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Attar A, Namvar S, Hosseinpour A, Azami P, Shekari A, Jamali L, Goudarzi N. Effect of different reperfusion strategies on recovery of ventricular function after ST-segment elevation myocardial infarction: A longitudinal single-center study. Health Sci Rep 2024; 7:e2220. [PMID: 38933425 PMCID: PMC11199175 DOI: 10.1002/hsr2.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Aims Although the clinical benefit of percutaneous coronary intervention (PCI) on cardiovascular outcomes has been widely investigated, the impact of this revascularization strategy compared to other alternatives on the degree of left ventricular function recovery is poorly demonstrated. In this regard, we investigated whether time delays between the presentation of ST-segment elevation myocardial infarction (STEMI) and PCI in reperfusion strategies have different impacts on left ventricular function recovery. Methods In this single-center study, all the patients who presented with STEMI and a reduced left ventricular ejection fraction (LVEF ≤ 40%) were enrolled. Included patients were subjected to four different treatment groups of primary, rescue (immediate transfer for angioplasty due to failed fibrinolytic therapy), facilitated (fibrinolytic therapy followed by angioplasty within 24 h), and deferred (successful fibrinolytic therapy and PCI after 24 h) PCI based on hospital facilities. Echocardiography was performed for all the patients at the time of hospitalization and 6 months later. Results A total of 128 patients were included in this study. The LVEF improved by 15.3 ± 6.3%, 11.5 ± 3.61%, 4.0 ± 1.0%, and -1.3 ± 7.0% in primary, rescue, facilitated, and deferred PCI groups, respectively (p < 0.001). Patients undergoing deferred PCI experienced a significantly lower improvement in LVEF compared with primary and rescue PCI (p < 0.001). Conclusion Primary PCI demonstrated the most promising recovery in left ventricular function following STEMI compared to other alternative strategies. Performing PCI as soon as possible provides better recovery of LVEF.
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Affiliation(s)
- Armin Attar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Soheila Namvar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Pouria Azami
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Arash Shekari
- Cardiovascular Diseases Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Leila Jamali
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Neda Goudarzi
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
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Sanjaya F, Pramudyo M, Achmad C. Statistical findings and outcomes of acute coronary syndrome patients during COVID-19 pandemic: A cross sectional study. IJC HEART & VASCULATURE 2023; 46:101213. [PMID: 37122630 PMCID: PMC10130330 DOI: 10.1016/j.ijcha.2023.101213] [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: 03/23/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
Introduction Time to treatment of acute coronary syndrome (ACS) can be a matter of life or death considering its major contribution to cardiovascular mortality. The sudden outbreak of the Coronavirus Disease in 2019 (COVID-19) caused great uncertainty in achieving ACS time-frame goals. This study assesses ACS presentation time and outcomes before and during the COVID-19 pandemic. Methods A total of 1287 ACS patients were included in this cross-sectional study. We compared mortality and other outcomes during hospital admission. Before-COVID was deemed as admission between March 2018 and February 2020, while admission between March 2020 and February 2022 was deemed as during-COVID. The association of admission on outcomes was measured using regression statistics. Results There was a 51.2 % decline of total patients before-COVID (865 patients) to during-COVID (422 patients). While there is no difference in first medical contact (FMC) before [3 h (IQR 1-7)] compared to during the pandemic [3 h (IQR 2-9), p 0.058], we found a decrease in door to wire time < 12 h (43.41 % vs 18.98 %, p < 0.001). There was also a non-significant decrease in fibrinolysis (20.45 % vs 15.18 %, p 0.054) but an increase in those undergoing percutaneous coronary intervention (PCI) (58.36 % vs 77.04 %, p value < 0,001). We also found reduced mortality (12.52 % vs 9.69 %, p 0.151), heart failure (28.16 % vs 25.81 %, p 0.31), but more cardiogenic shock during the pandemic (9.19 % vs 13.33 %, p 0.028). Conclusions While the mortality seems statistically unaffected, we found less admission and prolonged door to wire time during-COVID pandemic.
