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Gibbs T, Tapoulal N, Shanmuganathan M, Burrage MK, Borlotti A, Banning AP, Choudhury RP, Neubauer S, Kharbanda RK, Ferreira VM, Channon KM, Herring N. Neuropeptide-Y Levels in ST-Segment-Elevation Myocardial Infarction: Relationship With Coronary Microvascular Function, Heart Failure, and Mortality. J Am Heart Assoc 2022; 11:e024850. [PMID: 35766271 PMCID: PMC9333365 DOI: 10.1161/jaha.121.024850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The sympathetic cotransmitter, neuropeptide Y (NPY), is released into the coronary sinus during ST‐segment–elevation myocardial infarction and can constrict the coronary microvasculature. We sought to establish whether peripheral venous (PV) NPY levels, which are easy to obtain and measure, are associated with microvascular obstruction, myocardial recovery, and prognosis. Methods and Results NPY levels were measured immediately after primary percutaneous coronary intervention and compared with angiographic and cardiovascular magnetic resonance indexes of microvascular function. Patients were prospectively followed up for 6.4 (interquartile range, 4.1–8.0) years. PV (n=163) and coronary sinus (n=68) NPY levels were significantly correlated (r=0.92; P<0.001) and associated with multiple coronary and imaging parameters of microvascular function and infarct size (such as coronary flow reserve, acute myocardial edema, left ventricular ejection fraction, and late gadolinium enhancement 6 months later). We therefore assessed the prognostic value of PV NPY during follow‐up, where 34 patients (20.7%) developed heart failure or died. Kaplan‐Meier survival analysis demonstrated that high PV NPY levels (>21.4 pg/mL by binary recursive partitioning) were associated with increased incidence of heart failure and mortality (hazard ratio, 3.49 [95% CI, 1.65–7.4]; P<0.001). This relationship was maintained after adjustment for age, cardiovascular risk factors, and previous myocardial infarction. Conclusions Both PV and coronary sinus NPY levels correlate with microvascular function and infarct size after ST‐segment–elevation myocardial infarction. PV NPY levels are associated with the subsequent development of heart failure or mortality and may therefore be a useful prognostic marker. Further research is required to validate these findings.
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Affiliation(s)
- Thomas Gibbs
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom
| | - Nidi Tapoulal
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Matthew K Burrage
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Alessandra Borlotti
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Adrian P Banning
- National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom
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Abacioglu OO, Yildirim A, Koyunsever NY, Kilic S. The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention. Angiology 2021; 73:79-84. [PMID: 34180260 DOI: 10.1177/00033197211026420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) (P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.
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Affiliation(s)
- Ozge Ozcan Abacioglu
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Arafat Yildirim
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Nermin Yildiz Koyunsever
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Kilic
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
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Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indian Heart J 2020; 73:35-43. [PMID: 33714407 PMCID: PMC7961261 DOI: 10.1016/j.ihj.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The no-reflow phenomenon occurs in 25% of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may be associated with adverse outcomes. The aim of our study was to detect novel predictors of no-reflow phenomenon and the resulting adverse long term outcomes. Methods We enrolled 400 STEMI patients undergoing primary PCI; 228 patients had TIMI flow 3 after PCI (57%) and the remaining 172 patients had TIMI flow <3 (43%). Fibrinogen to albumin ratio (FAR), high sensitive C-reactive protein to albumin ratio (CAR), and atherogenic index of plasma (AIP) were calculated. Long term mortality and morbidity during 6 months follow up were recorded. These data were compared among both groups. Results In multivariate regression analysis, old age (OR = 1.115, 95% CI: 1.032–1.205, P = 0.006), higher troponin level >5.6 ng/mL (OR = 1.040, 95% CI: 1.001–1.080, P = 0.04), diabetes mellitus (OR = 4.401, 95% CI: 1.081–17.923, P = 0.04) and heavy thrombus burden (OR = 16.915, 95% CI: 5.055–56.602, P < 0.001) could be considered as predictors for the development of no-reflow. Interestingly, CAR >0.21, FAR >11.56, and AIP >0.52 could be considered as novel powerful independent predictors (OR = 3.357, 95% CI: 2.288–4.927, P < 0.001, OR = 4.187, 95% CI: 2.761–6.349, P < 0.001, OR = 16.794, 95% CI: 1.018–277.01, P = 0.04, respectively). Higher long term mortality (P < 0.001) and heart failure (P < 0.001) was also strongly related to incidence of no-reflow. Conclusion No-reflow could be attributed to novel predictors as CAR, FAR, and AIP. This phenomenon was associated with long term adverse events as higher mortality and pump failure.
