冠脉内注射替罗非班不同给药方式对急性心肌梗死介入治疗术中血流异常的影响

目的：比较急性心肌梗死介入治疗中冠脉内常规给予以及必要时给予血小板膜糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂替罗非班两种给药方式对冠脉血流异常的影响,寻找较好的替罗非班用药方式。方法：入选九四医院2005年1月至2008年10月急性心肌梗死直接PCI患者58例,随机分成常规给药组（血管开通前所有患者冠状动脉内均注射替罗非班,n=30）与必要时给药组（血管开通后即时造影显示TIMI血流≤2级者冠脉内注射替罗非班,TIMI血流3级者不给药,n=28）,观察支架植入后30分钟TIMI血流、30天内主要不良心血管事件（MACE）、出血以及血小板减少情况。结果：必要给药组冠脉内给药可显著改善冠脉血流（TIMI3级给药前46．4％,给药后75％,P〈0．05）,常规给药组支架植入后30分钟TIMI3级获得率高于必要给药组（96．7％比75％,P〈0．05）,MACE、出血和血小板减少事件两组之间差异无统计学意义。结论：冠脉内给予替罗非班可有效降低急性心肌梗死PCI术中血流异常情况,血管开通前冠脉内常规给药方式优于必要时给药方式。     

Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Background

Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI.

Methods

We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events).

Results

Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I² = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups.

Conclusions

This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.     

血小板与淋巴细胞比率对急性ST 段抬高型心肌梗死患者PCI术后无复 流的预测价值

目的:研究入院时血小板与淋巴细胞比率(Platelet-to-Lymphocyte Ratio,PLR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardia1 infarction,STEMI)患者冠脉介入治疗后无复流的预测价值。方法:共收集190例急性STEMI患者,发病12小时内并且行PCI(primary coronary intervention)术。按术中TIMI血流分级将病人分为2组:正常复流组(138例)和无复流组(52例),比较两组患者的基本临床资料、实验室检查结果及PCI结果,用Logistic回归分析无复流的预测因素,用受试者工作特征曲线(ROC曲线)论证得到PLR预测无复流的最佳临界值及其敏感度和特异度。结果:无复流组PLR显著高于正常复流组(246±98VS 169±108,P0.01)。当PLR=188时,预测无复流的敏感度为70%,特异度为72%。结论:入院时PLR是急性STEMI患者PCI术后无复流的预测因素。     

半量瑞替普酶溶栓后行转运PCI与直接转运PCI对急性ST段抬高型心肌梗死临床疗效的对比研究

目的:比较急性ST段抬高型心肌梗死(STEMI)使用半量瑞替普酶溶栓后行转运经皮冠脉介入治疗(PCI)与直接转运两种救治策略的临床效果。方法:回顾性分析2015年6月～2018年2月我院收治的100例STEMI患者的病历资料,根据救治方案不同分为易化PCI组(先在基层医院经半量瑞替普酶溶栓后再转运至我院行PCI,58例)、直接转运PCI组(拒绝在基层医院接受溶栓治疗而要求直接转运PCI,42例)。比较两组PCI前后血管再通率、PCI后无复流发生率和ST段回落率(STR)、住院期间主要不良心脏事件(MACE)及治疗期间出血并发症的发生情况及随访1年主要终点事件的发生情况。结果:入院后首次冠脉造影显示易化PCI组PCI前TIMI 3级血流者占32.7%(19/59),显著高于直接转运PCI组[14.3%(6/42),P0.05]。PCI后14 d时,易化PCI组TIMI 3级血流者占93.1%(54/58),较直接转运PCI组[90.5%(38/42)]差异无统计学意义(P0.05)。PCI后即刻冠脉造影显示易化PCI组无复流发生率为6.9%(4/58),较直接转运PCI组[21.4%(9/42)]显著降低(P0.05)。PCI后24 h时,易化PCI组STR值为(61.53±11.27)%,显著高于直接转运PCI组[(52.40±12.63)%,P0.05]。住院期间,易化PCI组MACE发生率为10.3%(6/58),较直接转运PCI组[14.3%(6/42)]差异无统计意义(P0.05)。治疗期间,易化PCI组出血并发症总发生率为19.0%(11/58),与直接转运PCI组的14.3%(6/42)相比差异亦无统计学意义(P0.05)。随访1年,易化PCI组主要终点事件发生率为19.0%(11/58),显著低于直接转运PCI组[40.5%(17/42),P0.05]。结论:与直接转运PCI相比,STEMI患者应用半量瑞替普酶溶栓后行转运PCI有利于早期开通梗死血管,提高介入干预效果,PCI后获得优异的心肌灌注水平,从而改善远期预后,且安全性相当。     

