IVUS-guided DES implantation is associated with significantly lower rates of adverse clinical events compared with angiography guidance. Further study is needed to clarify which subgroups of subjects with IVUS guidance will have greater benefit.

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Background and ObjectivesA higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI.Subjects and MethodsWe analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR≤3.30 (n=108), 3.316.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up.ResultsThe high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002).ConclusionThe NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.

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This updated meta-analysis demonstrates that transradial PCI reduces the risk of significant periprocedural bleeding and improve clinical outcomes in patients with STEMI.

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Seo JS, Kim DH, Kim WJ, Song JM, Kang DH, Song JK. Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility. Am J Physiol Heart Circ Physiol 298: H1608 -H1615, 2010. First published March 5, 2010; doi:10.1152/ajpheart.01231.2009.-We sought to test whether the peak systolic velocity of mitral annular longitudinal movement (S=) measured by pulsed tissue Doppler imaging technique is useful to assess global left ventricular (LV) contractility under various LV inotropic conditions, including regional wall motion abnormality. In addition, the accuracy of S= relative to LV ejection fraction (EF), a conventional index of LV contractility, and its association with apical rotation, a new index of LV contractility, were also evaluated. We measured S= at the medial mitral annulus and apical rotation in 11 open-chest anesthetized dogs at eight inotropic stages before and after ligation of either the left anterior descending or circumflex coronary artery. Maximal positive dP/dt (dP/dt peak) was monitored using a high-fidelity pressure catheter and used as the standard measure of LV contractility. S= showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. There was a stronger association between dP/dt peak and S= (R 2 ϭ 0.665, P Ͻ 0.001) than between dP/dtpeak and EF (R 2 ϭ 0.408, P Ͻ 0.001), and this trend was more apparent with coronary ligation, regardless of the ligation site. The strength of association between dP/dt peak and S= (R 2 ϭ 0.665) was not different from that between dP/dt peak and apical rotation (R 2 ϭ 0.726) (P ϭ 0.350). The association between LV EF and S= was modest (R 2 ϭ 0.472, P Ͻ 0.001), whereas a good association between S= and apical rotation was observed both with (R 2 ϭ 0.552, P Ͻ 0.001) and without (R 2 ϭ 0.674, P Ͻ 0.001) coronary ligation. S= is a more sensitive index of global LV contractility than is LV EF, reflecting both LV longitudinal shortening and torsional deformation. contractility; echocardiography; longitudinal movement; ventricular rotation DESPITE EARLY RECOGNITION of abundant longitudinal cardiac muscle fibers (31), the function of these longitudinal fibers could not be extensively investigated before successful clinical introduction of echocardiography. Initial M-mode recording of mitral annular descent or excursion reflecting left ventricular (LV) longitudinal shortening during ejection was reported to be a sensitive measure of LV systolic function, and the amplitude of long-axis motion during systole also correlates well with LV ejection fraction (EF) (12,23,28). Later, the development of tissue Doppler imaging (TDI) provided an easier way to measure peak systolic velocity of mitral annular longitudinal movement (S=), with S= found useful in diagnosing global LV systolic dysfunction in many cardiac diseases (2,4,8,16,20,27). Moreover, the prognostic implication of S= has been documented in patients with heart failure, mitral regurgitati...

Objectives: To evaluate the impact of cilostazol on the angiographic and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with stents and treated with aspirin and thienopyridine. Methods: A total of 11 randomized controlled trials including 8,525 patients comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included in the analysis. The primary end points were in-segment late loss and angiographic restenosis at angiographic follow-up. Secondary end points included mortality, stent thrombosis, target lesion revascularization (TLR) and major adverse cardiac events (MACE). Results: Triple antiplatelet therapy was associated with a significant reduction in late loss [weighted mean difference 0.14, 95% confidence interval (CI) 0.08–0.20; p < 0.001] and angiographic restenosis [odds ratio (OR) 0.58, 95% CI 0.48–0.71; p < 0.001]. Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.56, 95% CI 0.41–0.77; p < 0.001) and MACE (OR 0.72, 95% CI 0.60–0.86; p < 0.001) with no differences in mortality (p = 0.29), stent thrombosis (p = 0.60) or bleeding episodes (p = 0.77). Conclusions: Cilostazol in addition to dual antiplatelet therapy appears to be effective in reducing the risk of restenosis and repeat revascularization after PCI without any significant benefits for mortality or stent thrombosis.