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Objective: To evaluate the effects of ticagrelor and high-dose clopidogrel on the platelet functions in patients with inadequate response to clopidogrel. Methods: In this prospective, randomized and controlled study, patients who had been diagnosed as acute coronary syndrome (ACS) with inadequate response to clopidogrel in the Second Hospital of Hebei Medical University from July 2015 to June 2016 were enrolled. Inadequate response to clopidogrel was defined as absolute reduction of platelet aggregation rate (PAR) 70%. Eligible patients were randomly assigned to two groups, the high-dose group and the ticagrelor group. Clinical information and intervention protocols were compared. The PAR of the two groups were measured at the time of baseline, the 24th hour, 72nd hour, and the 7th day after treatments, the other platelet-related parameters were measured including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) at the same time points. Besides, the markers of platelet activation human P-selectin (CD62P) and thromboxane A2 (TXA2) were also recorded to compare. The incidence of major adverse cardiac events (MACE) and the side effects between two groups were followed up for three months. Results: A total of 74 patients were finally enrolled, 38 of whom were assigned to the ticagrelor group and the rest of them to the high-dose clopidogrel group. The baseline clinical and procedural characterists were similar. There were no significant differences in baseline levels of PAR between the two groups [(79.38±11.20)% vs. (73.97±12.74)%, P>0.05]. For both groups, the levels of PAR significantly decreased at each time point (P0.05), and there were no significant differences in the levels of PLT, PDW, and MPV at the 24th hour, 72nd hour and 7th day. It was lower in ticagrelor group than that in clopidogrel group at the 24th hour [(5.47±1.03) ng/ml vs. (8.02±1.45) ng/ml, P

Left ventricular aneurysm (LVA) after myocardial infarction often results in serious complications. So far, when the LVA happened is unclear. Furthermore, it is a question whether percutaneous coronary intervention (PCI) can change or reverse the formation of LVA? And the report about the long term follow-up was rare. So this study was to evaluate the time sequence of the formation of LVA through left ventriculography in large scale of consecutive acute myocardial infarction (AMI) patients and evaluate the influence of PCI at different time after AMI on the change of systolic synchrony through phase analysis of equilibrium radionuclide angiography. The change of serum brain natriuretic peptide (BNP) was also measured to investigate its association with LVA. And follow up to 3 years to record the major adverse cardiac events. Total of 326 consecutive patients of anterior AMI with LVA were enrolled into this study. All patients were divided into four groups according to the time 'onset to balloon': group A (3 h), group B (or =3 andor =6 h), group C (6 andor =12 h) and group D (1 week). The paradox volume image as well as the parameters of left ventricular function and systolic synchrony were measured by equilibrium radionuclide angiography at 1 week and 6th month after AMI. Plasma BNP was measured in different time after AMI. The major adverse cardiac events were recorded up to 3 years. At the 6th month after AMI, left ventricular ejection fraction, peak ejection rate and peak filling rate in group A, B and C were significantly increased than those in group D while phase shift and peak phase standard deviation were decreased significantly (P0.05, respectively). At 6th month after AMI, the paradox volume index in group A was lowered than that in group B, C, and D (P0.05, respectively). In 18th hour, 5th day and 24th week after AMI, the values of BNP in group D were higher than those in group A, B and C (P0.05, respectively). There was not significantly different between group B and group C. Within the 3rd year follow-up, the incidences of angina post-AMI and mortality in group A, B, and C were significantly lowered than those in group D (P0.05, respectively). The LVA can formate shortly after the AMI. The early, fully and permanently patency of infraction related artery can effectively inhibit the left ventricular remodeling process, prevent LVA formation, improve its function and prognosis.

Contrast-induced nephropathy limits the outcomes of percutaneous coronary intervention (PCI). The present study compared the protective effects of different statin doses on renal function. A total of 228 patients with acute coronary syndrome undergoing selective PCI were randomly divided into simvastatin 20-mg group (S20, n = 115) and simvastatin 80-mg group (S80, n = 113). Serum creatinine was measured at admission, the day of PCI, and 24 and 48 hours after PCI. The creatinine clearance was calculated using the Cochcroft-Gault formula. High-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 were also measured before and after the procedure. Contrast-induced nephropathy was defined as a postprocedure increase in serum creatinine ofor =0.5 mg/dl or25% from baseline. The serum creatinine significantly increased after PCI, with the peak value occurring at 24 hours, and then began to decrease. At 48 hours, the serum creatinine had decreased to the baseline level in the S80 group, but it had failed to do so in the S20 group. At 24 and 48 hours after PCI, the serum creatinine was lower in the S80 group than in the S20 group (p0.05 and p0.001, respectively). The creatinine clearance significantly decreased after PCI, with the lowest value occurring at 24 hours, and then it began to increase. In the S80 group, the creatinine clearance recovered to baseline level at 48 hours, but it failed to do so in the S20 group. The creatinine clearance was greater at 24 and 48 hours in the S80 group than that in the S20 group. Although the procedure caused a significant increase in high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels, the value was lower in the S80 group than in the S20 group (p0.001). In conclusion, pretreatment with simvastatin 80 mg before PCI could further decrease the occurrence of contrast-induced nephropathy compared with simvastatin 20 mg. This benefit was associated with the lowering of high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels.

