Admission hyperglycemia and TIMI frame count in primary percutaneous coronary intervention

We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels > 198 mg/dL (11 mmol/L) were defined as hyperglycemic. Hyperglycemia was observed in 36 (29.8%) patients. The TFC was significantly higher in patients with hyperglycemia (70.75 [10-96] vs 56.87 [8-100], P = .04). No-reflow frequency was higher in the hyperglycemia group (44.4% vs 23.5%, P = .02). In multivariate linear regression analysis admission glucose was an independent predictor of high TFC (B = 0.21, P = .02). Our findings suggest that admission blood glucose is a predictor of TFC which reflects coronary blood flow.     

血糖对直接经皮冠状动脉介入治疗后患者心肌灌注的影响

目的观察血糖升高对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后的预后和心肌灌注影响。方法选取接受直接PCI治疗的急性ST段抬高心肌梗死患者308例,根据入院第一次随机血糖分为3组,1组<7.8MMOL/L,2组7.8～11.0MMOL/L,3组≥11.0MMOL/L。1组为血糖正常组,2、3组为血糖升高组。结果入院随机血糖高的患者,女性所占比例较高(19.2%比31.4%、37.9%,P<0.05),平均年龄较大[(58.5±11.3)岁比(61.6±11.2)岁、(63.6±11.2)岁,P<0.05)]。3组与1组相比血甘油三酯[(1.53±0.77)MMOL/L比(1.30±0.67)MMOL/L,P<0.05]浓度较高。冠状动脉造影结果中,2、3组多支血管病变较多(53.8%比72.1%、69.7%,P<005)。PCI术后梗死相关血管TIMI血流分级(TFG)3级,三组差异无统计学意义(89.7%、86.0%和86.3%,P>0.05)。血糖升高的两组,PCI术后梗死相关血管的校正TIMI帧计数(CTFC)数值高于第1组[(28.4±18.3)和(27.1±17.2)比(22.3±12.8),P<0.05],TIMI心肌灌注分级(TMPG)0～1级(30.3%和29.0%比17.3%,P<0.05)多见。PCI术后心电图分析:3组1HST段回落≥50%及3HT波倒置较1组少(56.7%比72.0%,58.3%比73.4%,P<0.05)。左室射血分数在2、3组患者明显降低[(54.9±10.0)和(54.8±10.0)比(57.9±9.0),P<0.05]。血糖≥11.0MMOL/L组30D内病死率高于血糖正常组(10.4%比2.6%,P<0.05)。结论入院随机血糖升高的急性ST段抬高心肌梗死患者,进行直接介入治疗后的心肌灌注较差,进而影响心功能,增加患者30D内病死率。     

ST‐Segment Resolution Prior to Primary Percutaneous Coronary Intervention Is a Poor Indicator of Coronary Artery Patency in Patients with Acute Myocardial Infarction

Background: The prognostic value of ST‐segment resolution (STR) after initiation of reperfusion therapy has been established by various studies conducted in both the thrombolytic and mechanic reperfusion era. However, data regarding the value of STR immediately prior to primary percutaneous coronary intervention (PCI) to predict infarct‐related artery (IRA) patency remain limited. We investigated whether STR prior to primary PCI is a reliable, noninvasive indicator of IRA patency in patients with ST‐segment elevation myocardial infarction (STEMI). Methods: The study population consisted of STEMI patients who underwent primary PCI at our institution between 2000 and 2007. STR was analyzed in 12‐lead electrocardiograms recorded at first medical contact and immediately prior to primary PCI and defined as complete (≥70%), partial (70%? 30%), or absent (<30%). Results: In 1253 patients with a complete data set, STR was inversely related to the probability of impaired preprocedural flow (P_{for trend} < 0.001). Although the sensitivity of incomplete (<70%) STR to predict a Thrombolysis in Myocardial Infarction (TIMI) flow of <3 was 96%, the specificity was 23%, and the negative predictive value of incomplete STR to predict normal coronary flow was only 44%. Conclusions: This study establishes the correlation between STR prior to primary PCI and preprocedural TIMI flow in STEMI patients treated with primary PCI. However, the negative predictive value of incomplete STR for detection of TIMI‐3 flow is only 44% and therefore should not be a criterion to refrain from immediate coronary angiography in STEMI patients. Ann Noninvasive Electrocardiol 2010;15(2):107–115     

