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Comparative study of fractional lfow reserve measurement by intravenous ATP infusion through ;femoral veins and hand dosal veins

Jingjing LIU ; Tao QU ; Meng ZHANG ; Weihua JIN ; Ju GAO ; Bin WANG

Chinese Journal of Interventional Cardiology.2014;(4):251-255. doi:10.3969/j.issn.1004-8812.2014.04.009

Objective To compare and evaluate fractional flow reserve (FFR) by intravenous infusion of adenosine 5’-triphosphate (ATP) through femoral veins and hand dosal veins. To find the feasibility of measuring FFR through ATP infusion at hand dosal veins. Methods A total of 27 patients receiving coronary angiography (CAG) were enrolled. FFR was measured by intravenous injection of ATP through femoral veins and hand dosal veins separately in 31 stenosed coronary arteries. Results A linear correlation between ATP infusion measuring FFR through femoral and hand dosal veins was observed. Heart rates, PR intervals and side effects were of no difference between the 2 routes of ATP infusion (P=0.79, P=0.56, P=0.85). It indicated that ATP infusion[160μg/(kg·min)]measuring FFR through hand dosal veins was compatable to which measuring FFR though femoral veins (y=0.945x+0.0043, R2=0.904, P=0.001). Compared with ATP infusion by femoral vein[from (53.7±15.8) s to (58.2±11.6) s], the time to FFR by infusion ATP measurement by hand dosal veins was longer[(48.7±17.9) s, P=0.015]. Conclusions The FFR measurement through ATP infusion at hand dosal veins has similar results with the FFR measured by femoral veins ATP infusion.

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Association of serum angiopoietin-1 and angiopoietin-2 with ST-segment resolution in acute ;myocardial infarction patients treated with primary percutaneous coronary intervention

Shaomin CHEN ; Ming CUI ; Lijun GUO ; Wei GAO

Chinese Journal of Interventional Cardiology.2014;(4):246-250. doi:10.3969/j.issn.1004-8812.2014.04.008

Objective To investigate the association of serum angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) with myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods A total of 103 consecutive STEMI patients who received primary PCI were enrolled in this study. The patients were divided into two groups according to ST-segment resolution (STR) at 2 h after PCI:STR ≥ 50%group (n=69) and STR<50%group (n=34). Serum concentrations of Ang-1, Ang-2 and Ang-2 to Ang-1 ratios (Ang-2/Ang-1) before and immediately after PCI, 2 h, 6 h, 24 h after PCI were compared. Predictors of poor STR were identiifed by multivariable logistic regression analysis. Results The patients with STR≥50%had significant higher serum Ang-1 levels (P < 0.05) and lower Ang-2/Ang-1 ratios (P < 0.01) from before PCI to 6 h after PCI than those with STR < 50%;Ang-1 and Ang-2/Ang-1 at 24 h after PCI, and Ang-2 at all time points were not signiifcantly different between the two groups (P>0.05). In multivariable logistic regression analysis, Ang-2/Ang-1 before PCI was independently associated with STR < 50%;Other independent predictors were pain to balloon time, infarct related artery (LAD), and TIMI flow grade<Ⅲafter PCI. Conclusions Higher Ang-2/Ang-1 is an independent predictor of poor myocardial reperfusion in STEMI patients after PCI.

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The efficacy of intracoronary administration of tirofiban for acute coronary syndrome patients ;during percutaneous coronary intervention：a meta-analysis

Cuiping QIAN ; Wenzhong PENG ; Yu ZHANG ; Xiaomei GUO

Chinese Journal of Interventional Cardiology.2014;(4):237-245. doi:10.3969/j.issn.1004-8812.2014.04.007

