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[Influences of different aspiration results by aspiration thrombectomy catheter in emergent percutaneous coronary intervention for patents with acute myocardial infarction].
Lian, H, Yang, JQ, Chen, ZJ
Zhonghua yi xue za zhi. 2011;(40):2845-8
Abstract
OBJECTIVE To evaluate the influences of different aspiration results by Diver C.E. aspiration thrombectomy catheter on myocardium perfusion and clinical outcomes during emergency PCI (percutaneous coronary intervention) for the patients with acute ST segment elevation myocardial infarction (STEMI). METHODS The patients undergoing emergent PCI and using Diver C.E. aspiration thrombectomy catheter with STEMI from July 2008 to February 2011 were enrolled into the study group. According to the aspiration results, they were divided into 2 groups: aspiration-positive group (n = 38) and aspiration-negative group (n = 28). And those undergoing routine PCI alone during the same period were enrolled into the control group (n = 66). The baseline profiles, immediate post-operative CAG (coronary angiography) and follow-up data were compared. RESULTS No significant baseline differences existed among 3 groups. Compared with the control group, all parameters significantly improved in the aspiration-positive group. But in the aspiration-negative group, the differences of slow flow/no-reflow and major adverse cardiovascular events (MACE) were insignificant (P > 0.05). Compared with the aspiration-negative group, cTFC (29 ± 9 vs 35 ± 11 frames, P < 0.05), ST segment (90% ± 20% vs 76% ± 25%, P < 0.05) and the peak serum levels of CK-MB (creatine kinase-MB) and TnT (troponin-T) [CK-MB: (201 ± 86) U/L vs (264 ± 93) U/L, P < 0.05; TnT: (41 ± 21) µg/L vs (60 ± 24) µg/L, P < 0.05] decreased significantly. But the differences in slow flow/no-reflow and MACE were insignificant (P > 0.05). CONCLUSION Application of Diver CE. during emergent PCI i.s both safe and efficacious for STEMI patients with heavier thrombus burden. It may improve distal myocardium perfusion and abate myocardial damage. The patients with positive aspiration results have better clinical outcome. But the efficacy of aspiration-negative patients needs further evaluations.
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Variation in the human soluble epoxide hydrolase gene and risk of restenosis after percutaneous coronary intervention.
Kullmann, S, Binner, P, Rackebrandt, K, Huge, A, Haltern, G, Lankisch, M, Füth, R, von Hodenberg, E, Bestehorn, HP, Scheffold, T
BMC cardiovascular disorders. 2009;:48
Abstract
BACKGROUND Restenosis represents the major limiting factor for the long-term efficacy of percutaneous coronary intervention (PCI). Several genetic factors involved in the regulation of the vascular system have been described to play a role in the pathogenesis of restenosis. We investigated whether the EPHX2 K55R polymorphism, previously linked to significantly higher risk for coronary heart disease (CHD), was associated with the occurrence of restenosis after PCI. The association with incident CHD should have been confirmed and a potential correlation of the EPHX2 K55R variant to an increased risk of hypertension was analysed. METHODS An overall cohort of 706 patients was studied: This cohort comprised of 435 CHD patients who had undergone successful PCI. Follow-up coronary angiography in all patients was performed 6 months after intervention. Another 271 patients in whom CHD had been excluded by coronary angiography served as controls. From each patient EDTA-blood was drawn at the baseline ward round. Genomic DNA was extracted from these samples and genotyping was performed by real-time PCR and subsequent melting curve analysis. RESULTS In CHD patients 6 month follow-up coronary angiography revealed a restenosis rate of 29.4%, classified as late lumen loss as well as lumen re-narrowing >or= 50%.Statistical analysis showed an equal genotype distribution in restenosis patients and non-restenosis patients (A/A 82.0% and A/G + G/G 18.0% versus A/A 82.1% and A/G + G/G 17.9%). Moreover, neither a significant difference in the genotype distribution of CHD patients and controls nor an association with increased risk of hypertension was found. CONCLUSION The results of the present study indicate that the EPHX2 K55R polymorphism is not associated with restenosis after PCI, with incidence of CHD, or with an increased risk of hypertension and therefore, can not serve as a predictor for risk of CHD or restenosis after PCI.
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[Study on the relationship between aspirin resistance and incidence of myonecrosis after non-emergent percutaneous coronary intervention].