Verapamil Reverses Myocardial No-Reflow After Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

The present study evaluated the efficacy of intracoronary administration of verapamil to attenuate the no-reflow phenomenon following the primary percutaneous coronary intervention (PCI) in patients with the ST-segment elevation acute myocardial infarction (STEMI). A total of 201 patients with STEMI who underwent primary PCI within 12 h from the beginning of the heart attack were included. The no-reflow phenomenon was defined as substantial coronary anterograde flow of TIMI ≤2. Verapamil (100–200 μg) was injected into coronary artery immediately after no-reflow; the coronary arteriography was repeated later. Hundred and ninety-eight patients with STEMI successfully underwent primary PCI, and 246 stents were implanted with the average of 1.2 stents per patient. No-reflow occurred in 25 out of 198 patients (12.6 %). Twenty-one (84 %) patients developed the flow of TIMI ≥3 after intracoronary administration of verapamil, as revealed by repeated coronary angiography. Two patients developed transient hypotension which normalized without treatment within 3–5 min. Three patients showed sinus bradycardia, in one patient there was transient II sinoatrial block, and one patient developed type 1 atrioventricular block. All adverse effects were alleviated after intravenous injection of atropine (0.5–1 mg). In conclusion, the no-reflow phenomenon following primary PCI in patients with STEMI is significantly improved by intracoronary administration of verapamil which is useful to reduce cardiovascular events during operation.     

Safety and Effectiveness of Nitroprusside in Preventing No-Reflow During Percutaneous Coronary Intervention: A Systematic Review

The objective of this study was to evaluate the clinical efficacy and safety of nitroprusside injection for preventing the slow-flow/no-reflow phenomenon after percutaneous coronary intervention (PCI). We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2011), PubMed, EMbase, and Google Scholar for data. Two reviewers independently evaluated the quality of the included studies and extracted the data. A meta-analysis was performed using RevMan 5.0 software. Four randomized controlled trials (RCTs) involving 319 patients were included. The results of the meta-analyses showed that intracoronary nitroprusside is beneficial in preventing no-reflow/slow-flow, in reducing corrected TIMI frame count, and in improving left ventricular ejection fraction. It also likely reduces adverse reactions in patients after PCI and rehospitalization due to cardiovascular events. However, we must caution that in this review, there is a moderate possibility of bias with regard to patient selection, performance, and publication because of the small number of included studies. A larger sample size and high-quality RCTs are needed for a more reassuring analysis.     

Intravascular Ultrasound Observation of the Mechanism of No-Reflow Phenomenon in Acute Myocardial Infarction

Objective

To study the mechanism of the no-reflow phenomenon using coronary angiography (CAG) and intravascular ultrasound (IVUS).

Methods

A total of 120 patients with acute myocardial infarction (AMI) who successfully underwent indwelling intracoronary stent placement by percutaneous coronary intervention (PCI). All patients underwent pre- and post-PCI CAG and pre-IVUS. No-reflow was defined as post-PCI thrombolysis in myocardial infarction (TIMI) grade 0, 1, or 2 flow in the absence of mechanical obstruction. Normal reflow was defined as TIMI grade 3 flow. The pre-operation reference vascular area, minimal luminal cross-sectional area, plaque cross-sectional area, lesion length, plaque volume and plaque traits were measured by IVUS.

