Reperfusion In Acute Myocardial Infarction Research Articles

Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention?

This Perspective article is a form of 'pastiche', inspired by the 1993 review by Lincoff and Topol entitled 'Illusion of reperfusion', and explores how their concept continues to apply to percutaneous revascularization in patients with coronary artery disease and ischaemia. Just as Lincoff and Topol argued that reperfusion of acute myocardial infarction was facing unresolved obstacles that hampered clinical success in 1993, we propose that challenging issues are similarly jeopardizing the potential benefits of stent-based angioplasty today. By analysing the appropriateness and efficacy of percutaneous coronary intervention (PCI), we emphasize the limitations of relying solely on visual angiographic guidance, which frequently leads to inappropriate stenting and overtreatment in up to one-third of patients and the associated increased risk of periprocedural myocardial infarction. The lack of optimal revascularization observed in half of patients undergoing PCI confers risks such as suboptimal physiology after PCI, residual angina and long-term stent-related events, leaving an estimated 76% of patients with an 'illusion of revascularization'. These outcomes highlight the need to refine our diagnostic tools by integrating physiological assessments with targeted intracoronary imaging and emerging strategies, such as co-registration systems and angiography-based computational methods enhanced by artificial intelligence, to achieve optimal revascularization outcomes.

Abstract 1125: Percutaneous Optofluidic Catheter-guided Photo-triggered Nanogoldsomes Reduce Infarct Size And Mitigate Myocardial Dysfunction In A Swine Model Of Acute Myocardial Infarction

Introduction: S-nitrosoglutathione (GSNO) is an endogenous S-nitrosothiol that plays important roles in nitric oxide (NO) generation and signaling. We previously designed an Au-polymersomes/GSNO nanoparticle (nanogoldsome) that can be triggered by laser or ultrasound to accelerate the release of NO, which effectively dilates the arteries of the target organ and induces anti-apoptotic protection against ischemia-reperfusion injury. In this study we integrated an optofluidic coronary catheter with the photo-triggered nanogoldsomes, and investigate their roles in mitigating the infarct size in a swine model of acute myocardial infarction (AMI). Methods: In a swine AMI model of 90 min coronary artery (CA) occlusion, nanogoldsomes (0.145 mg Au and 3.66 μg GSNO/kg) were administered 5 min after balloon-off using a percutaneous coronary optofluidic catheter with 532 nm laser stimulation at the tip. The CA diameter was measured at baseline and at 0 and 15 min of reperfusion. Left ventricular (LV) function (max dp/dt) were measured at baseline, and 1 h and 7 days after reperfusion. The infarct area was determined at day 7 using triphenyltetrazolium chloride stain with the infarct fraction calculated in reference to the area at risk stained by Evan’s blue coronary infusion with balloon occlusion at the same site. Results: Compared to AMI group, the CA diameter showed significant dilatation 10 min after nanogoldsome/laser treatment (1.22 vs. 0.98 folds, P < 0.05), while systemic blood pressure showed no significant drop. The infarct fraction was significantly reduced (49% vs. 73%, P < 0.05) and LV function markedly better 7 days after AMI. By contrast, no significant differences were noted in the control groups of GSNO (3.66 μg/kg) and nanogoldsomes without laser stimulation. Conclusion: Percutaneous optofluidic catheter-guided infusion of nanogoldsomes at coronary orifice with simultaneous tip laser stimulation in the first minutes of AMI reperfusion magnified NO release in the most critical reperfusion period. This instantly dilated coronary arteries, and reduced infarct area and mitigated LV dysfunction 7 days after AMI. With large animal experiments showing pathophysiological benefits, further translation to pre-clinical studies is encouraged.

Intracoronary microcatheter indwelling for continuous pumping of low-dose thrombolytic drugs: A new approach to reperfusion in acute myocardial infarction.

