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Aim: We aimed to assess imprints of obesity on elderly patients post-primary PCI concerning early outcomes. Methods: This is a retrospective study with 1187 patients above 60 years old who underwent primary PCI identified between 2015 and 2020 and were divided into three groups according to their BMI. The study included a subgroup of 69 extremely elderly patients above 80 years old who had been further subdivided into 3 groups consistent with their BMI Results: Obese elderly group included 26% (n=311). Obese elderly patients were more in need of thrombus aspiration during coronary angiography but no significant difference was found amongst groups about multivessel and left main coronary diseases. The prevalence of severe myocardial dysfunction post-primary PCI was lower in obese compared to overweight and non-obese groups. We found numerical but statistically non-significant lower in-hospital mortality in obese elderly patients in the unadjusted analysis compared to the non-obese group (4% vs. 5% vs 5%, p=0.6). Yet in-hospital stay was prolonged for obese patients in the other 2 groups. BMI is not an independent predictor of in-hospital death among the elderly post-primary PCI. Extreme age obese patients were more smokers with higher haemoglobin levels on discharge and higher left ventricular ejection fraction as less presented by anterior wall MI, less in need for tirofiban use but no significant difference was estimated between groups regarding in-hospital mortality. Conclusion: obesity paradox is still significantly appearing in the elderly. Although BMI is not a predictor of mortality in this age group obesity increases the in-hospital stay with an increasing burden on the health system. [ABSTRACT FROM AUTHOR]

BACKGROUND: We previously reported the use of minimal stent area to predict angiographic in-stent restenosis after drugeluting stent implantation for unprotected left main (LM) disease. We aimed to evaluate the optimal minimal stent area criteria for up-front LM 2-stenting based on long-term clinical outcomes. METHODS: We identified 292 consecutive patients with LM bifurcation stenosis who were treated using the crush technique. The final minimal stent area was measured in the ostial left anterior descending artery (LAD), ostial left circumflex artery (LCX), and distal LM. The primary outcome was 5-year major adverse cardiac events, including all-cause death, myocardial infarction, and target lesion revascularization. RESULTS: The minimal stent area cutoff values that best predicted the 5-year major adverse cardiac events were 11.8 mm² for distal LM (area under the curve, 0.57; P=0.15), 8.3 mm² for LAD ostium (area under the curve, 0.62; P=0.02), and 5.7 mm² for LCX ostium (area under the curve, 0.64; P=0.01). Using these criteria, the risk of 5-year major adverse cardiac events was significantly associated with stent underexpansion in the LAD ostium (hazard ratio, 3.14; [95% CI, 1.23–8.06]; P=0.02) and LCX ostium (hazard ratio, 2.60 [95% CI, 1.11–6.07]; P=0.03) but not in the distal LM (hazard ratio, 0.81 [95% CI, 0.34–1.91]; P=0.63). Patients with stent underexpansion in both ostial LAD and LCX had a significantly higher rate of 5-year major adverse cardiac events than those with no or 1 underexpanded stent of either ostium (P<0.01). CONCLUSIONS: Stent underexpansion in the LAD and LCX ostium was significantly associated with long-term outcomes in patients who underwent up-front 2-stenting for LM bifurcation stenosis. [ABSTRACT FROM AUTHOR]

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BackgroundDiabetic kidney disease (DKD) had been proposed as a contributor in the pathogenesis of coronary artery disease (CAD). However, the relationship of DKD and the long-term adverse outcomes in patients with CAD after percutaneous coronary intervention (PCI) was still undiscovered.MethodsApproximately 892 patients with CAD enrolled from January 2012 to December 2016. The patients were divided into two groups, the DKD group (n = 341) and the None DKD group (n = 551). The primary outcome was major adverse cardiac events (MACE) after PCI. The average follow-up time was 1,897 ± 1,276 days.ResultsBaseline data showed that some factors were significantly different between the two groups, including age, body mass index, gender (female), hypertension, smoking, stroke history, heart failure, duration of diabetic mellitus (DM), low-density lipoprotein cholesterol, urinary protein/creatinine ratio, serum creatinine, hemoglobin, platelet, antiplatelet, beta blocker, statin, antihypertensive drugs, and insulin (all p

Firman Sugiharto,1 Yanny Trisyani,2 Aan Nuraeni,2 Ristina Mirwanti,2 Azalia Melati Putri,1 Nuraulia Aghnia Armansyah1 1Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia; 2Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, IndonesiaCorrespondence: Firman Sugiharto, Faculty of Nursing, Universitas Padjadjaran, Jl. Raya Ir. Soekarno KM. 21, Hegarmanah, Jatinangor, Sumedang, West Java, 45363, Indonesia, Tel +6282218235600, Fax +622287793411, Email firman17001@mail.unpad.ac.idAbstract: Several studies identify factors affecting increased length of stay (LOS) in patients with post-primary percutaneous coronary intervention (PCI). However, there has not been a review study that synthesizes these results. This study aimed to describe the duration of LOS and factors associated with increased LOS among patients with STEMI after PPCI. This study used scoping review using EBSCO-host Academic Search Complete, PubMed, Scopus, Taylor & Francis, and Google Scholar databases. The keywords used in English were “adults OR middle-aged” AND “length of stay OR hospital stay” AND “primary percutaneous coronary intervention OR PPCI” AND “myocardial infarction OR coronary infarction OR cardiovascular disease”. The inclusion criteria for articles were: the article was a full-text in English; the sample was STEMI patients who had undergone a PPCI procedure; and the article discussed the LOS. We found 13 articles discussing the duration and factors affecting LOS in patients post-PPCI. The duration of LOS was the fastest 48 hours, and the longest of LOS was 10.2 days. Factors influencing LOS are categorized into three predictors: low, moderate, and high. Post-procedure complications after PPCI was the most influential factors in increasing the LOS duration. Professional health workers, especially nurses, can identify various factors that can be modified to prevent complications and worsen disease prognosis to increase LOS efficiency.Keywords: length of stay, percutaneous coronary, revascularization, STEMI

Background: Female sexual dysfunction is a wide range of illnesses that can affect a patient's capacity to respond to or enjoy sexual activity in orgasm, interest/arousal, or Genito-pelvic pain/penetration which occurs most of the time and represents a problem to the patient (in DSM5 TR). Aim of the Work: To assess the correlation between ischemic heart disease and female sexual function in patients who underwent percutaneous female intervention in the last year. To study the risk factors of female sexual dysfunction after percutaneous coronary angiography in group 1. To assess the correlation between ischemic heart disease and depression, anxiety and post-traumatic stress disorder in patients who underwent percutaneous female intervention in the last year Patients and Methods: This study is a comparative cross-sectional study. This study conducted at cardiology outpatient Clinics at Ain Shams University Hospital. Ain Shams University is in Cairo and serves a catchment area of about the third of Greater Cairo. It serves both urban and rural areas, including areas around Greater Cairo as well. The Study period from March 2023 till end of the study. Results: Both groups showed 100% of cases have sexual dysfunction regardless undergoing intervention or not with no statistical difference between both group neither regarding the total score or each domain score and this may be explained by presence of worsening factors in both groups like presence of chest pain, most of patients are menopausal (60% in each group) with the most important factors seen in our study is the cultural concepts among women to have sexual relation in presence of chronic disease like ischemic heart disease and this has been shown when looking deeply in the patients we will found 7 patients (23.3%) who underwent the intervention scored only 2 in FSFI total score which is the minimal (indicating lack of any sexual activity in spite of presence of partner) with the same number seen in the group which didn't undergo the intervention this rate of having sexual activity. Conclusion: Comprehensive examination of the impact of sexual dysfunction, PTSD, depression, and anxiety in patients with ischemic heart disease, and how these factors interrelate with each other as well as with the intervention of stenting or angioplasty. The finding that sexual dysfunction is universally present across your study groups, regardless of intervention, underscores the complexity of sexual health in the context of chronic diseases. [ABSTRACT FROM AUTHOR]

