PubMed Health⌕ Search

Biomedical subjects

Chiung-Jen Wu

Publications and source records attributed to Chiung-Jen Wu.

54 records · Page 3Linked to original sources
PubMed2004

Effect of adjunctive tirofiban therapy on angiographic and clinical outcomes in patients with ST-segment elevated acute myocardial infarction undergoing primary stenting.

The benefit of primary percutaneous coronary intervention is limited by a 5% to 20% incidence of suboptimal epicardial coronary blood (< or = TIMI-2 flow). Recently, data has demonstrated that when administered in conjunction with primary stenting for the treatment of acute myocardial infarction (AMI), abciximab improves the success rate of the stenting procedure and provides additional clinical benefits. But data on a combination of tirofiban and primary stenting for treatment of ST-segment elevated (ST-se) AMI is unknown. Between May 1999 and September 2000, primary stenting without adjunctive tirofiban therapy was performed in 136 consecutive patients (control group) with ST-se AMI. Between January 2001 and May 2002, we routinely administered tirofiban to 133 consecutive patients (study group) with ST-se AMI before they underwent primary stenting. The angiographic and clinical outcomes of both groups were compared in a chronologically consecutive manner. The overall mortality rate was significantly higher in patients with failed (< or = TIMI-2 flow) than in patients with successful (TIMI-3) reperfusion (20.0% vs 3.5%, P < 0.0001). Univariate analysis demonstrated that there were no significant differences in the successful reperfusion (85.7% vs 84.6%, P = 0.84) or 30-day combined end points - death, recurrent ischemia or reinfarction (8.3% vs 11.0%, P = 0.59) between study and control group patients. Clinical variables were used to statistically analyze potential risk factors for unsuccessful reperfusion (< or = TIMI-2 flow) in the study group patients. Multiple stepwise logistic regression analysis demonstrated that the reference lumen diameter (RLD) of the infarct-related artery (IRA) > or = 3.5 mm (P = 0.0004) and the lesion length of the obstruction > or = 20.0 mm (P = 0.018) were the significant independent predictors of failed normalized coronary blood flow. There were no significant differences in the restenotic rate of IRA (29.2% vs 30.8%, P = 0.9) or mortality rate (1.6% vs 1.6%, P = 1.0) at six-month follow-up. In conclusion, our study demonstrates that primary stenting with adjunctive tirofiban therapy in ST-se AMI did not provide additional benefits in short-term and intermediate-term angiographic and clinical outcomes compared to conventional primary stenting.

Aged↗
PubMed2004

Pseudoaneurysm formation 12 years after ringed intraluminal graft replacement for type B aortic dissection.

A sutureless ringed intraluminal graft has been used as a substitute for the diseased aorta with the advantage of decreasing the aortic cross-clamp time and blood loss. Concerns remain about implications of anecdotal accounts of late complications with this graft. We report on the experience of a 68-year-old man, successfully treated for type B aortic dissection using the sutureless technique, who developed a pseudoaneurysm and aortobronchial fistula over the distal anastomosis of the intraluminal graft 12 years after the operation.

Aged↗
PubMed2003

Effect of the PercuSurge GuardWire device on the integrity of microvasculature and clinical outcomes during primary transradial coronary intervention in acute myocardial infarction.

The present study investigates whether preintervention thrombectomy with a PercuSurge distal balloon protection device can improve final angiographic results compared with adjunctive tirofiban therapy during primary percutaneous coronary intervention (PCI) in large infarct-related arteries (IRAs) (vessel size >/=3.5 mm) with high-burden thrombus formation (HBTF). Results indicate that this mechanical device is superior to adjunctive tirofiban therapy during primary PCI in large IRAs with HBTF in terms of final epicardial flow, microvasculature integrity, and 30-day clinical outcomes.

Angioplasty, Balloon, Coronary↗
PubMed2003

Acute myocardial infarction with simultaneous ST-segment elevation in the precordial and inferior leads: evaluation of anatomic lesions and clinical implications.

