Angiographic Quantification of Thrombus in ST-Elevation Acute Myocardial Infarction Presenting with an Occluded Infarct-Related Artery and Its Relationship with Results of Percutaneous Intervention

Introduction: Routine thrombectomy has been advocated for ST-segment-elevation myocardial infarction (STEMI), but it is unknown how many patients present with a large thrombus. We aimed to quantify the intracoronary thrombus in STEMI and to correlate it with procedure results.
Methods: In 98 patients with STEMI and TIMI flow grades 0–2 in the infarct-related artery, thrombus was qualified as small (ST) when its maximal dimension was <2 vessel diameters and large (LT) when ≥2. Main outcome measures were TIMI flow, myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment elevation resolution (STSER).
Results: Only a third of the patients presented with an LT. Thrombus grade was independent of the initial vessel patency. Diabetes (OR 3.1, 95% CI 1.20–8.02, P = 0.027) and pretreatment with clopidogrel (OR 0.27, 95% CI 0.08–0.86, P = 0.034) were independent predictors of LT. LT was an independent predictor of unfavorable results: <3 TIMI flow (OR 2.87, 95% CI 1.04–8.00, P = 0.043), MBG 0–1 (OR 3.36, 95% CI 1.10–10.26, P = 0.033), cTFC > 21 (OR 2.86, 95% CI 1.09–7.49, P = 0.033) and <50% STSER (OR 3.19, 95% CI 1.06–9.63, P = 0.039).
Conclusion: Only a third of STEMI patients present with an LT, being diabetes and lack of clopidogrel pretreatment independent predictors. An LT is strongly associated with worse PCI results.     

The cachexia associated with Trypanosoma cruzi acute infection in mice is attenuated by anti-TNF-a, but not by anti-IL-6 or anti-IFN-7 antibodies

BALB/c male mice acutely infected with Trypanosoma cruzi underwent a severe weight loss (around 20%, from day 18 to 31 post-infection), when compared to age-matched uninfected animals. Though mice regained weight later, when blood parasites were hardly detectable, wasting extended over the chronic phase of infection. The onset and the magnitude of weight loss were related to the mouse susceptibility to infection, since they were respectively earlier and higher in male mice which will die than in surviving ones, in males than in females, and in BALB/c than in B6D2 [(C57B1/6 × DBA/2)F1], a mouse strain more resistant to infection. Fat weight of infected mice (male BALB/c) was reduced by 60 to 80%, whereas lean mass was unaffected and water content rose by 6 to 10% in acute and chronic infection. Haematocrit was also decreased by 15–16% in acute infection. Animals failed to compensate their energetic loss since their food intake remained similar to that of uninfected animals. Injections of neutralizing anti-TNF-α monoclonal antibody into infected male mice, during the first two weeks but not later in infection, significantly attenuated the weight loss. Early administration of anti-IL-6 or anti-IFN-γ MoAbs did not improve the mouse wasting. Taken together, these data show that TNFis a key agent of cachexia occurring in the acute T. cruzi infection in mice.     

Aggressive Plaque Modification with Rotational Atherectomy and/or Cutting Balloon before Drug‐Eluting Stent Implantation for the Treatment of Calcified Coronary Lesions

Introduction: Calcified coronary lesions may be associated with stent underexpansion, malapposition, and high rates of restenosis. The use of drug‐eluting stents (DES) in such lesions has not been fully addressed in the major trials. We sought to examine the outcomes of patients who were treated with plaque modification (PM) to facilitate DES implantation. Methods: We analyzed 164 calcified coronary lesions in 145 consecutive patients who underwent aggressive PM with either rotational atherectomy (RA) and/or cutting balloon (CB) before DES implantation. CB was used in moderate calcified lesions and RA alone or followed by CB in severe calcified lesions. Results: Patients were 68.7 ± 10.1 years old, 47% were diabetic, 34% had left ventricular ejection fraction (LVEF) ≤50%, and 39% had 3‐vessel disease. Ninety‐five percent of lesions were classified as B2/C, 100% as moderately/severely calcified. PM was achieved by using CB in 57% and by RA alone or followed by CB in 43%. In 100%, a DES was implanted. There was no failure to deliver a stent. At 15 ± 11 months follow‐up, the overall major adverse cardiac events (MACE) rate was 9.6% (3.4% cardiac death, 2.3% myocardial infarction, and 3.4% target lesion revascularization [TLR]). The only independent predictor of MACE was LVEF ≤50% (odds ratio 3.88; 95% confidence interval: 1.15–13.1; P = 0.03). The incidence of stent thrombosis (ST) was 2.1%. There were no significant differences in MACE and TLR based on the type of PM used. Conclusions: In this population at high risk of restenosis, aggressive PM by CB and/or RA before DES implantation provides excellent mid‐term outcomes with only 3.4% TLR and 2.1% ST. (J Interven Cardiol 2010;23:240–248)