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Bai J, Chen L, Xu L, Zhang Q, Liu J, Zheng K. The value of serum Sema4D level in predicting the prognosis of patients with acute ST-segment elevation myocardial infarction and with high thrombus burden. BMC Cardiovasc Disord 2023; 23:230. [PMID: 37138227 PMCID: PMC10157983 DOI: 10.1186/s12872-023-03244-5] [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: 01/26/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease. High thrombus burden is an independent risk factor for poor prognosis of acute myocardial infarction. However, there is no study on the correlation between soluble semaphorin 4D (sSema4D) level and high thrombus burden in patients with STEMI. PURPOSE This study aimed to investigate the relationship between sSema4D level and the thrombus burden of STEMI and further explore its effect on the main predictive value of the occurrence of major adverse cardiovascular events (MACE). METHODS From October 2020 to June 2021, 100 patients with STEMI diagnosed in our hospital's cardiology department were selected. According to the thrombolysis in myocardial infarction(TIMI)score, STEMI patients were divided into high thrombus burden groups (55 cases) and non-high thrombus burden groups (45 cases) 0.74 patients with stable coronary heart disease (CHD) were selected as stable CHD group, and 75 patients with negative coronary angiography (CAG) were selected as control group. Serum sSema4D levels were measured in 4 groups. The correlation between serum sSema4D and high-sensitivity C-reactive protein (hs-CRP) in patients with STEMI was analyzed. The relationship of serum sSema4D levels between the high and non-high thrombus burden group was evaluated. The effect of sSema4D levels on the occurrence of MACE was explored in one year after percutaneous coronary intervention. RESULTS Serum sSema4D level was positively correlated with hs-CRP level in STEMI patients (P < 0.05) with a correlation coefficient of 0.493. The sSema4D level was significantly higher in the high versus non-high thrombus burden group (22.54(20.82,24.17), P < 0.05). Moreover, MACE occurred in 19 cases in high thrombus burden group and 3 cases in non-high thrombus burden group. The results of Cox regression analysis showed that sSema4D was an independent predictor of MACE (OR = 1.497,95% CI: 1.213-1.847, P < 0.001). CONCLUSION The sSema4D level is associated with coronary thrombus burden and is an independent risk factor for MACE.
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Affiliation(s)
- Jie Bai
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China
| | - Liang Chen
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China
| | - Louyuan Xu
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China
| | - Qingquan Zhang
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China
| | - Jun Liu
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China
| | - Koulong Zheng
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong First People's Hospital , Nantong, 226001, Jiangsu, China.
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Azarov AV, Zhuravlev AS, Semitko SP. Effectiveness of deferred coronary artery stenting in the prevention of no-reflow in patients with acute ST-segment elevation myocardial infarction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
It is known that even in spite of timely revascularization of the infarct-related artery, the myocardium in some patients remains hypoperfused. This condition is known as the no-reflow phenomenon, which is associated with an unfavorable prognosis. The systematic review is devoted to the effectiveness of deferred stenting in noreflow prevention. In patients with severe thrombosis, the two-stage revascularization technique is very promising. It is a primary intervention in the form of aspiration thrombectomy and/or balloon angioplasty followed by stenting after a certain period of time. This interval represents a certain therapeutic space, which allows various drugs to act resulting in reduction of blood clot size and risk of procedure-related distal embolization.
