Vapor-Liquid Equilibria Data for 2-Piperidineethanol and 1-(2-Hydroxyethyl)pyrrolidine in Aqueous Solutions and a UNIQUAC Model Representation.

This work reports equilibrium data for two amines, 2-piperidineethanol (2-PPE) and 1-(2-hydroxyethyl)pyrrolidine (1-(2HE)PRLD), and their aqueous solutions. The pressure, temperature, and composition data are used to calculate experimental activities. Data cover temperatures from 363 to 426 K for the pure amines and from 323 to 373 K for the aqueous solutions. A UNIQUAC model was used to represent the binary vapor-liquid equilibria (VLE), whereas the Antoine equation was used for pure components. In an aqueous solution, the vapor pressure of 1-(2-hydroxyethyl)pyrrolidine (1-(2HE)PRLD) over the measured composition and temperature ranges is higher than that of 2-piperidineethanol (2-PPE). The developed UNIQUAC models represent the data well. For 2-piperidineethanol (2-PPE), the model gave 1.9% deviations for total pressure, 12.4% for vapor-phase composition, 12.7% for the calculated activity coefficients, and 16.2% for the excess heat capacity. In the case of 1-(2-hydroxyethyl)pyrrolidine (1-(2HE)PRLD), the model was slightly more accurate, representing the data with 1.7% deviation for total pressure, 5.9% for vapor-phase composition, and 5.2% for the calculated activity coefficient.

New strategy for detection of subclinical coronary atherosclerosis in asymptomatic patients with type 2 diabetes based on cardiac multi-detector computed tomography and treadmill test.

BACKGROUND: The current screening strategy for subclinical coronary atherosclerosis in asymptomatic diabetic patients is not sufficient in real clinical practice. A new strategy was investigated that uses cardiac multi-detector computed tomography (MDCT) and a treadmill test (TMT). METHODS AND RESULTS: A total of 445 self-referred asymptomatic diabetic patients underwent cardiac MDCT. The treatment plan was determined according to the new strategy that uses MDCT and TMT. All patients underwent clinical follow-up and cardiac events were investigated. The incidence of subclinical atherosclerosis was 49.4%. The group without plaque underwent clinical follow-up without treatment and did not experience any cardiac events in 675.1 person-years of follow-up. Among patients with subclinical atherosclerosis without significant stenosis (n=136) who received medical treatment only, 11 patients experienced cardiac events over 326.4 person-years. The patients with significant stenosis (n=84) underwent TMT. Patients with positive TMT (n=14) underwent coronary angiograms and revascularization therapy was performed in all of them over 39.2 person-years. Patients with negative TMT (n=70) underwent medical treatment, and 27 of them experienced cardiac events. The incidence of cardiac death was 0% during 3 years of follow-up. CONCLUSIONS: The new strategy for detecting subclinical atherosclerosis on MDCT combined with TMT may be a useful method for minimizing the mortality rate from cardiovascular disease in asymptomatic diabetic patients.

Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach.

BACKGROUND AND OBJECTIVES: Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI. METHODS: Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018. RESULTS: Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p<0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p<0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases. CONCLUSIONS: Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.

Effect of the Metabolic Syndrome on Outcomes in Patients Aged <50 Years Versus >50 Years With Acute Myocardial Infarction.

The presence of metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease morbidity and mortality. Moreover, data are lacking on the association of MS with clinical outcomes in young adults with acute myocardial infarction (AMI). This study was a retrospective analysis of 2,082 patients with AMI who underwent percutaneous coronary intervention. The term young was defined as age <50 years. The prevalence of patients aged <50 years was 18.4%. Among those patients, 43.4% had MS. The highest incidence of long-term major adverse cardiac and cerebral events was in old patients without MS (30.7% in young patients with MS, 22.2% in young patients without MS, 38.4% in old patients with MS, and 40.4% in old patients without MS, p <0.001). However, recurrent AMI (re-AMI) was the highest in young AMI patients with MS (4.8%, 1.4%, 2.1%, and 1.5%, p = 0.035, respectively). In Kaplan-Meier curve, young AMI patients with MS tend to have highest incidence of re-AMI (p = 0.050). The presence of MS in young AMI patients was an independent predictor of 6-year major adverse cardiac and cerebral events (hazard ratio 3.320, 95% confidence interval 1.073 to 10.283, p = 0.038) and re-AMI (hazard ratio 7.782, 95% confidence interval 1.290 to 45.298, p = 0.022). In conclusion, almost half of young patients with AMI had MS. The young AMI patients with MS had the highest incidence of re-AMI compared with the other groups. Aggressive pharmacological intervention and lifestyle modification are needed for the management of AMI in young patients with MS.

Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction.

BACKGROUND/AIMS: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. METHODS: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). RESULTS: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). CONCLUSION: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.

Optimal Timing of Percutaneous Coronary Intervention for Nonculprit Vessel in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease.

BACKGROUND AND OBJECTIVES: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the optimal timing of staged percutaneous coronary intervention (PCI) remains unclear. SUBJECTS AND METHODS: This study was a retrospective analysis of 753 STEMI patients with MVD who were treated by multivessel PCI in the Convergent Registry of Catholic and Chonnam University for Acute myocardial infarction (MI). Patients were divided into 3 groups according to the time from initial to staged PCI: group 1 (n=316, multivessel PCI performed during the index procedure), group 2 (n=360, staged PCI within 1 week), and group 3 (n=77, staged PCI after 1 week). The endpoint was major adverse cardiac events (MACEs), including all-cause mortality, non-fatal MI, and repeat PCI during 3.4 years follow-up. RESULTS: The incidence of composite MACEs was higher in group 3 than in group 1 (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.06 to 3.18, p=0.031). However, the risk of MACEs in groups 1 and 2 was comparable (OR: 1.01, 95% CI: 0.70 to 1.46, p=0.950). In multivariate logistic regression, independent predictors of 3-year MACEs were high Killip class (OR: 2.72, 95% CI: 1.38 to 5.37, p=0.004), left ventricular ejection fraction <45% (OR: 1.57, 95% CI: 1.06 to 2.32, p=0.024), and group 3 (OR: 1.83, 95% CI: 1.06 to 3.18, p=0.009). CONCLUSION: Deferred staged PCI after one week index PCI was associated with the highest MACE, as compared to both simultaneous multivessel PCI and early staged PCI <1 week.