RESUMEN
BACKGROUND: Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI. METHODS AND RESULTS: Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh (<1 day), lytic thrombus (1 to 5 days), and organized thrombus (>5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95%) of 211 patients. In 12 patients (5%), only plaque components were identified, and in 85 patients (41%), both thrombus and plaque material were aspirated. In 18 (9%) of 199 patients, the thrombus was organized, and in 70 patients (35%), the thrombus showed lytic changes, whereas in 98 (49%), a completely fresh thrombus was found. In 14 (7%) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus. CONCLUSIONS: In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/complicaciones , Trombosis Coronaria/complicaciones , Trombectomía , Anciano , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Terapia Combinada , Enfermedad de la Arteria Coronaria/terapia , Trombosis Coronaria/tratamiento farmacológico , Trombosis Coronaria/patología , Trombosis Coronaria/cirugía , Trombosis Coronaria/terapia , Femenino , Filtración , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Rotura Espontánea , Stents , Succión , Trombectomía/métodos , Factores de TiempoRESUMEN
B-type natriuretic peptide (BNP) and the N-terminus of pro-BNP (NT-pro-BNP) have prognostic value in patients with heart failure and patients with acute coronary syndromes. Little is known about the prognostic value of baseline NT-pro-BNP alone or in combination with C-reactive protein (CRP) for clinical outcome after percutaneous coronary intervention (PCI). Within a single center registry of contemporaneous PCI, we investigated the prognostic value of baseline plasma NT-pro-BNP and CRP concentrations for the prediction of death or nonfatal myocardial infarction (MI) during 12 to 14 months of follow-up. Among 1,172 consecutive patients, the occurrence of death or MI increased significantly with baseline NT-pro-BNP before PCI (first quartile 0 of 294, second quartile 6 of 291 [2.1%], third quartile 4 of 294 [1.4%], fourth quartile 22 of 293 [7.5%)]; p <0.0001). NT-pro-BNP in the top quartile significantly predicted death (odds ratio [OR] 13.37, 95% confidence interval [CI] 4.50 to 40.38, p <0.0001) and was associated with nonfatal MI (OR 2.53, 95% CI 0.77 to 8.34, p = 0.22) An abnormal CRP was significantly associated with death (OR 3.47, 95% CI 1.26 to 9.54, p = 0.019). Stepwise multivariate logistic regression analysis identified age >65 years and NT-pro-BNP as independent significant predictors of death/MI (age OR 3.18, 95% CI 1.32 to 7.67, p = 0.01; NT-pro-BNP OR 4.57, 95% CI 2.07 to 10.10, p = 0.0001). Baseline NT-pro-BNP before PCI provides important, independent prognostic information for the occurrence of death or nonfatal MI during long-term follow-up.
Asunto(s)
Angioplastia Coronaria con Balón , Biomarcadores/sangre , Infarto del Miocardio/sangre , Infarto del Miocardio/mortalidad , Proteínas del Tejido Nervioso/sangre , Fragmentos de Péptidos/sangre , Anciano , Proteína C-Reactiva/análisis , Femenino , Humanos , Masculino , Péptido Natriurético Encefálico , Pronóstico , Análisis de RegresiónRESUMEN
BACKGROUND: We assessed the predictive value of preprocedural plasma C-reactive protein (CRP) concentrations and statin therapy on 6 months angiographic and 1-year clinical outcome after nonurgent coronary stent placement. METHODS AND RESULTS: Baseline plasma high-sensitivity CRP concentrations were prospectively measured in 345 patients undergoing elective stent placement in a native coronary artery. The binary angiographic in-stent restenosis (ISR; stenosis > or = 50% of vessel diameter) rate was 19% in patients with CRP values within the reference interval (< or = 3 mg/L) and 22% in patients with CRP >3 mg/L [odds ratio (OR) = 1.2; 95% confidence interval (CI), 0.73-2.09]. Statin therapy in a univariate analysis significantly reduced both angiographic and clinical ISR rates. Multivariate logistic regression analysis identified unstable angina, smoking, and stent length, but neither CRP concentration nor statin therapy as independent predictors for angiographic ISR. Patients with an abnormal CRP value showed a trend toward a higher risk of nonfatal myocardial infarction (3.8% vs 0.5%; OR = 7.43; 95% CI, 0.87-61.65). Target lesion revascularization rates did not differ between the two groups (9.6% vs 10.6%; OR = 1.13; 95% CI, 0.56-2.28). In multivariate analysis, male sex (OR = 0.44, 95% CI, 0.19-0.97) and statin therapy (OR = 0.26; 95% CI, 0.09-0.68) were independent predictors for the occurrence of target lesion revascularization. CONCLUSIONS: This study demonstrated a lack of association between preprocedural plasma CRP concentrations and angiographic coronary ISR or clinically driven target lesion revascularization. Patients with an abnormal CRP concentration showed a trend toward higher risk of nonfatal myocardial infarction during 1 year of follow-up. Statin therapy was independently associated with decreased clinically driven target lesion revascularization, underlining the beneficial effects of statins on clinical outcome.
