Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Background：Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients.However,little is known about the predictors of in-hospital mortality in patients with suspected myocarditis.Thus,the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods：A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013.A total of 238 males （59%） and 165 females （41%） were enrolled in this study.We divided the above patients into two subgroups （survival and nonsurvival）,according to their clinical in-hospital outcomes.To maximize the effectiveness of the prediction model,we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis,based on data pertaining to previously established risk factors and basic patient characteristics.We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses.Finally,we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results：The following prediction model for in-hospital mortality in patients with suspected myocarditis,including creatinine clearance rate （Ccr）,age,ventricular tachycardia （VT）,New York Heart Association （NYHA） classification,gender and cardiac troponin T （cTnT）,was established in the study：P =ea/（1 ＋ ea） （where e is the exponential function,P is the probability of in-hospital death,and a =-7.34 ＋ 2.99× [Ccr 〈60 ml/min =1,Ccr ≥60 ml/min =0] ＋ 2.01 × [age ≥50 years =1,age 〈50 years =0] ＋ 1.93 × [VT =1,no VT =0] ＋ 1.39 × [NYHA ≥3 =1,NYHA 〈3 =0] ＋ 1.25 × [male =1,female =0] ＋ 1.13 × [cTnT ≥50 μg/L 1,cTnT 〈50 μg/L =0]）.The area under the receiver operating characteristic curve was 0.96 （standard error =0.015,95% confidence interval [CI]：0.93-0.99）.The model demonstrated that a Ccr 〈60 ml/min （odds ratio [OR] =19.94,95% CI：5.66-70.26）,an age ≥50 years （OR =7.43,95% CI：2.18-25.34）,VT （OR =6.89,95% CI：1.86-25.44）,a NYHA classification ≥3 （OR =4.03,95% CI：1.13-14.32）,male gender （OR =3.48,95% CI：0.99-12.20）,and a cTnT level ≥50 μg/L （OR =3.10,95% CI：0.91-10.62） were the independent risk factors for in-hospital mortality.Conclusions：A Ccr 〈60 ml/min,an age ≥50 years,VT,an NYHA classification ≥3,male gender,and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis.In addition,sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.