Objective To probe the clinical effect, safety, economic benefit and cost of early PCI after thrombolysis with reteplase in the treatment of STEMI. Methods Patients with STEMI who admitted in our hospital from June 2009 to December 2010 were included in this study. A total of 71 patients whose symptom and ECG indicated the sign of repatency with residual stenosis of IRA>75% was divided into early PCI group (35 cases) and elective PCI group (36 cases). PCI was performed 6 h after thrombolysis in early PCI group, and 7 to 10 days after onset of AMI in elective PCI group. The clinical data, rate of coronary repatency, stenosis degree of coronary, thrombolysis in myocardial infarction flow grade pre-PCI and post-PCI, as well the TIMI myocardial perfusion grading (TMPG) were compared between the two groups. Echocardiography was performed 1 week and 3 months after onset of AMI respectively to evaluate the left ventricular function. The major adverse cardiac events (MACE) in hospital after AMI were followed up and compared between the two groups. The in-hospital stay and charges were also calculated and compared between the two groups. Results There were no statistic significances between the two groups in baseline characteristics. There were no significant differences in TIMI flow grade before PCI between the two group (all p>0.05). The repatency rate of IRA (TIMI flow grade 2 and 3) before PCI in early PCI group was 96.9%, while it was 89.5% in elective PCI group (p>0.05). The complete repatency rate (TIMI flow grade 3) in early PCI group was higher than that in elective PCI group (p 0.05). The left ventricular function in early PCI group at 1 week after AMI was no significant difference compared with that in elective PCI group (all p>0.05). Though the LVEDVI, LVESVI and LVEF 3 months after PCI were not significantly different between the two groups (all p>0.05), the value of LVEDVI and LVESVI at 3 months after AMI decreased significantly compared with that 1 week after AMI in early PCI group (both p 0.05). The in-hospital stay in early PCI group was shorter than that in elective group (p Conclusions Early PCI after thrombolysis repatency with reteplase in STEMI patients can improve the coronary blood flow and myocardial perfusion. There is also improvement in heart function and inhibit myocardial remodeling, as well as decrease in the in-hospital stay and cost compared with elective PCI.

Objective To investigate anisodamine for the prevention of Contrast Induced Nephropathy (CIN) in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods Consecutive patients undergoing primary PCI were randomly assigned to one of two groups: (1) patients in anisodamine group (ANI group) were assigned to receive anisodamine (3–4 ug/kg/min intravenous infusion of anisodamine within 30 min before primary PCI), (2) control group (CON group) to isotonic saline (0.9%) with the same volume. All patients were hydrated with intravenous isotonic saline (0.9%) for 12 h after PCI. The Serum creatinine (SCr) concentrations, estimated glomerular filtration rate (eGFR) and incidence of CIN were measured and compared at admission, 24, 48 and 72 h after PCI between the two groups. Results A total of 126 consecutive STEMI patients were randomly assigned to receive anisodamine (n=60) or placebo (control, n=66) from admission to 24 h after PCI. The renal function of all patients after PCI underwent a course from injury to recovery. The incidence of CIN was 5.0%, 8.3%, and 6.7% at hour 24, 48 and 72 respectively after primary PCI in ANI group, while in CON group it was 16.7%, 22.7%, and 19.7% respectively. The incidence of CIN in ANI group was lower than that in CON group within 72 h after PCI (all p Conclusions Intravenous infusion of anisodamine prior to primary PCI may prevent the incidence of CIN in STEMI patients.

Objective To assess the beneficial efficacy and safety of the high maintenance dose of clopidogrel in acute anterior myocardial infarction (AMI) patients undergoing selective percutaneous coronary intervention (PCI). Methods Fifty two patients were enrolled into this study. These cases were randomly divided into the high maintenance dose group (n=26, 14 males, 150 mg clopidogrel per day) and the control group (n=26, 15 males, 75 mg clopidogrel per day). QCA and TIMI Myocardial perfusion grading (TMPG) were used to analyse the lesion and reperfusion of the culprit vessel and myocardium. Record the information of patients in-hospital, in the 1 month and 6 months including the level of BNP, left ventricular ejection fraction (LVEF), the left ventricular peak ejection rate (LPER), the left ventricular peak filling rate (LPFR), the left ventricular time to peak ejection rate (LTPER) and left ventricular time to peak filling rate (LTPFR). Result 1. The CTFC of the high maintenance dose group after PCI was smaller than the standard dose group. The percentage of TMPG 3 grade was higher in the high maintenance dose group. 2. The left ventricular peak ejection rate (LPER), the left peak filling rate (LPFR) 6 months after PCI in the high maintenance dose group was higher than the control group. The left ventricular time to peak ejection rate (LTPER), left ventricular time to peak filling rate (LTPFR) 1 month after PCI in the high maintenance were lower than the control group. 3. There were less acute and subacute thrombosis cases in the high maintenance dose group than the standard dose group. There was no significant difference in haemorrhage events between two groups. Conclusion The high maintenance dose clopidogrel can improve cardiac function. There is potential benefit in increasing coronary blood flow and improving myocardium perfusion. High maintenance dose clopidogrel decreases the acute and subacute thrombosis but do not increase the haemorrhage events.

Objective To evaluate the method of yorkpig model of AMI-ADHF by coronary occlusion with balloon and injecting of microembolus and evaluate the change of coronary and renal haemodynamic parameters on York pig model on AMI-ADHF. Methods 10 York pigs were selected in this trial. LAD was occluded by balloon which was placed on mid-distal for 30–45 min until ST segment elevation for 15 min. After deflating the balloon, the sterile microembolus were injected into LAD intermittently and injecting stopped until LVEDP>18 mm Hg. The coronary pressure and flow velocity were recorded simultaneously at baseline, instant, 30 min and 60 min after AMI-ADHF model success. Average peak velocity (APV), coronary resistance and coronary flow reserve were obtained at basic and maximal hyperaemia. Renal artery angiography was performed and renal artery diameter and pressure was measured. Doppler flowire was placed in renal artery for measure of APV of renal artery (APV ra ), renal artery vascular resistance and renal blood flow. At the same time ECG were recorded per 15 min. CK-MB and TnI were measured in all York pigs at baseline, 2 h, 4 h, 8 h, 12 h and 24 h after reperfusion. Cardiac ultrasonograph was performed to evaluate the heart function. Results (1) According to the standards of AMI-ADHF, eight models were successfully established. (2) Basic and hyperaemia APV were all decreased significantly, they were lower than that of before AMI-ADHF. coronary resistance was increased after AMI-ADHF model success. coronary flow reserve was lower than that of baseline. (3) Renal artery pressure has increased trend than baseline. renal artery vascular resistance was increased, APVr and renal blood flow was decreased than baseline. Conclusion A stable experimental method of York pig model of AMI-ADHF was established successfully by coronary occlusion with balloon and injecting of microembolus in LAD. The method had advantages of closed chest, higher succeed rate and stablility to those of drug induced, tachycardia-pacing induced, coronary artery ligation induced or microsphere injection alone.

