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Handmark M, Lin A, Edsfeldt A, Sarno G, Fraser A, Rich-Edwards JW, Gonҫalves I, Pihlsgård M, Timpka S. STEMI, Revascularization, and Peak Troponin by Adverse Pregnancy Outcomes in Women With Myocardial Infarction. JACC. ADVANCES 2024; 3:101088. [PMID: 39070091 PMCID: PMC11277779 DOI: 10.1016/j.jacadv.2024.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/15/2024] [Accepted: 05/07/2024] [Indexed: 07/30/2024]
Abstract
Background Women with a history of adverse pregnancy outcomes have a higher risk of coronary heart disease. Emerging evidence suggests that women with a history of preeclampsia have a different pattern of overall coronary atherosclerosis and that they at the time of myocardial infarction (MI) more frequently present with ST-segment elevation MI (STEMI) compared to women with no such history. Objectives The purpose of this study was to determine whether among women with MI, those with a history of adverse pregnancy outcomes are more likely to present with STEMI or other clinical characteristics indicating a more severe myocardial injury. Methods The study sample consisted of 8,320 women aged ≤65 years with first MI in Sweden 2007 to 2022. Regression models were used to estimate the association between adverse pregnancy outcomes (hypertensive disorders of pregnancy [non-preeclamptic hypertension and preeclampsia], small for gestational age [SGA] infant, and preterm delivery) and STEMI, invasive revascularization, and high troponin, while considering known predictors of coronary heart disease. Results In total, 3,128 (38%) of women suffered STEMI. The adjusted OR of presenting with STEMI were higher in women with a history of preterm preeclampsia (OR: 1.40; 95% CI: 1.05-1.88), or an SGA infant (OR: 1.30; 95% CI: 1.13-1.50) compared to women with no such history, as well as for in-hospital revascularization. Stratified by infarct type, troponin levels did not differ by adverse pregnancy outcome history. Conclusions Among women with a first MI, a history of preterm preeclampsia or SGA infant were associated with STEMI and invasive revascularization.
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Affiliation(s)
- Moa Handmark
- Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Annie Lin
- Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Andreas Edsfeldt
- Cardiovascular Research - Translational Studies, Lund University, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Abigail Fraser
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Isabel Gonҫalves
- Cardiovascular Research - Translational Studies, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Mats Pihlsgård
- Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Simon Timpka
- Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
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Choi KH, Lee SY, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Kang TS, Gwon HC, Yang JH. Cardiogenic shock complicating acute myocardial infarction and multivessel disease: revascularization strategy according to ischemic territory. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00163-4. [PMID: 38815858 DOI: 10.1016/j.rec.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION AND OBJECTIVES The association of revascularization strategy with clinical outcomes according to the ischemic territory of nonculprit lesion has not been documented in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This study aimed to compare outcomes between culprit-only and immediate multivessel percutaneous coronary intervention (PCI) according to ischemic territory in patients with AMI-CS. METHODS A total of 536 patients with AMI-CS and multivessel disease from the SMART-RESCUE registry were categorized according to ischemic territory (nonculprit left main/proximal left anterior descending artery [LM/pLAD] vs culprit LM/pLAD vs no LM/pLAD). The primary outcome was a patient-oriented composite endpoint (POCE) consisting of all-cause death, myocardial infarction, rehospitalization due to heart failure, or repeat revascularization at 1 year. RESULTS Among the total population, 108 patients had nonculprit LM/pLAD, 228 patients had culprit LM/pLAD, and 200 patients had no LM/pLAD, with the risk of POCE being higher in patients with large ischemic territory lesions (53.6% vs 53.4% vs 39.6%; P = .02). Multivessel PCI was associated with a significantly lower risk of POCE compared with culprit-only PCI in patients with nonculprit LM/pLAD (40.7% vs 66.9%; HR, 0.52; 95%CI, 0.29-0.91; P=.02), but not in those with culprit LM/pLAD (P=.46) or no LM/pLAD (P=.47). A significant interaction existed between revascularization strategy and large nonculprit ischemic territory (P=.03). CONCLUSIONS Large ischemic territory involvement was associated with worse clinical outcomes in patients with AMI-CS and multivessel disease. Immediate multivessel PCI might improve clinical outcomes in patients with a large nonculprit ischemic burden.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Division of Cardiology, Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Woo Jin Jang
