Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and metaanalysis

BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Impact of primary percutaneous coronary intervention on ST-segment elevation myocardial infarction patients:A comprehensive analysis

BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.

Research Progress on the Depression Status and Nursing Intervention in Patients after Percutaneous Coronary Intervention

Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article reviews the current status and influencing factors of postoperative depression after PCI and summarizes the corresponding nursing interventions,to provide a literature reference to implement effective nursing interventions for depressed patients after clinical PCI.

Comparison of Treatment Outcomes of Ticagrelor and Clopidogrel among Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis

We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）. In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality（MD=0.83, 95%CI=0.74–0.93, P=0.001） and myocardial infarction（MI）（MD=0.78, 95%CI=0.70–0.88, P=0.000）. There were no significant differences in stroke（MD=1.34, 95%CI=0.99–1.79, P=0.06）, total bleeding（MD=0.97, 95%CI=0.84–1.12, P=0.66）, minor or major bleeding（MD=1.06, 95%CI=0.94–1.19, P=0.35） in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.

Contrast use in relation to the arterial access site for percutaneous coronary intervention:A comprehensive meta-analysis of randomized trials

AIM To compare the amount of contrast used during percutaneous coronary intervention(PCI) via trans-radial access(TRA) vs trans-femoral access(TFA).METHODS Scientific databases and websites were searched for:randomizedcontrolledtrials(RCTs). Data were extracted by two independent reviewers and was summarized as the weighted mean difference(WMD) of contrast used with a 95%CI using a random-effects model. RESULTS The meta-analysis included 13 RCTs with a total of 3165 patients. There was no difference between the two strategies in the amount of contrast used(WMD =-0.65 mL,95%CI:-10.94-9.46 mL; P = 0.901). CONCLUSION This meta-analysis shows that in patients undergoing PCI,the amount of contrast volume used was not different between TRA and TFA.

Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention： a meta-analysis

BackgroundSuboptimal 心肌的灌注在有圣片断举起的病人是普通的经历主要经皮的冠的干预(PPCI ) 的心肌的梗塞(STEMI ) 。而且，它导致增加的梗塞尺寸和死亡率。我们执行了元分析评估渴望 thrombectomy 的角色(在)在心肌的灌注和临床的 outcomes.MethodsPubMed 的改进与 glycoprotein IIb/IIIa 禁止者( GPI )的 intracoronary 管理结合了， Embase ，科学的网，并且中央数据库被寻找因为调查的使随机化的控制试用( RCT )联合了在并且 intracoronary GPI 治疗对在独自一个。利息的结果是在心肌的梗塞的 thrombolysis 心肌的灌注等级( TMPG )，梗塞尺寸()由心脏的磁性的回声成像估计了，左室的喷射部分( LVEF )，主要不利心脏的事件(向)在短期( 1 个月)并且长期( 6-12 月)后续，并且在包含 923 个病人的医院 stay.ResultsEight 试用期间为复杂并发症放血被包括。与相比在独自一个，联合了在， intracoronary GPI 显著地增加了 TMPG 3 流动(RR：1.15， 95% CI：1.04 ～ 1.26 ) ，减少[吝啬的差别(MD ) ：-3.46,95% CI：-5.18 到 -1.73], 和改进 LVEF (MD：1.44， 95% CI：0.54 ～ 2.33 ) 。而且， GPI 使用减少了在长期的后续的向的风险(RR：0.60， 95% CI：0.37 ～ 0.98 ) 。在未成年者的发生的二个组之间没有重要差别，主要流血 complications.ConclusionsOur 调查结果显示出那与相比在独自一个，联合了在， intracoronary GPI 治疗导致了改进心肌的灌注，更好心脏的功能，并且没有向的幸存与经历 PPCI 的 STEMI 为病人在长期的后续受益。

Intensive vs non-intensive statin pretreatment before percutaneous coronary intervention in Chinese patients:A meta-analysis of randomized controlled trials

