AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2641-0419/114
* Associate Professor Department of cardiology Burdwan medical college and Hospital West Bengal, India.
*Corresponding Author: Goutam Datta, Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University.
Citation: Goutam Datta (2020) Intracoronary Thrombolysis in no Flow after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. J. Clinical Cardiology and Cardiovascular Interventions, 3(13); Doi:10.31579/2641-0419/114
Copyright: © 2020 Goutam Datta, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 November 2020 | Accepted: 10 December 2020 | Published: 17 December 2020
Keywords: primary percutaneous coronary intervention; no flow; intracoronary tenectaplase
Introduction: Mechanical revascularization of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI).No-reflow occurs in ∼8.8-10% of cases of primary percutaneous coronary intervention(PCI) in STEMI patients. Intracoronary tenectaplase was used when there was huge thrombus causing no flow in coronary artery following primary PCI in STEMI patients.
Methods: Five hundred and eighty primary PCI patients were studied over a period of two years i.e. January 2016 to December 2017. Drug eluting stents were used in all cases. Majority of our patients (>90%) came 6 hours after onset of chest pain. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have given 20 mg of tenectaplase through microcatheter in those cases.
Results: There were 44 cases of no flow in our series (7.75%). TIMI 3 Flow was reestablished in thirty two patients after intracoronary tenectaplase (72%). Amongst twelve failure cases LAD involvement was most common eight cases. RCA was involved in four patients. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group. Both were statistically significant.
Conclusion: Refractory no reflow during primary PCI in STEMI is associated with high mortality and morbidity. There is no established strategy to solve this phenomenon. Intracoronary thrombolysis is an option to salvage these patients.
Acute myocardial infarction is due to plaque rupture and thrombotic occlusion of epicardial coronary artery. Primary percutaneous coronary intervention of infarct related artery(IRA)is the most effective treatment modality in ST-segment elevation myocardial infarction(STEMI) . Early revascularization of IRA will lead to favorable myocardial remodeling. It will reduce size of the infarct, improve left ventricular systolic and diastolic function and thereby will reduce MACE rate. Incidence of no flow is ∼8.8-10% in primary PCI of STEMI patients and it is associated with different risk factors like advanced age ,delayed presentation, ectatic coronary artery and huge thrombus burden. [1]
No flow after primary PCI may occur due to incomplete stent expansion, vaso spasm, dissection or in situ thrombosis. Microvascular obstruction and distal embolization are other contributing factors. Clinically no flow may present with the recurrence of chest pain, heart failure, malignant ventricular arrhythmias and cardiogenic shock. Angiographic no flow after PCI is associated with reduced myocardial salvage, larger infarct size and adverse cardiac remodeling. Early detection, preventive measures and treatment of no flow will decide final outcome after primary PCI. Routine use of aspiration catheter and Gp IIb/111a receptor blocker in primary PCI is not recommended now. [2] No therapies have been shown to prevent no-reflow. Different fibrinolytic agents are in use for systemic thrombolysis in STEMI. We have tried intracoronary tenectaplase when there is huge thrombus causing no flow in IRA after PCI in STEMI patients. There are case reports of intracoronary thrombolysis in STEMI patients when there is huge thrombus burden.3 It will lyse thrombus and will facilitate future revascularization. But we used intracoronary thrombolysis in those patients where there is no flow in IRA after primary PCI.
Methods: Our objective was to study whether intracoronary tenectaplase is beneficial or not in no flow in coronary artery after primary PCI. 'Ethical approval and consent to participate' was taken before conducting the study. Patients in the age group of 18 to 75 were only considered for our study. No flow was defined by Thrombolysis in myocardial infarction(TIMI) zero grade flow or TIMI I flow. We have studied 580 primary PCI patients done in our hospital over a period of two years i.e. January 2016 to December 2017. Drug eluting stents were used in all cases. Majority of our patients(>90%) came 6 hours after onset of chest pain. Average presentation was 8-12 hrs after onset of chest pain. Protocol guided periprocedural medication include Aspirin(325 mg first dose, then 75 mg daily), Ticagrelor(180mg first dose, then 90 mg twice daily),atorvastatin(80 mg first dose, then 80 mg daily). Patients with atrial fibrillation were excluded from the study. Long lesions requiring overlapping stents were also excluded from our study. Direct stenting was tried in all cases. Predilatation at low pressure was done where there was difficulty in stent delivery. Infarct related artery only was addressed in our study and only single stent strategy group was included in this study.We have used thrombus aspiration catheter and Gp IIb/IIIa receptor blocker when there is huge thrombus load ( TIMI thrombus grade 3 or more).Intracoronary adenosine and nicorandil were used as adjunctive pharmaco therapy to alleviate no flow. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have given 20 mg of tenectaplase through micro catheter in those cases. We have taken our patients 48 hours after procedure for routine repeat coronary angiography as study protocol. There were few haemodynamically unstable patients and we have taken them for repeat angiography after 7 days .TIMI 3 flow was taken as successful recanalization criteria.
