Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization?

AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12.1 years old; 80% males),two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction(STEMI) patients(in which reperfusion wassuccessfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction(NSTEMI) patients(percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event(95%CI of the mean 23.3-28.0). Primary endpoint was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events(MCE,defined as mortality or readmission for new MI,new revascularization,episodes of heart failure or stroke). Possible correlations between HRV parameters(mainly the standard deviation of all normal RR intervals,SDNN),clinical features(age,sex,type of MI,history of diabetes,left ventricle ejection fraction),angiographic characteristics(number of coronary arteries with critical stenoses,success and completeness of revascularization) and long-term outcomes were analysed.RESULTS Markedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN 70 ms was found in 16% and SDNN 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN(χ~2 =1.536,P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis(respectively: P = 0.008 and P = 0.008),while no correlation was found between depressed SDNN and history of previous MI(P = 0.999) or number of diseased coronary arteries(P = 0.428) or unsuccessful percutaneous coronary intervention(PCI)(P = 0.691). Patients with left ventricle ejection fraction(LVEF) 40% presented more often SDNN values in the lowest quartile(P 0.001). After 2 years from infarction,a total of 10 patients(3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI(P = 0.141),although all-cause and cardiac mortality were higher among NSTEMI cases(respectively: 14% vs 2%,P = 0.001; and 10% vs 1.5%,P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN(respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles(P = 0.540),with no difference for STEMI(P = 0.180) or NSTEMI patients(P = 0.541). By the contrary,eventsfree survival was worse if patients presented with LVEF 40%(P = 0.001).CONCLUSION In our group of patients with a recent complicated MI,abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases,and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression ofHRV parameters recorded in the subacute phase of the disease,both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.     

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease: optimal medical therapy versus revascularization

Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy (OMT) and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients (65–92 years of age) with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who underwent OMT than in those who underwent revascularization (6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04). However, the overall risks of major adverse cardiac cerebrovascular events (MACCE) were similar among all patients (6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67). Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.     

血栓抽吸导管在老年人急性心肌梗死治疗中的应用

Objective To evaluate the application of ZEEK thrombus aspiration catheter in treatment of acute myocardial infarction (AMI) in elderly patients. Methods The 52 patients with ST-elevation myocardial infarction(STEMI)were treated with percutaneous coronary intervention (PCI) plus thrombus aspiration by using ZEEK thrombus aspiration catheter (ZEEK group), and 42 STEMI patients were treated only with PCI (control group). The regression rate of ST segment, left ventricular ejection fraction (LVEF), incidence of no-reflow and mortality were followed up after PCI during hospitalization. Results No-reflow occurred in 5 (11.9%) patients and 1 (1.9 %) patient in the control group and ZEEK group, respectively. And 2 deaths were encountered only in the control group. The differences between the two groups were statistically significant (P＜0.05).Conclusions AMI treatments with PCI and application of ZEEK aspiration thrombus catheter are safe and effective. The two methods could lower thrombosis burden, may improve distal myocardium perfusion and cardiac function after the procedure.     

血栓抽吸导管在老年人急性心肌梗死治疗中的应用

Objective To evaluate the application of ZEEK thrombus aspiration catheter in treatment of acute myocardial infarction (AMI) in elderly patients. Methods The 52 patients with ST-elevation myocardial infarction(STEMI)were treated with percutaneous coronary intervention (PCI) plus thrombus aspiration by using ZEEK thrombus aspiration catheter (ZEEK group), and 42 STEMI patients were treated only with PCI (control group). The regression rate of ST segment, left ventricular ejection fraction (LVEF), incidence of no-reflow and mortality were followed up after PCI during hospitalization. Results No-reflow occurred in 5 (11.9%) patients and 1 (1.9 %) patient in the control group and ZEEK group, respectively. And 2 deaths were encountered only in the control group. The differences between the two groups were statistically significant (P＜0.05).Conclusions AMI treatments with PCI and application of ZEEK aspiration thrombus catheter are safe and effective. The two methods could lower thrombosis burden, may improve distal myocardium perfusion and cardiac function after the procedure.     