Objective To evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischaemic injury during PCI. Methods A total of 228 acute coronary syndrome (ACS) patients were randomly divided into standard statin group (SSG, n=115) and intensive statin group (ISG, n=113). Patients in SSG received 20 mg simvastatin and patients in ISG received 80 mg simvastatin for 7 days before PCI. TIMI grade flow (TGF), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Plasma level of CK-MB and cTnI were measured before and 24 h after the procedure. Results The TFG after stent deployment was significantly improved with less TIMI 0–1 patients and more TIMI 3 blood flow in ISG than in SSG (all p Conclusion Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect myocardium from ischaemic injury.

Objective To investigate clinical effects of clopidogrel combined with simvastatin or fluvastatin on the platelet aggregation rate (PAR), platelet activation marker CD62P and the incidence of major adverse cardiovascular events (MACE) in patients with ACS. Methods From April 2008 to December 2009, one hundred patients (79 male and 21 female, average age 61.46±12.84 years) who had been diagnosed as ACS were enrolled into this study. These cases were randomly divided into two groups, the Group A (n=50, treated with simvastatin 20 mg per night); the Group B (n=50, treated with fluvastatin 40 mg per night). Detailed clinical information was collected. PAR, CD62P, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) of the two groups were measured. All cases received clopidogrel (a loading dose of 300 mg and then 75 mg daily), aspirin and Low molecular weight heparin. The MACE within 14 days were recorded. Results There was no significant differences in baseline between the Group A and Group B. There was no significant differences in the PAR and expression rate of CD62P after 300 mg clopidogrel (p>0.05). 1h after treated with statins the expression rate of CD62P and PAR in the two groups were lower than that before treated with statins (p 0.05). After the above-mentioned medical treatment, the expression rate of CD62P and PAR in the two groups were similar (p>0.05). There were no significant differences in the incidence of MACE between two groups. Conclusion ACS patients with loading dose clopidogrel combined with simvastatin or fluvastatin could decrease the MACE, the results in two groups are similar. Neither simvastatin with clopidogrel nor fluvastatin with clopidogrel decreases the platelet activity of clopidogrel.

Objectives Anisodamine is widely used in the therapy of acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy (CIN) in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty. Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate of (eGFR) 60 ml/min/1.73 m 2 or less undergoing coronary angiography or angioplasty were randomly assigned to receive infusion of either sodium chloride (control group, n = 128) or anisodamine (treatment group, n = 132). Patients in treatment group received infusion of anisodamine at a rate of 0.2 μg/kg/min from 12 hours before to 12 hours after coronary angiography or angioplasty, while patients in control group received infusion of sodium chloride as the same volume as treatment group. All patients received intravenous sodium chloride hydration. Contrast-induced nephropathy is defined as a 25% increase in serum creatinine from baseline or an absolute increase of > 0.5 mg/dl within 3 days after contrast exposure. The primary end point was the incidence of CIN. The secondary end point was 25% or greater reduction in eGFR. Results There were no significant differences between two groups with regard to age, gender, risk factors, laboratory results, medications and intervention. The incidence of CIN was 9.8% (13/132) in treatment group and 20.3% (26/128) in control group ( P P Conclusions These results indicate the preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty.

Objectives To evaluate the additional benefit of preventive administration of anisodamine to tirofiban during primary PCI on myocardial reperfusion. Methods This study was prospectively observed the hemodynamic effects of anisodemine in STEMI patients undergoing early PCI following thrombolysis. From March 2010 to December 2010, consecutive STEMI patients within 12 h after thrombolysis were enrolled. All eligible patients were randomly assigned to anisodamine group (ANI) and control group (CON). Patients in ANI group received intracoronary bolus injection of anisodamine (2000 µg, 10 ml) over 2 min according to the heart rate and blood pressure, and the same volume of 0.9% sodium chloride in the CON group. The other medications and laboratory examinations were the same as phase 1. The primary end point was the level of TMPG after PCI, and the second end points were including the hemodymanic parameters, STR, peak level of CK-MB, TIMI flow grade and major adverse cardiac events after PCI. Results Seventy-six patients were prospectively enrolled, with 39 in ANI group and 37 in CON group. No significant differences in baseline clinical data and baseline angiography data were found (all p>0.05). Compared to CON group, the rate of TMPG 3 was higher in ANI group, while the CTFC was lower (both p Conclusions Intracoronary administration of anisodamine before PCI could improve the myocardil perfusion which may be result in the hemodynamic effects of anisodamine.

