国产雷帕霉素药物洗脱支架置入治疗急性心肌梗死108例

背景：大量临床实验已证明国产雷帕霉素药物洗脱支架在择期经皮冠状动脉支架置入中应用有较强的安全性和较好的生物相容性,但其应用于急性心肌梗死患者的安全性和有效性目前仍存在较大争议。 目的：观察雷帕霉素药物洗脱支架经皮冠状动脉置入急性心肌梗死患者的效果。 方法：纳入108例急性心肌梗死患者,男61例,女47例,年龄37~81岁,平均(57.2±13.1)岁。所有患者均行经皮冠状动脉支架置入,置入前后常规用药,观察梗死相关动脉TIMI血流结果,6~12个月门诊及电话随访,以心源性死亡、非致死性心肌梗死、靶血管血运重建的发生率为主要终点来判断临床事件。 结果与结论：支架置入后,梗死相关动脉血流TIMI分级为Ⅰ~Ⅱ级6例(5.6%),Ⅲ级102例(94.4%);支架置入成功率100%,临床成功率98.1%;支架置入后6,12个月主要不良心脏事件发生率分别为1.87%和3.74%。提示急性心肌梗死患者经皮冠状动脉置入雷帕霉素药物洗脱支架具有良好的安全性和有效性。     

雷帕霉素药物洗脱支架置入后发生血管再狭窄的相关因素及其安全性

目的：评价雷帕霉素药物洗脱支架置入的安全性,分析雷帕霉素药物洗脱支架支架血栓发生率和特征,探讨雷帕霉素药物洗脱支架治疗的患者中造影证实的支架血栓事件风险。 方法：以计算机检索方法在检索中国期刊全文数据库中(CNKI：1997/2009)检索关于雷帕霉素药物洗脱支架血栓形成原因分析及安全性的自身前后对照实验,检索词为“雷帕霉素、药物洗脱支架、金属裸支架、支架内血栓”。检索后对每项研究的资料结果进行提取、分析。 结果：共有12项实验3 839例雷帕霉素药物洗脱支架置入患者符合纳入标准,雷帕霉素药物洗脱支架置入后血管脉狭窄率均较术前降低,随访结果显示国产雷帕霉素洗脱支架与金属裸支架内血栓的发生率均较低,两者无显著性差异,再狭窄率国产雷帕霉素洗脱支架支架明显低于金属裸支架。远期临床随访结果表明,延长联合抗血小板治疗时间很有必要。 结论：雷帕霉素洗脱支架置入后的安全性尤其是晚期血栓问题的确值得关注,但发生率很低,临床实践中需要对雷帕霉素洗脱支架安全性以及危险与获益的相关性进行合理的判断。治疗多支血管病变时全部采用雷帕霉素洗脱支架优于金属裸支架,可获得较高的收益与风险比。     

急性心肌梗死置入药物洗脱支架与裸金属支架的安全性及即时效应比较

背景：药物洗脱支架越来越多应用于冠状动脉狭窄患者,效果良好。但急诊应用于急性心肌梗死患者的研究报道较少。 目的：对比观察Firebird支架(雷帕霉素洗脱支架)与普通金属裸支架在急性ST段抬高型心肌梗死急诊经皮腔内冠状动脉介入治疗中应用的安全性和临床疗效。 设计、时间及地点：回顾性分析,病例来自2006-01/2008-09洛阳150医院心内科。 对象：选择洛阳150医院心内科收治的ST段抬高型急性心肌梗死行直接经皮腔内冠状动脉介入治疗患者94例,男71例,女23例,年龄47~76岁。 方法：94例患者随机分为2组,Firebird支架组：均在靶病变置入Firebird支架1或2枚;普通支架组：在靶病变置入金属裸支架1或2枚。 主要观察指标：两组患者的安全性、临床疗效及随访情况。 结果：①94例患者介入治疗均获得成功。Firebird支架组52例,共置入68枚药物涂层支架;普通支架组42例,共置入56枚普通支架。两组平均置入支架个数、手术成功率、支架置入并发症发生率、置入前置入后平均狭窄程度及操作时间等差异均无显著性意义(P > 0.05);两组选用的支架内径相比,Firebird支架明显偏小(P < 0.01);两组支架长度相比,Firebird支架显著偏长(P < 0.05)。②住院期间观察两组患者心肌酶峰值,TnI峰值,血管开通后2 h ST段下降幅度,左室功能差异均无显著性意义(P > 0.05)。两组靶血管重建Firebird支架组1例,普通支架组2例,差异亦无显著性意义(P > 0.05)。两组各有2例患者死亡,住院期间心脏事件发生率差异无显著性意义(P > 0.05)。Firebird支架组和普通支架组平均住院时间差异无显著性意义[(11.3±4.2),(12.4±4.6)d,P > 0.05]。③出院后随访1~10个月,平均(6.5±2.4)个月,两组患者无心源性死亡、再梗死。普通支架组心绞痛发生率35.5%较Firebird支架组21.0%显著增高(P < 0.01)。Firebird支架组无心脏事件生存率95%;显著高于普通支架组78%(P < 0.01)。 结论：雷帕霉素药物洗脱支架与普通支架一样在ST段抬高型急性心肌梗死急诊经皮腔内冠状动脉介入中是安全有效的。     