Reperfusion therapy of acute myocardial infarction (AMI) refers to physical or chemical recanalization and restoration of blood flow to an occluded coronary artery, and current techniques for reperfusion therapy include intravenous thrombolysis, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The number of patients receiving emergency CABG in the real world is decreasing due to the disadvantages of CABG and the improvement in PCI procedures. Thrombolytic therapy has some disadvantages such as low recanalization rate, high risk of reocclusion and bleeding, and short time window. On the other hand, intracoronary interventional therapy may meet the requirements of "early, complete and persistent" patency of coronary arteries at different time points. However, in the emergency PCI, although thrombus aspiration via a catheter or balloon dilation is performed, residual thrombus with heavy or low TIMI (thrombolysis in myocardial infarction) myocardial perfusion grading is still observed in some patients, suggesting disordered microcirculation. Currently, the treatment of microcirculatory disturbance in emergency PCI mainly employed injection of tirofiban, adenosine, thrombolytic agent or other drugs into the local area via a microcatheter in a short time, all of which can significantly reduce the thrombus load and improve TIMI perfusion. Herein, we report that a microcatheter was indwelled in the coronary artery for continuous pumping of low-dose thrombolytic drugs as reperfusion therapy in 12 patients with acute and subacute MI.

Reperfusion Arrhythmia in Acute Myocardial Infarction

Management of reperfusion in acute myocardial infarction is an important component of myocardial cell survival to minimize the area experiencing infarction and improve patient clinical outcomes. However, this reperfusion also contributes to myocardial injury which is preceded by the ischemic process. One of the injuries related to the ischemia-reperfusion process in the myocardium is reperfusion arrhythmia. Reperfusion arrhythmias from several studies can begin to occur in the first minutes after restoration of obstructed coronary flow. The features of reperfusion arrhythmia can include accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, and other arrhythmias. The mechanism of reperfusion arrhythmia can be excess calcium in the cells, oxidative stress due to an increase reactive oxygen species, energy metabolism disorders, and neutrophil accumulation. Excessive intracellular calcium and other mechanisms cause a delay in the depolarization of previously ischemic cells. This reperfusion arrhythmia requires special attention because it can disrupt hemodynamics and patient outcomes after reperfusion procedures. Knowledge of the mechanisms of reperfusion arrhythmias will guide clinicians to provide better management during and after reperfusion procedures.

Contrast-enhanced cardiac MRI is superior to non-contrast mapping to predict left ventricular remodeling at 6 months after acute myocardial infarction

ObjectivesParametric mapping constitutes a novel cardiac magnetic resonance (CMR) technique enabling quantitative assessment of pathologic alterations of left ventricular (LV) myocardium. This study aimed to investigate the clinical utility of mapping techniques with and without contrast agent compared to standard CMR to predict adverse LV remodeling following acute myocardial infarction (AMI).Materials and methodsA post hoc analysis was performed on sixty-four consecutively enrolled patients (57 ± 12 years, 54 men) with first-time reperfused AMI. Baseline CMR was obtained at 8 ± 5 days post-AMI, and follow-up CMR at 6 ± 1.4 months. T1/T2 mapping, T2-weighted, and late gadolinium enhancement (LGE) acquisitions were performed at baseline and cine imaging was used to determine adverse LV remodeling, defined as end-diastolic volume increase by 20% at 6 months.ResultsA total of 11 (17%) patients developed adverse LV remodeling. At baseline, patients with LV remodeling showed larger edema (30 ± 11 vs. 22 ± 10%LV; p < 0.05), infarct size (24 ± 11 vs. 14 ± 8%LV; p < 0.001), extracellular volume (ECVinfarct; 63 ± 12 vs. 47 ± 11%; p < 0.001), and native T2infarct (95 ± 16 vs. 78 ± 17 ms; p < 0.01). ECVinfarct and infarct size by LGE were the best predictors of LV remodeling with areas under the curve (AUCs) of 0.843 and 0.789, respectively (all p < 0.01). Native T1infarct had the lowest AUC of 0.549 (p = 0.668) and was inferior to edema size by T2-weighted imaging (AUC = 0.720; p < 0.05) and native T2infarct (AUC = 0.766; p < 0.01).ConclusionIn this study, ECVinfarct and infarct size by LGE were the best predictors for the development of LV remodeling within 6 months after AMI, with a better discriminative performance than non-contrast mapping CMR.Clinical relevance statementThis study demonstrates the predictive value of contrast-enhanced and non-contrast as well as conventional and novel CMR techniques for the development of LV remodeling following AMI, which might help define precise CMR endpoints in experimental and clinical myocardial infarction trials.Key Points• Multiparametric CMR provides insights into left ventricular remodeling at 6 months following an acute myocardial infarction.• Extracellular volume fraction and infarct size are the best predictors for adverse left ventricular remodeling.• Contrast-enhanced T1 mapping has a better predictive performance than non-contrast standard CMR and T1/T2 mapping.