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Affiliation(s)
- A. V. Azarov
- I.M. Sechenov First Moscow State Medical University
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Immediate versus deferred percutaneous coronary intervention for patients with acute coronary syndrome: A meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0234655. [PMID: 32614851 PMCID: PMC7332029 DOI: 10.1371/journal.pone.0234655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/31/2020] [Indexed: 11/19/2022] Open
Abstract
Inconsistent results exist regarding the treatment effectiveness of immediate versus deferred percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the efficacy and safety of immediate versus deferred PCI in ACS patients. PubMed, EMBASE, and Cochrane Library electronic databases were systematically searched from their inception up to August 2019. Random-effects models were employed to calculate pooled relative risks (RRs) and weight mean differences (WMDs) with 95% confidence intervals (CIs). A total of 10 randomized controlled trials (RCTs) that recruited 3350 patients were selected for inclusion in the final meta-analysis. Four trials included patients with non-ST elevation ACS (NSTEACS), whereas the remaining six trials included patients with ST elevation myocardial infarction (STEMI). There were no significant differences between immediate versus deferred PCI for the risk of major adverse cardiovascular events (NSTEACS patients: RR, 0.76, 95%CI, 0.33-1.75, P = 0.513; STEMI patients: RR, 1.24, 95%CI, 0.80-1.92, P = 0.335), myocardial infarction (NSTEACS patients: RR, 0.88, 95%CI, 0.27-2.81, P = 0.826; STEMI patients: RR, 0.86, 95%CI, 0.43-1.74, P = 0.678), all-cause mortality (NSTEACS patients: RR, 0.85, 95%CI, 0.38-1.88, P = 0.686; STEMI patients: RR, 1.16, 95%CI, 0.82-1.66, P = 0.407), target vessel revascularisation (NSTEACS patients: RR, 1.26, 95%CI, 0.29-5.43, P = 0.756; STEMI patients: RR, 1.01, 95%CI, 0.51-1.97, P = 0.988), or major bleeding (NSTEACS patients: RR, 0.99, 95%CI, 0.64-1.54, P = 0.972; STEMI patients: RR, 0.90, 95%CI, 0.45-1.77, P = 0.753). Although patients who underwent immediate PCI may experience increased incidences of cardiac death (RR, 1.19, 95%CI, 0.69-2.07, P = 0.525) and no or slow reflow (RR, 1.60, 95%CI, 0.91-2.84, P = 0.105), these increases were not statistically significant. We noted that immediate versus deferred PCI was associated with a reduced incidence of myocardial brush grade 3 (RR, 0.70, 95%CI, 0.56-0.88, P = 0.002); however, no significant differences were observed between immediate and deferred PCI for TIMI III flow (RR, 0.98, 95%CI, 0.93-1.03, P = 0.453), complete ST-segment resolution (RR, 0.93, 95%CI, 0.75-1.17, P = 0.548), and ejection fraction (WMD, -1.05, 95%CI, -2.58 to 0.49, P = 0.182). The findings of this study suggested that deferred PCI did not yield significant benefits for clinical endpoints. Further large-scale RCTs should be conducted to verify the findings of this study.
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De Maria GL, Alkhalil M, Oikonomou EK, Wolfrum M, Choudhury RP, Banning AP. Role of deferred stenting in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention: A systematic review and meta-analysis. J Interv Cardiol 2017; 30:264-273. [PMID: 28370496 DOI: 10.1111/joic.12380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/23/2017] [Accepted: 03/05/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We conducted a meta-analysis of studies comparing deferred stenting strategy versus the conventional approach with immediate stenting in patients with ST elevation myocardial infarction. BACKGROUND Deferring stent after mechanical flow restoration has been proposed as a strategy to reduce the risk of "no reflow" in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Conflicting evidence is available currently, especially after the recent publication of three randomized clinical trials. METHODS Searches in electronic databases were performed. Comparisons between the two strategies were performed for both hard clinical endpoints (all cause-mortality, cardiovascular mortality, unplanned revascularization, myocardial infarction and readmission for heart failure) and surrogate angiographic endpoints (TIMI flow < 3 and myocardial blush grade (MBG) < 2). RESULTS Eight studies (three randomized and five non-randomized) were deemed eligible, accounting for a total of 2101 patients. No difference in terms of hard clinical endpoints was observed between deferred and immediate stenting (OR [95% CI]: 0.79 [0.54-1.15], for all-cause mortality; odds ratio (OR) [95% CI]: 0.79 [0.47-1.31] for cardiovascular mortality; OR [95% CI]: 0.95 [0.64-1.41] for myocardial infarction; OR [95% CI]: 1.37 [0.87-2.16], for unplanned revascularization and OR [95% CI]: 0.50 [0.21-1.17] for readmission for heart failure). Notably, the deferred stenting approach was associated with improved outcome of the surrogate angiographic endpoints (OR [95% CI]: 0.43 [0.18-0.99] of TIMI flow < 3 and OR [95% CI]: 0.25 [0.11-0.57] for MBG < 2. CONCLUSIONS A deferred stenting strategy could be a feasible alternative to the conventional approach with immediate stenting in "selected" STEMI patients undergoing pPCI.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Mohammad Alkhalil
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | | | - Mathias Wolfrum
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Robin P Choudhury
