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Satti Z, Omari M, Bawamia B, Cartlidge T, Egred M, Farag M, Alkhalil M. The Use of Thrombectomy during Primary Percutaneous Coronary Intervention: Resurrecting an Old Concept in Contemporary Practice. J Clin Med 2024; 13:2291. [PMID: 38673564 PMCID: PMC11050836 DOI: 10.3390/jcm13082291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Optimal myocardial reperfusion during primary percutaneous coronary intervention (pPCI) is increasingly recognized to be beyond restoring epicardial coronary flow. Both invasive and non-invasive tools have highlighted the limitation of using this metric, and more efforts are focused towards achieving optimal reperfusion at the level of the microcirculation. Recent data highlighted the close relationship between thrombus burden and impaired microcirculation in patients presenting with ST-segment elevation myocardial infarction (STEMI). Moreover, distal embolization was an independent predictor of mortality in patients with STEMI. Likewise, the development of no-reflow phenomenon has been directly linked with worse clinical outcomes. Adjunctive thrombus aspiration during pPCI is intuitively intended to remove atherothrombotic material to mitigate the risk of distal embolization and the no-reflow phenomenon (NRP). However, prior trials on the use of thrombectomy during pPCI did not support its routine use, with comparable clinical endpoints to patients who underwent PCI alone. This article aims to review the existing literature highlighting the limitation on the use of thrombectomy and provide future insights into trials investigating the role of thrombectomy in contemporary pPCI.
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Affiliation(s)
- Zahir Satti
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Muntaser Omari
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Bilal Bawamia
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Timothy Cartlidge
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
| | - Mohammad Alkhalil
- Cardiothoracic Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; (Z.S.); (M.O.); (B.B.); (T.C.); (M.E.); (M.F.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Milošević AD, Polovina MM, Jelic DD, Simic DD, Viduljevic MM, Matic DM, Tomic MM, Adzic TN, Asanin MR. Prognostic Implications of the Timing of ST-Elevation Myocardial Infarction Development in Relation to COVID-19 Infection. J Intensive Care Med 2024:8850666241232938. [PMID: 38374620 DOI: 10.1177/08850666241232938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have a worse clinical course and prognosis. The prognostic significance of the timing of STEMI in relation to COVID-19 infection was not investigated. Objectives: To assess whether the time of STEMI development in relation to COVID-19 infection (concurrent or following the infection) influenced the short-term prognosis. Methods: This was an observational study of consecutive COVID-19 patients with STEMI admitted to the COVID-hospital Batajnica (February 2021-March 2022). The patients were divided into the "STEMI first" group: patients with STEMI and a positive polymerase chain reaction test for COVID-19, and the "COVID-19 first" group: patients who developed STEMI during COVID-19 treatment. All patients underwent coronary angiography. The primary endpoint was in-hospital all-cause mortality. Results: The study included 87 patients with STEMI and COVID-19 (Mage, 66.7 years, 66% male). The "STEMI first" group comprised 54 (62.1%) patients, and the "COVID-19 first" group included 33 (37.9%) patients. Both groups shared a comparatively high burden of comorbidities, similar angiographic and procedural characteristics, and high percentages of performed percutaneous coronary interventions with stent implantation (90.7% vs. 87.9%). In-hospital mortality was significantly higher in the "COVID-19 first" group compared to the "STEMI first" group (51.5% vs. 27.8%). Following adjustment, the "COVID-19 first" group had a hazard ratio of 3.22 (95% confidence interval, 1.18-8.75, p = .022) for in-hospital all-cause death, compared with the "STEMI first" group (reference). Conclusion: Clinical presentation with COVID-19 infection, followed by STEMI ("COVID-19 first"), was associated with greater short-term mortality compared to patients presenting with STEMI and testing positive for COVID-19 ("STEMI first").
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Affiliation(s)
- Aleksandra D Milošević
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija M Polovina
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dario D Jelic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Damjan D Simic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mihajlo M Viduljevic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dragan M Matic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milenko M Tomic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana N Adzic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Pulmonary Disorders and Tuberculosis, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milika R Asanin
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Theodoropoulos KC, Bazmpani MA, Kouparanis A, Ziakas A, Kassimis G. Funny coronary arteriole perforation causes tamponade post- primary percutaneous coronary intervention. J Invasive Cardiol 2024; 36. [PMID: 38335513 DOI: 10.25270/jic/23.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
An emergency transradial coronary angiography in a 68-year-old woman demonstrated sub-total occlusion of the proximal left anterior descending artery.
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Affiliation(s)
| | - Maria-Anna Bazmpani
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kassimis
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Dogan Z, Erden I, Bektasoglu G, Karabulut A. Association Between History of Polymerase Chain Reaction-verified COVID-19 Infection and Outcomes of Subsequent ST-Elevation Myocardial Infarction. Angiology 2024; 75:131-138. [PMID: 36399778 PMCID: PMC9679326 DOI: 10.1177/00033197221139918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
While the acute phase of coronavirus disease 2019 (COVID-19) is associated with worsening cardiac outcomes, it is unclear whether it affects the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after the acute phase. In addition, while many studies compared the course of STEMI during the COVID-19 pandemic with the years before the outbreak, we evaluated the course of STEMI during the pandemic according to whether or not patients had history of COVID-19. Patients diagnosed with STEMI during the ongoing COVID-19 pandemic were included in the study. The Ministry of Health database was analyzed retrospectively, and patients with (n = 191) and without (n = 127) a history of polymerase chain reaction (PCR) confirmed COVID-19 infection were divided into groups. Clinical and angiographic characteristics were assessed. The rates of in-hospital major adverse cardiac events (MACE) were higher in those who had a history of PCR-verified COVID-19 infection. Angiographic and procedural findings indicating successful reperfusion were better in patients without a history of COVID-19. A history of COVID-19 infection (odds ratio 1.40, 95% confidence interval 1.25-1.60, P < .01) independently predicted MACE. A history of COVID-19 infection is a predictor of worse outcomes following coronary intervention and in-hospital MACE among patients with STEMI.
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Affiliation(s)
- Zeki Dogan
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Ismail Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Gokhan Bektasoglu
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Ahmet Karabulut
- Department of Cardiology, Acıbadem MAA University Atakent Hospital, Istanbul, Turkey
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Alhatemi AQM, Hashim HT, Aziz EMH, Abdulhussain TK, Hashim AT. De Winter syndrome in action: Captured on defibrillator. Clin Case Rep 2024; 12:e8511. [PMID: 38333658 PMCID: PMC10849977 DOI: 10.1002/ccr3.8511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
De Winter syndrome, though rare, demands heightened clinical suspicion. Recognizing its electrocardiographic subtleties is crucial, as prompt diagnosis allows for life-saving interventions such as percutaneous coronary intervention or thrombolysis.
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Kültürsay B, Yılmaz C, Güven B, Mutlu D, Karagöz A. Potential renoprotective effect of SGLT2 inhibitors against contrast-induced AKI in diabetic STEMI patients undergoing primary PCI. Kardiol Pol 2024; 82:29-36. [PMID: 38230461 DOI: 10.33963/v.kp.98260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND It has been demonstrated that there is a significant reduction in the incidence of cardiovascular events, mortality rates, and worsening kidney disease in patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, there is limited information about the effect of SGLT2i on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing primary percutaneous intervention (pPCI). AIMS Our research was focused on examining how SGLT2i exposure impacts CI-AKI occurrence in patients with ST-segment elevation myocardial infarction (STEMI) and undergoing pPCI. RESULTS This retrospective, single-center, case-control study included diabetic patients diagnosed with STEMI who underwent pPCI in a tertiary healthcare center between 2021 and 2022. The study population included SGLT2i users (n = 130) and non-SGLT2i users (n = 165). Inverse probability propensity score weighting and doubly robust estimation were performed to decrease bias and to balance covariate distribution for estimating average treatment for those treated. In a doubly robust inverse probability weighted regression model, in which covariates were balanced, CI-AKI risk was also found to be lower in the SGLT2i-user group (OR: 0.86 [0.76-0.98]; 95% CI; P = 0.028). In addition, ejection fraction, admission creatinine, albumin, and volume of contrast media were found to be independent predictors of CI-AKI in patients presenting with STEMI and undergoing pPCI. CONCLUSION Our study provides evidence supporting the potential protective effect of SGLT2i against CI-AKI in diabetic patients presenting with STEMI and undergoing pPCI.
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Affiliation(s)
- Barkın Kültürsay
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
| | | | - Barış Güven
- Department of Cardiology, Istanbul University - Cerrahpasa Institute of Cardiology, Istanbul, Turkey
| | - Deniz Mutlu
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey
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Zhang L, Zeng J, Huang H, Zhu Y, Peng K, Liu C, Luo F, Yang W, Wu M. Impact of chest pain center quality control indicators on mortality risk in ST-segment elevation myocardial infarction patients: a study based on Killip classification. Front Cardiovasc Med 2024; 10:1243436. [PMID: 38235291 PMCID: PMC10791892 DOI: 10.3389/fcvm.2023.1243436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Background Despite the crucial role of Chest pain centers (CPCs) in acute myocardial infarction (AMI) management, China's mortality rate for ST-segment elevation myocardial infarction (STEMI) has remained stagnant. This study evaluates the influence of CPC quality control indicators on mortality risk in STEMI patients receiving primary percutaneous coronary intervention (PPCI) during the COVID-19 pandemic. Methods A cohort of 664 consecutive STEMI patients undergoing PPCI from 2020 to 2022 was analyzed using Cox proportional hazards regression models. The cohort was stratified by Killip classification at admission (Class 1: n = 402, Class ≥2: n = 262). Results At a median follow-up of 17 months, 35 deaths were recorded. In Class ≥2, longer door-to-balloon (D-to-B) time, PCI informed consent time, catheterization laboratory activation time, and diagnosis-to-loading dose dual antiplatelet therapy (DAPT) time were associated with increased mortality risk. In Class 1, consultation time (notice to arrival) under 10 min reduced death risk. In Class ≥2, PCI informed consent time under 20 min decreased mortality risk. Conclusion CPC quality control metrics affect STEMI mortality based on Killip class. Key factors include time indicators and standardization of CPC management. The study provides guidance for quality care during COVID-19.
