Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

BACKROUND: Primary percutaneous coronary intervention (PCI) has been shown to be a better reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) compared with thrombolysis, particularly when applied early. The objective of the present study was to report our experience from treating patients presenting to the emergency room of our hospital with STEMI with primary PCI. PATIENTS AND METHODS: The population of the study included 100 patients who presented to our hospital with STEMI and underwent primary PCI over a 12-month period. Patients’ clinical and angiographic data were retrospectively collected and patients were followed up for 9 months. Technical details of the primary PCI, including stent implantation, and use of drug eluting stents, thrombus aspiration catheter, or platelet glycoprotein IIb/ΙΙΙa inhibitors were recorded and correlated to clinical and angiographic patient data. RESULTS: Of 196 patients who presented o the emergency room with STEMI during the study period, 100 (51%) patients (85 men and 15 women) underwent primary PCI. PCI was successful with TIMI 3 flow of the infarct-related coronary artery in 79 (79%) patients. Six (6%) patients died during hospitalization and another 4 (4.3%) patients died during the 9-month follow up period. Twenty one (22%) patients required rehospitalization for acute coronary syndrome, of whom 17 needed a repeat PCI and 4 patients were submitted to coronary artery bypass grafting. Left ventricular ejection fraction (LVEF) was <50% in 54 (54%) patients. In 52 patients primary PCI was performed in less than 4 hours from onset of symptoms. In his cohort, 19 patients were thrombolyzed before arriving to the catheterization laboratory. Antithrombotic therapy with platelet glycoprotein IIb/IIIa inhibitors was used in 48 (48%) patients. Univariate analysis showed that the odds of achieving TIMI 3 flow were higher after using IIb/ΙΙΙa inhibitors (odds ratio-OR 6.4) or if the LVEF ≥50% (vs LVEF < 50%) at the beginning of the PCI (OR 6.4). If the time from the onset of symptoms to PCI was >4 hours, the odds of achieving TIMI 3 flow were reduced by 23.4% compared to time from symptoms to PCI <4 hours. The presence of TIMI 3 flow of the infarct-related artery reduced the odds of death by 10.2% compared to the absence of TIMI 3 flow of the infarct-related coronary artery. CONCLUSION: Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of LVEF >50% and the importance of achieving TIMI 3 flow in the IRA at the end of the procedure

Determination of Antioxidant Charge and Total Phenolic Content in Greek aromatic plants by EPR/UV-Vis Spectroscopy

Aromatic plants and herbs are among the more important sources of phenolic compounds, which have been reported to show strong antioxidant activity. In the present work the total phenolic content and the antioxidant charge of five aromatic plants, Origanum vulgare L., Rosmarinus officinalis L., Ocimum basilicum L., Salvia officinalis L. and Achillea millefolium L., biologically grown in Western Greece, was determined by UV-vis and Electron Paramagnetic Resonance (EPR) spectroscopy. Dried plant leaves extracted in 50% methanol/ 48,5% H2O/ 1,5% formic acid solution were measured by UV-vis spectroscopy for the determination of total phenolics. Quantitative analysis has been done by using Gallic acid as standard solution. In addition the dry matter of plant leaves was measured at 77Kelvin by EPR spectroscopy. The EPR spectra of all samples contained stable radical signal with g-values 2.0046-49 and a linewidth of 3-5Gauss. These are characteristic of phenolic or quinone-type radicals with the unpaired electron partially on the Oxygen atom of the phenolic ring. Quantitative analysis of the radicals has been done using DPPH [1mm3 2x1013 spins] as reference. The calculations have been done per dry mass of the material. The present results reveal significant differences of radical concentration between samples of different origin by EPR spectra. The higher radical content was measured in Origanum vulgare L. and the lower in Ocimum basilicum L. plant leaves respectively. In addition a significant difference in total phenolics content was determined between plants. The higher concentration was found in Origanum vulgare L. and the lower in Achillea millefolium L. plant leaves respectively. It is concluded that a fraction of the total phenolics accumulation corresponds to the redox active antioxidant charge in plant leaves

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

We report our experience from treating a large number of patients who presented to the Emergency Department of our Hospital with ST-elevation acute myocardial infarction (AMI) with primary percutaneous coronary intervention (PCI). Of the 196 patients who presented with ST elevation AMI over a period of 12 months, 100 (51%) patients underwent primary PCI. Clinical and angiographic data were collected and patients were followed up for 9 months. Technical details of the primary PCI, including use of balloon, use of thrombus aspiration catheter, stent implantation, use of drug eluting stents, and use of GP IIb/IIIa inhibitors were recorded and correlated to clinical and angiographic patient data. Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of left ventricular ejection fraction >50% and the importance of achieving TIMI 3 flow in the AMI related artery at the end of the procedure