BACKGROUND: Simultaneous ST-segment elevation in the precordial and inferior leads is a rare ECG finding in patients with acute myocardial infarction (AMI) and its clinical implications rarely have been reported. The purpose of this study was to evaluate the clinical features of this distinctive ECG manifestation and its impact on clinical outcome. METHODS AND RESULTS: Between May 1993 and July 2001 in our hospital, direct percutaneous coronary intervention (dPCI) was performed in 924 patients with AMI. Of these 924 consecutive patients, 37 patients (4.0%) who had simultaneous ST-segment elevation (> or = 1 mm) in the precordial and inferior leads were retrospectively analyzed. Eight of these 37 patients who had a wrapped left anterior descending artery (LADA) occlusion were placed into group 1 (ie, wrapped LADA). Twenty-nine of the 37 patients who had anatomic lesions other than a wrapped LADA in the coronary arteries were placed into group 2 (ie, "nonwrapped" LADA). Group 2 patients had significantly higher incidences of cardiogenic shock (58.6% vs 0%, respectively; p = 0.004), pulmonary edema (43.8% vs 0%, respectively; p = 0.02), and sustained sudden cardiac death due to malignant ventricular tachyarrhythmias (44.8% vs 0%, respectively; p = 0.03) than did group 1 patients. Group 1 patients usually had ST-segment elevations of < 2 mm the inferior leads. However, group 2 patients always had ST-segment elevations of > or = 2 mm in the inferior leads. Univariate analysis demonstrated that the mean (+/- SD) ST-segment elevation in the inferior leads was significantly higher in group 2 patients than in group 1 patients (11.08 +/- 4.18 vs 2.95 +/- 0.92 mm, respectively; p = 0.0001). Coronary angiography demonstrated that the incidence of multivessel disease (93.1% vs 37.5%, respectively; p = 0.002) and the incidence of severe obstructive two-vessel disease (ie, stenosis of > 85%) [93.1% vs 0%, respectively; p = 0.0001] were significantly higher in group 2 than in group 1 patients. Although there was no significant difference in the rate of unsuccessful reperfusion (24% vs 13%, respectively; p = 0.38) between group 2 and group 1 patients, the 30-day mortality rate was significantly higher in group 2 patients than in group 1 patients (48.3% vs 0%, respectively; p = 0.015). CONCLUSIONS: AMI with ECG manifestation of simultaneous ST-segment elevation in precordial and inferior leads can be caused by either a wrapped LADA occlusion or a nonwrapped LADA occlusion. While patients with wrapped LADA occlusions usually have favorable clinical outcomes, patients with nonwrapped LADA occlusions usually have serious clinical presentations and unfavorable clinical outcomes. Specific clinical and ECG features identifying high-risk patients in this clinical setting would be extremely important for early, aggressive, and appropriate management.

Aged↗
PubMed2003

Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era.

BACKGROUND: Cardiac rupture, an uncommon yet catastrophic complication after acute myocardial infarction (AMI), has been studied primarily in the prethrombolytic and thrombolytic therapy eras but not in the direct percutaneous coronary intervention (d-PCI) reperfusion therapy era. The aim of this study was to delineate the incidence, potential risks, timing of occurrence, clinical features, and outcomes of cardiac rupture complicating AMI after d-PCI. METHODS AND RESULTS: Between May 1993 and July 2002, a total of 1,250 patients with AMI underwent d-PCI in our hospital. Of these 1,250 patients studied, 12 patients (0.96%) had cardiac rupture (ventricular septal defect [VSD], three patients; left ventricular [LV] free wall rupture, nine patients] after d-PCI, with a mean (+/- SD) time of occurrence of 52.3 +/- 36.2 h. Three patients with VSD had an insidious presentation, and two of these patients (66.6%) survived after surgical intervention. However, nine patients with LV free wall rupture always presented with sudden and unanticipated hemodynamic collapse. Cardiopulmonary resuscitation was uniformly unsuccessful in patients with LV free wall rupture, and all patients died as a result of this complication within minutes of its onset. The 30-day mortality rate was significantly higher in patients with cardiac rupture than in patients without this complication (83.3% vs 8.2%, respectively; p < 0.001). Univariate analysis demonstrated that the left anterior descending artery was the most likely to be totally occluded in patients who had developed cardiac rupture (100% vs 66.4%, respectively; p = 0.033). Multiple stepwise logistic regression analysis demonstrated that the most significant factors associated with cardiac rupture were advanced age, female gender, and lower body mass index (BMI; all p < 0.05), whereas early reperfusion with d-PCI was an independent determinant of preventing this complication (p < 0.0001). CONCLUSION: Compared with the prethrombolytic era, our study showed that d-PCI had a favorable impact on reducing the incidence of cardiac rupture after AMI. Old age, female gender, lower BMI, and longer time to reperfusion carried a substantially increased risk of cardiac rupture after patients experienced AMIs. Early successful d-PCI was the most powerful determinant of the avoidance of this catastrophic complication after AMI.

