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Pan D, Chen H. Relationship between serum albumin level and hospitalization duration following percutaneous coronary intervention for acute coronary syndrome. Sci Rep 2024; 14:23883. [PMID: 39396090 PMCID: PMC11470946 DOI: 10.1038/s41598-024-74955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/30/2024] [Indexed: 10/14/2024] Open
Abstract
Low serum albumin levels increase coronary morbidity, mortality, and postoperative cardiovascular risk. Therefore, this study investigated the relationship between these levels and the length of hospital stay in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. A total of 350 patients were divided into quartiles according to serum albumin levels. Univariate and multivariate analyses were performed to identify factors associated with the length of hospital stay. A non-linear regression analysis of serum albumin and length of hospital stay was also performed. The results of the multifactorial analysis revealed low serum albumin levels as an independent predictor of longer hospital stay, even in the fully adjusted model. In the segmented linear regression model, serum albumin level showed a U-shaped relationship with the length of hospital stay. In conclusion, low serum albumin level was an independent predictor of longer hospital stay in patients undergoing PCI for acute coronary syndrome, with shorter stays observed for increasing serum albumin levels. Low serum albumin can be used to identify patients who require longer hospitalization and may need additional nutritional support or interventions to improve their prognosis.
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Affiliation(s)
- Di Pan
- Department of Cardiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Haibo Chen
- Department of Cardiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China.
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Safak O, Yildirim T, Emren V, Avci E, Argan O, Aktas Z, Yildirim SE, Akgun DE, Kisacik HL. Prognostic Nutritional Index as a Predictor of No-Reflow Occurrence in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention. Angiology 2024; 75:689-695. [PMID: 37553838 DOI: 10.1177/00033197231193223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Nutritional status and its index (Prognostic Nutritional Index, PNI) is an important prognostic factor for ST-segment elevation myocardial infarction (STEMI). The present study investigated whether PNI it is associated with no-reflow in patients with STEMI. In this retrospective study, 404 patients with STEMI and underwent primary percutaneous coronary intervention (pPCI) were consecutively included, between January 2016 and December 2018. No-reflow phenomenon (NRP) was detected in 103 (25.4%) patients. In multivariate logistic regression analysis C-reactive protein (CRP) (odds ratio (OR): 1.693, 95% confidence interval (CI): 1.126-2.547, P = .011), left ventricle ejection fraction (LVEF) (OR: 0.777, 95% CI: 0.678-0.891, P < .001), SYNTAX score (OR: 1.114, 95% CI: 1.050-1.183, P = .001), low density lipoprotein cholesterol (LDL-C) (OR: 1.033, 95% CI: 1.013-1.055, P = .002), hemoglobin level (OR: 0.572, 95% CI: 0.395-0.827, P = .003), PNI (OR: 0.554, 95% CI: 0.448-0.686, P < .001) were associated with NRP. The area under curve of PNI was significantly higher than albumin (z = 4.747, P < .001) and lymphocyte values (z = 3.481 P < .001). PNI was associated with no-reflow occurrence and mortality. So, PNI may be useful to predict NRP risk in patients with STEMI before pPCI.
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Affiliation(s)
- Ozgen Safak
- Department of Cardiology, Balıkesir University, Balıkesir, Turkey
| | - Tarik Yildirim
- Department of Cardiology, Balıkesir University, Balıkesir, Turkey
| | - Volkan Emren
- Department of Cardiology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Eyup Avci
- Department of Cardiology, Balıkesir University, Balıkesir, Turkey
| | - Onur Argan
- Department of Cardiology, Balıkesir University, Balıkesir, Turkey
| | - Zihni Aktas
- Department of Cardiology, Balıkesir State Hospital, Balıkesir, Turkey
| | | | - Didar Elif Akgun
- Department of Cardiology, Kırklareli Training and Research Hospital, Kırklareli, Turkey
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Bayramoğlu A, Hidayet Ş. Association between pan-immune-inflammation value and no-reflow in patients with ST elevation myocardial infarction undergoing percutaneous coronary intervention. Scand J Clin Lab Invest 2023; 83:384-389. [PMID: 37498164 DOI: 10.1080/00365513.2023.2241131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
Noreflow is a condition associated with a poor prognosis in ST segment elevation myocardial infarction patients. It has been shown that many inflammatory markers and index such as procalcitonin, C-reactive protein, neutrophil to lymphocyte ratio, systemic immune inflammatory index (SII), are associated with noreflow. We used a brand-new index pan-immune-inflammation value (PIV) to retrospectively evaluate the relationship between PIV and noreflow. A total of 1212 patients were included for analysis. Noreflow was observed in 145 patients. In multivariate analysis, PIV (odds ratio (OR): 1.025; [1.002-1.115], p < 0.001), baseline ejection fraction (OR: 0.963; [0.934-0.993], p = 0.015), stent length (OR: 1.032; [1.010-1.054], p = 0.004), age (OR: 1.034; [1.014-1.053], p = 0.001) and pain to PCI time (OR: 1.003 [1.002-1.005], p < 0.001) were observed to be the independent predictors of noreflow. ROC curve analysis showed that the best cut off value of PIV for predicting noreflow was ≥889 with 77.2% sensitivity and 77.5% specificity (AUC, 0.828; 95% CI [0.806-0.849]). A ROC curve comparison analysis was performed to compare PIV and SII. The predictive power of PIV was higher than SII (differences between areas: 0.154; p < 0.001). According to our findings, an increase in PIV is an independent predictor of noreflow in patients with STEMI.
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Affiliation(s)
| | - Şıho Hidayet
- Department of Cardiology, Inonu University, Malatya, Turkey
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Kim SE, Choi KH, Song YB. An unusual no-reflow phenomenon due to neointimal tissue embolization during drug eluting balloon intervention in stent restenosis: A case report. Catheter Cardiovasc Interv 2023; 102:481-485. [PMID: 37465845 DOI: 10.1002/ccd.30771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023]
Abstract
Acute coronary syndrome is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI), along with various devices, have been technically developed to dramatically improve mortality risk in patients with acute myocardial infarction. However, no-reflow phenomenon still remains a problematic complication during a PCI, even in the era of drug eluting stents. There are various hypotheses and mechanisms for no-reflow phenomenon, but none have been confirmed. Treatment for no-reflow phenomenon also depends on various underlying conditions, but have not yet shown effective improvement. We presented a case of no-reflow phenomenon caused by an unusual cause.
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Affiliation(s)
- Sung Eun Kim
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Hong Choi
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Department of Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Demirci G, Şahin AA, Aktemur T, Demir AR, Çetin İ, Arslan E, Işık A, Gürbak İ, Ertürk M. Relationship between systemic immune-inflammation index and no-reflow in percutaneous coronary intervention for saphenous grafts. Biomark Med 2023. [PMID: 37449860 DOI: 10.2217/bmm-2023-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective: In this study, we investigated the occurrence of no-reflow (NR) in percutaneous coronary intervention (PCI) for saphenous vein grafts (SVGs) and its relationship with a new systemic immune-inflammation index (SII) that determines inflammation. Methods: We studied 303 patients with acute coronary syndrome without ST elevation who underwent PCI for SVG disease. Results: NR formation during SVG PCI was significantly higher in patients with high SII (p < 0.001). NR occurrence was 12.8% when SII was ≤548 and 41.9% when SII was >548. Conclusion: Our study is the first to investigate SII as the state of inflammation and its effect on the SVG PCI. Patients with higher SII have a higher risk of NR during an SVG for PCI.
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Affiliation(s)
- Gökhan Demirci
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet A Şahin
- Department of Cardiology, Istinye University, Liv Bahçeşehir Hospital, Istanbul, 34303, Turkey
| | - Tuğba Aktemur
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali R Demir
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İlyas Çetin
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Enes Arslan
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayan Işık
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İsmail Gürbak
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- University of Health Sciences, Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Tian XX, Luo JY, Liu F, Qiu YJ, Luo F, Zeng L, Zhang ZR, Yang YN, Li XM. Prognostic value of fibrinogen-to-albumin ratio combined with coronary calcification score in patients with suspected coronary artery disease. BMC Cardiovasc Disord 2023; 23:181. [PMID: 37016312 PMCID: PMC10071697 DOI: 10.1186/s12872-023-03193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE The aim of this work was to evaluate the predictive value of FAR combined with CACS for MACCEs. BACKGROUND The fibrinogen-albumin-ratio (FAR), a novel biomarker of inflammation, is associated with the severity of coronary artery disease (CAD). Coronary calcification score (CACS) is associated with the severity of coronary stenosis and is closely related to the prognosis of CAD patients. What is the prognostic value of FAR in patients with chest pain, which has not been reported. This study aims to evaluate the relationship between CACS and FAR and their impact on prognosis in patients with suspected CAD. METHODS We used information from 12,904 individuals who had coronary computed tomography angiography (CTA) for chest pain and tracked down any significant adverse cardiac and cerebrovascular events (MACCEs). The following formula was used to calculate FAR: fibrinogen (g/L)/albumin (g/L). Patients were separated into groups with greater levels of FAR (FAR-H) and lower levels of FAR (FAR-L) in accordance with the ideal cut-off value of FAR for MACCEs prediction. In addition, patients were divided into three groups based on their CACS scores (CACS ≤ 100, 100 < CACS ≤ 400, and CACS > 400). RESULTS 4946 patients [62(55-71) years, 64.4% male] were ultimately enrolled in the present study. During follow-up, a total of 234 cases (4.7%) of MACCEs were documented. Linear regression analysis results showed that CACS (R2 = 0.004, Standard β = 0.066, P < 0.001) was positively associated with FAR in patients with chest pain.Compared to ones with FAR-L, FAR-H had an increased risk for MACCEs (adjusted HR 1.371(1.053-1.786) P = 0.019). Multivariate Cox regression showed that age (adjusted HR 1.015 95% CI 1.001-1.028;p = 0.03), FAR (adjusted HR 1.355 95% CI 1.042-1.763;p = 0.023),FBG (adjusted HR 1.043 95% CI 1.006-1.083;p = 0.024) and CACS (adjusted HR 1.470 95% CI 1.250-1.727;p < 0.001) were the independent risk factors for MACCEs. The FAR and CACS significantly improved MACCEs risk stratification, contributing to substantial net reclassification improvement ( NRI 0.122, 95% CI 0.054-0.198, P < 0.001) and integrated discrimination improvement(IDI 0.011, 95% CI 0.006-0.017, P < 0.001). CONCLUSION FAR was an independent risk factor for MACCEs. The results showed that CACS was positively associated with FAR in patients with suspected CAD. A higher level of FAR and heavier coronary calcification burden was associated with worse outcomes among patients with suspected CAD. FAR and CACS improved the risk identification of patients with suspected CAD, leading to a significant reclassification of MACCEs.
