Acute Myocardial Infarction Lesions Research Articles

A Microenvironment-responsive small-molecule probe and application in quick acute myocardial infarction imaging

Acute myocardial infarction (AMI) patients are at an elevated risk for life-threatening myocardial ischemia/reperfusion injury. Early-stage nonradioactive and noninvasive diagnosis of AMI is imperative for the subsequent disease treatment, yet it presents substantial challenges. After AMI, the myocardium typically exhibits elevated levels of peroxynitrite (ONOO−), constituting a distinct microenvironmental feature. In this context, the near-infrared imaging probe (BBEB) is employed to precisely delineate the boundaries of AMI lesions with a high level of sensitivity and specificity by monitoring endogenous ONOO−. This probe allows for the early detection of myocardial damage at cellular and animal levels, providing exceptional temporal and spatial resolution. Notably, BBEB enables visualization of ONOO− level alterations during AMI treatment incorporating antioxidant drugs. Overall, BBEB can rapidly and accurately visualize myocardial injury, particularly in the early stages, and can further facilitate antioxidant drug screening.

Characteristics and correlation between FFR and RFR of non-culprit lesions in acute myocardial infarction

Background: While resting-full cycle ratio (RFR) is strongly correlated with fractional flow reserve (FFR), it has been extensively examined in stable coronary artery disease. However, there is a lack of evaluation regarding non-culprit lesions in patients with acute myocardial infarction (AMI). Objectives: To investigate the clinical characteristics and to identify the correlation and discordance between FFR and RFR among AMI patients with non-culprit lesions. Methods: A retrospective cohort study was conducted in 44 AMI patients who underwent percutaneous coronary intervention (PCI) for culprit lesions and > 90% stenosis non-culprit lesions. With non-culprit stenosis from 50 - 90%, 23 patients had simultaneous measurements of both FFR and RFR, and 17 patients underwent PCI based on FFR ≤ 0.8. Results: Approximately 79.5% of patients exhibited a presence of two or more risk factors associated with coronary artery disease. In 44 culprit lesions, 40.9% of cases located in the RCA branch, while in 46 nonculprit lesions, 61.4% of cases were found in the LAD branch. The average FFR among 44 patients was 0.82 ± 0.13. There was a significant improvement in FFR after PCI (0.89 ± 0.07) compared to pre-PCI (0.70 ± 0.11) in 17 patients with p < 0.001. The mean RFR among the 23 patients was 0.84 ± 0.12. Among 12 patients with positive RFR, RFR after PCI (0.95 ± 0.04) was higher than pre-PCI (0.78 ± 0.13) with p = 0.002. Furthermore, pre-PCI RFR showed a strong positive correlation with FFR (r = 0.662, p = 0.001). The discordant rate between RFR and FFR was 26.8%. The discordant rate of FFR and RFR measurements was 26.1%. Additionally, the left anterior descending artery (LAD) was assumed as a predictor of discordance in the high FFR group (FFR > 0.80) and low RFR group (RFR ≤ 0.89). Conclusion: The low discordance rate and strong correlation between FFR and RFR suggest their complementary roles in the assessment of intermediate non-culprit lesions in patients with AMI. Key words: fractional flow reserve, resting full-cycle ratio, non-culprit lesion, correlation, acute myocardial infarction.

Fractional flow reserve in assessment of intermediate non-culprit lesions in acute myocardial infarction