Age Factors↗
PubMed2003

Impact of tirofiban on angiographic morphologic features of high-burden thrombus formation during direct percutaneous coronary intervention and short-term outcomes.

BACKGROUND: Recently, we demonstrated that angiographic morphologic features of high-burden thrombus formation are independent predictors of combined slow flow (ie, Thrombolysis in Myocardial Infarction [TIMI] grade 2) and no reflow (ie, </= TIMI grade 1) in the infarct-related artery (IRA) after direct percutaneous coronary intervention (d-PCI) for the treatment of acute myocardial infarction (AMI). Current data have demonstrated that when administered in conjunction with PCI for acute coronary syndrome, platelet glycoprotein IIb/IIIa inhibitors can provide additional clinical benefits. Thus, we hypothesized that after pretreatment with tirofiban, angiographic morphologic features of high-burden thrombus formation would no longer be independent predictors of combined slow flow and no reflow after treatment with d-PCI. METHODS AND RESULTS: Between January 2001 and April 2002, tirofiban was administered to 210 consecutive patients with ST-segment elevated AMI before coronary angiography was performed, and 84 patients (40.0%) were found to have high-burden thrombus formation in the IRA. The TIMI flow grade of the IRA was assessed immediately after the performance of d-PCI, and the 30-day clinical outcomes were evaluated prospectively. The incidence of restoration of normal coronary flow in the IRA was 83.6%. Three baseline angiographic morphologic features indicating high-burden thrombus formation, including (1) the cutoff pattern of occlusion in the IRA (p = 0.0001), (2) the accumulated thrombus proximal to the occlusion (p = 0.0001), and (3) a reference lumen diameter of the IRA of > or = 4.0 mm (p = 0.001), were independent predictors of combined slow flow and no reflow. In stratified analysis, the rates of slow flow and no reflow after d-PCI rose rapidly as the number of independent predictors increased (0 predictors, 3.8%; 1 predictor, 29.0%; and 2 predictors, 70.6%). The overall 30-day mortality rate was 6.7%. The mortality rate was significantly higher in patients with TIMI flow lower than or equal to grade 2 than in those with TIMI grade 3 flow (15% vs 1.3%, respectively; p = 0.003). CONCLUSIONS: Tirofiban did not provide additional clinical benefits when administered in conjunction with d-PCI for AMI, even in the subgroup of patients with a high-burden thrombus. Those distinct angiographic morphologic features of high-burden thrombus formation remained as independent predictors of combined slow flow and no reflow after d-PCI, and were independent of the use of tirofiban.

Aged↗
PubMed2003

Intracoronary beta-irradiation with liquid rhenium-188: results of the Taiwan radiation in prevention of post-pure balloon angioplasty restenosis study.

