The long-term impact of a chronic total occlusion in a non-infarct-related artery on acute ST-segment elevation myocardial infarction after primary coronary intervention.

OBJECTIVES: To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality. METHODS: The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared. RESULTS: The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47-10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO. CONCLUSIONS: The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.

Systemic inflammation in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention.

BACKGROUND AND OBJECTIVE: Systemic inflammation plays an important role in both chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). The purpose of the present study was to assess the association of high-sensitivity C-reactive protein (hs-CRP), a biomarker of systemic inflammation, with in-hospital outcomes in patients with COPD undergoing percutaneous coronary intervention (PCI). METHODS: A total of 378 patients with COPD who were treated with PCI from January 2007 through January 2012, were divided into two groups according to hs-CRP level at admission. Demographics, clinical, angiographic data and in-hospital outcomes were compared. RESULTS: Patients with elevated hs-CRP (≥3 mg/L) were more likely to be female and current smokers, had more severe airflow limitation, more hypertension, diabetes and cardiac dysfunction and had increased incidence of three-vessel disease and more type C lesions. Subjects with elevated hs-CRP were also less likely to have been prescribed with statins and B-blockers, perhaps. Rate of in-hospital composite major adverse cardiovascular events (MACEs) was higher (15.5% vs. 8.2%, P = 0.041) and hospital stay was longer (8.2 ± 2.0 vs. 7.5 ± 1.7 days, P < 0. 001) in patients with elevated hs-CRP. A combined analysis of MACE on the basis of airflow limitation and hs-CRP showed an exaggerated hazard ratio in the presence of both severe airflow limitation and elevated hs-CRP. In a multivariate analysis, elevated periprocedural hs-CRP was independently related with MACEs and hospital stay. CONCLUSIONS: Elevated periprocedural hs-CRP is independently and additively related with increased incidence of in-hospital adverse outcomes in COPD patients undergoing PCI.

[Single center experience of primary percutaneous coronary intervention on left main disease complicated by acute myocardial infarction].

OBJECTIVE: To explore the clinical effect of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) induced by left main artery total or subtotal occlusion. METHODS: Between January 1995 and June 2010, there were 28 AMI patients [24 males, mean age (61.5 ± 2.3) years, 15 patients complicated with cardiac shock] with left main occlusion or severe stenosis who were treated with PCI in our center. The clinical features were compared between death group and survival group. All survival cases were prospectively followed up for the occurrence of major adverse cardiac events. RESULTS: Totally 25 patients received stent implantation, 2 received balloon dilation followed by coronary artery bypass graft, and 1 patient died during PCI. Total in-hospital mortality was 35.7% (10/28), and mortality was 53.3% (8/15) in cardiac shock patients. Compared with survival group, ratio of cardiac shock [80.0% (8/10) vs.38.9% (7/18), P < 0.05] and poor collateral circulation flow [100% (10/10) vs. 33.3% (6/18), P < 0.01] were higher in death group, and there was no significant difference in TIMI 3 grade of forward flow post procedure (P > 0.05). Hospital stay was (22.1 ± 2.6) days and the cumulative survival was 64.3% during 3 months follow up for survival group. CONCLUSIONS: Short-term clinical outcome is favorable for survived AMI patients with left main disease who underwent PCI. The ratio of cardiac shock and poor collateral circulation flow are risk factors for in-hospital death in AMI patients with left main disease who underwent PCI.

A no-reflow prediction model in patients with ST-elevation acute myocardial infarction and primary drug-eluting stenting.