1101/不同药物支架在急性心肌梗死治疗中的临床比较

目的：探讨进口西罗莫司药物洗脱支架（SES）和紫杉醇药物洗脱支架(PES)在急性ST 段抬高心肌梗死(STEMI) 患者急诊经皮冠状动脉介入治疗(PCI) 中应用的安全性和远期疗效。方法：选择我院心内科 2005 年7 月- 2008 年7 月收治的STEMI 且在发病12 h 内接受急诊置入药物洗脱支架的患者334例, 分为SES组(202例)和PES组( 132例)。比较2组随访1年时心脏事件( MACE) 的发生率。结果：随访 1年时的SES组与PES支架组在再发心肌梗死（1.5% vs 1.5%）和心脏性死亡（2.5% vs 3.0%）的发生率方面两组之间无统计学差异。造影随访结果显示:两组支架再狭窄率（5.0% vs 4.5%）无显著性差异,管腔内径丢失SES组为0.19±0.34mm,PES组0.19±0.37mm,两组无显著差异 。随访 1年时的 MACE 发生率 SES 支架组与 PES 组无显著性差异(8.9 % vs 9.1 % , P > 0 . 05)。结论: SES 和 PES 支架在STEMI 急诊PCI 中应用安全有效, 疗效相近。     

国产及进口雷帕霉素涂层支架在老年急性心肌梗死患者急诊介入治疗中的应用：随机分组随访比较★

目的：比较国产雷帕霉素洗脱支架（Firebird支架）和进口雷帕霉素洗脱支架（Cypher支架）在老年急性心肌梗死急诊冠状动脉介入治疗后的生物相容性及其安全性。 方法：选择2005-06/2007-01就诊于唐山工人医院心内科诊断急性心肌梗死且年龄 > 70岁患者共71 例, 患者及家属对治疗和实验知情同意。①采用计算机随机编码分成Cypher支架组37例和Firebird支架组34例。②行急诊介入治疗,共置入Cypher支架43枚,Firebird支架39枚。③随访6~9个月，观察比较置入两种支架后患者心绞痛再发率及主要不良心脏事件。6~9 个月复查冠状动脉造影,测量支架内最小管腔直径、病变节段内最小管腔直径、支架内晚期管腔丢失及节段内晚期管腔丢失。 结果：①两组患者一般情况、病变血管特征、冠状动脉介入治疗手术情况等差异无显著性意义。②临床随访9个月61例，总随访率85.9%（61/71），其中Cypher支架组86.5%（32/37）、Firebird支架组85.3%（29/34），两组比较差异无显著性意义。③主要不良心脏事件：Cypher支架组15.6%, Firbird支架组17.2%，两组比较差异无显著性意义。④复查冠状动脉造影，提示两组患者支架内再狭窄率、支架内最小管腔直径、节段内最小管腔直径、支架内晚期管腔丢失、节段内晚期管腔丢失差异无显著性意义（P > 0.05）。 结论：国产和进口雷帕霉素药物洗脱支架置入老年急性心肌梗死冠状动脉后临床效果有效，无特殊生物相容性和安全性问题，两种支架无明显差异。     

