Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the e...Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the effects of adjunctive therapy with an intracoronary bolus of urokinase was noninferior to the effects of an intracoronary bolus of tirofiban in patients with ST-elevation myocardial infarction （STEMI） undergoing PCI.Methods A total of 490 patients with acute STEMI undergoing primary PCI were randomized to an intracoronary bolus of tirofiban （10 μg/kg; n=247） or urokinase （250 kU/20 ml; n=243）.Serum levels of P-selectin,von Willebrand factor （vWF）,CD40 ligand （CD40L）,and serum amyloid A （SAA） in the coronary sinus were measured before and after intracoronary drug administration.The primary endpoint was the rate of complete （＞70％） ST-segment resolution （STR） at 90 minutes after intervention,and the noninferiority margin was set to 15％.Results In the intention-to-treat analysis,complete STR was achieved in 54.4％ of patients treated with an intracoronary bolus of urokinase and in 60.6％ of those treated with an intracoronary bolus of tirofiban （adjusted difference：-7.0％;95％ confidence interval：-15.7％ to 1.8％）.The corrected TIMI frame count of the infarct-related artery was lower,left ventricular ejection fraction was higher,and the 6-month major adverse cardiac event-free survival tended to be better in the intracoronary tirofiban group.An intracoronary bolus of tirofiban resulted in lower levels of P-selectin,vWF,CD40L,and SAA in the coronary sinus compared with an intracoronary bolus of urokinase after primary PCI （P＜0.05）.Conclusions An intracoronary bolus of urokinase as an adjunct to primary PCI for acute STEMI is not equally effective to an intracoronary bolus of tirofiban with respect to improvement in myocardial reperfusion assessed by STR.This may be caused by less reduction in coronary circulatory platelet activation and inflammation.展开更多
Background Transradial access has been increasingly used during primary percutaneous coronary intervention （PCI） for patients with acute ST-segment elevation myocardial infarction （STEMI） in last decade. Clinical ...Background Transradial access has been increasingly used during primary percutaneous coronary intervention （PCI） for patients with acute ST-segment elevation myocardial infarction （STEMI） in last decade. Clinical benefits of upstream use of tirfiban therapy in STEMI patients treated by primary PCI have been reported. We investigated the merits of transradial vs. transfemoral access in primary PCI for STEMI patients with upstream use of tirofiban. Methods Patients with STEMI treated with tirofiban between December 2006 and October 2012 then by primary PCI were compared between transradial （n=298） and transfemoral （n=314） access. Baseline demographics, angiographic and PCI features and primary endpoint of major adverse cardiac events （MACE） at 30-day clinical follow-up were recorded. Results Baseline and procedural characteristics were comparable between the two groups, apart from more patients in transradial group had hypertension and were treated by thrombus aspiration during primary PCI. Significantly fewer MACE occurred in the transradial group （5.4%） compared with the transfemoral group （9.9%） at 30-day clinical follow-up. Major bleeding events at 30-day clinical follow-up were 0 in transradial group and in 2.9% of transfemoral group. Multivariate analysis confirmed transradial approach as an independent negative predictor of 30-day MACE （HR 0.68; 95% CI 0.35-0.91; P=0.03）. Conclusions Using transradial approach in primary PCI for acute STEMI infarction patients treated with tirofiban was clearly beneficial in reducing bleeding complications and improving 30-day clinical outcomes.展开更多
Background Drug-eluting stent （DES） has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention （PCI）, but its long-t...Background Drug-eluting stent （DES） has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention （PCI）, but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction （STEMI） remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients （diabetic group） and 170 non-diabetic patients （non-diabetic group） with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event （MACE） including cardiac death, non-fatal recurrent myocardial infarction （re-MI） and target vessel revascularization （TVR） during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic （69.6% and 51.8%, P=-0.03） and had longer time delay from symptom onset to admission （（364±219） minutes and （309±223） minutes, P=-0.02） than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group （82.1% and 51.2%, P〈0.001）. Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade （TMPG） 〉2 was lower in diabetic group （75.0% vs 88.8% in non-diabetic groups, P=-0.02）. The MACE rate was similar during hospitalization between the two groups （5.4% vs 3.5%, P=-0.72）, but it was significantly higher in diabetic group （16.1%） during one-year follow-up, as compared with non-diabetic group （6.5%, P=-0.03）. The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group （78.6% vs 90.0%, P=0.02）. Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively （P=0.19）. All of these patients experienced non-fatal myocardial infarction. Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.展开更多
Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary inte...Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention （PCI）. This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI. Methods Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI （PA group） and the remaining 583 were free of anginal symptoms （non-PA group）. Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups. Results Diabetes was less common （17.5% vs. 23.3%, P=-0.04） and symptom-to-door time was shortened （（191.6_＋96.8） minutes vs. （357.2_＋341.9） minutes, P 〈0.001） in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery （TIMI flow grade 0-1） at initial angiography （75.0% vs. 90.7%, P 〈0.001）, and achieved more TIMI flow grade 3 after primary PCI （84.2% vs. 78.2%, P=0.04）. These were associated with higher rates of overall procedural success （95.9% vs. 91.8%, P=0.02） and of complete ST-segment resolution at 90 minutes after the procedure （51.7% vs. 40.3%, P=0.001）. During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved （（53.0±8.6）% vs. （51.1±9.7）%, P=-0.002） and the primary endpoint of major adverse cardiac events was reduced in the PA group （7.2% vs. 12.7%, P=0.01）. Conclusion Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.展开更多
