Objective To evaluate the effect of homemade tirofiban in percutaneous coronary intervention for acute myocardial infarction. Methods Sixty four cases of consecutive acute myocardial infarction were enrolled and divided into two groups: the tirofiban group (n=34) and the control group (n=30). In addition to intravenous heparin, patients in the tirofiban group received a bolus dose of tirofiban (10 ?g/kg) before stenting and followed by a 0.15 ?g/(kg?min) infusion for up to 12-36 hours. The control group only receive routine intravenous heparin therapy before and during PCI. The post operation TIMI blood flow, bleeding events and major adverse cardiac events were observed in the 2 groups. Results A 97.1% of patients in the tirofiban group compared with 76.7% in the control group obtained TIMI grade 2-3 flow respectively. Among them, 91.2% in the tirofiban group but 70.0% in the control obtained TIMI 3 flow. There were no serious in-hospital bleeding complications and MACE. Conclusion Homemade tirofiban is effective in improving the TIMI grade and prognosis of acute myocardial infarction after PCI.

Objective To explore the safety of tirofiban and short-term outcomes in elder patients (≥70 years old) with non-ST elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI). Methods One hundred and eight patients with NSTEACS were enrolled in the study with 42 patients older than 70 years (Group A) and another 66 patients younger than 70 years (group B). Basic characteristics, immediate success rate of PCI, the incidence of bleeding complications and thrombocytopenia were recorded. Clinical main adverse cardiac events(MACE) including cardiac death, recurrent angina pectoris, myocardial infarction(MI) and heart failure at 30-day were recorded and analyzed. Results Plasma levels of triglycerin and lipoprotein (a) in Group A were higher than that in Group B (2.06?1.38) mmol/L vs (1.53?0.55) mmol/L, P

Objective To demonstrate the effect on platelet aggregation rate (PAR) and clinical outcomes of tirofiban in patients undergoing emergency percutaneous coronary intervention (PCI) and to evaluate its safety. Methods Thirty patients presenting with STEMI and had received emergency PCI were enrolled into the tirofiban group. By means of matching, another 30 patients who received elective PCI during the same period from September 2005 to March 2006 were enrolled as the control in the 2nd Xiangya Hospital of Central South University. Patients in the tirofiban group received tirofiban infused at 10 ?g/kg within 3 minutes as bolus 10-30 minutes pre-operation followed by infusion at 0.15 ?g/(kg?min) for 36 hours. The control group received the same dosage of placebo. All patients received intravenous heparin and oral ADP receptor antagonist and aspirin. PAR, incidence of 7 and 30 days composite end point events (death, persistent myocardial ischemic, reinfarction and target vessel revascularization) and bleeding complications were observed in both groups. Results Compared with the control group, the tirofiban group showed a decrease in PAR (19?8)% vs (54?7)%, P

Objective To investigate the extablishment of minipigs no-reflow models after percutaneous coronary intervention of AMI. Methods A total of 20 wuzhishan minipigs (9?1 months old with body weight of 25?5 kg) were chosen. Left ventriculography and coronary angiography (CAG) were performed sequentially by femoral approach,AMI and no-reflow was set up by diliating balloon to occlude the coronary coronary and reperfusion after the injection of microthrombus into the left anterior descending artery. At the same time, left ventricular hemodynamics parameters were recorded. Changes in ECG and IC-ECG were monitored. Results (1) Sixteen animals survived after the procedures and fourteen of them reached the criterion of AMI with no-reflow (TIMI≤2, CTFC≥36.2). The model extablishment success rate was 70%. (2)The hemodynamics parameters including heart rate, PRI, LVEDP, and PCWP increased, but blood pressure decreased at the time no-reflow was formed compared with those before LAD was occluded. (3) During the experiment, the changes in ECG and IC-ECG were similar to those observed in human in AMI. Conclusion Minipig is an ideal species for the establishment of animal no reflow model reperfusion after microthombus injection and balloon occlusion of LAD.

Objective To examine the effects of nitroglycerin tolerance on the following myocardial ischemia reperfusion injury (MI/R). Methods Male Sprague-Dawley rats were rardomly subjected to either one of the following treatments: GTN 600 ?g/(kg/h) or saline infusion for 12 h. GTN tolerance was determined with the measurement of mean arterial blood pressure (MABP) and isolated arterial tension. All the GTN-tolerated and the control rats were subjected to 40 min of ischemia followed by 4 h of reperfusion. Myocardial apoptosis (TUNEL analysis), myocardial infarction size (Evans blue-TTC stain), plasma creatine kinase (CK) and lactate dehydrogenase (LDH) activity were determined. Results Nitrate tolerance aggravated MI/R injury as evidenced by increased myocyte apoptosis and infarction size and plasma CK, LDH activity. However, sole GTN tolerance without MI/R injury failed to show any deleterious effect on rat heart. Conclusion GTN tolerance may exert a “potential" deleterious effect on the ischemic hearts.