Context: Percutaneous coronary intervention (PCI) of intermediate non-culprit arteries can reduce death or heart attack risk in patients with acute myocardial infarction and multivessel coronary artery disease. Aims: To compare the effectiveness of fractional flow reserve (FFR)-guided PCI with angiography-guided PCI for intermediate non-culprit lesions in patients with acute myocardial infarction and multivessel coronary artery disease. Methods: In this cohort study, acute myocardial infarction patients with multivessel coronary artery disease who had successful percutaneous coronary intervention of the culprit artery were divided into group of patients receiving FFR-guided PCI (FFR≤0.80, n = 31) and group of patients receiving angiography-guided PCI (diameter stenosis of 50-90%, n = 62) for lesions in non-culprit arteries. These two groups were followed for at least 1 year for major adverse cardiovascular events. Results: There was no statistically significant difference in major cardiovascular events between FFR-guided percutaneous coronary intervention group and angiography-guided percutaneous coronary intervention group. However, FFR-guided percutaneous coronary intervention group had a lower mortality rate compared to the angiography-guided percutaneous coronary intervention group (3.2% vs. 4.8%). Additionally, there were no reported cases of myocardial infarction in angiography-guided PCI group, while angiography-guided PCI group had a rate of 1.6%. Conclusions: This study found that it remains uncertain whether FFR-guided PCI is superior than angiography-guided PCI for intermediate non-culprit lesions in patients with acute myocardial infarction and multivessel coronary artery disease.

Diagnostic efficacy of two-dimensional echocardiography combined with coronary angiogram in patients with acute myocardial infarction, and the effectiveness of atorvastatin

Purpose: To investigate the diagnostic significance of two-dimensional echocardiography (2DE) combined with coronary angiogram in patients with acute myocardial infarction, and to determine the effectiveness of atorvastatin.Methods: Patients (n = 100) with acute myocardial infarction admitted in Affiliated Hospital of Jinggangshan University, Ji’an, China, were divided into control group (CG) treated with conventional therapy, and study group (EG) treated with atorvastatin, in addition to conventional therapy. The diseased vessels examined by echocardiography and coronary angiogramv were recorded and compared. The effectiveness of atorvastatin treatment was assessed by evaluating myocardial injury, oxidative stress, vascular injury and cardiac function indices, viz, left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal diameter (LVEDD), left ventricular end-systolic internal diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV).Results: The number of double and multiple lesions shown on coronary angiogram were significantly higher than those shown in echocardiography. Phosphocreatine kinase (CK), creatine kinase isoenzyme (CK-MB) and cardiac troponin T (cTnT) improved significantly in both groups after surgery, with CK-MB significantly lower in EG than those in CG at 1 and 3 days post-operation. Interleukin-6 (IL- 6) was significantly lower in EG than in CG at 1 and 7 days after the surgery (p < 0.05). N-terminal Btype natriuretic peptidogen (NT-proBNP) was lower in EG than in CG on the 3rd day after surgery (p < 0.05). Superoxide dismutase (SOD) was significantly higher in EG than in the CG at 1, 3 and 7 days after surgery. The QRS scores significantly improved in both groups after surgery (p < 0.05).Conclusion: Echocardiography, when used in combination with coronary angiogram, accurately assesses the coronary lesions in acute myocardial infarction, and atorvastatin treatment after PCI reduces myocardial injury, relieves inflammation, and promotes the recovery of cardiac function in patients.

Lipid Fractions and Severity of Coronary Artery Lesions in Acute Myocardial Infarction: A Retrospective Single-Center Study

The relationship between different lipid fractions and the occurrence of atherosclerotic coronary artery disease(CAD) is a well-known fact. However, knowledge of the association of different lipid fractions and the severity and extension of coronary lesions has been rarely reported in clinical studies and is often contradictory. This study aimed to evaluate the association between different lipid fractions and the severity and extent of the coronary atherosclerotic lesion in patients with ST elevated acute myocardial infarction (STEMI). We analyzed data from 50 consecutive patients with STEMI who underwent coronary angiography during hospitalization at the Clinical Hospital in Tetovo. The severity and extent of CAD were defined using the Syntax score (SXscore) algorithm stratified according to tertiles. Laboratory analysis for lipid fractions was performed. It was noticed a statistically significant association between SXscore tertiles and the mean of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL) ratio (TC/HDL), (p=0.008). Correlation test showed week but significant positive correlation between SXscore tertiles and TC/HDL ratio (r=0.339, p=0.016) and Non-HDL (r=0.309, p=0.034). In regression analysis, reduced HDL and increased TC values statistically significantly predicted SXscore (p<0.05). Among all lipid variables examined, the TC/HDL ratio appeared as the most powerful indicator of severity and extension of the coronary lesion in patients with STEMI. The TC/HDL ratio should be used as an easy, non-invasive, and inexpensive method to measure the severity of CAD to determine the diagnosis strategy and treatment of patients with atherosclerotic coronary diseases at risk of acute infarction.

Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction

In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.

Quantitative flow ratio (QFR) identifies functional relevance of non-culprit lesions in coronary angiographies of patients with acute myocardial infarction

IntroductionIn patients with acute myocardial infarction (AMI) and multivessel coronary disease, revascularization of non-culprit lesions guided by proof of ischemia usually requires staged ischemia testing. Quantitative flow ratio (QFR) has been shown to be effective in assessing the hemodynamic relevance of lesions in stable coronary disease. However, its suitability in AMI patients is unknown. In this study, we tested the diagnostic value of QFR based on acute angiograms (aQFR) during AMI to assess the hemodynamic relevance of non-culprit lesions.MethodsWe retrospectively assessed the diagnostic efficiency of aQFR in 280 vessels from 220 patients, comparing it with staged ischemia testing using elective coronary angiography with FFR (n = 47), stress cardiac MRI (n = 200) or SPECT (n = 33).ResultsaQFR showed a very good diagnostic efficiency (AUC = 0.887, 95% CI 0.832–0.943, p < 0.001) in predicting ischemia of non-culprit lesions, significantly superior to coronary lesion’s geometry as assessed by quantitative coronary angiography. The optimal cut-off for aQFR to predict ischemia was 0.80 (sensitivity = 83.7%, specificity = 86.1%). Maintaining a predefined level of 95% sensitivity and specificity, we created a decision model based on aQFR: lesions with aQFR ≤ 0.75 should be treated, lesions with aQFR ≥ 0.92 do not yield any hemodynamic relevance, and lesions in the “grey zone” (aQFR 0.75–0.92) benefit from further ischemia testings. This model would allow to reduce staged ischemia tests by 46.8% without a relevant loss in diagnostic efficiency.ConclusionOur data demonstrate that aQFR allows an effective assessment of hemodynamic relevance of non-culprit lesions in AMI and may guide interventions of non-culprit coronary lesions.Graphic abstract

P6154Association between n-3 and n-6 polyunsaturated fatty acids and plaque vulnerability by optical coherence tomography in acute myocardial infarction patients

Abstract Background The values of n-3 and n-6 polyunsaturated fatty acids (PUFAs) like low eicosapentaenoic acid (EPA) /arachidonic acid (AA) ratio are known to be associated with cardiovascular events, however their relationship with coronary plaque vulnerability in acute myocardial infarction (AMI) is not revealed. Purpose We evaluated the relationship between n-3 and n-6 PUFAs and coronary plaque vulnerability assessed by optical coherence tomography (OCT) in AMI patients. Methods We investigated 79 AMI lesions (51 ST elevated myocardial infarction (STEMI) lesions and 28 non-STEMI lesions) that had undergone emergency percutaneous coronary intervention using OCT. Coronary plaque characteristics by OCT were compared with n-3 and n-6 PUFAs values which were measured on admission. Results Of all AMI lesions (n=79), 43 thin-cap fibroatheroma (TCFA) and 35 plaque rapture (PR) were detected by OCT. Lesions with TCFA had no significant relationship with n-3 and n-6 PUFAs values, whereas lesion with PR had significantly lower EPA values than those without (55.8±29.5 vs 74.3±37.1 μg/ml, p=0.018). Median low-density lipoprotein (LDL) cholesterol value was 117 (98–137) mg/dl and sub-analysis in patients who had lower LDL cholesterol values than median (n=39) revealed that EPA values were significantly lower in lesions with TCFA (56.3±30.9 vs 85.3±47.7 μg/ml, p=0.03). In STEMI patients, the values of EPA and EPA/AA ratio were significantly lower in lesions with TCFA (EPA: 55.5±22.8 vs 80.8±46.1 μg/ml, p=0.01; EPA/AA ratio: 0.34±0.16 vs 0.50±0.36, p=0.03). STEMI patients who had lower LDL cholesterol values &lt;114 mg/dl of median (n=26), the values of EPA, EPA/AA ratio, and EPA+ docosahexaenoic acid (DHA) /AA ratio were significantly lower in lesions with TCFA (EPA: 51.4±20.7 vs 93.1±53.0 μg/ml, p=0.01; EPA/AA ratio: 0.37±0.16 vs 0.67±0.41, p=0.01; EPA+DHA/AA ratio: 1.13±0.41 vs 1.63±0.76, p=0.04). In STEMI patients with lower LDL cholesterol values, EPA/AA ratio positively correlated with fibrous cap thickness (Spearman, ρ=0.35, p=0.08). The cutoff value of EPA/AA ratio predicting the existence of TCFA was 0.52 (area under the curve 0.78, sensitivity 93.8%, specificity 70.0%, p=0.02). Conclusion This study demonstrated that n-3 and n-6 PUFAs values were associated with coronary plaque vulnerability by OCT in AMI patients, especially in STEMI. These results suggest that n-3 and n-6 PUFAs may be residual risk markers of severe acute cardiovascular events in patients with low LDL cholesterol values.