Objectives This study was to investigate the safety and efficacy of thrombolysis followed by early PCI via transradial artery approach in patients with ST-segment elevation myocardial infarction (STEMI). Methods From September 2009 to March 2010, all consecutive STEMI patients within 12 h from symptom onset or thrombolysis in the Department of Cardiology of the Second Hospital of Hebei Medical University were enrolled. All eligible STEMI patients were divided into two groups according to patients received thrombolysis or not: early PCI group (E-PCI group, patients received thrombolytic agents in non-PCI capable hospital and immediately transferred to receive early PCI) and primary PCI group (P-PCI group, patients received primary PCI). Coronary angiography (CAG) and PCI were performed immediately after admission via transradial artery approach for patients in both groups with standard technique. According to the results of angiography, PCI was performed unless the blood flow of IRA achieved TIMI flow grade 3 without significant stenosis. Thrombus score, TIMI flow grade (TFG) of IRA before and after PCI, corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG) post PCI were analysed. Bleeding complications was also observed and evaluated. All patients were followed up for 6 months to assess major adverse cardiac events (MACE). Results A total of 161 cases were enrolled, with 53 cases in E-PCI group and 108 cases in P-PCI group. The patients in E-PCI group were younger than those in P-PCI group (51.36±12.24 vs 57.31±9.87, p=0.003). The other baseline clinical characteristics such as gender distribution, baseline levels of serum BNP, SCr and Hb, and the medication therapies were similar between the two groups (all p>0.05). The mean time from symptom onset to thrombolysis was 3.62±1.85 h in E-PCI group, and the time from thrombolysis to PCI was 5.13±3.03 h. Compared to P-PCI group, the mean time from onset to PCI was longer in E-PCI group (8.75±2.86 vs 6.03±3.19 h, p 0.05). However, cTFC of IRA post PCI in E-PCI group was lower than that in P-PCI group (28.12±5.06 vs 30.89±8.74, p 0.05). There was a trend toward lower in the peak value of serum CK-MB in E-PCI group. No significant differences were found in the incidence of bleeding complications and hospital stay between the two groups. There was a trend of better left ventricular function 7 days after PCI in E-PCI group than that in P-PCI group. After 6-month follow-up, the left ventricular function was improved in both the two groups (all p Conclusions The myocardial perfusion and left ventricular function were better in patients underwent thrombolysis followed by early PCI, without increases of bleeding complications and incidence of MACE. It is safe and efficacious for STEMI patients to receive thrombolysis followed by early PCI via transradial artery approach.

Objective To explore preventive effects of intracoronary administration of Anisodamine on myocardial microcirculation perfusion after primary PCI in STEMI patients. Methods From March 2009 to August 2010, a total of 86 consecutive patients with first STEMI who underwent primary PCI within 12 h of symptom onset were enrolled in this study. Patients were divided into anisodamine group (n=43) and saline control group (n=43) randomly. The lesion of IRA was treated by percutaneous transluminal coronary angioplasty with over the wire balloon. In anisodamine group, 2000 ug anisodamine (concentration 500 ug/ml) was injected into the coronary artery as a preventive measure via over-the-wire-balloon. In control group, equal volume of saline was injected into the coronary artery in the same way. After that the lesion was predilated with the balloon. Angiography was done after 5 min of stent implanted, CTFC and TMPG were recorded and compared. 200 ug nitroglycerin was bolus injected intracoronary before angiography to exclude spasm of coronary artery. The major adverse cardiac events (MACE) in hospital of the two groups were compared. Results There was no significant difference between the two groups in baseline characteristics (all p>0.05). There were no significant differences in IRA distribution, multi-vessel lesion and the use of tirofiban between the two groups. No significant differences were found in the oral drugs used after pPCI in the two groups (all p>0.05). Compared to control group, the proportion of patient with TMPG 3 grade in anisodamine group was much higher (83.72% vs 62.79%, p 0.05). The heart rate increased significantly, but no reperfusion arrhythmia happened in anisodamine group, while 10 cases of reperfusion arrhythmia (23.26%) happened in the control group (p Conclusion Preventive intracoronary administration of anisodamine can effectively improve myocardial microcirculation perfusion after primary PCI in acute STEMI, and decrease the incidence of reperfusion arrhythmia and MACE in hospital.

Objective To explore the safety and efficacy of early application of tirofiban in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Methods From September 2008 to march 2011, 157 STEMI patients who were preparing for PCI were enrolled into this study. All patients were randomly divided into early group (patients received tirofiban in emergency room) and late group (patients received tirofiban immediately before PCI in catheterisation laboratory). The patients in each group were divided into different subgroups after coronal artery angiography on the basis of characteristic of infarction related artery (IRA). The clinical information, the result of PCI, and the incidence of major cardiovascular adverse events (MACE) during the hospitalisation were compared between two subgroups. Results There were no significant difference in percentage of TIMI3 flow of IRA before PCI between early and late LAD group (p>0.05). However, TIMI 3 flow was significantly less frequent with late RCA group compared with that in early RCA group (p>0.05). After dilation with balloon, cTFC was significantly lower in early LAD group (p>0.05). In the RCA comparison group, early application of tirofiban was associated with lower cTFC in culprit vessel compared with late application of tirofiban (30.00±6.32 vs 36.36±8.83, p 0.05), and TMPG2/3 perfusion was significantly less frequent with late RCA group (74% vs 47%, p 0.05). There were no significant difference in the percentage of no-flow and slow-flow between early and late LAD group during the PCI (p>0.05), and percentage of no-flow and slow-flow was significantly lower in early group than in late group (6% vs 22%, p Conclusions Early application of tirofiban could improve the effect of primary PCI and could effectively limit the expansion of infarction area. Early application of tirofiban dose not increases the incidence of MACE during the hospitalisation.

Objectives To investigate the safety and efficacy of early percutaneous coronary intervention (early PCI) in patients with non-ST Segment elevation infarction (NSTEMI) undergoing elective PCI. Methods Ninety-one patients (79 males) who suffered from first NSTEMI within 24 h from symptom onset during October 2009 and July 2010 were enrolled in this study. All the cases were randomly divided into early PCI group (n=44) and elective PCI group (n=47). PCI was performed immediately after admission in early PCI group. Patients in elective PCI group received the same medical therapies with those in early PCI group, and PCI was performed 7–10 days after admission. TIMI flow of IRA before and after PCI, as well as TIMI Myocardial perfusion grading (TMP) after PCI were compared between the two groups. The differences of left ventricular function and MACE during hospitalisation and 6-month follow-up were analysed. Results Baseline characteristics were similar between the two groups. There were no differences in the rates of IRA total occlusion, TIMI flow grade 1, and TIMI flow grade 2 before PCI between the two groups (all p>0.05), while the rate of TIMI flow grade 3 in early PCI group was lower than that in elective group (22.73% vs 42.55%, p 0.05). After 6-month follow-up, both LVEDV and LVESV decreased significantly, and LVEF increased. The incidence of cardiac rehospitalisation was lower in early PCI group, while the cardiac death, severe heart failure, reinfarction, malignant arrhythmias, revasculisation of IRA, and bleeding complications were similar. Conclusions Both early and elective PCI can improve the heart function in NSTEMI patients at 6 months, and the effects of early PCI on improving heart function is better without increase of bleeding complications.

