OBJECTIVETo analyze the components of retrieved materials from the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients by manual aspiration during primary percutaneous coronary intervention (PCI).

METHODSVisible retrieved materials were collected, fixed in formalin and processed for paraffin embedding, sectioned and stained with hematoxylin and eosin (HE). The retrieved materials were microscopically divided into erythrocyte-rich thrombi, platelet/fibrin-rich thrombi, combined thrombi (similar proportions of erythrocytes and platelet/fibrin components), atherosclerotic plaque materials and edematous components. Based on pathological findings, thrombus materials were classified into fresh (< 1 d), lytic (1-5 d), fresh/lytic and organized thrombi (> 5 d) after formation. All patients were further classified into plaque positive and plaque negative groups. Clinical and angiographic data were also obtained for analyzing possible association between pathological findings and surrogates of myocardial reperfusion, including myocardial blush grade (MBG), enzymatic estimated infarction size (peak CK and CK-MB levels), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) which were assessed 16 h after procedure.

RESULTSVisible samples were collected from 49 patients by manual catheter aspiration (thrombus components in 46 patients, atherosclerotic plaque only in 3 patients). Frequency of erythrocyte-rich thrombi, platelet/fibrin-rich thrombi and combined thrombi were 41.3% (19/46), 30.4% (14/46) and 28.2% (13/46), respectively. The incidence of fresh, lytic, fresh/lytic and organized thrombi were 47.8% (22/46), 32.6% (15/46), 10.9% (5/46) and 8.7% (4/46), respectively. Plaque materials were found in 57.1% (28/49) patients, including ruptured plaque accompanied by thrombus formation [8.2% (4/49)], fibrous plaque [6.1% (3/49)] and thickened intima [2.0% (1/49)]. Baseline characteristics did not differ between plaque positive (n = 28) and plaque negative (n = 21) groups. Ratios of MBG 3 were higher in plaque positive group than in plaque negative group [82.1% (23/28) vs. 52.4% (11/21), P = 0.025]. Peak CK and CK-MB levels were lower in the former than in the later [(1705 +/- 1647) U/L vs. (2629 +/- 2013) U/L, P = 0.042; (146 +/- 136) microg/L vs. (258 +/- 215) microg/L, P = 0.016; respectively]. Furthermore, LVEF were higher in plaque positive group than in plaque negative group (0.59 +/- 0.10 vs. 0.52 +/- 0.08, P = 0.012).

CONCLUSIONManual catheter aspiration during primary PCI in STEMI patients is an effective way for removing thrombus and plaque materials, and plaque debulking before stenting or pre-dilation and this procedure might probably improve myocardial reperfusion, limit infarction size and improve cardiac function.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; pathology ; surgery ; Myocardial Reperfusion ; methods ; Suction

BackgroundVery few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion.

MethodsFrom January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year.

ResultsCompared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients.

ConclusionsCompared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.

Aged ; Coronary Occlusion ; pathology ; surgery ; Coronary Vessels ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; pathology ; surgery ; Percutaneous Coronary Intervention ; methods ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction ; pathology ; surgery ; Treatment Outcome

Heart Aneurysm ; mortality ; pathology ; surgery ; Humans ; Mitral Valve Insufficiency ; mortality ; physiopathology ; surgery ; Myocardial Infarction ; mortality ; physiopathology ; surgery ; Ventricular Dysfunction, Left ; pathology ; surgery

BackgroundFemales with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEMI is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI after percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, 1-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI.

MethodsThis study retrospectively analyzed 1920 consecutive STEMI patients (age ≤60 years) treated with PCI from January 01, 2006, to December 31, 2012. A propensity score analysis between males and females was performed to adjust for differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was performed using a Cox proportional hazards model for 3-year NACE.

ResultsCompared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P < 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2.12, 3.00], P < 0.001), high-density lipoprotein (1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P = 0.003), total cholesterol (4.98 ± 1.10 vs. 4.70 ± 1.15, t = -3.508, P < 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ± 18.03, t = -11.834, P < 0.001) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415-4.620, P = 0.002), hypertension (HR: 2.017, 95% CI: 1.138-3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI: 1.115-4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI: 0.437-0.894, P = 0.010) was independent protective factors of NACE.