Investigation of the Clinical Efficacy of 99mTc-Sestamibi Washout in Patients with Acute Myocardial Infarction and Comparison with Stress Myocardial Imaging with 99mTc-Sestamibi Using a Two-Day Protocol

Background: 99mTc-sestamibi myocardial perfusion imaging (MIBI) washout is associated with myocardial mitochondrial damage in patients with a successful percutaneous coronary intervention (PCI) following acute myocardial infarction (AMI) and may predict the functional improvement of the left ventricle in follow-ups. Objectives: This study aimed to investigate the clinical efficacy of 99mTc-MIBI washout in patients with AMI by measuring the mean defect area based on 99mTc-MIBI myocardial perfusion-single photon emission computed tomography (MP-SPECT) rest imaging in early and delayed phases and comparing it with the defect area based on 99mTc-MIBI MP-SPECT adenosine stress imaging based on a two-day rest/stress protocol. Patients and Methods: This study was conducted on 29 consecutive patients with AMI (23 males and 6 females; mean age, 71 ± 8.4 years), who underwent MP-SPECT using a standard two-day rest/stress protocol. The rest 99mTc-MIBI MP-SPECT images were acquired in the early phase at one hour after the injection of 99mTc-MIBI and in the delayed phase at three hours after the early phase. The total perfusion deficit (TPD) score for SPECT was measured to compare the defect area between the rest-early phase, rest-delayed phase, and post-stress imaging conditions. Results: Based on the results, the post-stress TPD score was significantly lower than the rest-delayed phase score (TPD: 22.2% ± 14.3% vs. 27.8% ± 14.0%; P &lt; 0.001). Also, the rest-early phase score was significantly lower than the rest-delayed phase score (TPD: 21.5% ± 14.9% vs. 27.8% ± 14.0%; P &lt; 0.001). However, no significant difference was observed between the post-stress score and the rest-early phase score. Conclusion: The combination of rest-early phase, delayed phase, and post-stress 99mTc-MIBI imaging using a two-day protocol after AMI reperfusion was a clinically useful method, which could identify residual ischemia and predict the left ventricular function improvement in the chronic phase of disease while reducing the exposure dose.

Combining VA-ECMO and Impella (EC-Pella) Before Reperfusion Mitigates Left Ventricular Injury Due to VA-ECMO in Acute Myocardial Infarction

<h3>Purpose</h3> Combining veno-arterial extracorporeal membrane oxygenation (ECMO) with an Impella CP (EC-Pella) is increasingly used in acute myocardial infarction (AMI). We recently reported that compared to reperfusion alone, ECMO increases, but Impella decreases infarct size in preclinical models. Whether EC-Pella limits cardiac damage remains unknown. We hypothesized that compared to ECMO alone, EC-Pella mitigates left ventricular (LV) injury when activated before reperfusion in AMI. <h3>Methods</h3> Ischemia-reperfusion injury (IRI) was induced in adult swine via percutaneous occlusion of the left anterior descending artery (LAD) for 120 minutes. We then activated either ECMO alone for 30 minutes or EC-Pella for 45 minutes with persistent LAD occlusion. All groups underwent 180 minutes of reperfusion (n=4-6/group). To study whether the sequence of device activation impacts infarct size, we compared activation of ECMO alone for 30 minutes followed by simultaneous Impella CP for 15 minutes (EC-Pella A) versus Impella CP activation for 30 minutes followed by simultaneous ECMO for 15 minutes (EC-Pella B) before reperfusion. LV hemodynamics, infarct size relative to the area at risk (IS) and cardioprotective signaling were assessed. <h3>Results</h3> Compared to IRI, ECMO increased IS. Compared to ECMO, IS was reduced in both EC-Pella groups (Fig. 1A). No difference in IS was observed between EC-Pella A versus EC-Pella B. Pressure-volume area (PVA) was lowest in EC-Pella B (Fig. 1B). Compared to IRI and ECMO, both EC-Pella configurations increased levels of phosphorylated Akt, Erk, and GSK3b within the infarct zone (Fig. 1C) and reduced pro-apoptotic signaling. <h3>Conclusion</h3> We report for the first time that compared to ECMO alone, initiation of EC-Pella before reperfusion reduces LV PVA, activates cardioprotective signaling, and reduces infarct size. These findings suggest that LV unloading may mitigate LV injury due to ECMO when applied before reperfusion in AMI.