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Introduction: Chronic Total Coronary Occlusion has a high risk of mortality associated with Acute Coronary Syndrome with significantly ventricular disfunction reflected in functional class patient by intolerance to perform physical effort. The Percutaneous Coronary Intervention is the gold standard approach, but in many patients this procedure is not successful. Cardiac Rehabilitation and Secondary Prevention Programs has showed improve the patient's ability to perform physical effort by its positive effect on endothelial function and promote angiogenesis, increasing the ischemic threshold. We evaluate the Cardiac Rehabilitation and Secondary Prevention program effect on myocardial performance and ischemic profile in successful and unsuccessful Chronic Total Occlusion Percutaneous Coronary Intervention patients.Materials and Methods. A non-randomized clinical trial was conducted in patients with CTCO underwent to Percutaneous Coronary Intervention (PCI). Patients were divided into two groups: 1) With successful PCI and 2) With unsuccessful PCI. All patients underwent a Sestamibi-Dipyridamole cardiac scan and stress test before and after of CRH&SP. The cardiac rehabilitation program considered 4-6 weeks of 5 weekly 30-minute training sessions with aerobic at 70% of Heart Resistance Reserve (HRR), with interspersed 3 weekly strength training sessions, as well as nutritional and Psychiatric group interventions.Results. We evaluated 25 patients with successful PCI (n = 13) and unsuccessful PCI (n = 12). For both groups, the CRH&SP showed significant improvement (p

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.

Background: Myocardial bridging (MB) of the coronary artery is a congenital anatomical variation, which has traditionally been considered a benign condition that does not cause cardiovascular events. However, recent studies have shown that MB is associated with major adverse cardiac events, including angina, myocardial infarction, arrhythmia, syncope, and even sudden death.Case: We report a case of a 41-year-old man who had hypothyroidism and MB associated with ventricular aneurysm following myocardial infarction. This patient was admitted to our hospital because of 11 days of sudden discomfort and pain in the chest. An electrocardiogram on admission showed an old myocardial infarction. Coronary angiography showed MB in the distal segment of the left anterior descending artery. Left ventricular angiography, which was performed using a pigtail catheter, showed ventricular aneurysm formation. Thyroid ultrasound demonstrated hypothyroidism and Hashimoto's thyroiditis. Patients with hypothyroidism and MB have a high risk of acute myocardial infarction or even sudden death.Conclusion: Observations in our case suggest that early recognition of hypothyroidism and MB is important for risk stratification and prognosis in patients with myocardial necrosis and acute coronary syndrome. Additionally, this early recognition may have positive effects on cardiovascular outcomes in patients with hypothyroidism.

Introduction: Chronic Total Coronary Occlusion has a high risk of mortality associated with Acute Coronary Syndrome with significantly ventricular disfunction reflected in functional class patient by intolerance to perform physical effort. The Percutaneous Coronary Intervention is the gold standard approach, but in many patients this procedure is not successful. Cardiac Rehabilitation and Secondary Prevention Programs has showed improve the patient's ability to perform physical effort by its positive effect on endothelial function and promote angiogenesis, increasing the ischemic threshold. We evaluate the Cardiac Rehabilitation and Secondary Prevention program effect on myocardial performance and ischemic profile in successful and unsuccessful Chronic Total Occlusion Percutaneous Coronary Intervention patients. Materials and Methods. A non-randomized clinical trial was conducted in patients with CTCO underwent to Percutaneous Coronary Intervention (PCI). Patients were divided into two groups: 1) With successful PCI and 2) With unsuccessful PCI. All patients underwent a Sestamibi-Dipyridamole cardiac scan and stress test before and after of CRH&SP. The cardiac rehabilitation program considered 4-6 weeks of 5 weekly 30-minute training sessions with aerobic at 70% of Heart Resistance Reserve (HRR), with interspersed 3 weekly strength training sessions, as well as nutritional and Psychiatric group interventions. Results. We evaluated 25 patients with successful PCI (n = 13) and unsuccessful PCI (n = 12). For both groups, the CRH&SP showed significant improvement (p <0.05) in myocardial performance parameters, ischemic profile, and physical effort tolerance, with a Cohen's Delta ≥ 80% in Nuclear Medicine Risk, NYHA functional class, METs reached, oxygen consumption, Myocardial Efficacy Index and Duke Score. Conclusions. The CRH&SP has a high positive effect on ventricular function improvement, myocardial performance, and ischemic profile in patients with Chronic Total Coronary Occlusion. [ABSTRACT FROM AUTHOR]

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vesselrelated myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while 859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/ TVR - 1.4% at both the intervals for 2493 patients at 2 years. follow-up. TV-MI & ST were 0.36% and 0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3% vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0 vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST. [ABSTRACT FROM AUTHOR]

Second-generation drug-eluting stents are currently considered the standard of care in patients undergoing treatment for coronary artery disease with percutaneous coronary intervention. Despite significant improvements in stenting technology and stent material over the past three decades, the concern that a permanent metallic prosthesis within the coronary vasculature can serve as a trigger for stent-related adverse events, mainly stent thrombosis and in-stent restenosis, still persists. In order to overcome the disadvantages of drug-eluting stents there has been a robust development in the field of bioresorbable coronary scaffolds (BRS). These devices aim to provide temporary scaffolding to restore vessel patency and, after serving its purpose, fully degrade and thus allow restoration of vasomotion along with luminal enlargement. The initial experience with bioresorbable scaffolds in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of these devices in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of adverse cardiac events, especially the late device thrombosis. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met in the clinical trials, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation, which persisted even at long-term follow-up raising concern on the future of BRS. This review article discusses the development, design, clinical data, and future directions in the field of BRS.

