Apixaban in Patients With Post-Myocardial Infarction Left Ventricular Thrombus: A Randomized Clinical Trial.

Background: Direct oral anticoagulants are frequently used to treat post-myocardial infarction (MI) left ventricular thrombus (LVT). This study was conducted to evaluate the efficacy and safety of use of apixaban, compared to the standard warfarin therapy, in post-MI LVT. Methods: This open-label, randomized controlled trial included patients with post-acute or recent anterior wall MI with transthoracic echocardiography-confirmed LVT. Patients were randomized to receive either apixaban 5 mg twice daily or warfarin to achieve an international normalized ratio of 2-3, in addition to dual antiplatelet therapy. The primary endpoint was LVT resolution at 3 months, with a noninferiority margin of 95% for apixaban compared to warfarin. The secondary endpoint was major adverse cardiovascular events (MACE) or any relevant bleeding according to the Bleeding Academic Research Consortium (BARC) classification. Results: Fifty patients were enrolled from 3 centres. The use of dual or single antiplatelet agents was similar in the 2 groups. The number of 1-, 3-, and 6-month LVT resolutions were 10 (40.0%), 19 (76.0%), and 23 (92.0%) in the apixaban group, and 14 (56%), 20 (80.0%), and 24 (96.0%) in the warfarin group, respectively, without significant differences (P < 0.036 for noninferiority at 3 months). Patients taking warfarin required longer hospital stays and more outpatient visits. Multivariate adjustment analysis revealed left ventricular aneurysm, larger baseline LVT area and lower left ventricular ejection fraction to be independent predictors of LVT persistence at 3 months. No MACE occurred in either group; 1 BARC-2 bleeding event occurred with warfarin. Conclusions: Apixaban was not inferior to warfarin in the resolution of post-MI LVT.

Contexte: Les anticoagulants oraux directs sont souvent utilisés pour traiter un thrombus du ventricule gauche (TVG) après un infarctus du myocarde (IM). Cette étude a été réalisée afin d'évaluer l'efficacité et l'innocuité de l'apixaban, comparativement au traitement de référence par la warfarine dans les cas de TVG consécutif à un IM. Méthodologie: Cette étude en mode ouvert, contrôlée et à répartition aléatoire portait sur des patients ayant subi un IM aigu ou un IM récent de la paroi antérieure et présentant un TVG confirmé par échocardiographie transthoracique. Les patients ont été répartis aléatoirement pour recevoir l'apixaban à 5 mg deux fois par jour ou la warfarine en vue d'obtenir un ratio international normalisé de 2-3, en plus d'une bithérapie antiplaquettaire. Le critère d'évaluation principal était la résolution du TVG à trois mois, avec une marge de non-infériorité de 95 % pour l'apixaban comparativement à la warfarine. Le critère d'évaluation secondaire était la survenue d'événements cardiovasculaires indésirables majeurs ou de tout saignement associé, selon la classification du Bleeding Academic Research Consortium (BARC). Résultats: Cinquante patients provenant de trois centres ont été sélectionnés. L'utilisation d'un seul ou de deux agents antiplaquettaires était similaire dans les deux groupes. Le nombre de résolutions du TVG à 1 mois, à 3 mois et à 6 mois était de 10 (40,0 %), 19 (76,0 %) et 23 (92,0 %) respectivement dans le groupe apixaban, et de 14 (56,0 %), 20 (80,0 %) et 24 (96,0 %) respectivement dans le groupe warfarine, sans différence significative (p < 0,036 pour la non-infériorité à 3 mois). Les patients qui prenaient de la warfarine ont dû être hospitalisés plus longtemps et consulter plus souvent en externe. L'analyse multivariée sur les ajustements a révélé que l'anévrisme du ventricule gauche, plus grande zone TVG de base et une faible fraction d'éjection du ventricule gauche étaient des facteurs prédictifs indépendants de la persistance du TVG à trois mois. Aucun événement cardiovasculaire indésirable majeur ne s'est produit dans les deux groupes; un saignement de classe 2 selon le BARC s'est produit dans le groupe prenant de la warfarine. Conclusions: L'apixaban n'était pas inférieur à la warfarine dans la résolution du TVG après un IM.