- Radcliffe Department of Medicine, Acute Vascular Imaging Centre, University of Oxford, Oxford, UK.,Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
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Qiao J, Pan L, Zhang B, Wang J, Zhao Y, Yang R, Du H, Jiang J, Jin C, Xiong E. Deferred Versus Immediate Stenting in Patients With ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.004838. [PMID: 28275065 PMCID: PMC5524015 DOI: 10.1161/jaha.116.004838] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background A number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST‐segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta‐analysis aims to assess optimal treatment strategies in patient with ST‐segment elevation myocardial infarction. Methods and Results We searched the PubMed, EMBASE, and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST‐segment elevation myocardial infarction. Nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta‐analysis. No significant differences were observed in the incidence of no‐ or slow‐reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio [OR] 0.51, 95%CI 0.17‐1.53, P=0.23, I2=70%) but not in observational studies (OR 0.13, 95%CI 0.06‐0.31, P<0.0001, I2=0%). Deferred stenting was associated with an increase in long‐term left ventricular ejection fraction (weighted mean difference 1.90%, 95%CI 0.77‐3.03, P=0.001, I2=0%). No significant differences were observed in the rates of major adverse cardiovascular events (OR 0.53, 95%CI 0.27‐1.01, P=0.06 [randomized OR 0.98, 95%CI 0.73‐1.30, P=0.87, I2=0%; nonrandomized OR 0.30, 95%CI 0.15‐0.58, P=0.0004, I2=0%]), major bleeding (OR=0.1.61, 95%CI 0.70‐3.69, P=0.26, I2=0%), death (OR=0.78, 95%CI 0.53‐1.15, P=0.22, I2=0%), MI (OR=0.97, 95%CI 0.34‐2.78, P=0.96, I2=35%) and target vessel revascularization (OR 0.97, 95%CI 0.40‐2.37, P=0.95, I2=24%), between deferred and immediate stenting. Conclusions Compared with immediate stenting, a deferred‐stenting strategy did not reduce the occurrence of no‐ or slow‐reflow, death, myocardial infarction, or repeat revascularization compared with immediate stenting in patients with ST‐segment elevation myocardial infarction, but showed an improved left ventricular function in the long term.
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Affiliation(s)
- Jianzhong Qiao
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Lingxin Pan
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Bin Zhang
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Jie Wang
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Yongyan Zhao
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Ru Yang
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Huiling Du
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Jie Jiang
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Conghai Jin
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Enlai Xiong
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
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Harbaoui B, Emsellem P, Cassar E, Besnard C, Dauphin R, Motreff P, Courand PY, Lantelme P. Primary angioplasty: Effect of deferred stenting on stent size. Arch Cardiovasc Dis 2017; 110:206-213. [PMID: 28139456 DOI: 10.1016/j.acvd.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/22/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary angioplasty with immediate stenting (IS) is the gold standard for ST-segment elevation myocardial infarction (STEMI). Deferred stenting (DS) has been proposed to limit periprocedural complications, and may influence stent size because of thrombus and spasm alleviation. AIM We sought to study the effect of DS on stent size. METHODS Over the study period, 258 patients underwent primary angioplasty for STEMI (DS, n=84; IS, n=174). An informative coronary angiogram run - i.e. allowing for proper lesion analysis - was selected and anonymized by an independent operator. Two experienced operators randomly analysed these runs, and proposed stent dimensions after having measured vessel diameter and lesion length by quantitative coronary analysis. The primary objective was the variation in stent size between the two coronary angiograms. RESULTS The median delay between the two coronary angiograms was 2 days. Overall, the stent length was shorter (-1.64mm; P=0.030) and its diameter was larger (+0.13mm; P<0.001) during the second coronary angiogram, especially in the right coronary arteries. CONCLUSIONS DS led to the implantation of a larger and shorter stent; this is probably because DS allows for more accurate assessment of the residual lesion after relief of spasm and thrombus, and may have clinical consequences in terms of stent thrombosis and restenosis.
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Affiliation(s)
- Brahim Harbaoui
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France
| | - Philippe Emsellem
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Emmanuel Cassar
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Cyril Besnard
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Raphael Dauphin
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Pascal Motreff
- Université d'Auvergne, Cardio-Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR 6284, 63000 Clermont-Ferrand, France; University Hospital of Clermont-Ferrand, Cardiology Department, 63000 Clermont-Ferrand, France
| | - Pierre-Yves Courand
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France
| | - Pierre Lantelme
- Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France.
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