Background-In patients with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) may cause thrombus dislodgment followed by reduced flow and impaired microcirculatory function. We prospectively compared conventional PCI to a strategy of additional pretreatment using the X-sizer thrombectomy system. Methods and Results-Sixty-six patients (51 [77%] men; 54.9Ϯ9.9 years) with ACS (49 with ST-elevation infarction [STEMI]) and suspected intracoronary thrombus were randomized 1:1 to pretreatment with X-sizer and conventional PCI alone. Various aspects of epicardial flow and microvascular function were studied. Baseline data were similar in both groups. Postprocedural TIMI 3 flow was obtained in 90% of X-sizer-treated patients and in 84% of controls (NS); however, corrected TIMI frame count was lower in X-sizer-treated patients (18.3Ϯ10.2 versus 24.7Ϯ14.1; PϽ0.05). No significant group differences were observed in final coronary flow reserve, myocardial blush grade, and myocardial dye intensity. In STEMI, the sum of ST elevation was significantly lower in X-sizer-treated patients immediately after (2.78Ϯ3.05 versus 6.15Ϯ6.32 mm; PϽ0.03) and 6 hours after (2.17Ϯ2.31 versus 4.14Ϯ3.7 mm; PϽ0.05) intervention. ST-segment resolution Ͼ50% was observed in 83% of X-sizer-treated patients and in 52% of controls (PϽ0.03). Multivariate analysis identified X-sizer treatment as the single independent predictor of ST-segment resolution Ͼ50% (OR 4.35; 95% CI, 1.13 to 16.9; PϽ0.04). Major adverse cardiac events after 30 days occurred in 2 patients in each group. Conclusions-In ACS with suspected thrombus, pretreatment with the X-sizer catheter system improves epicardial flow and accelerates ST-segment resolution compared with conventional PCI alone.

This is the first study describing follow-up deformation parameters in HTX patients undergoing STE. 'Healthy' HTX patients with normal coronary arteries and normal ejection fractions showed no deterioration of longitudinal strain values 3 years after the initial assessment. Apparently, deformation values remain stable over the years as long as the LVEF is preserved.

Even though 'healthy' heart transplants without CAD exhibit normal ejection fraction, deformation indices are reduced in this population when compared with control subjects. Our findings suggests that strain analysis is more sensitive than assessment of ejection fraction for the detection of abnormalities of systolic function.

The use of intermittent coronary sinus occlusion and intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood significantly decreases ischemic damage during coronary occlusions. Intermittent coronary sinus occlusion in combination with retroperfusion exhibits no significant profit in salvaging the ischemic myocardium in comparison with that provided by intermittent coronary sinus occlusion alone.

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Compliance measurements may be used for identification of patients with diffuse atherosclerotic processes of the coronary arteries.

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