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Affiliation(s)
- Lingling Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
- Medical Department, Xiangtan Central Hospital, Xiangtan, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ke Peng
- Department of Scientific Research, Xiangtan Central Hospital, Xiangtan, China
| | - Cai Liu
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
| | - Fei Luo
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
| | - Wenbin Yang
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
- Medical Department, Xiangtan Central Hospital, Xiangtan, China
| | - Mingxin Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
- Chest Pain Centre, Xiangtan Central Hospital, Xiangtan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Dou J, Gao J, Yang H, Guo R, Jiang C, Guo J, Luo D. Efficacy and Safety of a Pharmaco-Invasive Strategy Using Half-Dose Recombinant Human Prourokinase in Patients with ST-Segment Elevation Myocardial Infarction During Hospitalization. Clin Appl Thromb Hemost 2024; 30:10760296231221772. [PMID: 38166398 PMCID: PMC10768629 DOI: 10.1177/10760296231221772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
This study investigated the efficacy and safety of pharmaco-invasive strategy with half-dose recombinant human prourokinase (PHDP) during hospitalization for patients with ST-segment elevation myocardial infarction (STEMI) to provide references for the treatment of STEMI. Patients with STEMI who fulfilled the inclusion and exclusion criteria and attended Chengde Central Hospital, Hebei Province, China, between September 3, 2019, and December 28, 2021, were included in this study. The experimental group received PHDP and the control group underwent primary percutaneous coronary intervention (PPCI). This study enrolled 150 patients with STEMI, 75 in the experimental group and 75 in the control group. Coronary angiography revealed successful thrombolysis in 64 (85.33%) patients. Compared with the control group, the experimental group had shorter first medical contact-reperfusion time (P < 0.001), less slow flow/no-reflow (P < 0.001), and a lower utilization rate of Tirofiban (P < 0.001). Validity endpoints: no statistically significant differences between the two groups. Safety endpoints: no statistically significant differences between bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs), but the experimental group was more prone to arrhythmias (P = 0.040), particularly premature ventricular beats (PVB) (P = 0.008). In conclusion, the efficacy and safety of PHDP in the treatment of patients with STEMI were positive. Complete epicardial and myocardial reperfusion rates, risk for bleeding during hospitalization, and incidence of MACCEs were similar to those of the PPCI strategy. Although the PHDP group has a higher incidence of PVB, it does not increase the incidence of malignant arrhythmia. This study aimed to provide a new therapeutic strategy for the treatment of STEMI in hospitals without adequate PPCI resources condition.
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Affiliation(s)
- Jie Dou
- School of Medicine, Chengde Medical University, Chengde, Hebei, China
| | - Jie Gao
- School of Medicine, Chengde Medical University, Chengde, Hebei, China
| | - Huihui Yang
- School of Medicine, Chengde Medical University, Chengde, Hebei, China
| | - Ruoling Guo
- School of Medicine, Chengde Medical University, Chengde, Hebei, China
| | - Chao Jiang
- School of Medicine, Chengde Medical University, Chengde, Hebei, China
| | - Jingtao Guo
- Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, Hebei, China
| | - Donglei Luo
- Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, Hebei, China
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HASHEMI-JOKANDAN ENAYATOLLAH, KHALAJI AMIRREZA, ABDOLLAHZADEH ALI, SEPARHAM AHMAD. Pulse pressure and inferior wall ST-segment elevation myocardial infarction: investigating mortality, hospital major cardiovascular events, and long-term prognosis. J Public Health Afr 2023; 14:2743. [PMID: 38204807 PMCID: PMC10774853 DOI: 10.4081/jphia.2023.2743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 01/12/2024] Open
Abstract
Inferior Wall ST-Segment Elevation Myocardial Infarction (INF STEMI) is a severe condition with high mortality. Rapid treatment with Primary Percutaneous Coronary Intervention (PPCI) is preferred. Pulse Pressure (PP) is a known risk factor for both cardiovascular disease and may be a valuable predictor of outcomes in these patients. The study aims to evaluate the relationship between PP and long-term prognosis, mortality, and major cardiovascular events after inferior STEMI in cases who underwent PPCI. This cross-sectional study included subjects with a confirmed diagnosis of inferior STEMI who underwent PPCI. Patient data were gathered from hospital records and analyzed for the relationship between PP and MACE during hospitalization and one-year follow-up. Statistical analysis was performed using SPSS. This cross-sectional study of 320 cases found that DM, DBP, and Cr patients had a higher incidence of MACEs (P-value #x003C;0.05). Subjects with higher LVEF and SBP had fewer MACEs (P-value #x003C;0.05). Cases with a PP of ≤50 had a higher mortality and heart failure incidence during hospitalization than those with a PP >50 (P-value #x003C;0.05). However, the two groups had no significant difference in one-year MACE rates. The study found that increasing DBP, Cr, and DM and decreasing LVEF and SBP impacted MACE incidence. PP ≤50 had more heart failure incidence and mortality during hospitalization in patients with inferior STEMI.
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Affiliation(s)
| | - AMIRREZA KHALAJI
- Connective Tissue Diseases Research Center
- Immunology Research Center, Tabriz University of Medical Sciences, Iran
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Savic L, Mrdovic I, Asanin M, Stankovic S, Krljanac G, Lasica R, Simic D. Sudden cardiac death in long-term follow-up in patients treated with primary percutaneous coronary intervention. SCAND CARDIOVASC J 2023; 57:2176919. [PMID: 36776111 DOI: 10.1080/14017431.2023.2176919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Objective. Most studies analyzing predictors of sudden cardiac death (SCD) after acute myocardial infarction included only high-risk patients or index reperfusion had not been performed in all patients. The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of unselected patients with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI). Method. we analysed 3114 STEMI patients included included in the University Clinical Center of Serbia STEMI Register. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge. Results. During 6-year follow-up, lethal outcome was registered in 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e. 0.8% of the patients analyzed. The independent predictors for the occurrence of SCD during 6-year follow-up were EF < 45% (HR 3.07, 95% 1.87-5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37-5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12-2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23-2.97). Conclusion. There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. Predictors of SCD occurence during long-term follow-up in analyzed patients are clinical variables that are easily recorded during index hospitalization and include: EF ≤45%, post-procedural flow TIMI < 3, Killip class >1, and reduced baseline kidney function.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, Beograd, Serbia.,Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Damjan Simic
- Emergency Hospital, Coronary Care Unit & Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Akhtar A, Saleemi MS, Zarlish QM, Arshad MB, Hashmi KA, Ghafoor H. Experience and Outcomes of Primary Percutaneous Coronary Intervention in a Tertiary Care Hospital in South Punjab, Pakistan. Cureus 2023; 15:e50024. [PMID: 38186432 PMCID: PMC10767693 DOI: 10.7759/cureus.50024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) is the emergency procedure and gold standard for the treatment of ST-Elevation Myocardial Infarction (STEMI). OBJECTIVE To share the experience and outcomes of primary PCI in a tertiary care hospital in South Punjab, Pakistan. METHODS A descriptive cross-sectional study was planned from the 1st of April, 2023 to the 30th of September, 2023. All patients presenting with acute STEMI undergoing primary PCI were included in the study. Data regarding patient demographics, risk factors, procedural characteristics, time variables, and in-hospital events was observed. RESULTS A total of 1132 patients were included in the study. There were 934 (82.5%) males. Smoking is the most common risk factor among all the patients. Anterior wall myocardial infarction is the most common STEMI and the left anterior descending artery is the culprit vessel in 58.3% (n=660) of patients. Single vessel disease was present in 34.6% (n=392) of the patients. Thrombolysis in Myocardial Infarction (TIMI )Flow III was achieved in 80% (n=906) of patients after primary PCI. The average total ischemic time of the patients included in the study was 5 hours and 48 minutes, with a standard deviation of 3 hours and 55 minutes. Our mortality was 3.5% (n=40). CONCLUSION Our patients take a longer time to present to the PCI-capable centers. Despite their late presentation, primary PCI has better outcomes for treating acute STEMI.