Results

The no-reflow group was observed in 14 cases (11.6%) and normal blood-flow group in 106 cases (89.4%) based on CAG results. There was no statistically significant difference in the patients’ medical history, reference vascular area (no-flow vs. normal-flow; 15.5 ± 3.2 vs. 16.2 ± 3.3, p> 0.05) and lesion length (21.9 ± 5.1 vs. 19.5 ± 4.8, p> 0.05) between the two groups. No-reflow patients had a longer symptom onset to reperfusion time compared to normal blood-flow group [(6.6 ± 3.1) h vs (4.3 ± 2.7) h; p< 0.05] and higher incidence of TIMI flow grade< 3 (71.4% vs 49.0%, p< 0.05). By IVUS examination, the no-reflow group had a significantly increased coronary plaque area and plaque volume compared to normal blood-flow group [(13.7 ± 3.0) mm² vs (10.2 ± 2.9) mm²; (285.4 ± 99.8) mm³ vs (189.7 ± 86.4) mm³; p< 0.01]. The presence of IVUS-detected soft plaque (57.1% vs. 24.0%, p< 0.01), eccentric plaque (64.2% vs. 33.7%, p< 0.05), plaque rupture (50.0% vs. 21.2%, p< 0.01), and thrombosis (42.8% vs. 15.3%) were significantly more common in no-reflow group.

Conclusion

There was no obvious relationship between the coronary risk factors and no-reflow phenomenon. The symptom onset to reperfusion time, TIMI flow grade before stent deployment, plaque area, soft plaques, eccentric plaques, plaque rupture and thrombosis may be risk factors for the no-reflow phenomenon after PCI.     

急性心梗患者PCI术中并发心室纤颤的影响因素及Gensini评分、血钾对其预测价值

摘要 目的：探讨分析AMI患者PCI术中并发VF的影响因素以及冠脉Gensini评分、血钾对其预测价值。方法：从2016年6月至2019年6月于我院就诊的AMI患者中筛选出356例,对其临床资料进行回顾性分析。以AMI患者PCI术中是否并发VF为依据进行组别划分,分为VF组（49组）、NVF组（未并发VF,307例）。整理比较两组一般资料、临床资料,并对两组患者冠脉造影特征、冠脉Gensini评分作对比分析,对AMI患者PCI术中并发VF的可疑性影响因素行多因素Logistic回顾分析,以确定其危险因素,并对危险因素行ROC曲线分析以确定其预测价值。结果：VF组和NVF组在性别、年龄、吸烟史、饮酒史、高血压史、糖尿病史、既往应用β受体阻滞剂及阿司匹林,入院时收缩压和心率方面,均无统计学差别（P>0.05）,临床血指标检测上,VF组血钾水平明显低于NVF组,差异具有统计学意义（P<0.05）,冠脉造影检查显示VF组TIMI血流0级、Gensini积分高及血栓负荷重例数高于NVF组,差异具有统计学意义（P<0.05）。多因素Logistic回归分析显示TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素（P<0.05）。ROC曲线分析结果显示,TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值,其ROC曲线下面积分别为0.619、0.816、0.842（P值均＜0.05）,提示血钾、Gensini评分具有中等预测价值,TIMI血流分级0级预测价值较低。当血钾、Gensini评分分别处4.05、89.95最佳截断值时,其敏感度分别为100%、63.3%,特异度分别为为41.8%、94.1%。结论：TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素。TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值。血钾、Gensini评分具中等预测价值,TIMI血流分级0级预测价值较低。     

A3 adenosine receptor agonist IB-MECA reduces myocardial ischemia-reperfusion injury in dogs

