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Objective To observe the effects of Shexiang Baoxin pill combined with intracoronary injection of nicorandil on myocardial perfusion and short-term prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Methods 151 patients with acute myocardial infarction after PPCI were enrolled in this study. Those patients were admitted to our hospital during January 2017 to January 2018. According to the numerical randomization method, 51 patients were selected as routine treatment group (group A), 50 patients with intracoronary injection of nicorandil (group B) and 50 patients received intracoronary injection of nicorandil plus oral Shexiang Baoxin pills (group C). Intra-operative corrected TIMI frame count (cTFC), postoperative TIMI grade 3 blood flow ratio, 2-hour ECG ST segment fallback >50% index, the incidence of major adverse cardiovascular events (MACE) during hospitalization and the incidence of angina and MACE within 3 months after surgery were evaluated. Results cTFC, 2 hours postoperative ECG ST segment fall >50% index in group B and C were better than group A (P<0.05). The results from group C were better than group B. Group C exhibited better results than group B and C in post-operative angina pectoris 3 months after surgery (P<0.05). Conclusion Shexiang Baoxin pills combined with intra-coronary injection of nicorandil can improve myocardial perfusion and short-term prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction
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Abstract Background: The shape of the right coronary artery (RCA) may vary between individuals. Objective: The aim of this study was to investigate whether the shape of RCA has any effect on TIMI frame count (TFC), TIMI flow score, and lesion distribution length in patients with ST-elevation myocardial infarction (STEMI) caused by RCA. Materials and methods: The angiograms of 163 patients who applied to our hospital with STEMI caused by the RCA were included in the study. TFCs were calculated. Results: The patients were divided into two groups according to the geometric shape of the RCA as C (124 pts, 101 males, mean age 66.1 ± 12.3 years) or S (39 pts, 30 males, mean age 60.0 ± 10.8 years) based on the angiographic view from the left oblique position. Lesion location was significantly higher in the proximal and mid regions compared to the distal region in patients with C-RCA (p < 0.001). TFC was significantly higher in the S-RCA group (p = 0.0014). There was a statistically significant difference between the groups in terms of mean age of p = 0.003. Conclusion: Lesion frequency was significantly higher in the proximal and mid regions in patients with C-RCA. TFCs were significantly higher in the S-RCA group. Longer S-RCA length compared to C-RCA and local shear stress characteristics may also explain these findings.
Resumen Antecedentes: La forma de la arteria coronaria derecha puede variar entre los individuos. Objetivo: El objetivo de este estudio fue investigar si la forma de la arteria coronaria derecha (RCA) tiene algún efecto sobre el conteo de cuadros TIMI (TFC), el puntaje de flujo TIMI y la longitud de distribución de la lesión en pacientes con infarto de miocardio con elevación del ST (STEMI) causado por RCA. Material y métodos: Se incluyeron en el estudio los angiogramas de 163 pacientes que se aplicaron a nuestro hospital con STEMI causado por la arteria coronaria derecha. Se calcularon los TFC. Resultados: Los pacientes se dividieron en dos grupos según la forma geométrica de la arteria coronaria derecha como C (124 puntos, 101 masculino, edad media 66.1 ± 12.3 años) o S (39 puntos, 30 masculino, edad media 60.0 ± 10.8 años) según vista angiográfica desde la posición oblicua izquierda. La ubicación de la lesión fue significativamente mayor en las regiones proximales y medias en comparación con la región distal en pacientes con C-RCA (p < 0.001). TFC fue significativamente mayor en el grupo S-RCA (p = 0.0014). Hubo una diferencia estadísticamente significativa entre los grupos en términos de edad media de (p = 0.003). Conclusión: La frecuencia de las lesiones fue significativamente mayor en las regiones proximales y medias en pacientes con C-RCA. Los TFC fueron significativamente más altos en el grupo S-RCA. Una mayor longitud de S-RCA en comparación con C-RCA y las características locales de tensión de corte también pueden explicar estos hallazgos.