Objective To investigate the relationship between in-stent restenosis (ISR) and phosphorylated c-jun (reflecting the levels of activator protein-1), CD40L on platelets, tissue factors (TF) and tissue factor pathway inhibitor (TFPI) in patients with coronary heart disease. Methods A total of 200 patients undergoing percutaneous coronary intervention (PCI) were recruited in this study. According to the coronary angiography of 1 year after PCI, the patients were divided into ISR group (n=27) and control group (n=173). The amount of phosphorylated c-jun in leukocyte lysate, TF and TFPI were measured by enzyme-linked immunosorbent assay (ELISA), while the mean fluorescence intensity about CD40L on platelets was detected by flow cytometry. Risk factors for ISR were analyzed by multivariate Logistic regression. Results The absorbance of phosphorylated c-jun, the mean fluorescence intensity about CD40L on platelets, the plasma TF, TFPI and TF/ TFPI were significantly higher in the ISR group than those in the control group (P＜0.01). Correlation analysis showed that the absorbance of phosphorylated c-jun was positively correlated with the mean fluorescence intensity about CD40L on platelets, TF and TFPI (rs=0.766, 0.496 and 0.540, P＜0.05). The mean fluorescence intensity about CD40L on platelets was positively correlated with TF and TFPI (r=0.652, 0.702, P＜0.05). Multivariate Logistic regression analysis indicated that the higher mean fluorescence intensity about CD40L on platelets, TF/TFPI were risk factors for ISR (P＜0.05). Conclusion The high expression of inflammatory markers, phosphorylated c-jun, CD40L and increased expression of TF may promote the occurrence of ISR after PCI in patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Objective To observe the improvement situation of the left ventricular function by conducting late percutaneous coronary intervention(PCI)therapy after acute stage in the patients with acute myocardial infarction(AMI). Methods The echocardiographies before and after late PCI in 187 inpatients with AMI in this hospital from May 2013 to December 2017 were retrospectively analyzed, and compared with the echocardiographies at infarction initial stage and late stage in 43 cases of AMI treated by simple medication treatment(control group).The improvement situation of the left ventricular function after conducting late PCI in the patients with AMI was observed, including the differences of the left ventriculat function between the acute ST segment elevation myocardial infarction(STEMI)subgroup and non-ST segment elevation myocardial infarction(NSTEMI)subgroup, as well as the left ventricular function after late PCI by opening different infarct-related blood vessels and different numbers of infarct-related blood vessels. Results Compared with the control group, the left ventricular function in the patients with AMI undergoing late PCI had somewhat improvement, which manifested by the increase of left ventricular ejection fraction(LVEF)and left ventricular shortening fraction(LVFS), and significantly decrease of left ventricular end-diastolic dimension(LVEDD)and left ventricular end-systolic dimension(LVESD), and the differences were statistically significant(P<0.05). There were statistically significant differences in LVEF, LVFS, LVEDD and LVESD between the STEMI subgroup and the NSTEMI subgroup with the control group(P<0.05), but there was no statistically significant difference between the STEMI subgroup and the NSTEMI subgroup(P>0.05). When different infarct-related vessels were opened, LVEDD and LVESD in the left anterior descending branch group, the left circumflex branch group and the right coronary artery group were significantly decreased compared with the control group, and the differences were statistically significant(P<0.05).When different numbers of coronary arteries were opened, compared with the control group, LVEF was significantly increased(P<0.05), while LVEDD and LVESD were decreased, and the differences were statistically significant(P<0.05). Conclusion Conducting late PCI can improve the left ventricular function in the patients with AMI;its effect on the cardiac function has no difference between the STEMI subgroup and NSTEMI subgroup. Conducting late PCI can inhibit left ventricular remodeling by opening different infarct-related vessels.Opening different numbers of coronary arteries can improve the left ventricular function and inhibit the left ventricular remodeling. [ABSTRACT FROM AUTHOR]

Objective To evaluate the changes of cystatin C(CysC)levels before and after percutaneous coronary intervention(PCI)in the patients with coronary heart disease(CHD)complicating diabetes and/or hypertension, to analyze the critical value of CysC for diagnosing contrast-induced nephropathy(CIN)in CHD complicating diabetic and hypertension and to evaluate the consistency of CysC and creatinine for diagnosing CIN.Methods A total of 227 patients with CHD complicating diabetes and/or hypertension in this hospital from October 2016 to May 2018 were selected and divided into the simple CHD group(52 cases), CHD complicating hypertension group(74 cases), CHD complicating diabetes group(51 cases)and CHD complicating diabetes and hypertension group(50 cases).The serum CysC level and creatinine level before PCI and at 72 hafter PCI were recorded in each group.Then the changes of CysC level before and after PCI were statistically analyzed in each group.The incidences of CIN was calculated and evaluated in each group.The critical value of CysC for diagnosing CIN in the patients with CHD complicating diabetic and hypertension was calculated.The consistency between CysC and creatinine for diagnosing CIN was evaluated.Results The CysC level in the CHD complicating diabetes and hypertension group was the highest before and after PCI, then followed in turn by the CHD complicating diabetes group, CHD complicating hypertension group and simple CHD group(P<0.05), the CysC level in each group had statistical difference between before and after PCI(P<0.05);the CysC level after PCI in each group had statistical difference compared with that before PCI in the same group(P<0.05). The CIN occurrence rate had statistical difference among 4 groups(P<0.05).The consistency between CysC and creatinine for diagnosing CIN in CHD complicating diabetes and hypertension was general(κ=0.592, P=0.001), the CysC level after PCI was increased by 28.59% compared with before PCI, which could diagnose CIN, the maximal area under ROC curve was 92.50%, the sensitivity was 90.00% and the specificity was 82.50%.Conclusion The levels of CysC in the patients with CHD complicating diabetes and/or hypertension are different before and after PCI, the CysC level is the highest in the patients with CHD complicating diabetes and hypertension.The CIN occurrence rates are different in the patients with CHD complicating diabetes and/or hypertension, which is the highest in the patients with CHD complicating diabetes and hypertension(reaching 20.00%).CysC has a higher diagnostic value for CIN. [ABSTRACT FROM AUTHOR]