- Division of Cardiology, Department of Cardiology, Ehwa Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Tae-Soo Kang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Brandt V, Fischer A, Schoepf UJ, Bekeredjian R, Tesche C, Aquino GJ, O'Doherty J, Sharma P, Gülsün MA, Klein P, Ali A, Few WE, Emrich T, Varga-Szemes A, Decker JA. Deep Learning-Based Automated Labeling of Coronary Segments for Structured Reporting of Coronary Computed Tomography Angiography in Accordance With Society of Cardiovascular Computed Tomography Guidelines. J Thorac Imaging 2024; 39:93-100. [PMID: 37889562 DOI: 10.1097/rti.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE To evaluate a novel deep learning (DL)-based automated coronary labeling approach for structured reporting of coronary artery disease according to the guidelines of the Society of Cardiovascular Computed Tomography (CT) on coronary CT angiography (CCTA). PATIENTS AND METHODS A retrospective cohort of 104 patients (60.3 ± 10.7 y, 61% males) who had undergone prospectively electrocardiogram-synchronized CCTA were included. Coronary centerlines were automatically extracted, labeled, and validated by 2 expert readers according to Society of Cardiovascular CT guidelines. The DL algorithm was trained on 706 radiologist-annotated cases for the task of automatically labeling coronary artery centerlines. The architecture leverages tree-structured long short-term memory recurrent neural networks to capture the full topological information of the coronary trees by using a two-step approach: a bottom-up encoding step, followed by a top-down decoding step. The first module encodes each sub-tree into fixed-sized vector representations. The decoding module then selectively attends to the aggregated global context to perform the local assignation of labels. To assess the performance of the software, percentage overlap was calculated between the labels of the algorithm and the expert readers. RESULTS A total number of 1491 segments were identified. The artificial intelligence-based software approach yielded an average overlap of 94.4% compared with the expert readers' labels ranging from 87.1% for the posterior descending artery of the right coronary artery to 100% for the proximal segment of the right coronary artery. The average computational time was 0.5 seconds per case. The interreader overlap was 96.6%. CONCLUSIONS The presented fully automated DL-based coronary artery labeling algorithm provides fast and precise labeling of the coronary artery segments bearing the potential to improve automated structured reporting for CCTA.
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Affiliation(s)
- Verena Brandt
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
- Department of Cardiology, German Heart Centre Munich
| | - Andreas Fischer
- University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Cardiology, Clinic Augustinum Munich
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich
| | - Gilberto J Aquino
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Jim O'Doherty
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Siemens Medical Solutions USA, Siemens Healthineers, Malvern, PA
| | - Puneet Sharma
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Mehmet A Gülsün
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Paul Klein
- Department of Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Asik Ali
- Department of Digital Technology and Innovation, Siemens Healthineers, Bangalore, KA, India
| | - William Evans Few
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Gohannes Gutenberg University Mainz, Mainz
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Josua A Decker
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
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Juul AS, Kyhl K, Ekström K, Madsen JM, Sabbah M, Ahtarovski KA, Nepper-Christensen L, Vejlstrup N, Høfsten D, Kelbaek H, Køber L, Lønborg J, Engstrøm T. The Incidence and Impact of Permanent Right Ventricular Infarction on Left Ventricular Infarct Size in Patients With Inferior ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 186:43-49. [PMID: 36343445 DOI: 10.1016/j.amjcard.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Mounting evidence shows that right ventricle (RV) function carries independent prognostic influence in various disease states. This study aimed to investigate the incidence and impact of permanent RV infarction in patients with inferior ST-segment elevation myocardial infarction (STEMI) and culprit lesion in the right coronary artery (RCA). In this substudy of the DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) trial, cardiac magnetic resonance was performed in 291 patients at day 1 and follow-up 3 months after primary percutaneous coronary intervention of 674 patients with STEMI with the culprit lesion in the RCA. Final infarct was assessed using late gadolinium enhancement on cardiac magnetic resonance at 3 months. Patients with permanent RV infarction (20%) had lower ventricular function at follow-up; RV ejection fraction (EF) 47% ±6 versus 50% ± 5 (p <0.005) and left ventricular (LV) EF 56% ± 8 versus 60% ± 9 (p <0.006). Furthermore, patients with permanent RV infarction had a higher incidence of microvascular obstruction 39 (67%) versus 81 (39%) (p <0.001), larger final LV infarct size 16% ±8 versus 10% ± 8 (p <0.001) and larger LV area at risk 33% ± 10 versus 29% ± 9 (p <0.001). Permanent RV infarction was an independent predictor of final LV infarct size (p <0.001) but was not associated with LVEF (β = -0.0; p = 0.13) in multivariable analyses. In conclusion, permanent RV infarction was seen in 20% of patients with inferior STEMI and culprit lesion in RCA and independently predicted final LV infarct size. However, permanent RV infarction did not predict overall LV function. LGE was used to detect infarct location and quantify infarct size.17 LGE in RV free wall on follow-up CMR was considered as permanent infarction. LGE images were obtained 10 minutes after intravenous injection of 0.1-mmol/kg body weight of gadolinium-based contrast (Gadovist; Bayer Schering, Berlin, Germany) using an electrocardiogram (ECG)-triggered inversion-recovery sequence. The inversion time was adjusted to null the signal from the normal myocardium. Short-axis images were acquired from the atrioventricular plane to the apex with adjacent 8-mm slices. The remaining protocol has been described previously.16.
