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Yang YS, Xi DY, Duan Y, Yu M, Liu K, Meng YK, Hu CF, Han SG, Xu K. A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features. BMC Cardiovasc Disord 2024; 24:179. [PMID: 38528469 DOI: 10.1186/s12872-024-03847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE The aim of this study is to develop a nomogram model for predicting the occurrence of intramyocardial hemorrhage (IMH) in patients with Acute Myocardial Infarction (AMI) following Percutaneous Coronary Intervention (PCI). The model is constructed utilizing clinical data and the SYNTAX Score (SS), and its predictive value is thoroughly evaluated. METHODS A retrospective study was conducted, including 216 patients with AMI who underwent Cardiac Magnetic Resonance (CMR) within a week post-PCI. Clinical data were collected for all patients, and their SS were calculated based on coronary angiography results. Based on the presence or absence of IMH as indicated by CMR, patients were categorized into two groups: the IMH group (109 patients) and the non-IMH group (107 patients). The patients were randomly divided in a 7:3 ratio into a training set (151 patients) and a validation set (65 patients). A nomogram model was constructed using univariate and multivariate logistic regression analyses. The predictive capability of the model was assessed using Receiver Operating Characteristic (ROC) curve analysis, comparing the predictive value based on the area under the ROC curve (AUC). RESULTS In the training set, IMH post-PCI was observed in 78 AMI patients on CMR, while 73 did not show IMH. Variables with a significance level of P < 0.05 were screened using univariate logistic regression analysis. Twelve indicators were selected for multivariate logistic regression analysis: heart rate, diastolic blood pressure, ST segment elevation on electrocardiogram, culprit vessel, symptom onset to reperfusion time, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase-MB, high-sensitivity troponin T (HS-TnT), and SYNTAX Score. Based on multivariate logistic regression results, two independent predictive factors were identified: HS-TnT (Odds Ratio [OR] = 1.61, 95% Confidence Interval [CI]: 1.21-2.25, P = 0.003) and SS (OR = 2.54, 95% CI: 1.42-4.90, P = 0.003). Consequently, a nomogram model was constructed based on these findings. The AUC of the nomogram model in the training set was 0.893 (95% CI: 0.840-0.946), and in the validation set, it was 0.910 (95% CI: 0.823-0.970). Good consistency and accuracy of the model were demonstrated by calibration and decision curve analysis. CONCLUSION The nomogram model, constructed utilizing HS-TnT and SS, demonstrates accurate predictive capability for the risk of IMH post-PCI in patients with AMI. This model offers significant guidance and theoretical support for the clinical diagnosis and treatment of these patients.
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Affiliation(s)
| | - De-Yang Xi
- Xuzhou Medical University, Jiangsu, 221004, China
| | - Yang Duan
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Miao Yu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Kai Liu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Yan-Kai Meng
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Chun-Feng Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China
| | - Shu-Guang Han
- Xuzhou Medical University, Jiangsu, 221004, China.
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China.
| | - Kai Xu
- Xuzhou Medical University, Jiangsu, 221004, China.
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, 221006, China.
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Onea HL, Lazar FL, Olinic DM, Homorodean C, Cortese B. The role of optical coherence tomography in guiding percutaneous coronary interventions: is left main the final challenge? Minerva Cardiol Angiol 2024; 72:41-55. [PMID: 36321887 DOI: 10.23736/s2724-5683.22.06181-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Left main (LM) coronary artery disease is a high-risk lesion subset, with important prognostic implications for the patients. Recent advances in the field of interventional cardiology have narrowed the gap between surgical and percutaneous approach of this complex lesion setting. However, the rate of repeat revascularization remains higher in the case of percutaneous coronary intervention (PCI) on long-term follow-up. As such, the need for better stent optimization strategies has led to the development of intravascular imaging techniques, represented mainly by intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These techniques are both able to provide excellent pre- and post-PCI guidance. While IVUS is an established modality in optimizing LM PCI, and is recommended by international revascularization guidelines, data and experience on the use of OCT are still limited. This review paper deeply analyzes the current role of OCT imaging in the setting of LM disease, particularly focusing on its utility in assessing plaque morphology and distribution, vessel dimensions and proper stent sizing, analyzing mechanisms of stent failure such as malapposition and underexpansion, guiding bifurcation stenting, as well as offering a direct comparison with IVUS in this critical clinical scenario, based on the most recent available data.
