We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occlu...We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occluded at the mid-portion. In addition, the proximal and mid-portion of the right coronary artery （RCA） had a 60% occlusion. We inferred that the LCX was the culprit artery and primary PCI was successfully performed. Six weeks later, the patient had an eventful course with recurrence of chest pain. Coronary angiography showed no significant ste- nosis in the previous LCX lesion, while the proximal and middle potion of the RCA had a 90% occlusion. Our case demonstrates the systemic nature of acute coronary syndromes and highlights the inherent instability of coronary artery disease.展开更多
Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total o...Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total of 200 patients(60.1 ± 11.3 years) with STEMI who underwent successful PPCI from January 2010 to December 2013 were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions. Patients were divided into two groups according to the dosage of ramipril used at hospital discharge as follows: high dosage group(2.5–10 mg, q.d.) and low dosage group(1.25–2.5 mg, q.d.). Clinical and angiographic follow-up was performed for 12 months. The primary endpoint was clinically-driven percutaneous coronary intervention(PCI) for nonculprit lesions. The clinical and angiographic features were analyzed. Results Clinical and angiographic follow-up was performed with 87 patients in the high dosage group and 113 patients in the low dosage group. The numbers of patients who underwent additional PCI were six and 20 in the high and low dosage groups, respectively. The rate of having additional PCI performed was lower in the high dosage group than in the low dosage group(6.90% vs. 17.70%, P = 0.03). Conclusions A high dosage of ramipril may prevent progression of nonculprit lesions, which could be the major cause of recurrent PCI in patients with STEMI after PPCI.展开更多
Background Recent studies have demonstrated that epicardial flow in nonculprit arteries, which has been assumed to be normal, was slowed in the setting of ST-elevation myocardial infarction （STEMI）. However, the imp...Background Recent studies have demonstrated that epicardial flow in nonculprit arteries, which has been assumed to be normal, was slowed in the setting of ST-elevation myocardial infarction （STEMI）. However, the impact of primary percutaneous coronary intervention （PCI） on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified. The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors. Methods A total of 117 patients with anterior wall STEMI, the culprit artery being the left anterior descending artery （LAD）, undergoing primary PCI （the study group） and 100 patients with normal coronary angiography （the control group） were enrolled. To observe the differences of corrected TIMI frame count （cTFC） and myocardial blush grade （MBG） before and after primary PCI in both culprit and nonculprit arteries, the left circumflex coronary artery （LCX）, cTFC and MBG in the LAD and LCX were measured in the study group and control group. The study group was divided into three groups; refiow in the culprit artery group （the R group）, no reflow in culprit artery group （the NR group）, and no reflow in both the culprit artery and nonculprit artery group （the NRB group） according to MBG grade. The level of serum C-reactive protein （CRP）, catecholamine, and fibroblast growth factor-21 （FGF21）were assayed. The clinical and angiographic characteristics were also analyzed. Results cTFC （28.1±24.3 vs. 20.3±19.3, P 〈0.05） and MBG in the LCX were different in the study group compared to the control group before primary PCI. cTFC （25.2±22.3 vs. 28.1±24.3, P 〈0.05） and the MBG level in the LCX were improved after successful primary PCI, but were not recovered to the normal level. Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery （78% vs. 19%, P 〈0.0001）, and the levels of CRP （（3.29±1.31） mg/dl vs. （2.51±1.14） mg/dl vs. （2.93±1.07） mg/dl, P 〈0.05, respectively）, catecholamine （（epinephrine （693.48±89.78） pg/ml vs. （398.12±93.28） pg/ml vs. （562.54±96.22） pg/ml, P 〈0.0001, respectively）, and norepinephrine （（7012.43±932.47） pg/ml vs. （4012.34±814.16） pg/ml vs. （5549.03＋912.65） pg/ml, P 〈0.0001, respectively））in the NRB group were higher than those in the R group and NR group. The level of FGF21 （（0.299±0.093） ng/ml vs. （0.612±0.071） ng/ml vs. （0.428±0.074） ng/ml, P 〈0.0001 respectively） in the NRB group was lower than that in the R group and NR group. Conclusions The blood perfusion in the nonculprit artery may be impaired in patients with STEMI. Although nonculprit artery perfusion may be improved after successful primary PCI, it is still lower than that in the control group, and may be involved in inflammation and spasms.展开更多
基金supported by a grant from the National Natural ScienceFoundation of China(No.81270255)
文摘We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occluded at the mid-portion. In addition, the proximal and mid-portion of the right coronary artery （RCA） had a 60% occlusion. We inferred that the LCX was the culprit artery and primary PCI was successfully performed. Six weeks later, the patient had an eventful course with recurrence of chest pain. Coronary angiography showed no significant ste- nosis in the previous LCX lesion, while the proximal and middle potion of the RCA had a 90% occlusion. Our case demonstrates the systemic nature of acute coronary syndromes and highlights the inherent instability of coronary artery disease.