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Affiliation(s)
- Xin-Xin Tian
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Jun-Yi Luo
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ya-Jing Qiu
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Fan Luo
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Lu Zeng
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Zhuo-Ran Zhang
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Yi-Ning Yang
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiao-Mei Li
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, Xinjiang, China.
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Chen X, Chen X, Wang J, Yu FTH, Villanueva FS, Pacella JJ. Dynamic Behavior of Polymer Microbubbles During Long Ultrasound Tone-Burst Excitation and Its Application for Sonoreperfusion Therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:996-1006. [PMID: 36697268 PMCID: PMC9974862 DOI: 10.1016/j.ultrasmedbio.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Ultrasound (US)-targeted microbubble (MB) cavitation (UTMC)-mediated therapies have been found to restore perfusion and enhance drug/gene delivery. Because of the potentially longer circulation time and relative ease of storage and reconstitution of polymer-shelled MBs compared with lipid MBs, we investigated the dynamic behavior of polymer microbubbles and their therapeutic potential for sonoreperfusion (SRP) therapy. METHODS The fate of polymer MBs during a single long tone-burst exposure (1 MHz, 5 ms) at various acoustic pressures and MB concentrations was recorded via high-speed microscopy and passive cavitation detection (PCD). SRP efficacy of the polymer MBs was investigated in an in vitro flow system and compared with that of lipid MBs. DISCUSSION Microscopy videos indicated that polymer MBs formed gas-filled clusters that continued to oscillate, fragment and form new gas-filled clusters during the single US burst. PCD confirmed continued acoustic activity throughout the 5-ms US excitation. SRP efficacy with polymer MBs increased with pulse duration and acoustic pressure similarly to that with lipid MBs but no significant differences were found between polymer and lipid MBs. CONCLUSION These data suggest that persistent cavitation activity from polymer MBs during long tone-burst US excitation confers excellent reperfusion efficacy.
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Affiliation(s)
- Xianghui Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jianjun Wang
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francois T H Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Zhao W, Xiong FJ, Feng SG, Li YM, Lei XH, Jia SJ. Oral Chinese patent medicines for acute myocardial infarction after percutaneous coronary intervention: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31927. [PMID: 36482597 PMCID: PMC9726348 DOI: 10.1097/md.0000000000031927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a serious and fatal heart disease with one of the highest mortality rates in the world. In some countries, percutaneous coronary intervention (PCI) is the preferred reperfusion strategy after AMI, but it cannot achieve safe and effective treatment of AMI after PCI remains a challenging clinical problem. The potential of oral Chinese patent medicines to treat AMI after PCI has been demonstrated, but which type of oral Chinese patent medicines may be preferred remains controversial. The aim of this network meta-analysis was to investigate the efficacy and safety of multiple oral Chinese patent medicines in the treatment of AMI after PCI. METHODS We will conduct a literature search from China National Knowledge Infrastructure, formerly Chinese Biomedical Database (SinoMed), Wanfang Data, Chongqing VIP, PubMed, Embase, Web of Science and Cochrane Library (The Cochrane Database of Systematic Reviews) from their inception until to November 1, 2022, with language restricted to Chinese and English. Then, the study selection process will follow the Preferred Reporting Items for Meta-Analyses guideline, and the quality assessment will be conducted with Cochrane Collaboration's tool. Pairwise and network meta-analysis will be conducted using the WinBUGS V.1.4.3.37 and STATA V.13. Additionally, sensitivity analysis, subgroup analysis, quality assessment, Small-study effects and publication bias will be performed. ETHICS AND DISSEMINATION This work is based on published research and therefore does not require ethical approval. This review will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020188065.
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Affiliation(s)
- Wei Zhao
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Fan-Jie Xiong
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shu-Gui Feng
- Luzhou Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou, China
| | - Yan-Ming Li
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Xing-Hua Lei
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shi-Jian Jia
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
- *Correspondence: Shi-Jian Jia, Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, No.120 Xiangzhang Road, Xindu District, Chengdu, Sichuan Province 610500, China (e-mail: )
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Endothelial Autophagy in Coronary Microvascular Dysfunction and Cardiovascular Disease. Cells 2022; 11:cells11132081. [PMID: 35805165 PMCID: PMC9265562 DOI: 10.3390/cells11132081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
Coronary microvascular dysfunction (CMD) refers to a subset of structural and/or functional disorders of coronary microcirculation that lead to impaired coronary blood flow and eventually myocardial ischemia. Amid the growing knowledge of the pathophysiological mechanisms and the development of advanced tools for assessment, CMD has emerged as a prevalent cause of a broad spectrum of cardiovascular diseases (CVDs), including obstructive and nonobstructive coronary artery disease, diabetic cardiomyopathy, and heart failure with preserved ejection fraction. Of note, the endothelium exerts vital functions in regulating coronary microvascular and cardiac function. Importantly, insufficient or uncontrolled activation of endothelial autophagy facilitates the pathogenesis of CMD in diverse CVDs. Here, we review the progress in understanding the pathophysiological mechanisms of autophagy in coronary endothelial cells and discuss their potential role in CMD and CVDs.
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AKTAŞ H. Akut Koroner Sendrom ile Başvuran Hastalarda Daha Önceden Düzenli Asetilsalisilik Asit Kullanımının TIMI Akımı ve Miyokardiyal Hasar Üzerine Etkileri. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.975838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Zhang XT, Lin ZR, Zhang L, Zhao ZW, Chen LL. MELD-XI score predict no-reflow phenomenon and short-term mortality in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:113. [PMID: 35300593 PMCID: PMC8931958 DOI: 10.1186/s12872-022-02556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION No-reflow phenomenon (NRP) is one of the complications that mostly occur during percutaneous coronary intervention (PCI). In this study, we comprehensively examined the relationship between the model for end-stage liver disease-XI (MELD-XI) score and NRP. Moreover, we discussed whether the MELD-XI score could be considered as an accurate risk assessment score of patients with ST-segment elevation myocardial infarction (STEMI) who are candidates for PCI. METHODS This retrospective study involved 693 patients with acute STEMI and who underwent an emergency PCI. They were divided into a normal reflow group or a no-reflow group on the basis of the flow rate of post-interventional thrombolysis in myocardial infarction. Univariate, multivariate logistic regression, and Cox regression analyses were performed to identify the independent predictors of NRP in both groups. Receiver operator characteristic (ROC) curves and Kaplan-Meier curves were plotted to estimate the predictive values of the MELD-XI score. RESULTS MELD-XI score was found to be an independent indicator of NRP (odds ratio: 1.247, 95% CI: 1.144-1.360, P < 0.001). Multivariate Cox regression analysis also revealed that the MELD-XI score is an independent prognostic factor for 30-day all-cause mortality (hazard ratio: 1.155, 95% CI: 1.077-1.239, P < 0.001). Moreover, according to the ROC curves, the cutoff value of the MELD-XI score to predict NRP was 9.47 (area under ROC curve: 0.739, P < 0.001). The Kaplan-Meier curves for 30-day all-cause mortality revealed lower survival rate in the group with a MELD-XI score of > 9.78 (P < 0.001). CONCLUSION The MELD-XI score can be used to predict NRP and the 30-day prognosis in patients with STEMI who are candidates for primary PCI. It could be adopted as an inexpensive and a readily available tool for risk stratification.
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Affiliation(s)
- Xin-Tao Zhang
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhao-Rong Lin
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China
| | - Lin Zhang
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zi-Wen Zhao
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.,Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China
| | - Liang-Long Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China. .,Fujian Institute of Coronary Artery Disease, Fuzhou, 350001, Fujian, People's Republic of China.
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12
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Ma M, Wang L, Diao KY, Liang SC, Zhu Y, Wang H, Wang M, Zhang L, Yang ZG, He Y. A randomized controlled clinical trial of prolonged balloon inflation during stent deployment strategy in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a pilot study. BMC Cardiovasc Disord 2022; 22:30. [PMID: 35120436 PMCID: PMC8815170 DOI: 10.1186/s12872-022-02477-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023] Open
Abstract
Background Primary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for ST-segment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains common and is associated with adverse outcomes. Aims This study aimed to evaluate whether prolonged balloon inflation in stent deployment would lessen the occurrence of the no-reflow phenomenon in PPCI compared with conventional rapid inflation/deflation strategy. Methods Patients were randomly assigned to either the prolonged balloon inflation in stent deployment group (PBSG) or conventional deployment strategy group (CDSG) in a 1:1 ratio. A subset of patients was included in the cardiac magnetic resonance (CMR) assessment. Results Thrombolysis in MI (TIMI) flow grade 3 was found in 96.7% and 63.3% of the patients of the PBSG and CDSG, respectively (P = 0.005). The results of the PBSG and CDSG are respectively shown as follows: 0% versus 30% no-reflow or slow flow (P = 0.002); 90% versus 66.7% ST-segment resolution ≥ 50% (P = 0.028); 35.6 ± 14.5 frames versus 49.18 ± 25.2 frames on corrected TIMI frame count (P = 0.014); and 60% versus 20% myocardial blush grade 3 (P = 0.001). At 1 month, the major cardiovascular adverse event (cardiovascular mortality) rate was 3.3% in both groups; at 1 year, the rate was 3.3% and 6.7% for the PBSG and CDSG, respectively (P = 1.00). In the CMR subset of cases, the presence of microvascular obstruction (MVO) was detected in 6.7% and 50% of the patients in the PBSG and CDSG, respectively (P = 0.023). Conclusion In our pilot trial, prolonged balloon inflation during stent deployment strategy in PPCI reduces the occurrence of the no-reflow phenomenon in patients with STEMI and improved the myocardial microcirculation perfusion (ClinicalTrials.gov number: NCT03199014; registered: 26/June/2017).