OBJECTIVES: This study was undertaken to assess independent no-reflow predictors in patients with ST-elevation acute myocardial infarction (STEMI) and primary drug-eluting stenting in the current interventional strategies. DESIGN: One thousand four hundred and thirteen patients with STEMI were successfully treated with primary drug-eluting stenting within 12 h after AMI. All clinical, angiographic and procedural data were collected. Univariate and multivariate logistic regression was used to identify independent no-reflow predictors. RESULTS: The no-reflow was found in 297 (21%) of 1413 patients. Univariate and multivariate logistic regression identified that age (>65 years, OR 1.47, 95% CI 1.46-1.49; p = 0.007), long time-to-reperfusion (>6 h, OR 1.27, 95% CI 1.16-1.40; p = 0.001), admission plasma glucose (>13.0 mmol/L, OR 1.27, 95% CI 1.16-1.40; p = 0.027), collateral circulation (0-1, OR 1.69, 95% CI 1.25-2.29; p = 0.001), pre-PCI thrombus score (≥4, OR 1.36, 95% CI 1.16-1.79; p = 0.011), and IABP use before PCI (OR 2.89, 95% CI 1.65-5.05; p < 0.0001) were independent no-reflow predictors. The no-reflow rate significantly increased as the number of independent predictors increased (0%, 6%, 15%, 25%, 40%, 50% and 100% in patients with 0, 1, 2, 3, 4, 5, and 6 independent predictors, respectively; p < 0.0001). CONCLUSIONS: The prediction model consisted of six no-reflow predictors in patients with STEMI and primary drug-eluting stenting and should be confirmed in large-scale prospective studies.

[The in-hospital mortality and its determinants for very elderly patients with acute myocardial infarction].

OBJECTIVE: To explore the in-hospital mortality and its determinants for very eldly (80+ years of age) patients with acute myocardial infarction (AMI). METHODS: A retrospective cohort method was used. The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1, 2002 and February 22, 2010. RESULTS: Ninety-seven out of 499 patients died during hospitalization period, with total in-hospital mortality of 19.4%. Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades, complete A-V block, renal dysfunction, stent implant, and the type of AMI. CONCLUSIONS: The independent determinants for mortality of elderly AMI patients are as following, cardiac Killip grade, complete A-V block, renal dysfunction, stent implant, and the type of MAI. Urgent PCI is safe and effective for some very elderly with AMI, which could improve their survival rate within hospitalization period.

[The effect of admission hyperglycemia on coronary reflow in primary percutaneous coronary intervention].

OBJECTIVE: To assess the association between admission plasma glucose (APG) and no-reflow during primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI). METHODS: A total of 1413 patients with STEMI successfully treated with PCI were divided into no-reflow group and normal reflow group. RESULTS: The no-reflow was found in 297 patients (21.0%) of 1413 patients; their APG level was significantly higher than that of the normal reflow group [(13.80 ± 7.47) vs (9.67 ± 5.79) mmol/L, P < 0.0001]. Multivariate logistic regression analysis revealed that current smoking (OR 1.146, 95%CI 1.026 - 1.839, P = 0.031), hyperlipidemia (OR 1.082, 95%CI 1.007 - 1.162, P = 0.032), long reperfusion (> 6 h, OR 1.271, 95%CI 1.158 - 1.403, P = 0.001), admission creatinine clearance (< 90 ml/min, OR 1.046, 95%CI 1.007 - 1.086, P = 0.020), IABP use before PCI (OR 9.346, 95%CI 1.314 - 67.199, P = 0.026), and APG (> 13.0 mmol/L, OR 1.269, 95%CI 1.156 - 1.402, P = 0.027) were the independent no-reflow predictors. The no-reflow incidence was increased as APG increased (14.6% in patients with APG < 7.8 mmol/L and 36.7% in patients with APG > 13.0 mmol/L, P = 0.009). CONCLUSION: APG > 13.0 mmol/L is an independent no-reflow predictor in patients with STEMI and PPCI.

In-hospital outcome of primary PCI for patients with acute myocardial infarction and prior coronary artery bypass grafting.