基金supported by grants from Beijing’s high professional talents training project in the health sector (2013-3-009)
文摘Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total of 200 patients(60.1 ± 11.3 years) with STEMI who underwent successful PPCI from January 2010 to December 2013 were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions. Patients were divided into two groups according to the dosage of ramipril used at hospital discharge as follows: high dosage group(2.5–10 mg, q.d.) and low dosage group(1.25–2.5 mg, q.d.). Clinical and angiographic follow-up was performed for 12 months. The primary endpoint was clinically-driven percutaneous coronary intervention(PCI) for nonculprit lesions. The clinical and angiographic features were analyzed. Results Clinical and angiographic follow-up was performed with 87 patients in the high dosage group and 113 patients in the low dosage group. The numbers of patients who underwent additional PCI were six and 20 in the high and low dosage groups, respectively. The rate of having additional PCI performed was lower in the high dosage group than in the low dosage group(6.90% vs. 17.70%, P = 0.03). Conclusions A high dosage of ramipril may prevent progression of nonculprit lesions, which could be the major cause of recurrent PCI in patients with STEMI after PPCI.
基金Yh-is studywas supported by a grant from the National Natural Science Foundation of China （No. 81070227）.
文摘Background Recent studies have demonstrated that epicardial flow in nonculprit arteries, which has been assumed to be normal, was slowed in the setting of ST-elevation myocardial infarction （STEMI）. However, the impact of primary percutaneous coronary intervention （PCI） on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified. The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors. Methods A total of 117 patients with anterior wall STEMI, the culprit artery being the left anterior descending artery （LAD）, undergoing primary PCI （the study group） and 100 patients with normal coronary angiography （the control group） were enrolled. To observe the differences of corrected TIMI frame count （cTFC） and myocardial blush grade （MBG） before and after primary PCI in both culprit and nonculprit arteries, the left circumflex coronary artery （LCX）, cTFC and MBG in the LAD and LCX were measured in the study group and control group. The study group was divided into three groups; refiow in the culprit artery group （the R group）, no reflow in culprit artery group （the NR group）, and no reflow in both the culprit artery and nonculprit artery group （the NRB group） according to MBG grade. The level of serum C-reactive protein （CRP）, catecholamine, and fibroblast growth factor-21 （FGF21）were assayed. The clinical and angiographic characteristics were also analyzed. Results cTFC （28.1±24.3 vs. 20.3±19.3, P 〈0.05） and MBG in the LCX were different in the study group compared to the control group before primary PCI. cTFC （25.2±22.3 vs. 28.1±24.3, P 〈0.05） and the MBG level in the LCX were improved after successful primary PCI, but were not recovered to the normal level. Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery （78% vs. 19%, P 〈0.0001）, and the levels of CRP （（3.29±1.31） mg/dl vs. （2.51±1.14） mg/dl vs. （2.93±1.07） mg/dl, P 〈0.05, respectively）, catecholamine （（epinephrine （693.48±89.78） pg/ml vs. （398.12±93.28） pg/ml vs. （562.54±96.22） pg/ml, P 〈0.0001, respectively）, and norepinephrine （（7012.43±932.47） pg/ml vs. （4012.34±814.16） pg/ml vs. （5549.03＋912.65） pg/ml, P 〈0.0001, respectively））in the NRB group were higher than those in the R group and NR group. The level of FGF21 （（0.299±0.093） ng/ml vs. （0.612±0.071） ng/ml vs. （0.428±0.074） ng/ml, P 〈0.0001 respectively） in the NRB group was lower than that in the R group and NR group. Conclusions The blood perfusion in the nonculprit artery may be impaired in patients with STEMI. Although nonculprit artery perfusion may be improved after successful primary PCI, it is still lower than that in the control group, and may be involved in inflammation and spasms.