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Affiliation(s)
- Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.,Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Ling Wang
- Department of Cardiology, Mian Yang People's Hospital, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China
| | - Shi-Chu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Mian Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Li Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.
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Esenboğa K, Kurtul A, Yamantürk YY, Tan TS, Tutar DE. Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention. Acta Cardiol 2022; 77:59-65. [PMID: 33612077 DOI: 10.1080/00015385.2021.1884786] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Systemic immune-inflammation index (SII), on the basis of lymphocyte, neutrophil and platelet counts had been published to be a good prognostic factor in coronary artery disease. Nevertheless, the prognostic value of Systemic immune-inflammation index (SII) in a condition of no-reflow phenomenon (NRP) remains inconsistent, we evaluated the SII as a simple calculated tool for predicting the NRP among patients with STEMI who underwent primary percutaneus coronary intervention (PCI). METHOD 510 consecutive acute STEMI patients who underwent primary PCI within 12 h from symptom onset from October 2015 to January 2020 were enrolled in our study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. Multivariate stepwise logistic regression, including covariates found to have a significant association with NRP in univariate analysis, was used to identify independent predictors of no-reflow. RESULTS A ROC curve analysis showed that the best cut-off value of SII for predicting no-reflow was 1028, with sensitivity and specificity of 79% and 70, respectively (AUC, 0.839; 95% CI 0.797-0.881). An ROC curve comparison analysis was performed to compare the SII with NLR and PLR. Multivariate analysis revealed that SII ≥1028 value (OR = 6.622, 95% confidence interval (CI): 3.802-11.627, p < .001), not using aspirin prior to admission (OR = 0.431, 95%CI: 0.236-0.786, p = .006), and CRP (OR = 1.004, 95%CI: 1.001-1.008, p = .041) were independent predictors related to occurrence of NRP after primary PCI in patients with acute STEMI. CONCLUSION SII levels are independently associated with the NRP in patients undergoing primary PCI for acute STEMI. High SII may be a promising indicator for the prediction of NRP in these patients.
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Affiliation(s)
- Kerim Esenboğa
- aDepartment of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alparslan Kurtul
- bDepartment of Cardiology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | | | - Türkan Seda Tan
- aDepartment of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Durmuş Eralp Tutar
- aDepartment of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
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Myocardial Microvascular Physiology in Acute and Chronic Coronary Syndromes, Aortic Stenosis, and Heart Failure. J Interv Cardiol 2022; 2022:9846391. [PMID: 35935124 PMCID: PMC9297731 DOI: 10.1155/2022/9846391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023] Open
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Hu X, Wang W, Ye J, Lin Y, Yu B, Zhou L, Zhou Y, Dong H. Effect of GP IIb/IIIa inhibitor duration on the clinical prognosis of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction with no-/slow-reflow phenomenon. Biomed Pharmacother 2021; 143:112196. [PMID: 34560551 DOI: 10.1016/j.biopha.2021.112196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) accompanied by the no-/slow-reflow phenomenon, the maintenance duration of GP IIb/IIIa inhibitor (GPI) is controversial. We compare the efficacy and safety of short- and long-term GPI infusion in STEMI patients with the no-/slow-reflow phenomenon. METHODS From June 2016 to December 2019, we continuously included patients with on-set STEMI who underwent pPCI, accompanied by the no-/slow-reflow, during interventional procedures at Guangdong Provincial People's Hospital and Zhuhai Golden Bay Hospital. The hemorrhage events, heart function, and major adverse cardiovascular events (MACE) were compared between < 24 h and ≥ 24 h GPI duration groups. The Kaplan-Meier curve was used to estimate the 1-year MACE-free survival at different GPI utility times. RESULTS In total, 127 patients were divided into two groups based on the duration of tirofiban use (less and more than 24 h). There was no significant difference between two groups in terms of baseline characteristics, plaque condition, and coronary physiological function. The two groups showed similar in-hospital MACE (1 [1.85%] vs. 4 [5.48%], p = 0.394) and 1-year MACE-free survival (log-rank test p = 0.9085). The 1-year MACE remained consistent between the two groups in all subgroups of different risk factors of no-/slow-reflow. There was no significant difference in heart function and in-hospital hemorrhage events (3.7% vs. 1.37%, p = 0.179). CONCLUSION In the real world, prolonging the duration of GPI may not significantly improve the clinical outcome in patients with STEMI with no-/slow-reflow.
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Affiliation(s)
- Xiangming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Weimian Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Jingguang Ye
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519040, Guangdong, China.
| | - Yan Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Shantou University Medical College, Shantou 515041, Guangdong, China.
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China.
| | - Langping Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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Kai T, Oka S, Hoshino K, Watanabe K, Nakamura J, Abe M, Watanabe A. Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0. Circ J 2021; 85:1770-1778. [PMID: 34305099 DOI: 10.1253/circj.cj-21-0221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0. METHODS AND RESULTS In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Slow-flow/no-reflow was defined as TIMI Grade <3 by angiography after PCI, and impaired STR was defined as STR <50% on an electrocardiogram after PCI. Slow-flow/no-reflow was observed in 31 patients. In multivariate analysis, estimated glomerular filtration rate (eGFR; odds ratio [OR] 0.97; P=0.007), a history of cerebrovascular disease (OR 4.65, P=0.007), time to recanalization ≥4 h (OR 2.76, P=0.023), and systolic blood pressure ≤90 mmHg (OR 3.45, P=0.046) were independent predictors of slow-flow/no-reflow. Impaired STR was observed in 102 of 248 patients with TIMI Grade 3. In multivariate analysis, eGFR (OR 0.94, P<0.001) and occlusion of the left anterior descending artery (OR 4.48, P<0.001) were independent predictors of impaired STR; eGFR was the only independent predictor of both slow-flow/no-reflow and impaired STR. CONCLUSIONS Renal dysfunction may be related to coronary microvascular dysfunction and obstruction.
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Affiliation(s)
- Takahiko Kai
- Department of Cardiology, Fujieda Municipal General Hospital
| | - Satoshi Oka
- Department of Cardiology, Fujieda Municipal General Hospital
| | | | | | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital
| | - Makoto Abe
- Department of Cardiology, Fujieda Municipal General Hospital
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Myocardial preservation during primary percutaneous intervention: It's time to rethink? Indian Heart J 2021; 73:395-403. [PMID: 34474749 PMCID: PMC8424360 DOI: 10.1016/j.ihj.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Bianco HT, Povoa R, Izar MC, Luna Filho B, Moreira FT, Stefanini E, Fonseca HA, Barbosa AHP, Alves CMR, Caixeta AM, Gonçalves I, Moraes PIDM, Lopes RD, Paola AAVD, Almeida D, Moises VA, Fonseca FAH. Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive Approach. Arq Bras Cardiol 2021; 117:15-25. [PMID: 34320062 PMCID: PMC8294746 DOI: 10.36660/abc.20200241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Fundamento A intervenção coronária percutânea primária é considerada o “padrão-ouro” para reperfusão coronária. Entretanto, quando não disponível, a estratégia fármaco-invasiva é método alternativo, e o eletrocardiograma (ECG) tem sido utilizado para identificar sucesso na reperfusão. Objetivos Nosso estudo teve como objetivo examinar alterações no segmento-ST pós-lise e seu poder de prever a recanalização, usando os escores angiográficos TIMI e blush miocárdio (MBG) como critério de reperfusão ideal. Métodos Foram estudados 2.215 pacientes com infarto agudo do miocárdio com supra-ST submetidos à fibrinólise [(Tenecteplase)-TNK] e encaminhados para angiografia coronária em até 24 h pós-fibrinólise ou imediatamente encaminhados à terapia de resgate. O ECG foi realizado pré-TNK e 60 min-pós. Os pacientes foram categorizados em dois grupos: aqueles com reperfusão ideal (TIMI-3 e MBG-3) e aqueles com reperfusão inadequada (fluxo TIMI <3). Foi definido o critério de reperfusão do ECG pela redução do segmento ST >50%. Consideramos p-valor <0,05 para as análises, com testes bicaudais. Resultados O critério de reperfusão pelo ECG apresentou valor preditivo positivo de 56%; valor preditivo negativo de 66%; sensibilidade de 79%; e especificidade de 40%. Houve fraca correlação positiva entre a redução do segmento-ST e os dados angiográficos de reperfusão ideal (r = 0,21; p <0,001) e baixa precisão diagnóstica, com AUC de 0,60 (IC-95%; 0,57-0,62). Conclusão Em nossos resultados, a redução do segmento-ST não conseguiu identificar com precisão os pacientes com reperfusão angiográfica apropriada. Portanto, mesmo pacientes com reperfusão aparentemente bem-sucedida devem ser encaminhados à angiografia brevemente, a fim de garantir fluxo coronário macro e microvascular adequados.
