Prospective partially randomized comparison of clopidogrel loading versus maintenance dosing to prevent periprocedural myocardial infarction after stenting for stable angina pectoris: Results from the "Method of Clopidogrel Pre-treatment Undergoing Conventional Coronary Angiogram in Angina Patients (MECCA)" study.
氯吡格雷负荷与维持剂量预防稳定型心绞痛支架术后围手术期心肌梗死的前瞻性部分随机比较: “心绞痛患者接受常规冠状动脉造影的氯吡格雷预处理方法 (麦加)” 研究的结果。
- 作者列表："Park JH","Kim JS","Ahn CM","Hong SJ","Ahn KJ","Choi JW","Joo HJ","Yu CW","Lim DS
WHAT IS KNOWN AND OBJECTIVE:Pre-treatment of clopidogrel 600 mg is better than 300 mg loading for reducing periprocedural myocardial infarction (PMI). We aimed to evaluate pre-treatment methods for preventing PMI among patients undergoing conventional coronary angiography (CAG) for stable angina pectoris. MATERIALS AND METHODS:The study analyzed 402 patients who underwent percutaneous coronary intervention (PCI) during 2010 - 2011 at three Korean hospitals. Clopidogrel-naïve patients received routine maintenance therapy (75 mg/day for ≥ 5 days) and were randomly assigned to a 300-mg reload (RL) or only the maintenance dose (MD). Patients who received a loading dose (LD; 600 mg at 2 - 24 hours before the procedure) were entered into a non-randomized group. RESULTS:After excluding patients who showed an abnormal creatinine kinase myocardial band (CK-MB) level, the study included 233 patients in the LD group, 85 patients in the RL group and 84 patients in the MD group. The LD group had a significantly higher rate of PMI (LD: 21, RL: 3, MD: 0 cases; p = 0.007) and a significant increase in the mean CK-MB levels after 8 hours (p = 0.016) and 24 h (p = 0.01). However, there was no difference in PMI between the RL and MD groups. Furthermore, no significant differences between the three groups were observed in the P2Y12 reaction unit (PRU) values (p = 0.57). Albeit not significantly, the LD group had a higher rate of moderate-to-severe GUSTO bleeding within 7 days. WHAT IS NEW AND CONCLUSION:Clopidogrel maintenance is better than 600-mg loading for preventing PMI, and the RL protocol did not further prevent PMI.
已知和目的: 氯吡格雷600 mg的预处理对于减少围手术期心肌梗死 (PMI) 优于300 mg负荷。我们的目的是在接受常规冠状动脉造影 (CAG) 治疗的稳定型心绞痛患者中评估预防PMI的治疗前方法。 材料和方法: 该研究分析了402-2010年间在韩国三家医院接受经皮冠状动脉介入治疗 (PCI) 的2011例患者。氯吡格雷初治患者接受常规维持治疗 (75 mg/天，持续 ≥ 5天)，并被随机分配至300 mg reload (RL) 或仅维持剂量 (MD)。接受负荷剂量 (LD; 在手术前2-24小时600 mg) 的患者进入非随机化组。 结果: 在排除显示异常肌酐激酶心肌带 (ck-mb) 水平的患者后，研究包括LD组233例、RL组85例和MD组84例。LD组PMI发生率显著升高 (LD: 21，RL: 3，MD: 0例; p = 0.007)，8小时 (p = 0.016) 和24小时 (p = 0.01) 后ck-mb平均水平显著升高。然而，在RL和MD组之间的PMI没有差异。此外，在三组之间没有观察到P2Y12反应单位 (PRU) 值的显著差异 (p = 0.57)。虽然不显著，但LD组在7天内有较高的中度至重度味觉出血发生率。 什么是新的和结论: 氯吡格雷维持优于600 mg负荷预防PMI，RL方案没有进一步预防PMI。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
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.
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.