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Resumen: Introducción: el fenómeno de no reflujo (NR) coronario se define como la persistencia de un flujo inadecuado menor a TIMI 3 durante la angioplastia coronaria (ATC), en ausencia de obstáculo macroscópico en las arterias coronarias epicárdicas. Objetivo principal: determinar la incidencia de NR en pacientes tratados con ATC por cualquier indicación. Objetivos secundarios: describir las características clínicas y angiográficas de la población con NR, características del procedimiento de angioplastia, así como el tratamiento y el valor pronóstico del NR. Métodos: estudio observacional, prospectivo, unicéntrico, sobre el total de ATC realizadas en un centro de cardiología intervencionista entre octubre de 2016 y enero de 2017, excluyendo la reestenosis intrastent y la enfermedad de injertos venosos. Se definieron dos grupos: control (flujo normal) y con fenómeno de NR. Se analizaron variables clínicas, angiográficas, terapéuticas y pronósticas. Resultados: se incluyó un total de 322 pacientes, 291 control y 31 NR. La incidencia de NR fue de 9,6%, presentándose en 20,7% de los síndromes coronarios agudos con elevación de ST (SCAcST), en 6,3% de los síndromes coronarios agudos sin elevación de ST (SCAsST) y en 3% de las anginas estables. La adenosina a dosis altas fue el tratamiento más utilizado. Se comprobó una mejoría significativa del flujo coronario evaluado por TIMI Frame Count asociado al tratamiento instituido (39,4±1,6 pretratamiento vs 21,9±1,2 postratamiento, p<0,001). A tres meses, en los pacientes con NR vesus control se observó una mayor incidencia de ángor (6,6% vs 1,1% respectivamente, p=0,001), nueva coronariografía (10% vs 1,1%, p=0,017) y nueva ATC (19% vs 1,1%, p=0,009). Conclusiones: la incidencia de NR en pacientes sometidos a ATC fue de 9,6%, presentándose más frecuentemente en el SCAcST. La adenosina intracoronaria a dosis altas fue el tratamiento más frecuentemente instituido y fue eficaz para mejorar significativamente el flujo coronario.
Summary: Introduction: no-reflow phenomenon is defined as persistence of inadequate flow less than TIMI 3 during coronary angioplasty in the absence of an obstacle in epicardial coronary arteries. Primary endpoint: to determine the incidence of no-reflow in patients treated with coronary angioplasty performed for any indication. Secondary endpoints: to describe the clinical and angiographic characteristics, procedural characteristics, treatment and prognostic value of no-reflow phenomenon. Methods: this is an observational, prospective and unicentric trial including all coronary angioplasties performed in an interventional Cardiology center between October 2016 and January 2017, excluding instent reestenosis and coronary vein grafts disease. Two groups were defined: control (normal coronary flow) and no-reflow phenomenon. Clinical, angiographic and prognostic variables were analyzed. Results: 322 patients were included, 291 control and 31 no-reflow. No-reflow incidence was 9.6%, occurring in 20.7% of acute coronary syndromes with ST segment elevation, 6.3% in non-ST segment elevation syndromes and 3% in stable coronary artery disease. High dose adenosine was the most frequently used agent for no-reflow treatment. No-reflow treatment was associated with a significant improvement in coronary flow measured by TIMI Frame Count (39.4±1.6 pretreatment vs 21.9±1.2 postreatment, p<0.001). At 3 month follow up, no-reflow patients vs control had a higher incidence of angina pectoris (6.6% vs 1.1% respectively, p=0.001), coronary angiography (10% vs 1.1%, p=0.017) and coronary angioplasty (19% vs 1.1%, p=0.009). Conclusions: no-reflow incidence in patients treated with coronary angioplasty was 9.6%, occurring more frequently in ST segment elevation syndromes. High dose adenosine was the most frequently used agent for no-reflow treatment and significantly improved coronary flow.