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Affiliation(s)
- Ammar Akhtar
- Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Muhammad S Saleemi
- Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Qazi M Zarlish
- Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Muhammad B Arshad
- Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | | | - Hamza Ghafoor
- Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
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Price J, Rudman J, Schoenfeld D, Thomas SA, Rees P, Bloom B, McCartin M, Blumen I, Thomas SH. Survivorship With Incrementally Faster Times to Primary Percutaneous Coronary Intervention (SWIFT-PPCI): A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:356-362. [PMID: 37776583 DOI: 10.1016/j.amjcard.2023.08.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 10/02/2023]
Abstract
In the United States, there are approximately 750,000 ST-elevation myocardial infarction cases each year. Streamlined care and rapid delivery for primary percutaneous coronary intervention (PPCI) is associated with improved survival. This systematic review and meta-analysis aimed to generate a practical estimate of mortality savings for every notional 30-minute decrease in the time to achieving PPCI. Included studies were those that provided a specific absolute risk reduction for a specific reduction in pre-PPCI time. The eligible studies evaluated the survival benefit from pre-PPCI time savings measured in any interval ending with PPCI and commencing with objectively recorded timing, such as initial emergency call, first medical contact, or hospital arrival. Study planning called for the reporting of data as individual study results, with a pooled effect estimate of relative risk calculated with random-effects meta-analysis. A total of 1,088 records were eligible for review; 52 were reviewed in full text, with 4 studies (total patient n = 235,814, overall mortality 4.7% to 7.8%) included in the final analysis. All 4 studies reported significant time-related survival benefit over the study focus window of 60 to 180 minutes pre-PPCI. The number of lives saved per 100 cases for each 30-minute pre-PPCI time savings ranged from 0.8 to 1.9. The overall effect estimate generated was 0.753 (95% confidence interval 0.712 to 0.796), with acceptable heterogeneity (I2 = 36%). In conclusion, a pooled effect calculation estimated a 24.7% relative risk reduction for each 30 minutes of time savings. For cases that underwent PPCI within 60 to 180 minutes of initial presentation with known baseline mortality risk, the time savings in 30-minute epochs can be leveraged to estimate a specific number of lives saved; this may be useful for those involved in the organization of medical care who make systemwide plans and individual patient triage decisions.
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Affiliation(s)
- James Price
- Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation & Development, East Anglian Air Ambulance, Norwich, United Kingdom.
| | - Jordan Rudman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - David Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul Rees
- Department of Research, Audit, Innovation & Development, East Anglian Air Ambulance, Norwich, United Kingdom; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom; Department of Cardiology, St Bartholomew's Hospital and Barts Health NHS Trust, London, United Kingdom
| | - Ben Bloom
- Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom; Department of Emergency Medicine, The Royal London Hospital and Barts Health NHS Trust, London, United Kingdom
| | - Michael McCartin
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - Ira Blumen
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom
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Toprak K, Kaplangoray M, Memioğlu T, İnanır M, Omar B, Ermiş MF, Toprak İH, Acar O, Taşcanov MB, Altıparmak İH, Biçer A, Demirbağ R. The HbA1c/C-Peptide Ratio is Associated With the No-Reflow Phenomenon in Patients With ST-Elevation Myocardial Infarction. Angiology 2023:33197231213166. [PMID: 37920902 DOI: 10.1177/00033197231213166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Currently, the gold standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI), but even after successful pPCI, a perfusion disorder in the epicardial coronary arteries, termed no-reflow phenomenon (NR), can develop, resulting in short- and long-term adverse events. The present study assessed the relationship between NR and HbA1c/C-peptide ratio (HCR) in 1834 consecutive patients who underwent pPCI due to STEMI. Participants were divided into two groups according to NR status and the demographic, clinical and periprocedural characteristics of the groups were compared. NR developed in 352 (19.1%) of the patients in the study. While C-peptide levels were significantly lower in the NR group, HbA1c and HCR were significantly higher (P < .001, for all). In multivariable analysis, C-peptide, HbA1c, and HCR, were determined as independent predictors for NR (P < .05, for all). In Receiver Operating Characteristic (ROC) analysis, HCR predicted the NR with 80% specificity and 77% sensitivity. In STEMI patients, combining HbA1c and C-peptide in a single fraction has a predictive value for NR independent of diabetes. This ratio may contribute to risk stratification of STEMI patients.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Mustafa Kaplangoray
- Department of Cardiology, Faculty of Medical, Şeyh Edebali University, Bilecik, Turkey
| | - Tolga Memioğlu
- Department of Cardiology, Faculty of Medical, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet İnanır
- Department of Cardiology, Faculty of Medical, Abant Izzet Baysal University, Bolu, Turkey
| | - Bahadır Omar
- Department of Cardiology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Fatih Ermiş
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - İbrahim Halil Toprak
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Osman Acar
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | | | - Asuman Biçer
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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14
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Özilhan MO, Açıkgöz SK. Serum total bilirubin level is associated with contrast induced nephropathy after primary percutaneous coronary intervention. Angiology 2023; 74:981-986. [PMID: 37368236 DOI: 10.1177/00033197231186084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Contrast Induced Nephropathy (CIN) is a major complication of angiographic procedures. Primary percutaneous coronary intervention (pPCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) but is associated with a risk of CIN. Oxidative stress and free radical damage play a role in the pathogenesis of CIN. Bilirubin has anti-inflammatory and antioxidant activity and has been shown to have a protective effect on endothelial cells. The present study aimed to assess the association between serum bilirubin level and development of CIN after pPCI. Sequential STEMI patients (n = 595) who underwent pPCI between January 2021 and December 2022 were enrolled. Among the participants, 116 (19.5%) developed CIN. Serum total bilirubin level was significantly lower in the CIN group (P = .001). In multivariate logistic regression analysis, serum bilirubin level was found as an independent predictor of CIN. Age, gender, contrast volume, and white blood cell count were other independent predictors of CIN. A higher serum bilirubin level is associated with a lower risk of CIN in the present study. In STEMI patients undergoing pPCI, serum bilirubin level may be helpful to predict the risk of CIN and may help ensure early initiation of preventive treatment and careful follow-up.
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15
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Dang W, Cao N, Zhang Y, Li W, Li H. Association among β2-adrenergic receptor autoantibodies and proximal left anterior descending artery lesions in patients with initial ST-segment elevation myocardial infarction. Clin Cardiol 2023; 46:1371-1379. [PMID: 37587904 PMCID: PMC10642316 DOI: 10.1002/clc.24129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND β2 -adrenergic receptor autoantibody (β2 -AA) are widely present in patients with many different types of cardiovascular diseases. Proximal left anterior descending (LAD) artery lesions are associated with adverse prognostic events in patients with ST-segment elevation myocardial infarction (STEMI). HYPOTHESIS β2 -AA is associated with the presence of proximal LAD lesions in patients with STEMI. METHODS A cohort of 153 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) was enrolled in the study. Baseline characteristics were compared between the proximal LAD group (n = 62) and the nonproximal LAD group (n = 91). Admission serum of patients was collected to detect the level of β2 -AA. Data for echocardiogram within 24 hours after PPCI and at the 6-month follow-up were recorded. RESULTS The optical density values and positive rates of β2 -AA in the proximal LAD group were higher than those in the nonproximal LAD group (p < 0.05). β2 -AA positively correlated with high sensitivity C-reactive protein and peak N-terminal pro-B type natriuretic peptide levels in the proximal LAD group, but those were not relevant in the nonproximal LAD group. Multivariate logistic regression analysis revealed that high β2 -AA levels was independently associated with the presence of proximal LAD lesions in patients with STEMI. Furthermore, a receiver operating characteristic curve was used to show the efficiency of β2 -AA levels to detect proximal LAD lesions, and the AUC of the β2-AA OD value was 0.658 (95% confidence interval 0.568-0.749; p = 0.001). CONCLUSIONS The STEMI patients with high β2 -AA levels had a greater possibility having proximal LAD lesions.
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Affiliation(s)
- Wenxi Dang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
| | - Ning Cao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
| | - Yue Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
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16
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Vogel RF, Delewi R, Wilschut JM, Lemmert ME, Diletti R, van Vliet R, van der Waarden NWPL, Nuis RJ, Paradies V, Alexopoulos D, Zijlstra F, Montalescot G, Angiolillo DJ, Krucoff MW, Van Mieghem NM, Smits PC, Vlachojannis GJ. Direct Stenting versus Conventional Stenting in Patients with ST-Segment Elevation Myocardial Infarction-A COMPARE CRUSH Sub-Study. J Clin Med 2023; 12:6645. [PMID: 37892785 PMCID: PMC10607208 DOI: 10.3390/jcm12206645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Direct stenting (DS) compared with conventional stenting (CS) after balloon predilatation may reduce distal embolization during percutaneous coronary intervention (PCI), thereby improving tissue reperfusion. In contrast, DS may increase the risk of stent underexpansion and target lesion failure. METHODS In this sub-study of the randomized COMPARE CRUSH trial (NCT03296540), we reviewed the efficacy of DS versus CS in a cohort of contemporary, pretreated ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. We compared DS versus CS, assessing (1) stent diameter in the culprit lesion, (2) thrombolysis in myocardial infarction (TIMI) flow in the infarct-related artery post-PCI and complete ST-segment resolution (STR) one-hour post-PCI, and (3) target lesion failure at one year. For proportional variables, propensity score weighting was applied to account for potential treatment selection bias. RESULTS This prespecified sub-study included 446 patients, of whom 189 (42%) were treated with DS. Stent diameters were comparable between groups (3.2 ± 0.5 vs. 3.2 ± 0.5 mm, p = 0.17). Post-PCI TIMI 3 flow and complete STR post-PCI rates were similar between groups (DS 93% vs. CS 90%, adjusted OR 1.16 [95% CI, 0.56-2.39], p = 0.69, and DS 72% vs. CS 58%, adjusted OR 1.29 [95% CI 0.77-2.16], p = 0.34, respectively). Moreover, target lesion failure rates at one year were comparable (DS 2% vs. 1%, adjusted OR 2.93 [95% CI 0.52-16.49], p = 0.22). CONCLUSION In this contemporary pretreated STEMI cohort, we found no difference in early myocardial reperfusion outcomes between DS and CS. Moreover, DS seemed comparable to CS in terms of stent diameter and one-year vessel patency.