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Affiliation(s)
- Horea-Laurentiu Onea
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Calin Homorodean
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
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Dürig M, Arroyo D, Bedossa M, Commeau P, Fournier S, Müller O, Barragan P, Le Breton H, Puricel S, Cook S. Clinical outcomes after unprotected left main coronary artery occlusion: A retrospective multicentre cohort analysis. Catheter Cardiovasc Interv 2023; 101:679-686. [PMID: 36786485 DOI: 10.1002/ccd.30585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
AIMS Unprotected left main coronary artery (ULMCA) occlusion is a rare and disastrous condition with scarce data on presentation and outcomes. Herein, we report data on patients presenting with acute coronary syndrome due to ULMCA occlusion at four different institutions. METHODS This is an international multicentre observational study. Baseline characteristics were retro- and prospectively collected. Clinical follow-up was prospective. The primary outcome was in-hospital death. Patients surviving the index hospitalization were compared with nonsurvivors to find predictors of survival. RESULTS The study population consisted of 55 patients. Eight patients (15%) died in the cath lab, and 23 (42%) died in hospital. Three (6%) deaths were noncardiac and due to major bleeding. Thirty-two (58%) patients survived the index hospitalization and were discharged. These patients were followed for a median of 17.5 months during which three cardiac deaths occurred. Repeat revascularization was performed in 25% (n = 8). Overall mortality at maximum follow-up was 47% (n = 26). The only significant predictor for hospital survival was left ventricular ejection fraction (odds ratio [OR]: 1.10 (per 1 point increase); 95% confidence interval [CI]: 1.02-1.19; p = 0.02). CONCLUSION ULMCA occlusion carries a high short-term mortality. Patients who survive index hospitalization have similar mortality rates as compared with other st elevation myocardial infarction patients.
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Affiliation(s)
- Marco Dürig
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Diego Arroyo
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Marc Bedossa
- Department of Cardiology and Vascular Diseases, University of Rennes, Rennes, France
| | - Philippe Commeau
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Müller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Barragan
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | - Hervé Le Breton
- Department of Cardiology and Vascular Diseases, University of Rennes, Rennes, France
| | - Serban Puricel
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
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Beijk MAM, Palacios-Rubio J, Grundeken MJD, Kalkman DN, De Winter RJ. Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction. J Clin Med 2023; 12:jcm12041311. [PMID: 36835846 PMCID: PMC9959397 DOI: 10.3390/jcm12041311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) with occlusion of an unprotected left main coronary artery (ULMCA) is a rare condition with a high mortality. The literature on clinical outcomes after percutaneous coronary intervention (PCI) for cardiogenic shock secondary to ULMCA-related AMI is scarce. METHODS In this retrospective analysis, all consecutive patients undergoing PCI for cardiogenic shock secondary to total occlusive ULMCA-related AMI were included between January 1998 and January 2017. The primary endpoint was 30-day mortality. The secondary endpoints were long-term mortality and 30-day and long-term major adverse cardiovascular and cerebrovascular events. The differences in clinical and procedural variables were assessed. A multivariable model was created to search for independent predictors of survival. RESULTS Forty-nine patients were included, and the mean age was 62 ± 11 years. The majority of patients suffered cardiac arrest prior or during PCI (51%). Thirty-day mortality was 78%, of which 55% died within 24 h. The median follow-up of patients who survived 30 days (n = 11) was 9.9 years (interquartile range 4.7-13.6), and long-term mortality was 84%. Long-term all-cause mortality was independently associated with cardiac arrest prior or during PCI (hazard ratio [HR] 2.02, 95% confidence interval 1.02-4.01, p = 0.043). Patients who survived to the 30-day follow-up with severe left ventricular dysfunction had a significantly higher risk of mortality compared to patients with moderate to mild dysfunction (p = 0.007). CONCLUSIONS Cardiogenic shock secondary to total occlusive ULMCA-related AMI carries a very high 30-day all-cause mortality. Thirty-day survivors with a severe left ventricular dysfunction have a poor long-term prognosis.