BACKGROUND The results of intensive statin pretreatment before percutaneous coronary intervention(PCI)is inconsistent between Chinese and Western populations,and there are no corresponding meta-analyses involving hard clinical endpoints in the available published literature.AIM To evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through a meta-analysis.METHODS Relevant studies were identified by searching the electronic databases of PubMed,Embase and Cochrane’s Library to December 2019.The outcomes included an assessment of major adverse cardiovascular event(MACE),non-fatal myocardial infarction(MI),cardiac death,target vessel revascularization(TVR),myalgia/myasthenia and abnormal alanine aminotransferase(ALT)in all enrolled patients.Random effect model and fixed effect model were applied to combine the data,which were further analyzed byχ2 test and I2 test.The main outcomes were then analyzed through the use of relative risks(RR)and its 95%confidence interval(95%CI).RESULTS Eleven studies involving 3123 individuals were included.Compared with patients receiving placebo or no statin treatment before surgery,intensive statin treatment was associated with a clear reduction of risk of MACE(RR=0.44,95%CI:0.31-0.61,P<0.00001).However,compared with the patients receiving moderateintensity statin before surgery,no advantage to intensive statin treatment was seen(RR=1.04,95%CI:0.82-1.31,P=0.74).In addition,no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR(RR=0.43,95%CI:0.18-1.02,P=0.06),myalgia/myasthenia(RR=1.35,95%CI:0.30-5.95,P=0.69)and abnormal alanine aminotransferase(RR=1.47,95%CI:0.54-4.02,P=0.45)except non-fatal MI(RR=0.54,95%CI:0.33-0.88,P=0.01).CONCLUSION Compared with placebo or no statin pretreatment,intensive statin before PCI displayed reduced incidence of MACE.However,there was no significant benefit between high and moderate-intensity statin.In addition,no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR,myalgia/myasthenia and abnormal alanine aminotransferase except non-fatal MI.

Physical activity levels and predictors in patients following percutaneous coronary intervention: a cross-sectional study

Objective: To examine physical activity(PA) of post-percutaneous coronary intervention(PCI) patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: A total of 246 post-PCI patients from the Peking University Third Hospital in Beijing, China, were included in this crosssectional study through convenience sampling. Data were collected from a self-repor ted questionnaire. PA was categorized into low, moderate, or high levels. The ordinal multinomial logistic regression model was used to estimate the relationship among demographic, medical, and psychosocial characteristics. Results: The overall prevalence of low, moderate, and high PA was 20%, 70%, and 10%, respectively. For the domain-specific PA patterns, most par ticipants took par t in leisure-time PA(84.5%);walking was the most common PA. Increased motivation and selfefficacy, lower monthly income, and unemployment were predictors of high PA. Conclusions: PA levels in post-PCI patients was not optimal, and leisure-time PA had the highest par ticipation rate. Analyses of influencing factors can provide medical staff and health workers information to focus on high-risk groups and introduce more tailored interventions. Future studies can explore more regions, and ecological models can be introduced to study more influencing factors.

Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:An Updated Systematic Review and Meta-analysis

Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.

A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Diagnostic and prognostic value of minor elevated cardiac troponin levels for percutaneous coronary intervention-related myocardial injury:a prospective,single-center and double-blind study

Cardiac troponin-I （cTnI） and -T （cTnT） are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention （PCI）-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT （cTns） in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26± 9 months to observe the incidence of major adverse cardiac events （MACEs）. Our results showed that post- PCI cTnI and/or cTnT levels were increased to more than the 99^th percentile upper reference limit （URL） in 133 （13.2%） patients, among which 22 （2.2%） were more than 5 × 99^th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 （P = 0.33, 95% CI： 0.74-2.46）. In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.

Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention:Mechanisms,incidence and identification of patients at risk

Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.

Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction:A review of clinical evidence and guidelines

Acute ST segment elevation myocardial infarction(STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention(PPCI),however this does not always restore normal myocardial perfusion,mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure,especially in patients with a high thrombus burden. However,a large body of evidence from recent major randomized controlled trials(notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI.