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Affiliation(s)
- Rosanne F. Vogel
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jeroen M. Wilschut
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Miguel E. Lemmert
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ria van Vliet
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | | | - Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | | | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Gilles Montalescot
- ACTION Group, Groupe Hospitalier Pitie-Salpetriere Hospital (AP-HP), Sorbonne University, 75013 Paris, France
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32610, USA
| | - Mitchell W. Krucoff
- Department of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Pieter C. Smits
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Georgios J. Vlachojannis
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Cardiology, Euroclinic Athens, 11521 Athens, Greece
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17
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Kaplangoray M, Toprak K, Aslan R, Deveci E, Gunes A, Ardahanli İ. High CRP-albumin ratio is associated high thrombus burden in patients with newly diagnosed STEMI. Medicine (Baltimore) 2023; 102:e35363. [PMID: 37832116 PMCID: PMC10578711 DOI: 10.1097/md.0000000000035363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023] Open
Abstract
In patients undergoing primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI), an increased intracoronary thrombus burden is a strong predictive factor for adverse cardiovascular events. The C-reactive protein (CRP)-serum albumin (SA) ratio (CAR), used as an inflammatory marker, is closely associated with thrombogenicity. In this study, we investigated the relationship between coronary thrombus burden and CAR in patients undergoing pPCI due to newly diagnosed STEMI. A total of 216 patients who underwent pPCI due to STEMI were retrospectively included for the study. Angiographic thrombus burden was assessed according to thrombolysis in myocardial infarction (TIMI) grading, and those with grade 1, 2, 3 were classified as low thrombus burden (n = 120) and those with grade 4, 5 were classified as high thrombus burden (HTB) (n = 96). CAR was calculated as the ratio of CRP to SA. The average age of the patients was 60 ± 9.8, and the male ratio was 61.1. Compared to the LTB group, the HTB group had higher CAR, age, SYNTAX score, baseline cTnT, peak cTnT, CRP, glucose, WBC, and NLR while the LVEF and SA levels were lower (P < .05). Spearman's correlation analysis revealed a significant correlation between thrombus burden and CAR. The multivariable logistic regression analysis revealed that CAR (odds ratio: 10.206; 95% confidence interval: 2.987-34.872, P < .001) was a independent risk factor for HTB. According to the receiver operating characteristic (ROC) analysis, when the cutoff value for CAR was taken as ≥1.105 CAR could predict HTB with a sensitivity of 70.8% and specificity of 67.7%. Our data indicate that CAR an independent risk factor for thrombus burden.
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Affiliation(s)
| | - Kenan Toprak
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ramazan Aslan
- Department of Cardiology, Bilecik Şeyh Edebali University, Bilecik, Turkey
| | - Edhem Deveci
- Department of Cardiology, University of Health Sciences Mehmet Akif İnan Research and Training Hospital, Sanliurfa, Turkey
| | - Ahmet Gunes
- Department of Cardiology, University of Health Sciences Mehmet Akif İnan Research and Training Hospital, Sanliurfa, Turkey
| | - İsa Ardahanli
- Department of Cardiology, Bilecik Şeyh Edebali University, Bilecik, Turkey
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Choe JC, Oh JH, Lee HC, Lee JW, Park TS, Park JH, Kim LE, Kim MS, Ahn J, Park JS, Lee HW, Choi JH, Cha KS. The effect of nicorandil on cardiac function and clinical outcomes in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: a randomised trial. Acta Cardiol 2023; 78:880-888. [PMID: 36942830 DOI: 10.1080/00015385.2022.2129592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/05/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND We investigated the effect of nicorandil on infarct size, cardiac function assessed by cardiac magnetic resonance imaging (CMR) and outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS In a prospective, randomised, controlled trial, 83 patients with STEMI receiving primary PCI were randomised into the nicorandil (n = 40) or placebo (n = 43) groups. Nicorandil was administered in the emergency room before primary PCI as an intravenous bolus of 4 mg followed by a continuous infusion of 6 mg/h for 24 h and as 2-mg intracoronary injections prior to balloon dilatation and coronary stenting. Nicorandil was continued orally at 10-20 mg/d for 6 months. Infarct size and cardiac function were measured by CMR at 5 d and 6 months after primary PCI. Furthermore, major adverse cardiac events (MACEs) including all-cause death, nonfatal myocardial infarction (MI), any revascularisation, stroke, and definite/probable stent thrombosis (ST) were compared. RESULTS There were no significant differences in baseline clinical characteristics between the groups. Infarct size at baseline and 6 months as well as infarct size changes during 6 months as measured by CMR were similar between the groups. Similarly, other CMR parameters were comparable at baseline and 6 months between the groups. MACEs occurred in four patients (4.8%) during 6 months. No significant difference in the risk of MACEs was observed between the groups. CONCLUSIONS Treatment with nicorandil for 6 months after primary PCI was not associated with any improvement in infarct size, CMR-determined cardiac function, and outcomes in STEMI patients.
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Affiliation(s)
- Jeong Cheon Choe
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jun-Hyok Oh
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Han Cheol Lee
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae Sik Park
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jong Ha Park
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - La Eun Kim
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Su Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Jinhee Ahn
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Sup Park
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hye Won Lee
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Hyun Choi
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kwang Soo Cha
- Department of Internal Medicine, Division of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Liu J, Zhang K, Wang X, Liu Z, Chen M, Fan F, Jia J, Hong T, Li J, Huo Y, Gong Y, Zheng B. Complete revascularization based on angiography derived fractional flow reserve versus incomplete revascularization in patients with ST-segment elevation myocardial infarction. Cardiol J 2023; 31:226-234. [PMID: 37772351 DOI: 10.5603/cj.92762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated. METHODS In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up. RESULTS At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2-3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence. CONCLUSIONS In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk.
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Affiliation(s)
- Jiahui Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Department of Hypertension, Peking University People's Hospital, Beijing, China
| | - Kaiping Zhang
- Department of Cardiology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhaoping Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Tao Hong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China.
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China.
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20
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Watanabe T, Kobara S, Amisaki R, Yamamoto K. Primary percutaneous coronary intervention for cardio-cerebral infarction: a case report. Front Cardiovasc Med 2023; 10:1165735. [PMID: 37583581 PMCID: PMC10424438 DOI: 10.3389/fcvm.2023.1165735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are the leading causes of death globally. Cardio-cerebral infarction (CCI) is the rare occurrence of AMI and AIS, either simultaneously or one after the other. Treatment recommendations are not clear in case of the occurrence of AMI and AIS simultaneously, especially the strategy of primary percutaneous coronary intervention (PCI). Case presentation We report consecutive seven case series of patients with CCI who underwent primary PCI in our institute. Comorbidities, strategy of primary PCI, and outcomes were investigated. All patients presented with the chief complaints associated with stroke. Atrial fibrillation (AF) was complicated in five of CCI patients, and four of AF patients were not anticoagulated. The major causes of stroke were cardiogenic and/or hemodynamic in this case series. All patients showed total occlusion in the culprit lesion, and six patients had other diseased vessels. Thrombus aspiration was mainly chosen as the reperfusion strategy in PCI. However, only two patients were diagnosed as definitive coronary embolism, and stenting was needed in six patients due to severe atherosclerotic lesion in culprit coronary artery. Final thrombolysis in myocardial infarction (TIMI) 3 flow was achieved only in four patients. Hemorrhagic complications occurred in three patients. Two patients died during in-hospital stay, and most had to be transferred for rehabilitation. Conclusions CCI was a rare but fatal condition in patients who underwent primary PCI. Although CCI was associated with concomitant atrial fibrillation, organic coronary stenosis requiring stenting for revascularization was present in almost all the cases. Given the complexity of coronary artery lesions and high in-hospital mortality, further investigations are needed to determine the optimal treatment strategy.
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Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University,Yonago,Japan
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Maruszak N, Pilch W, Januszek R, Malinowski KP, Surdacki A, Chyrchel M. Risk Factors of Suboptimal Coronary Blood Flow after a Percutaneous Coronary Intervention in Patients with Acute Anterior Wall Myocardial Infarction. J Pers Med 2023; 13:1217. [PMID: 37623467 PMCID: PMC10455189 DOI: 10.3390/jpm13081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/29/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND AIMS Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. METHODS We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. RESULTS Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589-0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1-1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1-1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271-0.9985, p = 0.04). CONCLUSIONS Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure.
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Affiliation(s)
- Natalia Maruszak
- Faculty of Medicine, Student Scientific Group at Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland; (N.M.); (W.P.)
| | - Weronika Pilch
- Faculty of Medicine, Student Scientific Group at Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland; (N.M.); (W.P.)
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
| | - Krzysztof Piotr Malinowski
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7E Str., 31-034 Kraków, Poland
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Medyczna 7 Str., 30-688 Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
| | - Michał Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
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22
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Wu H, Jia S. A Comparative Study on Ticagrelor and Clopidogrel in Patients With Acute Coronary Syndrome Treated With Primary Percutaneous Coronary Intervention. J Clin Pharmacol 2023; 63:776-783. [PMID: 37017131 DOI: 10.1002/jcph.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023]
Abstract
This study was conducted to compare the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PPCI). A total of 3528 consecutive patients with ACS treated with PPCI were divided into the ticagrelor and clopidogrel groups based on their dual antiplatelet therapy regimen at hospital discharge. Patient follow-up visits were completed 1, 6, and 12 months after PPCI treatment. Major adverse cardiac events (MACEs) and Bleeding Academic Research Consortium (BARC) bleeding events were assessed in both groups. In total, 2501 cases were included in the ticagrelor group, and 817 cases were included in the clopidogrel group. The incidence of MACEs was lower in the ticagrelor group than in the clopidogrel group (P < .05). The ticagrelor group had lower incidence of all-cause death and cardiac death compared with the clopidogrel group, and the difference was significant (P < .05). The incidences of study end points, including recurrent myocardial infarction and repeat revascularization, were not significantly different between the groups (P > .05). The incidences of BARC total and major bleeding events were not significantly different between the groups (P > .05). However, the incidences of BARC type 1 and 2 bleeding events were lower in the ticagrelor group than in the clopidogrel group (P < .05). The multivariate Cox regression analysis suggested that ticagrelor could decrease all-cause death compared with clopidogrel (P = .021). In patients with ACS treated with PPCI, ticagrelor could significantly reduce the risk of MACEs compared with clopidogrel, without increasing the risk of bleeding.
