Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction.

BACKGROUND: CaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients. METHODS: One hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non-CMD groups according to the caIMR value. The baseline information, patient-related examinations, and the occurrence of MACE at the 12-month follow-up were collected to investigate risk factors in patients with STEMI. RESULTS: We divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non-CMD. A total of 21 MACE occurred during the 1 year of follow-up. Compared with non-CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non-culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50). CONCLUSION: CaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.

Chitosan/heparin sirolimus drug-eluting stent system improves anticoagulation and promotes early re-endothelialization in porcine coronary artery / 第二军医大学学报

Objective To construct a sirolimus loaded drug-eluting stent (DES) using chitosan/heparin coating membrane and to explore its effect on anticoagulation and early re-endothelialization in porcine coronary artery. Methods Chitosan/heparin layer-by-layer self-assembly coating was applied to sirolimus DES, and the asymmetric applicator was used to allow for the stent blood surface to be chitosan/heparin coated and the stent vascular surface to be polylactic acid (PLA)--irolimus. The experiment was divided into bare metal stent (BMS) group, chitosan/heparin stent group, sirolimus DES group and chitosan/heparin sirolimus DES group. The anticoagulation effect of chitosan/heparin sirolimus DES was tested by arteriovenous shunt model and high load thrombosis model. The effect of chitosan/heparin sirolimus DES on early re-endothelialization was tested by 1-week long balloon injury to porcine coronary artery. Results No thrombus was found on the surfaces of chitosan/heparin sirolimus DES and chitosan/heparin stent in the arteriovenous shunt model, while the surfaces of BMS and sirolimus DES were covered with thrombus. No stent thrombosiswas found in the high load thrombosis model test of chitosan/heparin sirolimusDES and chitosan/heparin stent within 6 hours, and stent thrombosis was found in BMS at (59. 0±8. 5) min and in sirolimus DES at (67. 0 ±7. 8) min (P<0. 01). Theearly re-endothelialization test showed endothelial coverage rates of chitosan/heparin sirolimus DES and chitosan/heparin stent after 7 d implantation were (82. 7± 16. 4) % and (80. 7 ± 14. 1) %, significantly higher than those of BMS and sirolimus DES ([64. 3±11]% and [59. 8±8. 4]%, respectively; P<0. 01). Conclusion Chitosan/ heparin-coated-sirolimus DES has satisfactory anticoagulation property and it can accelerate early re-endothelialization.