Prognostic significance of ischemia modified albumin after percutaneous coronary intervention.

UNLABELLED: Ischemia modified albumin (IMA) is a new biochemical marker of ischemia. IMA levels rise in patients who develop ischemia during percutaneous coronary intervention (PCI). It is unclear whether IMA elevations correlate with PCI variables. The possible prognostic value of post-PCI IMA elevation has not yet to be studied. METHODS: We studied 60 patients (mean age 61 years; 51 male) who underwent successful elective single-vessel PCI for the management of stable angina pectoris. IMA levels were measured and compared with PCI variables and target lesion revascularization rate. The median post-PCI follow up is 46 months (CI 44.6 to 47.7). RESULTS: We found that the only variable related to post-PCI IMA levels was periprocedural dissection of target vessel (147.6 vs. 141.1 kU/l, p=0.035). No correlation between high and low balloon inflation pressure (143.6 vs. 141.6 kU/l, p=0.64), short and long inflation pressure (141.5 vs. 143.6 kU/l, p=0.17), with and without stent placement (143.7 vs. 141.3 kU/l, p=0.93) was found. IMA level more then 130 kU/l was associated with higher frequency of target lesion revascularization at nearly 4-years follow-up (p=0.026). CONCLUSION: Post-PCI IMA elevation is associated with higher target lesion revascularization.

Transplantation of bone marrow derived progenitor cells in acute myocardial infarction. The first results.

The intracoronary administration of autologous bone marrow cells (BMCs) has been shown to improve the left ventricle function in the course of acute myocardial infarction. Therefore we have started a clinical trial using transplantation of BMCs in the acute phase of myocardial infarction. The aim of our study is to assess the feasibility and safety of this procedure, and effect on the left ventricle function of these patients. We describe the first experience in two patients with acute myocardial infarction reperfused using direct stenting. The aspiration of bone marrow from the sternum provided sufficient amount of the cells for transplantation. No serious ischemia and no changes in coronary artery patency were detected after intracoronary infusion. The left ventricle ejection fraction was increasing throughout the time of three-month follow-up. No other complications (ventricular arrhythmias, reinfarction, thrombus formation) were detected.

The "edge effect" after implantation of beta-emitting (55Co) stents with high initial activity.

The aim of this study was to evaluate the incidence and the cause of "edge restenosis" after implantation of high activity 41.1 microCi +/- 1.2 microCi = 1520 kBq +/- 44 kBq, beta-emitting (55Co) stents. Proton bombarding in cyclotron has brought the radioactivity. Intravascular ultrasound (IVUS) investigation has been completed in 10 patients. The angiographies performed at 6 month revealed restenosis >50% in 5 cases (50%). The analysis of edges (5 mm distally and proximally to the last stent struts) showed no significant changes in TVV (187.3 +/- 62.60 mm3 and 176.9 +/- 53.5 mm3) but PMV increase significantly (i.e. neointimal proliferation) from 61.9 +/- 31.2 mm3 to 82.2 +/- 43.4 mm3 (p<0.04) and was the major contributor (from 66%) to lumen volume loss (125.4 +/- 40.7 mm3 and 94.7 +/- 22.2 mm3, p<0.02). In conclusion, neither statistically significant positive nor negative remodelling at the "stent edges", were present. Statistically significant increase in plaque +/- media volume (i.e. neointimal hyperplasia) and reduction in lumen volume were found. The cause of "edge restenosis" was especially (from 66%) due to increase in plaque +/- media volume (i.e. neointimal hyperplasia). Probably, main reason for "edge effect"/neointimal hyperplasia was in this trial sharp fall-off in radiation at the edges of the stents.