODS:Left anterior descending coronary artery ligation was used to produce acute myocardial infarction models in hybrid canines. Bone marrow mononuclear cel s were harvested by using puncture of anterior crest and posterior superior iliac spine to prepare cel suspension. Sixteen hybrid canines were randomly divided into transplantation group (n=10) and control group (n=6). Bone marrow mononuclear cel s (transplantation group, n=10) or normal saline (control group, n=6) were intracoronarily infused into infarction-related arteries 2 hours after acute myocardial infarction. To evaluate the heart function, we used echocardiography at 2 hours and 6 weeks after acute myocardial infarction. Capil ary density was assessed 6 weeks after transplantation by using von Wil ebrand factor test. The mRNA levels of vascular endothelial growth factor 188, vascular endothelial growth factor 164, basic fibroblast growth factor and matrix metal oproteinase-9 in the infarct area were determined by reverse transcription-PCR at 6 weeks after transplantation. RESULTS AND CONCLUSION:In contrast to the control group, ejection fraction and stroke volume at 6 weeks after transplantation increased significantly in the transplantation group. The transplantation group had a greater amount of new vessels in the peri-infarct area than the control group. Compared with the control group, the mRNA levels of vascular endothelial growth factor 188, vascular endothelial growth factor 164, and basic fibroblast growth factor significantly increased in the transplantation group, but the mRNA level of matrix metal oproteinase-9 significantly decreased in the transplantation group. These findings suggest that intracoronary transplantation of autologous bone marrow mononuclear cel s may improve the cardiac function, and increase capil ary density, especial y in the border zone of infarcted myocardium. Otherwise, bone marrow mononuclear cel transplantation can increase the mRNA levels of vascular endothelial growth factor 188, vascular endothelial growth factor 164, and basic fibroblast growth factor, but decrease the mRNA level of matrix metal oproteinase-9.

Origen anómalo de arterias coronarias: Reporte de un caso y revisión de la literatura / Anomalous origin of coronary arteries: A case report and literature review

Las alteraciones anatómicas de las arterias coronarias representan un amplio espectro de anormalidades que son diagnosticadas habitualmente como un hallazgo incidental en autopsia o durante la realización de una arteriografía coronaria. Sin embargo, algunas de éstas tienen una significancia clínica variable y pueden estar asociadas con morbilidad cardiaca significativa, incluyendo muerte súbita en la infancia, la adolescencia o la vida adulta.

Anatomic abnormalities of the coronary arteries represent a wide spectrum of abnormalities that are usually diagnosed as an incidental finding at autopsy or during the performance of coronary arteriography. However, some of these abnormalities have a variable clinical significance and may be associated with significant cardiac disease, including sudden death in childhood, adolescence or adulthood.

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation / 世界急诊医学杂志（英文）

@#BACKGROUND: Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown. METHODS: A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. RESULTS: Of the 325 patients, 51(15.7％) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95％CI=0.088–0.727), pre-operative proteinuria (OR=5.351, 95％CI=2.128–13.459), pre-operative left ventricular insufficiency (OR=8.704, 95％CI=3.170–23.898), eGFR≤60 ml/min/1.73 m2 (OR=6.677, 95％CI=1.167–38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95％CI=1.001–1.034) were independent risk factors of AKI. CONCLUSIONS: AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors of AKI.

Risk factors and outcomes of patients with acute renal injury after intra-coronarystent implantation / 中华急诊医学杂志

Objective To investigate the risk factors and outcomes of acute kidney injury (AKI) in patients after intra--coronary stent implantation.Methods A retrospective and case control study was done with data analysis in 325 patients who underwent intra-coronary stent implantation from January 2010 to March 2011.The patients were divided into two groups as per the criteria of AKI identified on the 7th day after implantation of stent.The variables to be studied included:(1) age,gender,hypertension,diabetes,cerebrovascular disease,left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate,hyperuricemia,proteinuria,emergency operation,hydration,and medication (ACEI/ARB,statins) before operation; (2) dose of contrast media,operation time,hypotension during intra-operative period; and (3) postoperative:hypotension.The variables were analyzed with the process of One-way ANOVA and multivariate Logistical regression analysis.Consequently,the independent risk factors of AKI in patients after intra-coronary stent implantation could be found.Further,the prognosis of AKI patients was analyzed.Results Of the 325 patients,51 (15.7％) developed AKI.Compared the normal group,hospital stay (P ＜ 0.01 ) and in-hospital mortality (P ＜ 0.05) increased significantly in the AKI group.Monofactorial analysis showed that age,pre-operative laboratory and clinical data including left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration and emergency operation, and intraoperative information such as operation time and hypotension,and postoperative hypotension in AKI patients group were significantly different in comparison with control group ( P ＜ 0.05 ). Multivariate logistic regression analysis revealed that elderly age (OR =0.253),pre-operative proteinuria (OR =5.351 ),preoperative left ventricular insufficiency ( OR =8.704),eGFR ≤ 60 ml/ ( min · 1.73 m2 ) ( OR =6.677 ),prolonged operation time ( OR =1.017),intra-operative hypotension ( OR =25.245 ) were independent risk factors of AKI ( P ＜ 0.05 ).Conclusions AKI is a common complication and associated with increase in mortality after intra-coronary stent implantation.Increase in age,pre-operative proteinuria,pre-operative left ventricular insufficiency,pre-operative low estimated glomerular filtration rate,prolonged operation time,intra-operative hypotension are the independently risk factors associated with AKI.