Correlations Between Oxidative Stress Markers and Coronary Anatomy in Percutaneously Treated Patients With Acute ST-elevation Myocardial Infarction

Understanding biochemical mechanisms involved in acute myocardial infarction is crucial for future treatments. The current study analyzed the oxidative stress markers in patients with percutaneously treated acute ST-elevation myocardial infarction and correlated the findings to coronary anatomy and Syntax II score (SS-II). Blood samples were obtained before coronary re-perfusion, after one and 24 hours. The following markers of oxidative stress were determined: malondialdehyde (MDA), reduced glutathione to oxidized glutathione ratio (GSH/GSSG) and total antioxidant capacity (TAC). Thirty-seven consecutive patients were included. The patients were divided into groups according to the infarct-related artery: left anterior descending artery (LAD- group) vs non-LAD group, and according to the calculated SS-II, SS-II≤ 34 vs. SS-II>34. MDA concentration and GSH/GSSG ratio showed non-significant differences between LAD vs non-LAD groups at all time frames. Patients with LAD as the infarct-related artery had a significantly lower TAC 24 hours after re-perfusion: 30.22 ± 9.78 % inhibition in the LAD group vs. 35.7 ± 5.78 % inhibition in the non-LAD group, p=0.013. The oxidative stress markers were similar between patients regardless of the SS-II value, and neither the culprit vessel nor the SS-II significantly influenced the dynamics of oxidative stress markers

OXIDATIVE STRESS MARKERS IN ACUTE MYOCARDIAL INFARCTION TREATED BY PRIMARY PERCUTANEOUS CORONARY INTERVENTION

The current study analysed the dynamics of oxidative stress markers in patients with acute ST-elevation myocardial infarction treated by primary percutaneous intervention. Excessive reactive oxygen species production is known to induce myocardial reperfusion injury. There are few studies that evaluated oxidative stress markers in the interventional era, the historical papers were all based on thrombolysis as a mean of reperfusion. Thirty-seven patients were included. Peripheral venous blood samples were obtained prior to coronary angioplasty, at 1 hour and 24 hours after that. Plasma malondialdehyde, reduced glutathione / oxidised glutathione ratio and total antioxidant capacity were determined. Malondialdehyde was significantly lower at 1 hour (3.1 ± 0.96 nmol/ml vs 2.68 ± 0.81 nmol/ml, p<0.01) and 24 hours (3.1 ± 0.96 nmol/ml vs 2.15 ± 0.95 nmol/ml, p<0.01). Also, reduced glutathione / oxidised glutathione ratio dropped significantly at 1 hour (3.25 Q1-Q3 2.17-5.19 vs 2.33 Q1-Q3 1.53-2.82, p<0.01) and at 24 hours (3.25 Q1-Q3 2.17-5.19 vs 1.96 Q1-Q3 1.28-2.85, p<0.01). Total antioxidant capacity had non-significant variation. There was no correlation between these markers and time from symptom-onset or left ventricular ejection fraction. Reperfusion of the occluded coronary artery by percutaneous coronary intervention in acute myocardial infarction led to a rapid decrease of reduced glutathione / oxidised glutathione ratio, that may indicate a depletion of antioxidants as a consequence of overproduction of reactive oxygen species in the damaged area. However, the malondialdehyde level significantly decreased after vessel opening. This may suggest low reperfusion injury after angioplasty

HIGH-DOSE STATIN PRIOR TO PRIMARY PERCUTANEOUS CORONARY INTERVENTION REDUCES OXIDATIVE STRESS BURDEN IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION

The current study analysed the effect of high-dose statin loading prior to primary percutaneous coronary intervention on oxidative stress markers, in patients with acute ST-elevation myocardial infarction (STEMI). Besides the lipid lowering effect, statins have antioxidant properties that might reduce myocardial ischemia-reperfusion injury. From a total of 37 patients, 18 patients received high-dose statin before coronarography and were included in the statin group, while 19 statin naive patients were included in the control group. Peripheral venous blood samples were obtained before coronary reperfusion, at 1 hour and 24 hours after that. The following markers of oxidative stress were determined from the serum: malondialdehyde (MDA), reduced glutathione to oxidized glutathione ratio (GSH/GSSG) and total antioxidant capacity (TAC). Values are shown as medians and interquartile ranges. MDA concentration and TAC had non-significant differences between the two groups, at all time frames. Before angioplasty, GSH/GSSG ratio was comparable between the two groups: 3.59 (2.13-5.37) in the statin group vs 2.69 (2.15-5.02) in the control group, p=0.49. At 1 hour after reperfusion, values were still similar: 2.26 (1.32-4.28) in the statin group vs 2.33 (1.88-2.50) in the control group, p=0.55. After 24 hours, there was a significant increase of GSH/GSSG ratio in the statin group 2.41 (1.58-3.28) vs 1.56 (1.12-2.03) in the control group, p=0.01. This finding suggest that, in STEMI patients, high-dose statin loading before primary percutaneous coronary intervention significantly reduces oxidative stress burden, early after administration

Real-Life Benefit of OCT Imaging for Optimizing PCI Indications, Strategy, and Results