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Objective To study the effect of corrected TIMI frame count (CTFC) of infarction related artery on systolic function of infarct area of myocardium after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods One hundred and six patients with AMI having undergone successful PCI in Cangzhou Central Hospital were selected, and they were divided into two groups (each, 53 cases). The standard of fast or slow flow was in accord to the CTFC of infarction related artery (IRA) measured soon after successful PCI. The patients with greater value of CTFC were enrolled in the slow flow group, while the patients with smaller such value were assigned in the fast flow group. At 6, 12, 24 and 48 hours after PCI, the venous plasma MB isoenzyme of creatine kinase (CK-MB) level was measured. And at 1 week, 1 month and 3 months after PCI, the left ventricular ejection fraction (LVEF) was measured by cardiac ultrasound, and the levels of radial strain (RS) and longitudinal strain (LS) of the infarct area were measured via speckle tracking imaging (STI). The differences in CTFC, CK-MB, RS and LS between the two groups were analyzed, and the correlations between the strains and CTFC, CK-MB were analyzed by Pearson linear correlation method. Results After successful PCI, the CK-MB of fast flow group was higher than that of the slow flow group at 6 hours. However, the CK-MB of slow flow group was higher than that of the fast flow group after 12 hours, appearing separate phenomenon, and the statistical significance occurred beginning from 24 hours after PCI (U/L, 24 hours:98.43±11.65 vs. 86.43±18.97, 48 hours:51.09±8.94 vs. 49.80±6.92, both P 0.05). RS and LS in fast flow group were higher than those in slow flow group, and the statistically significant difference appeared from 1 month after PCI (1 month RS:29.74±6.66 vs. 26.86±5.61, LS:-16.37±3.91 vs. -15.27±3.22, 3 months RS: 30.03±6.31 vs. 27.63±5.67, LS: -17.74±3.96 vs. -15.75±4.17, all P 0.05). Both RS and LS at 1 week, 1 month and 3 months were of significantly positive correlation with CTFC of each group (fast flow group:r value of CTFC and RS was respectively-0.526,-0.515,-0.532, r value of CTFC and LS was respectively-0.532,-0.541,-0.572;slow flow group:r value of CTFC and RS was respectively-0.691,-0.685,-0.702, r value of CTFC and LS was respectively-0.621,-0.584,-0.605, all P<0.01). Conclusion CTFC has some relationship with the recovery of the systolic function in area of infarct myocardium after PCI, and can be regarded as an important index to predict the long-term prognosis in patients with AMI.
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Objective To investigate the risk factors of slow coronary flow (SCF) phenomenon; To study the prognosis of SCF patients and analyze the high risk factors of adverse events by follow-up.Methods 17930 patients were analyzed retrospectively who had undergone routine coronary angiography because of suspected coronary artery disease at TEDA International Cardiovascular Hospital from January 2006 to December 2010.By Thrombolysis in myocardial infarction Frame Count method,236 patients with normal coronary artery but slow coronary flow were enrolled in the SCF group and 240 patients with normal coronary artery and normal coronary flow (40-50patients per year) were enrolled in the control group.After that,the risk factors leading to SCF were analyzed by the multivariate logistic regression analysis and all patients were followed up from March 2012 to April 2012 to know about the incidence of adverse events (acute coronary syndrome,malignant arrhythmia and sudden cardiac death) and the high risk factors leading to the adverse events.Results (1) Compared to the patients in the control group,the patients in SCF group have higher percentage of male (76.69％ vs.42.08％,P =0.000) 、rate of smokers (58.48％ vs.27.50％,P =0.000) 、BMI (26.78 ±3.75 vs.26.13 ±3.20,P =0.043) 、serum uric acid (344.90 ± 86.18 vs.304.43 ±76.44,P =0.000) 、serum creatinine (68.27 ± 15.10 vs.60.92 ± 13.17,P =0.000)、triglyceride (1.85 ± 1.23 vs.1.65 ± 0.81,P =0.037) but younger age and lower high density lipoprotein cholesterol (1.14 ± 0.28 vs.1.19 ± 0.30,P =0.048).(2) By multivariate logistic regression analysis,male,smoking status,hiah BMI and serum uric acid are all independent factors for SCF.(3) The SCF phenomenon noted in lvessel,2 vessels and 3 vessels accounted for 7.29％,26.04％,66.67％,respectively.(4) During the follow-up,2 patients with malignant arrhythmia and 1 patients with ACS were found in SCF group,no sudden cardiac death took place.None of the adverse events happened in the control group.Conclusions Younger male smokers are prone to have SCF,high BMI and serum uric acid are also independent factors for SCF; The SCF phenomenon is most common in three coronary arteries.Both malignant arrhythmia and acute coronary syndrome took place in the SCF group in the follow-up.