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Affiliation(s)
- Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt.
| | - Ayman Tantawy
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Amr S Gamal
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Hanan Radwan
- Cardiology Department, Zagazig University, Zagazig, Egypt
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4
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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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Rgeeb AN, Alsalkh HA, Radhi AK, Amber K. Effect of Intravenous Abciximab on Coronary Flow Improvement After Re-vascularization in Primary Coronary Intervention and Short Term Impact. Med Arch 2020; 74:265-269. [PMID: 33041442 PMCID: PMC7520065 DOI: 10.5455/medarh.2020.74.265-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/13/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Of recognized fact the importance of early diagnosis and early management of ST-elevation myocardial infarction, to regain a normal or at least adequate coronary flow in the Primary Percutaneous Intervention. Slow or no-reflow is suboptimal myocardial reperfusion, without angiographic evidence of mechanical obstruction. Adenosine, Verapamil and saline flush are manoeuvres proved useful. The resolution of ST-segment is associated with successful revascularization and regarded as a predictor for future events. Glycoprotein IIB/IIIA inhibitors are a group of anti-platelets widely used in acute coronary syndrome. AIM The aim of the study was to investigate that: uses of intra venous Abciximab, does not improve coronary flow in patients with MI that develop sub optimal flow after primary PCI within 30 minutes, but the improvement need 12 to 24 hour as founded in other studies, and its beneficial effect is related to early improvement in LV function and decrease of re-infarction and re-hospitalization. METHOD Prospective, case-control study, enrolled fifty patients randomly assigned into two matching groups, first group (25 patients) received an intravenous Abciximab while the second group (25 patients) received intracoronary saline flush. Repeated angiography after 30 minutes, for immediate resultant flow assessment, Electrocardiographic changes resolution, bleeding and death. After a 30 days, a clinical assessment for primary outcome including, death, recurrent Myocardial infarction and Heart failure While the Secondary outcome including stent thrombosis, target vessel revascularization in addition to the primary outcome. RESULT There was no significant difference in the flow Improvement and ECG resolution between both groups. These findings not affected by the door to balloon time. However, patients with flow improvement had a significant resolution in their ECG. Bleeding propensity and mortality were not significantly affected. Literatures proved the benefit of Abciximab in acute coronary syndrome. CONCLUSION Both intravenous Abciximab and intracoronary saline flush had comparable effect on coronary flow improvement post primary percutaneous intervention, with minimal variation in the bleeding and in-hospital mortality.