We examined the effect of the A3 adenosine receptor (AR) agonist IB-MECA on infarct size in an open-chest anesthetized dog model of myocardial ischemia-reperfusion injury. Dogs were subjected to 60 min of left anterior descending (LAD) coronary artery occlusion and 3 h of reperfusion. Infarct size and regional myocardial blood flow were assessed by macrohistochemical staining with triphenyltetrazolium chloride and radioactive microspheres, respectively. Four experimental groups were studied: vehicle control (50% DMSO in normal saline), IB-MECA (100 microg/kg iv bolus) given 10 min before the coronary occlusion, IB-MECA (100 microg/kg iv bolus) given 5 min before initiation of reperfusion, and IB-MECA (100 microg/kg iv bolus) given 10 min before coronary occlusion in dogs pretreated 15 min earlier with the ATP-dependent potassium channel antagonist glibenclamide (0.3 mg/kg iv bolus). Administration of IB-MECA had no effect on any hemodynamic parameter measured including heart rate, first derivative of left ventricular pressure, aortic pressure, LAD coronary blood flow, or coronary collateral blood flow. Nevertheless, pretreatment with IB-MECA before coronary occlusion produced a marked reduction in infarct size ( approximately 40% reduction) compared with the control group (13.0 +/- 3.2% vs. 25.2 +/- 3.7% of the area at risk, respectively). This effect of IB-MECA was blocked completely in dogs pretreated with glibenclamide. An equivalent reduction in infarct size was observed when IB-MECA was administered immediately before reperfusion (13.1 +/- 3.9%). These results are the first to demonstrate efficacy of an A3AR agonist in a large animal model of myocardial infarction by mechanisms that are unrelated to changes in hemodynamic parameters and coronary blood flow. These data also demonstrate in an in vivo model that IB-MECA is effective as a cardioprotective agent when administered at the time of reperfusion.     

替格瑞洛在急性冠脉综合征患者经皮冠状动脉介入治疗术后的应用价值

目的:评价替格瑞洛在急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的应用价值。方法:将我院收治的565例成功行PCI的急性冠脉综合征(acute coronary syndrome,ACS)患者随机分为2组:氯吡格雷组253例,术后口服氯吡格雷75 mg、QD;替格瑞洛组312例,术后口服替格瑞洛首剂180 mg,维持量90mg、BID。两组患者术后常规口服阿司匹林100 mg、QD。研究主要终点为主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、靶血管血运重建和脑梗塞;次要终点为TIMI主要出血(定义为血红蛋白下降50 g/L或颅内出血有关的临床显著出血事件)。结果:565例患者平均随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组(3.8%vs.8.7%,P0.05),两组TIMI主要出血事件发生率比较,差异无统计学意义(2.9%vs.3.2%,P0.05)。结论:替格瑞洛能明显减少PCI术后主要不良心血管事件,并不增加主要出血。     

丹参注射液与丹参多酚酸盐注射液对不稳定型心绞痛患者冠状动脉微循环的影响

目的:比较丹参注射液与丹参多酚酸盐注射液对不稳定型心绞痛(UA)患者冠状动脉微循环的影响。方法:将2014年5月～2017年5月105例UA患者随机分为丹参组(n=50)与丹参多酚酸盐组(n=55),前者在PCI术前静脉滴注丹参注射液20 mL,1次/d,连续3 d;后者静脉滴注丹参多酚酸盐注射液200 mg,1次/d,连续3 d。分别在PCI术前及术后即刻检测冠状动脉血流储备(CFR)、冠状动脉微循环阻力系数(IMR)及TIMI血流分级。结果:两组术后CFR、IMR及TIMI血流分级均较术前明显改善(P0.05),丹参多酚酸盐组IMR明显小于丹参组(P0.05),CFR、TIMI血流分级与丹参组比较无统计学意义(P0.05)。结论:丹参注射液与丹参多酚酸盐注射液均能显著改善UA患者的冠状动脉微循环,丹参多酚酸盐注射液一定程度上优于丹参注射液。     

Vasodilative and anti-adrenergic effects of adenosine in diabetic rat hearts.