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P

Objective To investigate the safety and efficacy of prophylactic injection of sodium nitroprusside in primary percutaneous coronary intervention (pPCI) without reflow in elderly patients with ST segment elevation myocardial infarction (STEMI). Methods A total of 185 elderly patients with STEMI were divided into sodium nitroprusside group (n= 92) and control group (n=93) with completely randomized design. All patients were treated with pPCI. Sodium nitroprusside group received sodium nitroprusside 200 μg immediately after opening coronary artery. Control group received equal amount of physiological saline. The incidence of no-reflow, the levels of troponin T (cTnT) and ejection fraction (EF), the incidence of major adverse cardiovascular events (MACE) during hospitalization and 1 year follow-up were compared between two groups, and the risk factors of no-reflow were analyzed. Results In nitroprusside group, the incidence of no flow and cTnT, CRP, and the number of stent were significantly lower and LVEF, EF were significantly higher than those in control group (P＜0.05). There were no significant differences in HbA1c, infarct related artery (IRA), TIMI grade, Gensini score, SYNTAX score and incidence of MACE during hospitalization between two groups (P＞0.05). In nitroprusside group, the incidence of MACE in 1-year follow-up was significantly lower than that in control group (P＜0.05). Logistic regression analysis showed that without injection of nitroprusside, diabetes and the high SYNTAX scores were independent risk factors for no reflow. Conclusion The application of sodium nitroprusside can significantly reduce the incidence of no flow and MACE in 1-year follow up in elderly patients with STEMI treated with pPCI，and which has good safety. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 15 to 30% of patients undergoing percutaneous coronaryintervention (PCI) will require repeated revascularization. There is an ongoing debate concerningthe impact of prior PCI on subsequent coronary artery bypass graft (CABG) surgery. This studysought to compare immediate post-CABG complications between patients with and withoutprevious coronary stenting.Methods: A total of 556 CABG candidates including 73 patients with previous coronary stentingand 483 patients without prior stenting were enrolled in this retrospective-prospective study.Demographic information, cardiac markers (CK-MB, Troponin T), and postoperative dataincluding inotrope administration, intra-aortic balloon pump (IABP) use, bleeding, pathologicalelectrocardiography (ECG) changes, and overall complications were compared between the twogroups.Results: The mean age of the patients in stented group was significantly higher than that inunstented group (63.49±7.71 vs. 61.37±9.80 years, p=0.05). The mean serum level of TroponinT 12 h postoperation was significantly higher in the same group (323.26±33.16 vs. 243.30±11.52ng/dL; p=0.03). Comparing the stented and unstented groups, the rates of inotrope use (17.8% vs.7.2%; p=0.003), significant bleeding (15.1% vs. 4.3%; p=0.001), and overall complications (32.9%vs. 11.6%; odds ratio: 3.74 with 95% confidence interval of 2.13-6.55, p

Objective To investigate the relationship between fragmented QRS (fQRS) complex and the early left ventricular remodeling or heart function in patients with acute myocardial infarction (AMI). Methods A total of 76 patients with AMI hospitalized in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study. Patients were divided into fQRS group (n=29) and non-fQRS group (n=47). The clinical data including ECG, laboratory indicators, coronary angiography results and real-time three-dimensional (RT-3D) echocardiography parameter were collected in two groups. The relationship between fQRS and baseline data, fQRS and RT-3D echocardiography parameter were analyzed. At the same time, the influencing factors of left ventricular remodeling and heart function were discussed in the study. Results Compared with non-fQRS group, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly higher, and left ventricular ejection fraction (LVEF) was significantly lower in fQRS group (P＜ 0.05). Several three-dimensional parameters including Tmsv16-SD (%) and Tmsv 16-Dif (%) were significantly higher in fQRS group than those in non-fQRS group (P＜0.05). There were no significant differences in Tmsv 16-SD (ms), Tmsv 12- SD (ms), Tmsv 12-SD (%), Tmsv 6-SD (ms), Tmsv 6-SD (%), Tmsv 16-Dif (ms), Tmsv 12-Dif (ms), Tmsv 12-Dif (%), Tmsv 6-Dif (ms) and Tmsv 6-Dif (%) between two groups. Logistic regression analysis showed that fQRS and Gensini scores had effects on heart function. At the same time, fQRS was an independent predictor for left ventricular remodeling. Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with fQRS, and fQRS can predict left ventricular remodeling better. [ABSTRACT FROM AUTHOR]

Objective To investigate the short-term prognosis change trend in the patients with acute ST-segment elevation myocardial infarction(STEMI)in Ya'an area over the past 6 years. Methods The whole data in the patients with STEMI receiving direct percutaneous coronary intervention(PCI)in the Ya 'an Municipal People 's Hospital from January 2010 to January 2016 were collected. The patients were divided into the first group(132 cases，from January 2010 to January 2013)and second group(264 cases，from January 2013 to January 2016 ). Then the risk factors，drugs，PCI and 90 d prognosis change trend were assessed in the two groups. Results A total of 396 cases of STEMI were included with the mean age of(62.8 ± 12.5)years old，316 males(79.8%). The proportions of diabetic patients in the two groups were 22.7% and 32.6% respectively， showing a significantly increasing trend(P=0.047)；the high sensitive troponin T at admission was(1 593±2 489)pg/mL and (517±773)pg/mL，showing a significantly decreasing trend(P=0.005)；the symptom-to-balloon time was 346.5(30，825)min and207.5(17，648)min，showing a significantly increasing trend(P=0.022)，the door-to-balloon dilation time was 92(50，190) min and 55(20，124)min，showing a significantly decreasing trend(P=0.000)；the thrombus aspiration ratios were 6.1% and 15.2% respectively，the PCI success rates were 87.9% and 97.3% respectively，showing a significantly increasing trend(P= 0.009，P=0.000)；the ratios of postoperative TIMI blood flow gradeⅢ were 89.4% and 96.2%，showing a significantly increasing trend(P=0.012). The chewing rate of aspirin 300mg at the initial hospital in the two groups were 74.2% and 97.7% respectively，the orally taking rates of clopidogrel hydrogen sulfate 300 mg were 56.8% and 95.3% respectively，and the use rates of heparin were 50.0% and 88.6% respectively，and the use rates of platelet glycoprotein IIb/IIIa receptor antagonist were 9.8% and 31.1% respectively，all showing a significantly increasing trend(P<0.01). The hospitalization time were 9(4，15)d and 5 (4，14)d respectively，showing a significantly decreasing trend(P<0.01). In the aspect of 90 d prognosis，After adjusting the related baseline factors，the all-cause mortality rate in the second group was significantly declined compared with the first group [relative risk(RR)0.568，95% confidence interval(CI)0.369-0.825，P=0.001). Conclusion The short term prognosis in the patients with STEMI in Ya'an during the recent 6 years has been significantly improved，which mainly obtain the benefit from direct PCI. [ABSTRACT FROM AUTHOR]

Objective To explore the application effect of evidence based nursing in nursing of composite thermal insulation in emergency PCI.Methods Eighty patients undergoing emergency PCI in the catheter room of Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January to June 2018 were selected and divided into the observation group and control group by adopting the convenient sampling method, 40 cases in each group.The control group adopted the conventional care, while on the basis of routine nursing, the observation group was given the evidence based nursing.The vital signs, occurrence situation of shivering and satisfaction degree after emergency PCI were compared between the two groups.Results SpO2 and satisfaction in the observation group were higher than those in the control group, heart rate, systolic pressure, diastolic pressure and shivering occurrence rate were lower than those in the control group, and the differences were statistically significant(P<0.05).Conclusion The evidence based nursing can effectively increase the effect in nursing of composite thermal insulation in emergency PCI, reduce the incidence rate of shivering, reduce the occurrence of complications and increase the satisfaction of the patients. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate subepicardial and subendocardial left ventricular (LV) functions in patients with single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Methods: Patients with left anterior descending (LAD) lesion (n = 40) were evaluated. Patients un-derwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue doppler im-aging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the them. Finding: The systolic and diastolic pw-TDI parameters were apparently different between the patient after PCI, while the systolic pw-TDI parameters did not change. The diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P < 0.001) taken from the subepicardial layer decreased. Conclusion: In our study, left ventricular, left atrium, and aortic valve diameter increase in patients with coronary artery disease. The systolic and diastolic functions were impaired at subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dys-function persists, diastolic dysfunction improves at early stage after PCI. Key words: Angioplasty, Percutaneous Coronary, Echocardiography, Doppler, Tissue doppler imag-ing.