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Affiliation(s)
- Henrique Tria Bianco
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | | | - Flavio Tocci Moreira
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | | | - Adriano Mendes Caixeta
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Iran Gonçalves
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | - Renato Delascio Lopes
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Duke University Hospital, Durham, North Carolina - EUA
| | | | - Dirceu Almeida
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | - Valdir Ambrosio Moises
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
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Feng KF, Wu M, Ma LK. Factors Associated with the Prognosis of Patients with Acute Myocardial Infarction and Cardiogenic Shock. Med Sci Monit 2021; 27:e929996. [PMID: 34215715 PMCID: PMC8262259 DOI: 10.12659/msm.929996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/28/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) usually have high mortality. This study aimed to identify factors related to the short-term survival of patients with AMI and CS treated by percutaneous coronary intervention (PCI) under intra-aortic balloon pump (IABP) support. MATERIAL AND METHODS This retrospective study included consecutive patients with AMI and CS treated with PCI under IABP support. Clinical characteristics, including the infarct-related artery, lesion number, aspiration catheter usage, conventional or delayed stenting, and thrombolysis in myocardial infarction (TIMI) flow grade before and after PCI, were collected. Patients were followed up postoperatively for 30 days. Multivariate logistic regression was used to identify factors associated with the 30-day mortality. RESULTS There were marked differences between the nonsurvival group (n=49) and the survival group (n=92) in the no-reflow after surgery (49.0% vs 14.1%, P<0.001), postoperative TIMI grade 3 flow (65.3% vs 91.3%, P<0.001), and delayed stent implantation (18.4% vs 37.0%, P=0.022). Factors associated with 30-day mortality were postoperative TIMI grade 3 flow (odds ratio [OR]: 0.227; 95% confidence interval [CI]: 0.076-0.678; P=0.008), delayed stent implantation (OR: 0.371; 95% CI: 0.139-0.988; P=0.047), and intraoperative no-reflow (OR: 2.737; 95% CI: 1.084-6.911; P=0.033). CONCLUSIONS For patients with AMI complicated by CS treated with emergent PCI under IABP support, prevention of no-reflow during surgery by delayed stent implantation can reduce postoperative 30-day mortality in selected cases.
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Affiliation(s)
- Ke-Fu Feng
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Min Wu
- Department of Respiratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, China (mainland)
| | - Li-Kun Ma
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
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Messerli AW, Ahmed T. For Prediction of "No-Reflow," How Precise is PRECISE-DAPT? Angiology 2021; 73:7-8. [PMID: 34018406 DOI: 10.1177/00033197211018356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Taha Ahmed
- University of Kentucky Healthcare, Lexington, KY, USA
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21
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Coronary Endothelium No-Reflow Injury Is Associated with ROS-Modified Mitochondrial Fission through the JNK-Drp1 Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6699516. [PMID: 33613824 PMCID: PMC7878075 DOI: 10.1155/2021/6699516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
Coronary artery no-reflow is a complex problem in the area of reperfusion therapy, and the molecular mechanisms underlying coronary artery no-reflow injury have not been fully elucidated. In the present study, we explored whether oxidative stress caused damage to coronary endothelial cells by inducing mitochondrial fission and activating the JNK pathway. The hypoxia/reoxygenation (H/R) model was induced in vitro to mimic coronary endothelial no-reflow injury, and mitochondrial fission, mitochondrial function, and endothelial cell viability were analyzed using western blotting, quantitative polymerase chain reaction (qPCR), enzyme-linked immunosorbent assay (ELISA), and immunofluorescence. Our data indicated that reactive oxygen species (ROS) were significantly induced upon H/R injury, and this was followed by decreased endothelial cell viability. Mitochondrial fission was induced and mitochondrial bioenergetics were impaired in cardiac endothelial cells after H/R injury. Neutralization of ROS reduced mitochondrial fission and protected mitochondrial function against H/R injury. Our results also demonstrated that ROS stimulated mitochondrial fission via JNK-mediated Drp1 phosphorylation. These findings indicate that the ROS-JNK-Drp1 signaling pathway may be one of the molecular mechanisms underlying endothelial cell damage during H/R injury. Novel treatments for coronary no-reflow injury may involve targeting mitochondrial fission and the JNK-Drp1 signaling pathway.
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Abdallah AA, Elrhman MAA, Elshazly A, Bastawy I. Relationship of serum vitamin D levels with coronary thrombus grade, TIMI flow, and myocardial blush grade in patients with acute ST-segment elevation myocardial infarction. Egypt Heart J 2020; 72:84. [PMID: 33226540 PMCID: PMC7683648 DOI: 10.1186/s43044-020-00118-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is a prevalent condition that is found in about 30-50% of the general population, and it is increasing as a new risk factor for coronary artery disease. Our study aimed to evaluate the relationship of serum vitamin D levels with coronary thrombus burden, Thrombolysis In Myocardial Infarction flow grade, and myocardial blush grade in patients managed by primary percutaneous coronary intervention for their first acute ST-segment elevation myocardial infarction. RESULTS Eighty patients were included in the study with their first acute ST-segment elevation myocardial infarction and were managed by primary percutaneous coronary intervention. According to the serum concentrations of vitamin D, the study population was divided into 2 groups: group A with abnormal vitamin D levels less than 30 ng/ml (50 patients) and group B with normal vitamin D levels equal to or more than 30 ng/ml (30 patients). Angiographic data was recorded before and after coronary intervention. On comparing thrombus grade and initial and post-procedural Thrombolysis In Myocardial Infarction flow between both groups of patients, there was no significant difference (p = 0.327, p = 0.692, p = 0.397). However, myocardial blush grade was better in patients with normal vitamin D levels (p = 0.029) without a significant correlation between vitamin D concentration values and myocardial blush grade (r = 0.164, p = 0.146). CONCLUSIONS Patients with first acute ST-segment elevation myocardial infarction and normal vitamin D levels undergoing primary percutaneous coronary intervention had better myocardial blush grade and more successful microvascular reperfusion in comparison with patients with abnormal vitamin D levels. There was no significant difference between the normal and abnormal vitamin D groups regarding the coronary thrombus grade and Thrombolysis In Myocardial Infarction flow.
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Affiliation(s)
| | | | - Ahmd Elshazly
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Islam Bastawy
- Department of Cardiology, Ain Shams University, Cairo, Egypt.
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Shakiba M, Salari A, Mirbolouk F, Sotudeh N, Nikfarjam S. Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Heart Cent 2020; 15:50-56. [PMID: 33552194 PMCID: PMC7825467 DOI: 10.18502/jthc.v15i2.4183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00–1.09), hypertension (OR=2.91, 95% CI:1.35–6.27), diabetes (OR=4.18, 95% CI:1.89–9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02–12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88–9.77), chronic heart failure (OR=4.96, 95% CI:1.23–20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46–39.2 ), anemia (OR=3.42, 95% CI:1.33–8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19–0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow.
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Affiliation(s)
- Maryam Shakiba
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Department of Epidemiology and Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fardin Mirbolouk
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nozar Sotudeh
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Salman Nikfarjam
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ, Kubica J, Navarese EP. State of the Art: No-Reflow Phenomenon. Cardiol Clin 2020; 38:563-573. [PMID: 33036718 DOI: 10.1016/j.ccl.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary percutaneous coronary intervention is the preferred reperfusion strategy for the management of acute ST-segment elevation myocardial infarction. No reflow is characterized by the inadequate myocardial perfusion of a given segment without angiographic evidence of persistent mechanical obstruction of epicardial vessels. Both pharmacologic and device-based strategies have been tested to resolve coronary no reflow. This article provides an updated overview of the no-reflow phenomenon, discussing clinical evidence and ongoing investigations of existing and novel therapeutic strategies to counteract it.
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Affiliation(s)
- Gianluca Caiazzo
- ICCU, San Giuseppe Moscati Hospital, ASL CE, Via Gramsci 1, Aversa 81031, Italy
| | - Rita Leonarda Musci
- Department of Cardiology, Azienda Ospedaliera Bonomo, Viale Istria, Andria BT 76123, Italy
| | - Lara Frediani
- Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Viale Vittorio Alfieri, 36, Livorno LI 57124, Italy
| | - Julia Umińska
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, ul. Józefa Poniatowskiego 15, Kato 40-055, Katowice, Poland
| | - Krzysztof J Filipiak
- Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, Warszawa 02-091, Poland
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland
| | - Eliano Pio Navarese
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, SIRIO MEDICINE Network, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland; University of Alberta, 116 Street & 85 Avenue, Edmonton, AB T6G 2R3, Canada.
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Relation of Fibrinogen-to-Albumin Ratio to Severity of Coronary Artery Disease and Long-Term Prognosis in Patients with Non-ST Elevation Acute Coronary Syndrome. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1860268. [PMID: 32879878 PMCID: PMC7448116 DOI: 10.1155/2020/1860268] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
Previous studies showed that fibrinogen-to-albumin ratio (FAR) regarded as a novel inflammatory and thrombotic biomarker was the risk factor for coronary artery disease (CAD). In this study, we sought to evaluate the relationship between FAR and severity of CAD, long-term prognosis in non-ST elevation acute coronary syndrome (NSTE-ACS) patients firstly implanted with drug-eluting stent (DES). A total of 1138 consecutive NSTE-ACS patients firstly implanted with DES from January 2017 to December 2018 were recruited in this study. Patients were divided into tertiles according to FAR levels (Group 1: ≤8.715%; Group 2: 8.715%~10.481%; and Group 3: >10.481%). The severity of CAD was evaluated using the Gensini Score (GS). The endpoints were major adverse cardiovascular events (MACE), including all-cause mortality, myocardial reinfarction, and target vessel revascularization (TVR). Positive correlation was detected by Spearman's rank correlation coefficient analysis between FAR and GS (r = 0.170, P < 0.001). On multivariate logistic analysis, FAR was an independent predictor of severe CAD (OR: 1.060; 95% CI: 1.005~1.118; P < 0.05). Multivariate Cox regression analysis indicated that FAR was an independent prognostic factor for MACE at 30 days, 6 months, and 1 year after DES implantation (HR: 1.095; 95% CI: 1.011~1.186; P = 0.025. HR: 1.076; 95% CI: 1.009~1.147; P = 0.026. HR: 1.080; 95% CI: 1.022~1.141; P = 0.006). Furthermore, adding FAR to the model of established risk factors, the C-statistic increased from 0.706 to 0.720, 0.650 to 0.668, and 0.611 to 0.632, respectively. And the models had incremental prognostic value for MACE, especially for 1-year MACE (NRI: 13.6% improvement, P = 0.044; IDI: 0.6% improvement, P = 0.042). In conclusion, FAR was associated independently with the severity of CAD and prognosis, helping to improve risk stratification in NSTE-ACS patients firstly implanted with DES.