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Affiliation(s)
- Hui Wu
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Shaobin Jia
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, China
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23
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Lin TH, Chen KJ, Hu YC, Chang KH, Lai CH, Liu TJ, Lee WL, Su CS. STEMI patients receiving percutaneous coronary intervention for a culprit lesion with coronary artery bifurcation-efficacy and safety of the jailed semi-inflated balloon. Front Cardiovasc Med 2023; 10:1132062. [PMID: 37456820 PMCID: PMC10349388 DOI: 10.3389/fcvm.2023.1132062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Background We aimed to evaluate the efficacy and safety of the 'jailed semi-inflated balloon technique' (JSIBT) for side branch (SB) protection in STEMI patients with a culprit lesion involving a coronary artery bifurcation while undergoing emergent percutaneous coronary intervention (PCI). Methods We treated between Jan, 2011 and Jun, 2020, a total of 264 STEMI patients with a culprit lesion that involved a coronary artery bifurcation using primary PCI. In 30 patients, SB was protected by JSIBT (the JSIBT group). In 234 patients, SB was either protected or not protected by a placed wire (the non-JSIBT group). Results In both groups, after PCI procedure, TIMI flows of main vessel (MV) and SB were increased significantly compared with their measurements before the procedure. TIMI flows of post-procedural MV were similar between the two groups. In the JSIBT group, TIMI flows of SB both peri-procedure and post-procedure measurements were significantly greater than the non-JSIBT group. Despite a higher incidence of SB dissection in the JSIBT group, no inter-group difference was found in their total SB complications (like SB dissection, SB occlusion, wire entrapment or balloon rupture/entrapment). While JSIBT was an independent predictor for the SB TIMI 3 flow measured at the end of primary PCI, it was not an independent predictor for SB complications. Conclusion The use of JSIBT as a method of SB protection during primary PCI not only provided better SB protection, but it also had a similar rate of SB complications compared with those with or without prior application of SB wire. This technique may be an effective method of protecting SB for STEMI patients involving coronary artery bifurcation and underwent emergent PCI.
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Affiliation(s)
- Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuan-Ju Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Keng-Hao Chang
- Department of Internal Medicine, Cheng Ching Hospital, Taichung, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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24
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Gomez-Lara J, Gracida M, Rivero F, Gutiérrez-Barrios A, Muntané-Carol G, Romaguera R, Fuentes L, Marcano A, Roura G, Ferreiro JL, Teruel L, Brugaletta S, Alfonso F, Comín-Colet J, Gomez-Hospital JA. Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia: The Randomized RAIN-FLOW Study. J Am Heart Assoc 2023:e030285. [PMID: 37345805 DOI: 10.1161/jaha.123.030285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background ST-segment-elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow-mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow-mediated hyperemia in patients with ST-segment-elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN-FLOW (Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia) study, 67 patients with ST-segment-elevation myocardial infarction and no reflow were randomized to receive either pharmacologic-mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow-mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure-thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow-mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In-hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow-mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST-segment-elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941.
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Affiliation(s)
- Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Montserrat Gracida
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Fernando Rivero
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | | | - Guillem Muntané-Carol
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Lara Fuentes
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Ana Marcano
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Gerard Roura
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - José Luis Ferreiro
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Luis Teruel
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Salvatore Brugaletta
- Hospital Clínic i Provincial de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Fernando Alfonso
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | - Josep Comín-Colet
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Joan-Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
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25
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Arrivi A, Pucci G, Sordi M, Dominici M, Barillà F, Carnevale R, Morgantini A, Rosati R, Mangieri E, Tanzilli G. Repeated Glutathione Sodium Salt Infusion May Counteract Contrast-Associated Acute Kidney Injury Occurrence in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Randomized Subgroup Analysis of the GSH 2014 Trial. Life (Basel) 2023; 13:1391. [PMID: 37374173 DOI: 10.3390/life13061391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is still a major concern for referring physicians, especially in the setting of ST-elevation myocardial infarction (STEMI) patients undergoing primary-PCI (pPCI). To evaluate whether glutathione sodium salt (GSS) infusion impacts favorably on CA-AKI, an unplanned exploratory data analysis of the GSH 2014 trial was performed. METHODS One hundred patients with STEMI were assigned at random to an experimental group (No. 50) or to a placebo group (No. 50). Treatment consisted of an intravenous infusion of GSS lasting over 10 min before p-PCI. The placebo group received the same quantity of normal saline solution. After the interventions, glutathione was administered in the same doses to both groups at 24, 48 and 72 h. RESULTS CA-AKI occurred in 5 out of 50 patients (10%) allocated to the experimental group (GSS infusion) and in 19 out of 50 patients (38%) allocated to the placebo group (p between groups < 0.001). No patients in either group required renal replacement therapy. After allowing for multiple confounders, GSS administration (OR 0.17, 95% CI 0.04-0.61) and door-to-balloon time (in hours) (OR 1.61, 95% CI 1.01-2.58) have been the only independent predictors of CA-AKI. CONCLUSIONS the results of this sub-study, which show a significant trend towards an improved nephroprotection in the experimental group, led to the hypothesis of a possible new prophylactic approach to counteract CA-AKI using repeated GSS infusion. Subsequent studies with specific clinical outcomes would be necessary to confirm these data.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Giacomo Pucci
- Unit of Internal Medicine, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Martina Sordi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Marcello Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
- IRCCS Neuromed, Località Camerelle, 86077 Pozzilli, Italy
| | - Amalia Morgantini
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Riccardo Rosati
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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26
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Zoni CR, Mukherjee D, Gulati M. Proposed new classification for acute coronary syndrome: Acute coronary syndrome requiring immediate reperfusion. Catheter Cardiovasc Interv 2023; 101:1177-1181. [PMID: 37061867 DOI: 10.1002/ccd.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Cesar R Zoni
- Division Cardiothoracic Surgery, Department of Surgery, UConn Health, Farmington, Connecticut, USA
| | - Debabrata Mukherjee
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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27
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Zhou L, Hu X, Zhang H, Lu H, Lin Y, Wang W, Yu B, Liang W, Zhou Y, Li G, Dong H. Effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction. J Int Med Res 2023; 51:3000605231182547. [PMID: 37377087 DOI: 10.1177/03000605231182547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Evidence of therapy for dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is limited. This study was performed to compare the effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation. METHODS This retrospective study enrolled 597 consecutive patients with STEMI who underwent pPCI in 3 centers from June 2016 to December 2019. Dysfunctional coronary circulation was defined by the thrombolysis in myocardial infarction (TIMI) grade and the TIMI myocardial perfusion grade (TMPG). Logistic regression analysis was used to evaluate the impact of different statin types on dysfunctional coronary circulation. RESULTS The incidence of TIMI no/slow reflow did not differ between the two groups, but the incidence of TMPG no/slow reflow was significantly lower in the atorvastatin than rosuvastatin group (44.58% vs. 57.69%, respectively). After multivariate adjustment, the odds ratio with 95% confidence interval of rosuvastatin was 1.72 (1.17-2.52) for after pretreatment TMPG no/slow reflow and 1.73 (1.16-2.58) for after stenting TMPG no/slow reflow. Atorvastatin and rosuvastatin showed no significant differences in clinical outcomes during hospitalization. CONCLUSIONS Compared with rosuvastatin, atorvastatin was associated with better coronary microcirculatory perfusion in patients with STEMI who underwent pPCI.
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Affiliation(s)
- Langping Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haotian Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haoyu Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yan Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Shantou University Medical College, Shantou, China
| | - Weimian Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wensheng Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Nyingchi People's Hospital, Nyingchi, China
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Chodór P, Honisz G, Wilczek K, Świerad M, Chodór-Rozwadowska K, Kalarus Z. Double protection in patients with a massive thrombus in the infarct-related artery - a single-center retrospective study. Postepy Kardiol Interwencyjnej 2023; 19:127-134. [PMID: 37465636 PMCID: PMC10351081 DOI: 10.5114/aic.2023.129211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/25/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction ST-segment elevation myocardial infarction (STEMI) is associated with thrombus formation on a ruptured or ulcerated atherosclerotic plaque. The consequences of a massive thrombus (MT) may include lack of reperfusion, extensive myocardial infarction (MI) and its complications. Although there are various treatment options for patients with coronary thrombi, double protection (DP) - manual thrombectomy (MTH) with a distal protection device (DPD) - has not been tested yet. Aim To present DP outcomes in the treatment of patients with STEMI and MT patients. Material and methods Fourteen patients with STEMI and MT were included in the study. Those patients underwent primary percutaneous coronary intervention (PPCI) with DP. Results Inferior MI was found in 12 (85.8%) patients. Stents were implanted in 13 (92.8%) patients. Thrombolysis In Myocardial Infarction (TIMI) Thrombus Grade 5 was present in 11 (78.6%) patients and Grade 4 in 3 (21.4%) patients. The median thrombus length was 39.1 mm. Complete reperfusion (TIMI flow 3) was observed in 11 (78.6%) patients and TIMI flow 2 in 3 (21.4%) patients. Myocardial Blush Grade (MBG) was used in patients with TIMI flow 3 and Grade 3 was found in 5 (35.7%) patients. Resolution in ST-segment elevation > 50% was obtained in 13 (92.8%) patients. No myocardial rupture, stroke, or death occurred during hospitalization. Conclusions DP in MT patients is a safe and feasible procedure. However, further observations and studies are needed to assess the efficacy of this method.