Spontaneous Coronary Artery Dissection in Relation to Physical and Emotional Stress: A Retrospective Study in 4 Arab Gulf Countries.

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome and sudden cardiac death. The triggers for SCAD often do not include traditional atherosclerotic risk factors. The most commonly reported triggers are extreme physical or emotional stress. The current study compared in-hospital and follow-up events in patients with SCAD with and without reported stress. Data from 83 patients with a confirmed diagnosis of SCAD were collected retrospectively from 30 centers in 4 Arab Gulf countries (KSA, UAE, Kuwait, and Bahrain) from January 2011 to December 2017. In-hospital myocardial infarction (MI), percutaneous coronary intervention (PCI), ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, ICD placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared between those with and without reported stress. Emotional and physical stress was defined as new or unusually intense stress, within 1 week of their initial hospitalization. The median age of patients in the study was 44 (37-55) years. Foty-two (51%) were women. Stress (emotional, physical, and combined) was reported in 49 (59%) of all patients. Sixty-two percent of women with SCAD reported stress, and 51 % of men with SCAD reported stress. Men more commonly reported physical and combined stress. Women more commonly reported emotional stress (P < 0.001). The presence or absence of reported stress did not impact on overall adverse cardiovascular events (P = 0.8). In-hospital and follow-up events were comparable in patients with SCAD in the presence or absence of reported stress as a trigger.

STEMI and COVID-19 Pandemic in Saudi Arabia.

The COVID-19 pandemic had significant impact on health care worldwide which has led to a reduction in all elective admissions and management of patients through virtual care. The purpose of this study is to assess changes in STEMI volumes, door to reperfusion, and the time from the onset of symptoms until reperfusion therapy, and in-hospital events between the pre-COVID-19 (PC) and after COVID-19 (AC) period. All acute ST-segment elevation myocardial infarction (STEMI) cases were retrospectively identified from 16 centers in the Kingdom of Saudi Arabia during the COVID-19 period from January 01 to April 30, 2020. These cases were compared to a pre-COVID period from January 01 to April 30, 2018 and 2019. One thousand seven hundred and eighty-five patients with a mean age 56.3 (SD ± 12.4) years, 88.3% were male. During COVID-19 Pandemic the total STEMI volumes was reduced (28%, n = 500), STEMI volumes for those treated with reperfusion therapy was reduced too (27.6%, n= 450). Door to balloon time < 90 minutes was achieved in (73.1%, no = 307) during 2020. Timing from the onset of symptoms to the balloon of more than 12 hours was higher during 2020 comparing to pre-COVID 19 years (17.2% vs <3%, respectively). There were no differences between the AC and PC period with respect to in-hospital events and the length of hospital stay. There was a reduction in the STEMI volumes during 2020. Our data reflected the standard of care for STEMI patients continued during the COVID-19 pandemic while demonstrating patients delayed presenting to the hospital.

Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry.

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P = .029).

Acute myocardial infarction with multiple coronary thromboses in a young addict of amphetamines and benzodiazepines.

A 35-year-old man of average build and a smoker, with a background of a psychiatric disorder, was brought by his neighbor to the emergency department after an hour of severe chest pain. Upon arrival at the hospital he had cardiac arrest, was resuscitated, and moved to the catheterization laboratory with inferior, posterior, and lateral myocardial infarction. Coronary angiography showed an unusual thrombosis in multiple coronary branches. Toxicology report showed high levels of amphetamines and benzodiazepines in the patient's original blood sample. The patient was kept under ventilation for 18 days, with difficult recovery due to severe withdrawal manifestations, ventilation acquired pneumonia, and rhabdomyolysis inducing acute renal failure. The patient regained near normal left ventricular function after baseline severe regional and global dysfunction. We postulate a relationship between the use of amphetamines, potentiated by benzodiazepines, and occurrence of acute thrombosis of multiple major coronary arteries.

Clinical presentation and short-term outcome of acute coronary syndrome in native young Saudi population.