Objective To explore the application of echocardiography to guide interatrial septal puncture and evaluate the clinical effect in PBMV. Methods One hundren and sixty two patients were categorized into two groups according to whether echocardiography was applied in atrial septal puncture and real time monitoring. X-ray fluoroscopy guidence was used during atrial septal puncture in group 1 and in group 2, X-ray as well as echocardiography were used. The clinical outcomes were analyzed and contrasted between the 2 group. Results (1) The mean mitral pressure gradient dropped obviously in group 2 immediately after PBMV compared with group 1 (6.4?2.6 mm?Hg vs 10.2?3.7 mm?Hg,P

Objective To investigate the cause and development of atrioventricular block (AVB) occurred during and after transcatheter closure of ventricular septal defect (VSD), and to explore its feasible prevention and treatment. Methods From Mar, 2005 to Dec, 2005, 157 patients who suffered from congenital VSD underwent transcatheter interventional occlusion. Transient Ⅲ degree AVB occurred in 2 patients during the transcatheter therapy and Ⅱ degree AVB in 2 patients and Ⅲ degree AVB in 3 patients were observed 4 hours to 8 days after the therapy. Two of them suffered from Adams-Stokes syndrome. All patients were treated by intravenous injection of glucocorticosteroid, diuretic and dehydrator. One of them was also treated with temporary pacing. Results AVB did not re-occurred after the transcatheter closure in 2 patients who suffered from transient Ⅲ degree AVB during the transcatheter interventional therapy. The cardiac rhythm in 3 patients who suffered from Ⅲ degree AVB after the transcatheter closure reverted to sinus rhythm in 7, 8 and 18 days after the operation respectively. However, 2 of them suffered recurrent Ⅲ degree AVB after discharge, and one of them could not be restored to sinus rhythm. Three patients who suffered from the Ⅱ degree AVB resumed to sinus rhythm in 5, 7 and 8 days after the transcatheter closure respectively, and the type Ⅰ and the type Ⅱ of Ⅱ degree AVB alternated before the rhythm completely reverted. Conclusion AVB is a frequent complication during and after transcatheter closure of VSD. AVB occurred after transcatheter occlusion should be treated actively, or it may become permanent AVB. Improving the cardiac transcatheter interventional device and technique can prevent the high degree AVB in certain degree.

Objective To evaluate whether High-Dose folic acid supplementation may improve endothelial function in patients with coronary artery disease undergone interventional therapy. Methods Forty six patients with coronary artery disease and undergone interventional therapy were divided into two groups: 23 with folic acid supplement (20 mg/d) and 23 Patients without folic acid as the controls for 6 months. Plasma homocystine (Hcy) was measured by fluorescence polarization immunoassay and Flow-mediated endothelium-dependent dilation (FMD) of the brachial artery was assessed by high resolution ultrasound before and after 6 months. Results Compared with the control, folic acid supplementation resulted in lower plasma Hcy levels (8.82?3.32 ?mol/L vs 13.16?5.06 ?mol/L, P

0.05). Multivariate analysis revealed that risk factors for vascular complications included the difference in radial artery diameter and sheath size; prolonged procedure time and comorbidity of diabetes mellitus. Conclusion Transradial access is a safe and practical alternative approach for intervention procedure. Vascular ultrasonic examination is valuable for selection sheath before invention procedure especially in patients with diabetes mellitus and in assessment vascular complications after the procedure.

Objective To investigate the safety and effectiveness of sirolimus-eluting stents (SESs, Cypher stents) in the treatment of acute myocardial infarction. Methods Ninety seven SESs were implanted in 78 lesions of 78 patients with acute myocardial infarction. In all the lesions, 20.7% of the target vessel diameter ≤2.5 mm, 26% was in-stent restenosis, 82.3% was total occlusions lesions and 17.7% with degree of stenosis up to 95%. The in-hospital procedural success rate and the incidence of complications were observed. Major adverse cardiac events, restenosis rate and late lumen loss were also observed during follow-up. Results All stents were implanted successfully. There were no remained stenosis and major in-hospital complications. During clinical follow-up of 6-15 months (mean 10?3.6 months), 2 patients had recurrent angina due to in-stent restenosis confirmed by angiography, and required target vessel revascularization. No major adverse cardiac events was found in the other 76 patients, and the mortality was null. Follow up quantitative coronary angiographies were obtained in 64 patients, 9?2.2 months after the procedure. The average late lumen loss were 0.24?0.05 mm at the proximal edge, 0.19?0.03 mm within the stent segment, and 0.10?0.02 mm at the distal edge. The angiographic in-lesion restenosis rate was 3.1% and target vessel revascularization was 2.6%. Conclusion SES may be safe and feasiable for the treatment of acute myocardial infarction through reduction in restenosis and target vessel revascularization at 9 months after intervention.