Early changes of left ventricular filling pattern after reperfused ST-elevation myocardial infarction and doxycycline therapy: Insights from the TIPTOP trial.

Aim: Metalloproteinases inhibition by doxycycline reduces cardiac protein degradation at extracellular and intracellular level in the experimental model ischemia/reperfusion injury. Since both extracellular cardiac matrix and titin filaments inside the cardiomyocyte are responsible for the myocardial stiffness, we hypothesized that doxycycline could favorably act on left ventricular (LV) filling pressures in patients after reperfused acute ST-elevation myocardial infarction (STEMI).

Methods And Results: Seventy-three of 110 patients of the TIPTOP trial underwent a 2D-Echo-Doppler on admission, and at pre-discharge and at 6-month after a primary PCI for STEMI and LV dysfunction.

Effects of a timely therapy with doxycycline on the left ventricular remodeling according to the pre-procedural TIMI flow grade in patients with ST-elevation acute myocardial infarction.

Doxycycline has been demonstrated to reduced left ventricular (LV) remodeling, but its effect in patients with ST-elevation myocardial infarction (STEMI) and a baseline occluded [thrombolysis in myocardial infarction (TIMI) flow grade ≤1] infarct-related artery (IRA) is unknown. According to the baseline TIMI flow grade, 110 patients with a first STEMI were divided into 2 groups. Group 1: 77 patients with TIMI flow ≤1 (40 patients treated with doxycycline and 37 with standard therapy, respectively), and a Group 2: 33 patients with TIMI flow 2-3 (15 patients treated with doxycycline and 18 with standard therapy, respectively).

Predictor of stent thrombosis in patients treated with turbostratic carbon-coated stent implantation for acute myocardial infarction.

Background: Stent thrombosis is a major complication after percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (AMI) and is associated with reinfarction and increased risk of death.

Methods: Patients treated with the turbostratic carbon-coated stent (CID, Saluggia, Italy) for AMI were identified from a prospective primary PCI database. Primary end-point was stent thrombosis within 6 months.

Safety of immediate reversal of anticoagulation by protamine to reduce bleeding complications after infarct artery stenting for acute myocardial infarction and adjunctive abciximab therapy.

Infarct artery stenting with adjunctive abciximab therapy is widely used treatment for patients with acute myocardial infarction (AMI). However, bleeding complications have been associated with a worse clinical outcome. Randomized trials in elective patients have shown that postprocedural protamine administration is safe and associated with a significant reduction in bleeding complications.

Comparison of bivalirudin and unfractionated heparin plus protamine in patients with coronary heart disease undergoing percutaneous coronary intervention (from the Antithrombotic Regimens aNd Outcome [ARNO] trial).

Previous studies have compared bivalirudin and unfractionated heparin (UFH) plus the routine use of glycoprotein IIb/IIIa inhibitors. They have demonstrated that bivalirudin can decrease bleeding complications without a significant increase in ischemic complications, resulting in a better net clinical outcome, as defined by the efficacy (ischemic complications) or safety (bleeding complications) end point. The aim of the present study was to compare bivalirudin and UFH plus protamine in patients undergoing elective percutaneous coronary intervention and pretreated with clopidogrel and aspirin.

Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents.

Objectives: This study sought to determine the incidence of aspirin nonresponsiveness in addition to clopidogrel nonresponsiveness and whether this association identifies patients at an increased risk of drug-eluting stent (DES) thrombosis.

Background: Nonresponsiveness to clopidogrel is a predictor of DES thrombosis. No prospective data exist about the possible association of dual nonresponsiveness to clopidogrel and aspirin with DES thrombosis.

Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis.

Objectives: We sought to determine whether nonresponsiveness to clopidogrel as revealed by high in vitro post-treatment platelet reactivity is predictive of drug-eluting stent (DES) thrombosis.

Background: No data exist about the impact of nonresponsiveness to clopidogrel on the risk of DES thrombosis.

Methods: We conducted a prospective observational cohort study from July 2005 to August 2006 in an academic hospital.

Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial infarction.

Background: Age is a strong predictor of cardiogenic shock (CS) and death in patients with acute myocardial infarction (AMI). Few data on the impact of a routine early percutaneous revascularization strategy in elderly patients with CS complicating AMI exist.

Methods: We performed an analysis of age-related differences in outcome in 280 consecutive patients with AMI complicated by CS who underwent primary percutaneous coronary intervention (PCI) between January 1995 and September 2004 and who were included in a single-center prospective registry of primary PCI for AMI.

Drug-eluting stent supported percutaneous coronary intervention for unprotected left main disease.

Objectives: This study sought to determine the clinical and angiographic outcomes of unselected patients receiving drug-eluting stents for unprotected left main disease.

Background: The results of several series of percutaneous coronary intervention (PCI) for left main disease in the pre-drug-eluting stent era have arisen concerns on the safety and mid-term efficacy of PCI.

Methods: Consecutive patients with unprotected left main disease were considered eligible for drug-eluting stent supported PCI.

Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction.

Aim: To evaluate the long-term outcome of a nonoptimal result of a primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).

Methods And Results: An optimal PCI result was defined as TIMI flow grade 3 and residual stenosis < or = 20%. Long-term clinical follow-up (51 +/-+/- 21 months) data were collected from 1,009 consecutive patients with ST-elevation AMI who underwent primary PCI.

Drug-eluting stent-supported percutaneous coronary intervention for chronic total coronary occlusion.

Objectives: This study sought to determine the clinical and angiographic outcomes after drug-eluting stent (DES)-supported percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO).

Background: There are few data about the efficacy of DES-supported PCI for CTO.

Methods: All consecutive patients who had a sirolimus-eluting stent or a paclitaxel-eluting stent implanted for CTO from December 2003 to December 2004 were analyzed.

A randomized trial comparing clopidogrel versus ticlopidine therapy in patients undergoing infarct artery stenting for acute myocardial infarction with abciximab as adjunctive therapy.

Aim: To evaluate the impact of a clopidogrel therapy on the effectiveness of myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction (AMI) undergoing routine infarct-related artery (IRA) stent implantation and receiving routine abciximab therapy.

Background: Inflammatory processes after mechanical restoration of flow in AMI play a central role in decreasing the effectiveness of reperfusion at microcirculatory level. Several studies suggest that clopidogrel may exert a protective effect against adverse cardiovascular events by virtue of its anti-inflammatory properties.

Gated SPECT evaluation of outcome after abciximab-supported primary infarct artery stenting for acute myocardial infarction: the scintigraphic data of the abciximab and carbostent evaluation (ACE) randomized trial.

Unlabelled: We used gated SPECT to evaluate the impact of abciximab on the efficacy of myocardial reperfusion in patients with acute myocardial infarction undergoing infarct-related artery stenting.

Methods: The Abciximab and Carbostent Evaluation (ACE) trial randomized 400 infarct patients to stenting alone or stenting plus abciximab. One-month (99m)Tc-sestamibi gated SPECT was planned in a subgroup of consecutive patients to evaluate infarct size, infarct severity, left ventricular volumes, and ejection fraction.

Impact of insulin-requiring diabetes mellitus on effectiveness of reperfusion and outcome of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.

The relation between diabetes mellitus (DM) and outcome was assessed in a series of 1,061 patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). The efficacy of reperfusion was assessed by ST-segment resolution analysis. Of 1,061 patients, 166 had DM (15.

A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction.

Objectives: We sought to evaluate the efficacy of abciximab as adjunctive therapy to routine infarct-related artery (IRA) stenting.

Background: The impact of abciximab on the efficacy of myocardial reperfusion and the outcome of patients with acute myocardial infarction (AMI) undergoing IRA stenting have not yet been defined.

Methods: In a randomized trial, we assigned 400 patients with AMI to undergo IRA stenting alone or stenting plus abciximab.

Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention?