Experimental model of acute myocardial infarction for evaluation of prevention and rehabilitation strategies in cardiovascular diseases – a pilot study

Introduction: Acute myocardial infarction (AMI) is an important acute disease of myocardial tissue, that occurs as a result of an imbalance between coronary blood supply and myocardial demand. Isoproterenol (ISO) is a synthetic catecholamine, a beta-adrenergic agonist that produces extensive biochemical, functional, and histological alterations in the heart, characteristic for AMI. The present study has been designed to identify the best dose of ISO that induces electrocardiogram (ECG) alterations, enzymatic reaction, and histopathological changes characteristic of AMI. Material and method: AMI was induced to Wistar-Bratislava white male rats, using three different subcutaneous doses of ISO (85 mg/kg bw, 100 mg/kg bw, and 150 mg/kg bw). ISO was administrated twice, with the second dose at 24h after the initial one. The ECGs were recorded at 24 hours after the last dose of ISO. Blood samples were collected for measurement of creatine kinase (CK), and CK-MB serum levels, and the hearts were excised and prepared for histopathologic examination. Results and discussions: All doses of ISO induced alterations in the ECG patterns such as increased heart rate and prolongation of QT and QTc intervals. Depression of the ST segment coupled with marked T wave inversion were observed at the doses of 100 mg/kg bw and 150 mg/kg bw of ISO. All doses of ISO induced an elevation of CK and CK-MB with highest levels observed for the dose of 150 mg/kg bw. Histopathologic examination revealed subendocardial AMI lesions for all doses tested. Conclusions: ISO in doses of 100 mg/kg and 150 mg/kg is useful for induction of infarct-like lesion on ECG, increased levels of myocardial necrosis enzymes and morphological changes characteristic for AMI.

Chronic total occlusion intervention of the non-infarct-related artery in acute myocardial infarction patients: the Korean multicenter chronic total occlusion registry.

The Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes. Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model. After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality. In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.

P4625Functional evolution of non-culprit lesions in acute myocardial infarction. A quantitative flow ratio study

P4625Functional evolution of non-culprit lesions in acute myocardial infarction. A quantitative flow ratio study

Сравнение атеросклеротических поражений коронарных артерий у больных острым инфарктом миокарда и стабильной стенокардией по данным внутрисосудистого ультразвукового исследования

to compare noninfarct-related lesions in patients with acute myocardial infarction (MI) with culprit and non-culprit lesions in patients with stable angina pectoris (SAP) using intravascular ultrasound virtual histology (VH-IVUS).Overall 70 patients were enrolled: 38 with ST elevation (STE) MI and 32 with stable angina pectoris (SAP). All patients underwent three-vessel coronary angiography and gray-scale and VH-IVUS after percutaneous coronary intervention (PCI) of infarct-related lesion in STEMI or culprit lesion in SAP.A total of 130 plaques were examined: 70 in patients with STEMI and 60 in patients with SAP. Noninfarct-related lesions in acute MI compared with non-culprit lesions in SAP had significantly larger plaque burden and plaque volume, smaller minimum lumen area, and more positive remodeling. STEMI, hyperlipidemia, plaque burden, and hypertension were independent predictors of unstable plaques.