Impact of thrombus aspiration use and direct stenting on final myocardial blush score in patients presenting with ST-elevation myocardial infarction

BackgroundMany studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). In addition, distal coronary embolization is a major pitfall of conventional percutaneous coronary intervention (PCI) in such a context.AimThis study aimed to assess the impact of thrombus aspiration (TA) use before primary PCI on final myocardial reperfusion in patients presenting with STEMI.MethodsFrom January to December 2006, 100 patients presenting with STEMI in our catheterization laboratory were considered for the present study. During this time period, 50 patients underwent TA before primary PCI for treatment of STEMI and were then matched 1:1 to 50 controls who underwent conventional primary PCI for treatment of STEMI without TA. Patients of the control group were chosen after matching on age±3 years, sex, history of diabetes, and distribution of the infarct related coronary artery during the same period.ResultsBaseline clinical characteristics, initial TIMI flow and initial MBG of both groups were similar. There was a trend for a better final TIMI flow in the group with TA and the final MBG was significantly improved in the group with TA compared to the group without TA: final MBG of two or three in 70% versus 30% of the cases (P=.001). In addition, direct stenting was significantly more often used in the TA group (92% versus 64%, P=.001). There were four patients with evident distal embolizations in the group without TA and none in the group with TA.ConclusionTA use before primary PCI for STEMI treatment resulted in improved final myocardial reperfusion. Of importance, TA use may have led to a better choice of the stent size and more frequent direct stenting. This benefit may directly improve patient outcomes.     

阿托伐他汀对ST段抬高型急性心肌梗死患者急诊PCI术后无复流现象的影响

目的:探讨长期应用阿托伐他汀对冠状动脉介入治疗(PCI)术后无复流发生率的影响。方法:入选对象均为ST段抬高型急性心肌梗死(STEMI)患者,接受急诊PCI治疗且至少口服阿托伐他汀10mg/d3个月以上者入选阿托伐他汀组,未服用任何调脂药物者入选对照组,连续入选,至每组60例为止。PCI术中根据TI-MI血流分级法(TFG)、TIMI计帧法(cTFC)评价冠状动脉血流。术后24h进行实时心肌声学造影检查,计算心肌灌注缺损计分指数(CSI)及室壁运动计分指数(WMSI)。术后30min及24h记录心电图,观察ST段抬高最显著导联ST段回落的情况。术前、术后24h采取静脉血测定血浆高敏C反应蛋白(Hs-CRP)及sICAM-1水平。结果:阿托伐他汀组TIMI3级血流者显著多于对照组(P<0.05),而cTFC显著低于对照组(P<0.01)。阿托伐他汀组与对照组相比CSI(1.22±0.33:1.37±0.42,P<0.05),WMSI(1.53±0.40:1.71±0.38,P<0.05)均显著降低。术后30min阿托伐他汀组ST段回落≥50%者显著多于对照组(P<0.05),术后24h差异无统计学意义。术前、术...     

急性ST段抬高型心肌梗死患者平均血小板体积的变化及与冠状动脉影像的关系

目的:探讨急性ST段抬高型心肌梗死（STEMI）患者平均血小板体积（MPV）变化及与冠脉影像的关系。方法: STEMI患者200例,测定MPV和血生化等实验室指标,行心脏超声检查,阅读急诊冠脉造影结果,分析直接经皮冠脉介入术后梗死相关动脉的血流。选择同期接受冠脉造影但排除冠心病的住院患者200例作为对照。结果: STEMI患者MPV显著高于对照组;校正其它影响因素后,MPV与高密度脂蛋白胆固醇（HDL-C）和左室射血分数（LVEF）呈独立负相关,与冠脉病变积分呈独立正相关;MPV于冠脉多支病变亚组显著高于单支病变亚组,左前降支为梗死相关动脉亚组显著高于左回旋支亚组,梗死相关动脉无自发性开通亚组显著高于自发性开通亚组,直接经皮冠脉介入术后没有达到TIMIⅢ级血流的亚组显著高于达到TIMIⅢ级血流的亚组。结论: STEMI患者MPV显著升高,与冠脉病变严重程度和梗死相关动脉的慢血流有密切关系。     

