Acta cardiologica最新文献

Background: The present study aimed to investigate whether newly defined serum uric acid (SUA) to serum creatinine ratio (SUA/SCr) predicts no-reflow phenomenon (NRP) development in patients with non-ST-elevated acute coronary syndrome (NSTE-ACS).

Methods: The study group was divided into two groups: those who developed NRP and those who did not. Complete blood counts, SUA, serum creatinine, C-reactive protein (CRP) and albumin were obtained at admission. The SUA/SCr, SUA to albumin ratio (UAR), C-reactive protein to albumin ratio (CAR) and systemic immune inflammation (SII) index values of all patients were calculated and their relationships with NRP were evaluated.

Results: Patients with NRP had higher mean SUA/SCr ratio (7.19 ± 2.14 vs 5.30 ± 1.70, p < 0.001), mean UAR (1.73 ± 0.69 vs 1.38 ± 0.47, p < 0.001), median CAR (1.73 vs 1.54, p = 0.002), and median SII index (861.9 vs 730.9, p = 0.015) levels than in those who did not develop NRP. According to multivariant analysis models, SUA/SCr ratio, UAR, CAR and SII index were found to be independent predictors of NRP development (p < 0.05 for all) but only the area under the curve (AUC) for SUA/SCr ratio (AUC = 0.73, p < 0.001) was above the 0.70 proficiency level, performing markedly better than the other evaluated parameters. A SUA/SCr ratio ≥5.34 predicted the NRP with 75% sensitivity and 55% specificity.

Conclusion: SUA/SCr ratio can be used as a reliable marker in prediction the development of NRP in NSTE-ACS patients.

Objective: Current guidelines recommend the use of glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) only as a bail-out therapy. However, drug penetration to the jeopardised area may not be achieved due to impeded blood flow and increased microvascular resistance. Aim of our study is to investigate the impact of distal intracoronary GpIIb/IIIa inhibitor agent infusion in STEMI patients. Primary endpoints were microvascular obstruction (MVO) and infarct size.

Methods: Patients with STEMI who have high thrombus burden or slow-flow/NR phenomenon and undergoing primary percutaneous coronary intervention (pPCI) were enrolled. Tirofiban was the preferred GpIIb/IIIa inhibitor. Patients were assigned to the systemic intravenous infusion group and intracoronary infusion group in whom bolus dose of tirofiban was distally infused to the infarct related artery. MVO and size of the infarct size were assessed via cardiac MRI.

Results: We prospectively included 75 patients and mean follow-up duration was 383 days. Baseline characteristics were similar between groups except a lower rate of diabetes in distal intracoronary infusion group (p = .006). There was no significant difference in localisation of myocardial infarction, ischaemia duration and preloading of P2Y12 inhibitor between groups. MVO (p = .048) and infarct size (p = .030) were significantly lower in distal intracoronary infusion group.

Conclusions: Cardiac MRI based assessment revealed that intracoronary administration of GpIIb/IIIa inhibitors distal to the culprit lesion was associated with reduced MVO and infarct size in high thrombotic risk STEMI patients undergoing pPCI.

Background: The prevalence of coronary chronic total occlusion (CTO) in coronary angiography (CAG) has risen with ageing populations, along with the expansion of CTO percutaneous coronary interventions (CTO-PCI). However, CTO-PCI encounters challenges such as undersized stents, dissection risks, and limited access to intravascular imaging (IVI), particularly in regions with limited health budgets. This study introduces the 'GIVE IT TIME TO SOBER UP - GITSU strategy', a two-session CTO-PCI approach where Thrombolysis in Myocardial Infarction (TIMI-3) antegrade flow is achieved without stent placement in the first session. We aim to present its key attributes, outcomes, and implications for invasive cardiology.

Methods: Demographic data, CTO lesion characteristics in the first PCI session, procedural features, in-hospital major adverse cardiovascular adverse events (MACE), technical features of the second PCI session, and in-hospital MACE were examined.

Results: We applied the GITSU strategy to 53 CTO lesions between August 2020 and June 2023. The mean lesion length was shortened compared to the first session (21.3 ± 10.5%). There was an increase in mean distal reference vessel diameter (2.52 ± 0.49 mm), and the increase was 24.2%±11.3% compared to the first session. There was 24.4%±11.5% stent length savings. We achieved an increase in stent size of 20.3% to 10.1% compared to the mean stent diameter. The technical success and procedural success rate were 92.5% and 90.6%, respectively.

Conclusion: Patients who underwent GITSU used shorter and wider stents in the second PCI session. This strategy is likely to reduce TLR and ISR rates.

Objective: To provide valuable insight into the prevention and treatment of coronary heart disease, this study aimed to explore the association between psychosocial elements and endothelial dysfunction in diagnosed patients.

Methods: Using a cross-sectional study design, we selected patients with coronary heart disease who visited the cardiology department of our hospital from January to December 2021. According to coronary angiography results, patients were divided into the coronary stenosis group (≥50%) and the normal coronary group (<50%), with 100 cases in each group. We assessed the levels of psychosocial factors using the Type A Behaviour Pattern Scale (TABP), Self-Rating Anxiety Scale (SAS), Social Support Rating Scale (SSRS), and Self-Rating Depression Scale (SDS). Endothelial synthesis of nitric oxide (NOx) and endothelium-dependent (EDF) and endothelium-independent (NEDF) vasodilation functions were measured and compared using enzyme-linked immunosorbent assay (ELISA) and colour Doppler ultrasonography, respectively.

Results: Patients in the coronary stenosis group had significantly higher scores in Type A behaviour, anxiety, and depression and significantly lower scores in social support compared with the normal coronary group (t = 3.21, 4.15, 3.87; p < 0.05; t = -2.96; p < 0.05). EDF, NEDF, and NOx levels were significantly lower in the coronary stenosis group than in the normal coronary group (t = -4.32, -3.76, -4.67; p < 0.05). Psychosocial factors were negatively correlated with endothelial function indices (r = -0.31 to -0.48; p < 0.05). Multiple linear regression analysis revealed that Type A behavioural anxiety, depression, and social support were independent risk factors influencing endothelial dysfunction (β = -0.23, -0.26, -0.21, -0.19; p < 0.05).

Conclusion: A close relationship was observed between psychosocial factors and endothelial dysfunction in patients with coronary heart disease. Assessment and intervention of psychosocial factors in these patients should be strengthened to improve endothelial function and reduce the risk of cardiovascular events.