STUDY OBJECTIVE: To assess the feasibility and short-term outcome of intracoronary irradiation after pure balloon angioplasty (POBA) of de novo and post-POBA restenotic lesions with a liquid beta-emitter (188)Re-filled balloon. DESIGN AND SETTING: Nonrandomized prospective study with contemporaneous control group in a single medical center. PATIENTS AND METHODS: In the Taiwan Radiation in Prevention of Post-Pure Balloon Angioplasty Restenosis study, 40 patients underwent 14-Gy irradiation and 15 patients underwent 20-Gy irradiation at a tissue depth of 0.5 mm after POBA. Thirty control patients received a 5-min inflation with a perfusion balloon catheter after POBA. RESULTS: No procedural or in-hospital complications, or 30-day major adverse cardiac events were noted. Six-month angiographic restenosis rates were 49% in the 14-Gy group, 20% in the 20-Gy group, and 57% in the control group (p = 0.05, 20-Gy group vs control group). In the lesions with an arc of calcification of < 180 degrees, restenosis occurred in 15 of the 34 lesions (44%) in the 14-Gy group and in none of the 11 lesions (0%) in the 20-Gy group (p = 0.007). In a vessel with a reference diameter < 3.0 mm, restenosis occurred in 1 of the 8 lesions (13%) in the 20-Gy group, and in 8 of the 11 lesions (73%) in the control group (p = 0.02). In the post-POBA restenotic lesions, restenosis occurred in none of the six lesions (0%) in the 20-Gy group, and in five of the six lesions (83%) in the control group (p = 0.008). CONCLUSIONS: Post-POBA, catheter-based brachytherapy in nonstented native coronary artery with a (188)Re-filled balloon can effectively reduce target lesion restenosis with 20-Gy irradiation at a tissue depth of 0.5 mm and seems to be more effective in the treatment of lesions with an arc of calcification < 180 degrees, in a vessel with a reference diameter of < 3.0 mm, and in post-POBA restenotic lesions.

Aged↗
PubMed2003

Left atrial platelet activity with rheumatic mitral stenosis: correlation study of severity and platelet P-selectin expression by flow cytometry.

BACKGROUND: Previous studies have demonstrated that platelet activation, evaluated by measuring the secretory substances of platelets (ie, platelet factor 4 and beta-thromboglobulin), occurs in the peripheral blood of patients with rheumatic mitral stenosis (MS). However, the differences in platelet activation between peripheral and atrial blood, and the relationship between regional left atrial platelet P-selectin expression and the severity of MS have never been investigated. METHODS AND RESULTS: A total of 16 patients with symptomatic MS undergoing percutaneous transluminal mitral valvuloplasty were studied (group 1). The fractions of platelets expressing P selectin in the prevalvuloplasty left atrial, right atrial, peripheral venous, and arterial blood were determined by flow cytometry. The mitral valve area was calculated by means of the Doppler pressure half-time method. Peripheral venous platelet activity also was evaluated in 23 control patients (including 15 healthy volunteers who were in sinus rhythm [group 2] and 8 patients who had chronic lone atrial fibrillation [group 3]). The fraction of peripheral venous platelets expressing P selectin among group 1 patients was significantly higher than that of group 2 or 3 patients (p = 0.008). In group 1 patients, the fraction of platelets expressing P selectin in the left atrium was significantly higher than that in the right atrium, the femoral vein, or the femoral artery (p < 0.01). Correlation analysis demonstrated that there was a significantly direct relationship between the severity of MS and the fraction of left atrial platelets expressing P selectin (p = 0.01; r = -0.620). The fraction of peripheral venous platelets expressing P selectin among group 2 patients did not differ from that of group 3 patients CONCLUSIONS: In patients with rheumatic MS, increased regional left atrial platelet P-selectin expression had a significantly direct relationship with the severity of MS. The increased regional left atrial platelet P-selectin expression was not reflected in peripheral venous blood samples.

Adult↗
PubMed2003

The feasibility and safety of early discharge for low risk patients with acute myocardial infarction after successful direct percutaneous coronary intervention.