Effects of Levosimendan Preconditioning on Left Ventricular Remodeling after Myocardial Reperfusion in Acute Myocardial Infarction Patients Receiving Percutaneous Coronary Intervention

Levosimendan is a novel drug often used to treat heart failure. We aimed to explore the effects of levosimendan preconditioning on left ventricular remodeling (LVR) after myocardial reperfusion in acute myocardial infarction (AMI) patients receiving the percutaneous coronary intervention (PCI). A total of 258 AMI patients treated from January 2018 to September 2020 were randomly divided into control and observation groups. Based on conventional drug therapy, levosimendan was given 30 min before PCI for the observation group, and dobutamine was intravenously injected for the control group. Baseline data, thrombolysis in myocardial infarction (TIMI) blood flow grade, myocardial injury markers, and LVR indices were compared, and the influencing factors for LVR were analyzed. After treatment, various degrees of blood perfusion were found, and the TIMI grade was better than that before treatment in both groups (P < .05). The levels of aspartate aminotransferase, creatine kinase-MB, cardiac troponin T, and brain natriuretic peptide (BNP) declined in both groups, more significantly in the observation group (P < .05). Left ventricular end-systolic diameter, left ventricular end-diastolic diameter and left ventricular end-diastolic volume declined, whereas left ventricular ejection fraction rose in both groups, more significantly in the observation group (P < .05). Age and BNP were risk factors for LVR, whereas levosimendan preconditioning was a protective factor (P < .05). Levosimendan preconditioning can protect cardiac function and promote the recovery of the left ventricular structure. Age and BNP are risk factors for LVR after myocardial reperfusion in AMI patients undergoing PCI, and levosimendan preconditioning is a protective factor.

Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias

Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients. We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death. Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p<0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p=0.005) or extracorporeal membrane oxygenation (p<0.001), tracheal intubation (p<0.001) and persistent vegetative state (p=0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level. In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.

Ozone protects cardiomyocytes against ischemia/reperfusion injury: Regulating the heat shock protein 70 (HSP70) expression through activating the JAK2/STAT3 Pathway

ABSTRACT Ischemia/reperfusion (I/R) injury causes complications in early coronary artery reperfusion for acute myocardial infarction (AMI). Ozone (O3) has been reported to be applied for protecting I/R injury, but its detailed mechanism remains unclear. Our study focused on the protective effect of O3 pretreatment on myocardial I/R injury and JAK2/STAT3 signaling and HSP70 regulation involving in the mediation. The rat hearts which were perfused and isolated as well as the cultured cardiomyocytes of neonatal rat were exposed to hypoxia/reoxygenation (H/R) and different concentrations of O3 followed by heat shock protein 70 (HSP70) siRNA treatment. The results showed O3 attenuated the suppression of cell viability induced by H/R and decreased the release of activity of creatine kinase (CK), lactate dehydrogenase (LDH) and apoptosis of cardiomyocytes in vitro. Moreover, O3 also activated the JAK2/STAT3 signaling, upregulated the expression of HSP70 both in vitro and vivo, and decreased the index of apoptosis of cardiomyocytes caused by I/R as well as myocardial infarct area in vivo. In addition, HSP70 siRNA and JAK2 inhibitor AG490 inhibited the cardioprotective effect of O3. And the expression of HSP70 increased by ozone was reduced by AG-490. In conclusion, our results demonstrated that ozone protects cardiomyocytes in I/R injury through regulation of the expression of HSP70 by activating the JAK2/STAT3 pathway.