FUNDAMENTO: A ponte miocárdica constitui um dos principais diagnósticos diferenciais de doença arterial coronariana. Entretanto, ainda é subdiagnosticada e tem seus mecanismos fisiopatológicos e sua terapêutica não completamente elucidados. OBJETIVO: Analisar e descrever a evolução clínica e terapêutica de pacientes com diagnóstico angiográfico de ponte miocárdica, comparando os dados com a literatura atual, a fim de elucidar o perfil clínico e o prognóstico destes pacientes. MÉTODOS: Foram revisados os resultados de cineangiocoronariografias realizadas no período de 2003 a 2007, em um laboratório de hemodinâmica, efetuando-se análise de prontuários e entrevista de um grupo de pacientes selecionados. RESULTADOS: A frequência de diagnósticos de pontes miocárdicas foi de 3,6%. A idade média dos pacientes foi de 56,8 anos (DP = 11,83; IC = 0,73). A artéria descendente anterior foi acometida isoladamente em 100% dos casos. Após a seleção, realizou-se análise e entrevista de 31 pacientes. Não houve correlação entre os sintomas e o grau de estreitamento angiográfico obtido nos pacientes estudados. O tratamento medicamentoso incluiu o uso de agentes? bloqueadores, antagonistas do canal de cálcio, antiagregantes plaquetários e/ou nitratos, tendo, como resultado, melhora clínica em 30%, ausência de alterações no quadro clínico em 60% e piora dos sintomas em 10% dos pacientes. Um paciente apresentou morte súbita, dois pacientes realizaram angioplastia com melhora clínica significativa e nenhum paciente realizou procedimento cirúrgico. CONCLUSÃO: A maioria dos pacientes com ponte miocárdica tem um bom prognóstico, mas em longo prazo não há dados suficientes, realizados em um grande grupo de pacientes sintomáticos, para conclusões definitivas.FUNDAMENTO: El puente miocárdico constituye uno de los principales diagnósticos diferenciales de la enfermedad arterial coronaria. No obstante, aún está subdiagnosticado y sus mecanismos fisiopatológicos y su tratamiento no están completamente esclarecidos. OBJETIVO: Analizar y describir la evolución clínica y terapéutica de pacientes con diagnóstico angiográfico de puente miocárdico, comparando los datos con la literatura actual, a fin de clarificar el perfil clínico y el pronóstico de estos pacientes. MÉTODOS: Se revisaron los resultados de cinecoronariografias realizadas entre los años 2003 y 2007, en un laboratorio de hemodinamia, conjuntamente con el análisis de historias clínicas y la realización de entrevistas a un grupo de pacientes seleccionados. RESULTADOS: La frecuencia del diagnóstico de puente miocárdico fue del 3,6%. La edad promedio de los pacientes fue de 56,8 años (DE = 11,83; IC = 0,73). La arteria descendente anterior fue afectada aisladamente en el 100% de los casos. Tras la selección, se realizaron análisis y entrevistas a 31 pacientes. No existió correlación entre los síntomas y el grado de estrechamiento angiográfico obtenido en los pacientes estudiados. El tratamiento medicamentoso incluyó el uso de betabloqueantes, antagonistas de los canales de calcio, antiagregantes plaquetarios y/o nitratos, obteniendo, como resultado, mejoría clínica en el 30%, ausencia de alteraciones en el cuadro clínico en el 60% y empeoramiento de los síntomas en el 10% de los pacientes. Un paciente presentó muerte súbita; en dos pacientes se practicó una angioplastia con mejoría clínica significativa y ningún paciente fue sometido a un procedimiento quirúrgico. CONCLUSIÓN: La mayoría de los pacientes con puente miocárdico tiene un buen pronóstico, pero no hay datos suficientes a largo plazo, que permitan sacar conclusiones definitivas, mediante el seguimiento de un grupo numeroso de pacientes sintomáticos.BACKGROUND: The myocardial bridge constitutes one of the main differential diagnoses of coronary artery disease. However, it remains an underdiagnosed condition and its physiopathological mechanisms and therapeutics are yet to be elucidated. OBJECTIVE: To analyze and describe the clinical and therapeutic evolution of patients with an angiographic diagnosis of myocardial bridge, comparing the data with that in the current literature, in order to clarify the patients' clinical profile and prognosis. METHODS: The results of coronary angiographies carried out from 2003 to 2007 in a Laboratory of Hemodynamics were reviewed; the analysis of patients' files was carried out and selected patients were interviewed. RESULTS: The frequency of myocardial bridge diagnosis was 3.6%. The mean age of patients was 56.8 years (SD = 11.83; CI = 0.73). The anterior descending artery was affected in isolation in 100% of the cases. After the selection, the analysis and interview of 31 patients were carried out. There was no correlation between symptoms and degree of angiographic narrowing observed in the studied patients. The drug treatment included the use of beta-blockers, calcium-channel antagonists, platelet antiaggregants and/or nitrates and resulted in clinical improvement in 30%, absence of alterations in the clinical picture in 60% and symptom worsening in 10% of the patients. One patient presented sudden death; two patients underwent angioplasty followed by significant clinical improvement and none of the patients underwent surgical procedures. CONCLUSION: Most of the patients with myocardial bridge have a good prognosis, but in the long term, there are not enough data, obtained from a large sample of symptomatic patients, to draw definitive conclusions.

Background/Aim. Prognosis after acute myocardial infarction (AIM) depends on the extent of irreversibly damaged myocardium and viable tissue due to stunning or hibernation. The aim of the study was to assess the prognostic significance of early echocardiographic parameters of myocardial viability in prediction of late recovery of regional and global ventricular function. Methods. The study prospectively included 40 patients after the first, uncomplicated univessel AIM treated with percutaneous coronary intervention (PCI). Low-dose dobutamine echocardiography (LDDE) was preformed 7-10 days after AIM and follow-up resting echocardiography from 7 to 12 months later. Results. The sensitivity and specificity for the prediction of post revascularisation regional, dyssynergy improvement were 61.29% and 94.59% respectively. The positive and negative predicative values were 90.48% and 74.47% respectively. The number of viable segments (p = 0.01) and extent of contractile reserve (p = 0.01) were univariate, independent predictors of improvement in ejection fraction (EF). From the multivariate stepwise regression analysis contractile reserve was selected as most powerful predictor of late recovery of left ventricular contractile function (p = 0.007). Receiving-operator characteristic curve (ROC) analysis demonstrated that three or more recovered segments were necessary for an improvement of left ventricular ejection fraction (LVEF) ≥ 5% after the revascularisation, with the highest sensitivity, 100% and specificity 56% (p = 0.01). Conclusion. Low-dose dobutamine echocardiography is a powerful predictor of the regional dyssynergy recovery late after AIM treated with PTCA with implantation stent. Late full functional improvement of the left ventricle is related to the extent of contractile reserve and amount of viable tissue. At least three recovered segments are necessary for a significant recovery of the global left ventricular contractility.