There is a lack of consensus among cardiologists regarding the length of time patients should be hospitalized after an uncomplicated acute myocardial infarction (AMI) and successful direct percutaneous coronary intervention (d-PCI). The purpose of this study was to evaluate the feasibility and safety of early discharge (discharge <4 days after the procedure) for low risk patients with AMI who underwent successful d-PCI. From May 1996 through December 2001, d-PCI was performed in 898 consecutive patients with AMI. Of these 898 patients, 463 (51.6%) were stratified to be at low risk. Lower risk was defined as: (1) Killip classification < or = 2 on admission; (2) the infarct-related artery achieved normal blood flow without recurrent ischemia or reinfarction in the first 24 hours; (3) no mechanical or electrical complications after d-PCI. (4) no acute renal failure, acute stroke, or major bleeding complication; (5) no advanced congestive heart failure (defined as > or = New York Heart Association functional class 3); and (6) no sepsis. Patients who were discharged <4 days after undergoing the procedure were enrolled in group 1 (n = 266). Patients who were discharged > or = 4 days after undergoing the procedure were enrolled in group 2 (n = 197). Univariate analysis demonstrated that group 2 patients had a significantly longer hospital stay (P = 0.0001) than group 1 patients. At the first 30-day follow-up examination, there were no significant differences in the combined major cardiac events (death, recurrent isehemia, reinfarction, revascularization. or advanced congestive heart failure) between the group 1 and group 2 patients (1.50% vs 1.52%, P = 0.92). There were also no significant differences in the combined major noncardiac complications (acute stroke, acute renal failure, bleeding complications requiring blood transfusion, vascular sequelae, or sepsis) between the group 1 and group 2 patients (1.13% vs 0.51%. P = 0.89). Early discharge was feasible in a majority of the patients who experienced AMI and were at lower risk 24 hours after successful d-PCI. Thus, the patients had a shortened hospital stay and no increased risk.

Aged↗
PubMed2003

The safety and feasibility of transradial cutting balloon angioplasty: immediate results, benefits, and limitations.

Cutting balloon angioplasty can reduce the restenosis rate more than conventional balloon angioplasty, but is traditionally performed through a femoral artery. However, it is not clear how useful a transradial approach would be for cutting balloon angioplasty. This study was conducted to examine the safety, feasibility, and limitations of transradial as opposed to transfemoral cutting balloon angioplasty. From November 1999 to August 2001, 177 patients underwent cutting balloon coronary angioplasty. We compared the success rate, angiographic results, and complication rates of two groups of patients, those undergoing transradial (168 lesions from 153 patients) and those undergoing transfemoral (24 lesions from 24 patients) cutting balloon angioplasty. In both groups of patients who had similar clinical and target lesion characteristics. the percentage of lesions that required balloon predilation (27.4% vs 29.2%). stenting (7.7% vs 4.2%), and adjunct balloon dilation (28.0% vs 33.3%) due to dissection (35.7% vs 33.3%) or suboptimal results were comparable. Both approaches achieved a 100% primary success rate with similar acute gain (2.02 +/- 0.68 mm vs 1.94 +/- 0.70 mm), residual (luminal) diameter stenosis (19.2 +/- 11.7% vs 17.0 +/- 12.7%). proportion of lesions that achieved TIMI 3 flow (98.8% vs 100%), and clinical success rate (98.8% vs 95.8%). However, patients undergoing transradial cutting balloon angioplasty had earlier ambulation and a significantly shorter hospital stay than those undergoing a transfemoral approach (2.80 +/- 2.67 days vs 4.75 +/- 5.44 days, P = 0.005). We conclude that the transradial approach is a feasible and safe alternative to the transfemoral approach for cutting balloon angioplasty. In addition, it offers patients early ambulation and a short hospital stay.

Aged↗
PubMed2003

Intracoronary beta-irradiation with liquid rhenium-188 to prevent restenosis following pure balloon angioplasty: results from the TRIPPER-1 study.