Thrombolysis for acute myocardial infarction in Moroccan patients: Data from FES-AMI registry

Acute myocardial infarction (AMI) is the most serious form of acute coronary syndrome. It is essentially due to occlusive coronary thrombosis complicating rupture of atherosclerosis plaque. The aim of the management of this extreme emergency is to restore the coronary flow as soon as possible either by thrombolysis or by primary angioplasty depending on local conditions. To assess clinical, angiographic, therapeutic and prognostic features of Moroccan patients thrombolysed by tenecteplase in AMI. FES-AMI is a monocentric prospective registry that included all patients hospitalized for management of AMI within 5 days of onset of symptoms. We analyzed from this registry all patients who had undergone thrombolysis with tenecteplase between June 2006 and August 2018. We enrolled 900 patients. 79% of patients were males and mean age was 60 years old. 57% of patients were smokers, 35% were diabetics and 26% were hypertensives. A total of 71% of patients had more than 2 risk factors. In 80% of cases, patients are thrombolysed beyond the 3rd hour. Our patients received thrombolytic therapy within an average of 5 hours and 14 min after the onset of chest pain. All patients received Aspirin, Clopidogrel and Heparin. TIMI flow grade 2 or 3 has been found in 95% of successful thrombolysis. 60% of patients had multi-vessel disease. The heart failure complicated the myocardial infarction in 35% of cases. 8% of patients presented an atrial fibrillation, 5% a ventricular tachycardia, 3% a ventricular fibrillation and 4% a third-degree atrioventricular block. The rate of intracranial hemorrhage was 1%. The in-hospital mortality was 7.1%. Fibrinolysis remains an important option for reperfusion in acute myocardial infarction in Morocco. Higher rates of patency were observed in successful thrombolysis in our registry. Intracranial hemorrhage was the most serious complication of fibrinolytic therapy and its frequency did not exceed 1%.

Akut anterior ST segment miyokard infarktüsü sonrası GRACE risk skorunun sol ventrikül ejeksiyon fraksiyonundaki prediktif değeri

Purpose: The aim of the study is to investigate the predictive value of GRACE score for left ventricular ejection fraction (LVEF) after acute anterior segment acute myocardial infarction (AMI). Despite rapid and complete reperfusion in AMI, inadequate recovery of left ventricular function may result in a decrease in LVEF.Materials and Methods: We retrospectively analyzed 712 patients presented with AMI and 290 patients were included. Patients were divided into two groups according to LVEF and a value &amp;lt;50% was defined as depressed EF group (group 1), a value ≥50% was defined as preserved EF group (group 2). The GRACE risk scores of all patients were calculated.Results: 132 patients were included in the group 1, 158 patients were included in the group 2. In-hospital death GRACE risk score and in-hospital death/MI GRACE risk score were higher in group 1. A significant negative correlation was found between risk scores and LVEF. In multivariate regression analysis, in-hospital death risk score, and in-hospital death/MI risk score were found to be independently predictors of depressed LVEF.Conclusion: GRACE risk score has a clinically important role predicting depressed LVEF in acute anterior segment AMI patients treated with primary PCI.