Objective To analysis the relationship between BNP levels and CK-MB, cTNI concentrations, the degree of coronary artery disease and heart function in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 86 patients with AMI got intravenous thrombolysis within 6 h after myocardial infarction were divided into group A (BNP 500pg/ml) according to the BNP peak level. The BNP level, CK-MB, and the cTNI peak concentrations within 24 h were examined. The heart function was examined by UCG within one week, cardioangiography was performed within 7–10 days after AMI, so that to evaluate the relationship between BNP levels and CK-MB, cTNI concentrations, the degree of coronary artery disease, heart function. Result There were no statistical differences in baseline data among A, B, C groups, the higher the BNP level. The higher the CK-MB level (p Conclusion The higher the BNP peak levels, the higher the CK-MB, cTNI levels and the lower the LVEF in acute myocardial infarction patients. The between BNP peak levels had positive with CK-MB, cTNI peak concentrations and the degree of coronary artery disease, negative correlation-ship with LVEF.

Objective To assess the efficacy and safety of the tirofiban in acute coronary syndrome patients with clopidogrel resistance undergoing selective percutaneous coronary intervention (PCI). Methods A total of 90 acute coronary syndrome patients with clopidogrel resistance were randomised into two groups, the high maintenance clopidogrel group (HMCG, n=50) and the tirofiban group (TG, n=40). All the patients underwent PCI after 7-10 day9s medical treatment. Clinical information was collected. The platelet aggregation rate (PAR) were measured, and the markers of platelet activation, PAC-1 and CD62P were measured. Result There was no significant difference in baseline data between two groups. The expression rate of CD62P and PAC-1 in HMCG and TG were higher than the normal control group, but no difference between clopidogrel group and the tirofiban group. After the medical treatment the expression rate of CD62P and PAC-1 in TG is higher than that in HMCG (p Conclusion 150 mg/d clopidogrel can inhibit the activation of platelet but 75 mg/d clopidogrel can9t in patients of ACS with clopidogrel resistance. Tirofiban can decreases the MACE cases of patient with clopidogrel resistant during PCI but do not increase the haemorrhage events.

Objective To compare the effects of biventricular synchronous pacing with different pacing site on coronary Blood flow (CBF), myocardial oxygen consumption (MVO 2 ) and cardiac work efficiency (CWE). Methods RA-cHisB and RA-RVA sequential pacing, RVA-LVPL and cHisB-LVPL pacing, RA-RVA-LVPL and RA-cHisB-LVPL pacing were randomly performed in 14 dogs with general-anaesthetised, opened chest and artificial-ventilation. SNR was as self-control. Every pacing mode was to capture SNR for 20 min with a recovery of physiologic parameters for 10 min, and then shift another pacing mode in turn. CFB and CO were measured by a electromagnetic flowmeter. Blood sample were respectively collected from the catheters in left ventricle and coronary sinus for getting the arterial O 2 saturation (SaO 2 ), coronary sinus O 2 saturation (ScsO 2 ) and Hgb. Results No significant difference in CBF among the RA-cHisB-LVPL, RA-RVA-LVPL and RA-cHisB pacing were found. CBF in RA-RVA pacing was decreased than that in RA-cHisB-LVPL, RA-RVA-LVPL and RA-cHisB pacing. MVO 2 among the all groups had no significant changes compared with each other. CO of RA-cHisB, RVA-LVPL and cHisB-LVPL pacing were increased as compared with that in RA-RVA pacing (p 2 . Conclusion The biventricular synchronous pacing have the beneficial effects on maintaining the balance between myocardial oxygen supply and consumption and increasing CWE by enhancing the cardiac ejection performance.

Objective To compare the feasibility and safety of TUA-PCI to TRA-PCI (transradial artery PCI). Methods A total of 320 patients from 38 to 80 years old were randomised into transradial artery PCI group and transulnar artery group. The time of manipulative duration for each procedure of PCI was recorded. The time of Allen9s test, lumen diameter (mm), cross area of vessel lumen (mm 2 ), blood velocity (Vs max), blood flow resistance index in ulnar and radial artery were measured and recorded, respectively, as well were compared quantitatively before and after PCI procedure. Result In each group the success rate of puncture of access artery was 98.7%, because each group had two cases failed and transferred to another group. In PCI-TRU group 212 lesion segments of 178 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter and 215 stents were implanted. The average time of manipulative duration of guiding catheters engaging in ostium of target coronary artery, the average time of under x-ray fluoroscopy and the total time of the whole procedure were no significant difference between the PCI-TRU group and the PCI-TRA group. In PCI-TRA group 210 lesion segments of 177 vessels in were angioplasticized successfully via TRA by 6F guiding catheter and 214 stents were implanted. When the introducer was taken off, with maintaining heparin infusion immediately after procedure, the access site in ulnar or radial artery was compressed by a tourniquet for 6 h and the compress pressure were gradually decreased, and it was unnecessary to limit the ambulance of the patients. The average hospital stay was no statistic significance between PCI-TRU group and PCI-TRA group (p>0.05). No significant change was found in the parameters of the vessel diameter, blood velocity, cross area of vessel lumen, blood flow resistance index and the level of blood oxygen in finger and no complication such as occlusion of ulnar or radial artery in all patients following up 1 month after PCI procedure. Conclusion Transulnar artery PCI was as safety and efficacy as transradial artery, the ulnar artery might be selected as one approach of antebrachial artery for PCI in patients with coronary heart disease.

