Predictive Factors of No Reflow during Primary Angioplasty

Introduction: No reflow during primary angioplasty is associated with a poor prognosis despite the reopening of the culprit coronary. The aim of our work was to determine the predictive factors of no reflow. Methodology: Single-center retrospective analytical study from June 2000 to December 2016 that included patients presenting with STEMI took care of by primary angioplasty. No reflow was defined according to angiographic criteria: a TIMI flow Results: The prevalence of no reflow was 24%. In univariate analysis mean age, diabetes,hypertension, tachycardia, hypotension, killip stage 4 left ventricular failure, hyperglycemia > 11, renal failure, left ventricular dysfunction, tritruncal status, common trunk involvement, initial TIMI flow at 0, significant thrombotic load, delay to angioplasty > 6 hours, and predilation were all correlated with no reflow with a p 75 years [OR = 6.02, 95% CI 1.4 - 27, p = 0.014], tachycardia [OR = 4.3, 95% CI 1.6 - 7.4, p = 0.037], delay to angioplasty > 6 hours [OR = 1.3, 95% CI 1.1 - 2.1, p = 0.003] and high thrombotic load [OR = 1.5, 95% CI 1.3 - 3.2, p = 0.02] were independent predictors of no reflow. Conclusion: No reflow is associated with a poor short-term prognosis. Its care requires knowledge of predictive factors, prevention and treatment.

Timely reperfusion for ST-segment elevation myocardial infarction:Effect of direct transfer to primary angioplasty on time delays and clinical outcomes

Primary percutaneous coronary intervention(PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction(STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them,prehospital diagnosis and direct transfer to the cath lab,by-passing the emergency department of hospitals,has emerged as anattractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.

Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction

Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.

Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a randomized,controlled trial

Background Intravascular volume expansion represents a beneficial measure against contrast-induced acute kidney injury （CI-AKI） in patients undergoing elective angiographic procedures. However, the efficacy of this preventive strategy has not yet been established for patients with ST-elevation-myocardial infarction （STEMI）, who are at higher risk of this complication after primary percutaneous coronary intervention （PCI）. In this randomized study we investigated the possible beneficial role of periprocedural intravenous volume expansion and we compared the efficacy of 2 different hydration strategies in patients with STEMI undergoing primary PCI.

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China.Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke.Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion.Medical management is regarded as the standard treatment for this disease.With the development of endovascular treatment,some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy.We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery.Simple balloon angioplasty was performed,and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications.At 4 months followup,the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically.In addition,we briefly reviewed the relevant literature.

Percutaneous Coronary Intervention for a Pregnant Woman with Acute ST Elevation Myocardial Infarction: A Case Report

Acute myocardial infarction in women during childbearing age is rare. We report a case of a 40-year-old female patient with no history or cardiovascular risk factors, 24-week pregnant who presented with acute coronary syndrome with an ST-elevation anterior extended complicated by cardiogenic shock. Cardiac ultrasound showed systolic dysfunction of the left ventricle at 30%. Emergency coronary angiography revealed subocclusion of the proximal anterior interventricular artery. We performed a primary angioplasty with placement of a stent after balloon predilation with a satisfactory agiographic result and an improvement in the hemodynamic state. The patient gave birth by cesarean section at 30 weeks of pregnancy after a pocket rupture of infectious waters. The newborn died after 72 hours. After 6 years of evolution, the patient remained asymptomatic under medal treatment.

Optimizing care for ST-elevation myocardial infarction patients： application of systems engineering

Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality.

Impact of angina prior to acute ST-elevation myocardial infarction on short-term outcomes after primary percutaneous coronary intervention： results from the Shanghai Registry of Acute Coronary Syndrome （SRACE）

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.