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Elakabawi K, Huang X, Shah SA, Ullah H, Mintz GS, Yuan Z, Guo N. Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI. BMC Cardiovasc Disord 2020; 20:391. [PMID: 32854618 PMCID: PMC7457271 DOI: 10.1186/s12872-020-01673-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Suboptimal coronary blood flow after primary percutaneous coronary intervention (PCI) is a complex multifactorial phenomenon. Although extensively studied, defined modifiable risk factors and efficient management strategy are lacking. This study aims to determine the potential causes of suboptimal flow and associated impact on 30-day outcomes in patients presenting with anterior ST-elevation myocardial infarction (STEMI). METHODS We evaluated a total of 1104 consecutive patients admitted to our hospital from January 2016 to December 2018 with the diagnosis of anterior wall STEMI who had primary PCI. RESULTS Overall, 245 patients (22.2%) had final post-PCI TIMI flow ≤2 in the LAD (suboptimal flow group) and 859 (77.8%) had final TIMI-3 flow (optimal flow group). The independent predictors of suboptimal flow were thrombus burden grade (Odds ratio (OR) 1.848; p < 0.001), age (OR 1.039 per 1-year increase; p < 0.001), low systolic blood pressure (OR 1.017 per 1 mmHg decrease; p < 0.001), total stent length (OR 1.021 per 1 mm increase; p < 0.001), and baseline TIMI flow ≤1 (OR 1.674; p = 0.018). The 30-day rates of major adverse cardiovascular events (MACE) and cardiac mortality were significantly higher in patients with TIMI flow ≤2 compared to those with TIMI-3 flow (MACE: adjusted risk ratio [RR] 2.021; P = 0.025, cardiac mortality: adjusted RR 2.931; P = 0.031). CONCLUSION Failure to achieve normal TIMI-3 flow was associated with patient-related (age) and other potentially modifiable risk factors (thrombus burden, admission systolic blood pressure, total stent length, and baseline TIMI flow). The absence of final TIMI-3 flow carried worse short-term clinical outcomes.
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Affiliation(s)
- Karim Elakabawi
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
- Cardiovascular Department, Benha University, Benha, 13518, Egypt
| | - Xin Huang
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Sardar Ali Shah
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Hameed Ullah
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, 10022, USA
| | - Zuyi Yuan
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Ning Guo
- Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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Xu H, Song C, Xu B, Yin D, Zhu C, Feng L, Zhang D, Gao G, Song W, Qiao S, Wang Y, Li S, Yang Y, Dou K. A Scoring System to Predict No-Reflow Phenomenon in Elective Percutaneous Coronary Intervention: The RECOVER Score. Curr Probl Cardiol 2020; 46:100676. [PMID: 32873413 DOI: 10.1016/j.cpcardiol.2020.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
The RECOVER score system aimed to stratify the risk of no-reflow phenomenon in patients undergoing elective percutaneous coronary intervention. A total of 3967 patients with 5340 lesions were used for the construction and validating of the risk model and score system. In multivariable analyses, 3 variables were independently associated with the risk of no-reflow phenomenon (model C-statistic=0.746 (95% confidence interval [CI]: 0.690 to 0.803) with good calibration). No-reflow phenomenon rates in both construction and validation cohort increased significantly across different risk groups. The RECOVER score can help identify patients at risk for phenomenon during percutaneous coronary intervention.
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Affiliation(s)
- Han Xu
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Chenxi Song
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Bo Xu
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Dong Yin
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China.
| | - Chenggang Zhu
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Lei Feng
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Dong Zhang
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Guofeng Gao
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Weihua Song
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Yang Wang
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Sidong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Yuejin Yang
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China
| | - Kefei Dou
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Xicheng District, Beijing, China.
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Zhao W, Li J, Chen H, Wu Q, Deng Y, Tan Y. Efficacy and safety of traditional Chinese medicine injections in the treatment of acute myocardial infarction: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e21590. [PMID: 32769913 PMCID: PMC7592997 DOI: 10.1097/md.0000000000021590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As one of the common cardiovascular diseases, acute myocardial infarction (AMI) is characterized by a high mortality rate, frequent complications, and a serious threat to human health and quality of life. Traditional Chinese medicine injection (TCMI) has been used clinically to treat AMI; however, there is no uniform standard for clinical treatment of AMI. The purpose of this study is to evaluate the efficacy and safety of different TCMI by using systematic review and network meta-analysis. METHODS According to the strategy, the authors will retrieve both 4 Chinese databases and 3 English databases by June 30, 2020. After a series of screening, randomized controlled trials will be included related to TCMI for AMI. Two researchers will use Aggregate Data Drug Information System and STATA 15.0 to analyze the data. Finally, the evidence grade of the results will be evaluated. RESULTS This study will provide a reliable evidence for the selection of TCMI therapies for AMI. CONCLUSION The results of this study will provide references for evaluating the influence of different TCMI therapies for AMI, and provide decision-making references for clinical research. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/FYGBT.
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Affiliation(s)
- Wei Zhao
- Guang ’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Jun Li
- Guang ’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Hengwen Chen
- Guang ’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Qingjuan Wu
- Guang ’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Yawen Deng
- Guang ’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Yuqing Tan
- Beijing University of Chinese Medicine, Beijing, China
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Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2020; 30:270-276. [PMID: 31026233 DOI: 10.1097/mca.0000000000000726] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study is to identify the predictors of angiographic no-reflow development in patients who underwent primary percutaneous coronary intervention and to investigate the long-term (median follow-up time=59 months) clinical endpoints. PATIENTS AND METHODS We retrospectively evaluated 3205 patients (824 females, mean age: 58.6 years) with acute myocardial infarction (ST-segment elevation myocardial infarction) admitted within the first 12 h of chest pain and treated with primary percutaneous coronary intervention between January 2006 and January 2010. The patients were divided into angiographic no-reflow [final Thrombolysis In Myocardial Infarction (TIMI)<3 flow] (n=324) and reflow (final TIMI 3) (n=2881) groups. RESULTS On multivariate logistic regression analysis age [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.00-1.04, P=0.003], Killip class≥2 (OR=1.99, 95% CI: 1.30-3.04, P=0.002), pain-to-balloon time more than 4 h (OR=3.98, 95% CI: 2.50-6.32, P<0.001), baseline TIMI≤1 flow (OR=2.55, 95% CI: 1.05-6.22, P=0.038), lesion length of at least 15 mm (OR=4.31, 95% CI: 2.89-6.41, P<0.001), reference vessel diameter of at least 3.5 mm (OR=2.83, 95% CI: 1.87-4.27, P<0.001), cutoff occlusion pattern (OR=1.93, 95% CI: 1.03-3.62, P=0.04), and SYNTAX score of at least 19 (OR=1.76, 95% CI: 1.1.23-3.07, P<0.001)] were found as significant predictors for the development of no-reflow phenomenon. In no-reflow patients, in-hospital mortality (10.8 vs. 2.9%), heart failure (32.1 vs. 8.7%), and severe arrhythmias (23.1 vs. 9.3%) were significantly more common (P<0.001), for all. In the long-term follow-up, death (33.3 vs. 13.4%, P<0.001), advanced heart failure (12.5 vs. 5.4%, P<0.001), and stroke (3.5 vs. 1.7%, P=0.035) rates were significantly higher in the no-reflow group. CONCLUSION The no-reflow predictors that were identified in this study might be useful in the determination of the patients who could benefit from aggressive pharmaco-invasive therapy. Development of no-reflow is associated with both in-hospital and long-term very high morbidity and mortality rates.
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Gong X, Lei X, Huang Z, Song Y, Wang Q, Qian J, Ge J. D-Dimer Level Predicts Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention Within 2-7 Days of Symptom Onset in Patients with ST-Segment Elevation Myocardial Infarction. J Cardiovasc Transl Res 2020; 14:728-734. [PMID: 32212039 DOI: 10.1007/s12265-020-09991-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48 h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2-7 days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0-2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset (OR 2.52 per 1 mg/L increase, 95% CI 1.16-5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level. Graphical Abstract Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset. pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level.
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Affiliation(s)
- Xue Gong
- Department of Cardiology, DeltaHealth Hospital, Shanghai, China.,Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoting Lei
- Department of Cardiology, No. 1 Hospital of Tianshui City, Tianshui, Gansu Province, China
| | - Zheyong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Yanan Song
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Qibing Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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The CHADS-VASc score is a predictor of no-reflow in patients with non-ST-segment elevation myocardial infarction. Coron Artery Dis 2020; 31:7-12. [DOI: 10.1097/mca.0000000000000781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karakurt A, Yildiz C, Iliş D. Effect of no-reflow/reflow on P-wave time indexes in patients with acute myocardial infarction undergoing percutaneous coronary intervention. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Risk Factors of Periprocedural Bradycardia during Primary Percutaneous Coronary Intervention in Patients with Acute ST-Elevation Myocardial Infarction. Cardiol Res Pract 2019; 2019:4184702. [PMID: 31827919 PMCID: PMC6881770 DOI: 10.1155/2019/4184702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background Evidence available suggests that periprocedural bradycardia negates the benefit of primary percutaneous coronary intervention (PPCI) and worsens the prognosis of patients with acute ST-elevation myocardial infarction (STEMI). Objective To investigate the risk factors of periprocedural bradycardia during PPCI in patients with acute STEMI. Methods We enrolled 2,536 acute STEMI patients who had PPCI from November 2007 to June 2018 in Beijing Anzhen Hospital, Capital Medical University. We divided all patients into two groups according to periprocedural bradycardia (preoperative heart rate ≥50 times/min, intraoperative heart rate <50 times/min persistent or transient) during PPCI: periprocedural bradycardia group (434 cases) and control group (2102 cases). We compared demographic, clinical, and angiographic characteristics of the two groups. We analyzed the risk factors of periprocedural bradycardia. Results The incident rate was 17.1% (434/2536). Logistic regression analysis showed that the differences between the two groups in no-reflow, the culprit vessel was LAD, using thrombus aspiration devices during operation, gender, completely block of culprit vessel, and intraoperative hypotension were statistically significant (P < 0.05). The area under the receiver operating characteristic curve was 0.8390. Conclusions No-reflow, the culprit vessel was not LAD, using thrombus aspiration devices during operation, gender, completely block of culprit vessel, and intraoperative hypotension may be independent risk factors for predicting periprocedural bradycardia during PPCI in patients with acute STEMI. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023214; registered date: 16 May 2019).