Objective To evaluate the effect and safety of clopidogrel plus tirofiban in percutaneous coronary intervention (PCI) of acute myocardial infarction via transradial approach. Methods A total of 104 patients with ST segment elevation myocardial infarction who were underwent emergency PCI were randomised into two groups: clopidogrel combined tirofiban group (n=48) and clopidogrel group (n=56). Bolus tirofiban (10 μg/kg) was infused in 3 min before PCI and then 0.15 μg/kg/min continued pumping for 24 h in the clopidogrel combined tirofiban group, while saline was used in the same way in the clopidogrel group. The TIMI flow grade in IRA before PCI, after the first guide wire getting through and instant post-PCI were recorded and compared between the two groups. The myocardial blush grade post-PCI and heart function were analysed and compared between the two groups. Hemorrhagic complications and MACE in-hospital were monitored and followed up. Results The percentage of TIMI flow grade 1 of IRA before PCI was higher in the clopidogrel combined tirofiban group than that in the clopidogrel group (p Conclusions Clopidogrel combined tirofiban used during the emergency PCI for AMI via transradial approach can quickly inhibit the platelet aggregation, decrease thrombosis event, improve blood flow of IRA and increase the perfusion of myocardial microcirculation as well preserve the function of left ventricle and reduce the incidence rate of MACE during in-hospital, while not associate with increasing the incidence rate of serious haemorrhage complications.

Objective To compare the outcomes of IIb/IIIa antagonist assisted PCI within 12–72 h of onset with that of selective PCI within 7–10 days in STEMI patients. Methods Totally, 80 patients were randomly allocated into the delayed PCI group (n=38) and the selective PCI group (n=42). In the delayed PCI group, PCI was performed within 12–72 h of onset. Tirofiban (10 μg/kg) was administered intravenously over 3 min immediately before PCI, and then was intravenously administered at 0.15 μg/kg/min during the procedure and for at least 36 h after PCI. In selective PCI group, PCI was performed within 7–10 days of onset. Blood platelet aggregation rate (PAR) was measured immediately before PCI (time 0) and at sequently different time points (30 min, 2 h, 6 h, 12 h, 48 h and 7 days). Final TIMI grade flow (TGF), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the infarction related artery were recorded. Ultrasonic cardiography (1 week and 12 week after PCI) and raidonuclear ventricle imaging (RNVI) (1 week after PCI) parameters such as left ventricular peak ejection rate (LPER), left peak filling rate (LPFR), left ventricular time to peak ejection rate (LTPER) and left ventricular time to peak filling rate (LTPFR) were performed. Bleeding complications and major adverse cardiac events (MACE) were followed up for 3 months. Results In delayed PCI group, the cases with TGF 0–1 were significantly fewer before PCI, while the cases with TGF 3, TMPG 3 were more and CTFC was lower after PCI. The LPER, LPFR 1 week after PCI in delayed PCI group was higher and the LTPER, LTPFR were lower. LVEDD at 1 week and 3 months after PCI was all significantly smaller, while the LVEF was higher. There were no significant difference between the two groups regarding the incidence of hemorrhagic complications and MACEs. Conclusion Tirofiban facilitated delayed PCI for patients with STEMI of over 12 h of symptom onset is safe and effective.

Objective To compare the effects and complications of facilitated PCI and primary PCI in AMI patients for probe the feasibility and safety of the facilitated PCI via transradial artery approach. Methods Total of 94 first-time AMI patients were randomised to group A (facilitated PCI group, n=36) and group B (primary PCI group, n=58). In group A, rt-PA 50 mg thrombolytic treatment, then transferred to catherlab for CAG and PCI at once. In group B, the patients received primary PCI via transradial artery approach. In each group, recorded detail clinical information. Recorded LVEDP and left ventricular wall movement scores through LVG. All patients received ERNA and MIBI MPI in 1 week after PCI to evaluate the heart function and myocardial infarction area. Results There was no significant differences about baseline data between two groups. The patients got reperfusion about 3 h earlier than group B, and patients with TIMI 3 grade flow were more than group B before (p Conclusions The facilitated PCI via transradial artery approach has the benefit on the reduction of infarction area and protection of left ventricular function.

Objectives The purpose of this study was to establish an rat model of CIN and to evaluate its efficacy. Methods Totally 24 SD rats were randomly allocated into experimental group (group A, n=12) and control group (group B, n=12). After dehydration for 3 days, rats in group A were given intravenous MDDS, while rats in group B were given intravenous normal saline. Then, all rats got normal water-drinking to the end of study. Renal ultrasonic examination was performed to observe the morphologic changes, diameters of renal artery and blood flow in renal artery. Blood samples were taken to measure the level of serum creatinine. The tissue of kidney were incised for microscope and electron microscope study. Results The dimensions of the two groups before and after dehydration were not different. It gradually enlarged after CM injection. These changes were the most obvious at 6 and 12 h, which did not recover at 24 h. The PSV, EDV, S/D and VTI were lowerest at 6 h and then recover to normal level at 24 h. RI was increased after CM injection, the lowest occurred at 6 h, and recovered to normal level at 24 h. Serum creatinine was significantly elevated after dehydration, the highest level occurred at 12 h and then began to recover at 24 h. Microscope examination to renal sample at 12 h found patch disappearance of tubular structure, widely congestion at medullar area. No pathological glomerular changes were found under microscope. Electron microscope examination found desquamation, sparseness of microvillous of tubular endothelium, membrane confusion, disappearance, swelling, fragmentation of the MIT, with obstructed tubular lumen and basal membrane swelling. Conclusion Combined with dehydration, intravenous injection of contrast lead to obvious acute kidney injury, with the changes of kidney tissue pathology, haemodynamics and kidney functions which are similar to the characteristics of CIN in human beings.