OBJECTIVES: To investigate acute coronary syndromes (ACS) in the young Saudi population in Aseer Region, southwestern Saudi Arabia. MATERIALS AND METHODS: We retrospectively reviewed our database between January 2006 and May 2009, 924 patients were diagnosed to have ACS. Among them 107 patients (11.6%) met our definition of young [66 (61.7%) male < 45 years, and 41 (38.3%) female < 55 years]. We compared this study population to a control group of 50 elderly patients consecutively enrolled in a contemporary period. RESULTS: The overall age was 42.3 ± 7.9 and 68.7 ± 10.1 years in the study population and control respectively. 100% of the population and 92% of the control group presented with chest pain. Diabetes mellitus (DM) prevalence was 46.7% in the study population (63.4% in females), and 62% in the control group. Hypertension, smoking, dyslipidemia and overweight/obesity were reported in 31.8%, 25.2%, 21.5% and 44.9% of the study population and 58%, 6%, 26% and 42% of the control group, respectively. Past history of coronary artery disease was documented in 16.8% of the study population and 38% of the control group. The discharge diagnoses were ST-segment elevation myocardial infarction (STEMI) in 41 (38.3%) (representing 4.4% of the whole ACS population) and 11 (22%) patients of the study population and control group respectively, non-ST-segment elevation myocardial infarction in 36 (33.6%) and 23 (46%) patients of the study population and control group, respectively, and unstable angina in 30 (28.0%) and 15 (30%) patients of the study population and control group, respectively. Coronary angiography was performed in 86 (80.4%) and 41 (82%) patients in the study population and control group respectively. In hospital, one young patient had acute ischemic stroke and one elderly patient died, 22.4% of the study population and 32% of control group were discharged with clinical diagnosis of heart failure or in need for diuretics. CONCLUSION: In our study, the young Saudi population with ACS had chest pain as the leading symptom. STEMI was the major final diagnosis and among one of the highest reported worldwide. There is a high prevalence of DM; however, they have favorable in hospital and short-term outcome.

The safety and feasibility of bilateral radial approach in chronic total occlusion percutaneous coronary intervention.

Few studies have reported results for transradial (TR) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. The purpose of this study was to evaluate the feasibility and safety of bilateral radial PCI for CTO lesions.Eighty-five consecutive patients with CTO lesions received PCI via a bilateral TR approach. A high radial artery puncture (10-15 cm above styloid process) accommodating a 7 Fr catheter (85 cm long) was used for a retrograde approach, and a 6 Fr catheter was used in the other radial artery for an antegrade approach. Retrograde wiring was conducted primarily or after failure of antegrade wiring. Mean duration of CTO was 42.8 ± 54.9 months. Vessels with occlusions attempted were the left anterior descending artery (40.0%; 34/85), right coronary artery (58.8%; 50/85), and left circumflex artery (1/85). PCI re-attempts were made in 41.2% of the cases. The overall success rate was 87.1%. Retrograde wiring was successful in 61/85 cases (71.8%), via septal collaterals followed by epicardial collaterals and saphenous vein graft. There were no major complications (30 day in-hospital death, Q wave myocardial infarction, or emergency bypass surgery), or serious access site complications.For experienced TR-PCI operators who are already doing complex TR coronary interventions, the bilateral radial approach for CTO lesions appears feasible and safe.

Autologous bone marrow cell implantation attenuates left ventricular remodeling and improves heart function in porcine myocardial infarction: an echocardiographic, six-month angiographic, and molecular-cellular study.

