Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience

BACKGROUND: Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size. However, the safety and feasibility of such an approach has not been adequately established. METHODS: In this single-center prospective study we examined 73 consecutive patients who had an acute STEMI and at least one or more lesions > or = 70% in a major epicardial vessel other than the infarct-related artery. In the first 28 patients, forming the multi-vessel (MV) PCI group, all lesions were treated during the primary procedure. In the following 45 patients, forming the culprit-only (CO) PCI group, only the culprit lesion was treated during the initial procedure, followed by either planned-staged or ischemia-driven revascularization of the non-culprit lesions. Fluoroscopy time and contrast dye amount were compared between both groups, and patients were followed up for one year for major adverse cardiac events (MACE) and other significant clinical events. RESULTS: The two groups were well balanced in terms of clinical characteristics, number of diseased vessels and angiographic characteristics of the culprit lesion. In the MV-PCI group, 2.51 lesions per patient were treated using 2.96 +/- 1.34 stents (1.00 lesions and 1.76 +/- 1.17 stents in the CO-PCI group, both p < 0.001). The fluoroscopy time increased from 10.3 (7.2-16.9) min in the CO-PCI group to 12.5 (8.5-19.3) min in the MV-PCI group (p = 0.22), and the amount of contrast used from 200 (180-250) ml to 250 (200-300) ml, respectively (p = 0.16). Peak CK and CK-MB were significantly lower in patients of the MV-PCI group (843 +/- 845 and 135 +/- 125 vs 1652 +/- 1550 and 207 +/- 155 U/l, p < 0.001 and 0.01, respectively). Similar rates of major adverse cardiac events at one year were observed in the two groups (24% and 28% in multi-vessel and culprit treatment groups, p = 0.73). The incidence of new revascularization in both infarct- and non-infarct-related arteries was also similar (24% and 28%, respectively, p = 0.73). CONCLUSION: We may state from this limited experience that a multi-vessel stenting approach for patients with acute STEMI and multi-vessel disease is feasible and probably safe during routine clinical practice. Our data suggest that this approach may help to limit the infarct size. However, larger studies, perhaps using drug-eluting stents, are still needed to further evaluate the safety and efficiency of this procedure, and whether it is associated with a lower need of subsequent revascularization and lower costs

Elucidation of the liquid-liquid distribution behavior of ion associates of metal-halogeno complex anions with quaternary ammonium counter cations and its application to separation and analysis

第四級アンモニウムイオンを対イオンとする一価, 二価金属ハロゲノ錯陰イオンのイオン会合抽出挙動を把握し, 分離・分析的応用を図るために, 炭素数及び形状の異なる第四級アンモニウム陽イオンを用いて, 水-各種抽出溶媒 {1,2-ジクロロエタン, クロロホルム (CF), クロロベンゼン (Cl-B), ベンゼン (B), トルエン (T) 及び四塩化炭素 (CTC)} 系での抽出定数を求めた. 得られた抽出定数から次の知見を得た. (1) 配位子の抽出性に及ぼす影響 : 配位子がCl-, Br-, I-と変わるにつれ, この順に抽出性は良くなる. (2) 配位子数の影響 : 配位子数が多くなるに従い, 抽出性も良くなる. (3) 中心金属の影響 : 配位子数が同じ場合には, 抽出性はほぼ中心金属イオンの大きさの順となる. (4) 金属錯陰イオンの電荷の影響 : 一般に二価陰イオンよりも一価陰イオンのほうが抽出されやすい. (5) 対陽イオンのアルキル鎖のメチレン基の寄与 : メチレン基一つ当たり, 大体0.4～0.8の抽出定数 (log K(ex)) の増大となる. (6) 抽出溶媒の影響 : 抽出溶媒の抽出能は次の順となる : CTC<T<B<Cl-B<CF. (7) 金属ハロゲノ錯陰イオンの配位子の違いによる抽出定数の差 (Δlog K(ex)) は溶媒によらず, ほぼ一定である. これらの知見を基に, 金属ハロゲノ錯陰イオンと疎水性陽イオンとのイオン会合抽出を利用する幾つかの金属の分離・定量法を開発した.The distribution behavior of ion associates of both monovalent and divalent metal-halogeno complex anions with various quaternary ammonium cations between the aqueous phase and several organic phases {1,2-dichloroethane, chloroform (CF), chlorobenzene (Cl-B), benzene (B), toluene (T) and carbon tetrachloride (CTC)} was examined, and the extraction constants (log Kex) were determined. The larger is the size of the ligand (Cl-<Br-<I-) and the coordination number, the greater is the ion associability. For the same coordination number, in general, the larger is the size of the metal ion, the greater is the ion associability. In general, the extractability of monovalent metal-halogeno complex anions is larger than that of divalent metal-halogeno complex anions. A linear relationship was obtained between log Kex and the number of carbon atoms in quaternary ammonium ion, and the contribution of a methylene group to the extraction constant (Δlog K(ex)/-CH(2-)) was found to be about 0.4∼0.8. Among the ion associates examined, the order of the extractability of the extracting solvent was generally CTC<T<B<Cl-B<CF. Also, the order of the extractability of the ion associates for dihalogenocuprate (I), tetrahalogenoaurate (III) and tetrahalogenothallate (III) complex ions was as follows, respectively : CuCl(2)-<CuBr(2)-<CuI(2)- ; AuCl(4)-<AuBr(4)- ; TlCl(4)-<TlBr(4)-<TlI(4-). The values of Δlog K(ex) between the complex anions were almost equal, even though the extracting solvents were changed. From these results, several extraction-spectrophotometric methods for the determination of metal based on the formation of an ion associate of metal-halogeno complex anion with hydrophobic cations were developed