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Affiliation(s)
- Ahmed N. Rgeeb
- University of Kufa, Faculty of Medicine, Department of Internal Medicine, Najaf Cardiac Centre, Najaf, Iraq
| | - Hussein A. Alsalkh
- Faculty of Medicine, University of Kufa, Department of Paediatrics, Al-Zahraa Teaching Hospital, Najaf, Iraq
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Zhang E, Gao M, Gao J, Xiao J, Li X, Zhao H, Wang J, Zhang N, Wang S, Liu Y. Inflammatory and Hematological Indices as Simple, Practical Severity Predictors of Microdysfunction Following Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2020; 71:349-359. [PMID: 32013536 DOI: 10.1177/0003319719896472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
C-reactive protein (CRP) and high-sensitivity CRP (hsCRP), along with a series of hematological indices, platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and red blood cell distribution width (RDW), are regarded to be related to the incidence of no-reflow or slow flow. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and science direct from their inception to August 24, 2019. A total of 21 studies involving 7403 patients were included in the meta-analysis. Pooled analysis results revealed patients with higher hsCRP (odds ratio [OR] = 1.03, 95% confidence interval [CI], 1.01-1.05, P = .006), hsCRP (OR = 1.04, 95% CI: 1.0-1.08, P = .012), NLR (OR = 1.23, 95% CI: 1.11-1.37, P < .0001), PLR (OR = 1.13, 95% CI: 1.07-1.20, P < .0001), and MPV (OR = 2.13, 95% CI: 1.57-2.90, P < .0001) all exhibited significantly higher no-reflow incidence, but there was no significant association between no-reflow risk and RDW or PDW. Patients with higher CRP/hsCRP also performed higher rate of slow flow (OR = 1.06, 95% CI: 1.01-1.11, P = .018). Preangiographic CRP/hsCRP could independently predict no-reflow and slow flow. Moreover, some hematological indices are associated with no-flow.
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Affiliation(s)
- Enyuan Zhang
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Mingdong Gao
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Jianyong Xiao
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Xiaowei Li
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Haiwang Zhao
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Jixiang Wang
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Nan Zhang
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Shufeng Wang
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
| | - Yin Liu
- Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin, China
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Bai S, Liu H, Wu H, Wang X, Li R, Li X, Li X, Zhang L, Chen T, Du R. Predictive value of soluble suppression of tumourigenicity 2 on myocardial reperfusion. Intern Med J 2019; 50:985-992. [PMID: 31566840 DOI: 10.1111/imj.14639] [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: 06/10/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND High baseline level of soluble suppression of tumourigenicity 2 (sST2) was an independent predictor of cardiovascular death and heart failure in ST-segment elevation myocardial infarction (STEMI). AIMS To investigate the value of serum sST2 baseline levels in predicting myocardial reperfusion in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). METHODS Consecutive STEMI patients who underwent PPCI within 12 h after the onset of chest pain were enrolled, and were divided into Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grading (TMPG) 0/1/2 group and TMPG 3 group based on post-procedural TMPG. Baseline clinical characteristics, lesions and procedural characteristics were compared. Univariate logistic regression and multivariate linear logistic analysis were performed to identify independent predictors of impaired myocardial reperfusion (TMPG 0/1/2). Receiver-operating characteristics curve (ROC) analysis of sST2 was performed to identify the optimum cut-off value for predicting the myocardial reperfusion. RESULTS A total of 121 patients was enrolled in this study. Univariate logistic regression analysis showed that Killip II-III, high levels of sST2 and brain natriuretic peptide were risk factors of TMPG 0/1/2. Multivariable logistic regression analysis revealed that sST2 was an independent predictor of impaired myocardial reperfusion (odds ratio 12.318, 95% confidence interval 4.567-33.220, P < 0.001). ROC curve analysis showed that the area under curve of sST2 was 0.849, and the best cut-off value was 2.003 ng/mL, with a sensitivity of 89.2% and a specificity of 67.9%. CONCLUSION The elevated levels of sST2 on admission were associated with impaired myocardial reperfusion in STEMI patients undergoing PPCI.