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Affiliation(s)
- Piotr Chodór
- Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Honisz
- Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
| | - Krzysztof Wilczek
- Silesian Center for Heart Diseases, 3 Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Świerad
- Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
| | - Karolina Chodór-Rozwadowska
- Doctoral School, Division of Medical Sciences in Zabrze, Medical University of Silesia, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
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Takahashi K, Takemoto M, Sakaue T, Ikeda S, Okura T. Vasospasm in the First Septal Perforator Branch and Late High-Grade Atrioventricular Block Following Successful Primary Percutaneous Coronary Intervention for the Proximal Left Anterior Descending Coronary Artery: A Case Report. Cureus 2023; 15:e39172. [PMID: 37378154 PMCID: PMC10291964 DOI: 10.7759/cureus.39172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
We present a case of a high-degree advanced atrioventricular block (AVB), which occurred 24 hours after successful primary percutaneous coronary intervention (PCI) in the proximal left anterior descending coronary artery (LAD), the culprit of ST-segment elevation myocardial infarction (STEMI). The methylergometrine provocation test for coronary vasospasms, which was performed on the eighth hospital day, revealed transient total occlusion of the first septal perforator branch. After prescribing a calcium channel blocker to the patient, AVB did not recur for three years, as confirmed using an implantable loop recorder (ILR). In this patient, delayed high-grade AVB following primary PCI in the proximal LAD might be caused by the spasm of the first septal perforator branch. Documented cases of spasms in this branch are rare.
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Affiliation(s)
- Koji Takahashi
- Department of Cardiology, Yawatahama City General Hospital, Yawatahama, JPN
| | - Masafumi Takemoto
- Department of Medical Engineering, Yawatahama City General Hospital, Yawatahama, JPN
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Matsuyama, JPN
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Matsuyama, JPN
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Yawatahama, JPN
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Janjani P, Salehi N, Asadmobini A, Siabani S, Nalini M. Smoker pseudo-paradox in ST-segment elevation myocardial infarction patients. Folia Med (Plovdiv) 2023; 65:243-250. [PMID: 37144309 DOI: 10.3897/folmed.65.e80189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Cigarette smoking is a preventable cause of cardiovascular morbidity and mortality. Despite the adverse effects of smoking, some studies have reported the term "smoker's paradox', meaning better outcomes in smokers following acute myocardial infarction. AIM The aim of the present study was to evaluate the relationship between smoking status and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS This was a registry-based cohort study of STEMI patients from Imam-Ali hospital, Kermanshah, Iran. Consecutive STEMI patients (July 2016-October 2018) were stratified by smoking status and followed for one year. Cox proportional models were used to estimate crude, age-adjusted, and full-adjusted hazard ratios with 95% confidence intervals (HR, 95%CI). RESULTS Of 1975 patients (mean age 60.1 years, 76.6% male) included in the study, 48.1% (n=951) were smokers (mean age 57.7 years, 94.7% male). Crude and age-adjusted HR (95% CI) for the associations of smoking and mortality were 0.67 (0.50-0.92) and 0.89 (0.65-1.22), respectively. After adjusting for age, sex, hypertension, diabetes, body-mass index, anterior wall myocardial infarction, creatine kinase-MB, glomerular filtration rate, left ventricular ejection fraction, low-density lipoprotein cholesterol, and hemoglobin, smoking was associated with increased risk of mortality: HR (95% CI: 1.56 (1.04-2.35). CONCLUSIONS In our study, smoking was associated with an increased risk of mortality. Although the smokers had a better outcome, this would be reversed after controlling for age and the other STEMI associated factors.
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Affiliation(s)
- Parisa Janjani
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Salehi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Soraya Siabani
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Nalini
- Kermanshah University of Medical Sciences, Kermanshah, Iran
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Sun B, Wang CY, Chen RR. Clinical Efficacy and Safety of Early Intravenous Administration of Beta-Blockers in Patients Suffering from Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure Undergoing Primary Percutaneous Coronary Intervention: A Study-Level Meta-Analysis of Randomized Clinical Trials. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07448-x. [PMID: 37002468 DOI: 10.1007/s10557-023-07448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Several clinical studies have produced diverse results regarding the efficacy and safety of early intravenous beta-blockers in patients with acute ST-segment elevation myocardial infarction (STEMI). A study-level meta-analysis of randomized clinical trials (RCTs) comparing early intravenous beta-blockers versus placebo or routine care in STEMI patients undergoing primary percutaneous coronary intervention (PCI) was performed. METHODS A database search was conducted using PubMed, EMBASE, the Cochrane Library, and Clinicaltrials.gov for randomized clinical trials (RCTs) that compared intravenous beta-blockers versus placebo or routine care in STEMI patients who underwent primary PCI. The efficacy outcomes were infarct size (IS, % of LV) and the myocardial salvage index (MSI) based on magnetic resonance imaging, electrocardiographic findings, heart rate, ST-segment reduction percent (STR%), and complete STR. Safety outcomes included arrhythmias in the first 24 h (ventricular tachycardia and fibrillation [VT/VF], atrial fibrillation [AF], bradycardia, and advanced atrioventricular [AV] block), cardiogenic shock and hypotension during hospitalization, left ventricular ejection fraction (LVEF), and major adverse cardiovascular events (cardiac death, stroke, reinfarction, and heart failure readmission) at follow-up. RESULTS Seven RCTs with 1428 patients were included in this study, with 709 patients in the intravenous beta-blockers and 719 in the control group. Intravenous beta-blockers improved MSI compared to the control group (weighted mean difference [WMD] 8.46, 95% confidence interval [CI] 3.12-13.80, P = 0.002, I2 = 0%), but no differences were observed in IS (% of LV) between groups. Compared to the control group, the intravenous beta-blockers group had a lower risk of VT/VF (relative risk [RR] 0.65, 95% CI 0.45-0.94, P = 0.02, I2 = 35%) without an increase of AF, bradycardia, and AV-block and significantly decreased HR, hypotension. LVEF at 1 week ± 7 days (WMD 2.06, 95% CI 0.25-3.88, P = 0.03, I2 = 12%) and 6 months ± 7 days (WMD 3.24, 95% CI 1.54-4.95, P = 0.0002, I2 = 0%) was improved in the intravenous beta-blockers group compared to the control group. Subgroup analysis showed that intravenous beta-blockers before PCI decreased the risk of VT/VF and improved LVEF compared to the control group. Furthermore, sensitivity analysis showed that patients with a left anterior descending (LAD) artery lesion had a smaller IS (% of LV) in the intravenous beta-blockers group compared to the control group. CONCLUSION Intravenous beta-blockers improved the MSI, decreased the risk of VT/VF in the first 24 h, and were associated with increased LVEF at 1 week and 6 months following PCI. In particular, intravenous beta-blockers started before PCI is beneficial for patients with LAD lesions.
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Affiliation(s)
- Bing Sun
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Chi Yao Wang
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Rui Rui Chen
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China.
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Abushabana M, Korashy M, Al-Tahmody K. Left Ventricular Global Longitudinal Strain Following Acute ST-Elevation Myocardial Infarction - A Comparison of Primary Coronary Angioplasty and Tenecteplase-Based Pharmacological Reperfusion Strategy. Heart Views 2023; 24:98-103. [PMID: 37305330 PMCID: PMC10249634 DOI: 10.4103/heartviews.heartviews_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Abstract
Objective In the setting of acute ST-elevation myocardial infarction (STEMI), reperfusion therapy with primary percutaneous coronary intervention (PCI) performed by an experienced team or pharmacological reperfusion with thrombolytic therapy is highly recommended. Standard echocardiographic measurement of the left ventricular ejection fraction (LVEF) is widely used to assess left ventricular global systolic function. This study was designed to compare the assessment of global left ventricular function by standard LVEF and global longitudinal strain (GLS) in the two well-known reperfusion strategies. Materials and Methods We conducted a retrospective single-center observational study in 50 patients with acute STEMI who underwent primary PCI (n = 25) and Tenecteplase (TNK)-based pharmacological reperfusion therapy (n = 25). The primary outcome was left ventricle (LV) systolic function after primary PCI, as assessed by two-dimensional (2D) GLS using speckle-tracking echocardiography (STE), as well as LVEF using standard 2D echocardiogram using Simpson's biplane method. Results Overall mean age was 53.7 ± 6.9 years with 88% male gender. The mean door-to-needle time was 29.8 ± 4.2 min in the TNK-based pharmacological reperfusion therapy arm, and the mean door-to-balloon time was 72.9 ± 15.4 min in the primary PCI arm. LV systolic function was significantly better in the primary PCI arm as compared to the TNK-based pharmacological reperfusion therapy, both by 2D STE (mean GLS: -13.6 ± 1.4 vs. -10.3 ± 1.2, P ≤ 0.001) and LVEF (mean LVEF: 42.2 ± 2.9 vs. 39.9 ± 2.7, P = 0.006). There were no significant differences in mortality and inhospital complications in both groups. Conclusion Global LV systolic function is significantly better after primary coronary angioplasty as compared to TNK-based pharmacological reperfusion therapy when assessed by routine LVEF and 2D GLS in the setting of acute STEMI.