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Slovinski AP, Hajjar LA, Ince C. Microcirculation in Cardiovascular Diseases. J Cardiothorac Vasc Anesth 2019; 33:3458-3468. [PMID: 31521493 DOI: 10.1053/j.jvca.2019.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022]
Abstract
Microcirculation is a system composed of interconnected microvessels, which is responsible for the distribution of oxygenated blood among and within organs according to regional metabolic demand. Critical medical conditions, e. g., sepsis, and heart failure are known triggers of microcirculatory disturbance, which usually develops early in such clinical pictures and represents an independent risk factor for mortality. Therefore, hemodynamic resuscitation aiming at restoring microcirculatory perfusion is of paramount importance. Until recently, however, resuscitation protocols were based on macrohemodynamic variables, which increases the risk of under or over resuscitation. The introduction of hand-held video-microscopy (HVM) into clinical practice has allowed real-time analysis of microcirculatory variables at the bedside and, hence, favored a more individualized approach. In the cardiac intensive care unit scenario, HVM provides essential information on patients' hemodynamic status, e. g., to classify the type of shock, to adequate the dosage of vasopressors or inotropes according to demand and define safer limits, to guide fluid therapy and red blood cell transfusion, to evaluate response to treatment, among others. Nevertheless, several drawbacks have to be addressed before HVM becomes a standard of care.
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Affiliation(s)
| | | | - Can Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
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Gao M, Qin L, Zhang Z, Chen L, Zheng Y, Tong Q, Liu Q. Treatment Windows and Clinical Outcomes in Late-Presenting Patients with ST-Segment Elevation Myocardial Infarction. Am J Med Sci 2019; 358:248-255. [PMID: 31327461 DOI: 10.1016/j.amjms.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is the reperfusion strategy typically used in patients with ST-segment elevation myocardial infarction (STEMI) who present with prolonged ischemic symptoms (>12 hours after onset). However, there is no consensus on an optimal time window for PCI. We examined a real-world cohort, assessing time from symptom onset to balloon inflation in relation to long-term nonfatal recurrent myocardial infarction (MI) or all-cause mortality. MATERIALS AND METHODS A total of 825 consecutive patients presenting with ischemic symptoms of STEMI >12 hours after symptom onset and undergoing subsequent primary PCI were grouped by time-to-treatment status (≤7 days or >7 days post-MI). Primary endpoints were nonfatal recurrent MI and all-cause mortality. RESULTS Cumulative rates of recurrent nonfatal MI at 2 years were 4.1% and 3.3% in patients with symptom-onset-to-balloon inflation times of ≤7 days and >7 days, respectively (P = 0.049); and corresponding mortality rates were 3.4% and 4.7% (P = 0.238). In Cox multivariate analyses, syndrome-onset-to-balloon-inflation time was not independently predictive of recurrent MI (P = 0.052) or mortality (P = 0.651) at 2 years, once adjusted for certain clinical and angiographic variables known to influence patient outcomes. The 2-year rate of recurrent MI was highest in patients with multivessel coronary artery diseases undergoing primary PCI ≤7 days after symptom onset to balloon inflation (P = 0.005). CONCLUSIONS In patients presenting with ischemic signs or symptoms of STEMI >12 hours after initial symptom onset and treated by PCI, symptom-onset-to-balloon-inflation times ≤7 days showed no relation to nonfatal recurrent MI, unless in the presence of multivessel coronary artery diseases.
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Affiliation(s)
- Ming Gao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiguo Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liping Chen
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Qian Tong
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China.
| | - Quan Liu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China.
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Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:458-467. [PMID: 31308838 PMCID: PMC6612613 DOI: 10.11909/j.issn.1671-5411.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5-10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3-17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
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Association between the No-Reflow Phenomenon and Soluble CD40 Ligand Level in Patients with Acute ST-Segment Elevation Myocardial Infarction. MEDICINA-LITHUANIA 2019; 55:medicina55070376. [PMID: 31311177 PMCID: PMC6681218 DOI: 10.3390/medicina55070376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022]
Abstract
Background and objectives: No-reflow (NR) phenomenon is defined as insufficient myocardial perfusion in coronary circulation in the absence of angiographic evidence of mechanical obstruction. The primary mechanisms of the NR occurrence are thought to be high platelet activity and thrombus burden. Soluble CD40 ligand (sCD40L), which is released into the plasma following platelet activation, accelerates the inflammatory process and causes further platelet activation. The aim of our study is to investigate the relationship between the NR phenomenon and sCD40L level in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 81 acute STEMI patients undergoing primary percutaneous coronary intervention and 40 healthy participants were included in this study. Acute STEMI patients were classified into two groups: 41 patients with the NR phenomenon (NR group) and 40 patients without the NR phenomenon (non-NR group). The serum sCD40L level was measured for all groups. Results: The serum sCD40L level was significantly higher in the NR group than in non-NR and control groups (379 ± 20 pg/mL, 200 ± 15 pg/mL and 108 ± 6.53 pg/mL, respectively; p < 0.001). Univariate regression analysis demonstrated that male sex, age, Gensini score and sCD40L level were the possible factors affecting the occurrence of the NR phenomenon. In multivariate regression analysis, age (odds ratio [OR], 1.091; 95% confidence interval [CI], 1.023–1.163; p < 0.008) and serum sCD40L (OR, 1.016; 95% CI, 1.008–1.024; p < 0.001) remained the independent predictor of the presence of NR. Conclusions: Our study showed that serum sCD40L level was an independent predictor of the NR phenomenon occurrence.
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Chotechuang Y, Phrommintikul A, Kuanprasert S, Muenpa R, Patumanond J, Chaichuen T, Sukonthasarn A. Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial. HEART ASIA 2019; 11:e011201. [PMID: 31275432 PMCID: PMC6579563 DOI: 10.1136/heartasia-2019-011201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK. METHODS We randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke). RESULTS One hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054). CONCLUSIONS The delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention. TRIAL REGISTRATION NUMBER NCT02131103.
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Affiliation(s)
- Yotsawee Chotechuang
- Clinical Epidemiology Program, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Srun Kuanprasert
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Thammasat University Faculty of Medicine, Pathumthani, Thailand
| | - Tuanchai Chaichuen
- Cardiac Catheterization Laboratory Unit, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Atıcı A, Barman HA, Erturk E, Baycan OF, Fidan S, Demirel KC, Asoglu R, Demir K, Ozturk F, Elitok A, Okuyan E, Sahin I. Multilayer longitudinal strain can help predict the development of no-reflow in patients with acute coronary syndrome without ST elevation. Int J Cardiovasc Imaging 2019; 35:1811-1821. [PMID: 31093895 DOI: 10.1007/s10554-019-01623-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/06/2019] [Indexed: 12/22/2022]
Abstract
No-reflow (NR) is one of the major complications of primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aim to assess the value of multilayer longitudinal strain parameter to predict NR in patients with NSTEMI and preserved ejection fraction. 230 consecutive patients who were admitted to the emergency department and diagnosed with NSTEMI were prospectively included in this study. Echocardiography was performed 1 h before angiography. Specific analysis for endocardial, mid-myocardial and epicardial layers were performed by two-dimensional (2D) speckle tracking echocardiography (STE) for multilayer longitudinal strain. NR was described as flow grade of ≤ TIMI 2 when mechanical occlusions like dissection, intimal tear, arterial spasm and thromboembolism during angiography were excluded. 49 of 168 patients admitted to the study had NR. No significant differences were observed between the groups regarding age and gender. Multilayer longitudinal strain imaging (endocard, midmyocard and epicard) revealed lower strain values particularly in endocardial layer in patients with NR (GLS-endocard: - 14.14 ± 1.39/- 17.41 ± 2.34, p < 0.001; GLS-midmyocard: - 14.81 ± 1.40/17.81 ± 2.22, p < 0.001; GLS-epicard: - 16.14 ± 1.38/18.22 ± 2.00, p < 0.001). GLS-endocard, GLS-midmyocard, GLS-epicard and ST depression were found to be statistically significant independents parameters respectively to predict NR phenomenon (GLS-endocard: OR: 2.193, p < 0.001; GLS-midmyocard: OR: 1.510, p: 0.016; GLS-epicard: OR: 1.372, p: 0.035; ST depression: OR: 3.694, p: 0.014). We revealed that left ventricular strain study with speckle tracking echocardiography predicts NR formation. This noninvasive method may be useful for detecting NR formation in patients with NSTEMI.
