Quality of myocardial reperfusion according to ischemic time and infarcted territory.

BACKGROUND: The relationship of the ischemic time to primary angioplasty and the quality of myocardial reperfusion according to infarcted territory among patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: This study consisted of 140 patients with STEMI within 12 h from the symptom onset and undergoing a primary angioplasty from the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial. ST-segment resolution (STR) at 60 min was analyzed by an independent corelab using continuous ST monitoring. Patients were divided according to anterior (n=74) and nonanterior (n=64) locations and according to ischemic time in quartiles (<90, 90-148, 148-241, and 241-635 min). RESULTS: Although there was no significant decrement in the extent of STR with the ischemic time in the entire population (74, 51, 72, and 51%, respectively, P=not significant), patients with anterior location have a significant reduction in the extent of STR after 90 min compared with those coming after 90 min (70.6 vs. 29.2% of complete STR, P=0.003, respectively). CONCLUSION: Patients with anterior STEMI seem to have a stronger impact of ischemic time on the quality of myocardial reperfusion compared with patients with nonanterior location.

Intravascular thermographic assessment in human coronary atherosclerotic plaques by a novel flow-occluding sensing catheter: a safety and feasibility study.

OBJECTIVE: To report the safety and feasibility of a new occluding thermographic catheter in patients with coronary artery disease. BACKGROUND: Although plaque temperature heterogeneity is shown in atheromatous plaques, significant underestimation is encountered due to the cooling effect of the uninterrupted blood flow. METHODS: The catheter was positioned at the stenotic site. Blood flow was interrupted by an expandable braid located at the distal portion of the catheter. Then, thermographic assessment was performed. RESULTS: In one patient, the catheter could not reach the lesion due to tortuosity. Of the 20 lesions evaluated, 5 were excluded due to unsuccessful interruption of blood flow. We identified 5 lesions with a 0.3 degrees Celcius elevations compared to the same site without interruption of blood flow. There were no procedural complications. CONCLUSION: The new catheter-occluding thermographic device, while avoiding the blood flow cooling effect, appears to be safe and feasible for the assessment of human plaque temperature heterogeneity.

Use of drug-eluting stents for the treatment of in-stent restenosis in routine clinical practice.

BACKGROUND: Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established. METHODS: We retrospectively analysed patients treated for ISR with DESs from three referral hospitals. RESULTS: Eighty-seven consecutive patients, from June 2002 to April 2004, were included, with a mean age of 64+/-11 years; 83% were men, 32% had diabetes, 47% had had a previous myocardial infarction and 16% had low left ventricular ejection fraction. Angiographic characteristics were as follows: mean vessel diameter, 3.05+/-0.4 mm; lesion length, 17.8+/-7.7 mm; diameter stenosis, 84.0+/-10.7%; and complex lesion, 81%. The restenosis was focal in 45%, diffuse/proliferative in 51.3% and total occlusion in 3.7% of the cases. Sirolimus- and paclitaxel-eluting stents were used in 42 and 58% of the patients, respectively. Stent diameter was 3.1+/-0.3 mm and the length was 26.1+/-5.8 mm. Angiographic success was achieved in all patients, with one patient experiencing a post-procedural non-Q-wave myocardial infarction. At 6-month clinical follow-up, two patients had died from non-cardiac deaths, five had experienced a new TLR (5.7%, four percutaneous and one coronary artery bypass graft) and eight (9.2%) had had major adverse cardiac events. A stress test was performed in 60% of the population; target vessel ischemia was observed in one patient (3.3%). CONCLUSION: In this non-select cohort of patients, the use of DESs is a safe and effective strategy for ISR lesions.