Drug eluting stents (DES) have been shown to reduce in-stent restenosis rate and target vessel revascularization in large clinical trials. However, the safety and efficacy of DES use in the Taiwanese population has not been reported. We designed this trial to analyze the clinical results in patients using DES in a single tertiary center. Methods: We retrospectively analyzed the clinical data of all patients treated at National Taiwan University Hospital, Taipei, Taiwan, with sirolimus- or paclitaxel-eluting stents between September 2003 and January 2005. Results: A total of 585 patients (466 men, 119 women; mean age, 64.5 ± 11.2 years) were enrolled. Meanwhile, 205 sirolimus- and 717 paclitaxel-eluting stents were implanted, with a mean of 1.6 stents per patient. Half (50.2%) of the stents were placed in the left anterior descending artery. Among the enrolled patients, 41.8% had diabetes mellitus, 25% had a diagnosis of acute coronary syndrome, and 10.7% was treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Overall 8-month target vessel revascularization, major adverse cardiac event rate, and cardiac death rate were 8.8%, 9.7% and 2.5%, respectively. There was no difference in clinical events between sirolimus- and paclitaxel-eluting stents. The overall subacute stent thrombosis rate was 1.36%, significantly lower than that in patients who presented with acute coronary syndrome (4%). Conclusion: The use of DES in the Taiwanese population yielded comparable results as those in large clinical trials. Subacute stent thrombosis rate was higher in acute coronary syndrome. The safety of DES in these situations should be further clarified.

OBJETIVO: Avaliar o prognóstico clínico dos doentes coronários submetidos a revascularização percutânea com implantação de stents revestidos com fármacos na descendente anterior proximal. MÉTODOS: Cento e setenta doentes consecutivos, com idade média de 65 anos, 49 (29%) mulheres, receberam implante de pelo menos um stent revestido com fármaco, no nosso centro. O número total de stents revestidos com fármaco implantados foi 189, dos quais 115 (61%) de sirolimus (CYPHER®) e 74 (39%) de paclitaxel (TAXUS®). Em 100 (60%) dos casos, estava presente doença coronário multivaso. Em 61 (36%) dos doentes tratou-se outro segmento coronário para além da descendente anterior proximal. Efetuou-se um seguimento clínico durante um tempo médio de 11 ± 5 meses e controle angiográfico entre os seis e os nove meses. Obteve-se um endpoint final composto por morte, infarto agudo do miocárdio e pela necessidade de reintervenção sobre a descendente anterior. Analisou-se secundariamente a ocorrência de reestenose, a necessidade de reintervenção sobre o segmento proximal da descendente anterior e a trombose de stent. RESULTADOS: O procedimento teve êxito angiográfico imediato em todos os doentes. Registraram-se duas mortes, dois infartos agudos do miocárdio, e duas reintervenções coronárias percutâneas por trombose de stent no período intra-hospitalar. Aos seis meses de seguimento, observou-se mais uma morte cardíaca e identificaram-se três infartos do miocárdio; houve necessidade de três novos procedimentos de revascularização. Até ao final do seguimento, verificaram-se mais três mortes, três infartos do miocárdio e oito revascularizações da descendente anterior, duas delas por cirurgia. A sobrevivência livre de eventos cardíacos adversos maior foi de 91%. A mortalidade cardíaca foi de 3%. A reestenose binária no segmento proximal da descendente anterior foi de 4,1%. A sobrevivência livre de revascularização do vaso alvo foi de 94%. Não se observaram casos de trombose tardia de stent. CONCLUSÃO: A revascularização percutânea da descendente anterior proximal com a implantação de stents revestidos com fármacos constitui uma estratégia terapêutica segura e muito eficaz em curto e longo prazos.OBJECTIVE: To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery. METHODS: One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER TM) and 74 (39%) were paclitaxel-eluting stents (TAXUS TM). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 ± 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis. RESULTS: The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the follow-up, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed. CONCLUSION: Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.

Background: Previous studies have demonstrated that acute myocardial infarction (AMI) in young patients (age <45years) is associated with a high prevalence of smoking, obesity, hyperlipidemia and single vessel coronary artery disease (CAD). Hispanics represent the largest growing ethnic minority in the United States, yet features of AMI in young Hispanics have not been described.Methods: Patients undergoing percutaneous coronary intervention for AMI at Los Angeles County + University of Southern California Medical Center and Keck Medical Center were studied. We compared young Hispanics (age<45, n=47) with older patients (Hispanics and non-Hispanics age ≥45, n=888) to identify unique features of AMI in young Hispanics. We also compared young Hispanics with young non-Hispanics (n=33) and older Hispanics (n=447) in regards to traditional CAD risk factors, laboratory values and in-hospital outcomes. Multivariable logistic regression was performed to identify variables independently associated with in-hospital mortality.Results: Young Hispanics had higher triglyceride levels than young non-Hispanics and older patients (234.5±221.0mg/dL vs. 145.3±67.4mg/dL vs. 156±118.2mg/dL, p<0.0004); and higher triglyceride than older Hispanics (234.5±221.0 vs. 147.0±98.9mg/dL, p<0.02). Body mass index was independently associated with the logarithm (base10) of triglyceride levels (p<0.0001). Hispanic ethnicity and age<45years, however, were not independently associated with in-hospital mortality.Conclusions: Young Hispanics with AMI have higher triglyceride levels than young non-Hispanics and older Hispanics. The elevated triglyceride levels may be related to lifestyle changes experienced by a young immigrant population transitioning to life in the United States. [ABSTRACT FROM AUTHOR]