BACKGROUND: This study aims to analyze the in-hospital outcome of primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) and prior coronary artery bypass grafting (CABG). METHODS: This was a retrospective study. From January 2011 to December 2018, the data of 78 consecutive patients (study group) with prior CABG, who received primary coronary angiography in the setting of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), were screened. The study group was compared with another well-matched 78 patients without a history of CABG (control group). The information of the coronary angiograms and clinical data of both groups were analyzed. Multivariate conditional logistic regression models were constructed to test the association between PCI success rate and the prior CABG at age ≥65 and <65 years, respectively. RESULTS: The results revealed that the primary PCI success rate in the study group was significantly lower than in the control group (67.9% vs. 92.3%, P<0.001) and in-hospital mortality was significantly higher than in control group (11.5% vs. 2.5%, P=0.03). The multivariate logistic regression analysis indicated that the primary PCI success rate was significantly associated with the history of prior CABG both in young patients [age <65 years; odds ratio (OR) =5.26, 95% confidence interval (CI): 1.69-16.47] and elderly (age ≥65 years; OR =13.76, 95% CI: 2.72-69.75). CONCLUSIONS: The patients who receive primary PCI with AMI and prior CABG have poor in-hospital outcomes, with low PCI success rates and high mortality.

Impact of Prior Digestive System Disease on In-Hospital Gastrointestinal Bleeding in Patients with Acute Myocardial Infarction.

OBJECTIVE: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding. METHODS: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors. RESULTS: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86-9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07-7.04), indicated by multivariate logistic regression analysis. CONCLUSION: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.

[Efficacy comparison of primary percutaneous coronary intervention with biodegradable polymer- and durable polymer-based sirolimus-eluting stents for patients with acute myocardial infarction].

OBJECTIVE: This prospective random control study was performed to compare the efficacy and safety of primary percutaneous coronary intervention (PCI) with biodegradable polymer (Excel) and with durable polymer (Cypher Select) sirolimus-eluting stents in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: Consecutive patients with STEMI underwent primary PCI were randomly divided into Cypher group (n = 113) and Excel group (n = 115). The primary endpoints were major adverse cardiac events (MACE, including death, reinfarction and target vessel revascularization) within 12 months. The second endpoints included late luminal loss and restenosis at 9 months. RESULTS: Angiographic follow-up data at 9 months were available in 43 (38%) patients in Cypher group and 48 (42%) in Excel group. The rates of in-stent restenosis and in-segment restenosis were 2.3% vs. 2.1% (P = 0.937) and 4.7% vs. 6.3% (P = 0.738), respectively. The late luminal loss of in-stent and in-segment were (0.17 ± 0.26) mm vs. (0.18 ± 0.33) mm (P = 0.483) and (0.19 ± 0.36) mm vs. (0.20 ± 0.42) mm (P = 0.419), respectively. There were no significant differences in death (3.5% vs. 2.6%, P = 0.692), reinfarction (1.8% vs. 2.6%, P = 0.658), target vessel revascularization (1.8% vs. 2.6%, P = 0.658), MACE (5.3% vs. 6.1%, P = 0.788) or stent thrombosis (4.4% vs. 3.5%, P = 0.692) at 12 months between Cyper group and Excel group. CONCLUSIONS: Excel and Cypher Select stents may have similar mid-term efficacy and safety in patients with STEMI treated with primary PCI.Further investigation is warranted to validate the long-term efficacy and safety.

[Association between post primary percutaneous coronary intervention myocardium reperfusion and prognosis in patients with acute ST-elevation myocardial infarction].

OBJECTIVE: To explore the prognostic impact of post primary percutaneous coronary intervention (PCI) reperfusion status on outcome in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: A retrospective analysis was performed in 964 patients undergoing primary PCI for STEMI. Electrocardiogram and TIMI myocardial perfusion grade (TMPG) were analyzed by reader blinded to the clinical course. Patients were divided to four groups according to ST segment resolution (STR) and TMPG: group A were patients with good STR and TMPG(425/964), group B were patients with poor STR and good TMPG (239/964), group C were patients with good STR and poor TMPG (113/964) and group D were patients with poor STR and TMPG (113/964). RESULTS: Although TIMI grade III flow was achieved after mechanical reperfusion, abnormal reperfusion was still present in about 1/3 patients as shown by poor STR or TMPG. Older age, cardiac dysfunction and diabetes, prolonged time of pain to balloon/emergency room are independent risk factors for abnormal reperfusion post PCI. Major adverse cardiac events events in hospital (RR = 64. 63, P < 0.01) and during follow up (RR = 11.69, P < 0.01) were significantly higher in group D than in group A. CONCLUSION: Poor post PCI reperfusion status is associated with higher in hospital and during follow up major adverse cardiac events event in STEMI patients.