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Affiliation(s)
- Shiru Bai
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Huiliang Liu
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Haibo Wu
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Xuechao Wang
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Ruyi Li
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Xiangming Li
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Xinning Li
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Lina Zhang
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Tianlei Chen
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
| | - Rongpin Du
- Department of Cardiology, Hebei Provincial General Hospital, Shijiazhuang, China
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Del Turco S, Basta G, De Caterina AR, Sbrana S, Paradossi U, Taddei A, Trianni G, Ravani M, Palmieri C, Berti S, Mazzone A. Different inflammatory profile in young and elderly STEMI patients undergoing primary percutaneous coronary intervention (PPCI): Its influence on no-reflow and mortality. Int J Cardiol 2019; 290:34-39. [DOI: 10.1016/j.ijcard.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 12/31/2022]
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Xiao Y, Fu X, Wang Y, Wu Y, Wang W, Zhang Q. Development and Validation of Risk Nomogram Model Predicting Coronary Microvascular Obstruction in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Catheterization. Med Sci Monit 2019; 25:5864-5877. [PMID: 31387983 PMCID: PMC6693363 DOI: 10.12659/msm.915960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Coronary microvascular functional and structural obstruction (CMVO) remains a major complication in patients with ST-segment elevation myocardial infarction (STEMI). This study was designed to develop and validate a nomogram model to predict CMVO risk during primary percutaneous catheterization procedure. Material/Methods Starting January 2014 to December 2016, a cohort of eligible candidates were enrolled and divided into a training or a validation database. Each database was divided into MO or NMO subgroups based on TIMI myocardial perfusion grade results after recanalization. Independent factors were identified by multivariate logistic regression, from which the nomogram was plotted. The echocardiography measurement of the left ventricular ejection fraction (LVEF) was arranged within 7 days after the procedure. Results A nomogram was built for CMVO risk prediction for the first time. There were 446 participants in the training database with 319 cases in the NMO subgroup and 127 participants in the MO subgroup. The validation database included 99 participants with 25 cases in the NMO subgroup and 74 in the MO subgroup. The risk model was developed by 6 independently significant factors: age, symptom onset to balloon time, Killip classification, admission activated clotting time, neutrophil/lymphocyte ratio, and glucose value. Internal receiver operating characteristic displayed favorable performance with concordance index of 0.925, while external validation area under curve was 0.939. There were significant differences in LVEF values during hospitalization between the subgroups of each database (both P<0.001). Conclusions The nomogram model consisting of 6 factors could predict CMVO risk accurately for STEMI patients undergoing primary percutaneous catheterization.
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Affiliation(s)
- Yuyang Xiao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Xianghua Fu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yanbo Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yanqiang Wu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wenlu Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Qian Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Stankovic S, Obradovic S, Dzudovic B, Djenic N, Romanovic R, Jovic Z, Spasic M, Djuric O, Malovic D, Stavric M, Subota V. Lower plasma protein C activity is associated with early myocardial necrosis and no-reflow phenomenon in patients with ST elevation myocardial infarction. Acta Cardiol 2019; 74:331-339. [PMID: 30204553 DOI: 10.1080/00015385.2018.1494116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Activity of protein C has important role in the development of early necrosis and no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Methods: We examined association between plasma activity of protein C, antithrombin, coagulation factors II, VII, VIII and fibrinogen to early formation of new Q-waves (myocardial necrosis) before pPCI and early ST-segment resolution (microcirculatory reperfusion) after pPCI in patients with acute STEMI. According to ischaemic time, patients were considered as early or late presenters. 12-lead ECG was analysed for the presence of new Q-wave at admission and for significant ST-segment resolution 60 minutes after primary PCI. Results: In early presenters' group, protein C activity was significantly lower in patients who did not achieve significant ST-segment resolution after pPCI compared to patients who did (1.11 IU/L vs. 0.99 IU/L, p = .006) and in patients who had new Q-waves compared to group who had not (1.04 UI/l vs. 1.11 IU/L, p = .038). There was significant negative correlation between protein C activity and maximal CK-MB levels (R2 = 0.06, p = .009) and BNP levels (R2 = 0.109, p = .003) and significant positive correlation between protein C activity with LVEF (R2 = 0.065, constant = 33.940, b = 11.968, p = .007) in early STEMI presenters. There were no differences between the activity of other examined haemostasis factors. Conclusion: Therefore we concluded that STEMI patients with early myocardial necrosis and no-reflow phenomenon after pPCI have lower activity of plasma protein C levels.