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Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) patients. The association of patient age with angiographic characteristics of flow and perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) following the administration of fibrinolytic therapy has not been previously investigated. Objectives and Methods We examined the association between age (≥ 70 years or ＜ 70years)and clinical and angiographic outcomes in 1472 STEMI patients who underwent rescue/adjunctive PCI following fibrinolytic therapy in 7 TIMI trials. We hypothesized that elderly patients would have slower post-PCI epicardial flow and worsened outcomes compared to younger patients. Results The 218 patients aged ≥ 70 years (14.8%) had more comorbidities than younger patients. Although these patients had significant angiographic improvement in TIMI frame counts and rates of TIMI Grade 3 flow following rescue/adjunctive PCI, elderly patients had higher (slower)post-PCI TIMI frame counts compared to the younger cohort (25 vs 22 frames, P = 0.039), and less often achieved post-PCI TIMI Grade 3 flow (80.1 vs 86.4%, P = 0.017). The association between age ( ≥70 years) and slower post-PCI flow was independent of gender, time to treatment, left anterior descending (LAD) lesion location, and pulse and blood pressure on admission. Elderly patients also had 4-fold higher mortality at 30 days (12.0 vs 2.7%,P = 0. 001 ). Conclusions This study suggests one possible mechanism underlying worsened outcomes among elderly STEMI patients insofar as advanced chronological age was associated with higher TIMI frame counts and less frequent TIMI Grade 3 flow after rescue/adjunctive PCI.
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BACKGROUND AND OBJECTIVES: The eventual goal of reperfusion therapy, for an acute myocardial infarction (MI), is rapid and complete reperfusion into the myocardium beyond the epicardial artery. The recently designed TIMI frame count (TFC) and myocardial perfusion grade (TMPG) can be used to define the myocardial tissue perfusion. This study was undertaken to compare the TFC and TMPG for the assessment of myocardial reperfusion following primary angioplasty in patients with an acute anterior wall infarction. SUBJECTS AND METHODS: 33 patients, who admitted for acute myocardial infarction, between January 1998 and March 2001, were the subjects of this study. The subjects all underwent successful primary angioplasty on the LAD, with TIMI III flow. The ECGs, performed on admission and 1 hr after the angioplasty, were compared, the extent of the resolution of the ST elevation assessed. The TFC and TMPG were analyzed by 2 different observers using the coronary angiograms performed immediately and 7 days after the angioplasty. A retrospective analysis of the clinical events at the hospital, and the major coronary events during a follow-up of more than 6 months after discharge were performed. RESULTS: The subjects were divided into 3 groups, completely recovered (n=11) and incompletely recovered (n=12) and not recovered (n=10), according to extent of the resolution of the ST elevation. There were no differences between the groups in their baseline characteristics. The TFC in the completely recovered group was significant lower (p=0.02, p=0.01) than the other patient groups immediately after the angioplasty, but there was no significant difference (p=0.28, p=0.32) in the TFC between the 3 patients groups 7 day after the angioplasty. The TMPG in the completely recovered group was consistently higher than in the other patient groups, both immediately and 7 days after the angioplasty. Five patients, who developed major coronary events during 16 month follow-up, tended to show no, or an incomplete resolution, of their ST elevation. They also showed significantly lower TMPG compared with the others, both immediately, and 7 days, after PTCA, but no significant difference at all in the TFC. CONCLUSION: The TMPG was closely associated with the rate of the ST elevation resolution in both the early and late periods after the primary angioplasty in acute MI, indicating that the TMPG is a better marker for the evaluation of myocardial reperfusion after primary angioplasty than the TFC. The low TMPG was observed to be related with a higher major coronary event rate, suggesting its usefulness as a predictor of long-term prognosis.