Fractional Flow Reserve in Acute Myocardial Infarction: A Guide for Non-Culprit Lesions?

In patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the optimal therapy for non-culprit lesions is still a matter of debate. While guidelines discourage a concomitant treatment of infarct- and non-infarct-related arteries, recent studies document advantages of a complete (preventive) revascularization during primary percutaneous coronary intervention. Such an approach, however, may result in overtreatment, because angiography does not provide robust information about the functional severity of MVD. Fractional flow reserve (FFR) measurements can be a valuable guide for non-culprit lesions in acute myocardial infarction, but so far, only the reliability and safety of FFR measurements have been established in this setting. The clinical implications of an FFR-guided treatment strategy in STEMI patients with MVD are currently being tested in a large randomized trial.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-015-0040-4) contains supplementary material, which is available to authorized users.

Unique antibody responses to malondialdehyde-acetaldehyde (MAA)-protein adducts predict coronary artery disease.

Malondialdehyde-acetaldehyde adducts (MAA) have been implicated in atherosclerosis. The purpose of this study was to investigate the role of MAA in atherosclerotic disease. Serum samples from controls (n = 82) and patients with; non-obstructive coronary artery disease (CAD), (n = 40), acute myocardial infarction (AMI) (n = 42), or coronary artery bypass graft (CABG) surgery due to obstructive multi-vessel CAD (n = 72), were collected and tested for antibody isotypes to MAA-modifed human serum albumin (MAA-HSA). CAD patients had elevated relative levels of IgG and IgA anti-MAA, compared to control patients (p<0.001). AMI patients had a significantly increased relative levels of circulating IgG anti-MAA-HSA antibodies as compared to stable angina (p<0.03) or CABG patients (p<0.003). CABG patients had significantly increased relative levels of circulating IgA anti-MAA-HSA antibodies as compared to non-obstructive CAD (p<0.001) and AMI patients (p<0.001). Additionally, MAA-modified proteins were detected in the tissue of human AMI lesions. In conclusion, the IgM, IgG and IgA anti-MAA-HSA antibody isotypes are differentially and significantly associated with non-obstructive CAD, AMI, or obstructive multi-vessel CAD and may serve as biomarkers of atherosclerotic disease.

Determination of the severity of underlying lesions in acute myocardial infarction on the basis of collateral vessel development

We aimed to address the conflict over whether the underlying lesion that leads to acute myocardial infarction (AMI) is representative of low-grade or high-grade stenosis. Because the development of collateral vessels is an indication of ischemia, their presence was used as a surrogate marker for the existence of a high-grade lesion. Coronary angiography was used to assess 159 patients, divided into two groups, with (Rentrop 1-3) and without (Rentrop 0) collateral vessels, who had AMI with ST-segment elevation for which they underwent a percutaneous coronary intervention with the implantation of a coronary stent and had baseline thrombolysis in myocardial infarction 0/1 flow. Of the 159 patients recruited, the presence of collateral vessels was detected in 95 (collateral group; 60%), indicating that the causal lesion was representative of a high-grade stenosis. Among these 95 patients, the Rentrop scores were 1, 2, and 3 in 57 (60%), 33 (34.7%), and six (5.3%) patients, respectively. Logistic regression analysis showed that a baseline thrombolysis in myocardial infarction 0 flow (hazard ratio, 4.6; 95% confidence interval, 1.4-14.6; P=0.01) and a culprit right coronary artery (hazard ratio, 3.0; 95% confidence interval, 1.4-6.2; P=0.007) were independent predictors of the development of collateral vessels. The majority of AMI cases can be attributed to a severe stenosis, as demonstrated by the presence of collateral vessels in 60% of the patients in this study.

Histopathology of aspirated thrombi during primary percutaneous coronary intervention in patients with acute myocardial infarction.

