Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study.

Abstract

BACKGROUND: The CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation (CR) group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention (PPCI). We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI. METHODS: The Cardiovascular Magnetic Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm (63 immediate, 30 staged) who completed a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist. RESULTS: Patients treated with a staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001), higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2] of LV Mass, p = 0.012) and lower ejection fraction (42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019) compared with immediate CR. CONCLUSIONS: Of patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR. TRIAL REGISTRATION: ISRCTN70913605 , Registered 24th February 2011. DOI: 10.1186/s12968-016-0298-2 PMID: 27842548 [PubMed - in process] 2. Mol Med Rep. 2016 Nov 8. doi: 10.3892/mmr.2016.5933. [Epub ahead of print] Selection of suitable reference genes for gene expression studies in normal human ovarian tissues, borderline ovarian tumours and ovarian cancer. Ofinran O(1), Bose U(1), Hay D(1), Abdul S(2), Tufatelli C(1), Khan R(1). Author information: (1)Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, The University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK. (2)Department of Gynaecological Oncology, Royal Derby Hospital, Derby DE22 3NE, UK. The use of reference genes is the most common method of controlling the variation in mRNA expression during quantitative polymerase chain reaction, although the use of traditional reference genes, such as β actin, glyceraldehyde 3 phosphate dehydrogenase or 18S ribosomal RNA, without validation occasionally leads to unreliable results. Therefore, the present study aimed to evaluate a set of five commonly used reference genes to determine the most suitable for gene expression studies in normal ovarian tissues, borderline ovarian and ovarian cancer tissues. The expression stabilities of these genes were ranked using two gene stability algorithms, geNorm and NormFinder. Using geNorm, the two best reference genes in ovarian cancer were β glucuronidase and β actin. Hypoxanthine phosphoribosyltransferase 1 and β glucuronidase were the most stable in ovarian borderline tumours, and hypoxanthine phosphoribosyltransferase 1 and glyceraldehyde 3 phosphate dehydrogenase were the most stable in normal ovarian tissues. NormFinder ranked β actin the most stable in ovarian cancer, and the best combination of two genes was β glucuronidase and β actin. In borderline tumours, hypoxanthine phosphoribosyltransferase 1 was identified as the most stable, and the best combination was hypoxanthine phosphoribosyltransferase 1 and β glucuronidase. In normal ovarian tissues, β glucuronidase was recommended as the optimum reference gene, and the most optimum pair of reference genes was hypoxanthine phosphoribosyltransferase 1 and β actin. To the best of our knowledge, this is the first study to investigate the selection of a set of reference genes for normalisation in quantitative polymerase chain reactions in different ovarian tissues, and therefore it is recommended that β glucuronidase, β actin and hypoxanthine phosphoribosyltransferase 1 are the most suitable reference genes for such analyses.