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Affiliation(s)
- Anne-Sophie Juul
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health Science, University of Copenhagen.
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kathrine Ekström
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Muhammad Sabbah
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbaek
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
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Arai R, Fukamachi D, Migita S, Miyagawa M, Ohgaku A, Koyama Y, Fujito H, Fukumoto K, Ebuchi Y, Monden M, Takei N, Tamaki T, Kojima K, Murata N, Iida K, Kitano D, Okumura Y. Prognostic Significance of a Combination of Cardiogenic Shock and the Critical Culprit Lesion Location in ST-Elevation Myocardial Infarctions. Int Heart J 2022; 63:191-201. [DOI: 10.1536/ihj.21-296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Shohei Migita
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masatsugu Miyagawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Akihito Ohgaku
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yutaka Koyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Katsunori Fukumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasunari Ebuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masaki Monden
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Norio Takei
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takehiro Tamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Keisuke Kojima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Korehito Iida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Fabiszak T, Kasprzak M, Koziński M, Kubica J. Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:5445. [PMID: 34830726 PMCID: PMC8619668 DOI: 10.3390/jcm10225445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). METHODS We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. RESULTS Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). CONCLUSIONS According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
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Affiliation(s)
- Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
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7
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Hauguel-Moreau M, Barthélémy O, Farhan S, Huber K, Rouanet S, Zeitouni M, Guedeney P, Hage G, Vicaut E, Zeymer U, Desch S, Thiele H, Montalescot G. Culprit lesion location and outcomes in patients with multivessel disease and infarct-related cardiogenic shock: a core laboratory analysis of the CULPRIT-SHOCK trial. EUROINTERVENTION 2021; 17:e418-e424. [PMID: 32894227 PMCID: PMC9725066 DOI: 10.4244/eij-d-20-00561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Critical culprit lesion locations (CCLL) such as left main (LM) and proximal left anterior descending (LAD) are associated with worse clinical outcome in myocardial infarction without cardiogenic shock (CS). AIMS We aimed to assess whether CCLL identify a subgroup of patients with poorer prognosis when presenting with CS. METHODS In the CULPRIT-SHOCK trial, a core laboratory reviewed all coronary angiograms to identify CCLL. A CCLL was defined as a culprit lesion with a >70% diameter stenosis of the LM, LM equivalent (>70% diameter stenosis of both proximal LAD and proximal circumflex), proximal LAD or last remaining vessel. We evaluated the primary study endpoint of the CULPRIT-SHOCK trial according to CCLL. RESULTS A total of 269 (43%) out of 626 patients eligible for this analysis had a CCLL. Death or renal replacement therapy within 30 days, death within 30 days and death within one year were significantly higher in the CCLL than in the non-CCLL group (58.4% vs 43.4%, p<0.001, 55.8% vs 39.5%, p<0.001, 61.0% vs 44.5%, p<0.001, respectively). This was consistent after adjustment for baseline and angiographic characteristics. No interaction with the randomisation group (culprit lesion-only or immediate multivessel PCI) was found. CONCLUSIONS CCLL is frequent in CS and independently associated with worse clinical outcomes irrespective of the revascularisation strategy. TRIAL REGISTRATION www.clinicaltrials.gov NCT01927549.
