[show abstract][hide abstract] ABSTRACT: Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level > or = 115 micromol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis.
Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class > or = 2 (29.1% vs 18.6%, P = 0.02) and multi-vessel (62.8% vs 44.5%, P = 0.001) and triple vessel disease (32.6% vs 18.2%, P = 0.002), in-hospital mortality (9.3% vs 3.8%, P = 0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P = 0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P = 0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P = 0.15). Multivariate analysis revealed that the serum creatinine level > or = 115 micromol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31, 95% CI 1.19 - 9.18, P < 0.001).
Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.
Chinese medical journal 12/2008; 121(23):2379-83. · 0.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is continued debate as to whether a combined reperfusion regimen with platelet glycoprotein IIb/IIIa inhibitor-tirofiban provides additional benefit in optimal myocardial reperfusion for patients with acute ST-segment elevation myocardial infarction (STEMI). This study was conducted to investigate the clinical benefits of adjunctive tirofiban therapy combined with primary percutaneous coronary intervention (PCI) in patients with STEMI.
One hundred and seventy-two consecutive patients with STEMI presented within 12 h of symptoms were randomly allocated to primary PCI combined with early (upstream group, n=57) or late administration of tirofiban (downstream group, n=57) or primary PCI treatment alone (control group, n=58). Clinical characteristics, angiographic findings, and in-hospital outcomes were compared between groups, as well as left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACE, including death, reinfarction and target vessel revascularization) at 30-day and 6-month clinical follow-up.
Despite comparable baseline clinical features among three groups, angiographic and procedural characteristics and outcomes differed significantly between patients receiving tirofiban treatment and controls, with respect to preprocedural (upstream: 28.1%, downstream: 7.0%, control: 5.2%, P<0.001) and postprocedural thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct-related artery (98.2, 94.7, 86.2%, P=0.03), TIMI myocardial perfusion grade 3 (75.4, 70.2, 53.4%, P=0.03), corrected TIMI frame count (20.4+/-5.0, 23.1+/-5.3, 32.2+/-6.7, P<0.001), resolution of the sum of ST-segment elevation (6.16+/-1.21, 6.02+/-1.09, 4.53+/-2.65 mm, P<0.001), peak value of creatine kinase-MB (218.0+/-72.5, 224.2+/-69.4, 255.3+/-77.0 ng/ml, P=0.02) and troponin I (76.0+/-21.5, 79.8+/-18.7, 86.4+/-11.0 ng/ml, P=0.007), and average hospital stay (10.6+/-5.4, 12.6+/-4.7, 14.5+/-6.5 days, P=0.001). The MACE rate at 30 days (3.5, 5.3, 15.5%, P=0.04) was reduced and LVEF (0.51+/-0.07, 0.50+/-0.07, 0.47+/-0.08, P=0.008) was higher in upstream and downstream groups than in controls. At 6-month follow-up, the MACE rate was not significantly different among groups (7.0, 8.8, 17.2%, P=0.17), but LVEF in upstream and downstream groups was significantly improved (0.59+/-0.06, 0.57+/-0.07, 0.54+/-0.07, P<0.001). Subgroup analysis demonstrated a statistically significant difference between upstream and downstream groups in preprocedural TIMI grade 3 flow (P=0.003) and postprocedural corrected TIMI frame count (P=0.007), which resulted in a shortened hospital stay (P=0.04), reduction of MACE rate at 30-day and 6-month follow-up by 34 and 20%, respectively. Multivariate logistic analysis revealed that age more than 65 years [odds ratio (OR)=3.42, P<0.01], tirofiban therapy (OR=0.56, P<0.05) and LVEF less than 0.5 during hospitalization (OR=2.56, P<0.01) were major independent predictors of MACE at 6-month clinical follow-up. No significant difference in hemorrhagic complications among three groups was noted (upstream: 10.5%, downstream: 12.3%, control: 6.9%, P=0.61).
This prospective study indicates that adjunctive tirofiban therapy for patients with STEMI who undergo primary PCI can significantly improve reperfusion level in the infarct area, clinical outcomes at 30-day and 6-month follow-up, especially with upstream tirofiban therapy, and is safe.
[show abstract][hide abstract] ABSTRACT: Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts.
From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups.
Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P = 0.03) and had longer time delay from symptom onset to admission ((364 +/- 219) minutes and (309 +/- 223) minutes, P = 0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P < 0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) = 2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P = 0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P = 0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P = 0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P = 0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P = 0.19). All of these patients experienced non-fatal myocardial infarction.
Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.
Chinese medical journal 12/2007; 120(21):1862-7. · 0.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction (STEMI) remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients > 75 years of age with STEMI receiving primary percutaneous coronary intervention (PCI), compared with those treated by conservative approach.
