No clinical benefit from manual thrombus aspiration in patients with non-ST-elevation myocardial infarction

Introduction: There are scarce data on the usefulness of manual thrombectomy among patients with non-ST-elevation myocardial infarction (NSTEMI). Early positive reports were not supported by the clinical outcome in the recent TATORT-NSTEMI (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non-ST-Elevation Myocardial Infarction) study. Aim: To analyze the long-term outcome of NSTEMI patients treated with manual thrombectomy during percutaneous coronary intervention (PCI) in the Polish multicenter National Registry of Drug Eluting Stents (NRDES) study. Material and methods: There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry in 2010–2011. Patients with a diagnosis of NSTEMI were divided into two groups: those that were treated with manual thrombectomy for their primary PCI (T) and those who were not (NT). Results: There were 923 patients diagnosed with NSTEMI in NRDES. Aspiration thrombectomy was used in 71 (7.7%) patients and the remaining 852 (92.3%) NSTEMI cases were treated without thrombectomy during the index PCI. Thrombectomy was more often used in patients with TIMI less than 1, thrombus grades 4 and 5 and older male patients. Percutaneous coronary interventions complications such as distal embolization and slow flow were more often observed in the thrombectomy subgroup. Overall mortality at 1 year was 1.69% in the T and 5.92% in the NT group (p = 0.24 and p = 0.32 after propensity score matching adjustment with p = 0.11 in the multivariate logistic regression model). Conclusions: There was no mortality benefit from thrombus aspiration in NSTEMI patients at 1-year follow-up

Long-term quality of life and clinical outcomes in patients with resistant hypertension treated with renal denervation

Introduction: Pharmacological treatment combined with lifestyle modifications is an effective treatment for arterial hypertension. However, there are still patients who do not respond to standard treatments. Patients with pharmacologically resistant hypertension may benefit from renal denervation (RDN). Aim: To assess long-term quality of life (QoL) after RDN and effectiveness in reduction of blood pressure (BP) in patients with resistant hypertension. Material and methods: From 2011 to 2014, 12 patients with previously diagnosed resistant hypertension, treated by RDN, were included in this study. The QoL was assessed using a standardized Polish version of the Nottingham Health Profile questionnaire (NHP). Results: The median age was 54 (IQR: 51–57.5) years. Mean baseline ambulatory pre-procedural systolic/diastolic BP was 188/115 ±29.7/18 mm Hg. The mean values of systolic/diastolic BP measured perioperatively and 3, 6, 12 and 24 months postoperatively were 138/86, 138/85, 146/82, 152/86, and 157/91. All p-values for mean systolic and diastolic BP before versus successive time points after RDN were statistically significant; p-value for all comparisons < 0.05. Improvement of QoL was only observed in two sections of the NHP questionnaire: emotional reaction and sleep disturbance. The analysis of the NHP index of Distress (NHP-D) showed a lower distress level perioperatively and 3, 6, 12 and 24 months after RDN as compared to baseline. The RDN was not associated with any significant adverse events. Conclusions: Patients with pharmacologically resistant hypertension treated with RDN achieved significant reduction in BP during 24-month follow-up. Furthermore, a significant improvement in the QoL was observed in those patients

Codzienna praktyka kliniczna w ostrych zespołach wieńcowych bez uniesienia odcinka ST w szpitalach rejonowych - rejestr w Małopolsce