BACKGROUND: Patients who receive percutaneous transluminal coronary angioplasty (PTCA) are often haunted by restenosis of the target vessel within 6 months. Intracoronary irradiation has been shown to alter the luminal narrowing response after balloon angioplasty. METHODS: The Taiwan Radiation in Prevention of Post-Pure Balloon Angioplasty Restenosis-I (TRIPPER-I) study evaluated the feasibility, safety, and 6-month angiographic restenosis with intracoronary irradiation after pure balloon angioplasty (POBA) of de novo and post-POBA restenotic lesions in native coronary arteries using a self-centering beta-emitter rhenium-188 (Re-188)-filled balloon. RESULTS: Forty patients received 14 Gy at a 0.5-mm tissue depth with a Re-188 solution-filled perfusion balloon catheter, and 25 control patients received 5-min inflation with a perfusion balloon catheter. There were no procedural complications or in-hospital or 30-day major adverse cardiac events. Six-month angiographic follow-up was performed on 39 Re-188 (97.5%) and 25 control patients (100%). The restenosis rate was 49% in the Re-188 and 56% in the control groups (p=0.62). The composite end-points of death, myocardial infarction, and target-vessel revascularization were 40% in the Re-188 group and 36% in the control group (p=0.80). CONCLUSIONS: Catheter-based radiotherapy after POBA of de novo and post-POBA restenotic lesions with a Re-188-filled balloon is feasible but was ineffective in reducing target lesion restenosis with a dose of 14 Gy delivered at a 0.5-mm tissue depth in this study.

Aged↗
PubMed2003

Transradial intracoronary catheter-aspiration embolectomy for acute coronary embolism after mitral valve replacement.

An anticoagulated 51-year-old woman with a mechanical mitral prosthesis, which had been implanted 12 years earlier, sustained an acute anterior wall myocardial infarction caused by an embolus in the mid left anterior descending coronary artery. After treatment with tissue-plasminogen activator failed to lyse the obstruction, we performed intracoronary catheter-aspiration embolectomy via a transradial approach, which yielded a favorable result.

Acute Disease↗
PubMed2003

Direct stenting of a transradial left internal mammary artery graft.

Taking the transfemoral approach when performing a left internal mammary artery (LIMA) graft intervention is generally recognized as posing significant technical challenges. However, little has been reported on alternative transradial approaches to LIMA. In this report, we present our experience in a patient who had anastomosis-site LIMA graft stenosis and was successfully treated with direct stenting. We used a 6-French Kimny guiding catheter inserted through the left radial artery, even though the procedure was complicated by an acute occlusion of a LIMA body, requiring bail-out stenting following intra-aortic balloon pump support and temporary cardiac pacing. The patient was discharged 6 days after the procedure and remains asymptomatic during follow-up visits. Our results suggest that a transradial approach is feasible for LIMA intervention procedures.

Aged↗
PubMed2002

Clinical features and outcome of coronary artery aneurysm in patients with acute myocardial infarction undergoing a primary percutaneous coronary intervention.

BACKGROUND: While coronary artery aneurysm is an uncommon anatomic disorder and has various forms, its clinical features and outcome and its impact on thrombus formation and the no-reflow phenomenon in the clinical setting of acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (p-PCI) have not been discussed. The purpose of this study was to evaluate whether this anatomic disorder predisposes to a high burden of thrombus formation, and subsequently leads to the no-reflow phenomenon and untoward clinical outcome in patients with AMI undergoing p-PCI. METHODS AND RESULTS: In our hospital, emergency p-PCI was performed in 924 consecutive patients with AMI between May 1993 and July 2001. Of these 924 patients, 24 patients (2.6%) who had an infarct-related artery (IRA) with aneurysmal dilatation were retrospectively registered and constituted the patient population of this study. Angiographic findings demonstrated that the ectasia type (defined as diffuse dilatation of 50% or more of the length of the IRA) was found most frequently (70%), followed by the fusiform type (20%; defined as a spindle-shaped dilatation in the IRA) and the saccular type (10%; defined as a localized spherical-shaped dilatation in the IRA). The right coronary artery was the most frequently involved vessel (54.2%), followed by the left anterior descending (25.0%) and the left circumflex arteries (20.8%). Coronary angiography revealed that all of these aneurysmal IRA filled with heavy thrombus (indicated as high-burden thrombus formation). The no-reflow phenomenon (defined as <or=TIMI-2 flow) and distal embolization after p-PCI were found in 62.5 and 70.8% of the IRA, respectively. The incidence of cardiogenic shock and the 30-day mortality rate were 25 and 8.3%, respectively. The survival rate was 90.9% (20/22) during a mean follow-up of 19 +/- 30 months. CONCLUSIONS: While aneurysmal dilatation of an IRA is an uncommon angiographic finding in the clinical setting of AMI, it is frequently associated with high-burden thrombus formation and has a significantly lower incidence of successful reperfusion. However, the long-term survival of these patients is excellent.