BACKGROUND: We investigated the potential benefits and the underlying mechanisms of autologous bone marrow-derived mononuclear cell (BMDMNC) implantation in a porcine model of acute anterior wall myocardial infarction (AAWMI) by studying 6-month left ventricular (LV) function and LV remodeling. METHODS: After being aspirated from the iliac crest and cultured for 1 week, BMDMNCs were implanted immediately after AAWMI induction through the left anterior descending artery ligation. Thirty male mini-pigs (16-18 kg) were equally divided into group 1 [AAWMI plus saline injection into infarct-ischemia area (IA)], group 2 (AAWMI plus 3.0 × 107 BMDMNC transplantation into non-IA), group 3 (AAWMI plus 3.0 × 107 BMDMNC transplantation into IA), group 4 (sham control plus 3.0 × 107 BMDMNC transplantation into LV myocardium), and group 5 (normal control). RESULTS: By day 90, echocardiography demonstrated an increased LV end-diastolic and end-systolic dimensions but reduced LV ejection fraction (LVEF) in groups 1 and 2 than in other groups (all p < 0.01). Six-month angiographic study showed a lower LVEF and wall motion score but a higher mitral regurgitation in groups 1 and 2 than in other groups (all p < 0.01). In IA and peri-infarct area, the number of small vessels and mRNA expressions of endothelial nitric oxide synthase, Bcl-2, interleukin (IL)-10, and peroxisome proliferator-activated receptor-γ coactivator-1α were lower, whereas the number of apoptotic nuclei, caspase-3, Bax, endothelin-1, IL-8, and matrix metalloproteinase was higher in groups 1 and 2 than in other groups (all p < 0.01). CONCLUSIONS: Autologous BMDMNC transplantation into IA rather non-IA improves LV function and reduces LV remodeling via eliciting a broad-spectrum of molecular-cellular defensive mechanisms.

Level and value of circulating endothelial progenitor cells in patients with acute myocardial infarction undergoing primary coronary angioplasty: in vivo and in vitro studies.

Levels of circulating endothelial progenitor cells (EPCs) in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI) were investigated in this study. Flow cytometric analysis of the circulating EPC level (CD31/CD34 [E(1)], CD62E/CD34 [E(2)], and KDR/CD34 [E(3)]) was determined from blood samples of 161 consecutive patients with STEMI undergoing primary PCI. Angiogenesis was evaluated using mononuclear cell-derived EPCs on Matrigel. The EPC number (E(1-3)) was lower in STEMI patients than in normal subjects (n = 25) (P < 0.005). Patients with high EPCs (E(1-3)) (≥1.2%) had a lower left ventricular ejection fraction, elevated white blood cell count and creatinine level, advanced Killip score (≥class 3), more advanced congestive heart failure (CHF) (≥class 3), and increased 30-day mortality than those with a low EPC (E(1-3)) level (<1.2%) (P < 0.0001). Angiogenesis was lower in patients with a high EPC level than those with a low EPC level and normal controls (P < 0.001). Both the advanced Killip score and the CHF were independent predictors of increased EPC levels (P < 0.05). Multivariate analysis identified a high EPC (E(3)) level to be the most important predictor of increased 30-day major adverse clinical outcome (MACO) (P < 0.0001). In conclusion, the circulating EPC level is a major independent predictor of 30-day MACO in patients with STEMI undergoing primary PCI.

Cobalt chromium coronary stents and drug-eluting stents in real practice.

Cobalt chromium stents (CCS) are seldom compared to drug-eluting stents (DES) for coronary intervention in published clinical trials. We evaluated the daily usage patterns of CCS in comparison to DES unconstrained by eligibility criteria. We compared consecutive patients (n = 303) with de novo lesions treated exclusively with a CCS to 432 patients treated exclusively with a DES. Patients in the CCS group were older, frequently had heart failure, renal failure, prior coronary balloon angioplasty, prior stroke, more comorbidities, and more multivessel disease than the DES group. The DES group had longer and more type C and left anterior descending (LAD) coronary artery lesions. The in-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target lesion revascularization (TLR)) were similar. At 6 months, the cumulative rate of MACE was 12.9% in the CCS group and 5.6% in the DES group (P < 0.001), and this was driven by TLR. The rates of stent thrombosis were similar in CCS (0.9%) and DES (1.0%) patients. In conclusion, the CCS were used in clinically higher risk patients, while DES were used in more severely diseased coronary arteries. Drug-eluting stent use resulted in lower rates of clinically driven repeat revascularization with similar rates of death, MI, stroke, and stent thrombosis.

Comparison of 30-day mortality between anterior-wall versus inferior-wall ST-segment elevation myocardial infarction complicated by cardiogenic shock in patients undergoing primary coronary angioplasty.