Predictive value of HbA1c level for in-hospital acute coronary syndrome patients with diabetes

Background Diabetes mellitus (DM) is the major risk factor of coronary artery disease (CAD), and the control status of blood sugar has direct effect on the prognosis of CAD. HbA1c is the important parameter reflecting control status of blood sugar, however, it is unclear about the value of in-hospital HbA1c in patients with acute coronary syndrome (ACS). Methods A retrospective analysis was performed for 236 in-hospital diabetic patients with ACS. Patients were stratified into two groups according to HbA1c level when admission (Well controlled group (HbA1c≤7.0%) and High HbA1c group (HbA1c > 7.0% ); major adverse cardiovascular events (MACE) group and Non-MACE group). In-hospital MACE and mortality were set as the observation target. Results 282 patients (112 in Well controlled group and 170 in High HbA1c group) were enrolled, of which 146 (51.77%), 63 (23.34%), and 73 (25.89%) patients respectively had unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Inhospital all-cause mortality and in-hospital MACE were both similar in Well controlled group and High HbA1c group (6.25% vs. 7.06% and 15.18% vs. 16.47%, P > 0.05). In MACEs, cardiac death (4.46% vs. 5.29%), recurrent myocardial infarction (2.68% vs. 2.94%), hemorrhage events (5.35% vs. 5.29%), malignant arrhyth- mia (6.25% vs. 5.29%), cardiac shock (4.46% vs. 4.12%), acute heart failure (8.93% vs. 10.0%), revascularization (4.46% vs. 5.29%) were also all similar in both two groups. In addition, there were no significant difference in HbA1c level between MACE group and Non-MACE group. Single-factor logistic regression analysis showed that HbA1c was not a risk factor for in-hospital MACE (P > 0.05) 1 . Conclusion The present study sug-gests that admission HbA1c is not the risk factor of in-hospital MACE in ACS patients with diabetes.     

老年无保护左主干病变置人药物洗脱支架与行冠状动脉旁路移植术的预后比较

Objective To compare the 2 years outcome of elderly patients with ULMCA stenesis undergoing coronary artery bypass grafting (CABG) or drug eluting stent(DES). Methods From January 2004 to June 2006, 295 patients with ULMCA stenosis and age ≥ 70 years undergoing coronary revascularization with either CABG (n = 206) or DES (n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up. Results The cumulative rate of 2-year mortality were 10.2% (n = 21) in CABG-treated patients and 13.3% (n = 12) in DES-treated patients (P = 0.428). The survival rate during 2-year follow-up was 89.2% for CABG-treated patients and 86. 4% for DES-treated patients (P = 0.668). The incidence of 2-year myocardial infarction was 7. 8% (n = 16) in CABG-treated patients and 10.1% (n =9) in DES-treated patients (P = 0.501). The incidence of target lesion revascularization (TLR) was 4.9% (n=10) in CABG-treated patients and 13.5% (n = 12) in DES-treated patients (P=0.015). In the multivariable analysis, age (HR: 1.04,95% CI: 1.01-1.09, P=0.024), left ventricular dysfunction (ejection fraction < 30%, HR: 4. 97,95 % CI: 1.22-24. 85, P=0.018) and type 2 diabetes (HR: 2.22, 95% CI:1.31-4.86,P=0.001) were independent predictors of 2-year mortality. Conclusion In this study, 2-yaer mortality was comparable in elderly patients with ULMCA stenesis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.     

Thirty-day outcomes of in-hospital multi-vessel versus culprit-only 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 ...     

Prognostic factors of non-infarct-related arterial revascularization in STEMI patients with multivessel disease

Background Multivessel disease(MVD) is common in patients presenting with ST-segment elevation myocardial infarction(STEMI). But there is controversy over how to manage significant lesions in non-infarct-related artery(non-IRA). Methods A total of 221 patients diagnosed with STEMI and MVD who underwent percutaneous coronary intervention(PCI) at our cardiology department between January 2018 and June 2021 were included in this study. Among them, 115 patients underwent complete revascularization w...     

Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction: a multicenter random-ized clinical trial

Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction (STEMI) patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a prospective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate (40%–70%) stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban (15 μg/kg) were enrolled and were randomly assigned (1: 1) to stenting group (n = 201) and non-stenting group (n = 198). In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention (PCI) with stent implantation. In non-stenting group, patients received pharmacologic therapy and PCI (thrombectomy), but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiac death, non-fatal myocardial infarction (MI), repeat revascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complication. Median follow-up time was 12.4 ± 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group (adjusted HR: 0.42, 95% CI: 0.19–0.89, P = 0.02). The stenting group had lower non-fatal MI rate than non-stenting group, (1.5% vs. 5.5%, P = 0.03). The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.     