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Affiliation(s)
- Marcel A. M. Beijk
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-566-9111
| | - Julián Palacios-Rubio
- Cardiology Department, Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Maik J. D. Grundeken
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Debbie N. Kalkman
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Robbert J. De Winter
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Clinical and electrocardiographic features in acute total left main coronary artery occlusion without collateral circulation. J Electrocardiol 2023; 76:79-84. [PMID: 36512934 DOI: 10.1016/j.jelectrocard.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS Study concerning the clinical features, electrocardiogram (ECG) findings and outcomes in patients presenting with acute total occlusion of left main coronary artery (LM) without collateral circulation is limited. METHODS 25 patients with acute total LM occlusion without collateral circulation by emergency coronary angiography, from muti-center registry, were retrospectively studied. The clinical and angiographic characteristics, ECG and in-hospital mortality were reviewed. RESULTS Nineteen patients (76%) presented with cardiogenic shock. Twelve (60%, 12/20) patients had coronary slow flow or no reflow phenomenon after primary percutaneous coronary intervention (PCI). The in-hospital mortality rate was 88% (n = 22). All the patients presented with ST-segment elevation myocardial ischemia (STEMI) pattern, mostly involving leads I, aVL, V2, V3, V4, V5 and ST-segment depression in leads II, III and aVF. CONCLUSIONS Acute total LM occlusion without collateral circulation portends high in-hospital mortality. Anterior ST elevation in the precordial leads from V2 to V4 through V6, and ST elevation in leads I and aVL, accompanying with ST depression in the inferior leads is associated with acute total LM occlusion without collateral circulation.
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Xenogiannis I, Kolokathis F, Alexopoulos D, Rallidis LS. Myocardial infarction due to left main coronary artery total occlusion: A unique electrocardiographic presentation. J Electrocardiol 2023; 76:26-31. [PMID: 36399954 DOI: 10.1016/j.jelectrocard.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
Left main coronary artery (LMCA) total occlusion typically presents as anterolateral ST-segment myocardial infarction with or without right bundle branch block with left anterior fascicular block, and ST-segment elevation in aVR. On the contrary to the previously described electrocardiographic pattern we describe a distinct electrocardiographic presentation in a patient with total LMCA occlusion characterized by the presence of complete LBBB co-existing with upsloping ST-segment depression in precordial leads leading to symmetrical, tall, positive T waves, the so called de Winter's sign.
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Affiliation(s)
- Iosif Xenogiannis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece.
| | - Fotios Kolokathis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Dimitrios Alexopoulos
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Loukianos S Rallidis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece
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Onea HL, Spinu M, Homorodean C, Olinic M, Lazar FL, Ober MC, Stoian D, Itu LM, Olinic DM. Distinctive Morphological Patterns of Complicated Coronary Plaques in Acute Coronary Syndromes: Insights from an Optical Coherence Tomography Study. Diagnostics (Basel) 2022; 12:diagnostics12112837. [PMID: 36428897 PMCID: PMC9689106 DOI: 10.3390/diagnostics12112837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Optical coherence tomography (OCT) is an ideal imaging technique for assessing culprit coronary plaque anatomy. We investigated the morphological features and mechanisms leading to plaque complication in a single-center observational retrospective study on 70 consecutive patients with an established diagnosis of acute coronary syndrome (ACS) who underwent OCT imaging after coronary angiography. Three prominent morphological entities were identified. Type I or intimal discontinuity, which was found to be the most common mechanism leading to ACS and was seen in 35 patients (50%), was associated with thrombus (68.6%; p = 0.001), mostly affected the proximal plaque segment (60%; p = 0.009), and had no distinctive underlying plaque features. Type II, a significant stenosis with vulnerability features (inflammation in 16 patients, 84.2%; thin-cap fibroatheroma (TCFA) in 10 patients, 52.6%) and a strong association with lipid-rich plaques (94.7%; p = 0.002), was observed in 19 patients (27.1%). Type III, a protrusive calcified nodule, which was found to be the dominant morphological pattern in 16 patients (22.9%), was found in longer plaques (20.8 mm vs. 16.8 mm ID vs. 12.4 mm SS; p = 0.04) and correlated well with TCFA (93.8%; p = 0.02) and inflammation (81.3%). These results emphasize the existence of a wide spectrum of coronary morphological patterns related to ACS.