OBJECTIVES: In this study, 30-day mortality from cardiogenic shock caused by left anterior descending artery (LAD) occlusion was compared with that caused by left circumflex (LCX) or right coronary artery (RCA) occlusion after primary percutaneous coronary intervention (PCI). METHODS: Between May 2001 and December 2009, 212 consecutive patients with anterior-wall ST-elevation myocardial infarction complicated by cardiogenic shock due to LAD (n = 97) occlusion (group 1) and LCX or RCA (n = 115) occlusion (group 2) undergoing primary PCI were enrolled. RESULTS: The results showed a higher mean peak level of creatine phosphokinase and incidence of extracorporeal membrane oxygenation in group 1 than group 2 (all p < 0.01). However, no significant difference was noted in the achievement of normal blood flow in the infarct-related artery (p = 0.461) and 30-day morality (p = 0.338). Univariate analysis demonstrated a significant association of 30-day morality with age, lower left-ventricular ejection fraction, advanced congestive heart failure and unsuccessful reperfusion (all p < 0.02). Multivariate analysis revealed unsuccessful reperfusion as the most independent predictor of 30-day mortality (p = 0.002). CONCLUSION: No significant difference was noted in 30-day mortality between patients with acute myocardial infarction and cardiogenic shock caused by LAD occlusion and by either RCA or LCX occlusion undergoing primary PCI.

Transradial and transbrachial arterial approach for simultaneous carotid angiographic examination and stenting using catheter looping and retrograde engagement technique.

BACKGROUND: The purpose of this study was to introduce a novel and safe technique with high procedural success for carotid artery stenting (CAS). METHODS: From April 2004 to May 2009, 161 patients underwent CAS using either a high transradial arterial approach (TRA, defined as 10 cm above styloid process) or a transbrachial arterial approach (TBA) with a 7F arterial sheath. Selective carotid angiography was performed using a 6F Kimny guiding catheter and Teflon wire (260 cm in length) by Catheter Looping And Retrograde Engagement Technique (CLARET) with the guiding catheter seated on the right coronary cusp and its tip engaged into the common carotid artery (CCA). Teflon wire was introduced into the CCA again after the diagnostic procedure, followed by replacement of the 6F Kimny guiding catheter by a 7F Kimny catheter for CAS using one of the following techniques: (1) direct-engagement method, i.e., from right innominate artery into the right CCA; (2) looping method plus double-wire technique (utilized two Teflon wires to provide an adequate support) for both the right and left CCA; and (3) looping method plus a PercuSurge balloon anchoring at the external carotid artery. RESULTS: This distinctive technique offered 100% diagnostic success and 99.4% CAS success. Two patients (1.2%) experienced major ischemic stroke after CAS and two (1.2%) died during hospitalization. CONCLUSION: The results of the present study showed that high TRA/TBA using CLARET for CAS in patients with severe carotid artery stenosis is safe and technically feasible with an extremely high success rate.

Link between interleukin-10 level and outcome after ischemic stroke.

OBJECTIVES: The prognostic value of interleukin (IL)-10 in patients after acute ischemic stroke (IS) is not well understood. This study tested the hypothesis that serum levels of IL-10 are substantially increased after IS and predictive of IS outcome. METHODS: Serum IL-10 levels were examined 48 h after acute IS in 135 consecutive patients, and in 20 healthy and 30 at-risk controls. RESULTS: Mean serum IL-10 was significantly higher in IS patients than in both control groups (p < 0.0001, respectively). Additionally, serum IL-10 was significantly higher in patients with severe neurological impairment [defined as a score >or=12 on the National Institute of Health Stroke Scale (NIHSS)] than in patients with less severe neurological impairment (NIHSS score <12) 48 h after IS (p < 0.0001). Furthermore, higher serum IL-10 was strongly and independently correlated with severe neurological impairment (NIHSS >or=12) 48 h after acute IS (p < 0.0001), and independently predictive of combined major adverse clinical outcomes (defined as recurrent IS, any cause of death or NIHSS >or=12) on day 90 following IS (p < 0.0001). CONCLUSIONS: Serum IL-10 is an independent prognosticator of IS outcome.

Percutaneous coronary intervention of a stenotic left anterior descending artery with anomalous origin of right coronary artery.