Background/Aim. To present the results of percutaneous transluminal coronary angioplasty (PTCA) in the treatment of the patients with acute right ventricle myocardial infarction (ARVMI), with adjuvant analyses of the obtained results in the period of five years (2000-2004). Methods. Thrombolytic therapy and the primary percutaneous transluminal coronary angioplasty (PPTCA) was applied within the first 6 hours from the onset of anginous disorders, and rescue PTCA in the period from 6−24 hours from the onset of ARVMI. Results. A total number of 1175 patients, both sexes, 763 (64.8%) males and 412 females (35.2%), mean age 58.4 ± 7.8 years, were treated for acute myocardial infarction (AIM) of different localization in the period of five years (2000-2004). Anterior infarction was found in 645 (54.8%) of the patients, and inferoposterior infarction (IPI) was localized in 530 patients (45.2%) patients of which in 134 (25.2%) AIMDK was proven. Out of 134 patients with proven acute myocardial of the right ventricle AIMDK, 53 (39.5%) got thrombolytic therapy, 64 patients (47.7%) were treated with the conservative heparin therapy, whereas in 17 patients (12.8%), primary percutaneous coronary angioplasty (PPTCA) was done. Delayed or rescue PTCA was done in 22 (18.8%) patients, in 8 (36.3%) from the group which got thrombolytic therapy, and in 14 (63.7%) treated with the heparin therapy. Out of the total number of 22 patients who got heparin or thrombolytic therapy combined with rescue PTCA, in 7 patients (31.8%) the complete clinical and angiographic effect of thrombolysis with AIM was achieved only by using a balloon. Baloon dilatation with the implantantion of intracoronary stent was performed in another 11 patients (50%), while 2 (9.1%) were sent to revascularization of the myocard due to diffusion changes in each of the 3 blood vessels, and 2 patients (9.1%) died. Of the patients, 17 (12.6%) had PPTCA with the implantation of intracoronary stent with the additional direct inhibitor of the platelet membrane glycoproteins IIb/IIIa (abciximab). All the patients treated in this way survived. They had no side effects nor serious complications. Their clinical recovery was satisfactory. In the first three weeks of the intrahospital period in the group of 45 patients (33.5%) with AIMDK, who got only thrombolytic therapy, 7 patients (15.5%) died, whereas in the group of 50 patients (37.3%) treated only with heparin, 13 (26%) died. In the group of 22 patients (18.8%) treated with the combined therapy with rescue PTCA and heparin or thrombolytic therapy, 2 patients (9.1%) died. In the group of 84 patients (62.6%) with AIMDK, who were treated with thrombolytic therapy with primary or rescue PTCA, 9 (10.7%) died. In the AIMDK group of 134 patients, 22 patients (16.4%) died in the period of 1 month of the hospital treatment, whereas in the second group of 396 patients with IPI, but without IDK, 36 (9.1%) died (χ2 = 4.789; p < 0.001). Out of the total number of 1175 patients with AIM in the five-year period of the intrahospital treatment, 145 patients (12.3%) died. In the group of patients with IPI, 58 patients out of 530 (10.9%) died, whereas 87 patients out of 645 (13.4%) with anterior infarction died, (χ2 = 0.567; p < 0.452). Conclusion. The combination of thrombolytic therapy and PTCA shown in the obtained results completely justified this kind of treatment, and offered the patients with AIMDK a greater chance to survey than they had before.

Aim. To present the results and experience in diagnosing and treating of patients with acute right ventricle infarction, during the period of hospitalization of one month, with adjuvant analyses of the obtained results in the period of fifteen years. Methods. Acute right ventricle infarction porved clinicaly, enzymologicaly, by ECG, echochardiographically or scintigraphically we treated with thrombolitic therapy within first six hours after admittion, with salvaged PTA in case of the cardiogenic shock or AV block IIº−IIIº despite of thrommbolitic therapy, or with postponed PTA within first month of intrahospital treatment. Results. In the period from 1990 to 2004, 3 225 patients of both sexes were treated for acute myocardial infarction at the different localization in patients' at the mean age of 53.7 ± 5.8. One-hundredthirty - nine (43.9%) patients were treated with thrombolitic therapy according to the speed up protocole. Heparin was administered to 160 (50.7%) patients with water load, and 17 (5.4%) patients had the primary percutaneous transluminal coronary angioplasty (PPTCA), so that the mechanical blood flow could be established, by the implantation of a stent when necessary. In 316 patients with right ventricle infarction, 58 (18.3%) had postponed and salvaged percutaneous transluminal coronary angioplasty (PTCA). Twenty-two (15.8%) patients had thrombolitic therapy, whereas 36 (22.5%) patients were treated with heparin. We had a successful balloon dilatation in 21 (36.2%), whereas 32 (55.2%) patients had 1−3 intracoronary stents inplanted, depending upon the necessity, and 5 (8.6%) patients from this group were sent to surgical intervention. In the group of 214 (67.7%) patients treated with heparin or thrombolitic therapy combined therapy, with PTCA, 12 (5.7%) patients died, whereas in the group of 124 (39.3%) patients treated only with heparin 26 (16.2%) patients died, statistically significant difference (p < 0.001, χ2 = 18.423). Was noticed n the group of 1 204 patients with inferoposterior infarction, 122 (10.1% ) patients died. In the group of 316 patients with right ventricle infarction, 38 (12%) died. In the group of 888 control patients with inferoposterior infarction, but without right ventricle infarction, 84 (9.4%) patients died. In the group of 2 021 patients (62.2%) with anterior infarction, 248 (12.3%) died. Conclusion. The obtained results showed that the patients with right ventricle infarction, due to the great expansion of necrosis and the involvement of the inferoposterior wall of the left ventricle, as well as the ischemia of sinus and AV nodes, were the patients of a high risk. That was why it was essential to do urgent widening of the artery to reestablish blood flow either by using drugs or by means of mechanical methods.

Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV) is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA) was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab), according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

Background/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI. Methods. All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE) in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE. Results. Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2%) patients. Independent pre- dictors of major bleeding were advanced age (> 65 years), female gender, baseline anemia and elevated white blood cell (WBC) count and signs of congestive heart failure at admission (Killip class II-IV). In-hospital and 6-month mortality and MACE rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was a predictor of 6-month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for OR 1.20-7.61;p = 0.019), but was not a true independent predictor of MACE and mortality in the fully adjusted models. Conclusion: Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at particularly high risk of bleeding after primary PCI. Bleeding is associated with adverse outcome and may be an important marker of patient frailty, but it is not a true independent predictor of mortality/MACE. [ABSTRACT FROM AUTHOR]

Introduction. Stent entrapment and dislodgement in the coronary arteries is a rare but potentially fatal complication of percutaneous coronary intervention. Different retrival techniques of dislodged stents have previously been reported with high success rate but all of them are time-consuming, so as not quite useful in hemodinamically unstable patient. Case report. A 59-year old female patient with acute ST-elevation myocardial infaction of anterior wall was admitted for primary percutanous coronary intervention. Unexpectedly, during intervention stent entrapment and dislodgement in the distal left main coronary artery occured followed by occlusive coronary dissection and compromisation of the coronary flow in the left descending coronary artery with a rapid hemodinamic deterioration. In order to reestablish coronary flow as soon as possible, the dislodged unexpanded stent was crushed against the wall with a balloon in the distal left main. It immediately restored coronary flow in the left descending coronary artery and rapidly improved the patients hemodinamics. Intervention was successfuly completed with totally four stents implanted in the left main, the osteoproxymal circumflex coronary artery and the osteo-proxy-medial left descending coronary artery. Later post-interventional hospital course as well as the clinical and angiographic six month follow-up was uneventful. Conclusion. This case shows that percutaneous baloon crushing technique can be a safe and effective first option in management of dislodged and unexpanded stent in the left main coronary artery, particularly for a hemodynamically unstable patient. [ABSTRACT FROM AUTHOR]