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Affiliation(s)
- Marie Hauguel-Moreau
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Olvier Barthélémy
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen hospital and Sigmund Freund University, Medical School, Vienna, Austria
| | | | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Georges Hage
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (Ap-HP), Paris, France
| | - Uwe Zeymer
- Heart Centre Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany
| | - Steffen Desch
- Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Paris, France
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8
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Femia G, Faour A, Assad J, Sharma L, Idris H, Gibbs O, Pender P, Leung D, Hopkins A, Rajaratnam R, P Juergens C, Mussap C, K French J, Lo S. Comparing the clinical and prognostic impact of proximal versus nonproximal lesions in dominant right coronary artery ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 97:E646-E652. [PMID: 32870605 DOI: 10.1002/ccd.29245] [Citation(s) in RCA: 1] [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: 05/12/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the prognostic significance of culprit lesion location in dominant right coronary artery (RCA) ST-elevation myocardial infarction (STEMI). BACKGROUND In RCA STEMI, proximal culprit lesions have been shown to have higher rates of acute complications such as bradycardia and cardiogenic shock (CS) but data on mortality is limited. METHODS We retrospectively identified and analyzed data from consecutive patients with a dominant RCA STEMI who underwent either primary or rescue percutaneous coronary intervention (PCI) between January 2003 and December 2016. We compared the rates of sustained ventricular tachycardia (VT), CS, intra-aortic balloon pump (IABP), temporary cardiac pacing (TCP) and death between culprit lesions located proximal and distal to the origin of the last right ventricular (RV) marginal artery >1 mm in diameter. RESULTS The 939 patients were included; 599 (63.7%) had a proximal lesion and 340 (36.3%) had a nonproximal lesion. The 801 (85.3%) underwent primary PCI and 138 (14.7%) underwent rescue PCI. There was no difference in first medical contact to balloon or fibrinolysis times between the groups; p = .98 and .71. There was no significant difference in the rate of sustained VT (3.0%vs. 3.2%, p = .85) but proximal lesions were more likely to develop CS (10.9%vs. 5.8%, p = .01), require IABP (7.3%vs.2.9%, p < .01) and TCP (6.3%vs. 2.6%, p = .01). Thirty-day mortality was higher for proximal lesions (5.0%vs. 0.9%, p < .01) particularly for those with CS (35.3%vs. 10.0%, p = .05). CONCLUSION Culprit lesions located proximal to the origin of the last RV marginal artery had a higher rate of acute complications such as CS and mortality.
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Affiliation(s)
- Giuseppe Femia
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Amir Faour
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Joseph Assad
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Lokesh Sharma
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Hanan Idris
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Oliver Gibbs
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Patrick Pender
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Dominic Leung
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Andrew Hopkins
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Rohan Rajaratnam
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Christian Mussap
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales Medicine, Liverpool, New South Wales, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Wang J, He SY. Clinical and angiographic characteristics of patients with spontaneous reperfusion in ST-segment elevation myocardial infarction. Medicine (Baltimore) 2020; 99:e19267. [PMID: 32150062 PMCID: PMC7478519 DOI: 10.1097/md.0000000000019267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aims to investigate the clinical and angiographic characteristics of patients with spontaneous reperfusion in ST-segment elevation myocardial infarction (STEMI).A total of 519 patients with STEMI were enrolled in this study, who underwent primary percutaneous coronary intervention (PCI) treatments at Beijing Anzhen Hospital from January 2015 to December 2018. The patients were divided into 2 groups according to the TIMI flow grade before primary PCI, the non-spontaneous reperfusion group (TIMI flow grade 0-II) and the spontaneous reperfusion group (TIMI flow grade III). The incidence rate, the clinically relevant factors, and the features of the coronary angiographic lesions of spontaneous reperfusion from the 2 groups were recorded and analyzed.There were significant differences between the 2 groups in age, CTnI peak value, high thrombus burden, and locations of lesions in the distant of left anterior descending artery (LAD) (P = .000, .000, .002, .000, and .003, respectively). However, there were no significant differences between the groups in other clinic aspects including gender, hypertension, diabetes mellitus, smoking history, hyperlipemia, angina pectoris history, culprit vessel distribution, lesion distribution in left circumflex artery (LCX) and right coronary artery (RCA), and collateral circulation (P > .05 for all).Compared to the patients without spontaneous reperfusion, patients with spontaneous reperfusion were younger in age, lower in CTnI peak value, and higher in thrombosis burden, with culprit lesions mostly located in the distant of LAD.
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10
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Tang B, Yang H. Post percutaneous coronary interventional outcomes on proximal vs non-proximal lesions of the left and right coronary arteries: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16905. [PMID: 31415437 PMCID: PMC6831429 DOI: 10.1097/md.0000000000016905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The prognosis of patients with coronary artery disease is mainly related to the extent of myocardium at risk. Proximal coronary arteries, especially the proximal left anterior descending coronary artery (LAD), supply a large part of the myocardium. In this analysis, we aimed to systematically compare the post percutaneous coronary interventional (PCI) outcomes observed with proximal vs non-proximal lesions of the left and right coronary arteries. METHODS MEDLARS Online, Excerpta Medica database, www.ClinicalTrials.gov, and the Cochrane databases were searched for relevant studies comparing the post PCI outcomes reported on proximal vs non-proximal lesions of the coronary arteries. RevMan software version 5.3 was used to analyze the data to generate respective results. Odds ratios (OR) and 95% confidence intervals (CI) were derived to represent the results appropriately. RESULTS Six studies with a total number of 11,109 participants who were enrolled between 1990 and 2015 were included in this analysis. The current results showed major adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P = .0001) and mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly higher with proximal compared to non-proximal coronary lesions irrespective of the follow-up time periods. However, re-infarction (OR: 1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08, 95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI: 0.27-1.31; P = .20) were not significantly different.When patients specifically with LAD lesions were compared with associated non-proximal lesions, mortality was still significantly higher with proximal lesions (OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with right proximal coronary artery lesions were compared with the corresponding non-proximal lesions, no significant difference was observed in mortality. CONCLUSION In-hospital and long-term MACEs and mortality were significantly higher in patients with proximal compared to non-proximal coronary lesions following PCI. In addition, mortality was significantly higher in patients with proximal LAD lesions whereas no significant difference was observed in patients with right proximal coronary artery lesions. Larger trials should further confirm these hypotheses.