Objective To compare the effect of intracoronary versus intravenous administration of tiroifban for acute coronary syndrome (ACS) patients during percutaneous coronary intervention (PCI). Methods A search was retrieved from Pubmed, EMbase, Chinese Biomedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese Science and Technology Periodical Database (VIP), Cochrane Library to systematically collect the randomized controlled trials of intracoronary versus intravenous administration of tirofiban for the patients with ACS undergoing PCI. The data was extracted from the included studies and analyzed by Cochrane Collaboration's RevMan5.2 software. Results Twenty-five studies involving 2516 patients met the inclusion criteria. The results of meta-analysis showed that thrombolysis in myocardial infarction (TIMI) grade 3 lfow (RR 1.15, 95%CI 1.07-1.23, P=0.0001) were signiifcantly more often achieved in the patients by intracoronary administration of tiroifban (IC group) than those by intravenous strategy (IV group). Left ventricular ejection fraction (LVEF) values in a week after PCI which were evaluated by Cardiac Ultrasound were statistically significant between the two groups (WMD 2.69, 95%CI 0.14-5.25, P=0.04). LVEF values in IC group were increased by an average of 2.69% compared with group IV. Intracoronary administration resulted in a reduced incidence of major adverse cardiovascular events (MACE) at 30-day follow-up (RR 0.51, 95%CI 0.38-0.69, P < 0.0001). However, the incidence of bleeding complications was not statistically signiifcant between the two groups (RR 0.95, 95% CI 0.76-1.19, P=0.64). Conclusions Compared with intravenous strategy, intracoronary administration of tiroifban can be more effective in increasing coronary blood lfow and microvascular perfusion, more signiifcantly in reducing the incidence of MACE at 30-day follow-up and improving the prognosis after PCI without increasing the risk of bleeding.

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Efficacy of lipid-lowering and anti-inflammatory effects of statins sequential therapy in coronary ;heart disease patients undergoing elective PCI

Shao WANG ; Haitao ZHANG ; Chaozhong LIU

Chinese Journal of Interventional Cardiology.2014;(4):230-236. doi:10.3969/j.issn.1004-8812.2014.04.006

Objective To assess the inlfuence and safety of early atorvastatin sequential therapy in coronary heart disease (CHD) patients underdoing elective percutaneous coronary intervention on selected indicators of inflammation and serum lipids. Methods A total of 88 CHD patients who got ready to receive the elective percutaneous coronary intervention (PCI) were divided in two groups at random:The sequential dose group was called group A (atorvatatin 80mg as loading dose ,40 mg/d for 1 month after PCI and 20 mg/d subsequently, n=43), and the ordinary dose group was called group B ( atorvastatin 20 mg/d, n=45). During the follow-up, blood samples were taken at baseline, 3 days,1 month, 3 months and 6 months for myeloperoxidase (MPO), matrix metalloproteinase-9(MMP-9), serum lipids, serum alanine aminotransferase (ALT), glutamyl endopeptidase (GGT) and creatine kinase (CK) levels. Main adverse cardiac events and adverse effects were also analyzed. Results Compared with the baseline, the level of low-density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) was signiifcantly decreased in both two groups after treatment (P < 0.05). The LDL-C and TC in both groups were all decreased after treatment, and the degree of LDL-C and TC decreased at 3 days had signiifcant differences between the two groups (TC:26.6%vs. 14.0%;LDL-C:36.9%vs. 19.4%, both P<0.05). The degree of LDL-C decreased at 1 month between the two groups also had signiifcant differences (45.0%vs. 26.9%;P<0.05). The changes in LDL-C and TC level were also signiifcantly different between the two groups at 3 and 6 months (P<0.05). While TG and HDL-C remained unchanged. MMP-9 and MPO were both reduced post medication compared to pre-treatment levels (P<0.05). MPO was decreased signiifcantly in group A after treatment (F=18.455, P=0.000). And the same differences in group B were also signiifcant (P < 0.05). MPO post medication between the 2 groups were not significantly different (P > 0.05). Reduction in MMP-9 also showed signiifcant in both groups after treatment (group A:F=46.911, P=0.00;group B:F=19.156, P=0.00). The adverse effects had no signiifcant differences between the 2 groups (P>0.05). Conclusions The atorvastatin sequential theapy in CHD patients undergoing elective percutaneous coronary intervention could decrease serum lipids signiifcantly. Pretreatment with atorvastatin for patients undergoing PCI could inhibit inlfammation. The MACE and adverse effects were similar between the two groups.