To determine the vasodilative and negative inotropic effects of adenosine in hearts of diabetic rats, isolated hearts, perfused at constant perfusion pressure (Langendorff technique), were prepared from age-matched control Wistar rats and rats made diabetic 10 weeks prior to study by a single injection of streptozotocin (65 mg.kg-1, i.p.). Adenosine and nitroprusside each increased coronary inflow when administered either as bolus injections or as infusions. Coronary flow responses to nitroprusside were unchanged in diabetic hearts. Coronary flow responses of diabetic hearts to adenosine injections were unchanged, but responses to adenosine infusions tended to be larger than in normal hearts. Diabetes had no significant effect on the EC50 for either vasodilator. Adenosine inhibited the inotropic effect of isoproterenol (enhanced left ventricular (LV) pressure (P) and LV dP/dtmax) in normal hearts, independently of its vasodilative action. This negative inotropic action of adenosine appeared equally strong in diabetic hearts. We conclude that adenosine's coronary vasodilative and anti-beta-adrenergic, negative inotropic effects in the rat heart were not diminished after 10 weeks of streptozotocin-induced diabetes mellitus. Thus, earlier reports of diminished adenosine dilative efficacy in experimental diabetes may have been unique to those particular models.     

Adenosine A1/A2a receptor agonist AMP-579 induces acute and delayed preconditioning against in vivo myocardial stunning

The purpose of this study was to determine whether the adenosine A1/A2a receptor agonist AMP-579 induces acute and delayed preconditioning against in vivo myocardial stunning. Regional stunning was produced by 15 min of coronary artery occlusion and 3 h of reperfusion (RP) in anesthetized open-chest pigs. In acute protection studies, animals were pretreated with saline, low-dose AMP-579 (15 microg/kg iv bolus 10 min before ischemia), or high-dose AMP-579 (50 microg/kg iv at 14 microg/kg bolus + 1.2 microg.kg(-1).min(-1) for 30 min before coronary occlusion). The delayed preconditioning effects of AMP-579 were evaluated 24 h after administration of saline vehicle or high-dose AMP-579 (50 microg/kg iv). Load-insensitive contractility was assessed by measuring regional preload recruitable stroke work (PRSW) and PRSW area. Acute preconditioning with AMP-579 dose dependently improved regional PRSW: 129 +/- 5 and 100 +/- 2% in high- and low-dose AMP-579 groups, respectively, and 78 +/- 5% in the control group at 3 h of RP. Administration of the adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (0.7 mg/kg) blocked the acute protective effect of high-dose AMP-579, indicating that these effects are mediated through A1 receptor activation. Delayed preconditioning with AMP-579 significantly increased recovery of PRSW area: 64 +/- 5 vs. 33 +/- 5% in control at 3 h of RP. In isolated perfused rat heart studies, kinetics of the onset and washout of AMP-579 A1 and A2a receptor-mediated effects were distinct compared with those of other adenosine receptor agonists. The unique nature of the adenosine agonist AMP-579 may play a role in its ability to induce delayed preconditioning against in vivo myocardial stunning.     

Voltage-dependent K+ channels regulate the duration of reactive hyperemia in the canine coronary circulation

We previously demonstrated a role for voltage-dependent K(+) (K(V)) channels in coronary vasodilation elicited by myocardial metabolism and exogenous H(2)O(2), as responses were attenuated by the K(V) channel blocker 4-aminopyridine (4-AP). Here we tested the hypothesis that K(V) channels participate in coronary reactive hyperemia and examined the role of K(V) channels in responses to nitric oxide (NO) and adenosine, two putative mediators. Reactive hyperemia (30-s occlusion) was measured in open-chest dogs before and during 4-AP treatment [intracoronary (ic), plasma concentration 0.3 mM]. 4-AP reduced baseline flow 34 +/- 5% and inhibited hyperemic volume 32 +/- 5%. Administration of 8-phenyltheophylline (8-PT; 0.3 mM ic or 5 mg/kg iv) or N(G)-nitro-L-arginine methyl ester (L-NAME; 1 mg/min ic) inhibited early and late portions of hyperemic flow, supporting roles for adenosine and NO. 4-AP further inhibited hyperemia in the presence of 8-PT or L-NAME. Adenosine-induced blood flow responses were attenuated by 4-AP (52 +/- 6% block at 9 microg/min). Dilation of arterioles to adenosine was attenuated by 0.3 mM 4-AP and 1 microM correolide, a selective K(V)1 antagonist (76 +/- 7% and 47 +/- 2% block, respectively, at 1 microM). Dilation in response to sodium nitroprusside, an NO donor, was attenuated by 4-AP in vivo (41 +/- 6% block at 10 microg/min) and by correolide in vitro (29 +/- 4% block at 1 microM). K(V) current in smooth muscle cells was inhibited by 4-AP (IC(50) 1.1 +/- 0.1 mM) and virtually eliminated by correolide. Expression of mRNA for K(V)1 family members was detected in coronary arteries. Our data indicate that K(V) channels play an important role in regulating resting coronary blood flow, determining duration of reactive hyperemia, and mediating adenosine- and NO-induced vasodilation.     