The anomalous origin of the right coronary artery (RCA) from the left anterior descending (LAD) artery is rare. We report a case of single coronary artery with proximal LAD severe stenosis. The RCA originated from an unreported course of conal branch from the LAD. This anomalous RCA also had collaterals from left circumflex. Coronary intervention was successfully carried out on a severe stenosis at the proximal LAD artery. To the best of our knowledge the scenario of anomalous course and intervention is still to be reported.

Safety and efficacy of transradial vs transfemoral arterial primary coronary angioplasty for acute myocardial infarction: single-center experience.

BACKGROUND: The aim of the present study was to test the hypothesis that the transradial arterial approach (TRA) is not inferior to the transfemoral arterial approach (TFA) for

Role of stromal cell-derived factor-1alpha, level and value of circulating interleukin-10 and endothelial progenitor cells in patients with acute myocardial infarction undergoing primary coronary angioplasty.

BACKGROUND: The relationships among the circulating levels of endothelial progenitor cells (EPC), stromal cell-derived factor (SDF)-1alpha, interleukin (IL)-10 and outcome were examined in patients with ST-segment elevation acute myocardial infarction (ST-se AMI) undergoing primary coronary angioplasty. METHODS AND RESULTS: Circulating levels of IL-10, SDF-1alpha, and EPCs [defined by staining markers: CD31/CD34 (E(1)) and KDR/CD34 (E(2))] were examined by ELISA and flow cytometry, respectively. The IL-10 level was higher, whereas the circulating level of EPCs (E(1-2)) was lower (all P<0.05) in AMI patients than in normal subjects. Additionally, the SDF-1alpha level was significantly and independently predictive of an increased level of circulating EPCs (E(1-2)) (P<0.0001). Furthermore, patients with a high SDF-1alpha level (>1,500 pg/ml) had lower left ventricular performance, higher Killip score (defined as >or=3), and increased 30-day mortality than those with low SDF-1alpha level (or=3 or 30-day mortality) (P<0.01). CONCLUSIONS: The serum SDF-1alpha level is independently predictive of an increased level of circulating EPCs (E(1-2)). E(2) and IL-10 are major independent predictors of 30-day MACO in ST-se AMI patients undergoing primary coronary angioplasty.

Time courses of subcellular signal transduction and cellular apoptosis in remote viable myocardium of rat left ventricles following acute myocardial infarction: role of pharmacomodulation.

We tested hypothesis that acute myocardial infarction (AMI) induces cellular apoptosis and serial changes of protein kinase C epsilon (PKC-epsilon) and p38 mitogen-activated protein kinase (p38 MAPK), and tested cardio-protective effect of losartan in this condition. The rats were assigned to group A (sacrificed on day 2), group B (sacrificed on day 5), and group C (sacrificed on day 14). Rats in each group were further randomized into the following groups: AMI (ligation of left coronary artery) without losartan (AMI-L0); AMI with losartan 20 mg/ kg/d (AMI-L1); and sham groups (L0 and L1). The PKC-epsilon expression in membrane compartment was increased in AMI-L1 group than in other groups on day 5 and in AMI groups than in sham groups on day 14 (P < .01). Phosphorylated form of cytosolic p38 MAPK level was increased in AMI-L1 than in other groups on day 14 (P < .05). Furthermore, 14-day left ventricular ejection fraction was higher and cellular apoptosis was lower in AMI-L1 group than in AMI-L0 group (P < .0001).

Prognostic factors and outcomes in young chinese patients with acute myocardial infarction undergoing primary coronary angioplasty.