Thrombus aspiration in the setting of primary percutaneous coronary intervention is a recently recommended technique that facilitates thrombus removal from the culprit lesions in acute myocardial infarction (AMI) patients. Thrombectomy specimens from 50 patients with symptoms of AMI lasting usually not more than 12 h were examined by methods of routine histology, immunohistochemistry (IHC), and electron microscopy (ELMI). In 36 patients, there were fresh thrombi, in 10 older thrombi (8 of them with simultaneous presence of a fresh thrombi) and in 3 atheroma material only (in additional 7 patients atheroma material was admixed to the thrombi), and in one patient, there was carcinoma embolus. To help to distinguish between fresh and older thrombi, we recommend IHC (presence of macrophages and endothelia) and ELMI (loss of density of the erythrocyte matrix and presence of macrophages). On the other hand, changes of neutrophils (IHC degranulation/lysis) and of platelets (ELMI degranulation) appear early and thus contribute little to distinguishing between fresh and older thrombi. It could be concluded that, in a substantial proportion of patients with AMI, there is a discrepancy between duration of the symptoms and microscopic picture of the coronary thrombus. The thrombus may apparently be symptomless for a period of days or even weeks.

Molecular imaging of atherosclerosis: clinical state-of-the-art

Physicians depend greatly on imaging techniques that help them make clinical decisions. However, when a diagnosis is made on the basis of anatomical imaging alone, the disease process has often...

Left circumflex artery lesions in acute myocardial infarction

Left circumflex artery lesions in acute myocardial infarction

Diagnostic value of CTA in acute occlusion of coronary arterys

Objective To review the diagnostic value of CT angiography (CTA) (64-layer spiral CT) in coronary artery diseases in the recovery period of acute myocardial infarction (AMI) patients.Methods Coronary angiography (CAG) was taken as the gold standard,CTA and CAG were compared in 126 cases of recover-term AMI patients who underwent emergency PCI,to evaluate the value of CTA in the diagnosis of AMI lesions and distal vascular lesions.Results The sensitivity of CTA to recanalization in AMI lesions was 86.89％,specificity was 93.85％,positive predictive value was 92.98％ and negative predictive value was 88.41％.It was the most valuable diagnostic capabilities of the left anterior descending branch.In spite of the infarct-related artery reperfusion or nonreperfusion,the diagnostic value of CTA in distal vascular lesions were consistent with CAG(r=0.8123,P ＜ 0.01).Conclusion CTA can accurately diagnose coronary artery recanalization in AMI,and provide a primary diagnosis for the infarct-related lesion beyond related vessels. Key words: CTA; Coronary arterys; Diagnosis

Plaque shift and distal embolism in patients with acute myocardial infarction

Vessel expansion and axial plaque redistribution or distal plaque embolization contribute to the increase in lumen dimensions after stent implantation. Preintervention and postintervention grayscale volumetric intravascular ultrasound was used to study 43 de novo native coronary lesions treated with TAXUS or Express bare metal stents in the HORIZONS-AMI Trial. There was a decrease in lesion segment plaque + media (P + M) volume (-19.5 ± 22.2 mm(3) ) that was associated with a decrease in overall analysis segment (lesion plus 5 mm long proximal and distal reference segments) P + M volume (-17.5 ± 21.0 mm(3) ) that was greater than the shift of plaque from the lesion to the proximal and distal reference segments (1.9 ± 4.5 mm(3) , P < 0.0001). Overall analysis segment P + M volume decreased more in the angiographic thrombus (+) versus the thrombus (-) group (27.4 ± 23.4 vs. -8.9 ± 14.3 mm(3) , P = 0.003), whereas plaque shift to the reference segments showed no significant difference between the two groups (1.5 ± 5.2 vs. 2.3 ± 3.9 mm(3) , P = 0.590). Compared with the angiographic thrombus (-) group, patients in the thrombus (+) group more often developed no reflow (25% vs. 0%, P = 0.012) and had a higher preintervention CK-MB (P = 0.011), postintervention CK-MB (P < 0.001), and periprocedural (post-PCI minus pre-PCI) elevation of CK-MB (P = 0.001). In acute myocardial infarction lesions, there was a marked poststenting reduction in overall plaque volume that was significantly greater in patients with angiographic thrombus than without thrombus and may have explained a greater periprocedural rise in CK-MB.