Contribution of upper airway geometry to convective mixing

We investigated the axial dispersive effect of the upper airway structure (comprising mouth cavity, oropharynx, and trachea) on a traversing aerosol bolus. This was done by means of aerosol bolus experiments on a hollow cast of a realistic upper airway model (UAM) and three-dimensional computational fluid dynamics (CFD) simulations in the same UAM geometry. The experiments showed that 50-ml boluses injected into the UAM dispersed to boluses with a half-width ranging from 80 to 90 ml at the UAM exit, across both flow rates (250, 500 ml/s) and both flow directions (inspiration, expiration). These experimental results imply that the net half-width induced by the UAM typically was 69 ml. Comparison of experimental bolus traces with a one-dimensional Gaussian-derived analytical solution resulted in an axial dispersion coefficient of 200-250 cm(2)/s, depending on whether the bolus peak and its half-width or the bolus tail needed to be fully accounted for. CFD simulations agreed well with experimental results for inspiratory boluses and were compatible with an axial dispersion of 200 cm(2)/s. However, for expiratory boluses the CFD simulations showed a very tight bolus peak followed by an elongated tail, in sharp contrast to the expiratory bolus experiments. This indicates that CFD methods that are widely used to predict the fate of aerosols in the human upper airway, where flow is transitional, need to be critically assessed, possibly via aerosol bolus simulations. We conclude that, with all its geometric complexity, the upper airway introduces a relatively mild dispersion on a traversing aerosol bolus for normal breathing flow rates in inspiratory and expiratory flow directions.     

Lack of direct coronary vascular effects of Escherichia coli endotoxin in dogs

This study explored the hypothesis that coronary vascular injury and dysfunction result from intracoronary administration of Escherichia coli endotoxin (0.025 to 0.025 to 0.4 mg/kg) in dogs. Peak hyperemic coronary flow following a 15-sec period of stopped flow and the maximum flow in response to adenosine were used to estimate coronary vascular reserve. The wet-to-dry ratio of myocardial tissue was used to estimate extravascular water content as an indicator of vascular leak due to endothelial injury. Intracoronary saline was used as a control. Peak reactive hyperemia and maximum flow at constant coronary pressure were not different in the animals receiving intracoronary endotoxin (n = 6) and the animals receiving saline (n = 5) during 4 hr following treatment. In addition, wet-to-dry ratios were similar in these two groups. These data fail to support the hypothesis that endotoxin, per se, produces coronary vascular injury of sufficient magnitude to produce myocardial dysfunction.     

The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes

Objectives

Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo.

Background

Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome.

Methods

Retrospective cohort study reporting characteristics, PCI and FFR specifications, complications and 6-month follow-up for all consecutive patients from the beginning of off-site PCI in Venlo until July 2012. If possible, the data were compared with those of Medical Centre Alkmaar, the first off-site PCI centre in the Netherlands.

Results

Of the 333 patients, 19 (5.7 %) had a procedural complication. At 6 months, a major adverse cardiovascular event (MACE) occurred in 43 (13.1 %) patients. There were no deaths or emergency surgery related to the PCI or FFR procedures. There was no significant difference in occurrence of a MACE or adverse cerebral event between the Alkmaar and Venlo population in the 30-day follow-up.

Conclusion

This study demonstrates off-site PCI at VieCuri Venlo to have a high success rate. Furthermore, there was a low complication rate, low MACE and no procedure-related mortality.     