[The clinical characteristics and prognosis of acute myocardial infarction complicated by cardiogenic shock].

OBJECTIVE: To observe the effect of reperfusion therapy on the prognosis of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) in reperfusion era. METHODS: 89 cases of AMI with CS were included with 57 male and 32 female. 50 cases received conservative therapy and 39 cases reperfusion therapy. 28 of the 39 cases had successful reperfusion and 11 cases failed. 18 patients had intra-aortic balloon pump (IABP) within 1 hour of CS, they constituted an early group; 35 patients treated with IABP 1 hour after CS were of a late group. A group of 36 cases were not treated with IABP (no IABP group). RESULTS: The mortality of the early group with IABP was significantly lower than that of the late and no IABP group (33.3% vs. 74.2% vs. 86.1%, P < 0.01). The mortality of the group with successful reperfusion was significantly lower than that of unsuccessful reperfusion and conservative no IABP group (42.8% vs. 81.8% vs. 84.0% , P < 0.01). logistic regression analysis showed that successful reperfusion therapy (OR 4.232, 95% CI 1. 07 - 12.730, P = 0.01) and THE TIME of using IABP (OR 0.22, 95% CI 0.063 - 0.764, P =0.017) were independent risk factors for death. CONCLUSION: Early successful reperfusion and early institution of IABP were the most important therapeutic measures for reducing mortality of AMI complicated by CS.

[Long-term efficacy of sirolimus-eluting stents (Cypher) versus bare metal stents for patients with ST-segment elevation myocardial infarction].

OBJECTIVE: To observe the safety and long-term efficacy of Cypher stent versus bare metal stents (BMS) in patients with STEMI. METHODS: From Dec 2002 to Mar 2005, clinical and angiographic data of 407 consecutive patients with STEMI treated with Cypher stent (n = 131) or BMS (n = 276) were analyzed and followed up for a mean period of 28.7 +/- 11.7 months. Major adverse cardiac events (MACE): death, nonfatal reinfarction and target lesion revascularization (TLR) during follow up was compared between two groups. RESULTS: Compared with the BMS group, diameter of vessels were significantly smaller (3.0mm vs. 3.2mm, P = 0.00), the incidence of MACE (6.1% vs. 12.7%, P = 0.04) and total mortality (1.5% vs. 6.9%, P = 0.02) were significantly lower in the Cypher group. The relative risk for MACE in Cypher group was 0.61 (P < 0.05), while there was no significant difference in the rate of stent thrombosis, rate of target lesion revascularization and restenosis. CONCLUSION: Utilization of Cypher in the setting of primary PCI for STEMI was safe and improved the long-term clinical outcomes compared to BMS.

[Clinical and angiographic predicting factors leading to unfavorable myocardial reperfusion in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention].

OBJECTIVE: To investigate the clinical and angiographic morphologic features leading to worse myocardial reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). METHODS: Clinical and angiographic data were collected and logistic regression analysis performed in 964 STEMI patients undergoing primary PCI. RESULTS: Logistic regression analysis showed that non-anterior myocardial infarction, pain to balloon time and degree of cardiac dysfunction were clinical predictive factors while fade-out type of angiographic morphology, ie, presence of accumulated thrombus proximal to the occlusion was angiographic predictive factor of worse reperfusion for STEMI patients post PCI. CONCLUSION: These predictive clinical and angiographic morphologic factors in STEMI patients for worse myocardial reperfusion post PCI could help to identify patients at high risk post PCI.

[Very late stent thrombosis after implantation of sirolimus eluting coronary stents].

