| Part1Objective Direct percutaneous coronary intervention is the generally accepted superior strategy in acute ST-segment election myocardial infarction(STEMI), Yet, in as many as40%of patients, myocardial perfusion in the infarct-related artery territory is insufficient. The aim of the present study was to assess the early clinical outcome and no-reflow phenomenon in patients with acute STEMI. Methods A total of76patients (61.9±8.9years,40men) with STEMI who received successful PCI were included in this study. The extent of coronary artery lesions was measured by quantitative coronary artery angiography (QCA).Low reflow and no reflow were diagnosed by thrombolysis in myocardial infarction (TIMI) flow grade≤2or TIMI flow3with a final myocardial blush grade≤2. Subjects were tracked for subsequent major adverse cardiovascular events (MACE):cardiac death, myocardial infarction, unstable angina/non-ST elevation myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery bypass and stroke during12months following-up. The patients were divided into occurrence of MACE group (MACE group) and absence of MACE group (NMACE group). Results During12months follow-up,21of76(27.6%)study participants occurred main adverse cardiovascular events. There were more diagnosis of diabetes (P=0.0009), longer time from occurrence to balloon (P=0.0005) and higher rates of low reflow or no-reflow (P=0.0017) in the MACE group compared with NMACE group. Multivariate Cox analysis identified that reflow (HR:2.915,95%CI:1.098-7.742, P=0.0317), time from symptom to balloon (HR:2.736,95%CI:1.050-7.126, P=0.0357) and a diagnosis of diabetes (HR:2.736,95%CI:1.028-2.221, P=0.0394) as independent predictors of cardiovascular events after adjustment of all entered baseline variables. Conclusions Our study suggests that besides diabetes, low reflow or no reflow and time from symptom to balloon are prognostic factors for MACE in patients with acute ST elevation myocardial infarction following PCI. Part2Objective It has been found that inflammation play an important role in atherosclerosis, and the procedure of percutaneous coronary intervention (PCI) can lead to inflammation reaction.however the relationship of inflammation factors and the reflow has been less well defined in patients following PCI. The aim of this part is to study the effects of matrix metalloproteinase-9(MMP-9) and interleukin-6(IL-6) on the reflow after PCI. Methods We investigated the effects of both diagnostic coronary angiography (CA)[n=15; blood sampling immediately before CA and15min after CA] and PCI (n=39; blood sampling before PCI, local of PCI,15min after PCI) on levels of MMP-9and IL-6across comparable patient groups. Results There were no differences in baseline levels of MMP-9or IL-6between the two study groups (CA, PCI; all p=not significant). Following CA (before to15min after), there were no significant changes in MMP-9or IL-6(p=not significant). Following PCI, there were a significant increases of IL-6in femoral artery (P=0.025), even higher in the local lession in coronary artery. There were positive relation between local IL-6level and corrected thrombolysis in myocardial infarction frame count (cTFC, r=0.57, P＜0.001) after PCI, and there were also found that positive relation between the changes of MMP-9and IL-6following PCI (r=0.32,P=0.043), and found that a positive ralation between the changes of local MMP-9and local IL-6(r=0.41, p=0.009). The gental relation between changes of local MMP-9and cTFC was also expressed (r=0.33,P=0.040). Conclusions The increase of IL-6in patients following elective PCI may indicate that the procedure of PCI dereactly lead to inflammation reaction. The real level of regenal MMP-9as well as IL-6, remaining inflammation reaction in the lession of coronary artery, may affect on reflow after stenting. Part3Objective Thrombus overload had increased the risk of adverse cardiac events in patients with acute ST-elevation myocardial infarction (ASTEMI) following PCI. We sought to examine the effects of Diver DE aspiration on infarction related artery flow in thrombus over-load patients with ASTEMI undergoing primary PCI. Methods The patients were randomly assigned to aspiration group (study group, n=30) or no aspiration group (control group, n=31) by TIMI thrombus grade. TIMI, resolution of maximal ST-segment elevation were calculated before and after PCI; Left ventricular ejection fraction (LVEF) was detected by echocardiography5-7days after PCI. Major adverse cardiovascular events (MACE) were tracked during in-hospital and within one month following-up. Results There were no significantly found in clinical and lesion characteristics between two groups. The numbers of low reflow and no reflow in study group were less than those in control group (13.3%vs.35.5%, P=0.0446), and the ST segment resolution≥50%(83.3%vs.58.1%, P=0.0305) in aspiration group were higher than those in no aspiration group in thrombus grade two to three degree, and even the left ventricular ejection fractions in study group with aspiration were increased comparing with control without Diver CE (0.579±0.08vs.0.531±0.09, P=0.0358). There was a significant difference toward MACE in aspiration group compared to without aspiration (6.7%vs.19.4%), though it did not match the significant statistic level (P=0.1422). Conclusions Diver CE aspiration, increasing infarction related artery flow and improving left ventricular systolic function, would be better the prognosis of ASTEMI with thrombus over-load following Primary percutaneous coronary intervention. Part4Objective Ischaemic preconditioning limits the damage induced by subsequent ischaemia/reperfusion (I/R). However, preconditioning is of little practical use as the onset of an infarction is usually unpredictable. Recently, it has been shown that the heart can be protected against the extension of I/R injury if brief coronary occlusions are performed just at the beginning of the reperfusion. This procedure has been called postconditioning. We sought to examine the effects of postconditioning in patients with acute ST-elevation myocardial infarction (ASTEMI) undergoing primary PCI. Methods62patients with their first ASTEMI were randomly assigned to a study group (n=32) or control (n=30) within90minutes after adminssion. After predilatation, in the Control group, no intervention was applied in the first3minutes of reperfusion, while in the study group (Postconditioning group), three cycles of30-second angioplasty balloon deflation and30second inflation were repetitively applied. TIMI, corrected TIMI frame count, resolution of50%ST-segment elevation and creatine kinase were calculated before and after PCI. Results There were no significantly found in clinical and lesion characteristics between two groups. The numbers of reflow (81.3%vs.56.7%, P=0.0359) and ST segment resolution≥50%(93.8%vs.73.3.%, P=0.0289) in study group were much more that those in control, and the TIMI frame counts (28.5±9.1vs.37.4±12.4, P=0.0019) and creatine kinase (2159.9±485.5vs.1452.4±201.6, P=0.0282) were lower in the study group compared to control. Further, it was found that the hs-CRP levels in study group following PCI was significantly decreased comparing with those in control group following PCI(8.2±2.8mg/L vs.10.9±3.1mg/L, P=0.0005). Conclusions This study demonstrates that postconditioning in patients with acute ST-elevation myocardial infarction undergoing PCI, improving myocardial reperfusion and lessening inflammatory reaction, may benefit for the future. |
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