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Affiliation(s)
- Horea-Laurentiu Onea
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihail Spinu
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-746259047
| | - Calin Homorodean
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Maria Olinic
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Mihai Claudiu Ober
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Diana Stoian
- Advanta, Siemens SRL, 500097 Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brașov, 500174 Brasov, Romania
| | - Lucian Mihai Itu
- Advanta, Siemens SRL, 500097 Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brașov, 500174 Brasov, Romania
| | - Dan Mircea Olinic
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
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8
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Galván‐Román F, Fernández‐Herrero I, Ariza‐Solé A, Sánchez‐Salado JC, Puerto E, Lorente V, Gómez‐Lara J, Martín‐Asenjo R, Gómez‐Hospital JA, Comín‐Colet J. Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion-related myocardial infarction. ESC Heart Fail 2022; 10:111-120. [PMID: 36151843 PMCID: PMC9871657 DOI: 10.1002/ehf2.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS This study aimed to assess, in patients with cardiogenic shock secondary to unprotected left main coronary artery-related myocardial infarction (ULMCA-related AMICS), the incidence and predictors of no recovery of left ventricular function during the admission. METHODS AND RESULTS This was an observational study conducted at two tertiary care centres (2012-20). The main outcome measured was death or requirement for heart transplantation (HT) or left ventricular assist devices (LVAD) during the admission. A total of 70 patients were included. Percutaneous coronary intervention (PCI) was successful in 53/70 patients (75.7%). The combined endpoint of death or requirement of HT or LVAD during the admission occurred in 41/70 patients (58.6%). The highest incidence of the primary endpoint was observed among patients with profound shock and occluded left main coronary artery (LMCA) (20/23, 87%, P < 0.001). Although a successful PCI reduced the incidence of the event in the whole cohort (51.9% vs. 82.4% in failed PCI, P = 0.026), this association was not observed among this last group of complex patients (86.7% vs. 87.5% in failed PCI, P = 0.731). The predictive model included left ventricular ejection fraction, baseline ULMCA Thrombolysis In Myocardial Infarction flow, and severity of shock and showed an optimal ability for predicting death or requirements for HT or LVAD during the admission (area under the curve 0.865, P < 0.001). CONCLUSIONS ULMCA-related AMICS was associated with a high in-hospital mortality or need for HT or LVAD. Prognosis was especially poor among patients with profound shock and baseline occluded LMCA, with a low probability of recovery regardless of successful PCI.