Wstęp: Ostre zespoły wieńcowe bez uniesień odcinka ST (NSTE ACS) rozpoznaje się u ponad połowy pacjentów przyjmowanych do szpitali z powodu ostrego zespołu wieńcowego (ACS). Ze względu na całodobową dostępność pracowni hemodynamicznych w Małopolsce każdy pacjent z NSTE ACS wysokiego ryzyka przyjęty do szpitala rejonowego może zostać przetransportowany do ośrodka kardiologii interwencyjnej. Celem badania była ocena częstości kierowania pacjentów z rozpoznaniem NSTE ACS na badanie diagnostyczne tętnic wieńcowych do ośrodków kardiologii interwencyjnej oraz charakterystyka demograficzna i zastosowana farmakoterapia w tej grupie. Materiał i metody: Korzystając z ankiet, zebrano dane dotyczące 2382 kolejnych pacjentów z rozpoznaniem ACS, przyjętych do szpitali rejonowych w Małopolsce w okresie od kwietnia 2002 do lutego 2003 r. U 1396 chorych potwierdzono ostatecznie przy wypisie rozpoznanie ostrego zespołu wieńcowego bez uniesienia odcinka ST. Wyniki: U 42% (n = 582) chorych z końcowym rozpoznaniem NSTE ACS stwierdzono podwyższone stężenie markerów martwicy mięśnia sercowego, takich jak troponina T/I lub CK-MB (CM+), natomiast u 58% (n = 814) pacjentów nie odnotowano podwyższonego stężenia markerów (CM-). W grupie CM+ zaobserwowano większą śmiertelność wewnątrzszpitalną niż w grupie CM- (3,3% vs. 0,4%; p = 0,0002). Tylko 17,7% pacjentów z całej grupy CM+ skierowano w trakcie hospitalizacji do ośrodka kardiologii interwencyjnej w celu wykonania koronarografii i ewentualnego leczenia inwazyjnego. Wraz ze wzrostem ryzyka określanego w skali TIMI Risk Score zwiększał się odsetek osób kierowanych do pracowni hemodynamiki (TIMI Risk Score 0-2 pkt: 14%; 3-4 pkt: 15%; 5-7 pkt: 22%; p = 0,02 dla 3-4 vs. 5-7 oraz p = 0,01 dla 0&#8211;2 vs. 5&#8211;7). Jednocześnie obserwowano wzrost śmiertelności wewnątrzszpitalnej w grupie pacjentów nieskierowanych na leczenie inwazyjne 0,8% vs. 1,9% vs. 3,5% (p = 0,02 dla 0-2 vs. 5-7) odpowiednio dla grup z ryzykiem wynoszącym w skali TIMI Risk Score 0-2 vs. 3-4 vs. 5-7. Pacjenci kierowani na leczenie inwazyjne znamiennie częściej otrzymywali tienopirydyny (68,3% vs. 44,5%; p < 0,0001), blokery receptora IIb/IIIa (1,5% vs. 0,3%; p = 0,04), heparyny (92,7% vs. 85%; p = 0,003) oraz ß-blokery (88,3% vs. 78,8%; p = 0,002). Wnioski: Pomimo 24-godzinnego dostępu do pracowni hemodynamiki tylko niewielki odsetek pacjentów z NSTE ACS jest kierowanych ze szpitali rejonowych. U pacjentów z grup wysokiego ryzyka według klasyfikacji TIMI (TIMI Risk Score 5&#8211;7 pkt, w tym z podwyższonymi stężeniami markerów martwicy mięśnia sercowego), niekierowanych na leczenie inwazyjne, pomimo stosowanej terapii farmakologicznej rokowanie nadal jest złe. (Folia Cardiol. 2005; 12: 21&#8211;31

Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial. Lancet 2008;371:5

Summary Background Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be done within 90 min. However, the best subsequent management of patients after thrombolytic therapy remains unclear. To assess the best management, we randomised patients with STEMI treated by thrombolysis and abciximab at a non-interventional hospital to immediate transfer for PCI, or to standard medical therapy with transfer for rescue angioplasty

Analogs of Cinnamic Acid Benzyl Amide As Nonclassical Inhibitors of Activated JAK2 Kinase.