雷帕霉素药物洗脱支架置入前后稳定型心绞痛患者血清CXC趋化因子16的变化

背景：CXC趋化因子16作为一种炎症反应中的趋化因子冠状动脉粥样硬化发生机制中发挥重要作用。 目的：观察雷帕霉素药物洗脱支架置入前后稳定型心绞痛患者血清中CXC趋化因子16的变化。 方法：选择郑州大学第一附属医院心内科住院行冠状动脉支架置入并置入1或2枚雷帕霉素药物洗脱支架的稳定型心绞痛患者40例,另选同期于本院经冠状动脉造影显示无异常的健康者10名作为对照组。对受试者进行CXC趋化因子16、超敏C-反应蛋白检测,并分析其相互关系。 结果与结论：与对照组相比,血清CXC趋化因子16在支架置入前、置入后0.5,2,24 h均升高(P < 0.05);与置入前相比,置入后0.5,2 h升高(P < 0.01)。置入后0.5,2,24 h患者血清超敏C-反应蛋白较对照组显著升高(P < 0.01),其中置入后 0.5 h与2 h差异无显著性意义(P > 0.05),2 h高于24 h(P < 0.01)。血清CXC趋化因子16和超敏C-反应蛋白水平呈正相关性(r=0.632,P=0.017)。     

药物洗脱支架与金属支架生物相容性比较及支架置入后的血管再狭窄

药物洗脱支架与裸金属支架相比,最大的改进就是在原有裸金属支架平台上,增加了药物载体和药物。虽然冠状动脉支架的成功率和安全性有了提高,但是再狭窄仍然是限制支架应用的一个障碍。药物洗脱支架置入后的过敏反应已有报道。文章在药物洗脱支架与普通金属裸支架的生物相容性比较分析的基础上,对药物洗脱支架置入后的再狭窄进行了临床研究,探讨了支架再狭窄产生的原因并从临床实例角度综合研究了药物洗脱支架置入后再狭窄的新进展与启示。 关键词：冠状动脉粥样硬化性心脏病;药物洗脱支架;裸支架;生物相容性     

国产雷帕霉素支架置入后血管再狭窄与炎症指标的变化

背景：支架再狭窄是支架置入后血管壁受牵张和损伤引起炎症性愈合反应为特征的病理过程。炎症细胞在支架再狭窄中起了重要作用,针对这些炎性细胞是防治支架再狭窄的最佳选择,调节炎症反应可减少支架再狭窄。 目的：观察冠状动脉支架置入前后急性冠脉综合征患者炎症指标高敏C-反应蛋白、补体C3质量浓度的变化,分析冠状动脉支架置入后炎症反应与支架再狭窄的关系。 设计、时间及地点：对比观察,于2005-12/2009-05在邢台市人民医院心内科完成。 对象：纳入邢台市人民医院心内科收治的急性冠脉综合征行冠心病支架置入治疗的病例65例。 方法：65例急性冠脉综合征患者根据冠状动脉造影结果,行冠状动脉支架置入治疗,根据病变置入国产雷帕霉素药物洗脱支架——Firebird支架。 主要观察指标：支架置入前常规查血常规,置入6个月后复查冠状动脉血管造影。分别于支架置入前、支架置入后48 h、6个月取肘静脉血,检测高敏C-反应蛋白、补体C3质量浓度。 结果：65例患者中56例完成随访,临床再狭窄率为9%(5/56)。支架置入后48 h外周静脉血高敏C-反应蛋白、补体C3质量浓度均显著高于支架置入前(P < 0.05),支架置入后6个月显著低于支架置入后48 h (P < 0.05)。与非支架再狭窄组患者相比,支架再狭窄组支架置入前白细胞数、中性粒细胞百分比、高敏C-反应蛋白、补体C3质量浓度明显增高(P < 0.05),支架置入后48 h静脉血中高敏C-反应蛋白、补体C3质量浓度明显增高(P < 0.05)。 结论：支架再狭窄与炎症反应有关,雷帕霉素支架抑制支架再狭窄。     

药物洗脱支架与裸支架置入治疗冠心病的安全性及生物相容性比较

药物洗脱支架与裸金属支架相比，最大的改进就是在原有的裸金属支架平台上，增加了药物载体和药物。药物洗脱支架的药物载体主要是多聚物涂层，其目的是用于承载足够的药量，并在药物洗脱支架置入人体后能有效控制药物的分解、扩散和释放。在临床治疗中，聚合物载体的生物相容性及完整性会影响到药物洗脱支架的安全性，而聚合物载体对药物的控释性则影响到药物洗脱支架有效性。从目前的发展趋势来看，涂层药物要具备保护内皮的功能，在最大程度上保持支架表面的光滑度，从而提高支架的生物相容性，使支架平台和多聚载体可吸收、药物释放体系更科学,将是未来药物洗脱支架的发展方向。     

