Effect of intraaortic balloon pumping on left ventricular function in patients with persistent ST segment elevation after revascularization for acute myocardial infarction

Tako-tsubo cardiomyopathy complicated by QRS prolongation

A 68-year-old woman was admitted to our hospital due to sudden onset of dyspnea. On admission, electrocardiogram (ECG) showed T-wave inversion and QRS prolongation (120 msec) that were not found in her previous ECG. Chest X-ray showed pulmonary edema and cardiac enlargement. Left ventriculogram showed akinesis of the left ventricle except in the basal region. No significant coronary stenosis was found on angiogram. She was diagnosed as having tako-tsubo cardiomyopathy complicated by QRS prolongation. Intraaortic balloon pumping (IABP) was subsequently initiated for the treatment of acute heart failure. QRS prolongation was resolved immediately after the initiation of IABP, and left ventricular dysfunction was resolved within 9 days. She was discharged 14 days later.

Right bundle-branch block in anterior acute myocardial infarction in the coronary intervention era: Acute angiographic findings and prognosis

BACKGROUND

Previous studies in the prethrombolytic or thrombolytic era have reported that right bundle-branch block (RBBB) is associated with poor clinical outcome in patients with acute myocardial infarction (AMI).

METHODS AND RESULTS

The purpose of this study was to examine the relations between RBBB and angiographic findings or clinical outcomes in patients with AMI in the coronary intervention era. A total of 430 patients with a first anterior AMI who underwent coronary angiography within 12 h after the onset were enrolled in this study. Seventy-one patients (17%) had RBBB documented during their hospital stay. RBBB was documented on admission in 35 patients. Patients with RBBB were older (p<0.01) and had prodromal angina less frequently (p=0.03) than those without. On the initial angiograms, patients with RBBB had an occluded left anterior descending artery (p<0.01) and multivessel disease (p=0.01) more frequently than those without. Thirty-day mortality rate was significantly higher in patients with RBBB than in those without (14.0% vs 1.9%, p<0.01). Multiple logistic-regression analysis demonstrated that RBBB (odds ratio 5.89, p<0.01) and multivessel disease (odds ratio 4.36, p=0.01) were independent predictors of 30-day mortality.

CONCLUSIONS

Our data suggested that RBBB was still associated with poor clinical outcome in patients with anterior AMI even in the coronary intervention era.

Predictive Factors of Major Adverse Cardiac Events in Acute Myocardial Infarction Patients Complicated by Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND

The aim of this study was to assess in-hospital mortality and major adverse cardiac events (MACE) during long-term clinical follow-up of patients who developed cardiogenic shock (CS) after acute myocardial infarction (AMI) and who underwent primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS

The data from 147 patients with CS after AMI (61.7 +/-10.4 years, M:F =156:99) who underwent primary PCI at Chonnam National University Hospital between January 1999 and December 2002 were analyzed: clinical characteristics, coronary angiographic findings and mortality during admission, and MACE during a 1-year clinical follow-up. Of the enrolled patients, 121 patients survived (group I, M:F =94:27) and 26 died (group II, M:F =14:12) during admission. By binary logistic regression analysis, in-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization (p=0.02, odds ratio (OR) =1.3). Eighty-nine patients (60.5%) survived without MACE during the 1-year clinical follow-up and MACE was associated with a C-reactive protein (CRP) of more than 1 mg/dl (p=0.002, OR =6.3) and low TIMI flow after coronary revascularization (p<0.001, OR =7.8).

CONCLUSIONS

Primary PCI achieving TIMI 3 flow reduces in-hospital death in AMI with CS. High concentration of CRP and low TIMI flow are associated with MACE during long-term clinical follow-up.

Effectiveness of thrombectomy before stent implantation in acute myocardial infarction

Percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) may cause distal embolization, with deterioration of distal flow and further extension of the infarct. The purpose of the present study was to evaluate the effectiveness of pretreatment by thrombectomy on myocardial salvage after stent implantation in patients with AMI. From January 2000 to July 2002, 209 consecutive patients with AMI successfully underwent emergency stent implantation. They were divided into 2 groups: those treated in the year before the introduction of the thrombectomy device (Group A; n=109), and those treated the year after introduction of the device (Group B; n=100). Follow-up quantitative coronary angiography (QCA) and left ventriculography were carried out 6 months after PCI. Microvascular circulation after revascularization was assessed by Thrombolysis in myocardial infarction (TIMI) flow grade analysis, the maximum creatine kinase concentration was recorded, and the follow-up left ventricular ejection fraction and ST segment score were assessed on the 12-lead electrocardiography just before revascularization and on return to the coronary care unit. The QCA data, rate of restenosis (% restenosis) and rate of target lesion revascularization were also compared between the 2 groups. The results demonstrated that the introduction of thrombectomy had increased the number of patients who displayed blush-3 after primary angioplasty, which suggests that thrombectomy before stent implantation has the potential to minimize myocardial ischemic insult, presumably by protecting the coronary microvasculature.

Impact of the Magnitude of the Initial ST-Segment Elevation on Left Ventricular Function in Patients With Anterior Acute Myocardial Infarction

BACKGROUND

In the percutaneous coronary intervention (PCI) era, the impact of initial ST-segment elevation magnitude on left ventricular (LV) function in patients with acute myocardial infarction (AMI) remains unclear.

METHODS AND RESULTS

In the present study, 239 patients with total occlusion and 81 patients with spontaneous reperfusion within 12 h of their first anterior AMI were evaluated. The sum of ST-segment elevation (SigmaST) was measured in leads I, aV(L) and V(1-6) shortly before angiography. Predischarge LV ejection fraction (LVEF) was obtained at 15+/-5 days. In total occlusion, the predischarge LVEF was significantly lower in patients with SigmaST >/=10 mm than in those with SigmaST <10 mm (51+/-14% vs 57+/-14%, p<0.01). However, in spontaneous reperfusion, there was no significant difference between patients with ST >/=10 mm and those with SigmaST <10 mm (61+/-13 vs 62+/-14 %, p=NS). Predischarge LVEF significantly correlated with SigmaST in total occlusion (r=-0.25, p<0.01), but not in spontaneous reperfusion (r=0.03, p=NS).

CONCLUSION

The results suggest that initial SigmaST is an important predictor of LV function in patients with total occlusion, but not in those with spontaneous reperfusion.