Background-Intracoronary Doppler guidewires can be used for real-time detection and quantification of microembolism during percutaneous coronary interventions (PCIs). We investigated whether the frequency of Doppler-detected microembolism is related to the incidence of myonecrosis during elective PCI. Methods and Results-The study population included 52 consecutive patients (aged 64Ϯ10 years; 36 men, 16 women) with coronary artery disease who underwent elective PCI of a single-vessel stenosis. Using intracoronary Doppler ultrasound, we compared the frequency of microembolism during PCI in 22 patients with periprocedural non-STsegment elevation myocardial infarctions (pNSTEMI) and 30 patients without pNSTEMI. The 2 groups were comparable with regard to their clinical and procedural characteristics. In the group with pNSTEMI, the total number of coronary microemboli after PCI (27Ϯ10 versus 16Ϯ8, PϽ0.001) was higher than in the group without pNSTEMI. Although high-sensitivity C-reactive protein plasma levels were similar before PCI (2.9Ϯ2.2 versus 3.4Ϯ1.7 mg/L, PϭNS), they were higher in the group with pNSTEMI after PCI (12.6Ϯ10.

Approximately one-fourth of patients with NSTEMI revealed OCA that was more frequently found in coronary arteries supplying the infero- or posterolateral myocardium. Patients with OCA had larger infarcts and more non-fatal reinfarctions than patients with non-OCA. Well-developed collaterals may limit the myocardial damage in these patients.

Background-Collaterals can maintain myocardial function or preserve viability in chronic total coronary occlusions (CTOs). It is unknown whether and to what extent collaterals regress after successful recanalization of a CTO. Methods and Results-In 103 patients with successful recanalization of a CTO collateral function was assessed by intracoronary Doppler and pressure recordings before and after recanalization, and again after 5.0Ϯ1.3 months. Doppler (CFI) and pressure-derived collateral function indexes (CPI) and collateral (R Coll ) and peripheral resistance indexes (R P ) were calculated. In 10 patients with reocclusion, all without myocardial infarction during follow-up, collateral function had reached a similar level as before the first recanalization. In the other 93 patients with or without restenosis, collateral function was attenuated during follow-up. CPI had decreased by 23% immediately after recanalization (PϽ0.001) and decreased further by another 23% at follow-up (PϽ0.001). The R Coll increased immediately after recanalization by 82% (PϽ0.001) and by a further 273% at follow-up (PϽ0.001). In contrast, R P increased only by 22% after recanalization (PϽ0.001) and by an additional 12% at follow-up (PϽ0.05). The initial size of the collaterals but not the incidence of a restenosis influenced the collateral regression. Only 18% of patients at follow-up had collaterals with a CPI Ͼ0.30, presumably sufficient to prevent ischemia during acute occlusion. Conclusions-Collateral function regresses during long-term follow-up, especially in collaterals with a small diameter. In the majority of patients, collaterals are not readily recruitable in the case of acute occlusion. However, collaterals have the potential to recover in the case of chronic reocclusion.

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In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

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Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals (HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention (PCI). Methods and Results:In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated (r = 0.97, p , 0.001). In the clinical study, 32 patients (mean (SD) age 61 (11) years; 23 men, nine women) with coronary artery disease were treated with balloon dilatation and stent implantation for a single vessel stenosis. In these patients HITS were detected during PCI in 84% (27 of 32). Reproducibility (r = 0.99, p , 0.001) and interobserver agreement (r = 0.84, p , 0.001) of HITS counts were significant. The number of HITS after stent implantation was significantly higher than after balloon dilatation (11 (7) v 2 (4), p , 0.001). Postprocedural coronary flow velocity reserve (CFVR) was , 2.0 in 55% (16 of 29) of all patients after balloon dilatation and , 2.0 in 23% (six of 26) after stent implantation. The number of HITS after stent implantation did not differ significantly between patients with CFVR , 2.0 and patients with CFVR > 2.0 (12 (8) v 10 (7), not significant). Conclusions: Embolic particles can be detected as HITS by an intracoronary Doppler ultrasound device. Coronary microembolism is often observed during PCI, especially after stent implantation. However, the incidence of HITS alone does not explain a reduced CFVR after PCI.