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Copyright of Polimery is the property of Industrial Chemistry Research Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Scientific Papers of Silesian University of Technology. Organization & Management / Zeszyty Naukowe Politechniki Slaskiej. Seria Organizacji i Zarzadzanie is the property of Silesian Technical University, Organisation & Management Faculty and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation., Methods: In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes., Results: Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%., Conclusion: Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.

Residual stenosis, dissection and/or microvascular damage have been proposed as mechanisms of impaired flow after primary angioplasty (PCI) for acute myocardial infarction (MI). In this report we present a patient who underwent PCI for acute anterior MI. Coronary flow reserve (CFR) assessment performed after balloon dilatation suggested possible improvement of coronary flow after stenting. However, we did not observe any improvement in CFR just after stent implantation. We conclude that in patients treated with primary PCI the use of additional pharmacological treatment to prevent microcirculation injury during reperfusion and slow-flow or no-reflow phenomenon should be considered.

Unlabelled: The use of IIbIIIa receptor blockers decreases the number of major ischemic adverse cardiac events during PCI. However, microinfarcts (post procedural CK-MB elevations) still occur despite optimal antithrombotic treatment. In patients (pts) with increased risk of atheroembolization during PCI the use of additional mechanical protection of embolization can be considered. The purpose of the study was to determine safety and efficacy of additional use of first generation coronary filter (Angioguard) to prevent microembolization during PCI in pts with unstable angina (UA)., Methods: 31 pts with UA (Braunwald IIB, IIIB) undergoing urgent PCI were randomized in the catheterization laboratory for additional use of Angioguard coronary filter or not (placebo). All pts were treated with aspirin, ticlopidine (500 mg/d), heparin (60 U/kg, ACT 200-300 sec.) and eptifibatide (bolus 2 x 180 micrograms/kg i.v. and 2 micrograms/kg/min. infusion for 18-24 h). We analyzed the extent of microembolization (serial CK-MB), presence of embolic material in the device after procedure, technical problems. Major cardiac events (death, myocardial infarction (MI), urgent target vessel revascularization (TVR)) were also considered., Results: PCI was successful in all pts. There was no death, Q wave MI or urgent TVR. Angioguard was successfully installed in 100% pts; however balloon predilatation was necessary in 9 (60%) pts. In 9 pts (60%) there was no possibility to prevent embolization oflarge side branches that originated close to the culprit lesion. Presence of embolic material in the filter was confirmed in microscopic analysis of each device. However CK-MB level was elevated in 4 pts (29%) in Angioguard group comparing to 0% in control group without protection device., Conclusion: First generation Angioguard protection device do not successfully prevent distal embolisation during PCI in pts with UA and its use is associated with many technical problems.

Experience with intravascular ultrasound (IVUS) and physiological methods for measuring coronary flow reserve during percutaneous coronary interventions (PCI) has shown that quantitative coronary angiography (QCA) is far from ideal to evaluate immediate efficacy of PCI. Balloon angioplasty under IVUS guidance allows for safe use of larger balloon catheters than estimated by QCA and provides long-term outcomes similar to stenting. The aim of the present study was to evaluate the effect of percutaneous balloon angioplasty guided by IVUS on postprocedural coronary flow reserve. The study population included 21 patients undergoing percutaneous transluminal coronary angioplasty using balloon catheters sized according to the angiographic reference segment diameter, in whom residual stenosis did not exceed 35% and there was no vascular wall dissection requiring stenting. CFR was measured at baseline, after dilatation with QCA sized balloons and after IVUS guided intervention. As compared with angio-graphically guided balloon angio-plasty, PTCA with IVUS guidance resulted in a significantly increased CFR relative to its baseline value. The present findings suggest that impaired coronary flow reserve after angiographically guided PCI may be a result of non-optimal vessel dilatation due to limitations of quantitative coronary angiography in balloon sizing. PCI with IVUS guidance allows for improvement of CFR as compared with conventional balloon angioplasty.