Coronary artery bypass graft surgery versus drug-eluting stents for patients with isolated proximal left anterior descending disease

Background Few recent studies have compared the outcomes of coronary artery bypass graft(CABG) surgery with percutaneous coronary interventions(PCIs) in patients with isolated(single vessel) proximal left anterior descending(PLAD) coronary artery disease in the era of drug-eluting stents(DES).Objectives The goal of this study was to compare outcomes in patients with PLAD who underwent CABG and PCI with DES.Methods New York's Percutaneous Coronary Interventions Reporting System was used to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008 and December 31, 2010, and who were followed-up through December 31, 2011. A total of 5,340 of 6,064(88%) patients received DES. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York's administrative data to obtain readmissions for myocardial infarction(MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and / or DES pairs, and3 outcome measures were compared across the pairs.Results Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and /or stroke, but repeat revascularization rates were lower for CABG(7.09% vs. 12.98%; P = 0.0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates(CABG and / or DES adjusted hazard ratio(AHR): 1.14; 95% confidence interval [CI]: 0.70 to 1.85) or mortality, MI, and / or stroke rates(AHR: 1.15; 95% CI: 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients(AHR: 0.54; 95% CI: 0.36 to 0.81).Conclusions Despite the higher rating in current guidelines of CABG(Class Ⅱa vs. Class Ⅱb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and / or stroke, although CABG patients had significantly lower repeat revascularization rates.(From: Journal of the American College of Cardiology Volume 64, Issue 25, 30 December 2014, Pages 2717-2726)     

不同类型老年急性心肌梗死患者的临床特点比较

目的探讨不同类型老年急性心肌梗死患者的临床特点及血运重建状况。方法对比分析262例ST段抬高心肌梗死(STEMI)患者(STEMI组)和189例非ST段抬高心肌梗死(NSTEMI)患者(NSTEMI组)的临床特点,冠状动脉病变及院内血运重建情况。结果与NSTEMI组比较,STENM1组患者男性比例多,平均年龄相对偏小,典型胸痛症状比例高,血肌酸激酶和肌酸激酶同工酶明显高,差异有统计学意义(P<0.05)。而NSTEMI组患者伴有高血压、血脂异常和2型糖尿病比例多,差异有统计学意义(P<0.05)。NSTEMI组多支血管病变、弥漫病变、≥90%严重狭窄的梗死相关动脉(IRA)比例、IRA闭塞的侧支循环开放率均明显高于STEMI组(P<0.05,P<0.01);而IRA完全闭塞率低于STEMI组,差异有统计学意义(P<0.01)。NSTEMI组住院期间血运重建率显著低于STEMI组,差异有统计学意义(P<0.01)。2组院内主要不良心脏事件发生率类似。结论老年NSTEMI患者临床合并症较多,冠状动脉病变较重,血运重建比例低。     

Long-term prognosis of first myocardial infarction according to the electrocardiographic pattern (ST elevation myocardial infarction, non-ST elevation myocardial infarction and non-classified myocardial infarction) and revascularization procedures

The aim of this study was to describe differences in the characteristics and short- and long-term prognoses of patients with first acute myocardial infarction (MI) according to the presence of ST-segment elevation or non-ST-segment elevation. From 2001 and 2003, 2,048 patients with first MI were consecutively admitted to 6 participating Spanish hospitals and categorized as having ST-segment elevation MI (STEMI), non-ST-segment elevation MI (NSTEMI), or unclassified MI (pacemaker or left bundle branch block) according to electrocardiographic results at admission. The proportions of female gender, hypercholesterolemia, hypertension, and diabetes were higher among NSTEMI patients than in the STEMI group. NSTEMI 28-day case fatality was lower (2.99% vs 5.26%, p = 0.02). On multivariate analysis, the odds ratio of 28-day case fatality was 2.23 for STEMI patients compared to NSTEMI patients (95% confidence interval 1.29 to 3.83, p = 0.004). The multivariate adjusted 7-year mortality for 28-day survivors was higher in NSTEMI than in STEMI patients (hazard ratio 1.31, 95% confidence interval 1.02 to 1.68, p = 0.035). However, patients with unclassified MI presented the highest short- and long-term mortality (11.8% and 35.4%, respectively). The excess of short-term mortality in unclassified and STEMI patients was mainly observed in those patients not treated with revascularization procedures. In conclusion, patients with first NSTEMI were older and showed a higher proportion of previous coronary risk factors than STEMI patients. NSTEMI patients had lower 28-day case fatality but a worse 7-year mortality rate than STEMI patients. Unclassified MI presented the worst short- and long-term prognosis. These results support the invasive management of patients with acute coronary syndromes to reduce short-term case fatality.     