In-hospital Outcomes of Rotational Atherectomy in ST-Elevation Myocardial Infarction: Results From the Multicentre ROTA-STEMI Network

Although the use of rotational atherectomy (RA) is off-label in the setting of ST-elevation myocardial infarction (STEMI), it can be the only option in severely calcified culprit lesions to achieve procedural success. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention (PPCI).This was a retrospective observational study of patients who underwent RA during PPCI from 12 European centers. The main outcomes were procedural success (defined as successful stent implantation with final TIMI flow 3 and residual stenosis <30%) and in-hospital mortality. A comparison of patients presenting with and without shock was performed.In 104 patients with RA during STEMI the mean age was 72.8±9.1 years, 35% presented with cardiogenic shock. Bailout RA was performed in 76.9% of cases. Mean burr size was 1.42±0.21mm. Procedural success was achieved in 86.5% of cases, with no difference between shocked and non-shocked patients (94.4% vs. 82.4%, p=0.13). In-hospital stent thrombosis occurred in 0.96%, perforation in 1.9% and burr entrapment in 2.9% of cases. In-spite of equally high procedural success, in-hospital mortality was higher in shocked (50%) compared with non-shocked patients (1.5%, p<0.0001).Patients presenting with STEMI, requiring RA, represent a high-risk population, frequently presenting with cardiogenic shock. In this analysis of selected patients, RA was performed as a bailout strategy in the majority, and as such RA seems to be feasible with a high procedural success rate. In the absence of cardiogenic shock, RA-facilitated PCI seems to be associated with low in-hospital mortality

A neural architecture for autonomous visually guided robots Results of the NAMOS project

SIGLEAvailable from TIB Hannover: ZN 6951(388)+a+b / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

One-Month Versus Three-Month Dual-Antiplatelet Therapy in High Bleeding Risk Patients With Chronic Kidney Disease

