BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

• MeSH
• ST Elevation Myocardial Infarction * mortality   surgery   therapy   MeSH
• Percutaneous Coronary Intervention mortality   MeSH
• Humans MeSH
• Randomized Controlled Trials as Topic * MeSH
• Myocardial Revascularization * methods   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Age Factors MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH

We have recently developed a model of pancreatic islet transplantation into a decellularized pancreatic tail in rats. As the pancreatic skeletons completely lack endothelial cells, we investigated the effect of co-transplantation of mesenchymal stem cells and endothelial cells to promote revascularization. Decellularized matrix of the pancreatic tail was prepared by perfusion with Triton X-100, sodium dodecyl sulfate and DNase solution. Isolated pancreatic islets were infused into the skeletons via the splenic vein either alone, together with adipose tissue-derived mesenchymal stem cells (adMSCs), or with a combination of adMSCs and rat endothelial cells (rat ECs). Repopulated skeletons were transplanted into the subcutaneous tissue and explanted 9 days later for histological examination. Possible immunomodulatory effects of rat adMSCs on the survival of highly immunogenic green protein-expressing human ECs were also tested after their transplantation beneath the renal capsule. The immunomodulatory effects of adMSCs were also tested in vitro using the Invitrogen Click-iT EdU system. In the presence of adMSCs, the proliferation of splenocytes as a response to phytohaemagglutinin A was reduced by 47% (the stimulation index decreased from 1.7 to 0.9, P = 0.008) and the reaction to human ECs was reduced by 58% (the stimulation index decreased from 1.6 to 0.7, P = 0.03). Histological examination of the explanted skeletons seeded only with the islets showed their partial disintegration and only a rare presence of CD31-positive cells. However, skeletons seeded with a combination of islets and adMSCs showed preserved islet morphology and rich vascularity. In contrast, the addition of syngeneic rat ECs resulted in islet-cell necrosis with only few endothelial cells present. Live green fluorescence-positive endothelial cells transplanted either alone or with adMSCs were not detected beneath the renal capsule. Though the adMSCs significantly reduced in vitro proliferation stimulated by either phytohaemagglutinin A or by xenogeneic human ECs, in vivo co-transplanted adMSCs did not suppress the post-transplant immune response to xenogeneic ECs. Even in the syngeneic model, ECs co-transplantation did not lead to sufficient vascularization in the transplant area. In contrast, islet co-transplantation together with adMSCs successfully promoted the revascularization of extracellular matrix in the subcutaneous tissue.

• MeSH
• Decellularized Extracellular Matrix MeSH
• Endothelial Cells MeSH
• Neovascularization, Physiologic * MeSH
• Rats MeSH
• Cells, Cultured MeSH
• Islets of Langerhans * immunology   MeSH
• Humans MeSH
• Mesenchymal Stem Cells * MeSH
• Pancreas MeSH
• Islets of Langerhans Transplantation * methods   MeSH
• Mesenchymal Stem Cell Transplantation * methods   MeSH
• Adipose Tissue * cytology   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Humans MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting.Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. METHODS: Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. RESULTS: The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). CONCLUSION: Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.

• MeSH
• Anastomosis, Surgical * MeSH
• Computed Tomography Angiography MeSH
• Coronary Angiography MeSH
• Coronary Artery Bypass * methods   adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Graft Occlusion, Vascular * etiology   physiopathology   MeSH
• Vascular Patency * MeSH
• Aged MeSH
• Saphenous Vein * transplantation   diagnostic imaging   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: Up to 50% of patients with ST elevation myocardial infarction (STEMI) have ≥ 50% stenosis in a major non-infarct-related artery. Several studies have evaluated the prognostic value of the completion of revascularization with overall inconclusive results. Selection of the stenoses was based on the angiographic evaluation, invasive hemodynamic measurement or the combined approach. It is unknown whether such a selection provides correlation of comparable patient groups. MATERIAL AND METHODS: We enrolled 51 patients (62.7 ±10.2 years) with acute STEMI and at least one residual (50-90%) stenosis in a non-infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67.9 ±10.7%) were evaluated angiographically following primary percutaneous coronary intervention and the hemodynamic significance was estimated with respect to the stenosis severity, caliber of the arterial segment, localization of the stenosis (proximity) as well as the estimated size of the supplied vascular territory. During subsequent hospitalization, invasive measurement of the hemodynamic significance using fractional flow reserve (FFR) was performed to guide the final revascularization strategy (FFR value of ≤ 0.80 considered significant). RESULTS: Based on angiographic evaluation, a total of 44 stenoses would be recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, visual evaluation and hemodynamic measurement were discrepant in 27 of 65 (41.5%) stenoses. CONCLUSIONS: We observed a weak correlation between visual angiographic evaluation and invasive hemodynamic measurement. More stents would be implanted based on angiographic evaluation compared to FFR measurement.

