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Background: Conflicting results comparing bivalirudin versus heparin anticoagulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), in part due to the confounding effect of glycoprotein IIb/IIIa inhibitors (GPI). The aim of the study was to compare the safety and effectiveness of bivalirudin plus a post-PCI high-dose infusion vs heparin with or without bail-out GPI use. Methods: We conducted a pre-specified subgroup analysis from the BRIGHT-4 trial that randomized 6016 STEMI patients who underwent primary PCI to receive either bivalirudin plus a post-PCI high-dose infusion for 2–4 h or heparin monotherapy. GPI use was only reserved as bail-out therapy for procedural thrombotic complications. The primary outcome was a composite of all-cause death or Bleeding Academic Research Consortium (BARC) types 3–5 bleeding at 30 days. Results: A total of 5250 (87.4%) patients received treatment without GPI while 758 (12.6%) received bail-out GPI. Bail-out GPI use was associated with an increased risk of the primary outcome compared to non-GPI use (5.28% vs. 3.41%; adjusted hazard ratio (aHR), 1.62; 95% confidence interval (CI), 1.13–2.33; P = 0.009) and all-cause death (5.01% vs. 3.12%; aHR, 1.74; 95% CI, 1.20–2.52; P = 0.004) but not in the risk of BARC types 3–5 bleeding (0.53% vs. 0.48%; aHR, 0.90; 95% CI, 0.31–2.66; P = 0.85). Among patients without GPI use, bivalirudin was associated with lower rates of the primary outcome (2.63% vs. 4.21%; aHR, 0.55; 95% CI, 0.39–0.77; P = 0.0005), all-cause death (2.52% vs. 3.74%; aHR, 0.58; 95% CI, 0.41–0.83; P = 0.003), and BARC types 3–5 bleeding (0.15% vs. 0.81%; aHR, 0.19; 95% CI, 0.06–0.57; P = 0.003) compared with heparin. However, among patients requiring bail-out GPI, there were no significant differences observed in the rates of the primary outcome (5.76% vs. 4.87%; aHR, 0.77; 95% CI, 0.36–1.66; P = 0.50; Pinteraction = 0.07) or its individual components between bivalirudin and heparin groups. Conclusions: Bivalirudin plus a post-PCI high-dose infusion was associated with significantly reduced 30-day composite rate of all-cause death or BARC types 3–5 bleeding compared with heparin monotherapy in STEMI patients undergoing primary PCI without GPI use. However, these benefits might be less pronounced in patients requiring bail-out GPI due to thrombotic complications during primary PCI. Trial registration: ClinicalTrials.gov NCT03822975. [ABSTRACT FROM AUTHOR]

