Raffaela Fetiveau

Integrated analysis of myocardial blush and ST-segment elevation recovery after successful primary angioplasty: Real-time grading of microvascular reperfusion and prediction of early and late recovery of left ventricular function.

Background—ST-segment elevation (&Sgr;STe) recovery and the angiographic myocardial blush (MB) grade are useful markers of microvascular reperfusion after recanalization of the infarct-related artery. We investigated the ability of a combined analysis of MB grade and &Sgr;STe changes to identify different patterns of myocardial reperfusion shortly after primary percutaneous coronary angioplasty (PTCA) and to predict 7-day and 6-month left ventricular (LV) functional recovery. Methods and Results—MB grade and &Sgr;STe recovery were evaluated shortly after successful primary PTCA (restoration of TIMI grade 3 flow) in 114 consecutive patients with &Sgr;STe acute myocardial infarction. LV function was assessed by 2D echocardiograms before PTCA and at 7 days and 6 months thereafter. By combining MB and &Sgr;STe changes, 3 main groups of patients were identified. Group 1 patients (n=60) had both significant MB (grade 2 to 3) and &Sgr;STe recovery (>50% versus basal &Sgr;STe) and a high rate of 7-day (65%) and 6-month (95%) LV functional recovery. In group 2 patients (n=21), who showed MB but persistent &Sgr;STe, the prevalence of early LV functional recovery was low (24%) but increased up to 86% in the late phase. Group 3 patients (n=28), who had neither significant MB nor &Sgr;STe resolution, had poor early (18%) and late (32%) LV functional recovery. Conclusions—After successful primary PTCA, integrated analysis of MB and &Sgr;STe recovery allows a real-time grading of microvascular reperfusion of the infarct area and predicts the time-course and magnitude of LV functional recovery.

No evidence of association between prothrombotic gene polymorphisms and the development of acute myocardial infarction at a young age

Background—We investigated the association between 9 polymorphisms of genes encoding hemostasis factors and myocardial infarction in a large sample of young patients chosen because they have less coronary atherosclerosis than older patients, and thus their disease is more likely to be related to a genetic predisposition to a prothrombotic state. Methods and Results—This nationwide case-control study involved 1210 patients who had survived a first myocardial infarction at an age of <45 years who underwent coronary arteriography in 125 coronary care units and 1210 healthy subjects matched for age, sex, and geographical origin. None of the 9 polymorphisms of genes encoding proteins involved in coagulation (G-455A &bgr;-fibrinogen: OR, 1.0; CI, 0.8 to 1.2; G1691A factor V: OR, 1.1; CI, 0.6 to 2.1; G20210A factor II: OR, 1.0; CI, 0.5 to 1.9; and G10976A factor VII: OR, 1.0; CI, 0.8 to 1.3), platelet function (C807T glycoprotein Ia: OR, 1.1; CI, 0.9 to 1.3; and C1565T glycoprotein IIIa: OR, 0.9; CI, 0.8 to 1.2), fibrinolysis (G185T factor XIII: OR, 1.2; CI, 0.9 to 1.6; and 4G/5G plasminogen activator inhibitor type 1: OR, 0.9; CI, 0.7 to 1.2), or homocysteine metabolism (C677T methylenetetrahydrofolate reductase: OR, 0.9; CI, 0.8 to 1.1) were associated with an increased or decreased risk of myocardial infarction. Conclusions—This study provides no evidence supporting an association between 9 polymorphisms of genes encoding proteins involved in hemostasis and the occurrence of premature myocardial infarction or protection against it.

Anti-beta 2 glycoprotein I antibodies and the risk of myocardial infarction in young premenopausal women.

Background: Contrasting data have been reported on the association between the presence of anti‐phospholipid antibodies (aPL) and arterial thrombotic events, particularly those in coronary arteries. This discrepancy is perhaps related to the confounding effect of traditional risk factors. Among them, coronary atherosclerosis appears to be the most important in studies conducted in middle‐aged and elderly patients.Objective: To minimize such confounding effects, a multicenter case–control study on the association between aPL and myocardial infarction (MI) was carried out in a rare cohort of young premenopausal women.Methods: We evaluated 172 cases hospitalized for a first MI before the age of 45 years and 172 controls individually matched with cases for age, sex and geographical origin. Clinical and laboratory data were collected and levels of anti‐cardiolipin (aCL), anti‐beta2 glycoprotein I (anti‐β2GPI) and anti‐nuclear antibodies (ANA) were measured.Results: A significant association between MI and IgG/IgM anti‐β2GPI antibodies was observed; the results were confirmed after adjusting for smoking and hypertension (anti‐β2GPI IgG OR = 2.47, 95% CI 1.81–3.38; anti‐β2GPI IgM 4th quartile OR 3.68, 95% CI 1.69–8.02). The association between anti‐β2GPI antibodies and MI was detected in both subgroups with and without coronary artery stenosis. Whereas the association of aCL IgG with MI was modest, ANA showed no significant association with MI. No aPL were found in unselected patients (mainly males) who recently developed acute MI.Conclusions: Anti‐β2GPI antibodies are a significant risk factor for MI in young premenopausal women independently of other risk factors, including the degree of coronary artery stenosis.

Unplanned surgery after drug eluting stent implantation: a strategy for safe temporary withdrawal of dual oral antiplatelet therapy.

We describe four cases of patients with multiple coronary drug eluting stent implantation who underwent major surgery (cardiac and noncardiac) early after stent implantation and needed premature interruption of dual antiplatelet therapy. The transitory withdrawal of oral antiplatelet therapy was accomplished without complications with the use of an IIb/IIIa glycoprotein inhibitor (Tirofiban).

Circulating CD34-positive cell number is related to effective myocardial reperfusion in acute myocardial infarction treated with primary coronary angioplasty.

Objective In patients with ST-segment elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (PCIs), we sought to correlate circulating CD34+ and CD34+CD133+ cell levels with clinical and laboratory findings that are known to affect prognosis in such patients. Background Although recent studies have focused on circulating adult peripheral blood stem cells in those patients, the possible relations between their circulating number and the various factors that may influence STEMI outcome have never been reported. Methods In 74 patients with STEMI presenting within 12 h from symptoms onset and treated with successful primary PCI, blood samples were collected before PCI (baseline) and 5–8 days thereafter (post-PCI). Myocardial blush was used as an index of effective myocardial reperfusion. Left ventricular functional recovery was assessed with echocardiography at 4–6 months. Results In STEMI patients, baseline CD34+ cell as well as CD34+CD133+ cell numbers were lower than that of age-matched participants without history of ischemic heart disease. Both cell populations however increased post-PCI (P < 0.0001). A significant inverse relation was found between both CD34+, CD34+CD133+ cell numbers and age, whereas both cell populations were directly related to myocardial blush grade (CD34+ r = 0.39, P = 0.002; CD34+CD133+ r = 0.37, P = 0.003). By multiple regression analysis, a significant myocardial blush (grade 2–3) was the only predictor of left ventricular functional recovery (OR 10.77, 95% CI 3.1–22.8). Conclusion CD34+ and CD34+CD133+ cell number rises 5–8 days after STEMI, such increase being hampered by old age and favoured by effective myocardial reperfusion after primary PCI.