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Affiliation(s)
- Ferdy Sanjaya
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Indonesia
| | - Miftah Pramudyo
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Indonesia
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Kyriakoulis KG, Trontzas IP, Kyriakoulis IG, Terentes-Printzios D, Papageorgiou NG, Fyta E, Kotteas E, Kollias A. ST-Segment Elevation Myocardial Infarction (STEMI) Management in the Era of COVID-19: A Systematic and Critical Review of Published Guidance Reports. Rev Cardiovasc Med 2023; 24:54. [PMID: 39077423 PMCID: PMC11273141 DOI: 10.31083/j.rcm2402054] [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: 10/06/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 07/31/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) had a major impact on healthcare systems worldwide. During the early phase of the pandemic many elective procedures were postponed. At the same time, the safe and effective management of medical emergencies such as ST-segment elevation myocardial infarction (STEMI) has been a challenge. Methods A systematic literature search was conducted aiming to identify published guidance reports by national or international societies regarding the management of patients suffering STEMI in the era of COVID-19. Results Among 1681 articles initially retrieved, six fulfilled the inclusion criteria and were included in the systematic review. Two reports were international consensus documents, while four reports were national guidance statements from Asian countries (Taiwan, India, Iran, and China). Most documents were drafted during the early phase of the pandemic. According to the international consensus documents, percutaneous coronary intervention (PCI) should be regarded as the reperfusion method of choice. On the other hand, in three out of four national consensus statements (Taiwan, Iran and China) fibrinolysis was considered as the reperfusion method of choice for STEMI in suspected/confirmed patients with COVID-19, unless contraindicated or in the presence of high cardiovascular risk clinical features. Authors of all documents underlined the need for early COVID-19 testing in patients with STEMI to better determine the next therapeutical steps. Conclusions National and international consensus statements for STEMI management in the era of COVID-19 have been published mainly during the early peak phase of the pandemic. Authors recognise that these recommendations are mainly based on expert opinions and observational data. As global immunization rates increase and methods for rapid COVID-19 detection are widely available, the implementation of traditional evidence-based practices used before the pandemic is becoming more feasible.
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Affiliation(s)
- Konstantinos G Kyriakoulis
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Ioannis P Trontzas
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Ioannis G Kyriakoulis
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Dimitrios Terentes-Printzios
- 1st Department of Cardiology, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Nikolaos-Georgios Papageorgiou
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Eleni Fyta
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Elias Kotteas
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Anastasios Kollias
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 11527 Athens, Greece
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Li F, Luo R, Wang XT, Jia JF, Yu XY. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia. Open Med (Wars) 2023; 18:20220621. [PMID: 36694625 PMCID: PMC9830634 DOI: 10.1515/med-2022-0621] [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: 09/28/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 01/11/2023] Open
Abstract
Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.
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Affiliation(s)
- Feng Li
- Department of Cardiology, Jieshou People’s Hospital, 339 Renmin Road, Jieshou, Fuyang, Anhui, 236500, China
| | - Rong Luo
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xiao-Ting Wang
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Jun-Feng Jia
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xue-Ying Yu
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
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Chacón-Diaz M, Custodio-Sánchez P, Rojas De la Cuba P, Yábar-Galindo G, Rodríguez-Olivares R, Miranda-Noé D, López-Rojas LM, Hernández-Vásquez A. Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country. BMC Cardiovasc Disord 2022; 22:296. [PMID: 35768779 PMCID: PMC9244071 DOI: 10.1186/s12872-022-02730-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). The pharmacoinvasive strategy (PIs) is a reasonable alternative when prompt PPCI is not possible, especially in resource-limited regions. We aimed to compare PPCI versus PIs outcomes in Peru. METHODS This was a retrospective cohort study based on the second Peruvian Registry of STEMI (PERSTEMI II). We compared the characteristics, in-hospital outcomes and 30-day mortality of patients undergoing PPCI during the first 12 h and those receiving a PIs. A propensity score-matched analysis was conducted to compare the effects of each treatment strategy on clinical outcomes. RESULTS PIs patients were younger than PPCI patients, had a shorter first medical contact time, first medical contact to reperfusion time, and total ischemic time until reperfusion. Successful PCI was more frequent in the PIs group (84.4% vs. 71.1%, p = 0.035). There were no differences between PIs and PPCI in terms of total in-hospital mortality (5.2% vs. 6.6%, p = 0.703), cardiovascular mortality (4.2% vs. 5.3%, p = 0.735), cardiogenic shock (8.3% vs. 13.2%, p = 0.326), heart failure (19.8% vs. 30.3%, p = 0.112), or major bleeding (0% vs. 2.6%, p = 0.194). In the propensity score-matched analysis, the rates of cardiovascular mortality, postinfarction heart failure and successful reperfusion were similar. CONCLUSIONS In this real-world study, no differences were found in the in-hospital outcomes between patients with STEMI who received PIs or PPCI.
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Affiliation(s)
- Manuel Chacón-Diaz
- Instituto Nacional Cardiovascular INCOR, Essalud, Lima, Peru.,Universidad Científica del Sur, Lima, Peru
| | | | | | | | | | | | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
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