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11
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Noaman S, Goh CY, Vogrin S, Brennan AL, Andrianopoulos N, Dinh DT, Lefkovits J, Reid CM, Walton A, Al-Mukhtar O, Biswas S, Stub D, Duffy SJ, Cox N, Chan W. Comparison of short-term clinical outcomes of proximal versus nonproximal lesion location in patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction: The PROXIMITI study. Catheter Cardiovasc Interv 2019; 93:32-40. [PMID: 30019827 DOI: 10.1002/ccd.27665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the association of proximal and nonproximal location of culprit coronary lesions with clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). BACKGROUND Proximal culprit lesion location in patients presenting with STEMI is associated with increased mortality when compared to distal culprit lesions in the thrombolytic era. The impact of lesion location on clinical outcomes in the era of PCI remains unclear. METHODS We analyzed 3,283 patients with STEMI who enrolled in the Victorian Cardiac Outcomes Registry. We compared outcomes in those with proximal lesion location versus patients with nonproximal location. RESULTS Of 3,283 participants, 1,376 (41.9%) had a proximal lesion location. Patients with proximal lesion location presented with greater rates of cardiogenic shock and out-of-hospital cardiac arrest, and left ventricular systolic dysfunction, all P < .01. Procedural success rates were similar (96% vs. 95%, P = .08). Patients with proximal lesion location had higher rates of in-hospital and 30-day mortality, major adverse cardiac events (MACE; mortality, myocardial infarction, stent thrombosis, and unplanned revascularization) and major adverse cardiac and cerebrovascular events (MACCE; MACE, and stroke) compared to the nonproximal group, all P < .001. However, on multivariable regression analysis, proximal lesion location was not independently associated with MACE during in-hospital stay or at 30-days (OR 1.32, 95% CI 0.95-1.83, P = .09 and OR 1.23, 95% CI 0.92-1.65, P = .15) respectively. CONCLUSIONS Patients with proximal lesion location had greater hemodynamic instability and higher-risk features; however, proximal lesions per se were not independently associated with worse clinical outcomes compared to nonproximal lesions.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Cheng Yee Goh
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Antony Walton
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Monash University, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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12
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Abstract
An automatic coronary artery tree labeling algorithm is described to identify the anatomical segments of the extracted centerlines from coronary computed tomography angiography (CCTA) images. This method will facilitate the automatic lesion reporting and risk stratification of cardiovascular disease. Three-dimensional (3D) models for both right dominant (RD) and left dominant (LD) coronary circulations were built. All labels in the model were matched with their possible candidates in the extracted tree to find the optimal labeling result. In total, 83 CCTA datasets with 1149 segments were included in the testing of the algorithm. The results of the automatic labeling were compared with those by two experts. In all cases, the proximal parts of main branches including LM were labeled correctly. The automatic labeling algorithm was able to identify and assign labels to 89.2% RD and 83.6% LD coronary tree segments in comparison with the agreements of the two experts (97.6% RD, 87.6% LD). The average precision of start and end points of segments was 92.0% for RD and 90.7% for LD in comparison with the manual identification by two experts while average differences in experts is 1.0% in RD and 2.2% in LD cases. All cases got similar clinical risk scores as the two experts. The presented fully automatic labeling algorithm can identify and assign labels to the extracted coronary centerlines for both RD and LD circulations.
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13
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Culprit lesion location and outcome in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 2016; 105:1030-1041. [DOI: 10.1007/s00392-016-1017-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/28/2016] [Indexed: 01/18/2023]
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14
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Baek YS, Park SD, Kim SH, Lee MJ, Shin SH, Kim DH, Kwan J, Park KS, Woo SI. Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2015; 56:1235-43. [PMID: 26256965 PMCID: PMC4541652 DOI: 10.3349/ymj.2015.56.5.1235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/03/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18-31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37]. RESULTS The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Soo-Han Kim
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Man-Jong Lee
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Jun Kwan
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Keum-Soo Park
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Seong-Ill Woo
- Division of Cardiology, Inha University Hospital, Incheon, Korea.