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Affiliation(s)
- Suncica Stankovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Djenic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Radoslav Romanovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Zoran Jovic
- Clinic for cardiology, Military Medical Academy, Belgrade, Serbia
| | - Marijan Spasic
- Clinic for cardiology, Military Medical Academy, Belgrade, Serbia
| | - Obrad Djuric
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Dragana Malovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Milena Stavric
- Institute for Biochemistry, Military Medical Academy, Belgrade, Serbia
| | - Vesna Subota
- Institute for Biochemistry, Military Medical Academy, Belgrade, Serbia
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Kim MC, Cho JY, Jeong HC, Lee KH, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Hong YJ, Park HW, Kim JH, Jeong MH, Cho JG, Park JC, Seung KB, Chang K, Ahn Y. Long-Term Clinical Outcomes of Transient and Persistent No Reflow Phenomena following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction. Korean Circ J 2016; 46:490-8. [PMID: 27482257 PMCID: PMC4965427 DOI: 10.4070/kcj.2016.46.4.490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/09/2015] [Accepted: 12/08/2015] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Subjects and Methods The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade≤2). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. Results The persistent no reflow group was associated with higher all-cause mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p=0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p=0.002) compared with the normal reflow group. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). Conclusion The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.
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Affiliation(s)
- Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Ki Hong Lee
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Hyun Joo Youn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Ki-Bae Seung
- Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
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Serum NT-proBNP on admission can predict ST-segment resolution in patients with acute myocardial infarction after primary percutaneous coronary intervention. Herz 2015; 40:898-905. [DOI: 10.1007/s00059-015-4309-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/14/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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13
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Cuculi F, Herring N, De Caterina AR, Banning AP, Prendergast BD, Forfar JC, Choudhury RP, Channon KM, Kharbanda RK. Relationship of plasma neuropeptide Y with angiographic, electrocardiographic and coronary physiology indices of reperfusion during ST elevation myocardial infarction. Heart 2013; 99:1198-203. [PMID: 23403409 DOI: 10.1136/heartjnl-2012-303443] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The co-transmitter neuropeptide Y (NPY) is released during high levels of sympathetic stimulation and is a potent vasoconstrictor. We defined the release profile of plasma NPY during acute ST elevation myocardial infarction, and tested the hypothesis that levels correlate with reperfusion measures after treatment with primary percutaneous coronary intervention (PPCI). DESIGN Prospective observational study. SETTING University hospital heart centre. PATIENTS 64 patients (62.6±11.7 years-old, 73% male) presenting throughout the 24-h cycle of clinical activity with ST elevation myocardial infarction. INTERVENTIONS PPCI. MAIN OUTCOME MEASURES NPY was measured (ELISA) in peripheral blood taken before and immediately after PPCI and at 6, 24 and 48 h post-PPCI. Reperfusion was assessed by angiographic criteria, ST segment resolution, invasive measurement of coronary flow reserve and the index of microcirculatory resistance. RESULTS Plasma NPY levels were highest before PPCI (17.4 (8.8-42.2) pg/ml, median (IQR)) and dropped significantly post-PPCI (12.4 (6.5-26.7) pg/ml, p<0.0001) and after 6 h (9.0 (2.6-21.5) pg/ml, p=0.008). Patients with admission NPY levels above the median were significantly more hypertensive and tachycardic and were more likely to have diabetes mellitus. Patients with angiographic no-reflow (less than thrombolysis in myocardial infarction 3 flow and myocardial blush grade >2, n=16) or no electrocardiographic ST resolution (<70%, n=30) following PPCI had significantly higher plasma NPY levels. Patients with a coronary flow reserve <1.5 or index of microcirculatory resistance >33 also had significantly higher plasma NPY levels pre-PPCI and post-PPCI. CONCLUSIONS Plasma NPY levels correlate with indices of reperfusion and coronary microvascular resistance.