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Affiliation(s)
- Francisco Galván‐Román
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Ignacio Fernández‐Herrero
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Albert Ariza‐Solé
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - José Carlos Sánchez‐Salado
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Elena Puerto
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Victòria Lorente
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Josep Gómez‐Lara
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Roberto Martín‐Asenjo
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Joan A. Gómez‐Hospital
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Josep Comín‐Colet
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
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Ahmed A, Aguirre FV, Chambers J, Sharkey SW, Tannenbaum MA, Yildiz M, Garberich R, Garcia S, Henry TD. STEMI: Considerations for Left Main Culprit Lesions. Curr Cardiol Rep 2022; 24:645-651. [PMID: 35384548 DOI: 10.1007/s11886-022-01685-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW There is a paucity of data regarding the prevalence, clinical characteristics, and outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to left main (LM) culprit vessel. RECENT FINDINGS LM culprit STEMI (LMCSTEMI) is an uncommon, but frequently catastrophic event. Prior meta-analyses and registries have described a varying prevalence of LMCSTEMI, associated cardiogenic shock, and in-hospital mortality among those surviving to hospital presentation. These observed clinical discrepancies may be partially attributable to diverse clinical and angiographical subsets among this STEMI population. STEMI due to LM culprit artery disease represents a clinically high-risk subset of patients with substantial in-hospital mortality. In this paper, we summarize the available clinical data pertaining to STEMI with LM culprit, discuss unique ECG characteristics, and discuss contemporary revascularization therapy. We also report the preliminary findings from a contemporary, STEMI database describing clinical characteristics and angiographically defined subsets of LM culprit STEMI.
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Affiliation(s)
- Ameera Ahmed
- Cardiovascular Institute of Northern Colorado, Banner Health, Loveland, USA
| | - Frank V Aguirre
- Prairie Education and Research Cooperative, Springfield, IL, USA
| | - Jenny Chambers
- Prairie Education and Research Cooperative, Springfield, IL, USA
| | - Scott W Sharkey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, USA
| | | | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA
| | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, USA
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA.
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10
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Cardiogenic shock due to left main related myocardial infarction: is revascularization enough? J Geriatr Cardiol 2022; 19:152-157. [PMID: 35317397 PMCID: PMC8915424 DOI: 10.11909/j.issn.1671-5411.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Optical Coherence Tomography-OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes. J Clin Med 2022; 11:jcm11010265. [PMID: 35012006 PMCID: PMC8745669 DOI: 10.3390/jcm11010265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary imaging technique, developed in order to overcome the diagnostic limitations of a standard coronary angiography and has an extremely high resolution, similar to that of a usual histological evaluation of a biopsy sample, thus, OCT provides a histological-like information, but in a in vivo environment. The aim of this article is to review the current knowledge regarding non-atherosclerotic coronary lesions, with an emphasis on the importance of OCT for optimal identification, characterization of pathogenic mechanisms and optimal treatment selection.
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Gao G, Feng L, Fu J, Li Y, Huo Z, Zhang L, Wang L, Niu H, Kang L, Zhang J. Prognostic value of the SYNTAX score on myocardial injury and salvage in STEMI patients after primary percutaneous coronary intervention: a single-center retrospective observational study. BMC Cardiovasc Disord 2021; 21:591. [PMID: 34886799 PMCID: PMC8656094 DOI: 10.1186/s12872-021-02395-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SYNTAX score (SS) was shown to positively correlate with postprocedural myocardial injury in patients after elective coronary artery intervention, but evidence about the association of SS with myocardial salvage in ST-segment elevation myocardial infarction (STEMI) patients is still needed. This study aimed to evaluate the prognostic value of SS for myocardial injury and salvage assessed by cardiac magnetic resonance (CMR) after primary percutaneous coronary intervention (PCI) in STEMI patients. METHODS This single-center retrospective study consecutively enrolled STEMI patients who had undergone primary PCI within 12 h from symptom onset. Both angiography and CMR were performed during hospitalization, and patients were divided into low SS (SS ≤ 22), mediate-high SS (SS > 22) groups. Correlation and multivariable analyses were performed. RESULTS A total of 149 STEMI patients (96 low SS, 53 mediate-high SS) were included. In terms of myocardial injury parameters, there was a positive correlation (p < 0.001, Spearman r = 0.292) between SS and infarct size (IS), and a negative correlation (p < 0.001, Spearman r = - 0.314) between SS and myocardial salvage index (MSI). In the multivariable model, SS (> 22 as categorical variable, OR = 2.245, 95% CI [1.002-5.053], p = 0.048; as continuous variable, OR = 1.053, 95% CI [1.014-1.095], p = 0.008) was significantly associated with high IS (≥ mean 35.43). The areas under the receiver operating characteristic (ROC) curves of SS for high IS and low MSI (≤ median 28.01) were 0.664 and 0.610. CONCLUSIONS In STEMI patients undergoing primary PCI, SYNTAX score positively correlated with infarct size and negatively with myocardial salvage, indicating an independent predictive value of the myocardial injury.
