Impact of Occluded Culprit Arteries on Long‐Term Clinical Outcome in Patients with Non‐ST‐Elevation Myocardial Infarction: 48‐Month Follow‐Up Results in the COREA‐AMI Registry

Background

The prognostic impact of occluded culprit arteries in non‐ST‐elevation myocardial infarction (NSTEMI) patients beyond 12 months has not been investigated.

Objectives

The impact of occluded culprit arteries on a composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) in patients who presented with NSTEMI was investigated during a 48‐month follow‐up using propensity‐score (PS) matching.

Methods

A total of 2,878 NSTEMI patients in the COREA‐AMI (COnvergent REgistry of cAtholic and chonnAm university for Acute MI) Registry were classified according to the angiographic flow of culprit arteries (occlusion [OC], n = 1,070; nonocclusion, n = 1,808). After PS matching, the incidence of the primary end‐point, a composite of CD, RMI, and TVR was compared.

Results

The median follow‐up duration was 47.3 months (IQR 32.7–66.2). In the PS‐matched population, the 48‐month cumulative rates of the primary end‐point (27.5% vs. 17.9%, P < 0.001) and each event were higher in the OC group (CD: 9.0% vs. 5.4%, RMI: 16.3% vs. 9.4%, TVR: 10.5% vs. 5.6%, respectively, P < 0.05). In multivariate Cox regression analysis, occluded culprit arteries showed the significant statistical impact on the primary end‐point (HR 1.689 [1.385–2.059], P < 0.001) and each event (CD: 1.736 [1.218–2.475], RMI: 1.918 [1.468–2.505], TVR: 2.042 [1.453–2.869], respectively, P < 0.05). Furthermore, in the 12‐month landmark analysis, occluded culprit arteries were still associated with higher risk of primary end‐point beyond 12 months (P < 0.001).

Conclusions

Occluded culprit arteries were independently associated with the higher risk of CD, RMI, and TVR in NSTEMI patients during the 48‐month follow‐up. (J Interven Cardiol 2014;27:12–20)

     

Improvement of Screening Accuracy of Mini-Mental State Examination for Mild Cognitive Impairment and Non-Alzheimer's Disease Dementia by Supplementation of Verbal Fluency Performance

Objective

This study aimed to investigate whether the supplementation of Verbal Fluency: Animal category test (VF) performance can improve the screening ability of Mini-Mental State Examination (MMSE) for mild cognitive impairment (MCI), dementia and their major subtypes.

Methods

Six hundred fifty-five cognitively normal (CN), 366 MCI [282 amnestic MCI (aMCI); 84 non-amnestic MCI (naMCI)] and 494 dementia [346 Alzheimer''s disease (AD); and 148 non-Alzheimer''s disease dementia (NAD)] individuals living in the community were included (all aged 50 years and older) in the study.

Results

The VF-supplemented MMSE (MMSE+VF) score had a significantly better screening ability for MCI, dementia and overall cognitive impairment (MCI plus dementia) than the MMSE raw score alone. MMSE+VF showed a significantly better ability than MMSE for both MCI subtypes, i.e., aMCI and naMCI. In the case of dementia subtypes, MMSE+VF was better than the MMSE alone for NAD screening, but not for AD screening.

Conclusion

The results support the usefulness of VF-supplementation to improve the screening performance of MMSE for MCI and NAD.     

Clinical Significance of Induced Atrial Tachycardia After Termination of Longstanding Persistent Atrial Fibrillation Using a Stepwise Approach