Objective 1. To investigate the relationship between sleep apnea syndrome (SAS) and myocadial ischaemic events in patients with coronary heart disease (CHD). 2. To compare the differences of age, gender distribution, coronary angiography results in CHD patients with and without SAS. 3. To compare the differences of C-reactive protein (CRP) and haemoglobin levels in CHD patients with and without SAS. Methods 25 CHD patients with typical symptoms of angina and ECG changes were enrolled in this study. After overnight polysomnography (PSG), all the cases were monitored by portable device at night for 7 days in order to exclude the conditions that the cases did not sleep or had waked, apnea and hypopnoea events were recorded during 24: 00–4:00. Blood samples were collected 5–10 min after monitoring, and the levels of haemoglobin and C-reactive protein were examined. Results 1. The incidence of myocardial ischaemia caused by apnea and low ventilation was significantly higher in CHD patients with SAS. 2. There were significant differences between the two groups in the decrease of oxygen desaturation and the increase of heart rate. 3. BMI in CHD patients was significantly higher in those with SAS. There were more multi-vessel lesions and long lesions in CHD patients with SAS (p Conclusion 1. The incidence of SAS is much higher in patients with CHD, and the incidence of myocardial ischaemic events is higher in CHD patients with SAS. and the more seriuos respiratory disorders, the more easily myocardial ischaemia happens. With apnea related to myocardial ischaemia and oxygen reduction, has nothing to do with the heart rate. 2. Lesions of SAS in patients with coronary heart disease are heavier than Simple CHD group in coronary angiography. BMI of SAS in patients with coronary heart disease are high than Simple CHD group. 3. The levels of CRP and haemoglobin are higher in CHD patients with SAS.

Objective To investigate the change of brain natriuretic peptide (BNP) in plasma and the relationships with the left ventricular aneurysm (LVA) and cardiac performance in acute myocardial infarction (AMI) patients using left ventriculography (LVG). Methods A total of 64 patients with primary anterior AMI accompanied LVA diagnosed by LVG were enrolled in this study and divided into LVA group (33 patients) and non-LVA group (31 patients). Plasma BNP was measured. At the immediately after PCI and 6th month after AMI, the parameters of LVEDVI, LVESVI, LVEF, WMS and LVEDP were measured by LVG. The main adverse cardiac events (MACE) were recorded during 24 week after PCI. Results The peak value of plasma BNP in LVA group was higher and the arrived time of peak values of peak time of plasma BNP was earlier than those in the non-LVA group (p Conclusions The value of plasma BNP in the AMI patients with LVA was higher than that with non-LVA, and significantly correlated with left ventricular remodelling status and homodynamic change. It is indicated that the over secretion of BNP is involved in the left ventricular remodelling and the process of LVA formation.

Objective To investigate the effects and mechanism of the pretreatment with simvastatin on the area of myocardial infarction in reperfusion injury rabbits after acute myocardial infarction (AMI). Method 20 New Zealand white rabbits were randomly divided into four groups: group A, AMI/reperfusion; group B, pretreated with simvastatin (5 mg/kg) for 3 days before AM I; group C, treated with glibenclamide (KATP channel blocker) (5 mg/kg) before AMI, group D, treated with glibenclamide and simvastatin before AMI. Models of AMI/reperfusion were established by 180-min of coronary occlusion and 60-min of reperfusion. At the end of reperfusion, the coronary artery was reoccluded, and the risk zone was delineated with Evan’ blue. Hearts were sectioned (2 mm) and incubated in 1% TTC in phosphate buffer for 20 min to define white necrotic tissue when fixed in 10% formalin for 24 h, and the level of plasma creatine kinase-MB was assessed and evaluated. Result (1)The content of CK-MB was significantly decreased in group B than that in group A and group C ( P 0.05). However, it was markedly decreased in group D (36.8±3.4%) than that of group A (P

Objective Anisodamine is a M-cholinergic receptor inhibitor that plays improvement effectiveness on the microcirculative perfusion. Our previous study had ever shown reversing effect on no-reflow phenomenon (NRP) in the miniswine models with AMI. The purpose of this study was continually to explore the effect of preventive intracoronary administration of anisodamine on myocardial microcirculation in York swines models with AMI by TIMI frame count, TIMI myocardial perfusion grade and haemodynamic parameters. Methods 18 York swines (25∼35 kg, 3∼4 months old) were divided into saline group (n=9) and Anisodamine group (n=9). Immediately after 2 ml saline and 2 mg anisodamine were injected into LAD in the two groups respectively, PMBS were injected into the coronary artery by three times with 5 min interval, then incidence of NRP was recognised by TIMI frame count and TIMI myocardial perfusion grade. TnI and CK-MB were measured before PMBS injection and at 5, 60, 120, 180 min after PMBS injection. MPP and PCWP were measured by Swan-Ganz catheter. ECG was recorded before and immediately after PMBS injection and ΣST were calculated. The changes of PR, QRS and QT duration were also compared. Results 16 of 18 York swines survived in the whole procedure. NRP was found in all of the eight swines in saline group while four of eight swines in anisodamine group. MPP (mean perfusion pressure) was slightly increased by 4.76% only in anisodamine group (p>0.05), while MPP were significant decreased by 25.23%, 23.63%, 19.66 % immediately, 3 min and 1 h after NRP in saline group (118.5±16.2 vs 88.6±12.3, 118.5±16.2 vs 90.5±14.3, 118.5±16.2 vs. 95.2±16.3 mm Hg, p Conclusion Preventive intracoronary administration of anisodamine could improve AMI survival rate with NPR by maintaining effective myocardial microcirculation status and raising coronary perfusion pressure as well decreasing the size of myocardial infarction.

Objectives To compared and evaluated the acute haemodynamic effects and safety of intravenous rhBNP versus nitroglycerin (NIT) in AMI patients with ADHF by Swan-Ganz catheter (6F, ARROW, Inc USA) monitoring through a prospectively designed study. Methods 42 consecutive AMI patients with ADHF were randomised into rhBNP group (n=21, 1.5 μg·kg −1 bolus intravenous injection followed by 0.0075 μg·kg −1 ·min −1 for the first 3 h and 0.015–0.03 μgċkg −1 ·min −1 infusion for following 21 h) and NIT group (n=21, 10 to 100 μg·min −1 intravenous infusion for 24 h). The invasive haemodynamic parameters were measured at the baseline, during 24 h of drug infusion and 6 h of post-infusion by Swan-Ganz catheter monitoring via subclavian access while total urine output during 30 h and relative serum chemistries were measured. MACE was followed up 1 week. Results As early as 30 min after the initiation of rhBNP, PCWP was reduced by 48.9% contrasted to baseline and cardiac index (CI) was increased by 27.1% at 1 h of rhBNP infusion respectively, (p 0.05), while serum potassium concentration in rhBNP group was significantly increased relative to baseline value (3.4±0.5 vs 4.0±0.4 mmol·L −1 , p Conclusions Intravenous injection of rhBNP results in more rapid, strong and prolong haemodynamic improvement than that of NIT in AMI patients with ADHF as well it is also feasible and safe in clinic as a selective agent for AMI patients with ADHF.