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Evaluation of cardiac magnetic resonance in 25 suspected coronary heart disease patients with ;abnormal electrocardiogram findings but normal coronary angiography

Dengfeng MA ; Zhiqiang PEI ; Jinsheng SU ; Lei JI ; Xing LI ; Chen WANG ; Shuyu ZHANG

Chinese Journal of Interventional Cardiology.2014;(3):167-171. doi:10.3969/j.issn.1004-8812.2014.03.008

Objective To evaluate the diagnostic value of cardiac magnetic resonance (CMR) in suspected coronary heart disease patients with electrocardiogram abnormalities but normal coronary angiography. Methods The data of 25 suspected coronary heart disease patients with electrocardiogram abnormalities but normal coronary angiography were collected from Taiyuan central hospital between October 2010 and April 2012. Comparison was done in terms of anterior interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end diastolic dimension, left ventricular end systolic dimension, left atrial diameterand ejection fraction measured by CMR and by UCG. Correlation of the aboved paremeters between the 2 imaging exams. Results 40%of patients had their diagnosis changed after CMR exam, 32%of the patients with adjusted assessment. The differences in anterior interventricular septal thickness, left ventricular posterior wall thickness, left ventricular enddiastolic dimension, left ventricular end systolic dimension, left atrial diameter, ejection fraction by CMR and by UCG were similar (P>0.05) with positive correlation (P<0.01). Conclusions CMR can provide diagnosis and evaluation information to chest pain patients with ECG abnormalities but normal CAG, and it is a good supplement for routine examination.

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Clinical observation of ultrasound guided injection different dosage of thrombin for treatment of ;iatrogenic femoral artery pseudoaneurysm

Qizhu TANG ; Kezhong MA ; Rui ZHU ; Wenwei LIU

Chinese Journal of Interventional Cardiology.2014;(3):163-166. doi:10.3969/j.issn.1004-8812.2014.03.007

Objective To investigate the efifcacy and adverse effect of ultrasound-guided injection of different dosage of thrombin in the treatment of femoral artery pseudoaneurysm formed after vascular intervention. Methods 48 cases of femoral artery pseudoaneurysm after vascular interventional operation in our hospital were randomly divided into two groups according to the dosage thrombin given.Under ultrasound guidance, patients in the observation group (n=24) received injection thrombin 100U/ml while patients in the control group received injection of thrombin 500U/ml.All the operational procedures were identical between the 2 groups. Results No statistical differences were found in clinical characteristics, total number injection needed and operation time between two groups.Recurrence pseudoaneurysm was noted in 1 cases in the observation group. 2 cases of superifcial femoral arteries thrombin and 1 case of fever were recorded in control group. There was no difference in adverse event rates between the 2 group. Conclusions Ultrasound-guided injection with low dose thrombin in the treatment of post interventional femoral artery pseudoaneurysm is equally effective as higher dose.

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A novel channel dilator for coronary chronic total occlusion recanalization

Yuhong PENG ; Leisheng RU ; Jiaan SUN ; Yuying ZHAO ; Li ZHANG ; Dongmei WANG

Chinese Journal of Interventional Cardiology.2014;(3):153-157. doi:10.3969/j.issn.1004-8812.2014.03.005

Objective To assess the efficacy and safety of using a novel channel dilator (the Corsair microcatheter) accompanied with special occlusion guide wires for coronary chronic total occlusion (CTO) recanalization. Methods From 2011 December to 2013 August,we performed 89 cases (the study group) using channel dilator and the new special occlusion guide wires for CTO recanalization. Another 89 CTO lesions treated before using the corsair microcatheter were compared as the control group.We recorded clinical characteristic, outcome of PCI,radiation exposure time, contrast utilization and the procedure time. The MACE rate was monitored during follow up. Results The intracoronary channel dilator accompanied with special occlusion guide wires were inserted into 33 left anterior descending arteries, 17 left circumlfex arteries and 38 right coronary arteries. The success rates of procedure were signiifcantly higher in the study group than in the control group (91% vs. 67.7%, P < 0.05). Procedure and lfuoroscopy time tended to be lower in the study group than in the control group. There were no serious complications related to the catheter and no death case recorded. Conclusions The channel dilator accompanied with special occlusion guide wires may facilitate the conventional approach with a higher success rate in PCI.