Background: Reports showed no change of 7‐day mortality after primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI) between 2001 and 2011 in China. National rolling one‐year interventional standardized training programme began in September 2009. However, the improvement in clinical outcome following STEMI PCI after 2011 remains unclear. Methods and Results: This multicentre MOODY registry study aimed to analyse the clinical improvement after STEMI PCI. Of a total of 9265 acute MI patients registered from 24 centres, 3142 STEMIs having a first medical contact time ≤12 hours and undergoing primary PCI were assigned to the Pre Group (n = 1014, between March 1999 and October 2010) or the Post Group (n = 2128, between 2010 November and 2016 October). The primary endpoint was in‐hospital cardiac death. Study endpoints were also compared between trained and untrained operators and between experienced (≥50 primary PCIs/year) and inexperienced personnel. In‐hospital death after PCI was 3.0% in the Pre Group, significantly higher than 1.6% in the Post Group (P =.035). The improvements in clinical outcome after PCI between the 2016 and Pre Groups were stably sustained through one‐year follow‐up. The significant reduction for in‐hospital death was noted when primary PCI was performed by trained (1.4% vs 5.4%, P <.001) or experienced (2.7% vs 4.8%, P =.001) operators, compared to untrained or inexperienced operators, respectively. Inclusion of the untrained operator into the conventional risk model strongly enhanced the prediction for endpoints. Age, Killip Class 3, diabetes, trans‐radial approach and system delay were five predictors of in‐hospital death after primary PCI. Conclusion: PCI for STEMI by a trained and experienced operator was associated with significant reduction of in‐hospital death. Our results strongly warrant the need for promoting the current system response and patient education. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the long term outcomes (all-cause death, myocardial infarction, target vessel revascularization, and silent restenosis at 12 months) of one-stent vs. two-stent implantation due to coronary bifurcation lesionsin diabetic patients using AIR2 as a new endpoint., Methods and Results: A total of 178 diabetic patients with true coronary bifurcation lesions underwent percutaneous coronary intervention in the DK-Crush trials. All patients were stratified based on the stent placement strategy: one-stent group (n=76) and two-stent group (n=102). Results showed the primary endpoint, AIR2, in one-stent group was twice that in two-stent group (32.9% vs. 16.7%, P=0.013). The incidence of silent restenosis at 12 months was also significantly higher in one-stent group (19.7% versus 4.9%, P=0.003). Moreover, Kaplan-Meier analysis revealed the cumulative AIR2-free survival rate after a 12-month follow-up was markedly lower in one-stent group than in two-stent group. Interestingly, MACEs, including death, myocardial infarction and repeat revascularization, were not comparable between 2 groups (13.2% vs. 12.7%, P=0.935). Likewise, the incidence of definite or probable ST in one-stent group was also similar to that in two-stent group (2.6% vs. 4.9%, P=0.761)., Conclusion: Our study indicates that, in terms of the AIR2 as a combined clinical and angiographic endpoint, two-stent implantation is superior to one-stent implantation for the treatment of coronary bifurcation intervention in diabetic patients.

Objective: To investigate the effect of low shear stress (LSS) on apoptosis of human vascular endothelial cells (ECs) and explore the possible mechanisms., Methods: Parallel flow chamber was used to apply LSS at 2 dyne/cm(2) on EA.hy926 cells derived from human umbilical vein endothelial cells for 120 min. Cell apoptosis following LSS was verified by morphological observation, DAPI staining and TUNEL test. The level of intracellular reactive oxygen species (ROS) was measured by dihydroethidium (DHE) and mitoSOX. Western blotting was performed to detect the activity of Akt in the cells., Results: EC detachment and apoptosis were observed after exposure to 2 dyne/cm(2) LSS for 120 min. Time course study showed that the phosphorylation level of Akt on residues Ser473 and Thr308 was elevated after flow initiation. Exposure to LSS at 2 dyne/cm(2) for 120 min resulted in increased ROS production in the ECs at both the mitochondrial and cytoplasmic levels., Conclusion: Akt activation and increased ROS levels are involved in LSS-induced EC apoptosis.

Background: Studies have revealed that stem cells improve clinical outcomes in patients with severe ischemic cardiomyopathy, but the role of bone marrow mesenchymal stem cells is not well understood., Methods: Twenty-two patients received an implantation of autologous bone marrow mesenchymal stem cell therapy; another 23 patients were placed in a control group after percutaneous coronary intervention (PCI) of the chronically occluded left anterior descending artery., Results: Reversible defect in the cell therapy group decreased from 16 +/- 8% at baseline to 6 +/- 2% at 12 months (p < 0.05), and this improvement was maintained throughout the entire follow-up period. Compared to the control group (5 +/- 3 METS at baseline vs. 5 +/- 3 METS at 3 months; p = NS), the level of exercise tolerance improved significantly 3 months after cell therapy (5 +/- 2 METS at baseline vs. 7 +/- 3 METS at 3 months; p < 0.05). The NYHA function class also improved in the cell therapy group (2.7 +/- 0.8 at baseline vs. 1.6 +/- 0.1 at 3 months; p < 0.05). PCI alone did not increase left ventricular ejection fraction (LVEF), but following stem cell therapy, the LVEF increased significantly from 26 +/- 6% at baseline to 37 +/- 9% at 3 months (p < 0.05)., Conclusion: Intracoronary transplantation of autologous bone marrow mesenchymal stem cells improved clinical outcomes in patients with chronic ischemic cardiomyopathy.