GP Ⅱb/Ⅲa受体拮抗剂对STEMI患者急诊PCI治疗中TIMI血流的影响

目的 探讨ST段抬高型急性心肌梗死（STEMI）患者急诊经皮冠状动脉介入（PCI）治疗中运用血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对患者梗死相关血管血流的影响作用。方法 按照就诊顺序将92例STEMI患者分为试药组和对照组各46例,试药组患者行PCI前1~3 h冠脉内应用替罗非班,对照组直接行PCI,比较两组患者PCI中梗死相关血管的急性心肌梗死溶栓试验(TIMI)血流情况、主要心血管不良事件及预后情况。结果 PCI术前,研究组的TIMI血流分级Ⅲ级（33%）、Ⅱ级（43%）高于对照组的Ⅲ级和Ⅱ级构成比,试药组的TIMI血流分布显著优于对照组（P<0.05）。PCI术后,试药组的TIMI血流分级Ⅲ级（91%）、Ⅱ级（9%）与对照组的Ⅲ级（85%）、Ⅱ级（15%）分布比较接近,两组PCI术后TIMI血流分级比较差异不显著。PCI术前与术后,试药组的TIMI心肌再灌注(TMP)血流分级分布均显著的优于对照组（P<0.05）。PCI术后住院期间,两组患者的主要心血管不良事件发生率、术后左室射血分数值,血小板计数减少情况比较差异均不显著。结论 急诊PCI术前常规应用替罗非班对改善术前梗死血管血流、心肌灌注、术后心肌灌注均有显著作用。     

Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study

Most patients with acute ST-elevation myocardial infarction (STEMI) cannot receive timely primary percutaneous coronary intervention (PCI) because of lack of facilities or delays in patient transfer or catheterization team mobilization. In these patients, early routine post-thrombolysis PCI might be a reasonable, useful strategy. This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90?min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3-24?h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients were enrolled and underwent diagnostic angiography 3-11.3?h (median 6.5?h) after thrombolysis. Forty-six patients underwent PCI. No procedure-related complications occurred, except two patients who had no reflow after PCI. Twenty-two (47.8%) patients had TIMI grade 3 flow before PCI and 33 (71.7%) after PCI. CTFC was significantly improved after PCI (48.5?±?32.1 vs. 37.9?±?25.6, P?=?0.01). MBG and TMPFC exhibited a similar improving trend after PCI, and the best myocardial perfusion tended to be achieved 3-12?h after lysis. During the 30-day follow-up, there were two deaths. The composite end point of death, cardiogenic shock, heart failure, reinfarction, and recurrent ischemia occurred in four patients. TIMI minor bleeding occurred in four patients. No TIMI major bleeding and stroke occurred. Early routine PCI after half-dose alteplase thrombolysis in Chinese population appears feasible. A larger clinical trial should be designed to further elucidate its efficacy and safety. Early PCI after thrombolysis in STEMI: The EARLY-PCI pilot feasibility study, ChiCTR-TNC-11001363.     

疏血通注射液对STEMI患者直接PCI术心肌灌注和临床预后的影响

目的 探讨应用疏血通注射液对ST段抬高型急性心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）术后心肌灌注和临床预后的影响。方法 80例行直接PCI的STEMI患者随机分为疏血通组（40例）和替罗非班组（40例）,比较两组基础临床情况、介入治疗结果、术后30 min ST段回落情况、出血事件、住院期间左室射血分数(LVEF)及6个月内主要心脏不良事件(MACE)（死亡、再次心肌梗死、靶血管的再次血运重建、严重心力衰竭）。结果 共有79例完成试验,两组术前血管开通率、术后TIMI血流、校正的TIMI血流帧数（CTFC）、术后30 min ST段回落>50%的获得率、出血事件、住院和随访期间MACE的发生率均无明显差异。疏血通组和替罗非班组在住院期间各有1例死亡,在6个月随访期间疏血通组有1例死亡,1例复发心肌梗死,替罗非班组有1例行冠状动脉旁路移植术。结论 疏血通注射液联合STEMI直接PCI术在改善PCI术后的心肌灌注和患者的临床预后方面与替罗非班无显著差异。     