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Affiliation(s)
- Florim Cuculi
- Department of Cardiovascular Medicine, University of Oxford, The John Radcliffe Hospital, Oxford OX39DU, UK
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Waks JW, Scirica BM. Established and novel biomarkers in ST-elevation myocardial infarction. Future Cardiol 2011; 7:523-46. [PMID: 21797748 DOI: 10.2217/fca.11.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac biomarkers assist in the diagnosis of and risk stratification in acute coronary syndromes. In ST-elevation myocardial infarction (STEMI), rapid diagnosis and initiation of reperfusion via primary percutaneous coronary intervention or fibrinolysis is often based on the clinical history and presenting ECG, but measurement of biomarkers in the early and/or late phases of STEMI may allow the selection of patients who are at increased or decreased risk of subsequent complications. Although the measurement of only three biomarkers (troponin, natriuretic peptides and C-reactive protein) are currently included in practice guidelines, more than 20 other novel cardiac biomarkers have been proposed to provide improved risk stratification after a STEMI.
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Affiliation(s)
- Jonathan W Waks
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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15
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Relation of circulating osteoprotegerin levels on admission to microvascular obstruction after primary percutaneous coronary intervention. Am J Cardiol 2011; 107:857-62. [PMID: 21247537 DOI: 10.1016/j.amjcard.2010.10.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 10/30/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
Abstract
Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor receptor superfamily, has recently been linked to atherosclerosis and development of postinfarction heart failure. This study was designed to assess the association between admission OPG levels and microvascular obstruction (MVO) in patients who underwent primary percutaneous coronary intervention (p-PCI). Plasma samples for OPG analysis were obtained <30 minutes after admission in 47 patients who underwent p-PCI. Angiographic no-reflow (Thrombolysis In Myocardial Infarction [TIMI] flow grade <3 or 3 with myocardial blush grade 0 or 1 after p-PCI) was assessed immediately after p-PCI. MVO was assessed and quantified by the intracoronary hemodynamic measure of index of microcirculatory resistance performed on day 4 or 5 after p-PCI. Patients with angiographic no-reflow had significantly higher OPG levels on admission. On multiple linear regression analysis, OPG (β = 0.412, p = 0.001) and B-type natriuretic peptide (β = 0.409, p = 0.001) levels were independently and directly associated with the index of microcirculatory resistance. In conclusion, plasma OPG levels on admission are strongly associated with MVO and significantly correlated with the degree of MVO after p-PCI. It remains to be established whether improvement of microvascular perfusion is feasible with therapeutic strategies aimed to decrease circulating OPG levels.
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Tello-Montoliu A, Marín F. Biomarcadores en la estratificación del riesgo del síndrome coronario agudo sin elevación del segmento ST: ¿hay algo más después de la troponina? Med Clin (Barc) 2009; 133:586-8. [DOI: 10.1016/j.medcli.2009.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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Najib S, Martín-Romero C, González-Yanes C, Sánchez-Margalet V. Role of Sam68 as an adaptor protein in signal transduction. Cell Mol Life Sci 2005; 62:36-43. [PMID: 15619005 DOI: 10.1007/s00018-004-4309-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sam68, the substrate of Src in mitosis, belongs to the family of RNA binding proteins. Sam68 contains consensus sequences to interact with other proteins via specific domains. Thus, Sam68 has various proline-rich sequences to interact with SH3 domain-containing proteins. Moreover, Sam68 also has a C-terminal domain rich in tyrosine residues that is a substrate for tyrosine kinases. Tyrosine phosphorylation of Sam68 promotes its interaction with SH2 containing proteins. The association of Sam68 with SH3 domain-containing proteins, and its tyrosine phosphorylation may negatively regulate its RNA binding activity. The presence of these consensus sequences to interact with different domains allows this protein to participate in signal transduction pathways triggered by tyrosine kinases. Thus, Sam68 participates in the signaling of T cell receptors, leptin and insulin receptors. In these systems Sam68 is tyrosine phosphorylated and recruited to specific signaling complexes. The participation of Sam68 in signaling suggests that it may function as an adaptor molecule, working as a dock to recruit other signaling molecules. Finally, the connection between this role of Sam68 in protein-protein interaction with RNA binding activity may connect signal transduction of tyrosine kinases with the regulation of RNA metabolism.
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Affiliation(s)
- S Najib
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Investigation Unit, Virgen Macarena University Hospital, Av. Sanchez Pizjuan 4, Seville 41009, Spain
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