Preventive percutaneous coronary intervention and aspiration thrombectomy-updates in the management of ST-elevation myocardial infarction

Delayed endovascular surgery in patients with acute ST-segment elevation myocardial infarction due to massive culprit arterial thrombosis in the prevention of slow/no-reflow phenomenon

Aim. To assess whether delayed coronary artery stenting (CAS) can reduce the slow/no-reflow incidence in patients with ST-segment elevation myocardial infarction (STEMI) and massive thrombosis (TTG ≥3) of the infarct-related coronary artery (IRCA) compared with immediate CAS within primary PCI.

Material and methods. Out of 3651 primary PCIs performed for acute STEMI in the period from January 2016 to May 2020 at the Mytishchi City Clinical Hospital, the retrospective analysis included 105 patients with massive IRCA thrombosis (TTG ≥3). The patients were divided into two groups: first group (n=55) — delayed CAS, second group (n=50) — immediate CAS. In the immediate CAS group, the PCI procedure ended with routine stent implantation, and in the delayed CAS group, stent implantation was delayed for at least 5 days.

Results. In the delayed CAS group in comparison with immediate one, the slow/no-reflow phenomenon developed much less frequently in the form of a significant increase in the prevalence of TIMI 3 flow, better myocardial perfusion of myocardial blush grade (MBG) 2-3 (81,8 vs 64%; odds ratio (OR) 2,53; p=0,039) and ST segment resolution ≥70% (87,3% vs 58%; OR 4,97; p=0,001).

Conclusion. Delayed CAS in patients with STEMI with massive thrombosis (TTG ≥3) of IRCA reduces the risk of slow/no-reflow phenomenon and can be considered as a possible alternative treatment vs immediate CAS, provided that stable coronary flow is restored before TIMI 3.

High prevalence of genetic determined familial hypercholesterolemia in premature coronary artery disease

Background: Premature coronary artery disease (CAD) is a major cause of mortality and morbidity. Increased low-density lipoprotein-cholesterol (LDL-C) level is a major risk factor for CAD and thus the main target for its prevention. Familial Hypercholesterolemia (FH) is a genetic inherited disorder characterized by high LDL-C, and subsequent premature CAD development. Early drug treatment with lipid-lowering medications in FH prevents cardiovascular disease onset. The FH prevalence in the Northern European general population is 0.3%, and it is estimated that it explains 20% of premature CAD cases in individuals with familial clustering. Despite the wide number of papers showing the prevalence of clinical FH in cardiovascular disease, the prevalence of genetic FH in individuals with premature CAD is not yet well known. Here, we examined the prevalence of genetically determined FH in individuals with premature CAD. Patients and methods: 66 patients who underwent coronary angiography with suspected premature acute coronary syndrome (age <50 years for men and <55 years for women) underwent genetic screening to identify FH-causing mutations. All patients underwent physical and clinical examinations. Information about family and personal history, drug therapy and habits were also collected. Results: We found FH-causative mutations in 3/66 (4.5%) screened individuals with premature CAD. When considering individuals with confirmed CAD after coronary angiography, the FH mutation prevalence was 6.1% (3/49). After excluding individuals with classical risk factors for CAD other than hypercholesterolemia, the FH mutation prevalence raised to 15.8% (3/19). Conclusion: In conclusion, we found that individuals with premature CAD have a more than 15-fold increased prevalence of FH mutations compared to the general population.

Comparison of right and left trans-radial catheterization for coronary angiography and intervention in patients with Acute myocardial infarction

Objective:

To compare the clinical characteristics between the right and left radial approach in treating acute myocardial infarction, helping physicians make treatment strategies correctly.

Methods:

The patients admitted at our institution and undergoing percutaneous coronary angiography and interventional procedures by left or right radial approach between November 2013 and July 2016 were retrospectively reviewed. The access time, compression time, ambulation time, the amount of contrast material used, fluoroscopy time, interventional procedural time, the number of catheters used, the percentage of procedures completed using the assigned approach and the major vascular complications were recorded and compared between the two groups.

Results:

There were no significant differences in access time, compression time, the amount of contrast material used, number of catheters used as well as the time to ambulation between the two groups (p>0.05), but the fluoroscopy time and interventional procedural time were significantly longer in right radial approach group than those in left radial approach group (p<0.05). The left radial approach group presented with a higher percentage of procedures completed using the assigned approach than that of right radial approach group (p<0.05).

Conclusion:

The left radial approach has more advantages than right radial approach in treating acute myocardial infarction.