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Effects of collateral circulation on ventricular function of patients with ST-segment-elevation ;myocardial infarction treated with primary coronary intervention

Huagang ZHU ; Ruofei JIA ; Shuai MENG ; Xiang LI ; Duo YANG ; Zening JIN

Chinese Journal of Interventional Cardiology.2014;(3):149-152. doi:10.3969/j.issn.1004-8812.2014.03.004

Objective To determine whether the presence of coronary collateral lfow, as evidenced by angiography, has a beneifcial effect on left ventricular function in ST-segment-elevation myocardial infarction (STEMI) treated by means of early percutaneous coronary intervention (PCI). Methods Between April 2012 to November 2013, 95 patients with STEMI treated with primary PCI successfully were analyzed. According to the Rentrop grade, these patients were divided into 2 groups:collateral circulation group (n=16) and non-collateral circulation group (n=79). The left ventricular function was evaluated within 24 hours after PCI and 30 days later. Results Comparison of 2 groups showed that collateral lfow was associated with better left ventricular ejection fraction within 24 hours and 30 days after PCI. And non-collateral lfwa was associated with more ventricular aneurysm formation. Conclusions The presence of angiographically detectable collaterals has a protective effect on left ventricular function in ST-segment-elevation myocardial infarction (STEMI) treated by primary PCI.

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The appilication of diver CE thrombus aspiration catheter in patients during the recovery of acute ;myocardial infarction with percutaneous coronary intervention

Heping NIU ; Jun ZHANG ; Chen YUAN ; Jinguo FU ; Ling FEI ; Yanfang WAN ; Changhou WANG

Chinese Journal of Interventional Cardiology.2014;(3):176-180. doi:10.3969/j.issn.1004-8812.2014.03.010

Objective To evaluate the effect of Diver CE aspiration thrombus catheter used in patients during the recovery of acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI). Methods A total of 50 AMI patients were enrolled from January 2010 to December 2011. Twenty-ifve patients received PCI and used the Diver CE aspiration thrombus catheter (aspiration group);and the other 25 patients received routine PCI (routine PCI group). The basic characteristics, PCI characteristics, myocardial perfusion indexes and clinical data were compared and analyzed. Results There was no statistically difference between two groups in basic characteristics. Compared with the routine PCI group, higher rate of myocardial blush grade 3 but lower thrombus scores were found in the aspiration group. The incidence of no-lfow or slow-lfow were also lower in aspiration group (all P<0.05). The LVEF after 6 and 12 months were higher in the aspiration group (both P<0.05), no difference in MACE between the two groups. Conclusions Using the Diver CE thrombus aspiration in PCI is a simple and safe by method for treatment of acute myocardial infarction with high thrombosis burden. It can improve reperfusion decrease the rates of no-relfow on slow-relfow and can improve the long-term left ventricular function.

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Short term clinical efficacy and safety of ticagrelor in patients received percutaneous coronary intervention

Yingyan MA ; Yanxia WANG ; Baige XU ; Na LI ; Guanghua HUANG ; Cailian WANG ; Yi FANG ; Yaling HAN

Chinese Journal of Interventional Cardiology.2014;(6):380-383. doi:10.3969/j.issn.1004-8812.2014.06.010

Objective To observe the efifcacy and safety of ticagrelor in patients received percutaneous coronary intervention (PCI). Methods 50 patients with non-responding platelet aggregation rate and CYPC219 gene after clopidogrel treatment were given ticagrelor and enrolled in the study. All enrolled patients received aspirin loading dosage 300 mg, followed by maintenance dosage 100 mg, once daily and ticagrelor maintenance dosage 90 mg twice daily, for 1 year. The primary endpoint for the study were the incidence of major cardiovascular events (including death, stent thrombosis, stent restenosis, nonfatal myocardial infarction, target vessel revascularization) and stroke after followed up for a month. The secondary endpoint were the incidence of general events (including minor bleeding, allergies, breathing dififculties) and platelet count changes. Results No occur major cardiovascular and stroke events record after 1 month of ticagrelor treatment. The general events rates included 2 cases of dyspnen, 1 case of epitaxis and 1 case of subcutaneous bleeding. The platelet aggregation with ticagrelor was signiifcantly lower than clopidogrel without signiifcant decrease in platelets count. Conclusions Using ticagrelor for antiplatelet in patients with coronary artery stenting in clopidogrel resistance cases is safe and effective.

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