Predictors and prognosis of spontaneous reperfusion in acute myocardial infarction

ST elevation myocardial infarction (STEMI) remains one of the most frequent emergencies, requiring an as early as possible reperfusion that may result, in some cases, from physiological fibrinolysis. We aimed to analyze the clinical characteristics of patients presenting with clinical markers of spontaneous reperfusion (SR) during acute myocardial infarction, and to evaluate its effect on hospital prognosis. We retrospectively reviewed data for 1785 patients admitted for STEMI. The patients were divided into SR group (spontaneous relief of chest pain less than 5 on a scale from 0 to 10, and ST segment elevation resolution of more than 50% from baseline) and non-SR group (the remaining population). The clinical and prognostic features of the patients were analyzed. The incidence of SR in our population was 10.4% of patients ( N = 187). SR patients were younger (57.6 vs. 61.1 years; P = 0.002) and had a higher prevalence of current smoking (77.9% vs. 65.9%; P = 0.003) and less myocardial damage as indicated by lower peak creatine kinase (1158 vs. 2022 UI/l; P < 0.001). In hospital mortality (3.2% vs. 10%; P = 0.013), heart failure (8.4% vs. 19.7%; P = 0.001), atrial fibrillation (0.6% vs. 7.3%; P = 0.002) and acute pericarditis (0% vs. 4%; P = 0.011) were significantly lower for SR patients. Multivariate analysis found smoking as the only predictor factor of SR (OR = 1.82, 95% CI [1.2–2.7]; P = 0.003). Our data shows that SR decreased infarction size, improved heart function and reduced mortality. The subgroup of STEMI with SR carries a more favorable prognosis.

Effect of WeChat Platform on ST-Segment Elevation Acute Myocardial Infarction Reperfusion Treatment Time and Curative Effect

Objective: The objective of the study is to construct a regional ST-segment elevation myocardial infarction (STEMI) treatment network system using the WeChat platform as a carrier and to explore the effect of this system on the time to reperfusion treatment and efficacy of treatment for patients with acute STEMI. Materials and Methods: The Department of Cardiology at our hospital constructed a STEMI rescue WeChat group including 120 emergency departments and acute care hospitals in the district. For all suspected STEMIs, relevant medical history data were uploaded to the WeChat group, a physician from the Department of Cardiology was consulted electronically, and this cardiologist was able to inform the local physician of a reperfusion treatment plan. One hundred and seventy-seven STEMI patients were transferred to our hospital within 12 h of presentation, of which 81 cases were transferred before the establishment of the WeChat group (the control group), and 96 cases were transferred using the WeChat system (WeChat group). The time to reperfusion, O-to-FMC time, FMC-to-B time, D-to-B time, average hospitalization stay, and mortality during hospitalization were observed and compared between the two groups. Results: The WeChat group had a lower O-to-FMC time compared with the control group, but this difference was not statistically significant. The FMC-to-B time, the time of D-to-B, and the average days of hospitalization in the WeChat group were all lower compared with those in the control group. The incidence of cardiovascular events and the heart function ratio of the patients after 6 months were compared, and the WeChat group was statistically superior to the control group in relation to these outcomes. Conclusion: The establishment of a STEMI regional treatment network based on the WeChat platform can shorten the time to reperfusion treatment, reduce postreperfusion cardiovascular events, shorten the days of hospitalization, and improve the heart function of patients.

Reperfusion of Acute Myocardial Infarction in the elderly (clinical characteristics and prognosis) Results of the IMSS Nuevo León infarction code program

Background: The age is an important prognostic factor in patients with acute myocardial infarction.

Adjunctive laser-stimulated stem-cells therapy to primary reperfusion in acute myocardial infarction in humans: Safety and feasibility study.

Low-level laser therapy (LLLT) has photobiostimulatory effects on stem cells and may offer cardioprotection. This cell-based therapy may compliment primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). In this randomized control trial, our primary objective was to determine the safety and feasibility of LLLT application to the bone marrow in patients with STEMI undergoing PPCI. We randomly assigned patients undergoing PPCI to LLLT or non-laser therapy (NLT). In the LLLT group, 100 s of laser therapy was applied to the tibia bone prior to PPCI, as well as 24 and 72 h post-PPCI. In the control group, the power source was turned off. The primary outcome was the difference in door-to-balloon (D2B) time, and additional outcomes included differences in circulating cell counts, cardiac enzymes, and left-ventricular ejection fraction (LVEF) at pre-specified intervals post-PPCI. Twenty-four patients were randomized to LLLT (N = 12) or NLT (N = 12). No adverse effects of the treatment were detected. The D2B time was not significantly different between the groups (41 ± 8 vs 48 ± 1 min; P = 0.73). Creatinine Phosphokinase area under the curve, was lower after LLLT (22 ± 10) compared to NLT (49 ± 12), but this was not statistically significant (P = 0.08). Troponin-T was significantly lower after LLLT (2.7 ± 1.4 ng/mL) in comparison to NLT (5.2 ± 1.8 ng/mL. P < 0.05). At 9 months, LVEF improved in both groups without a significant difference between LLLT (55 ± 9%) and NLT (52 ± 9%; P = 0.90). LLLT is a safe and feasible adjunctive cell-based therapy to PPCI that may benefit ischemic myocardium.