OBJECTIVE: To analyze the clinical date of 4 patients who developed very late stent thrombosis after implantation of sirolimus eluting stents. METHODS: From Oct. 2002 to Aug. 2006, 835 sirolimus eluting stents were implanted in 612 patients. From Jan. 2006 to Aug. 2006, very late thrombosis in sirolimus eluting stents occurred in 4 patients (0.65%), and which caused acute myocardial infarction in anterior wall. Emergency percutaneous coronary interventions (PCIs) were performed in 4 patients immediately after re-admission. The clinical date of the 4 cases were analyzed retrospectively. RESULTS: These 4 patients were male with the age of 40-69 years. Very late stent thrombosis occurred 31-37 months after successful implantation of sirolimus eluting stents. Application of clopidogrel was stopped 7-12 months after first stents implantation. Aspirin was continued in 3 patients, while the other patient discontinued taking aspirin 18 moths before thrombosis occurred. Emergency coronary angiogram showed that sirolimus eluting stents in LADs were all occlude by thrombosis with TIMI 0 flow. All 4 patients survived after successfully primary PCIs. CONCLUSIONS: Our report presents evidence of very late thrombosis in sirolimus eluting coronary stents, and more careful and prolonged flow-up was required in patients after implantation of drug eluting stents.

[Effects of intracoronary or intravenous tirofiban administration in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To compare the effects on MACE of intracoronary or intravenous tirofiban bolus administration in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: A total of 60 consecutive STEMI patients ready to receive primary PCI were randomly assigned to intracoronary tirofiban bolus (10 microg/kg) prior to the first balloon inflation (Group IC) or to intravenous tirofiban bolus at the same dose prior to coronary angiography (Group IV), followed by a 36-hours IV tirofiban (0.15 microg . kg(-1) . min(-1)) infusion for all patients. Clinical and angiographic features between 2 groups before and after PCI were analyzed. RESULTS: Fifty-four out of 60 STEMI patients accomplished the study. Group IC was superior to Group IV in terms of TIMI flow grade, TIMI myocardial perfusion grade, ST-segment resolution, the distal embolism of IRA immediately after PCI and ejection fraction at 5 - 7 days after the PCI. The in-hospital MACE rate and bleeding complications were similar between the groups while, the combined incidence of MACE during follow-up was significantly lower in the Group IC compared with Group IV (7.1% versus 30.8%; P = 0.02). CONCLUSION: Intracoronary bolus application of tirofiban is associated with superior clinical prognosis compared with the standard intravenous bolus application of tirofiban in patients with STEMI undergoing primary PCI.

[Single lead ST-segment resolution in acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: prognostic impact and associated factors].

OBJECTIVE: To evaluate the prognostic value of ST resolution (STR) measured in a single ECG lead obtained early after primary PCI in patients with ST-elevation myocardial infarction (STEMI). METHODS: In this retrospective study, STR, MACE and factors contributed to STR were analyzed in 964 patients underwent primary PCI post STEMI. The ECGs analysis was made by technicians blinded to the clinical data. MACE was compared between the STR (n = 662) and the non-STR (n = 302) groups. Factors associated with non-STR were analyzed by logistic regression method. RESULTS: Although TIMI grade III flow was achieved after PCI, non-STR was shown in nearly 1/3 patients and these patients were older, dominant with anterior myocardial infarction, cardiac dysfunction, diabetes and was associated with a higher MACE ratio (25.5% vs. 4.4%, P < 0.001). Cox regression showed that non-STR was one of the independent predictors of in-hospital MACE (RR = 3.33, P < 0.001). Logistic regression showed that anterior myocardial infarction, the pain to balloon time, cardiac dysfunction and white blood cell count on admission were predictive factors of non-STR. CONCLUSIONS: STR obtained in a single ECG lead is an easy and important prognosticator of MACE post PCI in patients with STEMI. It could therefore be used to identify low- and high-risk STEMI patients post primary PCI.

[Clinicopathologic study of four cases of vagal paraganglioma].