Adult↗
PubMed2002

Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon.

BACKGROUND: Growing evidence suggests that no-reflow reperfusion after direct percutaneous coronary intervention (d-PCI) is associated with an unfavorable clinical outcome. The purpose of this study was to evaluate whether prerevascularization angiographic morphologic features of infarct-related arteries (IRAs) and timely reperfusion could convey information on slow-flow (Thrombolysis In Myocardial Infarction [TIMI] 2 flow) or no-reflow (TIMI grade < or = 1 flow) reperfusion after d-PCI. METHODS AND RESULTS: Between May 1993 and September 2000, d-PCI was performed in 794 consecutive patients with acute myocardial infarction. Coronary blood flow failed to normalize in 120 patients (15.1%). The incidence of failure to achieve TIMI 3 flow in the IRAs was significantly higher in patients with vs those without the following distinctive prerevascularization angiographic morphologic features: cutoff pattern of occlusion in the IRA (52.4% vs 10.3%, p < 0.001), accumulated thrombus (> 5 mm) proximal to the occlusion (37.5% vs 3.4%, p < 0.001), presence of floating thrombus (66.7% vs 12.7%, p < 0.001), persistent dye stasis distal to the obstruction (51.9% vs 13.8%, p < 0.001), reference lumen diameter (RLD) of the IRA > or = 4 mm (46.3% vs 9.6%, p < 0.001), and incomplete obstruction with presence of accumulated thrombus more than three times the RLD of the IRA (51.7% vs 3.9, p < 0.0001). Each of these six angiographic morphologic features indicated "high-burden thrombus formation." Multiple stepwise logistic regression analysis demonstrated that each of six angiographic morphologic features was an independent predictor of combined slow-flow and no-reflow phenomenon in the IRAs after d-PCI (p < 0.05). In contrast, early reperfusion time (< 240 min, p = 0.0017), prerevascularization TIMI flow grade > or = 2 (p = 0.0006), and the taper pattern of occlusion in the IRA (p = 0.0284) were independent predictors of freedom from slow-flow or no-reflow phenomenon in the IRAs after d-PCI. The 30-day overall mortality was 8.7% (69 of 794 patients). The 30-day mortality was significantly higher in patients with combined slow-flow and no-reflow phenomenon than in patients with normal coronary blood flow after d-PCI (27.5% vs 5.3%, p < 0.001). CONCLUSIONS: Early reperfusion reduces the incidence of slow-flow or no-reflow phenomenon in the IRA and overall 30-day mortality. The specific angiographic morphologic features in the IRAs can be used as a simple and efficacious method to predict slow-flow or no-reflow phenomenon. These findings provide apparently clinically useful information for the selection of patients who are potential candidates for subsequent prepercutaneous coronary intervention adjunctive therapy.

Adult↗
PubMed2002

Clinical features and outcome of patients with direct percutaneous coronary intervention for acute myocardial infarction resulting from left circumflex artery occlusion.