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Affiliation(s)
- Adem Atıcı
- Cardiology Department, İstanbul Gaziosmanpasa Taksim Training and Research Hospital, Osmanbey Caddesi, 621 Sokak, Gaziosmanpaşa, Istanbul, Turkey
| | - Hasan Ali Barman
- Cardiology Department, Okmeydani Training Ve Research Hospital, Darulaceze street No:25, Okmeydani, 34384, Istanbul, Turkey.
| | - Emre Erturk
- Cardiology Department, Medical Park İzmir Hospital, İmbatlı Mahallesi, 1825. Sk., 35575, Karşıyaka/Izmir, Turkey
| | - Omer Faruk Baycan
- Cardiology Department, Istanbul Medeniyet University, Dr. Erkin street, 34722, Istanbul, Turkey
| | - Serdar Fidan
- Cardiology Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, Cevizli Mah. Denizer Cad. Cevizli Kavşağı No:2, 34865, Kartal/Istanbul, Turkey
| | - Koray Celal Demirel
- Cardiology Department, 29 Mayıs State Hospital, Aydınlar Mah. Dikmen Cad. No: 312 PK, 06105, Çankaya/Ankara, Turkey
| | - Ramazan Asoglu
- Cardiology Department, Adiyaman Training Ve Research Hospital, Yunus Emre Mahallesi, 1164 Sokak No:13, Merkez/Adıyaman, Turkey
| | - Koray Demir
- Cardiology Department, Mus State Hospital, Saray, Mus Center, 49200, Mus, Turkey
| | - Fatih Ozturk
- Cardiology Department, Mus State Hospital, Saray, Mus Center, 49200, Mus, Turkey
| | - Ali Elitok
- Cardiology Department, Istanbul University Istanbul School of Medicine, Turgut Ozal street No: 118, Fatih, 34093, Istanbul, Turkey
| | - Erugrul Okuyan
- Cardiology Department, Bagcilar Training Ve Research Hospital, Bagcilar Center, Mimar Sinan street, Bagcilar, 34100, Istanbul, Turkey
| | - Irfan Sahin
- Cardiology Department, Bagcilar Training Ve Research Hospital, Bagcilar Center, Mimar Sinan street, Bagcilar, 34100, Istanbul, Turkey
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Zhao Y, Yang J, Ji Y, Wang S, Wang T, Wang F, Tang J. Usefulness of fibrinogen-to-albumin ratio to predict no-reflow and short-term prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Vessels 2019; 34:1600-1607. [DOI: 10.1007/s00380-019-01399-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
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Kaya A, Keskin M, Tatlisu MA, Uzman O, Borklu E, Cinier G, Yildirim E, Kayapinar O. Atrial Fibrillation: A Novel Risk Factor for No-Reflow Following Primary Percutaneous Coronary Intervention. Angiology 2019; 71:175-182. [DOI: 10.1177/0003319719840589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P = .021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P < .001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P < .001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P < .001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI.
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Affiliation(s)
- Adnan Kaya
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Muhammed Keskin
- Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | | | - Osman Uzman
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Edibe Borklu
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Goksel Cinier
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Ersin Yildirim
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Osman Kayapinar
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
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Ashoori A, Pourhosseini H, Ghodsi S, Salarifar M, Nematipour E, Alidoosti M, Haji-Zeinali AM, Nozari Y, Amirzadegan A, Aghajani H, Jalali A, Hosseini Z, Jenab Y, Geraiely B, Omidi N. CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction. ACTA ACUST UNITED AC 2019; 55:medicina55020035. [PMID: 30717292 PMCID: PMC6409514 DOI: 10.3390/medicina55020035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
Background and objectives: We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. Materials and Methods: We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. Results: The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30–2.25) and 1.60 (1.17–2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01–1.35), 1.59 (1.28–1.76), and 8.65 (3.76–24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62–0.81). Conclusions: Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.
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Affiliation(s)
- Ammar Ashoori
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | | | - Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | | | - Yones Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Alireza Amirzadegan
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Zahra Hosseini
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Babak Geraiely
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
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Manolis AS. Is Atherothromboaspiration a Possible Solution for the Prevention of No-Reflow Phenomenon in Acute Coronary Syndromes? Single Centre Experience and Review of the Literature. Curr Vasc Pharmacol 2019; 17:164-179. [DOI: 10.2174/1570161116666180101150956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022]
Abstract
Background: Intracoronary thrombus in acute Myocardial Infarction (MI) confers higher
rates of no-reflow with attendant adverse consequences. Earlier Randomized-Controlled-Trials (RCTs)
of routine thromboaspiration during Percutaneous Coronary Intervention (PCI) indicated a clinical benefit,
but more recent RCTs were negative. However, data of selective use of this adjunctive approach
remain scarce.
</P><P>
Objective: The aim of this single-centre prospective study was to report the results of selective thromboaspiration
during PCI in patients with intracoronary thrombi, and also to provide an extensive literature
review on current status of thromboaspiration.
</P><P>
Methods: The study included 90 patients (77 men; aged 59.3±12.7 years) presenting with acute MI (STElevation
MI (STEMI) in 74, non-STEMI in 16) who had intracoronary thrombi and were submitted to
thromboaspiration.
</P><P>
Results: Total (n=67) or subtotal (n=18) vessel occlusions were present in 85 (94%) patients. Thromboaspiration
and subsequent PCI were successful in 89/90 (98.9%) patients, with coronary stenting in 86
(96.6%). In 4 patients with residual thrombus, a mesh-covered stent was implanted. IIb/IIIa-inhibitors
were administered in 57 (63.3%) patients. No-reflow occurred in only 1 (1.1%) patient. The postprocedural
course was uneventful. Review of the literature revealed several early observational and
RCTs and meta-analyses favouring manual, not mechanical, thrombectomy. However, newer RCTs and
meta-analyses significantly curtailed the initial enthusiasm for the clinical benefits of routine use of
thromboaspiration.
</P><P>
Conclusion: Selective thromboaspiration for angiographically visible thrombi in MI patients undergoing
PCI, as an adjunct to mechanical reperfusion and to IIb/IIIa-inhibitors, may be an option since this
manoeuvre may improve procedural and clinical outcome.
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Affiliation(s)
- Antonis S. Manolis
- Third Department of Cardiology, Athens University School of Medicine, Sotiria Hospital, Athens, Greece
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Jia Y, Li D, Cao Y, Cheng Y, Xiao L, Gao Y, Zhang L, Zeng Z, Wan Z, Zeng R. Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction: A prospective cohort study. Medicine (Baltimore) 2018; 97:e13615. [PMID: 30558040 PMCID: PMC6319978 DOI: 10.1097/md.0000000000013615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/16/2018] [Indexed: 02/05/2023] Open
Abstract
The inflammation-based Glasgow Prognostic Score (GPS), which involves C-reactive protein and serum albumin levels, has been reported to be a strong independent predictor of mortality in many cancers. This study aimed to investigate whether the GPS is associated with mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).In this study, 406 consecutive patients with STEMI at our emergency department (ED) who were undergoing pPCI were prospectively enrolled and assigned a GPS of 0, 1, or 2. Kaplan-Meier survival and multivariable Cox regression analyses were used to evaluate the associations between the GPS and long-term mortality.Twenty-three patients (5.7%) died at the hospital, and 37 (9.7%) died during follow-up (14.4 [9.3-17.6] months). Compared with patients with a lower GPS, those with a higher GPS had significantly higher in-hospital mortality (GPS = 0 vs GPS = 1 vs GPS = 2: 3.3% vs 6.3% vs 28.0%, P < .001), follow-up mortality (4.6% vs 14.3% vs 55.6%, P < .001), and cumulative mortality (9.6% vs 21.1% vs 71.1%, P < .001). Multivariable Cox regression analysis revealed that in patients with a GPS of 1 and 2 (versus 0), the multivariable adjusted hazard ratios (HR) for all-cause mortality were 2.068 (95% CI: 1.082-3.951, P = .028) and 8.305 (95% CI: 4.017-17.171, P < .001), respectively, after controlling for all of the confounding factors. Subgroup analysis showed that a higher GPS was associated with an increased risk of cumulative mortality in the different subgroups.The GPS on admission may be useful for stratifying the risk of adverse outcomes in patients with STEMI undergoing pPCI in the ED.
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Affiliation(s)
- Yu Jia
- Department of Emergency Medicine, West China Hospital
- Disaster Medicine Center
- Laboratory of Emergency Medicine
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, West China Hospital
- Disaster Medicine Center
- Laboratory of Emergency Medicine
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital
- Disaster Medicine Center
- Laboratory of Emergency Medicine
| | - Yisong Cheng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Xiao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine, West China Hospital
- Disaster Medicine Center
- Laboratory of Emergency Medicine
| | - Lin Zhang
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, China
| | - Zhi Zeng
- Department of Emergency Medicine, West China Hospital
| | - Zhi Wan
- Department of Emergency Medicine, West China Hospital
- Disaster Medicine Center
- Laboratory of Emergency Medicine
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Delayed vs. immediate stenting in STEMI with a high thrombus burden : A systematic review and meta-analysis. Herz 2018; 44:726-734. [PMID: 29651617 DOI: 10.1007/s00059-018-4699-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/23/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The results of several large-scale randomized controlled trials are controversial regarding the advantages of delayed stenting (DS) compared with immediate stenting (IS). We sought to determine whether DS has benefits for patients with ST-segment elevation myocardial infarction (STEMI) with a high thrombus burden compared with IS. METHODS We systematically searched four electronic databases. Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, TIMI myocardial blush grade (TMBG), complete ST-segment resolution (>70%), major adverse cardiac events (MACE), and major bleeding complications were studied as outcomes. Data analysis was performed using a random-effects model utilizing the Review Manager 5.3 software. RESULTS Our meta-analysis included eight studies involving 744 patients. DS showed greater benefits than IS in terms of TIMI grade 3 flow (odds ratio [OR]: 5.09, 95% confidence interval [CI]: 1.98-13.02, p < 0.001), TMBG (OR: 4.17, 95% CI: 1.87-9.31, p < 0.001), complete ST-segment resolution (OR: 2.16, 95% CI: 1.36-3.43, p = 0.001), and MACE (OR: 0.48, 95% CI: 0.25-0.94, p = 0.03). No significant difference was observed regarding major bleeding events (OR: 1.76, 95% CI: 0.40-7.66, p = 0.45). CONCLUSION DS yielded satisfactory outcomes regarding myocardial tissue reperfusion, demonstrated by the improved TIMI flow grade, TMBG, complete ST-segment resolution, and decreased MACEs without increasing major bleeding events in patients with STEMI and a high thrombus burden. DS may be preferred to IS for treating patients with this characteristic presentation.