One hundred and two patients > 75 years of age with STEMI presented < 12 hours were randomly allocated to primary PCI (n = 50) or conservative therapy only (n = 52). The baseline characteristics, in-hospital outcome and major adverse cardiac events (MACE), including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups.
Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular-weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group (21.3% and 45.2%, P = 0.029). Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI (OR = 0.34, 95% CI: 0.21 - 0.69, P = 0.03) improved MACE-free survival rate for STEMI patients aged > 75 years.
Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.
Chinese medical journal 08/2006; 119(14):1151-6. · 0.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess plasma renin activity (PRA) of renal veins in patients with unilateral renal artery atherosclerotic stenosis and its relationship with blood pressure changes after renal artery stenting.
Fifty patients with significantly unilateral renal artery stenosis (lumen loss > or = 70%) and coronary artery stenosis were included. Bilateral renal vein and peripheral PRA and angiotensin II were determined and their relations with blood pressure changes after stenting were analyzed.
All patients were revascularized successfully for both coronary and renal artery stenosis. PRA in the ischemic kidney was significantly higher than that in the contralateral kidney (1.44 +/- 1.73 ng.ml(-1).h(-1) vs 1.27 +/- 1.57 ng.ml(-1).h(-1), P = 0.04). Ischemic and contralateral renal vein renin ratio (RVRR) was > or = 1.5 in 14 patients (28%) (renal vascular hypertension, RVH group). During follow-up (12 +/- 9 months), blood pressure returned to normal in 9 patients after revascularization, 7 were of RVH group (50%) and 2 were in control group (6%) (P < 0.001). Multivariate logistic analysis indicated RVRR > or = 1.5 was significantly related to the decrease of hypertension after renal artery stenting (OR = 3.15, 95% CI = 1.49 approximately 5.97, P = 0.02).
PRA was significantly increased in the ischemic kidney in about one-third of patients with unilateral renal artery stenosis. Hypertension could be controlled easily to normal value after renal artery stenting in half of the patients with RVRR > or = 1.5. Measurement of renal vein renin activity in patients with renal artery stenosis is very useful in evaluating the effects of renal artery stenting on hypertension.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 07/2005; 33(6):539-42.
[show abstract][hide abstract] ABSTRACT: To evaluate the immediate and mid-term efficacy of coronary stenting in patients with acute coronary syndrome (ACS) and renal dysfunction.
Sixty-three ACS patients with renal dysfunction were included (RD group) and 63 contemporaneous ACS patients with normal renal function served as a control group. The clinical characteristics, stenting procedure and follow-up information were compared between the two groups.
Patients in the RD group had higher basic serum creatinine levels [(177 +/- 31) micro mol/L vs (98 +/- 21) micro mol/L, P < 0.001], lower left ventricular ejection fraction (0.45 +/- 0.10 vs 0.50 +/- 0.09, P < 0.05) and increased prevalence of multivessel coronary artery disease (84% vs 65%, P < 0.05) as well as > 50% renal artery stenosis (27% vs 8%, P < 0.05). There was no statistical difference in procedural success rate and major adverse cardiac events occurrence during a mean follow up time of 27 months (13% vs 8%, P = 0.38). In the RD group, the mean level of serum creatinine was significantly decreased [(177 +/- 31) micro mol/L vs (147 +/- 11) micro mol/L, P < 0.05] and 9 (69%) patients with renal artery stent implantation had normal creatinine levels during follow-up.
Coronary stenting is a safe and effective therapy for ACS patients complicated with renal dysfunction, two thirds of patients receiving renal stent implantation had normal serum creatinine during follow-up.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 02/2004; 43(2):106-8.
[show abstract][hide abstract] ABSTRACT: To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis.
Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing >/= 70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.
Renal stenting was performed in 98 stenotic arteries of 87 patients, and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176 +/- 21) micro mol/L to (179 +/- 11) micro mol/L (P = 0.15) 48 hours after the procedure, but significantly decreased to (149 +/- 15) micro mol/L at 6 months (P < 0.001). CCr was also greatly improved [(37 +/- 11) ml/min before versus (51 +/- 8) ml/min at 6 months, P < 0.001]. During follow-up, 61% of the patients experienced a normal renal function. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting [(163 +/- 23)/(96 +/- 13) mm Hg before versus (148 +/- 12)/(79 +/- 15) mm Hg at 6 months, all P < 0.001], and hypertension was well controlled in 67% of the patients at 6 months' follow-up.
Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.
Chinese medical journal 10/2003; 116(10):1451-4. · 0.90 Impact Factor