Objective To investigate the long-term safety and efficacy of the domestic biodegradable drug-eluting coronary stents (BuMA) in treating coronary heart disease (CHD). Methods Patients (n=440) who received BUMA stents were designated as observation group while patients (n=460) received Resolutestents were designated as control group. The baseline clinical characteristics, extend of pathological change shown by Coronary Arteriography (CAG), the procedure of percutaneous coronary intervention were similar between these two groups. The patients were followed up for a mean of 24±4 months; the primary endpoint was the occurrence of definite or probable stent thrombosis; secondary endpoint was major adverse cardiac events (MACEs) including complex end such as recurrent angina, acute non-fatal myocardial infarction, death, target vessel revascularization (TVR); other endpoints include all- cause mortality, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), non-target vessel revascularization and stroke. Some patients were lost during follow up, which include 5 in observation group and 26 in control group. Results Patients in observation groups were inserted with 615 stents while patients in control group were implanted with 614 stents, both groups with average of implanting 1.41 stent/case. There are no statistical significance differences in the primary endpoint [1.4% (6/435) vs 1.8% (8/434), χ²=0.087], secondary endpoint [12.3% (54/435) vs 10.8% (47/434), χ²=0.524] and other endpoints between the two groups. Conclusion These data suggest that domestic biodegradable drug-eluting coronary stents (BuMA) are with good long-term safety and efficacy. [ABSTRACT FROM AUTHOR]

Objective To explore the incidence and risk factors of depression in coronary heart disease patients who underwent revascularization therapy. Methods A total of 493 patients who were admitted in Tianjin chest hospital from April 2012 to February 2013 were enrolled, among whom 258 patients accepted coronary artery bypass grafting (CABG) and the rest 235 patients underwent percutaneous coronary intervention (PCI). Self-rating depression scale (SDS) was employed to assess the state of patients at both 1 day before and 7 days after the operations. According to the postoperative scores, CABG group was divided into the depression group (n=90) and non-depression group (n=168) while PCI group was also divided into depression group (n=54) and non-depression group (n=181). Basic clinical datum of patients were collected and analyzed and independent risk factors of depression was analyzed though logistic multi-variant regression. Results The incidence of postoperative depression among CABG patients was significantly higher than that in PCI patients (P<0.05). (1) In the CABG group, age, ratio of female gender, alcohol intake, rate of past depression, length of anaesthesia, length of staying in ICU and incidence of postoperative cognitive dysfunction (POCD)were all higher in depression subgroup than those in non-depression subgroup. Female and preoperative depression were both independent risk factors for postoperative depression in patients underwent CABG. (2)In PCI group, ratio of female gender, blood pressure, incidence of Diabetes Mellitus, the rate of past Myocardiac infraction (MI), length of intervention therapy and the number of planted stents were all higher in depression subgroup than non-depression subgroup. Female, past MI and length of intervention therapy are all independent factors of post-operative depression in patients underwent PCI. Conclusion Incidence of depression in patients underwent revascularization is high. Female is the dependent risk factor in both CABG group and PCI group. Compared with PCI, CABG had greater influence on development of depression in postoperative patients. [ABSTRACT FROM AUTHOR]

It was presented the case of a 50-year-old male, with no previous history of cardiovascular disease, who was successfully treated with induced mild hypothermia and primary percutaneous coronary intervention after cardiac arrest and prolonged resuscitation (twelve electrical cardioversions), following acute ST-segment elevation myocardial infarction. The patient had full recovery and uneventful short and long-term neurological course. Mild hypothermia has been considered a safe option for cerebral preservation after cardiopulmonary resuscitation. Several mechanisms mediate brain protection during hypothermia, including a possible prevention of apoptosis (programmed cell death). The role of apoptosis following ischemic and/or hypoxic brain injury is also reviewed.

A 65-year-old patient with the left anterior descending artery (LAD) ostial stenosis proved by coronary angiography is presented. LAD ostial stenosis is an uncommon condition whose etiology is unknown. The patient also had a coronary artery bypass graft combined with aortic valve replacement 13 years ago. The clinical and angiographic profiles of the patient are discussed here, supported by the literature., Case Presentation: A 65-year-old female patient with a medical history of hypertension and dyslipidemia came to the outpatient department with a complaint of chest pain and shortness of breath. Coronary angiography was carried out in 2008, which revealed triple vessel coronary artery disease, valvular heart disease, and ostial stenosis. In 2009, the patient underwent coronary artery bypass graft surgery combined with aortic valve replacement and remained asymptomatic thereafter. In 2022, transthoracic echocardiography and a Doppler study were conducted, which revealed normal size left ventricle, an ejection fraction of 55%, and diastolic dysfunction grade I. A graft study was done, which revealed left main and right coronary artery were normal, and the left circumflex artery with mild stenosis and obtuse marginal with subtotal stenosis and severe ostial stenosis of the LAD was observed., Clinical Discussion: Recognizing this complication early can prevent life-threatening complications and is then of the utmost importance. Coronary ostial stenosis is an uncommon but potentially dangerous consequence of aortic valve replacement whose etiology is not well understood in the literature. Rapid clinical identification is therefore essential. Coronary angiography needs to be done right away if coronary ostial stenosis is suspected. The mainstay of treatment for ostial stenosis is coronary artery bypass surgery or percutaneous coronary angioplasty. Since the patient has already undergone a coronary artery bypass graft (CABG) surgery, there is a significant risk of redoing CABG, as it is associated with considerable morbidity, which has a negative effect on long-term quality of life., Conclusion: Despite the fact that CABG is the most common form of therapy, percutaneous coronary intervention has demonstrated good short-term outcomes. To assess the effectiveness of CABG with drug-eluting stents for the treatment of coronary ostial stenosis, further information on long-term outcomes is required., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective To investigate the effects of high loading dose of atorvastatin on lipoprotein-associated phospholipase A2 (Lp-PLA2) and inflammatory cytokines in patients with acute myocardial infarction (AMI), who underwent emergency percutaneous coronary intervention (PCI). Methods A total of 65 cases with AMI who underwent emergency PCI between October 2011 and August 2013 were randomly divided into two groups: control group (n=32, atorvastatin 20 mg/24 h) and high dose atorvastatin group (n=33, atorvastatin 40 mg/24 h). Two groups of patients were given the same basic treatment. Blood samples were obtained before treatment and 72 h after PCI in two groups. Levels of Lp-PLA2, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), alanine transaminase (ALT) and aspartate transaminase (AST) were detected in two groups. The adverse drug reactions were observed. Results There were no significant differences in Lp-PLA2, IL-6, TNF-α, ALT and AST levels between two groups (P>0.05). After PCI, the levels of Lp-PLA2, IL-6 and TNF-α were significantly increased compared with those of baseline in two groups, and they were more notable in control group than those of high dose atorvastatin group (P<0.05). The levels of ALT and AST were also significantly higher after operation compared with those of basic levels (P<0.05), while there were no significant differences in ALT and AST after PCI between two groups (P>0.05). Conclusion The high loading dose of atorvastatin in AMI patients underwent emergency PCI can decrease the inflammation and stabilize the plaques in acute stage, and which is safe. [ABSTRACT FROM AUTHOR]