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Humans , Angioplasty , Arteries , Electrocardiography , Follow-Up Studies , Infarction , Myocardial Infarction , Myocardial Reperfusion , Myocardium , Perfusion , Prognosis , Reperfusion , Retrospective StudiesABSTRACT
Objective To assess the value of corrected TIMI frame count(CTFC) in patients with acute myocardial infarction(AMI) underwent primary percutaneous coronary intervention(PCI) and the change of CTFC before and after adenosine interference. Methods CTFC was defined as the number of cineframes from coronary filling with radiographic reagent to visualization of distal coronary landmark in the infarct-related artery. Normal antegrade flow was 0.05), and CTFC of the patients with slow antegrade flow, who underwent PCI, was not significantly different before and after administering adenosine. LVEF of the patients with normal antegrade flow was significantly higher than that of the patients with slow antegrade flow(P=0.001). MACE of the patients with slow blood flow were obviously higher than that of the patients with natural blood flow(P
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BACKGROUND AND OBJECTIVES: Primary intervention by stent implantation during acute myocardial infarction is a novel strategy to provide better myocardial perfusion compared to thrombolysis or baloon angioplasty. We aimed to assess the reperfusion achieved by primary stenting, employing TIMI frame count for more objective and quantitative measurement. MATERIALS AND METHOD: Measurements for number of frames required to opacify standardized angiographic landmark branch(TIMI frame count) were determined for the coronary arteries of 77 normal controls and 65 patients with acute myocardial infarction who underwent primary stenting within 12 hours of symptom onset. RESULTS: In normal subjects, TIMI frame count for left anterior descending artery(LAD) was 1.3 times of mean count of right coronary artery(RCA) and left circumflex artery(LCx), and significant less than that of TIMI study(22.3+/-4.9 vs 36.2+/-2.6, p0.05). There was no difference of CTFC of non-infarct related arteries between patients and normal controls. CONCLUSION: The TIMI frame count of LAD artery in normal Korean subjects was significantly less than that of American counterpart. In patients with acute myocardial infarction, primary stenting appeared to provide improved coronary flow similar to that observed in normal subjects, as measured by TIMI frame counting.
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Humans , Angioplasty , Arteries , Coronary Vessels , Myocardial Infarction , Perfusion , Reperfusion , StentsABSTRACT
Objective To study the probability of evaluating myocardial tissue perfusion by corrected TIMI frame count (CTFC) after successful percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods Sixty-three patients with their first acute myocardial infarction (AMI) who accepted primary coronary intervention were recruited. All these patients got TIMI 3 grade flow. CTFC was measured after successful PCI in these patients. Wall Motion Score Index (WMSI) assessed by two-dimensional echocardiography before and one month after PCI and the correlation studied between CTFC and WMSI. Results According to CTFC the patients were divided into two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group. CTFC had a significant correlation with the change in WMSI. Elapsed time from the onset of symptoms to reperfusion in the TIMI slow group was significantly longer than that of the TIMI fast group. Conclusion CTFC is a quantitative, and reproducible index of coronary blood flow. Lower CTFC is associated with greater functional recovery and could supply evidence for additional adjunctive treatment.