Successful primary percutaneous coronary intervention determines the very long-term prognosis in ST-segment elevation myocardial infarction even in survivors of the acute phase. The ANIN Myocardial Infarction Registry

Effects of using primary percutaneous coronary interventions on the incidence of new-onset atrial fibrillation following an acute myocardial infarction

BACKGROUND

Acute ST-segment elevation myocardial infarction (STEMI) and new-onset atrial fibrillation (AF) are associated with increased risk of mortality.

HYPOTHESIS

This study aimed to determine the proportion of patients who go on to develop new-onset a AF after undergoing a primary or delayed percutaneous coronary intervention (PCI) for an acute STEMI and to explore possible risk factors.

METHODS

One hundred and fifty-four patients who underwent PCI after STEMI were included in the study. Patient characteristics, baseline blood tests and cardiac parameters, type of PCI, and incidence of new-onset AF within 3 months of PCI were recorded and analyzed.

RESULTS

Fifteen developed new-onset AF following the PCI, and 139 patients maintained a sinus rhythm. Univariate analysis showed significant differences between the two patient groups in terms of age, nature of the PCI (primary vs. delayed), left atrial diameter, and left ventricular diastolic dysfunction (p < .05). Age (odds ratio [OR] = 1.065, 95% confidence interval [CI]: 1.007-1.127, p < .05) and left atrial diameter (OR = 1.165, 95% CI: 1.008-1.347, p < .05), were independent predictors of new-onset AF after PCI. Primary PCI (OR = 0.232, 95% CI: 0.066-0.814, p < .05) was an independent protective factor.

CONCLUSION

Age and left atrial diameter were independent risk factors of new-onset AF in patients undergoing a PCI following an acute myocardial infarction, while primary PCI was a protective factor. This discovery can help reduce mortality rate, improve long-term prognosis, and provide a theoretical basis for the prevention of new-onset AF.

In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention

BACKGROUND

The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).

METHODS

Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.

RESULTS

A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.

CONCLUSIONS

Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.

Oxidative stress and its association with ST resolution and clinical outcome measures in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention

Objective

Reperfusion of ischemic myocardium generates oxidative stress, which itself can mediate myocardial injury. So, in this study, we investigated the level of oxidative stress markers and its association with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.

Results

As indicated in the results, Post MI (Myocardial Infarction) heart failure was significantly higher in the group A (11% vs 4%, p = 0.047). Complete STR (ST-segment resolution) was observed to be significantly higher in the group B (36% vs 17%, p = 0.006). The SOD (Superoxide dismutase) and GPX (Glutathione peroxidase) levels were significantly higher in the group B compared to the other group (1547.51 ± 328.29 vs. 1449.97 ± 246.06, p = 0.019 and 60.62 ± 11.95 vs 57.41 ± 10.14, p = 0.042). The levels of GPX and SOD were shown to be directly related with complete STR and post PCI (Percutaneous coronary intervention)TIMI(Thrombolysis in Myocardial Infarction) flow 3 in the group A (p = 0.002 and p < 0.01, p = 0.005 and p < 0.02, respectively).