Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.

Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.

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Abstract. Reperfusion injury (RI) remains an important limitation of myocardial revascularization. The aim of the present study was to evaluate the influence of the intracoronary injection of adiponectin on RI and cardiomyocyte death in a porcine myocardial infarction model. Acute infarction in 14 Polish domestic pigs was induced by inflation of an over the wire balloon (OTW) catheter in the medial left anterior descending artery for 60 min. The study group consisted of 7 pigs in which intracoronary adiponectin (50 µg) was infused through the OTW catheter immediately before reperfusion. The control group (n=7) was administered placebo. Animals were sacrificed after two days of follow-up. The infarct area (IA) was stained with tetrazoline and the area at risk (AAR) with intracoronary administration of Evans Blue dye before euthanasia. Hearts in each group had similar AARs (46.2±9.9% vs. 48.4±6.2% of the whole myocardium, p=ns). The IA/AAR% and IA were smaller in the study group when compared to the control (24.7±4.0% vs. 45.3±22.5%, p=0.005; and 11.7±4.9% vs. 20.5±5.6%, p=0.01, respectively). These outcomes corresponded well with the peak troponin levels after 12 h (109.9±60.9 ng/ml vs. 185.5±39.4 ng/ml, p=0.017). After two days there was a significantly higher LVEF in the study group (51.4±8.5% vs. 33.9±8.6%, p=0.002). There was also a trend toward lower apoptosis enhancement in the viable myocardium in the study group (3.11±2.3 vs. 8.92±6.3; p=0.07). The administration of adiponectin into the infarctrelated artery is safe and feasible. The treatment significantly reduced the infarct size.Introduction current strategies of reperfusion in ST elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (pPCI) are highly efficient with a high periprocedural success rate and with the hospital mortality ranging from 3-7% (1-3). However, in long-term observations, almost 30% of these patients develop heart failure (4,5) associated with substantial long-term mortality (6). This is mostly due to the formation of post-infarction scars and to left ventricular remodelling. Timely percutaneous coronary intervention (PCI) can significantly reduce the infarct size by 40%, while 30-40% of the final infarct area can be attributed to lethal reperfusion injury (RI) (7). This kind of injury can significantly reduce the benefit of reperfusion in STEMI and since it is potentially preventable, new approaches are being currently tested in animal models and in clinical trials (8).Reperfusion can be described as a double edge sword (9) because it leads to the necrosis of cardiac myocytes that were viable before the restoration of the blood flow. RI may result in myocyte cell death (lethal RI), transient myocardial dysfunction (myocardial stunning, arrhythmias) or to a no-reflow phenomenon. As shown in experimental studies, RI is a chain reaction involving the generation of reactive oxygen compounds and increased oxidative stress, disruption of the sarcoplasmic reticulum and intracellular and mitochondrial calc...

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