急性心肌梗死介入治疗中应用抽吸导管对心肌再灌注的影响

目的:分析在急性ST段抬高型心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)中应用抽吸导管对心肌再灌注影响.方法:首次STEMI行PCI患者80例,随机分为试验组(41例,应用抽吸导管后再行PCI),对照组(39例,直接行PCI).比较2组术后即刻计算校正TIMI计帧数和心肌Blush分级、术中慢复流现象、心电图90 min ST段下降率.在术后24 h、1周时应用心肌声学造影计算灌注对比积分指数(CSI)、室壁运动积分指数(WMSI).结果:PCI后试验组的校正TIMI计帧数明显低于对照组,Blush分级≥2级获得率高于对照组,慢复流现象减少;再通后90 min心电图相关导联ST段下降率试验组明显大于对照组(P<0.05).同时在研究的每一个时点,试验组CSI、WMSI较对照组明显降低(P<0.05).结论:在STEMI急诊行PCI中应用抽吸导管可改善梗死相关血管前向血流情况,改善心肌再灌注,减少无复流现象.     

Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent: MICAMI–MGUARD

BackgroundDistal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI).ObjectiveAssess the efficacy of a mesh covered stent (MGuard? stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS).MethodsForty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC).ResultsAt baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up.ConclusionsIn this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.     

Effect of trimetazidine on myocardial salvage index in patients with acute ST segment elevation myocardial infarction undergoing primary PCI

IntroductionAcute STEMI is the most serious presentation of CAD. Restoration of the coronary flow facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. However, reperfusion may result in paradoxical cardiomyocyte dysfunction, a phenomenon termed reperfusion injury. Trimetazidine is a metabolic anti-ischemic drug which is beneficial in reducing periprocedural myocardial reperfusion injury.The aim of the work is to study the effect of trimetazidine on myocardial salvage index in patients with acute STEMI who underwent primary PCI.MethodsForty patients presented with acute STEMI, underwent primary PCI with injection of an intravenous dose of Tc-99m labeled Sestamibi before primary PCI then first set of SPECT images were taken within 6 h from injection time to assess the initial size of the perfusion defect. Prior to discharge the patients received another dose of Tc-99m labeled Sestamibi and follow up SPECT images were taken to assess the final perfusion defect and to calculate myocardial salvage and myocardial salvage index.Twenty patients of them received trimetazidine before primary PCI (study group) and the other twenty patients did not receive trimetazidine (control group).Results(1) Patients with acute STEMI undergoing primary PCI who received trimetazidine before primary PCI had better myocardial salvage index, however it was statistically non significant. (2) Statistically significant better myocardial salvage index with post procedural TIMI 3 flow than with post procedural TIMI 2 flow among patients who received trimetazidine before primary PCI.ConclusionIn the presence of post procedural TIMI3 flow trimetazidine is beneficial in improving myocardial salvage index in patients presented with acute STEMI who underwent primary PCI.     

急性ST段抬高心肌梗死急诊介入治疗后心肌再灌注不良对近、远期预后的影响

目的 探讨急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)后心肌再灌注状态不良的发生率及其对近、远期临床预后的影响.方法 回顾性收集964例急性ST段抬高心肌梗死(STEMI)行急诊PCI治疗患者的临床资料、冠状动脉造影资料与心电图,以ST段回落程度与心肌梗死溶栓试验心肌灌注(TMP)分级等指标评估心肌再灌注状态.患者分为4组:A组为ST段回落率≥50%并且术后TMP分级为Ⅲ级;B组为ST段回落率<50%并且术后TMP分级为Ⅲ级;C组为ST段回落率≥50%并且术后TMP分级≤Ⅱ级;D组为ST段回落率<50%并且术后TMP分级≤Ⅱ级.以A组代表心肌灌注状态良好者,D组代表心肌灌注状态不良者.分析心肌再灌注不良患者的发生率及其对近远期预后的影响.结果 STEMI急诊PCI术后梗死相关动脉前向血流达到TIMIⅢ级而TMP分级为Ⅱ级以下者占27.3%(237/964),心电图ST段回落小于50%者占30.6%(266/964).11.31%(109/964)的患者发生远端栓塞.A组占总例数的48.9%(425/964),D组占总例数的10.5%(91/964).与A组比较,D组患者在住院期间(RR=64.63,P<0.01)以及随访期间(RR=11.69,P<0.01)均有较高的主要不良心脏事件发生风险.结论 急性心肌梗死急诊PCI后不到50%的患者心肌再灌注良好,心肌再灌注状态与近、远期临床预后显著相关.     