肌钙蛋白T与降钙素基因相关肽对急性冠状动脉综合征患者危险分层及预后评估的价值

目的　探讨肌钙蛋白T(cTnT)与降钙素基因相关肽 (CGRP)对急性冠状动脉综合征 (ACS)患者危险分层及预后评估的价值。方法　选择ACS患者 15 8例 ,其中ST段抬高心肌梗死 (STEMI) 72例 ,非ST段抬高心肌梗死(NSTEMI) 2 3例 ,不稳定型心绞痛 (UA) 6 3例 ,入院后立即抽取肘静脉血采用ELISA法测定cTnT和CGRP水平 ,并观察患者住院期间和随访 6个月期间主要心血管事件 (MACE)。结果　NSTEMI组与STEMI组相比 ,cTnT及CGRP水平无显著性差异 ,但NSTEMI组CGRP水平高于STEMI组 ,cTnT水平低于STEMI组。与STEMI组相比 ,UA组患者cTnT水平明显降低 (P <0 .0 5 ) ,而CGRP水平显著增高 (P <0 .0 5 )。陈旧心肌梗死、左心室射血分数、cTnT及CGRP水平是ACS患者MACE发生的独立预测因子。结论　cTnT及CGRP水平在NSTEMI组与STEMI组相似 ,在心绞痛组cTnT亦有轻度增高 ;心肌梗死较心绞痛患者发病时CGRP水平低 ;cTnT及CGRP水平是ACS患者MACE发生的独立预测因子。     

Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction

ObjectivesThe aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era.BackgroundData regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era.MethodsThe National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described.ResultsThe analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort.ConclusionsContemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post–myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.     

非ST段抬高急性心肌梗死患者的临床特点及不良事件发生率分析

目的探讨非ST段抬高急性心肌梗死的临床特点及住院不良事件发生率。方法回顾性分析我院急性心肌梗死患者105例,分为ST段抬高组（n=68）和非ST段抬高组（n=37）,分析比较两组患者的冠状动脉造影特点及住院不良事件发生率。结果冠状动脉造影示病变血管数差异无显著性意义（P〉0．05）;非ST段抬高组以老年人多见（71％）,其中〉60岁的女性患者占41％,相关血管不完全闭塞比例较高、累及非主支血管较多,且梗死相关血管周围多有侧支循环形成。非ST段抬高组总住院不良事件（包括心力衰竭、再次心肌梗死、再次冠脉介入治疗和脑卒中等）的发生率明显较低,差异有显著性意义（P〈0．01）,但住院病死率和消化道出血发生率差异无显著性意义（P〉0．05）。结论非ST段抬高者以老年、女性患者居多,临床表现和冠状动脉造影的结果不典型,但有较好的近期预后。     

CD14+ monocyte levels in subgroups of acute coronary syndromes

OBJECTIVES: We aimed to investigate whether there were any differences in the percentages of CD14(+) monocytes between subgroups of acute coronary syndromes (ACS). CD14(+) is a monocyte surface receptor that plays a role in the innate immune system. CD14(+) monocytes are associated with complications of atherosclerosis. METHODS: In total we enrolled 115 patients with ACS: 24 with unstable angina (UA); 29 with non-ST elevation myocardial infarction (NSTEMI); and 62 with ST elevation myocardial infarction (STEMI). The levels of C-reactive protein and percentage of CD14(+) monocyte were measured on admission. RESULTS: CD14(+) monocyte percentages were observed to be different between groups by analysis of variance test. The percentages of CD14(+) monocyte were 81.24+/-10.04% in the UA group; 89.40+/-5.84% in the NSTEMI group; and 87.22+/-11.75% in the STEMI group (P=0.013). The differences between the UA and the NSTEMI and between the UA and the STEMI groups with Bonferroni posthoc testing were significant (P=0.014 and P=0.049 respectively). Moreover, no significant difference was found between the NSTEMI and STEMI groups (P=1.000). The C-reactive protein levels in the UA group were detected to be significantly low with Bonferroni posthoc testing compared with both the NSTEMI and STEMI groups (for both comparisons, P<0.002). CONCLUSIONS: A significant difference in CD14(+) monocyte percentages between subgroups of ACS was determined. CD14(+) monocyte percentages can be a useful parameter in differentiating between the subgroups of ACS, especially between UA and myocardial infarction.     