Background: The aim of this study was to evaluate the benefit of standard practice Optical Coherence Tomography (OCT) imaging, as a complement to coronary angiography (CA), for optimizing the indications, strategy, and results of percutaneous coronary interventions (PCI). Methods: We retrospectively analyzed 182 patients with OCT imaging in a single tertiary center. Results: OCT use had a low prevalence (3.1% of 4256 CAs and 1.7% of 3027 PCIs). OCT was used post-CA in 71.5% and post-PCI in 28.5% of cases, mainly in acute coronary syndromes—95.6%. OCT was performed for borderline lesions in 43.4% of cases; lesion severity was reassessed as severe and led to PCI in 64.5% of them. OCT was performed for nonsignificant lesions in 17% of cases; lesion severity was reassessed as severe and led to PCI in 38.7% of them. OCT provided optimal selection for PCI strategy in 11% of cases. OCT identified suboptimal PCI results in 54% left main PCIs and in 48% bifurcation PCIs with optimal CA; PCI optimization was performed. In the only seven patients with suboptimal PCI, OCT revealed an optimal result in four cases, thus avoiding unneccessary optimization. In 27.3% of patients with post-CA OCT and PCI result “systematic” OCT control, a PCI optimization was indicated. Conclusion: OCT supplied a major benefit in 86.2% of cases, especially by identifying significant coroanry stenosis in CA borderline and nonsignificant lesions; OCT led to PCI indication in two-thirds and, respectively, one-third of these cases. In the post-PCI context, OCT led to an indication of PCI optimization in half of the complex left main and bifurcation lesions, as well as in a quarter of “systematic” post-PCI OCT controls.</jats:p

Antithrombotic treatment in peripheral artery disease

Abstract. This review treats antithrombotic use for peripheral arterial disease (PAD). In asymptomatic patients, there are no scientific data to support single antiplatelet therapy (SAPT) for primary prophylaxis. In symptomatic PAD, SAPT with aspirin or clopidogrel is indicated. The efficacy of aspirin is controversial. Clopidogrel may be preferred over aspirin. Ticagrelor is not superior to clopidogrel in reducing major adverse cardiovascular events and major adverse limb events, but lowers the risk of ischaemic stroke. In symptomatic PAD, dual antiplatelet therapy (DAPT) with clopidogrel and aspirin does not provide benefit over SAPT with aspirin alone and is associated with increased risk of major bleeding. DAPT with ticagrelor 60 mg b. i. d. and aspirin provides a significant major adverse cardiovascular events reduction in symptomatic PAD patients and may be considered in PAD patients with prior myocardial infarction. The use of a new thrombin receptor antagonist, vorapaxar, on top of SAPT or DAPT with aspirin and/or clopidogrel, reduces the risk of acute limb ischaemia and peripheral artery revascularization in patients with symptomatic PAD, at the cost of an increased risk for bleeding. Rivaroxaban (2.5 mg b. i. d.) plus aspirin (100 mg daily) is the first antithrombotic association that proved significant benefit for PAD patients, in terms of strong endpoints – total mortality and cardiovascular mortality. Therefore, this association shows the strongest evidence for secondary prevention of symptomatic PAD patients. In PAD patients undergoing percutaneous peripheral interventions, at least four weeks of DAPT with aspirin and clopidogrel is recommended after infrainguinal stent implantation. Stenting below-the-knee arteries is often followed by a longer period of DAPT, but no specific evidence is available. Anticoagulation is mandatory to prevent arterial occlusion during radial or brachial invasive procedures. The strategy includes use of unfractioned heparin, bivalirudin or enoxaparin. Vitamin K antagonists may be considered after autologous vein infrainguinal bypass. </jats:p

Real-Life Benefit of OCT Imaging for Optimizing PCI Indications, Strategy, and Results

Background: The aim of this study was to evaluate the benefit of standard practice Optical Coherence Tomography (OCT) imaging, as a complement to coronary angiography (CA), for optimizing the indications, strategy, and results of percutaneous coronary interventions (PCI). Methods: We retrospectively analyzed 182 patients with OCT imaging in a single tertiary center. Results: OCT use had a low prevalence (3.1% of 4256 CAs and 1.7% of 3027 PCIs). OCT was used post-CA in 71.5% and post-PCI in 28.5% of cases, mainly in acute coronary syndromes&#8212;95.6%. OCT was performed for borderline lesions in 43.4% of cases; lesion severity was reassessed as severe and led to PCI in 64.5% of them. OCT was performed for nonsignificant lesions in 17% of cases; lesion severity was reassessed as severe and led to PCI in 38.7% of them. OCT provided optimal selection for PCI strategy in 11% of cases. OCT identified suboptimal PCI results in 54% left main PCIs and in 48% bifurcation PCIs with optimal CA; PCI optimization was performed. In the only seven patients with suboptimal PCI, OCT revealed an optimal result in four cases, thus avoiding unneccessary optimization. In 27.3% of patients with post-CA OCT and PCI result &#8220;systematic&#8222; OCT control, a PCI optimization was indicated. Conclusion: OCT supplied a major benefit in 86.2% of cases, especially by identifying significant coroanry stenosis in CA borderline and nonsignificant lesions; OCT led to PCI indication in two-thirds and, respectively, one-third of these cases. In the post-PCI context, OCT led to an indication of PCI optimization in half of the complex left main and bifurcation lesions, as well as in a quarter of &#8220;systematic&#8222; post-PCI OCT controls