Induced Atrial Tachyarrhythmia During Atrial Fibrillation Ablation. Introduction: The utility of inducibility test of atrial tachycardia (AT) in patients with longstanding persistent atrial fibrillation (AF; LPAF) is unclear. This study aimed to evaluate the significance of induced AT and the impact of their ablation on the clinical outcome. Methods: In 194 patients with LPAF (>1 year) who underwent catheter ablation (pulmonary vein isolation with substrate ablation), an inducibility test was performed after AF termination. Results: AT was induced in 108 (56%) patients (induced AT group); neither AT nor AF was inducible in 37 (19%, noninduction group). During 39 ± 21 months, AT recurred in 30 patients (28%), AF in 19 (17%), and no arrhythmia in 56 (52%) among induced AT group, although there was a recurrence of AT in 9 (24%, P = 0.68), AF in 6 (16%, P = 0.85), and no arrhythmia in 22 (60%, P = 0.42) among noninduction group (P = NS). Note that 10 patients with repeated ablation in induced AT group revealed 8 different and 2 similar recurrent ATs compared to the induced ATs at first session. The mean cycle length of induced AT that terminated by ablation (271 ± 64 ms) was longer than that without (249 ± 58 ms, P < 0.05). In induced AT group, AT recurrence rate in patients who achieved AT termination by ablation was lower than those without termination (5% vs 36%, P < 0.05). Conclusions: ATs that are inducible after LPAF termination do not necessarily become clinical AT. However, patients who achieved noninducibility of AT by ablating slower cycle length of AT had better outcomes. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1171–1178, November 2012)     

Iron-sulphur cluster nitrosyls, a novel class of nitric oxide generator: mechanism of vasodilator action on rat isolated tail artery.

1. Two iron-sulphur cluster nitrosyls have been investigated as potential nitric oxide (NO.) donor drugs (A: tetranitrosyltetra-mu 3-sulphidotetrahedro-tetrairon; and B: heptanitrosyltri-mu 3-thioxotetraferrate(1-)). Both compounds are shown to dilate precontracted, internally-perfused rat tail arteries. 2. Bolus injections (10 microliters) of compound A or B generate two kinds of vasodilator response. Doses below a critical threshold concentration (DT) evoke transient (or T-type) responses, which resemble those seen with conventional nitrovasodilators. Doses > DT produce sustained (or S-type) responses, comprising an initial, rapid drop of pressure, followed by incomplete recovery, resulting in a plateau of reduced tone which can persist for several hours. 3. T- and S-type responses are attenuated by ferrohaemoglobin (Hb) and by methylene blue (MB), but not by inhibitors of endothelial NO. synthase. Addition of either Hb or MB to the internal perfusate can restore agonist-induced tone when administered during the plateau phase of an S-type response. Moreover, subsequent removal of Hb causes the artery to re-dilate fully. 4. We conclude that T- and S-type responses are both mediated by NO.. It is postulated that S-type responses represent the sum of two vasodilator components: a reversible component, superimposed upon a non-recoverable component. The former is attributed to free NO., preformed in solution at the time of injection; and the latter to NO. generated by gradual decomposition of a 'store' of iron-sulphur-nitrosyl complexes within the tissue. This hypothesis is supported by histochemical studies which show that both clusters accumulate in endothelial cells.     

Dense artery sign of the middle cerebral artery: Traumatic cause

Dense artery sign of the middle cerebral artery on non-enhanced computed tomography is recognized as an early sign of ensuing major cerebral infarction and is usually a consequence of thrombosis or embolism of an ischaemic stroke. A case is described resulting from trauma that correlated with angiographic and Doppler ultrasound findings and the significance of this sign in this case is discussed.     

Effects of dibutyryl adenosine 3',5'-cyclic monophosphate on erythropoietin production in human renal carcinoma cell cultures

A human renal carcinoma from a patient with erythrocytosis, serially transplanted into athymic nude mice, was grown in primary monolayer cell cultures. After reaching confluency, the cultured cells formed multicellular hemicysts (domes), which became more abundant as the cultures approached saturation density. Erythropoietin (Ep) production by this renal carcinoma in culture was only slightly increased at the time of semiconfluency but showed a marked increase after the cultures reached confluency, in parallel with dome formation. Dibutyryl adenosine 3',5'-cyclic monophosphate significantly (P less than .01) stimulated Ep production and dome formation in the semiconfluent and confluent cultures of the renal carcinoma.