ConclusionsFemales with STEMI undergoing PCI have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians.

Adolescent ; Adult ; China ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction ; pathology ; surgery ; Percutaneous Coronary Intervention ; methods ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction ; pathology ; surgery ; Time Factors ; Treatment Outcome ; Young Adult

OBJECTIVEHuman umbilical cord blood contains abundant immature stem/progenitor cells, which may contribute to the repair of infarcted myocardium. Present study aimed to explore the feasibility and effects of human umbilical cord blood mononuclear cells (HUCBC) transplantation for the treatment of myocardial infarction.

METHODSForty-five male Wistar rats were randomly divided into three groups: (1) Myocardial infarction (MI plus vehicle, n = 15), (2) MI plus cell transplantation (HUCBC were implanted into the peri-infarct area immediately after MI, n = 15), (3) Normal control group (n = 15). After echocardiography and hemodynamic measurements, the rats were sacrificed for histological and immunochemical examinations one month post MI.

RESULTSThe transplanted HUCBC survived and participated the repair process in host heart. Significantly improved left ventricular function was evidenced by echocardiography in cell transplantation group compared to the MI control group. Left ventricular end-diastolic pressure was significantly reduced LVEDP (21.08 +/- 8.10) vs (30.82 +/- 9.59) mm Hg, P < 0.05], +dp/dt(max) [(4.29 +/- 1.27) vs (3.24 +/- 0.75) mm Hg/ms, P < 0.05] and -dp/dt(max) increased [(3.71 +/- 0.79) vs (3.00 +/- 0.49) mm Hg/ms, P < 0.05] in cell transplantation rats compared with MI control rats. vWF immunostaining examination showed significantly increased microvessels within the boundary of infarcted myocardium in cell transplantation group compared to the MI control group (P < 0.01).

CONCLUSIONSHUCBC transplantation may improve cardiac function in MI rats by promoting microvessel formation.

Animals ; Cord Blood Stem Cell Transplantation ; Humans ; Male ; Myocardial Infarction ; pathology ; surgery ; Random Allocation ; Rats ; Rats, Wistar

BACKGROUNDA growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.

METHODSFrom September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).

RESULTSBaseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P = 0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P = 0.74). Aspirated thrombi were categorized as small thrombi (< 3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (> 7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P = 0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P = 0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.

CONCLUSIONSBoth Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.

Coronary Angiography ; Echocardiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; pathology ; surgery ; Thrombectomy ; instrumentation ; methods ; Treatment Outcome

OBJECTIVE: To determine the use of septal plication with Dor or Cooley procedure for post infarction anterior and anterior-septal aneurysm of the left ventricle. METHODS: A total of 23 patients with post infarction anterior and anterior-septal aneurysm of the left ventricle underwent septal plication and Dor or Cooley procedure along with coronary artery bypass grafting concomitantly. Data of NYHA grading, left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) were recorded before the surgery, before discharge and 3 months after the surgery. RESULTS: Compared with the preoperative data, the NYHA grading before the discharge and 3 months after the surgery improved from 3.21 ± 0.62 to 1.72 ± 0.31 and 1.57 ± 0.23(P<0.05); LVEDVI decreased from (102.31 ± 18.71) mL/m² to (62.11 ± 6.21) mL/m² and (54.63 ± 4.54) mL/m² (P<0.05); LVESVI decreased from (69.32 ± 17.48) mL/m² to (30.23 ± 3.25)mL/m² and (28.34 ± 3.12) mL/m²; while LVEF increased from (32.92 ± 8.12)% to (48.78 ± 4.51)% and (50.52 ± 4.68)% (P<0.05), respectively. CONCLUSION Ventricular septal plication combined with Dor or Cooley procedure can remarkably improve the left heart function in patients with post infarction ventricular aneurysm.
Aged ; Coronary Artery Bypass ; methods ; Female ; Heart Aneurysm ; etiology ; surgery ; Heart Ventricles ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; Ventricular Function, Left ; physiology ; Ventricular Septum ; surgery