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Affiliation(s)
- Guangren Gao
- Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Lianrong Feng
- Department of Neurology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Zhaoyang Huo
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Zhang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Wang
- Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Heping Niu
- Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Liqing Kang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
| | - Jun Zhang
- Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China.
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Gutiérrez-Barrios A, Mialdea-Salmerón D, Cañadas-Pruaño D, Garcia-Molinero D, Zayas-Rueda R, Calle-Pérez G, Vázquez-García R, Toro R, Gheorghe L. Electrocardiographic findings in true acute left main coronary total occlusion a subanalisys from ATOLMA registry. J Electrocardiol 2021; 68:48-52. [PMID: 34333405 DOI: 10.1016/j.jelectrocard.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Acute total occlusion of the left main coronary artery (ATOLMA) usually leads to a catastrophic presentation. Prediction of ATOLMA by electrocardiogram (ECG) may contribute to early detection and reperfusion. Limited data have been reported previously. This study aims to identify the admission 12‑leads ECG features that can predict the presence of ATOLMA and in-Hospital mortality in these patients. METHODS The admission ECGs findings in 24 patients from the previously reported ATOLMA multicenter registry were compared to the ECGs findings in 15 patients with an acute subtotal occlusion of the left main (ASOLMA) and to 15 patients with anterior ST-elevation myocardial infarction of the proximal left anterior descending (LADp-STEMI). RESULTS Some ECG features at presentation can predict an ATOLMA: QRS left axis deviation (-61.17 ± 9 degrees); ST-segment elevation in aVL (1.9 ± 0.65 mm); absence of ST-segment elevation in V1 (0.0 ± 0.6 mm); bifascicular block (58%); fragmented QRS (62.5%); prolongation of QTc interval (465 ± 19 ms) and of QRS interval (136 ± 12 mm). The multivariate analysis found that the independent predictors to distinguish ATOLMA from ASOLMA were aVL ST-segment deviation (OR 5.6(95% CI 1.5-21), p = 0.01) and absence of V1 ST-segment elevation (OR 27(95% CI 1.4-52), p = 0.01); and from LADp-STEMI was QRS width (OR 1.1(95% CI 1.02-1.2), p = 0.02). Fragmented QRS was the only independent predictor of in-hospital mortality in ATOLMA (OR 0.125(95% CI 0.01-0.81), p = 0.03). CONCLUSIONS aVL ST-segment elevation, the absence of V1 ST-segment elevation, left axis deviation, the presence of bifascicular block, and prolongation of QRS and QTc interval are predictors of ATOLMA. Fragmented QRS predicts in-hospital mortality in ATOLMA.
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Affiliation(s)
- A Gutiérrez-Barrios
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain.
| | | | - D Cañadas-Pruaño
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | | | - R Zayas-Rueda
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - G Calle-Pérez
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - R Vázquez-García
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - R Toro
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - L Gheorghe
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
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14
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Januszek R, Bujak K, Gąsior M, Legutko J, Bartuś S. Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission. Medicine (Baltimore) 2021; 100:e24360. [PMID: 33530230 PMCID: PMC7850639 DOI: 10.1097/md.0000000000024360] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patients with AMI.Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA.This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am-10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm-6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan-Meier method.The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P = .001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan-Maier survival curves (P = .001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P = .099).Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period.