BACKGROUND: Little is known about the clinical features and outcome of patients with left circumflex artery (LCX) infarct-related acute myocardial infarction (AMI). This study was conducted to investigate the clinical features and outcome of patients who underwent direct percutaneous coronary intervention (d-PCI) for AMI caused by LCX occlusion, and to discover prognostic determinants in this clinical setting. METHODS AND RESULTS: Between May 1993 and October 2000, a total of 819 patients with AMI underwent d-PCI in our hospital. Sixty-seven patients (8.2%) who had LCX infarct-related AMI constituted the population of this study. Ten of 67 patients (14.9%) were in cardiogenic shock. Angiographic findings demonstrated that the incidences of triple-vessel disease, reference lumen diameter (RLD) of the LCX > or = 4.0 mm, and LCX as the dominant artery in these patients were 26.9%, 22.4%, and 34.3%, respectively. Sixteen patients (23.9%) had unsuccessful reperfusion (defined as Thrombolysis in Myocardial Infarction flow < or = 2). Univariate analysis showed that dominant LCX, RLD of the LCX > or = 4.0 mm, cardiogenic shock, precordial ST-segment depression, and complete atrioventricular block were significantly related to unsuccessful reperfusion. Multiple stepwise logistic regression analysis demonstrated that dominant LCX and cardiogenic shock were significant independent predictors of unsuccessful reperfusion. The 30-day mortality rate in the 67 patients was 14.9%. Univariate analysis demonstrated that triple-vessel disease, dominant LCX, cardiogenic shock, poor left ventricular ejection fraction, and unsuccessful reperfusion were significantly associated with 30-day mortality. By multiple stepwise logistic regression analysis, dominant LCX, cardiogenic shock, and triple-vessel disease were significant independent predictors of increased 30-day mortality. CONCLUSIONS: LCX infarct-related AMI has its unique clinical features. The presence of dominant LCX and cardiogenic shock were independent determinants of unsuccessful reperfusion, and the presence of dominant LCX, cardiogenic shock, and triple-vessel disease were independent determinants of increased 30-day mortality in this clinical setting.

Angioplasty, Balloon, Coronary↗
PubMed2002

Comparison of primary angioplasty and conservative treatment on short- and long-term outcome in octogenarian or older patients with acute myocardial infarction.

It has long been established that advanced age is not only associated with greater myocardial infarction frequency but also greater mortality and morbidity. The treatment of acute myocardial infarction (AMI) in 80 year old patients remains problematic with conflicting results; in these patients, the risks of conservative treatment are high and the risks and benefits of thrombolytic therapy are still controversial. The purpose of this study was to evaluate whether primary angioplasty can offer an important alternative method to improve short- and long-term outcomes in octogenarian or older patients who experience AMI. Between May 1986 and March 2000, 171 consecutive 80 year old patients hospitalized for AMI were not randomized to be registered and divided into a medical therapy group (group 1: an historical control group, n=11) and a primary angioplasty group (group 2, n=60). In-hospital mortality was markedly increased with advanced Killip scores (Killip 3 or 4) in both groups. Twenty-four hours after admission, group 1 patients had a significantly higher incidence of progression to higher Killip scores than did group 2 patients (P=0.006). The 30-day overall mortality of group 2 patients was significantly lower than in group 1 patients (30.0% vs 54.1%, P=0.003). Patients without cardiogenic shock treated by primary angioplasty had a significantly lower incidence of overall mortality at 30 days than patients without cardiogenic shock treated conservatively [3.1% vs 24.3%, P=0.016 (Killip 1 and 2); 18.2% vs 52.6%, P=0.044 (Killip 3)]. However, the mortality rate of cardiogenic shock was extremely high and did not differ significantly between groups I and 2 (86.1% vs 88.2%, P=0.99). The 3-year cumulative survival rate was significantly higher in group 2 than in group 1 patients (P=0.0009). In conclusion, primary angioplasty is feasible and effective, and can improve short-and long-term mortalities in octogenarian or older patients with AMI but without cardiogenic shock.

Aged↗