• Publication type
• Journal Article MeSH

Aim of the study: To present our rescue approach of carotid artery occlusion as well as to discuss other possible techniques that can be applied in similar situations.Materials and methods: Two cases from our institution with acute complications during carotid micro-endarterectomy (CEA).Results: Two cases from our institution with acute postoperative complications during CEA that were successfully addressed are presented with imaging and detailed description of the surgical techniques used.Conclusion: CEA are common surgical procedures pursued to achieve revascularization of carotid arteries when occluded partially or fully by an atherosclerotic plaque. As with any surgical procedure, associated complications exist in small percentage of the cases. These can include blood flow limitation due to an insufficient artery wall after atherosclerotic plaque extraction as well as distal kinking of the internal carotid artery. A direct end-to-end ACE-ACI bypass with occlusion of the proximal ACI and distal ACE stump preserves distal flow to the ACI, however the original arteriotomy of ACC must be completely sutured up to the arterial stumps.

• MeSH
• Anastomosis, Surgical MeSH
• Carotid Artery, Internal diagnostic imaging   surgery   MeSH
• Plaque, Atherosclerotic * MeSH
• Endarterectomy, Carotid * methods   MeSH
• Humans MeSH
• Carotid Stenosis * diagnostic imaging   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Clinical outcomes and treatment selection after completing the randomized phase of modern trials, investigating antiplatelet therapy (APT) after percutaneous coronary intervention (PCI), are unknown. OBJECTIVES: The authors sought to investigate cumulative 15-month and 12-to-15-month outcomes after PCI during routine care in the MASTER DAPT trial. METHODS: The MASTER DAPT trial randomized 4,579 high bleeding risk patients to abbreviated (n = 2,295) or standard (n = 2,284) APT regimens. Coprimary outcomes were net adverse clinical outcomes (NACE) (all-cause death, myocardial infarction, stroke, and BARC 3 or 5 bleeding); major adverse cardiac and cerebral events (MACCE) (all-cause death, myocardial infarction, and stroke); and BARC type 2, 3, or 5 bleeding. RESULTS: At 15 months, prior allocation to a standard APT regimen was associated with greater use of intensified APT; NACE and MACCE did not differ between abbreviated vs standard APT (HR: 0.92 [95% CI: 0.76-1.12]; P = 0.399 and HR: 0.94 [95% CI: 0.76-1.17]; P = 0.579; respectively), as during the routine care period (HR: 0.81 [95% CI: 0.50-1.30]; P = 0.387 and HR: 0.74 [95% CI: 0.43-1.26]; P = 0.268; respectively). BARC 2, 3, or 5 was lower with abbreviated APT at 15 months (HR: 0.68 [95% CI: 0.56-0.83]; P = 0.0001) and did not differ during the routine care period. The treatment effects during routine care were consistent with those observed within 12 months after PCI. CONCLUSIONS: At 15 months, NACE and MACCE did not differ in the 2 study groups, whereas the risk of major or clinically relevant nonmajor bleeding remained lower with abbreviated compared with standard APT. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020).

• MeSH
• Stroke * etiology   prevention & control   MeSH
• Myocardial Infarction * complications   MeSH
• Platelet Aggregation Inhibitors MeSH
• Drug Therapy, Combination MeSH
• Percutaneous Coronary Intervention * adverse effects   methods   MeSH
• Hemorrhage chemically induced   MeSH
• Humans MeSH
• Drug-Eluting Stents * adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