This study sought to determine the impact of female gender on clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) due to predominant ventricular failure undergoing percutaneous coronary intervention (PCI). We analyzed gender-related differences in procedural, angiographic, and clinical outcomes in 208 consecutive patients with AMI complicated by CS. Out of 208 patients with CS, 65 were women and 143 men.

Abciximab therapy improves 1-month survival rate in unselected patients with acute myocardial infarction undergoing routine infarct artery stent implantation.

Background: The impact of abciximab therapy on mortality in unselected patients with acute myocardial infarction (AMI) undergoing routine primary infarct-related artery (IRA) stent implantation is not yet defined, and previous randomized studies have produced conflicting results.

Methods: A strategy of IRA stenting alone as opposed to IRA stenting plus abciximab was compared in a series of 561 consecutive unselected patients with AMI. Abciximab treatment was strongly encouraged for all patients.

Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation.

The impact of abciximab therapy on mortality in patients with acute myocardial infarction (AMI) who are undergoing infarct-related artery (IRA) stent implantation, which is complicated by cardiogenic shock (CS) due to predominant ventricular failure has not been established, whereas concluded randomized trials comparing IRA stenting plus abciximab with IRA stenting alone in patients with AMI have produced conflicting results. Moreover, these trials have excluded patients with CS from randomization. This study sought to determine whether IRA stenting plus abciximab treatment has an impact on 1-month mortality compared with IRA stenting alone in consecutive patients with AMI complicated by CS due to predominant ventricular failure.

Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty.

The benefit of thrombolysis is dependent on time to treatment, but there is lack of evidence of this relation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA). The hypothesis that the relation of time to treatment to mortality is dependent on patient risk was tested in a series of 1,336 patients who underwent successful primary PTCA and were stratified into "low-risk" and "not low-risk" patient groups according to the Thrombolysis In Myocardial Infarction criteria. After stratification, 942 patients (71%) were at not low risk, and 394 (29%) were at low risk.

Percutaneous reperfusion of left main coronary disease complicated by acute myocardial infarction.

Previous studies have shown a benefit of a strategy of direct angioplasty and stenting in patients with acute myocardial infarction (AMI) complicated by early cardiogenic shock. However, few data exist for the subset of patients with left main trunk disease complicated by AMI and cardiogenic shock. We performed an analysis of patients with AMI who underwent mechanical intervention between January 1995 and December 2000.

Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction.

It is unknown if collateral circulation (CC) has a beneficial effect on outcomes of patients who undergo mechanical intervention in the first hours after onset of acute myocardial infarction (AMI). This study analyzes the relation between CC and outcome in patients with AMI who underwent primary angioplasty or stenting within 6 hours of symptom onset. The analysis was performed in a series of 1,164 consecutive patients.

Clinical and angiographic outcomes following elective implantation of the Carbostent in patients at high risk of restenosis and target vessel failure.

The Carbostent is a new balloon-expandable, stainless steel, tubular stent with innovative multicellular design and unique turbostratic carbon coating. The aim of this study was to assess clinical and angiographic outcomes after Carbostent implantation in 112 patients poorly suitable for an effective treatment with stenting because of the high risk of thrombosis, late restenosis, and clinical target vessel failure. The inclusion criteria were age > 75 years, diabetes mellitus, a lesion length > 10 mm, a reference vessel diameter < 3.

Direct infarct artery stenting without predilation and no-reflow in patients with acute myocardial infarction.

Background: In patients with acute myocardial infarction (AMI), the rate of microvascular embolization and no-reflow promoted by coronary stenting with the use of conventional techniques (CS) appears to be greater than the one that occurs with balloon angioplasty. The minor invasiveness of direct stenting (DS) of the infarct artery without predilation could be expected to reduce embolization in the coronary microvasculature and no-reflow in patients with AMI.

Methods: In a cohort of 423 consecutive patients with AMI who underwent infarct-artery stenting, we compared CS and DS in terms of angiographic no-reflow rate and 1-month clinical outcome.