OBJECTIVE: To determine if pathologic examination can be useful in both diagnosing cervical paraganglioma and deducing its vagal origin. METHODS: Four cases of vagal paraganglioma were studied by light microscopy and immunohistochemistry, with clinical and radiologic (computerized tomography and/or magnetic resonance imaging) correlation. RESULTS: All patients were females and complained of upper neck mass with symptoms and signs of vagus nerve involvement, such as hoarseness of voice, ipsilateral vocal cord dysfunction and cough induced by drinking or local pressure. Radiological examination showed a tumor mass over the common carotid artery bifurcation, lying between the internal carotid artery and internal jugular vein. On gross inspection, the stump of the resected vagus nerve could be identified, with nerve bundles splaying over the tumor surface. Microscopically, the tumors showed a relatively uniform nesting arrangement (Zellballen pattern) of cells and were associated with rich sinusoidal vessels and fibrous stroma. Multiple myelinated nerve fibers were present in stroma and fibrous capsule of the tumor. Sometimes, invasion of nerve trunk by tumor cells was seen. Immunohistochemically, the tumor cells showed diffuse positivity for chromogranin A, neuron-specific enolase and synaptophysin. There was no expression of cytokeratin. The sustentacular cells and nerve bundles were highlighted by S-100 protein. CONCLUSION: In addition to the microscopic accurate diagnosis of paraganglioma, histopathologists can be of help in deducing the vagal origin of this tumor.

[Primary percutaneous coronary intervention in patients with acute myocardial infarction induced by left main artery occlusion or severe stenosis].

OBJECTIVE: The effects of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) induced by left main (LM) artery occlusion were analyzed retrospectively in this study. METHODS: A total of 1343 consecutive AMI patients who underwent primary PCI between January 1995 and December 2004 were retrospectively studied. RESULTS: LM occlusion or severe stenosis were found in 11 patients [all male, mean age (56.4 +/- 9.2) years (range 43-70 years)], cardiogenic shock was overt in 6 patients. Primary PCI were performed under the assistance of intra-aortic balloon pump (IABP) in these patients [8 stent implantation, 3 balloon dilation and 2 necessitating emergency CABG after balloon dilation]. In-hospital mortality was 45.5% (5/11). Three-month follow-up were made in all survivals (6/11). Analysis showed good collateral circulation flow from right coronary artery to left coronary artery was existed in all survival cases before PCI. CONCLUSION: Prognosis of AMI patients with LM artery obstruction or severe stenosis was poor. Patients with pre-existed collateral circulation before primary PCI and IABP had a better clinical outcomes.

[Effect of pre-angiography use of tirofiban in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention].

OBJECTIVE: To observe the safety and efficiency of ultra-early glycoprotein IIb/IIIa receptor blockade tirofiban use in patients with acute ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). METHODS: From April 2005 to April 2006, 158 consecutive AMI patients (117 males, mean age of 58.8 +/- 25.2 years) were randomly received tirofiban (10 microg/kg bolus i.v. followed by 0.15 microgxkg(-1)xmin(-1) for 36 hours) before PCI in emergency room (early, n = 78) or immediately before PCI in catheterization lab (late, n = 80). Clinical and angiographic features between 2 groups before and after PCI were analyzed. RESULTS: Baseline clinical characteristics before PCI were similar between the two groups. Tirofiban was administered 39.8 minutes earlier in early group than that in the late group. The TIMI 3 flow rate (23.1% vs. 10.0%, P = 0.032) and the combined TIMI 2 or 3 flow rate (39.7% vs. 23.8%, P = 0.040) at initial angiography before PCI were significantly higher in early group than that in late group. However, TIMI 3 flow rate, myocardial Blush grade or corrected TIMI frames immediately after PCI were similar between the groups. The combined incidence of death or recurrent MI as well as bleeding complications or thrombocytopenia rate during early follow-up were similar between the groups (P > 0.05). CONCLUSIONS: Early initiation of tirofiban in patients with acute STEMI treated by primary PCI was safe. A better patency (TIMI 3 and TIMI 2-3 flow) in infarct related artery was obtained in patients with early tirofiban administration.

Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years.

INTRODUCTION: Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare. METHODS: From January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed. RESULTS: Cardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01). CONCLUSION: AMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.