Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one ca...Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.展开更多
SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledg...SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledge of the various forms of presentation are mandatory for optimal medical therapy. We present a case report of a 45-year-old patient who was admitted to the coronary unit showing symptoms and laboratory tests compatible with myocardial infarction. Complete diagnosis was obtained only with more specific exams. The manifestations of the disease in the case described and the main features of the disease are discussed.展开更多
Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an a...Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.展开更多
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleed...Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.展开更多
Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous cor...Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.展开更多
The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,p...The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GP Ⅱ/Ⅲ or direct thrombectomy can＇t improve short or long-term clinical outcomes, So we evaluated the safety and efficacy of distal protection device （GuardWire PlusTM） in the acute myocardial in farction （AMI） combined with percutaneous coronary intervention （PCI）. Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group （GW group） and non-distal protection group（NGW） group. Data analyzed between the two groups were included the clinical characteristics, angiographic results, ST segment resolution, postoperative TIMI flow grade, TIMI frame count, myocardial blush grade, the left ventricular ejection fraction （LVEF） by eehocardiography in a Week after or 3 months after PCI, myocardial enzymes,preoperative and postoperative neuroendoerine biomarkers： endothelin （ET）, plasma renin activity （PRA）, angiotensin Ⅱ （AII）, aldosterone（ALD）, norepinephrine（NE）, epinephrine （E）. Results ST segment resolution ≥ 50% was significantly higher in the GW group （68.4%） than in NGW group （41.2%, P 〈 0.05）. Early peak CK-MB and CTNI in GW group versus NGW group （8.63 ±2.42 hours vs 11.18 ±2.26 hours,10.16 ±2.96 hours vs 12.35 ±2.06 hours）, and peak reduction difference were observed （63.3 ±9.82 vs 74.28 ＋ 6.15 P = 0.000, 18.01 ＋ 7.21 vs 21.48 ±5.61 P = 0.027）. Left ventricular ejection fraction （LVEF） was higher in GW group （P = 0.01） than in NGW group. TIMI grade exhibited no difference while TIMI frame count （P = 0.043） and myocardial blush grade were significantly different （P = 0.0001）. Postoperative biomarkers in endocrine expression were higher significantly in NGR group （P 〈 0.05）. Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism, reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.展开更多
Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation th...Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation therapy should be adopted for patients with arteriovenous embolism. Balancing the risk of ischemia and hemorrhage is especially challenging in these patients in order to achieve an optimal clinical benefit. We report on a 55-year-old female with acute pulmonary embolism （PE）, subsequently diagnosed as having acute myocardial infarction （AMI） and a cerebral infarction. Examinations had been carried out, excluding potential arteriovenous shunts, cancer, an- tiphospholipid syndrome and other common hypercoagulable states. A combination of an anticoagulant drug （rivaroxaban, an Xa inhibitor） and an antiplatelet agent （clopidogrel, an ADP receptor inhibitor） was prescribed with a β-blocker and atorvastatin. The embolus was gradually shrunk during the next 10 months, and then it turned back into expanding. During the 16 months＇ follow-up, an aneurysm of left ventricular apex was found through an echocardiogram and an angiotensin-converting enzyme inhibitor was administered. We conclude that combined anticoagulation and antiplatelet therapy significantly relieved the symptoms and improved the prognosis in patients suffering from arteriovenous embolism without any major clinical bleeding events.展开更多
文摘Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.
文摘SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledge of the various forms of presentation are mandatory for optimal medical therapy. We present a case report of a 45-year-old patient who was admitted to the coronary unit showing symptoms and laboratory tests compatible with myocardial infarction. Complete diagnosis was obtained only with more specific exams. The manifestations of the disease in the case described and the main features of the disease are discussed.
文摘Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.
文摘Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.
文摘Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.
文摘The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GP Ⅱ/Ⅲ or direct thrombectomy can＇t improve short or long-term clinical outcomes, So we evaluated the safety and efficacy of distal protection device （GuardWire PlusTM） in the acute myocardial in farction （AMI） combined with percutaneous coronary intervention （PCI）. Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group （GW group） and non-distal protection group（NGW） group. Data analyzed between the two groups were included the clinical characteristics, angiographic results, ST segment resolution, postoperative TIMI flow grade, TIMI frame count, myocardial blush grade, the left ventricular ejection fraction （LVEF） by eehocardiography in a Week after or 3 months after PCI, myocardial enzymes,preoperative and postoperative neuroendoerine biomarkers： endothelin （ET）, plasma renin activity （PRA）, angiotensin Ⅱ （AII）, aldosterone（ALD）, norepinephrine（NE）, epinephrine （E）. Results ST segment resolution ≥ 50% was significantly higher in the GW group （68.4%） than in NGW group （41.2%, P 〈 0.05）. Early peak CK-MB and CTNI in GW group versus NGW group （8.63 ±2.42 hours vs 11.18 ±2.26 hours,10.16 ±2.96 hours vs 12.35 ±2.06 hours）, and peak reduction difference were observed （63.3 ±9.82 vs 74.28 ＋ 6.15 P = 0.000, 18.01 ＋ 7.21 vs 21.48 ±5.61 P = 0.027）. Left ventricular ejection fraction （LVEF） was higher in GW group （P = 0.01） than in NGW group. TIMI grade exhibited no difference while TIMI frame count （P = 0.043） and myocardial blush grade were significantly different （P = 0.0001）. Postoperative biomarkers in endocrine expression were higher significantly in NGR group （P 〈 0.05）. Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism, reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.
基金Project supported by the National Natural Science Foundation of China （Nos. 31171392 and 31371475）
文摘Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation therapy should be adopted for patients with arteriovenous embolism. Balancing the risk of ischemia and hemorrhage is especially challenging in these patients in order to achieve an optimal clinical benefit. We report on a 55-year-old female with acute pulmonary embolism （PE）, subsequently diagnosed as having acute myocardial infarction （AMI） and a cerebral infarction. Examinations had been carried out, excluding potential arteriovenous shunts, cancer, an- tiphospholipid syndrome and other common hypercoagulable states. A combination of an anticoagulant drug （rivaroxaban, an Xa inhibitor） and an antiplatelet agent （clopidogrel, an ADP receptor inhibitor） was prescribed with a β-blocker and atorvastatin. The embolus was gradually shrunk during the next 10 months, and then it turned back into expanding. During the 16 months＇ follow-up, an aneurysm of left ventricular apex was found through an echocardiogram and an angiotensin-converting enzyme inhibitor was administered. We conclude that combined anticoagulation and antiplatelet therapy significantly relieved the symptoms and improved the prognosis in patients suffering from arteriovenous embolism without any major clinical bleeding events.
