Primary percutaneous coronary intervention and thrombolysis remain therapies of choice for patients presenting with ST-segment elevation myocardial infarction (STEMI). Clinical outcome in the management of acute STEMI is dependent on myocardial reperfusion time and reperfusion strategies. Optimisation of these strategies should take into consideration logistical limitations of the local medical systems and the various patient profiles. We review the reperfusion strategies and its history in Singapore, comparing its clinical application with that in some developed Western countries.
Humans ; Myocardial Infarction ; blood ; physiopathology ; therapy ; Myocardial Reperfusion ; methods ; Singapore

In the field of percutaneous coronary intervention, the evolution of coronary metal stents has been well established for the past three decades, but research on bioresorbable scaffolds has only gained momentum in the recent past. Although second-generation drug-eluting metal stents are the gold standard for the treatment of obstructive coronary artery disease, a few drawbacks exist. The development of bioresorbable scaffolds is an attempt to overcome the limitations of metal stents. This review highlights the rationale for the bioresorbable scaffold, its properties and potential applications. It also focuses on the current evidence and concerns regarding the application of the bioresorbable scaffold in day-to-day practice.

We report a 38-year-old man with previous Kawasaki disease who presented with exertional dyspnoea and was found to have multivessel coronary aneurysm and stenoses on coronary angiography. Coronary artery bypass surgery was subsequently performed. This case highlights the angiographic and intravascular ultrasonographic imaging features of this relatively uncommon condition presenting to an adult general cardiology service in Singapore.
Adult ; Coronary Aneurysm ; diagnosis ; etiology ; Coronary Angiography ; methods ; Coronary Stenosis ; diagnosis ; etiology ; Coronary Vessels ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Ultrasonography, Interventional ; methods

Acute Coronary Syndrome ; physiopathology ; Coronary Angiography ; Disease Progression ; Humans ; Myocardial Infarction ; classification ; physiopathology ; Plaque, Atherosclerotic ; diagnostic imaging ; physiopathology

INTRODUCTIONThis was a single centre registry study on clinical efficacy and safety of drug-eluting stent (DES) in diabetic patients undergoing percutaneous coronary intervention (PCI) for complex coronary lesions.

MATERIALS AND METHODSA total of 288 diabetic patients who underwent elective PCI between September 2003 and June 2006 in our centre were enrolled and followed-up for 18 months. Among them, 79 (27.4%) patients received sirolimus-eluting stent (SES), 138 (47.9%) paclitaxel-eluting stent (PES) and 71 (24.7%) zotarolimus-eluting stent (ZES). The endpoints were major adverse cardiac events (MACE) and stent thrombosis rates.

RESULTSBaseline demographics were comparable among the 3 DES groups (median age was 60 years; 69% men). Complex lesions (defined as ACC/AHA type C stenosis) accounted for 55.6% of the total lesions: SES (50.6%), PES (65.2%) and ZES (43.7%), P = 0.005. At 18 months follow-up, the composite endpoint of MACE was found in 12.7% in SES group, 8.7% in the PES group, 12.7% in ZES group and (P = 0.55). Stent thrombosis (ST) occurred in 1 patient (1.3%) in the SES group, 2 patients (1.4%) in PES group and 1 patient (1.4%) in ZES group, respectively (P = 1.00).

CONCLUSIONThe use of DES for elective PCI in diabetic patients was associated with favourable intermediate-term clinical outcomes with no significant differences in efficacy among the 3 groups. Stent thrombosis had low event occurrence rate.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis ; prevention & control ; Coronary Stenosis ; complications ; surgery ; Diabetes Complications ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; Male ; Middle Aged ; Myocardial Infarction ; Paclitaxel ; administration & dosage ; Sirolimus ; administration & dosage ; analogs & derivatives ; Survival Analysis ; Treatment Outcome

Aged ; Cardiac Catheters ; Combined Modality Therapy ; Coronary Restenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; therapeutic use ; Percutaneous Coronary Intervention ; instrumentation ; Stents ; Treatment Outcome ; Tubulin Modulators ; administration & dosage ; therapeutic use

Cardiology ; history ; Echocardiography ; history ; History, 20th Century ; History, 21st Century ; Hospitals ; Humans ; Singapore ; Universities

Abscess/diagnosis* ; Cardiac Tamponade/etiology* ; Humans ; Klebsiella Infections/diagnosis* ; Klebsiella pneumoniae ; Mediastinal Diseases/diagnostic imaging*

INTRODUCTIONSeveral randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.

MATERIALS AND METHODSWe studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2).

RESULTSThe mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60].

CONCLUSIONSPrimary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Adult ; Angioplasty, Balloon, Coronary ; Antifibrinolytic Agents ; therapeutic use ; Electrocardiography ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; drug therapy ; surgery ; Registries ; Renal Insufficiency, Chronic ; complications ; Retrospective Studies ; Survival Analysis

INTRODUCTIONStudies have suggested that women who present with non-ST-segment elevation myocardial infarction (NSTEMI) may differ in their clinical response to early invasive strategy compared to male patients. We examined the impact of gender difference in NSTEMI patients on outcomes following invasive versus conservative treatment.

MATERIALS AND METHODSPatients enrolled in our national myocardial infarction (MI) registry between January 2000 and September 2005 with diagnosis of NSTEMI were retrospectively analysed. The study endpoint was the occurrence of major adverse cardiac events (MACE) in the patients at 1 year.

RESULTSA total of 1353 patients (62.2% male) with NSTEMI were studied. The mean age of men was 62 +/- 14 versus 72 +/- 12 years in women in the cohort (P <0.001). The prevalence of hypertension and diabetes mellitus were significantly higher in women. Men were more likely to undergo revascularisation than women (OR, 2.97; 95% CI, 2.18-3.89, P <0.001). Among those who were revascularised, there was no gender difference in survival or recurrent MI rates during hospitalisation and at 1 year. Compared to medical therapy, percutaneous coronary intervention (PCI) was associated with a significant reduction in MACE in both women (OR, 0.44; 95% CI, 0.20-0.95) and men (OR, 0.40; 95% CI, 4.79-12.75). The most important predictor of MACE for females was diabetes mellitus (HR, 1.98; 95% CI, 1.17-3.33).

CONCLUSIONSThere is a gender-based difference in the rate of revascularisation among patients with NSTEMI. Women benefit from an invasive approach as much as men, despite their advanced age, with similar rates of mortality and recurrent MI at 1-year follow-up.

Adrenergic beta-Antagonists ; therapeutic use ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; surgery ; Platelet Aggregation Inhibitors ; therapeutic use ; Practice Patterns, Physicians' ; Recurrence ; Sex Factors ; Survival Analysis