基金The study was supported by grants from the Shanghai Science and Technology Foundation （No. 05DZ19503） and the National Natural Science Foundation of China （No. 30900589） Conflict of interest： None
文摘Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the effects of adjunctive therapy with an intracoronary bolus of urokinase was noninferior to the effects of an intracoronary bolus of tirofiban in patients with ST-elevation myocardial infarction （STEMI） undergoing PCI.Methods A total of 490 patients with acute STEMI undergoing primary PCI were randomized to an intracoronary bolus of tirofiban （10 μg/kg; n=247） or urokinase （250 kU/20 ml; n=243）.Serum levels of P-selectin,von Willebrand factor （vWF）,CD40 ligand （CD40L）,and serum amyloid A （SAA） in the coronary sinus were measured before and after intracoronary drug administration.The primary endpoint was the rate of complete （＞70％） ST-segment resolution （STR） at 90 minutes after intervention,and the noninferiority margin was set to 15％.Results In the intention-to-treat analysis,complete STR was achieved in 54.4％ of patients treated with an intracoronary bolus of urokinase and in 60.6％ of those treated with an intracoronary bolus of tirofiban （adjusted difference：-7.0％;95％ confidence interval：-15.7％ to 1.8％）.The corrected TIMI frame count of the infarct-related artery was lower,left ventricular ejection fraction was higher,and the 6-month major adverse cardiac event-free survival tended to be better in the intracoronary tirofiban group.An intracoronary bolus of tirofiban resulted in lower levels of P-selectin,vWF,CD40L,and SAA in the coronary sinus compared with an intracoronary bolus of urokinase after primary PCI （P＜0.05）.Conclusions An intracoronary bolus of urokinase as an adjunct to primary PCI for acute STEMI is not equally effective to an intracoronary bolus of tirofiban with respect to improvement in myocardial reperfusion assessed by STR.This may be caused by less reduction in coronary circulatory platelet activation and inflammation.
文摘Background Transradial access has been increasingly used during primary percutaneous coronary intervention （PCI） for patients with acute ST-segment elevation myocardial infarction （STEMI） in last decade. Clinical benefits of upstream use of tirfiban therapy in STEMI patients treated by primary PCI have been reported. We investigated the merits of transradial vs. transfemoral access in primary PCI for STEMI patients with upstream use of tirofiban. Methods Patients with STEMI treated with tirofiban between December 2006 and October 2012 then by primary PCI were compared between transradial （n=298） and transfemoral （n=314） access. Baseline demographics, angiographic and PCI features and primary endpoint of major adverse cardiac events （MACE） at 30-day clinical follow-up were recorded. Results Baseline and procedural characteristics were comparable between the two groups, apart from more patients in transradial group had hypertension and were treated by thrombus aspiration during primary PCI. Significantly fewer MACE occurred in the transradial group （5.4%） compared with the transfemoral group （9.9%） at 30-day clinical follow-up. Major bleeding events at 30-day clinical follow-up were 0 in transradial group and in 2.9% of transfemoral group. Multivariate analysis confirmed transradial approach as an independent negative predictor of 30-day MACE （HR 0.68; 95% CI 0.35-0.91; P=0.03）. Conclusions Using transradial approach in primary PCI for acute STEMI infarction patients treated with tirofiban was clearly beneficial in reducing bleeding complications and improving 30-day clinical outcomes.
基金the-grant from Shanghai Science and Technology Foundation(No.05DZ19503)
文摘Background Drug-eluting stent （DES） has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention （PCI）, but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction （STEMI） remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients （diabetic group） and 170 non-diabetic patients （non-diabetic group） with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event （MACE） including cardiac death, non-fatal recurrent myocardial infarction （re-MI） and target vessel revascularization （TVR） during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic （69.6% and 51.8%, P=-0.03） and had longer time delay from symptom onset to admission （（364±219） minutes and （309±223） minutes, P=-0.02） than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group （82.1% and 51.2%, P〈0.001）. Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade （TMPG） 〉2 was lower in diabetic group （75.0% vs 88.8% in non-diabetic groups, P=-0.02）. The MACE rate was similar during hospitalization between the two groups （5.4% vs 3.5%, P=-0.72）, but it was significantly higher in diabetic group （16.1%） during one-year follow-up, as compared with non-diabetic group （6.5%, P=-0.03）. The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group （78.6% vs 90.0%, P=0.02）. Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively （P=0.19）. All of these patients experienced non-fatal myocardial infarction. Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30900589）.
文摘Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention （PCI）. This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI. Methods Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI （PA group） and the remaining 583 were free of anginal symptoms （non-PA group）. Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups. Results Diabetes was less common （17.5% vs. 23.3%, P=-0.04） and symptom-to-door time was shortened （（191.6_＋96.8） minutes vs. （357.2_＋341.9） minutes, P 〈0.001） in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery （TIMI flow grade 0-1） at initial angiography （75.0% vs. 90.7%, P 〈0.001）, and achieved more TIMI flow grade 3 after primary PCI （84.2% vs. 78.2%, P=0.04）. These were associated with higher rates of overall procedural success （95.9% vs. 91.8%, P=0.02） and of complete ST-segment resolution at 90 minutes after the procedure （51.7% vs. 40.3%, P=0.001）. During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved （（53.0±8.6）% vs. （51.1±9.7）%, P=-0.002） and the primary endpoint of major adverse cardiac events was reduced in the PA group （7.2% vs. 12.7%, P=0.01）. Conclusion Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.