Scaffold-based analogs of cinnamic acid benzyl amide (CABA) exhibit pleiotropic effects in cancer cells, and their exact molecular mechanism of action is under investigation. The present study is part of our systemic analysis of interactions of CABA analogs with their molecular targets. These compounds were shown to inhibit Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) and JAK2/signal transducer and activator of transcription 5 (STAT5) signaling and thus are attractive scaffolds for anticancer drug design. To identify the potential mechanisms of action of this class of compounds, direct interactions of the selected CABA analogs with JAK2 kinase were examined. Inhibition of JAK2 enzymatic activity was assessed, and molecular modeling studies of selected compounds-(E)-2-cyano-N-[(S)-1-phenylethyl]-3-(pyridin-2-yl)acrylamide (WP1065), (E)-2-cyano-N-[(S)-1-phenylbutyl]- 3-(3-bromopyridin-2-yl)acrylamide (WP1130), and (E)-2-cyano-N-[(S)-1,4-diphenylbutyl]-3-(3-bromopyridin-2-yl)acrylamide (WP1702)-in the JAK2 kinase domain were used to support interpretation of the experimental data. Our results indicated that the tested CABA analogs are nonclassical inhibitors of activated (phosphorylated) JAK2, although markedly weaker than clinically tested ATP-competitive JAK2 inhibitors. Relatively small structural changes in the studied compounds affected interactions with JAK2, and their mode of action ranged from allosteric-noncompetitive to bisubstrate-competitive. These results demonstrated that direct inhibition of JAK2 enzymatic activity by the WP1065 (half-maximal inhibitory concentration [IC50] = 14.8 µM), WP1130 (IC50 = 3.8 µM), and WP1702 (IC50 = 2.9 µM) potentially contributes, albeit minimally, to suppression of the JAK2/STAT signaling pathways in cancer cells and that additional specific structural modifications may amplify JAK2-inhibitory effects

Time delay in primary angioplasty: how relevant is it?

See article on page 124

Inter-individual variability in response to clopidogrel in patients with coronary artery disease

Background: Clopidogrel, especially when combined with aspirin, reduces the rate of ischaemic events in patients with coronary artery disease (CAD). There are scare data in literature on the inter-individual variability in response to clopidogrel.Aim: To assess the incidence of clopidogrel resistance using rapid whole blood platelet function assessment, and to examine the possibility of early identification of non-responders.Methods: In 31 consecutive patients with stable angina treated with aspirin, the degree of platelet aggregation inhibition (DPAI) in the whole blood was assessed at baseline and 3, 6, 12 as well as 24 hours after administration of loading dose of clopidogrel (300 mg). Response to clopidogrel was measured by calculating the absolute difference between the baseline DPAI and DPAI obtained at the investigated time-points (&#8710;DPAI).Results: After 24 hours from clopidogrel administration, seven (22.6%) patients were identified as non-responders (&#8710;DPAI &#8804;10%). Demographic and clinical variables as well as baseline DPAI were similar in responders and non-responders (DPAI: 5.8&#177;3.7% vs 7.1&#177;5.3%, p=NS). Out of the patients who were found to be resistant to clopidogrel at the six-hour time-point, 87.5% remained resistant to this agent 24 hours after drug administration. &#8710;DPAI calculated at the 24-hour time-point highly correlated with the six-hour &#8710;DPAI (r=0.74). No differences in the rate of ischaemic or bleeding complications between responders and non-responders were noted.Conclusions: The assessment of the degree of platelet aggregation inhibition allows early (six hours from the initiation of treatment) identification of patients who are resistant to clopidogrel. The method of the rapid whole blood platelet function assessment is feasible in every-day clinical practice

Successful recanalisation of chronic total occlusion using retrograde approach

Chronic total occlusion (CTO) is defined as an occlusion of a coronary vessels (TIMI 0 flow) lasting longer than 3 months. Successful recanalisation of CTO improves left ventricular function and survival. Retrograde technique can be used in patients, who have well-developed collaterals, when the antegrade approach is ineffective or difficult to perform. A 68-year-old male was referred for coronary angiography because of exercise angina chest pain. Coronary angiogram showed a CTO of RCA with collaterals from LAD. Following the unsuccessful traditional antegrade approach in 2004, we attempted a retrograde approach. The PCI procedure was performed successfully and without complications