Objective To prospectively compare the imaging quality of CAG and feasibility in manipulation with 4Fr versus 6Fr catheters by transradial CAG. Methods A total of 866 consecutive patients who required coronary angioplasty were enrolled into this study. First, all patients underwent CAG with a 4Fr catheter by transradial approach, and 1 week later, underwent CAG with a 6Fr catheter before the coronary angioplasty by transradial approach. The handing, torque, selectivity, and stability with the 4Fr and 6Fr catheter were graded from 1 (excellent) to 4 (unacceptable) by the operator. The angiographic quality (QUAL) of CAG was also graded from 1 (unacceptable) to 10 (excellent) by two doctors in the catheter laboratory. Results There were no statistical differences between the 4Fr catheter and 6Fr catheter in procedural time and fluoroscopy time, whereas compression time in the 4Fr catheter was significantly shorter (p 0.05). However, the feasibility scores of the pigtail catheter was significantly difference between the 4Fr and 6Fr catheter p 0.05). The total contrast volume was significantly less in the 4Fr catheter group (p Conculsion CAG with 4Fr catheters is technically feasible; it reduces access-site complications after the procedure and the angiographic results were acceptable.

Objectives The purpose of this study was to establish a rat model of CIN and to evaluate its efficacy. Methods Totally 24 SD rats were randomly allocated into experimental group (group A, n=12) and control group (group B, n=12). After dehydration for three days, rats in group A were given intravenous MDDS, while rats in group B were given intravenous normal saline (NS). Then, all rats got normal water-drinking to the end of study. Renal ultrasonic examination was performed to observe the morphologic changes, diameters of renal artery and blood flow in renal artery. Blood samples were taken to measure the level of serum creatinine. The tissue of kidney were incised for microscope and electron microscope study. Results The dimensions of the two groups before and after dehydration were not different. It gradually enlarged after CM injection. These changes were the most obvious at 6 and 12 h, which did not recover at 24 h. The PSV, EDV, S/D and VTI were lowerest at 6 h and then recover to normal level at 24 h. RI was increased after CM injection, the lowest occurred at 6 h, and recovered to normal level at 24 h. Serum creatinine was significantly elevated after dehydration, the highest level occurred at 12 h and then began to recover at 24 h. Microscope examination to renal sample at 12 h found patch disappearance of tubular structure, widely congestion at medullar area. No pathological glomerular changes were found under microscope. Electron microscope examination found desquamation, sparseness of microvillous of tubular endothelium, membrane confusion, disappearance, swelling, fragmentation of the MIT, with obstrcted tubular lumen and basal membrane swelling. Conclusion Combined with dehydration, intravenous injection of contrast lead to obvious acute kidney injury, with the changes of kidney tissue pathology, haemodynamics and kidney functions which are similar to the characteristics of CIN in humanbeings.

Objective To address the relationship between low antiplatelet response of clopidogrel and Obstructive Sleep Apnea Syndrome (OSAS) in patients with unstable angina pectoris. Methods Total of 112 patients hospitalised with unstable angina pectoris from February 2008 to December 2009 were enrolled in this randomised consecutive study. All patients accepted routine treatment including clopidogrel, aspirin, low molecular weight heparin daily. Platelet aggregation (PAR) parameters were measured on samples obtained at baseline and 2 nd , 4 th , 6 th day. All patients were examined for the presence of sleep-disordered breath into 4 quartiles by ApneaLink. The concentration serum adrenaline and norepinephrine were measured in the morning at 6 a.m. after the sleep study. Result There were no significant differences in the baseline data in all 4 quartiles. However, there was a significant differences in the number of diabetes patients in the first quartibesity, heale (p=0.0038) compared with other quartiles. At day 2 PAR were inhibited to 63.91% of baseline (p 0.05) of baselinctively, in the first quartile. At each of these time points, platelet activity was significantly higher than in patients in other quartiles. At day 6 platelet aggregation were reduced to 32.37%, and 29.75% of baseline respectively in group 2 through 4 (p 0.05). Compared with that in thebidity of OSAS in the second and third were 25.0% and 14.3% (p Conclusion OSAS is aicator of low clopidogrel response in unstable angina patients, and higher concentration of epinephrine and norepinephrine in OSAS pa reliable ind tients plaorepinephry a more important role in this situation.

Objective To evaluate the effect of intracoronary anisodamine to correct the no-reflow phenomenon during AMI on no-reflow minipig model made by superselective LAD with 4F catheter then injection of micro thrombus. Method 14 no-reflow minipig models were randomised to intracoronary saline (4 ml), diltiazem (1 mg diluted to 4 ml) and anisodamine (2 mg to 4 ml) groups. CAG was performed at 1, 3, 5, 10th minute after intracoronary injection. Corrected TIMI frame count and coronary artery diameter were obtained by QCA, meanwhile ECG and homodynamic parameters (HR, LVEDP, intracoronary MAP,) were recorded. Results The corrected TIMI frame count in Anisodamine group was significantly decreased by 13.2%, 25.3%, 35.6%, 33.6% at 1, 3, 5, 10th minute compared with saline group, while decreased by 10.6%, 20.4%, 14.3%, 21.5% at 1, 3, 5, 10th minute compared with diltiazem group, (respectively). The medial LAD diameter in Anisodamine group increased from 2.12±0.38 mm to 2.60±0.43 mm (p Conclusions Intracoronary anisodamine might reduce and correct the no-reflow phenomenon after PCI-AMI with the dilation of coronary vessel and homodynamic improvement, as well as no serious side effect and toxic reaction.