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15
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Calais F, Lagerqvist B, Leppert J, James SK, Fröbert O. Proximal coronary artery intervention: Stent thrombosis, restenosis and death. Int J Cardiol 2013; 170:227-32. [DOI: 10.1016/j.ijcard.2013.10.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 09/02/2013] [Accepted: 10/19/2013] [Indexed: 01/28/2023]
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16
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Cho SG, Kim JH, Cho JY, Kim HS, Bom HS. Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT. Nucl Med Mol Imaging 2013; 47:158-65. [PMID: 24900102 DOI: 10.1007/s13139-013-0208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). METHODS Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. RESULTS The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80 ± 0.35 vs 2.76 ± 1.13 for pLAD and mdLAD groups, respectively, p = 0.034), while global MFR was not different (2.10 ± 1.10 vs 2.34 ± 0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0 ± 11.5 % vs 21.1 ± 15.8 %, p = 0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. CONCLUSIONS The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Young Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Hyeon Sik Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam Korea 519-763
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam Korea 519-763
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17
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Ishikawa T, Nakano Y, Hino S, Mutoh M. Comparison of long-term clinical and 1-year angiographic outcomes after primary stenting (-12 hours) and late reperfusion (12 hours-) using sirolimus-eluting stents for ST-segment elevated myocardial infarctions: a propensity score matching analysis. Intern Med 2013; 52:1303-10. [PMID: 23774538 DOI: 10.2169/internalmedicine.52.0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We compared the long-term clinical and 1-year angiographic outcomes in ST-segment elevation myocardial infarction (STEMI) patients who presented between 12 to 48 hours after symptom onset and underwent emergent procedures (late reperfusion) using sirolimus-eluting stents (SES; Cypher Bx Velocity) with those of primary stenting patients who presented within 12 hours. METHODS The study design was a retrospective, nonrandomized single-center study in which the investigations were conducted in October 2012 following the enrollment of consecutive STEMI patients treated with late reperfusion (n=75) and primary stenting using SES (n=386) between September 2004 and May 2007. The incidence of the primary end points (cardiac death, nonfatal recurrent MI and definite stent thrombosis) after late reperfusion (6.7%; mean follow-up, 2,176±742 days) was not significantly different from that observed after primary stenting (8.5%; 2,237±722 days) (p=0.59). The incidence of the secondary end point (binary in-stent restenosis: % diameter stenosis greater than 50% on secondary angiography at approximately one year) after late reperfusion (11.1%, n=54) was not statistically different from that observed after primary stenting (8.0%, n=276) (p=0.45). Using a propensity score matching analysis, the incidences of the primary (6.7%, n=75) and secondary (11.3%, n=53) end points after late reperfusion were not found to be significantly different from those observed after primary stenting (8.0% and 9.4%) (p=0.75 and 0.75, respectively). CONCLUSION The present small study showed the long-term clinical and 1-year angiographic outcomes after late reperfusion using SES for STEMI patients in emergent procedures in daily practice to be statistically equivalent to those observed after primary stenting using SES for STEMI patients.
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Affiliation(s)
- Tetsuya Ishikawa
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, Japan.
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18
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Ahmed TA, Sorgdrager BJ, Cannegieter SC, van der Laarse A, Schalij MJ, Jukema W. Pre-infarction angina predicts thrombus burden in patients admitted for ST-segment elevation myocardial infarction. EUROINTERVENTION 2012; 7:1396-1405. [DOI: 10.4244/eijv7i12a219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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19
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Wykrzykowska JJ, Mintz GS, Garcia-Garcia HM, Maehara A, Fahy M, Xu K, Inguez A, Fajadet J, Lansky A, Templin B, Zhang Z, de Bruyne B, Weisz G, Serruys PW, Stone GW. Longitudinal Distribution of Plaque Burden and Necrotic Core–Rich Plaques in Nonculprit Lesions of Patients Presenting With Acute Coronary Syndromes. JACC Cardiovasc Imaging 2012; 5:S10-8. [DOI: 10.1016/j.jcmg.2012.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/13/2011] [Accepted: 01/17/2012] [Indexed: 11/26/2022]
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20
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Aertker RA, Barker CM, Anderson HV, Denktas AE, Giesler GM, Julapalli VR, Ledoux JF, Persse DE, Sdringola S, Vooletich MT, McCarthy JJ, Smalling RW. Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction. West J Emerg Med 2012; 12:408-13. [PMID: 22224129 PMCID: PMC3236158 DOI: 10.5811/westjem.2011.2.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/02/2011] [Accepted: 02/04/2011] [Indexed: 12/02/2022] Open
Abstract
Introduction Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n = 35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P = 0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n = 37), there was no significant difference in ST-segment deviation between the 2 groups. Conclusion The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals.