Inclusion criteria for intracoronary tenectaplase :
1) Age group 18-80
2) Primary PCI patients
3) No flow flow after mechanical thrombus aspiration and pharmacological vasodilator therapy
4) No prior history of intracranial hemorrhage
Statistical analysis: Instat 3 software was used for statistical analysis.
Fisher exact test was done to evaluate statistical significance between two groups.
Majority of our procedures (70%) were done by radial route and rest (30%) by femoral route. Manual compression was done to secure haemostasis.We have observed 44 cases of no flow in our series. Incidence is around 7.75%.Twenty six patients were suffering from diabetes. Incidence was 60%.Thirty patients were male and fourteen were female patients. Male prevalence was 68% and female prevalence was 32%. (Table 1and 2) Twenty four patients were hypertensive. Incidence is about 54%.
Thirty two patients were smokers taking more than 10 cigarettes per day. Prevalence is around 72% and it was most common risk factor. Dyslipidaemia was seen only in sixteen patients and incidence was about 36%.No flow was common in elderly patients. Only four patients were below 40 years age group. Twelve patients were in the 40-60 years age group. (Chart 1) Twenty patients were in the age group of 60 –80.Fourteen patients were in cardiogenic shock requiring pharmacological pressure support mainly noradrenaline, dobutamine and dopamine.
We did not use mechanical circulatory support device in any of our patients. Amongst patients with cardiogenic shock ten patients had anterior wall STEMI and four patients had inferior wall STEMI. Amongst cardiogenic shock cases ten patients were diabetic. Incidence is 70%. Majority of them were having multi vessel disease. Two patients died during hospital stay. They were suffering from anterior wall STEMI. We could not reestablish flow in those patients. They were having persistent cardiogenic shock. Incidence of no flow was higher in longer stent length. (Chart 2)Left anterior descending artery(LAD )was involved in eighteen patients. Right coronary artery(RCA) was culprit in twenty four cases. No flow was most common in RCA territory. Least common was left circumflex(LCX) artery. (Chart 3) Only two caseswere seen in LCX territory. TIMI 3 Flow was reestablished in thirty two patients. Success rate was around 72%. (Chart 4) Out of twelve failure cases LAD involvement was most common ---eight cases. RCA was involved in four patients.
Though incidence of no flow was higher in RCA territory but successful TIMI 3 flow restoration was also most common in RCA. Average diameter of RCA was greater than LAD. Most RCA were tortuous, dilated and ectatic. Overall failure rate was 28%. Amongst failure cases two patients died in their hospital stay and they were having persistent cardiogenic shock. Four patients died during thirty days. One died in his home probably because of arrhythmia. Two died due to persistent heart failure later on. Another was admitted with heart failure but died due to incessant ventricular tachycardia refractory to recurrent electrical cardioversion. Two more patients died within one year again due to heart failure. Amongst successful recanalization group two patients died due to ventricular arrhythmia in first month. Two patients succumbed within a year because of heart failure. None of them died during their hospital stay. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. (Table 3). (Chart 5) One year mortality was 14.5% in successful recanalization group and 72% in no reflow group. (Table 4) One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group.
Relative risk of dying within one month in no-reflow group as compared to successful recanalization group is highly significant (RR is 8.00 ;95%Confidence interval 1.864 to 34.333; with a p-value of 0.0027). Thirty two patients died in first year in no reflow group(72%). Seventy six patient died in first year in successful recanalization group(14.4%).Relative risk of dying within one year in no-reflow group as compared to successful recanalization group is statistically significant (RR is 5.333 ;95% Confidence interval 1.961 to 14.504; with a p-value of 0.0009).
No flow is seen around 8.8-10% patients of primary percutaneous intervention(PCI) in ST elevation myocardial infarction(STEMI) patients. No flow is associated with increased morbidity and mortality. No flow can result in poor healing of the infarct, adverse left ventricular remodeling and it increases risk for major adverse cardiac events, including congestive heart failure and death. Despite considerable insight in recent years regarding who is at risk for no-reflow and how management strategies work, no specific therapies have been devised, and the evidence in support of their use remains contentious in many cases.