冠状动脉内注射负荷量替罗非班对急性心肌梗死患者心肌灌注及心功能的影响

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉注射负荷量盐酸替罗非班对心肌灌注及心功能的影响。方法：选择急性ST段抬高型心肌梗死患者270倒,随机分为实验组（n=133）和对照组（n=137）。所有入选患者均急诊进行经皮冠状动脉介入治疗（PCI）,术中实验组患者予冠脉内注射负荷量盐酸替罗非班,对照组不予注射,主要终点为观察PCI术后即刻造影结果,同时观察术后3天、30天、360天的左室射血分数（EF）,左室舒张末期内径（LVEDD）、左室收缩期末内径（LVESD）及术后360天主要心血管不良事件的发生率;次要终点为一般出血事件的发生率、血小板下降情况、血小板聚集率的变化。结果：实验组患者术后校正的TIMI帧数、术后2小时ST段回落程度、磷酸肌酸肌酶同工酶（CK-MB）峰值及峰值时间显著优于对照组（P〈0．05）．梗死相关血管无复流发生率及360天MACE的发生率显著低于对照组（P〈0．05）,与对照组相比,术后30天、360天的EF值明显增加,术后30天、360天的LVEDD、LVESD显著降低（P〈0．05）;实验组术后2天血小板聚集率明显低于对照组（P〈0．05）。结论：急诊PCI术中联合冠脉内注射负荷量替罗非班可以改善心肌灌注水平及心功能,且不增加出血事件的发生率,提高远期愈后。     

Alpha-human atrial natriuretic peptide is a coronary vasodilator in the Langendorff-perfused guinea pig heart

The circulating form of atrial natriuretic peptide is now believed to be composed of 28 amino acids (1). Therefore, we studied the coronary vasoactivity of the 28 amino acid, alpha-human atrial natriuretic peptide (alpha-hANP) in five isolated guinea pig hearts Langendorff-perfused at constant pressure (46 mmHg) with Krebs-Henseleit solution. The reactivity of the coronary bed was assured in each heart with bolus injections of norepinephrine, adenosine, and the vasoconstrictor atrial natriuretic peptide, atriopeptin II (APII). APII was a coronary constrictor in each of these five hearts. Nineteen boluses of alpha-hANP were administered to the five hearts, spanning the range 1.6 to 64 nmol/g wet heart weight. alpha-hANP was vasodilator in all five hearts. The equation for the regression of y = flow, % increase, on x = dose, nmol/g, is y = 17.98 logx - 4.11. The correlation coefficient, r, is 0.83, and the coefficient of determination, r2, is 0.69. Analysis of variance of the regression of y on x yields an F statistic of 36.9, P less than 0.00001. These results indicate that coronary vasodilation is correlated with dose of alpha-hANP over much of the range 1.6-64 nmol/g.     

Saline aerosol bolus dispersion. I. The effect of acinar airway alteration.

We explored the possibility of using a saline aerosol for bolus dispersion measurements to detect peripheral airway alterations in smokers. Indexes of ventilation inhomogeneity in conductive (S(cond)) and acinar (S(acin)) lung zones, as derived from the multiple-breath N(2) washout (Verbanck S, Schuermans D, Van Muylem A, Noppen M, Paiva M, and Vincken W, J Appl Physiol 83: 1807-1816, 1997), were also measured. The saline bolus test consisted of inhaling 60-ml saline aerosol boluses to different volumetric lung depths (VLD) in the 1.1 liter volume above functional residual capacity. In the never-smoker group (n = 12), saline boluses showed bolus dispersion values consistent with normal values reported in the literature for 0.5- to 1-microm aerosols. In the smoker group (n = 12; 28 +/- 9 pack years, mean +/- SD), significant increases were seen on dispersion and skew of the most peripherally inhaled saline boluses (VLD = 800 ml; P < 0.05) as well as on S(acin) (P = 0.007) with respect to never-smokers. Shallow inhaled boluses (VLD = 200 ml) and S(cond) did not reveal any significant differences between smokers and never-smokers. This study shows the consistent response of two conceptually independent tests, in which both saline aerosol and gas-derived indexes point to a heterogeneous distribution of smoking-induced structural alterations in the lung periphery.