\ua9 2024 Elsevier Inc.Shortening the duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) was shown to be effective and safe in patients at high bleeding risk (HBR). We aimed to investigate the effect of 1 versus 3-month DAPT on outcomes after drug-eluting stent in HBR patients with or without chronic kidney disease (CKD). Data from 3 prospective single-arm studies (XIENCE Short DAPT Program) enrolling HBR patients after successful coronary implantation of cobalt-chromium everolimus-eluting stent (XIENCE, Abbott) were analyzed. Subjects were eligible for DAPT discontinuation at 1 or 3 months if free from ischemic events. The primary end point was all-cause death or any myocardial infarction. The key secondary end point was Bleeding Academic Research Consortium Type 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after PCI. CKD was defined as baseline creatinine clearance &lt;60 ml/min. Of 3,286 patients, 1,432 (43.6%) had CKD. One-month versus 3-month DAPT was associated with a similar 12-month risk of the primary outcome irrespective of CKD status (CKD: 9.5% vs 10.9%, adjusted hazard ratio 0.86, 95% confidence interval 0.60 to 1.22; no-CKD: 6.6% vs 5.6%, adjusted hazard ratio 1.15, 95% confidence interval 0.77 to 1.73; p interaction 0.299). Bleeding Academic Research Consortium 2 to 5 bleeding rates were numerically but not significantly lower with 1-month versus 3-month DAPT in both CKD (9.9% vs 12%) and no-CKD (6.4% vs 9.0%) patients. In conclusion, in HBR patients, 1-month versus 3-month DAPT was associated with a similar risk of ischemic complications and a trend toward fewer bleeding events at 12 months after PCI, irrespective of CKD status

1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT Global Program

\ua9 2024 Elsevier Inc.This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from 3 prospective, single-arm studies (XIENCE Short DAPT Program), including patients with high bleeding risk successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and &lt;75 years). The primary end point was all-cause death or myocardial infarction (MI). The key secondary end point was Bleeding Academic Research Consortium type 2 to 5 bleeding. The outcomes were assessed from 1 to 12 months after index PCI. Of 3,364 patients, 2,241 (66.6%) were aged ≥75 years. The risk of death or MI was similar with 1- versus 3-month DAPT in patients aged ≥75 (8.5% vs 8.0%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.69 to 1.30) and &lt;75 years (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60 to 1.57, interaction p = 0.478). Bleeding Academic Research Consortium type 2 to 5 bleeding was consistently lower with 1- than with 3-month DAPT in patients aged ≥75 years (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48 to 0.91) and &lt;75 years (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57 to 1.29, interaction p = 0.737). In conclusion, in patients at high bleeding risk who underwent PCI, patients older and younger than 75 years derived a consistent benefit from 1- compared with 3-month DAPT in terms of bleeding reduction, with no increase in all-cause death or MI at 1 year

Duration of Dual Antiplatelet Therapy for Patients at High Bleeding Risk Undergoing PCI

Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) among patients at high bleeding risk (HBR) is unknown. Objectives: The purpose of this analysis was to compare 1 vs 3 months of DAPT in HBR patients undergoing drug-eluting stent implantation. Methods: The XIENCE Short DAPT program comprised 3 prospective, multicenter, single-arm studies of HBR patients treated with a short DAPT course followed by aspirin monotherapy after PCI with a cobalt-chromium everolimus-eluting stent. In this exploratory analysis, patients who received 1-month DAPT (XIENCE 28 USA and 28 Global) were compared with those on 3-month DAPT (XIENCE 90) using propensity score stratification. Ischemic and bleeding outcomes were assessed between 1 and 12 months after index PCI. Results: A total of 3,652 patients were enrolled and 1,392 patients after 1-month DAPT and 1,972 patients after 3-month DAPT were eligible for the analyses. The primary endpoint of all-cause mortality or myocardial infarction was similar between the 2 groups (7.3% vs 7.5%; difference −0.2%; 95% CI: −2.2% to 1.7%; P = 0.41). The key secondary endpoint of BARC (Bleeding Academic Research Consortium) type 2-5 bleeding was lower with 1-month DAPT compared with 3-month DAPT (7.6% vs 10.0%; difference −2.5%; 95% CI: −4.6% to −0.3%; P = 0.012). Major BARC type 3-5 bleeding did not differ at 12 months (3.6% vs 4.7%; difference −1.1%; 95% CI: −2.6% to 0.4%; P = 0.082), but was lower with 1-month DAPT at 90 days (1.0% vs 2.1%; P = 0.015). Conclusions: Among HBR patients undergoing PCI, 1 month of DAPT, compared with 3 months of DAPT, was associated with similar ischemic outcomes and lower bleeding risk. (XIENCE 90 Study; NCT03218787; XIENCE 28 USA Study; NCT03815175; XIENCE 28 Global Study; NCT03355742