Outcomes of direct stenting in patients with ST-elevated myocardial infarction.

BACKGROUND: We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). METHODS: We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P­PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. RESULTS: Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. CONCLUSION: DS in P­PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.

Predictors and prognostic significance of troponin-I release following elective coronary angioplasty.

The objective of this study was to investigate the predictors and prognostic significance of post-procedural cardiac troponin (cTn)-I elevations in a consecutive series of patients who underwent elective percutaneous coronary intervention (PCI). cTn-I was measured in 100 patients immediately before and within 24 h after the elective PCI. Post-procedural cTn-I elevation was observed in 27 of the 100 patients. In multivariate analysis, basal haemoglobin values and the number of repeated balloon dilatations were found to be independent predictors of cTn-I elevation. During the follow-up period of 12 +/- 1.2 months, the cTn-I-positive group had more major adverse cardiovascular events than the cTn-I-negative group (33.3% versus 16.4%, respectively), but the difference was not significant. An increase in cTn-I levels following elective PCI procedures was frequent but did not predict a poor long-term outcome.

Reversible myocardial stunning due to carbon monoxide exposure.

We report on a 37-year-old patient who suffered from myocardial stunning after exposure to carbon monoxide, despite having normal coronary arteries. As myocardial ischaemia may be asymptomatic in these patients, close monitoring with serial electrocardiography and of serum cardiac enzymes and troponins is recommended.

Elastic properties of aorta in patients with primary hyperparathyroidism.

In this study, we aimed to evaluate whether hyperpara thyroidism affects the elastic properties of aorta, calculated as aortic distensibility and aortic stiffness index. Eighteen patients with hyperparathyroidism were enrolled in the study. The control group consisted of 18 healthy subjects with similar baseline characteristics. All subjects underwent echocardiographic examination. Internal aortic root diameters were measured at 3 cm above the aortic valve by the use of two-dimensional guided M-mode transthoracic echocardiography, and arterial blood pressure was measured simultaneously from the brachial artery by sphygmomano metry. Two indexes of the aortic elastic properties were measured which are aortic distensibility and aortic stiffness index. The mean aortic stiffness index of hyperparathyroidic patients was higher (3.04 +/- 1.26 vs. 2.36 +/- 1.09; p = 0.048), and aortic distensibility was lower (15.62 +/- 5.84 vs. 22.64 +/- 14.54; p = 0.035) than the control group. The left ventricular (LV) mass index (242.44 +/- 46.3 vs. 212.8 +/- 43.97; p = 0.048), although it has failed to reach statistical significance, and LV wall stress (57.81 +/- 18.22 vs. 46.57 +/- 15.72; p = 0.08) of these patients was also higher than control group. Hyperparathyroidism increases aortic stiffness index and decreases aortic distensibility of primary hyper parathyroidic patients compared with normal population. The affected aortic elastic properties can be a factor in increased LV mass index and wall stress.