We investigated the prognostic risk and the clinical outcome of young-adult patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Between May 1999 and September 2007, primary PCI was performed in 1680 consecutive patients with AMI of onset < 12 hours (cardiogenic shock within 18 hours) at Kaohsiung Chang Gung Memorial Hospital. Of these patients, 163 (9.7%) young-age patients (defined as male of < 45 years old and female of < 55 years old) were enrolled into this study. A comparable number (n = 175) of patients > or = 55 years old, who presented with AMI of < 12 hours duration having undergone primary PCI between November 2004 and May 2006, were retrospectively reviewed and enrolled as control subjects. The procedural success (defined as normal blood flow achieved in the infract-related artery) was similar between the young-age and old-age patients (P = 1.0). Additionally, the incidence of an advanced Killip score (defined as > or = score 3 upon presentation), 30-day and 6-month cumulative mortality did not differ between these two groups of patients (P > 0.1). However, the 30-day major adverse clinical outcome (MACO) (defined as New York Heart Association Functional Classification > or = 3 or 30-day mortality) was significantly lower in the young-age than in the old-age patients (P < 0.001). Further, multiple stepwise logistic regression analysis showed that an advanced Killip score along with the peak level of CK-MB was independently predictive of 30-day MACO (P < 0.05) in young-age patients. In conclusion, the prognostic outcome is favorable in young-adult ST-se AMI undergoing primary PCI. Traditional risk factors remain effective for stratification of young-adult AMI patients into high- or low-risk subgroups.

Autologous bone marrow-derived mononuclear cell therapy prevents the damage of viable myocardium and improves rat heart function following acute anterior myocardial infarction.

BACKGROUND: We examined the effects of bone marrow-derived mononuclear cells (BMDMNCs) on preventing viable myocardium damage from myocardial infarction (MI) in a rat MI model. METHODS AND RESULTS: Saline (group 1) or BMDMNCs (group 2) were implanted into the infarct area (IA) of 1-week-old anterior wall MI Sprague-Dawley (SD) rats. Twenty SD rats without MI served as the controls (group 3). The results demonstrated that in remote viable myocardium, the integrated area (microm2) of connexin43 spots was lower, whereas the number of apoptotic nuclei were higher in group 1 than in groups 2 and 3 on day 90 following BMDMNC implantation (all p<0.001). Additionally, the number of vessels and survival myocardium in the IA was lower in group 1 than in groups 2 and 3 (all p<0.005). Furthermore, the mRNA expressions of nitric oxide synthase, interleukin-8/Gro-alpha, interleukin-10 and matrix metalloproteinase-9 were higher in group 2 than in groups 1 and 3 in peri-IA (all p<0.05). On days 42 and 90, the left ventricular (LV) function was lower in group 1 than in groups 2 and 3 (p<0.001). CONCLUSIONS: Autologous BMDMNC therapy improves LV function, and mitigates molecular and cellular perturbation following MI.

Diabetes mellitus downregulates expression of connexin43 in rat aortic medial smooth muscle cells and can be reversed by simvastatin and losartan therapy.

BACKGROUND: Diabetes mellitus (DM) plays a crucial role in the pathogenesis of initiation and propagation of atherosclerosis. Although previous studies have suggested that interactions between cells form the framework for understanding the pathogenesis of atherosclerosis, little is known about how DM impacts intercellular communication within arteries, which occurs via connexin43 (Cx43) gap junctions (GJs). This study tested the hypothesis that DM suppresses expression of Cx43 GJs, and that this suppression can be abrogated via simvastatin or losartan treatment. METHODS: An experimental model of DM (induced by streptozocin 60 mg/kg body weight) in adult male rats (n = 24) was utilized to investigate Cx43 expression in the aorta. These rats were divided into group I (insulin therapy only), group II (insulin plus simvastatin 20 mg/kg/day) and group III (insulin plus losartan 20 mg/kg/day). Twenty-four diabetic rats and 8 healthy rats (group IV) were sacrificed 3 weeks after DM induction for Western blot and immunofluorescence analysis. RESULTS: By day 21, the blood sugar level was significantly higher than the respective baseline values in groups I, II and III (all values of p < 0.0001). Additionally, the final blood sugar levels of groups I-III were significantly higher than that of group IV (p < 0.0001). The final body weight in group IV was significantly higher than that in groups I-III (all values of p < 0.0001). Experimental results demonstrated that Cx43 expression in the aortic wall did not differ among groups II-IV (p > 0.1). However, compared with groups II-IV, Cx43 expression in the aortic wall was significantly mitigated in group I (all values of p < 0.05). Western blot results showed that relative density of Cx43 to beta-actin was significantly higher in groups II-IV than in group I (p < 0.01). CONCLUSIONS: DM markedly suppressed expression of Cx43 in rat aortic walls. Both simvastatin and losartan treatment significantly reversed the effects of DM on integrity of Cx43 expression.