BACKGROUND: Drug-eluting stents (DESs) based on biodegradable polymers (BPs) have been introduced to reduce the risk for late and very late stent thrombosis (ST), which were frequently observed with earlier generations of DES designs based on durable polymers (DPs); however, randomized controlled trials on these DES designs are scarce. The meriT-V trial is a randomized, active-controlled, non-inferiority trial with a prospective, multicenter design that evaluated the 2-year efficacy of a novel third-generation, ultra-thin strut, BP-based BioMime sirolimus-eluting stent (SES) versus the DP-based XIENCE everolimus-eluting stent (EES) for the treatment of de novo lesions. METHODS: The meriT-V is a randomized trial that enrolled 256 patients at 15 centers across Europe and Brazil. Here, we report the outcomes of the extended follow-up period of 2 years. The randomization of enrolled patients was in a 2:1 ratio; the enrolled patients received either the BioMime SES (n = 170) or the XIENCE EES (n = 86). The three-point major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction (MI), or ischemia-driven target vessel revascularization (ID-TVR), was considered as the composite safety and efficacy endpoint. Ischemia-driven target lesion revascularization (ID-TLR) was evaluated as well as the frequency of definite/probable ST, based on the first Academic Research Consortium definitions. RESULTS: The trial had a 2-year follow-up completion rate of 98.44% (n = 252/256 patients), and the clinical outcomes assessment showed a nonsignificant difference in the cumulative rate of three-point MACE between both arms (BioMime vs. XIENCE: 7.74% vs. 9.52%, P = 0.62). Even the MI incidences in the BioMime arm were insignificantly lower than those of the XIENCE arm (1.79% vs. 5.95%, P = 0.17). Late ST was observed in 1.19% cases of the XIENCE arm, while there were no such cases in the BioMime arm (P = 0.16). CONCLUSIONS: The objective comparisons between the novel BP-based BioMime SES and the well-established DP-based XIENCE EES in this randomized controlled trial show acceptable outcomes of both the devices in the cardiac deaths, MI, ID-TVR, and ST. Moreover, since there were no incidences of cardiac death in the entire study sample over the course of 2 years, we contend that the findings of the study are highly significant for both these DES designs. In this preliminary comparative trial, the device safety of BioMime SES can be affirmed to be acceptable, considering the lower three-point MACE rate and absence of late ST in the BioMime arm over the 2-year period.

• Publication type
• Journal Article MeSH

Atherosclerosis is the most common cause of coronary steno-occlusive disease and acute myocardial infarction is the leading cause of death in industrialized countries. In patients with acute ST elevation myocardial infarction (STEMI), there is unquestionable evidence that primary percutaneous coronary intervention providing recanalization of the infarct related artery (IRA) is the preferred reperfusion strategy. Nevertheless, up to 50% of patients with STEMI have multivessel coronary artery disease defined as at least 50% stenosis exclusive of IRA. There is conflicting data regarding the optimal treatment strategy and timing in such patients. Currently, it is assumed that stable patients might benefit from complete revascularization particularly in reducing the need for future unplanned procedures but only culprit lesion should be treated during index procedure in unstable patients. In this article, we provide a comprehensive overview of this important and currently highly debated topic.

• MeSH
• Acute Coronary Syndrome * etiology   surgery   MeSH
• ST Elevation Myocardial Infarction * etiology   surgery   MeSH
• Myocardial Infarction * MeSH
• Percutaneous Coronary Intervention * adverse effects   MeSH
• Humans MeSH
• Coronary Artery Disease * complications   surgery   MeSH
• Arrhythmias, Cardiac MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Iatrogenní disekce aorty je sice vzácnou, ale život ohrožující komplikací perkutánních koronárních intervencí (PCI). V případě spontánní disekce aorty typu A je doporučena urgentní chirurgická léčba, pro iatrogenní disekce specifická doporučení formulována nebyla. V prvotních studiích dosahovala mortalita chirurgicky léčených pacientů s iatrogenní disekcí aorty až 50 %, dle aktuálních dostupných dat z registrů se však zdá srovnatelná s mortalitou pacientů operovaných pro spontánní disekci aorty typu A (přibližně 16 %). Řada autorů však prezentovala kazuistiky pacientů úspěšně léčených konzervativně s kompletním zhojením disekce, a to i v případě rozsáhlého poškození aortální stěny.

Iatrogenic aortic dissection is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Emergency surgical treatment is recommended for spontaneous type A aortic dissection, but no specific recommendations have been formulated for iatrogenic dissections. In early studies, the mortality rate of surgically treated patients with iatrogenic aortic dissection was as high as 50%, but according to the currently available registry data, the mortality rate seems comparable to that of patients operated on for spontaneous type A aortic dissection (approximately 16%). However, case reports have been presented of patients successfully treated conservatively with complete healing of the dissection, including cases with extensive aortic wall damage.