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Affiliation(s)
- Robert A Aertker
- University of Texas at Houston Medical School, Department of Internal Medicine-Division of Cardiology, Houston, Texas
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Arinell K, Josefsson J, Magnuson A, Fröbert O. Angiographic morphology impacts outcomes in STEMI patients with LAD occlusion. Catheter Cardiovasc Interv 2010; 77:29-34. [DOI: 10.1002/ccd.22604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Relative spatial distributions of coronary artery bypass graft insertion and acute thrombosis: a model for protection from acute myocardial infarction. Am Heart J 2010; 160:195-201. [PMID: 20598992 DOI: 10.1016/j.ahj.2010.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/05/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Randomized trials have demonstrated coronary artery bypass surgery (CABG) to be superior to percutaneous coronary intervention with respect to long-term mortality and morbidity from myocardial infarction within specific high-risk cohorts. The purpose of this study was to analyze the spatial distribution of coronary artery bypass graft anastomoses relative to acute thromboses in native coronary arteries. We hypothesized that insertion sites of bypass grafts are located distal to sites of acute thrombosis and consequently decrease cardiac morbidity and mortality associated with plaque rupture. METHODS We analyzed 168 patients with prior CABG and 208 patients with ST-segment elevation myocardial infarctions (STEMI) presenting to the Brigham and Women's Hospital who underwent coronary angiography. We constructed a spatial map of the coronary arterial bypass graft insertion sites and compared these locations to sites of acute thrombosis leading to STEMI. RESULTS Graft insertion sites were consistently located distal to acute thrombosis sites (left anterior descending artery median graft insertion versus median thrombosis site = 72 versus 34 mm, right coronary artery 91 versus 42 mm, left circumflex artery 44 versus 37 mm). Greater than 97% of thrombosis sites were located proximal to 75% of graft insertion sites. CONCLUSIONS Coronary arterial bypass grafts provide the coverage of anatomic zones at risk for STEMI. The superior performance of CABG in high risk patients may be attributed to targeting of proximal coronary locations where thrombosis risk is clustered.
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Nakamura N, Gohda M, Satani O, Tomobuchi Y, Ueno Y, Tanimoto T, Kitabata H, Takarada S, Kubo T, Mizukoshi M, Hirata K, Tanaka A, Imanishi T, Akasaka T. Myocardial salvage for ST-elevation myocardial infarction with terminal QRS distortion and restoration of brisk epicardial coronary flow. Heart Vessels 2009; 24:96-102. [PMID: 19337792 DOI: 10.1007/s00380-008-1092-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 07/10/2008] [Indexed: 11/30/2022]
Abstract
Recently, it has been reported that large infarcts associated with terminal QRS distortion (QRSDIS) on the admission electrocardiograms of patients with ST-elevation myocardial infarctions (STEMIs) may be caused by a failure to achieve thrombolysis in myocardial infarction (TIMI) grade 3 flow after primary percutaneous coronary intervention (PCI). However, the relationship between QRSDIS and final infarct size when TIMI grade 3 flow could be achieved by primary PCI is still unclear. Sixty-two consecutive patients with first anterior STEMI and who achieved TIMI grade 3 flow by primary PCI were classified into two groups according to the presence (Group A, n = 18) or absence (Group B, n = 44) of QRSDIS. Two weeks after the onset of acute myocardial infarction, Group A had a larger left ventricular (LV) end-systolic volume index (LVESVI) and a lower LV ejection fraction (LVEF) than Group B (LVESVI: 38 +/- 13 vs 31 +/- 12 ml/m(2), P = 0.025: LVEF: 42% +/- 10% vs 51% +/- 10%, P = 0.004). Through multivariate analysis, independent predictors of poor LV systolic function (LVEF < 40%) were determined to be the presence of QRSDIS (odds ratio 21.04, P = 0.021) and proximal left anterior descending artery occlusion (odds ratio 16.15, P = 0.033). Myocardial damage could not be reduced in patients experiencing STEMI with QRSDIS, even when TIMI grade 3 flow could be achieved by primary PCI, as much as in patients experiencing STEMI without QRSDIS.