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Mirbolouk F, Gholipour M, Salari A, Shakiba M, Kheyrkhah J, Nikseresht V, Sotoudeh N, Moghadam N, Mirbolouk MJ, Moayeri far M. CHA2DS2-VASc Score Predict No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention in Primary Percutaneous Coronary Intervention. J Cardiovasc Thorac Res 2018; 10:46-52. [PMID: 29707178 PMCID: PMC5913693 DOI: 10.15171/jcvtr.2018.08] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/11/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction: No-reflow is one of the major complications of primary PCI in patients with acute ST elevation myocardial infarction. This phenomenon is associated with adverse outcomes in these patients. In the current study, we evaluated the effectiveness of CHA2DS2-VASc score in predicting no-reflow phenomenon. CHA2DS2-VASc score is a risk stratification method to estimate the risk of thromboembolism in patients with atrial fibrillation. Methods: In total, 396 patients with ST elevation myocardial infarction who had undergone primary PCI were evaluated in our study. Based on post interventional TIMI flow rate results, the patients were divided into two groups: control group (294 patients) and no-reflow group (102 patients). The CHA2DS2-VASc score was calculated for each participant. Multivariate regression analysis was performed to determine the predictive value of this score. Results: Our findings showed that CHA2DS2-VASc score can predict no-reflow independently (odds ratio: 3.06, 95%, confidence interval: 2.23-4.21, P <0 .001). Moreover, lower systolic blood pressure, higher diastolic blood pressure, grade 0 initial TIMI flow rate and smaller stent size were other independent predictors of the no-reflow in our study. We also defined a cut off value of ≥ 2 for the CHA2DS2-VASc score in predicting the no-reflow with a sensitivity of 88% and specificity of 67%, area under curve: 0.83 with 95% CI (0.79-0.88). Conclusion: The CHA2DS2-VASc score could be used as a simple applicable tool in the prediction of no-reflow before primary PCI in the acute ST elevation myocardial infarction patients.
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Affiliation(s)
- Fardin Mirbolouk
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran
| | - Maryam Shakiba
- Cardiovascular diseases research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Jalal Kheyrkhah
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran
| | - Vahid Nikseresht
- Healthy Heart Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nozar Sotoudeh
- Cardiovascular diseases research Center, Department of cardiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Negar Moghadam
- Cardiovascular diseases research Center, Department of cardiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Jaafar Mirbolouk
- Cardiovascular diseases research Center, Department of cardiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Mani Moayeri far
- Cardiovascular diseases research Center, Department of cardiology, Guilan University of Medical Sciences, Rasht, Iran
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48
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Lindsey ML, Bolli R, Canty JM, Du XJ, Frangogiannis NG, Frantz S, Gourdie RG, Holmes JW, Jones SP, Kloner RA, Lefer DJ, Liao R, Murphy E, Ping P, Przyklenk K, Recchia FA, Schwartz Longacre L, Ripplinger CM, Van Eyk JE, Heusch G. Guidelines for experimental models of myocardial ischemia and infarction. Am J Physiol Heart Circ Physiol 2018; 314:H812-H838. [PMID: 29351451 PMCID: PMC5966768 DOI: 10.1152/ajpheart.00335.2017] [Citation(s) in RCA: 357] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Myocardial infarction is a prevalent major cardiovascular event that arises from myocardial ischemia with or without reperfusion, and basic and translational research is needed to better understand its underlying mechanisms and consequences for cardiac structure and function. Ischemia underlies a broad range of clinical scenarios ranging from angina to hibernation to permanent occlusion, and while reperfusion is mandatory for salvage from ischemic injury, reperfusion also inflicts injury on its own. In this consensus statement, we present recommendations for animal models of myocardial ischemia and infarction. With increasing awareness of the need for rigor and reproducibility in designing and performing scientific research to ensure validation of results, the goal of this review is to provide best practice information regarding myocardial ischemia-reperfusion and infarction models. Listen to this article’s corresponding podcast at ajpheart.podbean.com/e/guidelines-for-experimental-models-of-myocardial-ischemia-and-infarction/.
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Affiliation(s)
- Merry L Lindsey
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi.,Research Service, G. V. (Sonny) Montgomery Veterans Affairs Medical Center , Jackson, Mississippi
| | - Roberto Bolli
- Division of Cardiovascular Medicine and Institute of Molecular Cardiology, University of Louisville , Louisville, Kentucky
| | - John M Canty
- Division of Cardiovascular Medicine, Departments of Biomedical Engineering and Physiology and Biophysics, The Veterans Affairs Western New York Health Care System and Clinical and Translational Science Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York
| | - Xiao-Jun Du
- Baker Heart and Diabetes Institute , Melbourne, Victoria , Australia
| | - Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx, New York
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital , Würzburg , Germany
| | - Robert G Gourdie
- Center for Heart and Regenerative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia Health System , Charlottesville, Virginia
| | - Steven P Jones
- Department of Medicine, Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky
| | - Robert A Kloner
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes , Pasadena, California.,Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - David J Lefer
- Cardiovascular Center of Excellence, Louisiana State University Health Science Center , New Orleans, Louisiana
| | - Ronglih Liao
- Harvard Medical School , Boston, Massachusetts.,Division of Genetics and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Elizabeth Murphy
- Systems Biology Center, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland
| | - Peipei Ping
- National Institutes of Health BD2KBig Data to Knowledge (BD2K) Center of Excellence and Department of Physiology, Medicine and Bioinformatics, University of California , Los Angeles, California
| | - Karin Przyklenk
- Cardiovascular Research Institute and Departments of Physiology and Emergency Medicine, Wayne State University School of Medicine , Detroit, Michigan
| | - Fabio A Recchia
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione G. Monasterio, Pisa , Italy.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Lisa Schwartz Longacre
- Heart Failure and Arrhythmias Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland
| | - Crystal M Ripplinger
- Department of Pharmacology, School of Medicine, University of California , Davis, California
| | - Jennifer E Van Eyk
- The Smidt Heart Institute, Department of Medicine, Cedars Sinai Medical Center , Los Angeles, California
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School , Essen , Germany
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49
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Bayramoğlu A, Taşolar H, Kaya A, Tanboğa İH, Yaman M, Bektaş O, Günaydın ZY, Oduncu V. Prediction of no-reflow and major adverse cardiovascular events with a new scoring system in STEMI patients. J Interv Cardiol 2017; 31:144-149. [DOI: 10.1111/joic.12463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Adil Bayramoğlu
- Department of Cardiology; Faculty of Medicine, Ordu University; Ordu Turkey
| | - Hakan Taşolar
- Department of Cardiology; Adiyaman University Training and Research Hospital; Adıyaman Turkey
| | - Ahmet Kaya
- Department of Cardiology; Faculty of Medicine, Ordu University; Ordu Turkey
| | | | - Mehmet Yaman
- Department of Cardiology; Faculty of Medicine, Ordu University; Ordu Turkey
| | - Osman Bektaş
- Department of Cardiology; Faculty of Medicine, Ordu University; Ordu Turkey
| | | | - Vecih Oduncu
- Department of Cardiology; Bahçeşehir University Medical School; Istanbul Turkey
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50
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Lago IM, Novaes GC, Badran AV, Pavão RB, Barbosa R, Figueiredo GLD, Lima MDO, Haddad JL, Schmidt A, Marin JA. In-Lab Upfront Use of Tirofiban May Reduce the Occurrence of No-Reflow During Primary Percutaneous Coronary Intervention. A Pilot Randomized Study. Arq Bras Cardiol 2017; 107:403-410. [PMID: 27982267 PMCID: PMC5137384 DOI: 10.5935/abc.20160149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/10/2016] [Indexed: 01/14/2023] Open
Abstract
Background Despite successful opening of culprit coronary artery, myocardial reperfusion
does not always follows primary percutaneous coronary intervention (PPCI).
Glycoprotein IIb/IIIa inhibitors are used in the treatment of no-reflow
(NR), but their role to prevent it is unproven. Objective To evaluate the effect of in-lab administration of tirofiban on the incidence
of NR in ST-elevation myocardial infarction (STEMI) treated with PPCI. Methods STEMI patients treated with PPCI were randomized (24 tirofiban and 34
placebo) in this double-blinded study to assess the impact of intravenous
tirofiban on the incidence of NR after PPCI according to angiographic and
electrocardiographic methods. End-points of the study were: TIMI-epicardial
flow grade; myocardial blush grade (MBG); resolution of ST-elevation <
70% (RST < 70%) at 90min and 24h after PPCI. Results Baseline anthropometric, clinical and angiographic characteristics were
balanced between the groups. The occurrence of TIMI flow < 3 was not
significantly different between the tirofiban (25%) and placebo (35.3%)
groups. MBG ≤ 2 did not occur in the tirofiban group, and was seen in
11.7% of patients in the placebo group (p=0.13). RST < 70% occurred in
41.6% x 55.8% (p=0.42) at 90min and in 29% x 55.9% (p=0.06) at 24h in
tirofiban and placebo groups, respectively. Severe NR (RST ≤ 30%) was
detected in 0% x 26.5% (p=0.01) at 90 min, and in 4.2% x 23.5% (p=0.06) at
24h in tirofiban and placebo groups, respectively. Conclusion This pilot study showed a trend toward reduction of NR associated with in-lab
upfront use of tirofiban in STEMI patients treated with PPCI and paves the
way for a full-scale study testing this hypothesis.
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Affiliation(s)
- Igor Matos Lago
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - Gustavo Caires Novaes
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - André Vannucchi Badran
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - Rafael Brolio Pavão
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Geraldo Luiz de Figueiredo
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - Moysés de Oliveira Lima
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - Jorge Luiz Haddad
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - André Schmidt
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | - José Antônio Marin
- Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
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