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Affiliation(s)
- Mosaad Abushabana
- Department of Cardiology, Dubai Health Authority, Dubai Hospital, Dubai, UAE
| | - Mahmoud Korashy
- Department of Cardiology, The Ministry of Health and Prevention, Fujairah Hospital, Fujairah, UAE
| | - Kamaleldin Al-Tahmody
- Department of Cardiology, Dubai Health Authority, Dubai Hospital, Dubai, UAE
- Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Çınar T, Şaylık F, Hayıroğlu Mİ, Asal S, Selçuk M, Çiçek V, Tanboğa İH. The Association of Serum Uric Acid/Albumin Ratio with No-Reflow in Patients with ST Elevation Myocardial Infarction. Angiology 2023; 74:381-386. [PMID: 35726733 DOI: 10.1177/00033197221110700] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this investigation was to explore the relationship between serum uric acid/albumin ratio (UAR) and no-reflow (NR) in ST elevation myocardial infarction (STEMI) patients (n = 838) who underwent primary percutaneous coronary intervention (pPCI). Angiographic NR was defined as thrombolysis in myocardial infarction (TIMI) flows 0, 1, and 2 in the absence of coronary spasm or dissection. NR developed in 91 (10.9%) STEMI patients. Patients with NR had higher UAR and according to multivariable logistic regression models, a high UAR was an independent risk factor for NR. The area under the curve (AUC) value of the UAR was .760 (95%CI: .720-.801) in a receiver-operating characteristics curve (ROC) assessment. Notably, the UAR AUC value was greater than that of its components: albumin (AUC: .642) and serum uric acid (AUC: .637) (P < .05 for both comparisons). The optimum UAR value in detecting NR in STEMI patients was >1.21 with a sensitivity of 82% and a specificity of 67%. This was the first study to report that the UAR was independently associated with NR in STEMI patients who underwent pPCI.
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Affiliation(s)
- Tufan Çınar
- Department of Cardiology, 506079Istanbul Sultan II Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Faysal Şaylık
- Department of Cardiology, 64259Van Training and Research Hospital, Van, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, 111319Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Suha Asal
- Department of Cardiology, 506079Istanbul Sultan II Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, 506079Istanbul Sultan II Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Vedat Çiçek
- Department of Cardiology, 506079Istanbul Sultan II Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey.,Department of Cardiology, 385796Nisantası University, Istanbul, Turkey.,Department of Biostatistics, Atatürk University, Erzurum, Turkey
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Arrivi A, Truscelli G, Pucci G, Barillà F, Carnevale R, Nocella C, Sordi M, Dominici M, Tanzilli G, Mangieri E. The Combined Treatment of Glutathione Sodium Salt and Ascorbic Acid for Preventing Contrast-Associated Acute Kidney Injury in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Hypothesis to Be Validated. Antioxidants (Basel) 2023; 12:antiox12030773. [PMID: 36979021 PMCID: PMC10045886 DOI: 10.3390/antiox12030773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The occurrence of Contrast-Associated Acute Kidney Injury (CA-AKI) in patients with ST-Elevation Myocardial Infarction (STEMI) has a negative impact on the length of hospital stay and mortality. Reactive Oxygen Species (ROS) release, along with vasoconstriction and hypoperfusion, play a key role in its development. To date, there is still no validated prophylactic therapy for this disease. The use of antioxidants, based on experimental and clinical studies, looks promising. Taking into consideration previous literature, we speculate that an early, combined and prolonged intravenous administration of both Glutathione (GSH) and ascorbic acid in STEMI patients undergoing primary Percutaneous Coronary Intervention (pPCI) may be of value in counteracting the occurrence of CA-AKI. We aimed at evaluating this hypothesis by applying a multicenter research protocol, using a double-blind randomized, placebo-controlled trial design. The primary endpoint will be to test the efficacy of this combined antioxidant therapy in reducing the occurrence of renal damage, in patients with acute myocardial infarction treated with pPCI. Furthermore, we will investigate the effect of the study compounds on changes in oxidative stress markers and platelet activation levels through bio-humoral analyses.
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Affiliation(s)
- Alessio Arrivi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | | | - Giacomo Pucci
- Unit of Internal Medicine, S. Maria University Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies Sapienza University, 04100 Latina, Italy
- IRCCS Neuromed, Località Camerelle, 86077 Pozzilli, Italy
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Sordi
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Marcello Dominici
- Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy
| | - Gaetano Tanzilli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrico Mangieri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Hayek A, Dargaud Y, Maillard L, Finet G, Bochaton T, Rioufol G, Dérimay F. Thrombus burden management during primary coronary bifurcation intervention: a new experimental bench model. Cardiol J 2023; 31:24-31. [PMID: 36896636 PMCID: PMC10919574 DOI: 10.5603/cj.a2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Management of thrombus burden during primary percutaneous coronary intervention (pPCI) is a key-point, given the high risk of stent malapposition and/or thrombus embolization. These issues are especially important if pPCI involves a coronary bifurcation. Herein, a new experimental bifurcation bench model to analyze thrombus burden behavior was developed. METHODS On a fractal left main bifurcation bench model, we generated standardized thrombus with human blood and tissue factor. Three provisional pPCI strategies were compared (n = 10/group): 1) balloon-expandable stent (BES), 2) BES completed by proximal optimizing technique (POT), and 3) nitinol self-apposing stent (SAS). The embolized distal thrombus after stent implantation was weighed. Stent apposition and thrombus trapped by the stent were quantified on 2D-OCT. To analyze final stent apposition, a new OCT acquisition was performed after pharmacological thrombolysis. RESULTS Trapped thrombus was significantly greater with isolated BES than SAS or BES+POT (18.8 ± 5.8% vs. 10.3 ± 3.3% and 6.2 ± 2.1%, respectively; p < 0.05), and greater with SAS than BES+POT (p < 0.05). Isolated BES and SAS tended show less embolized thrombus than BES+POT (5.93 ± 4.32 mg and 5.05 ± 4.56 mg vs. 7.01 ± 4.32 mg, respectively; p = NS). Conversely, SAS and BES+POT ensured perfect final global apposition (0.4 ± 0.6% and 1.3 ± 1.3%, respectively, p = NS) compared to isolated BES (74.0 ± 7.6%, p < 0.05). CONCLUSIONS This first experimental bench model of pPCI in a bifurcation quantified thrombus trapping and embolization. BES provided the best thrombus trapping, while SAS and BES+POT achieved better final stent apposition. These factors should be taken into account in selecting revascularization strategy.
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Affiliation(s)
- Ahmad Hayek
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Yassim Dargaud
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, CRTH de Lyon, CHU de Lyon, France
| | | | - Gerard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Thomas Bochaton
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - François Dérimay
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
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Jakl M, Cervinka P, Kanovsky J, Kala P, Poloczek M, Cervinkova M, Bezerra HG, Valenta Z, Costa MA. Randomized comparison of 9-month stent strut coverage of biolimus and everolimus drug-eluting stents assessed by optical coherence tomography in patients with ST-segment elevation myocardial infarction. Long-term (5-years) clinical follow-up (ROBUST trial). Cardiol J 2023:VM/OJS/J/90905. [PMID: 36896638 DOI: 10.5603/cj.a2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/01/2023] [Accepted: 01/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The aim of the study was to compare healing (assessed by optical coherence tomography [OCT]) of biolimus A9 (BES) and everolimus drug-eluting stents (EES) at 9-month follow-up in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Nine-month clinical and angiographic data were also compared in both groups as well as clinical data at 5 years of follow-up. METHODS A total of 201 patients with STEMI were enrolled in the study and randomized either to pPCI with BES or EES implantation. All patients were scheduled for 9 months of angiographic and OCT follow-up. RESULTS The rate of major adverse cardiovascular events (MACE) was comparable at 9 months in both groups (5% in BES vs. 6% in the EES group; p = 0.87). Angiographic data were also comparable between both groups. The main finding at 9-month OCT analysis was the greatly reduced extent of mean neointimal area at the cost of a higher proportion of uncovered struts in the BES group (1.3 mm² vs. 0.9 mm²; p = 0.0001 and 15.9% vs. 7.0%; p = 0.0001, respectively). At 5 years of clinical follow-up the rate of MACE was comparable between both groups (16.8% vs. 14.0%, p = 0.74). CONCLUSIONS The study demonstrates a very low rate of MACE and good 9-month stent strut coverage of second-generation BES and EES in patients with STEMI. BES showed greatly reduced extent of mean neointimal hyperplasia area at the cost of a higher proportion of uncovered struts when compared to EES. The rate of MACE was low and comparable in both groups at 5 years.
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Affiliation(s)
- Martin Jakl
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
- Department of Emergency Medicine, University Hospital in Hradec Kralove, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajska Zdravotni a.s., Masaryk Hospital and UJEP Usti nad Labem, Czech Republic.
| | - Jan Kanovsky
- Department of Cardiology and Internal Medicine, University Hospital Brno, Czech Republic
- Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Petr Kala
- Department of Cardiology and Internal Medicine, University Hospital Brno, Czech Republic
| | - Martin Poloczek
- Department of Cardiology and Internal Medicine, University Hospital Brno, Czech Republic
| | - Michaela Cervinkova
- Department of Cardiology, Krajska Zdravotni a.s., Masaryk Hospital and UJEP Usti nad Labem, Czech Republic
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, United States
| | - Zdenek Valenta
- Department of Statistical Modelling, Institute of Computer Science, Czech Academy of Science, Prague, Czech Republic
| | - Marco Aurelio Costa
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, United States
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Ozturk E, Esenboga K, Kurtul A, Kilickap M, Karaagaoglu E, Karakaya J. Measurement of Uncertainty in Prediction of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention Using Systemic Immune Inflammation Index: The Gray Zone Approach. Diagnostics (Basel) 2023; 13. [PMID: 36832197 DOI: 10.3390/diagnostics13040709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Systemic immune-inflammation index (SII), which is a good predictive marker for coronary artery disease, can be calculated by using platelet, neutrophil, and lymphocyte counts. The no-reflow occurrence can also be predicted using the SII. The aim of this study is to reveal the uncertainty of SII for diagnosing ST-elevation myocardial infarction (STEMI) patients who were admitted for primary percutaneous coronary intervention (PCI) for the no-reflow phenomenon. A total of 510 consecutive acute (STEMI) patients with primary PCI were reviewed and included retrospectively. For diagnostic tests which are not a gold standard, there is always an overlap between the results of patients with and without a certain disease. In the literature, for quantitative diagnostic tests where the diagnosis is not certain, two approaches have been proposed, named "grey zone" and "uncertain interval". The uncertain area of the SII, which is given the general term "gray zone" in this article, was constructed and its results were compared with the "grey zone" and "uncertain interval" approaches. The lower and upper limits of the gray zone were found to be 611.504-1790.827 and 1186.576-1565.088 for the grey zone and uncertain interval approaches, respectively. A higher number of patients inside the gray zone and higher performance outside the gray zone were found for the grey zone approach. One should be aware of the differences between the two approaches when making a decision. The patients who were in this gray zone should be observed carefully for detection of the no-reflow phenomenon.
