Effect of cardiac rehabilitation care after coronary intervention on cardiac function recovery and negative mood in patients with myocardial infarction

BACKGROUND Cardiovascular disease,particularly myocardial infarction(MI)profound impact on patients'quality of life and places a substantial burden on the healthcare and economy systems.Developments in medical technology have led to the emer-gence of coronary intervention as an essential method for treating MI.AIM To assess the effects of cardiac rehabilitation care on cardiac function recovery and negative emotions in MI after coronary intervention.METHODS This study included a total of 180 patients with MI during the period from June 2022 to July 2023.Selected patients were divided into two groups:An observation group,which receiving cardiac rehabilitation care;a control group,which re-ceiving conventional care.By comparing multiple observation indicators such as cardiac function indicators,blood pressure,exercise tolerance,occurrence of adverse cardiac events,and negative emotion scores between the two groups of patients.All the data were analyzed and compared between two groups.RESULTS There were 44 males and 46 females in the observation group with an average age of 36.26±9.88 yr;there were 43 males and 47 females in the control group,with an average age of 40.87±10.5 yr.After receiving the appropriate postoperative nursing measures,the results of the observation group showed significant improvement in several indicators compared with the control group.Indicators of cardiac function,such as left ventricular end-diastolic internal diameter and left ventricular ejection fraction were significantly better in the observation group than in the control group(P<0.05).Exercise endurance assessment showed that the 6-minute walking test distance was significantly increased in the patients of the observation group(P<0.01).In addition,the incidence of adverse cardiac events was significantly lower in the observation group,and negative mood scores were significantly reduced(P<0.05).CONCLUSION Cardiac rehabilitation care after coronary intervention has a significant positive impact on functional recovery.This emphasizes the importance of cardiac rehabilitation care to improve patient recovery.

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient:A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.

Comprehensive analysis of the impact of primary percutaneous coronary intervention on patients with ST-segment elevation myocardial infarction

This comprehensive analysis by Saeed and Faeq investigates the impact of primary percutaneous coronary intervention(pPCI)on mortality among patients with ST-segment elevation myocardial infarction(STEMI)at the Erbil Cardiac Center.Analyzing data from 96 consecutive STEMI patients,the study identified significant predictors of in-hospital mortality,emphasizing the critical impact of time of hospital arrival post-symptom onset on overall prognosis.Findings indicate that factors such as atypical presentation,cardiogenic shock,chronic kidney disease,and specific coronary complications are associated with higher mortality rates.The study underscores the necessity of prompt medical intervention for improving survival outcomes in STEMI patients,especially in the high-risk subgroup.This research offers valuable insights into optimizing STEMI management and enhancing patient survival rates through effective and timely pPCI.

Inflammation as a cause of acute myocardial infarction in patients with myeloproliferative neoplasm

Myeloproliferative neoplasms(MPN)are a group of diseases characterized by the clonal proliferation of hematopoietic progenitor or stem cells.They are clinically classifiable into four main diseases:chronic myeloid leukemia,essential thrombocythemia,polycythemia vera,and primary myelofibrosis.These pathologies are closely related to cardio-and cerebrovascular diseases due to the increased risk of arterial thrombosis,the most common underlying cause of acute myocardial infarction.Recent evidence shows that the classical Virchow triad(hypercoagulability,blood stasis,endothelial injury)might offer an explanation for such association.Indeed,patients with MPN might have a higher number and more reactive circulating platelets and leukocytes,a tendency toward blood stasis because of a high number of circulating red blood cells,endothelial injury or overactivation as a consequence of sustained inflammation caused by the neoplastic clonal cell.These abnormal cancer cells,especially when associated with the JAK2V617F mutation,tend to proliferate and secrete several inflammatory cytokines.This sustains a pro-inflammatory state throughout the body.The direct consequence is the induction of a pro-thrombotic state that acts as a determinant in favoring both venous and arterial thrombus formation.Clinically,MPN patients need to be carefully evaluated to be treated not only with cytoreductive treatments but also with cardiovascular protective strategies.

Delay Times and Clinical Outcomes in Acute Myocardial Infarction: Comparison of Periods before and during the COVID-19 Pandemic—Myocardial Infarction and the Pandemic

Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for patients with ST-segment elevation myocardial infarction (STEMI) may have affected clinical outcomes. Objectives: To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), before and during the COVID-19 pandemic. Methods: Retrospective observational study that included patients with STEMI undergoing PPCI from December 2018 to July 2021. The COVID-19 pandemic cases were divided into two groups: pandemic I—from March to August 2020;and pandemic II—from September 2020 to July 2021. Patients were compared according to the period of hospitalization. Primary outcomes were delay times in assistance and clinical outcomes (acute kidney injury [AKI], post-procedural vascular complications and in-hospital mortality). Results: 108 patients were included, 39 (36.1%) in the pre-pandemic period, 13 (12.1%) in pandemic I and 56 (51.8%) in pandemic II. Time from onset of symptoms to arrival at the service and door-to-balloon time did not differ significantly among groups. Vascular complications were more frequent during the pandemic (I and II) than in the pre-pandemic period (2.5% pre-pandemic vs 15.4% pandemic vs 12.5% pandemic II;p = 0.03). AKI incidence was similar in all three periods. There was a non-significant increase in in-hospital mortality during the COVID-19 pandemic. Conclusion: In patients with STEMI, there was an increase in vascular complications and a trend toward increased mortality during the COVID-19 pandemic. Delay times to admission and reperfusion did not differ significantly between before and during the pandemic.

Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.

Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction

AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.

Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: A review

The diagnosis of myocardial infarction with non-obstructive coronary arteries(MINOCA)necessitates documentation of an acute myocardial infarction(AMI),non-obstructive coronary arteries,using invasive coronary angiography or coronary computed tomography angiography and no clinically overt cause for AMI.Historically patients with MINOCA represent a clinical dilemma with subsequent uncertain clinical management.Differential diagnosis is crucial to choose the best therapeutic option for ischemic and non-ischemic MINOCA patients.Cardiovascular magnetic resonance(CMR)is able to analyze cardiac structure and function simultaneously and provides tissue characterization.Moreover,CMR could identify the cause of MINOCA in nearly two-third of patients providing valuable information for clinical decision making.Finally,it allows stratification of patients with worse outcomes which resulted in therapeutic changes in almost half of the patients.In this review we discuss the features of CMR in MINOCA;from exam protocols to imaging findings.

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.

Feasibility and efficacy of delayed pharmacoinvasive therapy for STelevation myocardial infarction

BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.

Acute myocardial infarction in myeloproliferative neoplasms

Myeloproliferative neoplasms(MPNs)are a heterogeneous group of hematologic malignancies characterized by an abnormal proliferation of cells of the myeloid lineage.Affected individuals are at increased risk for cardiovascular and thrombotic events.Myocardial infarction(MI)may be one of the earliest clinical manifestations of MPNs or may be a thrombotic complication that develops during the natural course of the disease.In the present review,we examine the epidemiology,pathogenesis,clinical presentation,and management of MI in MPNs based on the available literature.Moreover,we review potential biomarkers that could mediate the MI-MPNs crosstalk,from classical biochemical tests,e.g.,lactate dehydrogenase,creatine kinase and troponins,to pro-inflammatory cytokines,oxidative stress markers,and clonal hematopoiesis.

General awareness of symptoms of myocardial infarction and the need for urgent treatment:A cross-sectional,street survey in Chennai,Tamil Nadu

Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive research design and convenience sampling.A sample of 800 subjects,using self-structured knowledge questionnaires,was selected for data collection and analysis.The study was conducted at Dr.M.G.R.Educational and Research Institute,India,from February to November 2022.Awareness of myocardial infarction symptoms and intervention timeline(the golden time)was investigated.A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.Results:A total of 800 subjects were included.Among the subjects,367(45.8%)were male,433(54.2%)were female,and 443(55.3%)participants failed to recognize the golden time.Our multivariate logistic regression analysis showed that people with a bachelor’s degree(OR=0.41,95%CI:0.23-0.74,P=0.03)and a high school level diploma(OR=0.55,95%CI:0.31-0.97,P=0.03)are more likely to know about myocardial infarction(golden time)than illiterate people.Additionally,people who are employed(OR=0.59,95%CI:0.41-0.85,P=0.05)are more likely to know about myocardial infarction(golden time)than those who are not.Conclusions:The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action.The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention,which can lead to an increase in mortality and morbidity.

Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction:Impact on in-hospital arrhythmia

BACKGROUND Myocardial ischemia and ST-elevation myocardial infarction(STEMI)increase QT dispersion(QTD)and corrected QT dispersion(QTcD),and are also associated with ventricular arrhythmia.AIM To evaluate the effects of reperfusion strategy[primary percutaneous coronary intervention(PPCI)or fibrinolytic therapy]on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia.METHODS This prospective,observational,multicenter study included 240 patients admitted with STEMI who were treated with either PPCI(group I)or fibrinolytic therapy(group II).QTD and QTcD were measured on admission and 24 hr after reperfusion,and patients were observed to detect in-hospital arrhythmia.RESULTS There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients.QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II(53±19 msec vs 60±18 msec,P=0.005 and 60±21 msec vs 69+22 msec,P=0.003,respectively).The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I(25 patients,20.8%vs 8 patients,6.7%,P=0.001).Furthermore,QTD and QTcD were higher in patients with in-hospital arrhythmia than those without(P=0.001 and P=0.02,respectively).CONCLUSION In STEMI patients,PPCI and fibrinolytic therapy effectively reduced QTD and QTcD,with a higher observed reduction using PPCI.PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy.In addition,QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.

Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock

BACKGROUND Cardiogenic shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outcomes in patients with CS.AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases,Karachi,Pak-istan,between January 2018 and December 2022.The primary outcome was immediate mortality,defined as mortality within index hospitalization.Uni-variate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.RESULTS In a sample of 305 patients with 72.8%male patients and a mean age of 58.1±11.8 years,the immediate mortality rate was found to be 54.8%(167).Multivariable analysis identified Killip class IV at presentation[odds ratio(OR):2.0;95%co-nfidence interval(CI):1.2-3.4;P=0.008],Multivessel disease(OR:3.5;95%CI:1.8-6.9;P<0.001),and high thrombus burden(OR:2.6;95%CI:1.4-4.9;P=0.003)as independent predictors of immediate mortality.CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies.Killip class IV at presentation,multivessel disease,and high thrombus burden(grade≥4)were identified as independent predictors of immediate mortality.These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI,particularly in those with these high-risk characteristics.

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.

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.

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.

Genetics of coronary artery disease and myocardial infarction

Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.

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.