Cardiomyocytes deceased during myocardial infarction (MI) are replaced with non-contractile scar tissue, which has a great chance to cause heart failure. Repair of dead or injured myocardium and improvement of cardiac function remain a serious challenge for the therapy of heart failure. Recently, stem cells have been transplanted in experimental settings to replace lost myocardium. This article summarizes the recent experimental findings on transplantation of embryonic stem cells (ESCs) and their derived cells in animals with myocardial injury and highlights the progresses in research of these particular cell types. Beneficial effects of cell transplantation with other cell types in injured hearts have been detailed in other reviews. ESCs are pluripotent cells derived from early mammalian embryos at the blasto-stage. These cells have the capacity for prolonged undifferentiated proliferation or differentiation into all of specialized somatic cell types of the body in culture, including cardiomyocytes. Because of the great ability of proliferation and differentiation to mature tissues, ESCs are a potential valuable resource for cell therapy targeting regeneration of functional myocardium in diseased hearts. In recent animal studies intramyocardial transplantation of ESCs or their differentiated cardiac-like cells regenerated injured myocardium and improved heart function in infarcted animal models. In addition, intravenous infusion of ESCs significantly increased the survival rate and attenuated myocardial injury in viral myocarditic mice. Development and characterization of cardiomyocytes in vitro from human ESCs have been reported recently. However, many ethical, political, and scientific barriers have to be overcome before clinical utilization of human ESCs and their differentiated cells for treating end-stage cardiac diseases.
Animals ; Cell Differentiation ; Cells, Cultured ; Embryo, Mammalian ; Humans ; Myocardial Contraction ; Myocardial Infarction ; pathology ; surgery ; Myocarditis ; pathology ; surgery ; virology ; Myocytes, Cardiac ; pathology ; Stem Cell Transplantation ; Stem Cells ; cytology ; Transplantation, Heterologous

PURPOSE: Coronary flow reserve (CFR) is recognized as an indicator of myocardial perfusion. The aim of this study was to assess the relationship between CFR in the non-infarcted myocardium and the incidence of major adverse cardiac events (MACEs). MATERIALS AND METHODS: 100 consecutive patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were enrolled in the present study, and divided into MACE and non-MACE groups according to the incidence of 12-month MACEs. Left ventricular function and CFR were analyzed using two-dimensional echocardiography and myocardial contrast echocardiography at one week after PCI. Cardiac troponin I levels were assayed to estimate peak concentrations thereof. RESULTS: The MACE group was associated with lower CFR, compared to the non-MACE group (2.41 vs. 2.77, p < 0.001). In the multivariable model, CFR in the non-infarcted myocardium was an independent predictor of 12-month MACE (hazard ratio: 0.093, 95% confidence interval: 0.020–0.426, p=0.002) after adjustment for baseline demographic and clinical characteristics. CONCLUSION: CFR in the non-infarcted myocardium is a useful marker for predicting 12-month MACEs in patients with AMI undergoing primary PCI.
Aged ; Coronary Circulation/*physiology ; *Echocardiography ; Female ; Fractional Flow Reserve, Myocardial ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnostic imaging/*physiopathology/*surgery ; Myocardial Perfusion Imaging ; Myocardium/*pathology ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Treatment Outcome ; Ventricular Function, Left/*physiology

BACKGROUNDA large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm (LVA). This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm.

METHODSWe followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox's proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival.

RESULTSThe operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke,and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association (NYHA) class III-IV was the only risk factor for hospital re-admission.

CONCLUSIONSPostinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Heart Aneurysm ; mortality ; pathology ; surgery ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; physiopathology ; surgery ; Proportional Hazards Models ; Survival Analysis ; Treatment Outcome ; Ventricular Dysfunction, Left ; pathology ; surgery