Effect of completeness of revascularization on clinical outcome in patients with multivessel disease presenting with unstable angina who undergo percutaneous coronary intervention

We evaluated the current short- and medium-term outcomes of complete revascularization, compared to culprit lesion percutaneous coronary intervention (PCI), in patients with multivessel coronary disease presenting with unstable angina. One hundred fifty-one patients with multivessel coronary disease presented to a tertiary cardiothoracic center with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) between January 2000 and September 2001. In group A (n=71), the intended strategy was complete revascularization by multivessel PCI. In group B (n=80), culprit lesion PCI was intended despite the presence of other lesions amenable to PCI (B1) or due to confounding anatomical factors (B2). Clinical variables and endpoints were collected from patient notes, a dedicated database and telephone follow-up, and included recurrent stable and unstable angina, need for repeat PCI or elective coronary artery bypass graft, incidence of non-fatal myocardial infarction (MI) and death. Baseline characteristics were similar in each group. Procedural success was achieved in over 95% of cases in both groups with high stent implantation rates (>96%). There was no observed difference in mortality or incidence of MI between the groups. Compared to group A, more patients in group B1 had residual angina [22.8% (13/57) versus 9.9% (7/71); p=0.041] and required further PCI [17.5% (10/57) versus 7.0% (5/71); p=0.045]. There was a non-significant trend toward fewer readmissions for UA and less long-term antianginal medication in group A [38.0% (27/71) versus 52.6% (30/57); p=0.043]. Complete and culprit lesion revascularization by PCI are safe methods of treating patients with multivessel coronary disease presenting with UA/NSTEMI. Reductions in residual angina, repeat PCI and need for antianginal therapies suggest that complete revascularization should be the strategy of choice when possible.     

非ST段抬高型与ST段抬高型急性心肌梗塞冠脉造影病变的对比

目的：比较非ST段抬高型与ST段抬高型急性心肌梗塞（AMI）病人冠状动脉血管造影结果。方法：回顾分析我院接受冠脉造影的268例AMI患者的资料,患者被分为A、B两组：A组为非ST段抬高型AMI（NSTEMI）。共148例,B组为ST段抬高型AMI（STEMI）,共120例。结果：非ST段抬高型AMI组冠脉造影病变的血管数及血管狭窄程度明显高于ST段抬高型AMI组的（P〈0．01）。4年随访中NSTEMI组死亡19例（12．8％）。STEMI组死亡9例（7．5％）,NSTEMI组死亡率显著高于STEMI组（P〈0．01）。结论：非ST段抬高型AMI的病情较ST段抬高型AMI更重。     

Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry)

Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50% of the time, potentially delaying treatment and resulting in worse outcomes. In contemporary practice, little is known about the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). We identified patients with myocardial infarction from April 2004 to June 2009 in the CathPCI Registry treated with percutaneous coronary intervention for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting. Logistic generalized estimating equation modeling was used to compare the outcomes, including in-hospital mortality between patients with STEMI and non-STEMI (NSTEMI) adjusting for differences in the baseline characteristics. Of the 27,711 patients with myocardial infarction and acute LCx territory occlusion, 18,548 (67%) presented with STEMI and 9,163 (33%) with NSTEMI. With the exception of a greater proportion of cardiac risk factors and cardiac history in the NSTEMI group, the demographic and baseline characteristics were clinically similar between the 2 groups, despite the statistical significance resulting from the large population. The patients with STEMI were more likely to have a proximal LCx culprit lesion (63% vs 27%, p <0.0001) and had greater risk-adjusted in-hospital mortality (odds ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002) compared to patients with NSTEMI. In conclusion, acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.     

Herzinfarktverbund Essen: Ergebnisse nach 1 Jahr

The myocardial infarction network "Herzinfarktverbund Essen" was initiated on September 1, 2004 in order to establish a standardized strategy and therapy for patients with ST elevation myocardial infarction (STEMI) in the city of Essen. The primary goal is the immediate reopening of the infarcted vessel by direct transfer of the patient to a hospital with 24-h stand-by catheter laboratory. The first 1-year follow-up, completed on August 31, 2006, showed a low 1-year mortality rate (11.2%), whereby 7.6% of the patients died in hospital. There was a significant dependency of mortality on age, the prehospital stability of cardiovascular circulation, the amount of left ventricular damage, the TIMI flow after intervention, and the duration of interventional therapy ("puncture-to-balloon" time). The coronary status, anticoagulation therapy as well as diabetes mellitus were also dependent variables, whereas the type of stent showed no influence. The rate of restenosis was greater with bare-metal stents (BMS) compared to the use of drug-eluting stents (DES). There was a low rate of repeated STEMI or NSTEMI (non-ST elevation myocardial infarction; 1.8%, 1.7%). These first long-term data confirm the successful implementation of treatment guidelines for STEMI patients within a standardized strategy in an urban environment.