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Affiliation(s)
- Nobuo Nakamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
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Clinical and angiographic characteristics of premenopausal women with coronary artery disease. Chin Med J (Engl) 2008. [PMID: 19102955 DOI: 10.1097/00029330-200812010-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Kataiwa H, Kuroi A, Tsujioka H, Tanimoto T, Nakamura N, Mizukoshi M, Hirata K, Akasaka T. Distribution and frequency of thin-capped fibroatheromas and ruptured plaques in the entire culprit coronary artery in patients with acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol 2008; 102:975-9. [PMID: 18929696 DOI: 10.1016/j.amjcard.2008.05.062] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the distribution and frequency of thin-capped fibroatheromas (TCFAs) within the entire length of culprit coronary arteries in patients with acute coronary syndrome. Our population was drawn from 43 consecutive patients with acute coronary syndrome (with or without ST-segment elevation) who underwent optical coherence tomography to visualize the entire culprit coronary artery using a nonocclusive optical coherence tomographic technique. Patients were categorized divided into a TCFA group or a no-TCFA group on the basis of the optical coherence tomographic findings. There were no differences in baseline characteristics or angiographic findings between the 2 groups. High-sensitive C-reactive protein in the TCFA group was significantly higher than in the no-TCFA group (median 3.3 mg/L, interquartile 3.1, vs 1.7 mg/L, interquartile 2.2, p = 0.03). Plaque rupture was found in 28 patients (65%) and multiple plaque ruptures in 5 patients (12%). Optical coherence tomogram revealed 21 TCFAs in 18 patients (42%). Multiple TCFAs were found in the same vessel in 3 patients (7%). The distribution of TCFAs in the right coronary arteries of our subject population was relatively even (proximal 2 [12%], mid 5 [29%], distal 3 [18%], p = 0.42), whereas TCFAs in the left anterior descending artery were common in proximal sites (proximal 6 [27%], mid 2 [9%], distal 0, p = 0.018). In conclusion, the use of optical coherence tomography to look for TCFAs and identify their distribution when combined with C-reactive protein may contribute to forming a strategy for preventing impending coronary events.
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Location of acute coronary artery thromboses in patients with and without chronic kidney disease. Kidney Int 2008; 75:80-7. [PMID: 18818684 DOI: 10.1038/ki.2008.480] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with chronic kidney disease have high rates of myocardial infarction and death following an initial attack. Proximal location of coronary atherosclerotic lesions has been linked to the risk of acute myocardial infarction and to infarction-associated mortality. To examine if the spatial distribution of lesions differs in patients with and without chronic kidney disease, we used quantitative coronary angiography to measure this in patients with acute coronary thromboses who were having angiography following acute myocardial infarction. Multivariable linear regression was used to adjust for differences in baseline characteristics. Among 82 patients with stage 3 or higher chronic kidney disease, 55.6% of lesions were located within 30 mm and 87.7% were within 50 mm of the coronary ostia. This compared to 34.7 and 71.8%, respectively, among 299 patients without significant kidney disease. Chronic kidney disease was independently and significantly associated with a 7.0 mm decrease in the distance from the coronary ostia to the problem lesion. Our study suggests that a causal link between a more proximal culprit lesion location in patients with chronic kidney disease and their high mortality rates after myocardial infarct is possible and may have important implications for interventions to prevent infarction.
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Relation of spontaneous reperfusion in ST-elevation myocardial infarction to more distal coronary culprit narrowings. Am J Cardiol 2008; 101:308-10. [PMID: 18237590 DOI: 10.1016/j.amjcard.2007.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 08/08/2007] [Accepted: 08/08/2007] [Indexed: 11/22/2022]
Abstract
Spontaneous reperfusion (SR) of the infarct-related artery may occur in patients with ST-segment-elevation myocardial infarctions (STEMIs). Limited data are available on the angiographic characteristics of these patients. The objective of this study was to determine if there are differences in the distance of the culprit lesion from the coronary ostium in patients with STEMIs with and without SR. Patients who presented with acute STEMIs<12 hours after pain onset and who underwent coronary angiography were entered into the study. Measurement of the distance from the coronary ostium to the culprit lesion was performed. A total of 469 patients with STEMIs were included in the study, of whom 77 met criteria for SR (significant relief of chest pain associated with >or=50% resolution of ST-segment elevation on follow-up electrocardiography) and 392 did not. A highly significant difference was seen in ostial to culprit lesion distance, with the culprit lesions in the SR group being more distal than those in the non-SR group (45+/-22 vs 39+/-20 mm, p<0.009). In conclusion, the findings of this study demonstrate that the location of the culprit lesion in patients with STEMIs who undergo SR is more distal in the involved artery than in patients with STEMIs who do not undergo SR.
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