Zhang, Y, Liang, J, Zhou, YJ, Yuan, H, Zhang, YZ, Dong, L
Zhonghua xin xue guan bing za zhi. 2005;(8):695-9
Abstract
OBJECTIVE To investigate the occurrence of aspirin resistance in coronary heart disease (CHD) patients and its influence on myonecrosis among patients undergoing non-emergent percutaneous coronary intervention (PCI). METHODS 256 CHD patients who have been on aspirin (100 mg/d) for at least 7 days were recruited based on aspirin responsiveness determination. All the patients were divided into two groups: aspirin-resistant group and aspirin-sensitive group. For all patients scheduled for non-emergent PCI, a loading dose of 300 mg of clopidogrel was given at least 12 h before PCI and a 75 mg maintenance dose was given every morning before and after PCI. The incidence of myonecrosis was evaluated by the levels of creatine kinase-myocardial band (CK-MB) and troponin I (TnI) before and after PCI. RESULTS Aspirin resistance was found in 67 (26.2%) patients and 189 (73.8%) patients were aspirin-sensitive. There was a significantly higher proportion of female subjects in the aspirin-resistant group. The incidence of any CK-MB elevation was 38 (56.7%) in aspirin-resistant group and 42 (22.2%) in aspirin-sensitive group (P < 0.01). The elevation of TnI was observed in 41 (61.2%) of the aspirin-resistant group and in 67 (35.4%) of the aspirin-sensitive group (P < 0.05). Multivariate analysis revealed that aspirin resistance was an independent predictor for CK-MB elevation after PCI (OR = 2.5; 95% CI 1.5 to 6.5; P < 0.05). CONCLUSION Aspirin resistance exists in some CHD patients, which increases the risk of myonecrosis following non-emergent PCI.
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Effect of abciximab on cardiac enzyme elevation after transluminal extraction atherectomy (TEC) in high-risk saphenous vein graft lesions: comparison with a historical control group.
Khan, MA, Liu, MW, Chio, FL, Yates, VB, Chapman, GD, Misra, VK, Sweeney, A, Dean, LS
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2001;(1):40-4
Abstract
Saphenous vein graft (SVG) intervention has been associated with an increased incidence of distal embolization. Long lesions and lesions associated with thrombus are particularly at increased risk. This study was performed to determine whether abciximab may decrease this risk in high risk SVG angioplasty. From June 1994 to June 1998, 84 patients with at least one high risk factor, i.e., lesion length >20 mm or angiographic evidence of thrombus, underwent Transluminal extraction atherectomy (TEC) procedure followed by balloon dilatation or stenting. Of these 84 patients, 37 who had procedure after September 1995 underwent TEC with abciximab (Abciximab Group) and 47 who had their procedure before that date had TEC without abciximab thereby serving as historic control (Non-Abciximab Group). All patients had normal pre-procedure CK and CK-MB. Total creatine kinase (CK) and CK-MB were measured every 8 hr post-procedure for 24 hr. Baseline demographics, angiographic characteristics, incidence of LV dysfunction and triple vessel disease were similar between the two groups. Graft age was similar between two groups (122 +/- 70 vs. 117 +/- 54 months). Graft diameter, pre and post-procedure percent stenoses were not different between the two groups. Stents were used in 65% in the Abciximab group and 45% in Non-Abciximab group (P = 0. 14). There was no in-hospital repeat PTCA, urgent bypass surgery, or cardiac death. There was no difference between the two groups in regards to the incidence of any elevation of total CK (27% vs. 21. 3%) or CK-MB (54% vs. 51%). When used in conjunction with TEC in treating high risk vein graft lesions, abciximab did not reduce post procedure CK-MB elevation in this patient population.
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A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study).
Dill, T, Dietz, U, Hamm, CW, Küchler, R, Rupprecht, HJ, Haude, M, Cyran, J, Ozbek, C, Kuck, KH, Berger, J, et al
European heart journal. 2000;(21):1759-66
Abstract
AIMS: Rotablation is a widely used technique for the treatment of complex coronary artery lesions but is so far only poorly supported by controlled studies. The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and rotablation in patients with angiographically pre-defined complex coronary artery lesions. METHODS AND RESULTS At seven clinical sites 502 patients with pre-defined complex coronary artery lesions were assigned to either PTCA (n=250) or rotablation (n=252). Primary end-points were procedural success, 6-month restenosis rates in the treated segments, and major cardiac events during follow-up. Procedural success was achieved in 78% (PTCA), and 85% (rotablation) (P=0.038) of cases. Crossover from PTCA to rotablation was 4% and 10% vice versa (P=0.019). There was no difference between PTCA and rotablation with respect to procedure-related complications such as Q wave infarctions (2.4% each), emergency bypass surgery (1.2% versus 2.4%), and death (1.6% versus 0.4%). However, more stents were required after PTCA (14.9% versus 6.4%, P<0.002), predominantly for bailout or unsatisfactory results. Including bail-out stents as an end-point, the procedural success rates were 73% for angioplasty and 84% for rotablation (P=0.006). At 6 months, symptomatic outcome, target vessel reinterventions and restenosis rates (PTCA 51% versus rotablation 49%, P=0.33) were not different. CONCLUSION Complex coronary artery lesions can be treated with a high level of success and low complication rates either by PTCA with adjunctive stenting or rotablation. The long-term clinical and angiographic outcome is comparable.