No abstract

The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 ± 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.Graphical Abstract

A 48-year-old man with a history of current smoking presented to our department with sudden-onset chest pain at rest. Elevated high sensitivity troponin level led to urgent coronary angiography (CAG). CAG revealed intermediate stenosis with multiple linear filling defects in the mid right coronary artery (RCA) (Figure 1A). Cross-sectional (Figure 1B-1D) and longitudinal (Figure 1F) optical coherence tomography (OCT) demonstrated a honeycomblike structure with multiple cavities of various size separated by tissue with high-signal intensity (Supplementary Video 1). Three-dimensional OCT also showed multiple cavities communicating with true lumen (Figure 1E, asterisks) and we concluded that this represented recanalized thrombus. Regarding the left anterior descending artery (LAD) lesion, CAG revealed severe stenosis in the proximal LAD (Figure 1G). OCT demonstrated thrombus, both protruding (Figure 1K, arrow) and laminar (Figure 1H, 1I, and 1L, arrowheads) with underlying heterogenous plaque without evidence of disruption, suggestive of plaque erosion, and minimal lumen area of 2.24 mm 2 (Figure 1J) (Supplementary Video 2). Therefore, based on OCT findings, we concluded that the proximal LAD was more relevant to the culprit lesion. Successful percutaneous coronary intervention was achieved with a 3.5×32 mm novolimuseluting stent in the RCA and 4.0×23 mm everolimus-eluting stent in the LAD. CAG in patients presenting with non-ST elevation acute coronary syndrome can pose diagnostic challenges (>10% patients have multiple culprits and >30% no identifiable culprit). 1) We report the invaluable role that intracoronary imaging can play in delineating the underlying substrate for acute coronary syndrome, as highlighted in the recent expert consensus. 2)

Purpose: Contrast-induced nephropathy (CIN) has resulted in significant hospital morbidity and mortality as use of contrast media (CM) for percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been increasing. Nicorandil, a K-ATP channel opener and a nitric oxide donor, is used to treat angina pectoris. Therefore, we investigated whether the use of nicorandil would reduce the incidence of CIN in patients with AMI undergoing PCI. Methods: From November 2005 to August 2011, we evaluated 1,492 AMI patients with Killip class I and serum creatinine (sCr) less than 3.0 mg/dL who underwent PCI. The patients were divided into two groups: group I receiving nicorandil (n = 442) and group II not receiving nicorandil (n = 1,050). Results: Among the 1,492 patients, CIN developed in 398 (26.7%). There were no significant differences in baseline clinical characteristics between the two groups. The incidence of CIN also did not differ between two groups (25.1% vs. 27.3%, P = 0.405). The incidence of CIN and the increase in average percentage of sCr (ΔsCr) were not significantly different between the two groups (18.2% vs. 20.4%, P= 0.296). In univariate analysis, nicorandil was not an independent predictor of CIN (OR: 1.122 95%, CI: 0.87-1.446, P= 0.376). Conclusion: The use of nicorandil did not decrease the incidence of CIN in patients with AMI undergoing PCI.