• MeSH
• Angiography MeSH
• Aortic Valve Stenosis diagnostic imaging   MeSH
• Aortic Dissection * diagnostic imaging   etiology   classification   physiopathology   pathology   therapy   MeSH
• Iatrogenic Disease MeSH
• Percutaneous Coronary Intervention * adverse effects   MeSH
• Humans MeSH
• Aged MeSH
• Rare Diseases diagnostic imaging   etiology   physiopathology   pathology   therapy   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

Cíl studie: Určit aktuální využití primární perkutánní koronární intervence (PPCI) a dodržování doporučených postupů pro klinickou praxi při léčbě pacientů s infarktem myokardu s elevacemi ST (STEMI). Metody: Pacienti s akutním STEMI byli odesláni do našeho kardiocentra za účelem PPCI. Ihned po přijetí byla odebrána úplná anamnéza se zaměřením na délku trvání bolesti na hrudi, minulou anamnézu a sociální anamnézu. U každého pacienta byla provedena stratifikace rizikových faktorů ischemické choroby srdeční, jako jsou diabetes mellitus, hypertenze a kouření. U pacientů se STEMI bylo léčbou volby rychlé otevření uzavřené koronární tepny a obnovení průtoku krve pomocí PPCI. V našem centru se PPCI provádí 24 hodin denně, 7 dní v týdnu u všech pacientů s akutním infarktem myokardu (IM) v souladu s národními doporučenými postupy. Výsledky: Do studie bylo zařazeno 251 pacientů s akutním IM odeslaných do Basrah Cardiac Center za účelem PPCI. Jednalo se o 209 (83,3 %) mužů a 42 (16,7 %) žen. Věk pacientů byl v rozmezí od 26 do 90 let a jejich průměrný věk byl 55,05 ± 11,37. Většina (89,6 %) pacientů ve studii byla ve věku 40 let a více, přičemž pacienti mladší než 40 let tvořili pouze 10,4 %. Průměrný čas mezi nástupem bolesti na hrudi a příjezdem do našeho kardiocentra byl 93,6 ± 45,6 minut. Postižení kmene levé koronární tepny (ACS) a ramus circumflexus (RC) jsme častěji pozorovali u diabetických pacientů (p < 0,05), kdežto nemoc/postižení ramus interventricularis anterior (RIA) a pravé koronární tepny (ACD) nebyla/nebylo s diabetes mellitus (DM) pozitivně spojena/spojeno. Tato studie také prokázala významnou spojitost mezi kouřením a nemocí/postižením ACD, jakož i negativní spojitost kouření s nemocí/postižením kmene ACS, RIA a RC; naproti tomu hypertenze byla spojena významně s nemocí/postižením RC a negativně s nemocí/postižením kmene ACS, RIA a ACD. Závěr: Tato studie ukázala, že většina pacientů s diagnózou akutního STEMI byla odeslána v rámci časového limitu a bezodkladně léčena koronární intervencí. Proto doporučujeme, aby PPCI byla hlavní účinnou strategií léčby pacientů se STEMI během prvních 24 hodin.

Aim of study: To determine the current use of primary percutaneous coronary intervention (PPCI) and adherence to clinical practice guidelines in managing patients with ST­-elevation myocardial infarction (STEMI). Methods: Patients with acute STEMI were referred to our cardiac center for PPCI. Immediately after admission, a complete medical history was taken focusing on the duration of chest pain, past medical history, and social history. Risk factors for ischemic heart disease were stratified for each patient, such as diabetes mellitus, hypertension, and smoking. In patients with STEMI, rapid opening of the occluded coronary artery and restoration of blood flow by PPCI has become the treatment of choice. In our center, PPCI is performed 24 hours a day, 7 days a week, for all patients with acute myocardial infarction (MI) according to the national guidelines. Results: The study included 251 patients with acute MI referred to the Basrah Cardiac Center for PPCI. There were 209 (83.3%) male and 42 (16.7%) female patients. Patient age ranged from 26 to 90 years and the mean age was 55.05 ± 11. 37. The majority (89.6%) of patients in the study were those aged 40 years and older, whereas patients younger than 40 accounted only for 10.4%. The mean time from the onset of chest pain to the arrival at our cardiac center was 93.6 ± 45.6 minutes. The left main stem (LMS) disease and left circumflex (LCx) artery disease were seen more commonly among diabetic patients (p < 0.05), whereas the left anterior descending (LAD) artery and right coronary artery (RCA) diseases had no positive association with diabetes mellitus (DM). The study also showed a significant association between smoking and RCA disease, and a negative association of smoking with LMS, LAD, and LCx diseases; by contrast, hypertension was significantly associated with LCx disease and negatively with LMS, LAD, and RCA diseases. Conclusions: In conclusion, this study showed that most patients diagnosed with acute STEMI were referred within the time limit and were managed immediately by coronary intervention. Therefore, we recommend that PPCI be the main effective strategy for managing patients with STEMI during the first 24 hours.

• MeSH
• ST Elevation Myocardial Infarction * therapy   MeSH
• Cardiac Care Facilities MeSH
• Clinical Studies as Topic MeSH
• Percutaneous Coronary Intervention methods   MeSH