Influence of cognitive impairment on cardiac mortality after percutaneous coronary intervention in very elderly patients: a retrospective observational study

Background Cognitive impairment (CI) increases cardiac mortality among very elderly patients. Percutaneous coronary intervention (PCI) for ischemic heart disease (IHD) patients is considered a favorable strategy for decreasing cardiac mortality. Here, we investigated the influence of CI on cardiac mortality after PCI in very elderly patients. Methods We performed a retrospective observational analysis of patients who received PCI between 2012 and 2014 at the South Miyagi Medical Center, Japan. IHD patients over 80 years old who underwent the Mini-Mental State Examination for CI screening during hospitalization and/or who had been diagnosed with CI were included. Participants were divided into CI and non-CI groups, and cardiac mortality and incidence of adverse cardiac events in a 3-year follow-up period were compared between groups. Statistical analyses were performed using the t-test,χ^2 test, and multivariable Cox regression analysis, with major comorbid illness and conventional cardiac risk factors as confounders. Results Of 565 patients, 95 were included (41 CI, 54 non-CI). Cardiac mortality during the follow-up period was significantly higher in the CI group (36%) compared with the non-CI group (13%)(OR = 4.3, 95% CI: 1.56–11.82, P < 0.05). CI was an independent cardiac prognostic factor after PCI and, for CI patients, living only with a CI partner was an independent predictor of cardiac death within three years. Conclusions CI significantly affected cardiac prognosis after PCI in very elderly patients, particularly those living with a CI partner. To improve patients’ prognoses, social background should be considered alongside conventional medical measures.

Correlation between intracoronary thrombus components and coronary blood flow after percutaneous coronary intervention for acute myocardial infarction at different onset time

BACKGROUND Acute myocardial infarction(AMI)is a leading cause of mortality.Early reperfusion to restore blood flow is crucial to successful treatment.In the current reperfusion regimen,an increasing number of patients have benefited from direct percutaneous coronary intervention(PCI).In order to understand whether there is a correlation between the components of coronary thrombosis and the absence of reflow or slow blood flow after coronary stent implantation in direct PCI,we collected data on direct PCI cases in our hospital between January 2016 and November 2018.AIM To investigate the correlation between intracoronary thrombus components and coronary blood flow after stent implantation in direct PCI in AMI.METHODS We enrolled 154 patients(85 male and 69 female,aged 36–81 years)with direct PCI who underwent thrombus catheter aspiration within<3,3–6 or 6–12 h of onset of AMI between January 2016 and November 2018.The thrombus was removed for pathological examination under a microscope.The patients of the three groups according to the onset time of AMI were further divided into those with a white or red thrombus.The thrombolysis in myocardial infarction(TIMI)blood flow after stent implantation was recorded based on digital subtraction angiography during PCI.The number of patients with no-reflow and slow blood flow in each group was counted.Statistical analysis was performed based on data such as onset time,TIMI blood flow.RESULTS There were significant differences in thrombus components between the patients with acute ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction(P<0.01).In the group with PCI<3 h after onset of AMI,there was no significant difference in the incidence of no-reflow and slow-flow between the white and red thrombus groups.In the groups with PCI 3-6 and 6-12 h after onset of AMI,there was a significant difference in the incidence of no-reflow and slow-flow between the white and red thrombus groups(P<0.01).There was a significant correlation between the onset time of AMI and the occurrences of no-reflow and slow blood flow during PCI(P<0.01).CONCLUSION In direct PCI,the onset time of AMI and color of coronary thrombus are often used to predict whether there will be no reflow or slow blood flow after stent implantation.

Prognostic Value of NT-proBNP in Stable Coronary Artery Disease in Chinese Patients after Percutaneous Coronary Intervention in the Drug-eluting Stent Era

Objective The predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with stable coronary artery disease(SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention(PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits(Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval(CI), 0.687-0.849; P < 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43(95% CI, 2.99-13.82; P < 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with < 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era.

Rehabilitation training improves exercise tolerance after percutaneous coronary intervention

The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group（26 cases） and control group（31 cases）.Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls（P 〈 0.05,or 0.01）.However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

Clinical and procedural predictors of no-ref low in patients with acute myocardial infarction after primary percutaneous coronary intervention

BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interval(CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours(OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg(OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI(OR= 1.949, 95%CI 1.168–3.253, P=0.011), low(≤1) TIMI fl ow grade before primary PCI(OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden(OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion(OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-refl ow.CONCLUSION: The occurrence of no-refl ow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.