Asunto(s)
Angioplastia Coronaria con Balón , Proteína C-Reactiva/metabolismo , Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/sangre , Stents , Anticolesterolemiantes/uso terapéutico , Estudios de Cohortes , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Reestenosis Coronaria/prevención & control , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
To determine the influence of coronary artery stent strut thickness on angiographic late luminal loss, 663 patients were included in a single-center observational cohort after receiving an ACS Multilink stent in a native coronary vessel. At 6- to 10-month follow-up, 287 patients treated with a thin-strut stent (50 microm) had significantly less late luminal loss than 376 patients treated with a thick-strut stent (> or =90 microm) (mean 0.92 +/- 0.59 vs 1.06 +/- 0.71 mm, p = 0.011); on multivariate regression analysis, strut thickness was found to be an independent predictor for late luminal loss.
Asunto(s)
Enfermedad Coronaria/terapia , Vasos Coronarios/patología , Stents , Túnica Íntima/patología , Distribución de Chi-Cuadrado , Angiografía Coronaria , Enfermedad Coronaria/patología , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to determine predictors of left ventricular (LV) function recovery at the time of primary percutaneous coronary intervention (PCI). BACKGROUND: Angiographic, intracoronary Doppler flow, and electrocardiographic variables have been reported to be predictors of recovery of LV function after acute myocardial infarction (MI). We directly compared the predictive value of Thrombolysis In Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (cTfc), myocardial blush grade, coronary Doppler flow velocity analysis, and resolution of ST-segment elevation for recovery of LV function in patients undergoing primary PCI for acute MI. METHODS: We prospectively studied 73 patients who underwent PCI for an acute anterior MI. Recovery of global and regional LV function was measured using an echocardiographic 16-segment wall motion index (WMI) before PCI, at 24 h, at one week, and at six months. Directly after successful PCI, coronary flow velocity reserve (CFR), cTfc, TIMI flow grade, and myocardial blush grade were assessed. RESULTS: Mean global and regional WMI improved gradually over time from 1.86 +/- 0.23 before PCI to 1.54 +/- 0.34 at six-month follow-up (p < 0.0001) and from 2.39 +/- 0.30 before PCI to 1.87 +/- 0.48 at six-month follow-up (p < 0.0001), respectively. Multivariate analysis revealed CFR as the only independent predictor for global and regional recovery of LV function at six months. CONCLUSIONS: Doppler-derived CFR is a better prognostic marker for LV function recovery after anterior MI than other currently used parameters of myocardial reperfusion.
Asunto(s)
Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Stents , Función Ventricular Izquierda/fisiología , Angioplastia Coronaria con Balón , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Velocidad del Flujo Sanguíneo/fisiología , Estudios de Cohortes , Circulación Coronaria/fisiología , Ecocardiografía Doppler , Electrocardiografía , Femenino , Estudios de Seguimiento , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Factores de TiempoRESUMEN
PURPOSE: We investigated the associations between baseline C-reactive protein levels in patients undergoing percutaneous coronary angioplasty and death, nonfatal myocardial infarction, and repeat revascularization during 14 months of follow-up. METHODS: In a single-center, prospective, cohort study, plasma levels of C-reactive protein were measured in 1458 consecutive patients undergoing elective or urgent coronary angioplasty. Patients were followed at 12 to 14 months for the occurrence of death, nonfatal myocardial infarction, and repeat revascularization. RESULTS: The incidence of death or myocardial infarction was 6.1% (44/716) in patients with an increased C-reactive protein level (>3 mg/L) and 1.5% (11/742) in patients with a normal level (relative risk [RR] = 4.4; 95% confidence interval [CI]: 2.2 to 8.5; P <0.0001). In a multivariate logistic regression model, an increased C-reactive protein level was an independent predictor of death or nonfatal myocardial infarction (RR = 3.6; 95% CI: 1.8 to 7.2; P =0.0001). The incidence of repeat revascularization was similar in patients with or without an increased C-reactive protein level (23% [168/716] vs. 22% [163/742], P = 0.54). Statin therapy at the time of the procedure was associated with a lower mean (+/- SD) C-reactive protein level (5.8 +/- 9.7 mg/L vs. 7.2 +/- 12.1 mg/L, P =0.02), but was not associated with the risk of death, nonfatal myocardial infarction, and repeat revascularization during follow-up. CONCLUSION: An increased C-reactive protein level is an independent prognostic indicator for the occurrence of death or nonfatal myocardial infarction following coronary angioplasty, but is not associated with the need for repeat revascularization.