药物洗脱支架与金属支架置入后再狭窄及其生物相容性比较

目的：比较并总结金属裸支架与药物洗脱支架的生物相容性及支架置入后的冠状动脉再狭窄,展望生物可降解支架的临床应用。 方法：以药物洗脱支架,金属裸支架,生物相容性,再狭窄为检索词,检索中国期刊全文数据库(1999-01/2009-06),以drug eluting stent, bare metal stent, biocompatibility, restenosis为检索词,检索PubMed数据库(1999-01/2009-06),文献检索语种限制为中文和英文。以再狭窄率,支架的生物相容性及炎症因子的表达为评价指标。纳入药物洗脱支架与金属支架置入后血管再狭窄的临床研究;排除动物实验。 结果：计算机初检得到523篇文献,根据纳入排除标准,对金属裸支架与药物洗脱支架置入后血管再狭窄的临床研究进行分析。经皮冠状动脉支架置入已成为治疗冠状动脉粥样硬化性心脏病最常用的治疗方法,其主要包括球囊扩张、普通金属裸支架置入、药物洗脱支架置入。用普通金属裸支架取代球囊扩张,使支架内再狭窄由50%下降到20%~30%;药物洗脱支架改善了冠状动脉介入治疗的愈后,但同时也带来了许多新问题。大多数药物洗脱支架由药物、药物载体、支架平台3部分组成,其中金属支架和聚合物不能被人体吸收。金属置入物和药物载体长期存留于血管中,影响内皮化、引起局部的慢性炎症反应和后期的血栓形成。 结论：药物洗脱支架在防止支架内再狭窄及再次血运重建明显优于普通金属裸支架。生物可降解支架的临床应用,在一定程度上减少了药物载体对血管内皮的影响。     

Efficacy and safety of enoxaparin in unselected patients with ST-segment elevation myocardial infarction

In randomized clinical trials the low-molecular-weight heparin enoxaparin has been shown to reduce ischemic complications in patients with acute ST elevation myocardial infarction (STEMI) treated with fibrinolysis. Little is known about the use and efficacy of enoxaparin in unselected patients with STEMI in clinical practice. In a retrospective analysis of the prospective ACOS registry we compared the outcomes of patients with STEMI treated with enoxaparin or unfractionated heparin. A total of 6,299 patients with STEMI < 12 hours were included in this analysis, 609 (10%) were treated with enoxaparin and 5,690 (90%) with unfractionated heparin. In the multivariable propensity score analysis enoxaparin was associated with a reduction in the combined endpoint of death and non-fatal reinfarction in the entire group (odds ratio 0.59; 95% CI 0.43-0.80) and the subgroups of patients treated without early reperfusion (odds ratio 0.65, 95% CI 0.43-0.97), fibrinolysis (odds ratio 0.64; 95% CI 0.33-1.26) and primary percutaneous coronary intervention (odds ratio 0.33; 95% CI 0.15-0.72). There was no significant increase in severe bleeding complications with enoxaparin (6.5% versus 5.5%, p = 0.4). In clinical practice in unselected patients with STEMI treated with or without early reperfusion therapy early treatment with enoxaparin compared to unfractionated heparin is associated with a significant reduction of the combined endpoint of inhospital death and reinfarction without a significant increase in severe bleeding complications.     

Comparison between ticlopidine and clopidogrel in patients with ST-segment elevation myocardial infarction treated with coronary stenting

Controversy still surrounds the question, which antiplatelet drug should be added to aspirin in patients undergoing coronary stent implantation. The aim of the current study was to compare ticlopidine and clopidogrel in a consecutive series of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary stenting. Our population is represented by 883 consecutive patients with STEMI undergoing primary stenting from April 1997 to October 2001. All clinical, angiographic, and follow-up data were prospectively collected. A total of 523 patients on clopidogrel were compared with 360 patients on ticlopidine after primary stenting. Except for age and statin therapy, no difference in demographic and clinical characteristics was observed between the two groups. Patients on clopidogrel had a higher rate of successful reperfusion (80.7% vs 73.1%, p = 0.008). No difference was observed between the two groups at both 30-day and 1-year follow-up. These data were confirmed after correction for age, successful reperfusion and statin therapy. This study shows no difference in long-term clinical outcome between clopidogrel and ticlopidine as adjunctive antiplatelet therapy in patients with STEMI undergoing stent implantation.     

Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction

Recent data has indicated that interindividual variability of intestinal absorption is an important determinant of the wide response variability to clopidogrel. We hypothesised that the physiological state of STEMI influences the intestinal absorption of clopidogrel. To evaluate this, we determined the pharmacokinetic response to a high loading dose of clopidogrel and the absolute ADP induced change in aggregation from baseline in STEMI patients and healthy volunteers. We found a significantly impaired bioavailability in STEMI patients as compared to healthy volunteers and a strong correlation between the reduction in platelet aggregation and the maximal plasma concentration of the active metabolite of clopidogrel. Although large clinical trails have clearly demonstrated the effectiveness of clopidogrel in the setting of STEMI, this small observational study encourages further research based on clinical endpoints to define the optimal dosing of clopidogrel in STEMI patients.     

Prothrombotic markers and early spontaneous recanalization in ST-segment elevation myocardial infarction

We tested the hypothesis that selected prothrombotic biomarkers might be associated with early spontaneous coronary recanalization in patients with ST-segment elevation acute myocardial infarction (STEMI). We prospectively enrolled 123 patients with STEMI including 53 patients with spontaneous coronary recanalization (cases) and 70 patients with persistent occlusion (controls) at the time of emergent coronary angiography and before angioplasty. All had received aspirin and heparin. Blood samples were collected immediately before angioplasty to measure soluble P-selectin, circulating microparticles originating from platelets (PMPs), granulocytes (GMPs), endothelial cells (EMPs); tissue factor-associated MP (TF-MP); soluble platelet glycoprotein V (sGPV) and prothrombin F1 + 2; tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1) and plasmin-antiplasmin (PAP). A sub-group of 70 patients (35 cases, 35 controls) was available for flow cytometry analysis of platelet P-selectin and activated GPIIb-IIIa. Baseline clinical characteristics did not differ between groups except for more frequent hypertension and dyslipidemia in controls. Platelet activation markers and PMP did not differ between the two groups. Controls had higher numbers of EMPs and GMPs compared to cases, but the difference was no longer significant when corrected for risk factors. Controls differed from cases by higher plasma levels of sGPV [64 (47-84) ng/ml vs. 53 (44-63) ng/ml] and PAP [114(65-225) ng/ml vs. 88 (51-147) ng/ml]. The difference persisted after adjustment for risks factors (p = 0.031 and 0.037, respectively). Persistent occlusion of the infarct related artery is associated with some markers related to higher thrombin (sGPV) and plasmin (PAP) production but is not associated with markers of platelet activation.     

Prior simvastatin treatment is associated with reduced thrombin generation and platelet activation in patients with acute ST-segment elevation myocardial infarction

Background

It has been reported that statin therapy produces additional effects including impaired activation of blood coagulation. It is not clear whether statins can affect hemostasis in patients with acute coronary syndrome. The aim of this study was to investigate the effect of prior statin treatment on thrombin generation and platelet activation in patients with ST-segment elevation myocardial infarction (STEMI).

Methods

We studied 53 consecutive STEMI patients admitted within 12 hours of pain onset, including 19 treated with simvastatin (40 mg/d) (simvastatin group) at least one month prior to STEMI, and 34 not receiving any statins (no-statin group) on admission. Thrombin-antithrombin (TAT) complexes generation and soluble CD40 ligand (sCD40L) release were determined in 60-second blood samples collected at the site of microvascular injury.

Results

There were no significant intergroup differences with respect to clinical and laboratory variables, including plasma TAT and sCD40L levels, except lower total cholesterol and low-density lipoprotein cholesterol in the simvastatin group. The mean maximum rate of TAT generation was 47.5% lower (p = 0.0002) and sCD40L release 33.3% lower (p = 0.0006) in the simvastatin group. Total amounts of TAT (p < 0.0001) and sCD40L (p = 0.002) collected within 5 minutes of bleeding were lower in simvastatin-pretreated patients. By multivariate regression analysis, variables describing local TAT and sCD40L profiles in the whole group were independently associated with simvastatin pretreatment (p < 0.0001), but not with cholesterol, platelet count or troponin levels.

Conclusions

Prior simvastatin use is associated with lower thrombin generation and platelet activation following vascular injury in the early phase of STEMI.     