No flow is accompanied by chest pain, electrical instability and possible hemodynamic compromise. The mechanisms of no reflow are thrombus-plaque embolisation, platelet activation, release of vasoconstrictors and vasospasm. Thirty day mortality of refractory no flow is 32%. [4] No reflow is directly proportional to thrombus burden. Lot of STEMI patients have huge thrombus burden. After stent deployment or balloon dilatation thrombus may fragment and migrate distally in coronary artery. Routine use of aspiration catheter and Gp 11b/111a receptor blocker in primary PCI is not recommended now. TASTE trial has proven that routine use of aspiration catheter is not beneficial but it increases incidence of stroke. [5]
Rezkalla et al had studied 347 STEMI patients treated with primary PCI and found no-reflow phenomenon in 32% of patients. Patients with no-reflow had received pharmacological vasodilator therapy like intracoronary nitroprusside, nicardipine, or verapamil and they had experienced improvement in coronary flow and better prognosis. [6] Factors known to be associated with high risk of no flow in STEMI patients include delayed presentation to the catheterization laboratory, hyperglycemia, and hypercholesterolemia. No flow is also more frequently encountered in association with female sex, hypertension, mild-to-moderate renal insufficiency, and elevated inflammatory markers. [7] There are also lesion-specific features that may increasethe risk of no flow, such as plaque composition and hrombus burden as detected by intravascular ultrasound. [8] In patients with diabetes, optimal blood sugar control before the procedure can reduce the occurrence of no flow. In individuals with hyperlipidemia, intensive statin therapy before PCI is beneficial in reducing no-reflow.9Prevention strategies should include primary stenting, avoidance of high pressure stent deployment, and thrombectomy before the intervention if there is huge thrombus load. [10] In a study by Sezer M et al, primary PCI followed by the intracoronary low-dose streptokinase was compared with standard primary PCI without the use of intracoronary streptokinase. In the streptokinase group, 250 kU of streptokinase diluted with 20 ml of saline was infused through the guiding catheter. It has been shown that intracoronary strptokinase therapy prevents left ventricular dilation, preserves systolic function, and decreases long-term LV infarct size by 31%. [11] Daniela Boscarelli et al had studied thirty STEMI patients having large thrombus burden after failed mechanical thrombus aspiration. Intracoronay thrombolysis was used in low dose by infusion catheter (one-third systemic dose of tenecteplase 27% cases) or alteplase (73% cases). In their series thirty three percent patients presented 12 hours after onset of chest pain and seventeen percent were in cardiogenic shock. TIMI flow grade improved from 0/1 at baseline (93%) to ≥2 in most patients (97%). Blush grade 2–3 was observed in 85% of patients and there were more than 50% ST-segment resolution in 82% of cases. In-hospital mortality was 10%. They did not observe any major bleeding complication. [12] Kelly et al had studied thirty four STEMI patients who had no flow after primary PCI. They have used GP 11b/111a receptor blocker and low dose intracoronary tenectaplase. Mean dose of 10.2 ± 5.2 mg. There was improvement in angiographically visible thrombus and/or intracoronary blood flow in 31 (91%) patients. But there were four in‐hospital deaths, two reinfarctions, no stroke, one major bleeding event, and three minor bleeding events in their series. [13]
In our study incidence of no flow was 7.75%.Relative risk of death was higher in this group(9.75). TIMI 3 flow was established in 72% of cases after intracoronary tenectaplase. Relative risk of death in patients who did not achieve TIMI 3 flow after intracoronary tenectaplase were high( one month relative risk 8 and one year relative risk 5.3).Right coronary artery was most commonly involved and least common was left circumflex artery. Left anterior descending artery was most recalcitrant artery for TIMI 3 flow restoration after thrombolysis. Thrombus burden and vessel ectasia were two important predisposing factors for no flow. Late presentation could be contributing factor for large, recalcitrant thrombus burden. There was no major bleeding complication in our study. We did not observe any intracranial of gastrointestinal bleeding complication. Local puncture site haematoma were also not significant after intracoronary thrombolysis Primary PCI is associated with high rates of distal embolization due to high thrombus burden. The sequelae of distal embolization results in reduced myocardial perfusion and increased myocyte damage. Macroscopic distal embolization may be seen in up to 16% of patients undergoing primary PCI and suboptimal tissue perfusion may be seen in 20% to 40% of patients despite restoration of TIMI 3 epicardial flow in the catheterization laboratory. [14] A number of vasodilator agents have been shown to improve TIMI flow rate, corrected TIMI frame counts, and wall motion score index. Such vasodilator agents include adenosine, verapamil, nicorandil, and norepinephrine and sodium nitroprusside. [15]
Conclusion: Refractory no reflow during primary PCI in STEMI is associated with high mortality and morbidity. There is no established strategy to solve this phenomenon. Intracoronary thrombolysis is an option to salvage these patients.
Limitations: Majority of or patients had presented six hours after onset of chest pain making thrombus burden heavy. It was a single centre observational study, not a randomized trial. There could be selection bias in our observation.
Conflict of interest: I do not have any conflict of interest.
Financial:
I do not have any financial disclosure regarding this manuscript
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