Correction: A systematic review and meta-analysis of the protective effects of metformin in experimental myocardial infarction

[This corrects the article DOI: 10.1371/journal.pone.0183664.].

Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI)

BackgroundThe Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) demonstrated superiority of routine early coronary angiography (and percutaneous coronary intervention [PCI]) compared with standard therapy in fibrinolytic-treated patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The aim of the current study was to evaluate the long-term (>7 year) effects of an early invasive strategy. MethodsWe linked the study cohort and administrative datasets to assess long-term follow-up status including repeat procedures, hospitalizations, and major adverse cardiovascular events (MACE). Kaplan-Meier and Cox regression analysis were used to evaluate the relationship between randomized treatment and long-term adverse outcomes. ResultsA total of 881 patients had long-term follow-up and were included in our study. After a mean follow-up of 7.8 years, there were no significant differences in death, myocardial infarction (MI), unstable angina, stroke, transient ischemic attack (TIA), or heart failure admissions (hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.73–1.13]; P = 0.41) between those randomized to an early invasive vs standard treatment strategy. Following the index hospitalization, there were no significant difference in the rates of coronary revascularization between the early invasive and the standard therapy groups (81 [19.3%] vs 76 [17.9%]; P = 0.61). ConclusionsDespite the short-term benefit and safety of an early invasive strategy in patients with STEMI receiving fibrinolysis, no statistically significant differences in MACE were observed over 7.8 years.

Implication of serum microRNA-7a/B with myocardial cell injury induced by ischemia reperfusion

Objective: To investigate the association between serum microRNA-7a/b and Myocardial Cell Injury (MCI) induced by ischemia reperfusion in Acute Myocardial Infarction (AMI) patients. Methods: Sixty (60) senile AMI patients were selected and placed in the observation group (A group), while 60 healthy people served as the healthy control group (group B). Depending on their conditions after emergency thrombolytic therapy, the AMI patients were sub-divided into no-reflow group (A1 group, 23 cases) and reperfusion group (A2 group, 37 cases). Blood levels of high-sensitive C-reactive protein (hs-CRP) and N-terminal pro-natriuretic peptide (NT-proBNP) were determined in all patients. MicroRNA-7a/b expressions were measured in venous blood 24 h and 120 h before and after thrombolytic therapy. Results: There were significant, time-dependent increases in microRNA-7a/b expression after thrombolytic therapy, when compared with the control group (p<0.05). Results of correlation analysis showed that microRNA-7a/b was positively correlated with hs-CRP (r1=0.666, p<0.05; but negatively correlated with D-D (r2=-0.642, p<0.05). Conclusion: In myocardial cell injury induced by ischemia reperfusion, microRNA-7a/b expression is linked to oxidative stress and apoptosis of cardiomyocytes. Thus I/RI might be mitigated by regulating the expression of this microRNA.

A case of sudden-onset painless unilateral vision loss postintravenous streptokinase in a patient of acute inferior-wall myocardial infarction

Coronary thrombolysis with intravenous (IV) streptokinase is widely used as a strategy for coronary reperfusion for acute myocardial infarction (MI). Systemic administration of fibrinolytic agents is associated with hemorrhagic risks such as cerebral hemorrhage, gastrointestinal bleeding, cardiogenic shock, and unusual complications such as splenic rupture, aortic dissection, and cholesterol embolization. Herein, we report a case of intraocular hemorrhage 1 day after the IV administration of streptokinase for acute inferior-wall MI.