肝素缓释支架置入联合心肌钻孔对急性心肌梗死猪心肌细胞再生的影响

背景：课题组前期发明了一种新的心肌再血管化的方法,即肝素缓释支架置入联合心肌钻孔,可明显改善心肌灌注。 目的：观察肝素缓释支架置入联合心肌钻孔在猪急性心肌梗死后心肌细胞再生中的作用。 方法：通过结扎冠状动脉前降支制作猪急性心肌梗死模型,随机分为模型对照组、支架置入组,6只/组。支架置入组于心肌梗死区采用自制高速钻孔器由心外膜打2个直径为3.5 mm透壁孔道,每个孔道内置入1枚肝素缓释支架。置入后静脉注射BrdU用以标记DNA复制。观察治疗前后基质细胞衍生因子1 mRNA表达及心肌灌注、新生心肌、心功能等变化。 结果与结论：与模型对照组比较,置入6周后支架置入组基质细胞衍生因子1的表达明显增强(P < 0.001),灌注质量缺损百分率的差值明显降低(P < 0.001),左室射血分数明显提高(P < 0.05),新生心肌明显增加(P < 0.001),缺血区存活心肌明显增多(P < 0.001)。证实心肌钻孔与肝素缓释支架置入可以通过提高基质细胞衍生因子1表达和增加缺血区灌注,增强心肌梗死区损伤心肌细胞的修复,改善心功能。 关键词：心肌梗死;心肌细胞;再生;支架;肝素;生物材料 doi:10.3969/j.issn.1673-8225.2010.03.014     

Advances in antithrombotic therapy as adjunct to reperfusion therapies for ST-segment elevation myocardial infarction

The treatment of ST-segment elevation myocardial infarction (STEMI) has improved over the past decades, mainly due to reperfusion therapies. The aim of this article is to provide an updated review of adjunctive antithrombotic therapy to reperfusion strategies for STEMI. As compared to unfractionated heparin (UFH), among patients treated with thrombolysis, low-molecular-weight heparins (LMWHs), mainly enoxaparin, fondaparinux and clopidogrel have been shown to improve outcome in terms of death and reinfarction, whereas GP IIb-IIIa inhibitors, mainly abciximab, and direct thrombin inhibitors have reduced reinfarction, but not mortality. Among patients undergoing primary angioplasty, early UFH should still be regarded as the gold standard in anticoagulation therapy. In addition to ASA, early GP IIb-IIIa inhibitors, especially abciximab, should be considered since it has been shown to provide further benefits in terms of preprocedural recanalization. Despite the positive results observed in the HORIZONS trial, additional studies are needed to investigate the role of bivalirudin as compared to abciximab administration. In our opinion, bivalirudin may be considered instead of GP IIb-IIIa inhibitors among STEMI patients at high risk for bleeding complications. Due to the very low mortality currently achieved by primary angioplasty, a further reduction in short- or medium-term mortality would be quite improbable to be observed. Thus, additional endpoints, such as infarct size and myocardial perfusion, may be considered in future randomized trials among patients undergoing mechanical revascularization for STEMI.     

Frequency of naturally-occurring regulatory T cells is reduced in patients with ST-segment elevation myocardial infarction

BACKGROUND: Naturally-occurring regulatory T cells (Treg) constitute a mature T-cell population characterized phenotypically by co-expression of CD4 and CD25(high) surface molecules. We investigated here the frequency of circulating Treg in patients presenting with STEMI in comparison with subjects without coronary artery disease (CAD). The effect of primary percutaneous coronary intervention (PCI) with implantation of a bare (BS) or paclitaxel-eluting stent (PES) on peripheral Treg distribution was also examined. METHODS: Peripheral blood mononuclear cells were isolated from 30 consecutive patients presenting with STEMI and from 30 age-matched control subjects with angiographically normal coronary arteries. Treg were detected by flow cytometry according to their characteristic CD4+ CD25(high) membrane phenotype, and their frequency was assessed before PCI and at 48 h and at 6 days after PCI. CD27 expression identifying a highly suppressive Treg subset was also analysed. RESULTS: The percentages of both (CD27+)Treg and (CD27-)Treg were significantly lower in patients with STEMI in comparison with controls. In addition, the (CD27+)Treg/(CD27-)Treg ratio was skewed toward the CD27- population. The frequency of both Treg subsets significantly increased 48 h after either BS or PES implantation, remaining elevated for up to at least 6 days after PCI. CONCLUSIONS: Our data suggest that the percentage of circulating Treg is significantly reduced in patients with STEMI, suggesting that this immunosuppressive T-cell subset is compartmentalized within the acutely ischemic myocardium to limit the ongoing inflammation associated with this condition, and that coronary revascularization is associated with partial reconstitution of peripheral Treg pool.