盐酸替罗非班对急性心肌梗死急诊经皮冠状动脉介入治疗中TIMI血流影响的临床研究

目的分析Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对ST段抬高急性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)治疗中TIMI血流的影响。方法选择急诊入院STEMI患者48名,分为试验组(盐酸替罗非班+PCI)27例和对照组(直接PCI)21例。收集所有病例的临床和冠状动脉造影资料,观察PCI术前、术后TIMI血流情况。结果试验组于术前应用盐酸替罗非班使PCI前梗死相关血管TIMI血流分级提高,试验组达1级血流者比例高于对照组(37%比9.5%,P<0.05);对照组完全闭塞者比例明显高于试验组(38.1%比7.4%,P<0.01);两组患者PCI术后TIMI3级血流比例差异无统计学意义,TIMI2级血流比例试验组低于对照组。结论Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班可改善STEMI患者梗死相关血管的TIMI血流。     

ST changes before and during primary percutaneous coronary intervention predict final infarct size in patients with ST elevation myocardial infarction

BackgroundIn patients with ST elevation myocardial infarction (STEMI), spontaneous ST resolution (spontSTR) is a marker of successful microvascular reperfusion. The significance of increase in ST elevation during reperfusion therapy (the ST peak phenomenon), however, is controversial.AimsThe purpose of the study was to evaluate whether preprocedural and periprocedural ST changes predict final infarct size (IS) in STEMI patients treated with primary percutaneous coronary intervention (primary PCI).MethodsTwelve-lead electrocardiograms (ECGs) were acquired in the prehospital phase and on admission in 200 STEMI patients transferred for primary PCI. Continuous ST monitoring was performed during and 90 minutes after primary PCI. The exact timing of interventional procedures and the resulting thrombolysis in myocardial infarction (TIMI) flow were registered. A 1-month single-photon emission computerized tomography was performed to evaluate IS. Patients were stratified into groups according to preprocedural and periprocedural ST changes as follows: patients with spontSTR before primary PCI and without (A) or with (B) ST peak during primary PCI and patients with persistent ST elevation before primary PCI and without (C) or with (D) ST peak during primary PCI.FindingsGroups A (n = 45), B (n = 10), C (n = 109), and D (n = 36) differed with regard to IS (median, 2%, 3%, 13% vs 22% of the left ventricle; P < .0001). In multivariable analysis adjusting for baseline characteristics, preprocedural and periprocedural ECG findings and routine angiography findings, spontSTR was associated with smaller IS (B = ?8.6%; P < .001), whereas the ST peak phenomenon was associated with larger IS (B = +5.0%; P = .006). There was no difference in TIMI flow grades in relation to coronary interventions among patients with and without ST peak during primary PCI.ConclusionsIn STEMI patients, spontSTR before primary PCI and the ST peak phenomenon during primary PCI predict minor vs extensive IS independent of angiographic patency grades. Further studies are needed to clarify whether the ST peak phenomenon is “a marker of injury before reperfusion” or “a marker of reperfusion-induced injury.”     

Relation between leucocyte count, myonecrosis, myocardial perfusion, and outcomes following primary angioplasty

We examined whether leukocytosis is a negative prognostic factor in patients who underwent primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and, if so, determined whether it is associated with impaired myocardial perfusion. Previous studies have identified leukocytosis as a predictor of mortality in AMI. Whether this association holds in patients how have undergone primary PCI using contemporary pharmacotherapy and correlates with impaired myocardial perfusion is unknown. Clinical outcomes and reperfusion success, using Thrombolysis In Myocardial Infarction (TIMI) flow and myocardial blush grades, were examined according to tertiles of baseline leukocyte count in 1,268 patients who underwent primary PCI for AMI in the CADILLAC trial. Patients with higher leukocyte count were younger and more likely to be current smokers. Preprocedure TIMI grade 0 flow was more frequent in patients with higher leukocyte counts, but postprocedural TIMI grade 3 flow rates were equally high (>94%) in all 3 groups. Myocardial blush grade 2/3 was achieved at similar rates after PCI in patients with low, intermediate, and high baseline leukocyte counts (52.0% vs 51.5% vs 50.1%, p = 0.8). Higher baseline leukocyte counts were associated with greater myonecrosis (p <0.0001) and increased mortality at 1 year (2.7% vs 4.6% vs 5.4%, respectively, p = 0.047). By multivariate analysis, baseline leukocyte count (in increments of 1,000, hazard ratio 1.07, 95% confidence interval 1.02 to 1.10, p = 0.005) and peak creatine phosphokinase (hazard ratio 1.22, 95% confidence interval 1.14 to 1.29, p <0.001) were independent predictors of 1-year mortality. In conclusion, baseline leukocytosis is an independent correlate of larger infarct and increased mortality after primary PCI in AMI, an effect not explained by decreased myocardial perfusion.     

Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level

BACKGROUND:

Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.

OBJECTIVE:

To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.

METHODS:

A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.

RESULTS:

Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).

CONCLUSION:

Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.     

盐酸替罗非班对急诊经皮冠状动脉介入治疗无再流现象的影响

目的：观察盐酸替罗非班对ST段抬高急性心肌梗塞（STEMI）患者急诊经皮冠状动脉介入治疗（PCD中血流的影响。方法：一选择急诊入院STEMI患者43名，随机分为盐酸替罗非班组23例和对照组20例。替罗非班组PCI术前开始应用盐酸替罗非班，持续泵人至术后36-48h。对照组应用常规PCI。收集所有病例的临床及冠状动脉造影资料，观察PCI术前、术后血流情况。结果：替罗非班组急诊PCI术后TIMI血流3级的发生率（94％）较对照组（89％）显著增加（P〈0．05）。结论：替罗非班可改善STEMI患好梗塞相关血管的TIMI血流。     

Intracoronary thrombectomy with the export aspiration catheter before angioplasty in patients with ST-segment elevation myocardial infarction

OBJECTIVE: We aimed to assess the safety and feasibility of thrombectomy with the Export Aspiration Catheter (EAC) before angioplasty, and its ability to improve angiographic results in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Distal embolization of atherothrombotic material often occurs during angioplasty in STEMI, compromising optimal myocardial reperfusion. METHODS: We performed a thrombus-aspiration with EAC prior to angioplasty in 64 consecutive patients with STEMI. Successful thrombectomy was defined as an improvement of TIMI flow grade >or=1. RESULTS: Successful thrombectomy (increase of TIMI flow >or=1) was achieved in 40 patients (62.5%). Mean TIMI flow grade increased from 0.7 +/- 1 to 1.9 +/- 1.2 (p < 0.0001) after thrombectomy. TIMI flow grade 3 was observed more frequently after EAC compared with guidewire alone (51.5% vs. 9%, p = 0.0062). Direct stenting was performed in most of the patients (n = 41, 64%). Distal embolization and no reflow/slow flow phenomenon occurred in 8 patients (12.5%). No vessel injury after EAC thrombectomy was reported. After treatment with balloon angioplasty and/or stenting, final TIMI flow grade 3 was achieved in 54 patients (84.5%). By multivariate analysis, ischemic time < 6 hours was a significant independent predictor of successful thrombectomy (p = 0.0437). CONCLUSIONS: Our series suggests that EAC thrombectomy prior to angioplasty in the setting of STEMI is safe and feasible. It might reduce the culprit coronary lesion's thrombus burden, leading to improved flow restoration and myocardial reperfusion. Further large randomized studies are warranted to confirm these preliminary results and to assess the impact of thrombus-aspiration on infarct size as well as on clinical outcomes.     

血栓抽吸导管在冠脉介入治疗中对血栓病变TIMI血流的影响

目的:探讨血栓抽吸导管在经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中对于血栓病变TIMI血流的影响。方法:对我院1年来急性冠脉综合征(ACS)冠状动脉造影(CAG)显示靶病变相关血管(target-related artery,TRA)血栓负荷的患者48(男35,女13)例,年龄(58±8)岁,随机分成试验组(血栓抽吸+PCI,n=25)与对照组(直接PCI,n=23)。收集所有病例的临床和CAG资料,对比两组患者PCI术中相关血管心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流情况。结果:试验组患者PCI术中无复流及慢血流发生率明显低于对照组(0%vs.17%,P0.05),两组患者PCI术后TIMIⅢ级血流无显著差异。结论:对于冠脉有血栓负荷病变进行血栓抽吸可以明显改善ACS患者IRA远端的前向血流,降低无复流现象的发生。