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Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital
- Institute of Cardiology, Jagiellonian University Medical College
- Department of Clinical Rehabilitation, University school of Physical Education, Kraków
| | - Kamil Bujak
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice
| | - Mariusz Gąsior
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze
- School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital
- Institute of Cardiology, Jagiellonian University Medical College
- Jagiellonian University Medical College, Kraków, Poland
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15
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Gutiérrez-Barrios A, Gheorghe L, Camacho-Freire S, Valencia-Serrano F, Cañadas-Pruaño D, Calle-Pérez G, Alarcón de la Lastra I, Silva E, García-Molinero D, Agarrado-Luna A, Zayas-Ruedas R, Vázquez-García R, Serra A. Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion-The ATOLMA Registry. J Interv Cardiol 2020; 2020:5246504. [PMID: 32774186 PMCID: PMC7403907 DOI: 10.1155/2020/5246504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. BACKGROUND ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. METHODS This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). RESULTS In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), p < 0.001). CONCLUSIONS Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.
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Affiliation(s)
- A. Gutiérrez-Barrios
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - L. Gheorghe
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - S. Camacho-Freire
- Departamento de Cardiología Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | - D. Cañadas-Pruaño
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
- Departamento de Cardiología Hospital de Jerez, Cádiz, Spain
| | - G. Calle-Pérez
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | | | - E. Silva
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - D. García-Molinero
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - R. Zayas-Ruedas
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - R. Vázquez-García
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - A. Serra
- Departamento de Cardiología Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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16
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Homorodean C, Iancu AC, Dregoesc IM, Spînu M, Ober MC, Tãtaru D, Leucuţa D, Olinic M, Olinic DM. Renal Failure Impact on the Outcomes of ST-Segment Elevation Myocardial Infarction Patients Due to a Left Main Coronary Culprit Lesion Treated Using a Primary Percutaneous Coronary Intervention. J Clin Med 2019; 8:E565. [PMID: 31027307 PMCID: PMC6518004 DOI: 10.3390/jcm8040565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (PPCI) on a left main culprit lesion have very high mortality rates. The interaction of chronic kidney disease (CKD) with such a catastrophic acute event on the background of their highly complex atherosclerotic lesions is not well established. Therefore, we sought to evaluate in these patients the influence of the estimated glomerular filtration rate (eGFR) on short- and long-term mortality. METHODS We retrospectively analyzed renal function in 81 patients with STEMI and PPCI on a left main culprit lesion from two tertiary centers. RESULTS Patients were divided in two groups according to an eGFR cut-off of 60 mL/min/1.73 m2: 40 patients with CKD and 41 without CKD. Patients with renal failure were older, had more diabetes, and had experienced more frequent myocardial infarction MIs. CKD patients had a higher baseline-SYNTAX score (p = 0.015), higher residual-SYNTAX score (p < 0.001), and lower SYNTAX revascularization index-SRI (p = 0.003). Mortality at 30-day, 1-year, and 3-year follow-ups were not significantly different between the two groups. However, when analyzed as a continuous variable, eGFR emerged as a predictor of 1-year mortality, both in univariate analysis (OR = 0.97, 95% CI: 0.95-0.99, p = 0.005) and in multivariate analysis, after adjusting for cardiogenic shock and Thrombolysis in Myocardial Infarction TIMI 0/1 flow (OR = 0.975, 95% CI: 0.95-0.99, p = 0.021). CONCLUSIONS In STEMI with PPCI on a left main culprit lesion, renal failure was associated with more complex coronary lesions and less complete revascularization, and turned out to be an independent predictor of mortality at 1-year follow-up.
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Affiliation(s)
- Cãlin Homorodean
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
| | - Adrian Corneliu Iancu
- Department of Cardiology, "Niculae Stãncioiu" Heart Institute, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania.
| | - Ioana Mihaela Dregoesc
- Department of Cardiology, "Niculae Stãncioiu" Heart Institute, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania.
| | - Mihai Spînu
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
| | | | - Dan Tãtaru
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
| | - Daniel Leucuţa
- Dept. of Medical Informatics and Biostatistics, "Iuliu Hatieganu " University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Maria Olinic
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
| | - Dan Mircea Olinic
- 1st Dept. of Internal Medicine, "Iuliu Hatieganu " University of Medicine and Pharmacy, 4000060 Cluj-Napoca, Romania.
- Emergency County Hospital, 400000 Cluj-Napoca, Romania.
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