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Procedural microvascular activation in long lesions treated with bioresorbable vascular scaffolds or everolimus-eluting stents: the PROACTIVE trial.

生物可吸收血管支架或依维莫司洗脱支架治疗长病变的程序性微血管激活: 前瞻性试验。

  • 影响因子:2.41
  • DOI:10.4244/EIJ-D-18-01138
  • 作者列表:"Pellicano M","Di Gioia G","Ciccarelli G","Xaplanteris P","Delrue L","Toth GG","Van Durme F","Heyse A","Wyffels E","Vanderheyden M","Bartunek J","De Bruyne B","Barbato E
  • 发表时间:2020-06-12
Abstract

AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.

摘要

目的: 长支架冠状动脉段后显著的血小板活化与围手术期微血管损伤和心肌坏死相关。在用依维莫司洗脱生物可吸收血管支架 (BVS) 或依维莫司洗脱支架 (EES) 治疗的长病变中,我们旨在研究 (a) 手术相关的微血管损伤。(b) 血小板活化与微血管功能和相关肌坏死的关系。 方法和结果: 66 例长病变择期经皮冠状动脉介入治疗 (PCI) 患者随机 1:1 接受BVS或EES。主要终点是PCI术后压力来源的微血管阻力校正指数 (cIMR) 变化的组间差异。采用多平板分析仪,通过高敏心肌肌钙蛋白T (hs-cTnT) 、高敏二磷酸腺苷 (hs-ADP) 诱导的血小板反应性评估围手术期心肌坏死。BVS组术后扩张更频繁,随之而来的手术时间更长。观察到两组在主要终点 Δ cimr (p = 0.04) 方面存在显著差异。Hs-ADP在不同时间点组间无差异。PCI术后hs-cTnT明显升高,组间无差异。 结论: 在长病变中,与EES相比,BVS植入与IMR显著急性降低相关,与血小板反应性或围手术期肌坏死无显著相互作用。

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翻译标题与摘要 下载文献
影响因子:2.41
发表时间:2020-06-12
DOI:10.4244/EIJ-D-18-01138
作者列表:["Pellicano M","Di Gioia G","Ciccarelli G","Xaplanteris P","Delrue L","Toth GG","Van Durme F","Heyse A","Wyffels E","Vanderheyden M","Bartunek J","De Bruyne B","Barbato E"]

METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:1.67
发表时间:2020-01-01
DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.

心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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