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Gok M, Kurtul A, Taylan G, Ozturk C, Cakır B, Yılmaz E, Altay S, Yalta K. Impact of chronic total occlusion in a non-infarct-related coronary artery on contrast-associated nephropathy in acute ST-elevation myocardial infarction. Acta Cardiol 2023; 78:118-123. [PMID: 35678246 DOI: 10.1080/00015385.2022.2085357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Co-existing chronic total occlusion (CTO) in a non-infarct-related artery (IRA) might serve as an important trigger of adverse outcomes in ST-segment elevation myocardial infarction (STEMI). Therefore, we planned to analyse the potential impact of non-IRA CTO on the evolution of contrast-associated nephropathy (CAN) in STEMI patients managed with primary percutaneous coronary intervention (P-PCI). METHODS A total of 537 subjects with STEMI undergoing P-PCI during the first 12 h after the onset of their symptoms were enrolled in this retrospective study. The subjects were categorised based on the angiographic presence of non-IRA CTO. Moreover, the subjects were also divided into 2 groups based on their CAN status following P-PCI (CAN (+) and CAN (-)). RESULTS Co-existing non-IRA CTO was demonstrated in 86 subjects (16%). During the hospitalisation period, we identified 81 (15.1%) subjects with CAN. Subjects with non-IRA CTO had a significantly higher incidence of CAN compared with those without (56 [12.4%] vs 25 [29.1%], respectively, p < 0.001). In a logistic regression analysis, an existing non-IRA CTO (odds ratio: 2.840, 95%CI: 1.451-5.558, p = 0.002), as well as age, haemoglobin, diabetes mellitus, creatinine, and white blood cell count, were independent of predictors of CAN. CONCLUSION In STEMI patients managed with P-PCI, a co-existing non-IRA CTO had an independent association with the evolution of CAN.
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Affiliation(s)
- Murat Gok
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Alparslan Kurtul
- Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Gokay Taylan
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Cihan Ozturk
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Burcu Cakır
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Efe Yılmaz
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Servet Altay
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Kenan Yalta
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
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Zhao X, Song L, Li J, Zhou J, Li N, Yan S, Chen R, Wang Y, Liu C, Zhou P, Sheng Z, Chen Y, Zhao H, Yan H. Effect of Triglyceride-Glucose Indices and Circulating PCSK9-Associated Cardiovascular Risk in STEMI Patients with Primary Percutaneous Coronary Artery Disease: A Prospective Cohort Study. J Inflamm Res 2023; 16:269-282. [PMID: 36713050 PMCID: PMC9875734 DOI: 10.2147/jir.s389778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023] Open
Abstract
Background and Aims This study aimed to determine whether convertase subtilisin/kexin type 9 (PCSK9)-associated cardiovascular risk is modulated by triglyceride-glucose (TyG) in ST-segment elevation myocardial infarction (STEMI) patients with primary percutaneous coronary disease (PCI). Methods A total of 1541 patients with STEMI (aged ≥18 years) undergoing primary PCI were consecutively enrolled between March 2017 and March 2019. Outcomes When stratifying the overall population according to TyG indices less than or greater than the median (TyG median = 9.07) as well as according to quartiles of PCSK9 levels, higher TyG index levels were significantly associated with all-cause mortality only when TyG levels were 9.07 or higher (ie, relative to quartile 1 [Q1], the adjusted HR for all-cause mortality was 3.20 [95% CI, 0.54-18.80] for Q2, p = 0.199; 7.89 [95% CI, 1.56-40.89] for Q3, p = 0.013; and 5.61 [95% CI, 1.04-30.30] for Q4, p = 0.045. During a median follow-up period of 1.96 years, the HR for all-cause mortality was higher in the subset of patients with TyG ≥median and PCSK9 ≥median (p for trend = 0.023) among those with type 2 diabetes mellitus (T2DM). However, there were no statistically significant differences among the subgroups. Among T2DM patients with a TyG index greater than the median, the Kaplan-Meier curve showed that patients with the highest PCSK9 levels had an increased risk of all-cause mortality (log-rank p = 0.017) and cardiac-cause mortality (log-rank p = 0.037) compared with lower PCSK9 quartile levels. Conclusion Elevated PCSK9 levels are related to all-cause mortality and cardiac-related mortality when TyG levels are greater than the median, but not when levels are less than the median. This suggests a potential benefit of lowering circulating PCSK9 levels in STEMI patients with insulin resistance.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Nan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Shaodi Yan
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China,Hanjun Zhao, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167, Beijing, 100037, People’s Republic of China, Tel +86-15210020808, Email
| | - Hongbing Yan
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China,Correspondence: Hongbing Yan, Fuwai Hospital, Chinese Academy of Medical Sciences, 12 Langshan Road, Shenzhen, 518000, People’s Republic of China, Tel +86-13701339287, Email
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Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention. J Clin Med 2023; 12:jcm12030840. [PMID: 36769488 PMCID: PMC9917385 DOI: 10.3390/jcm12030840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a rare but critical complication following ST-elevation myocardial infarction (STEMI). The risk of AIS or transient ischemic attack (TIA) may be amplified by invasive procedures, including primary percutaneous coronary intervention (PCI). This study aimed to investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who required primary PCI. METHODS We included 941 STEMI patients who underwent primary PCI and divided them into an AIS/TIA group (n = 39) and a non-AIS/TIA group (n = 902), according to new-onset AIS/TIA. The primary interest was to find the factors associated with AIS/TIA by multivariate logistic regression analysis. We also compared clinical outcomes between the AIS/TIA and non-AIS/TIA groups. RESULTS The incidence of in-hospital deaths was significantly higher in the AIS/TIA group (46.2%) than in the non-AIS/TIA group (6.3%) (p < 0.001). Multivariate analysis revealed that cardiogenic shock (OR 3.228, 95% CI 1.492-6.986, p = 0.003), new-onset atrial fibrillation (AF) (OR 2.280, 95% CI 1.033-5.031, p = 0.041), trans-femoral approach (OR 2.336, 95% CI 1.093-4.992, p = 0.029), use of ≥4 catheters (OR 3.715, 95% CI 1.831-7.537, p < 0.001), and bleeding academic research consortium (BARC) type 3 or 5 bleeding (OR 2.932, 95% CI 1.256-6.846, p = 0.013) were significantly associated with AIS/TIA. CONCLUSION In STEMI patients with primary PCI, new-onset AIS/TIA was significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, the use of ≥4 catheters, and BARC type 3 or 5 bleeding. We should recognize these modifiable and unmodifiable risk factors for AIS/TIA in the treatment of STEMI.
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Li SY, Liu L, Wang DK, Ding XS, Li WP, Li HW. Prognostic Value of Pentraxin-3 Change After Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction. J Inflamm Res 2023; 16:1255-1266. [PMID: 36987516 PMCID: PMC10040170 DOI: 10.2147/jir.s393703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose So far, ST-segment elevation myocardial infarction (STEMI) is still the main cause of morbidity and mortality of cardiovascular diseases worldwide. Recent studies showed that pentraxin-3 (PTX3) was related to the early diagnosis and prognosis of coronary heart disease. This study aimed to investigate the dynamical change of PTX3 after primary percutaneous coronary intervention (pPCI) in STEMI patients and its prognostic value. Patients and methods In this prospective cohort study, a total of 350 patients were enrolled. The plasma level of PTX3 was measured at admission, 24-hour and 5-day after pPCI. The primary endpoint was the incidence of major adverse cardiac cerebral events (MACCEs) during 1-year follow-up. Results Compared with the admission, PTX3 levels were significantly increased at 24 hours, and decreased at 5 days after pPCI in the whole cohort. PTX3 levels at these three time points were not significantly different between the patients with and without MACCEs. Notably, the change in PTX3 from admission to post-pPCI 24-hour (ΔPTX3) was higher in patients with MACCEs (112.83 vs 17.94 ng/dl, P = 0.001). The ROC curves showed that the cut-off value was 29.22 ng/dl and the area under curves was 0.622 (95% CI: 0.554-0.690, p = 0.001). Multivariable cox regression models revealed that the high ΔPTX3 group was an independent predictor of MACCEs (adjusted HR = 2.010, 95% CI = 1.280-3.186, p = 0.003). The higher ΔPTX3 group had significantly higher incidences of revascularization (HR = 2.094, 95% CI: 1.056-4.150, p = 0.034) and composite MACCEs (HR = 2.219, 95% CI: 1.425-3.454, p < 0.001). However, the change of PTX3 level from admission to post-pPCI 5-day had no independently predictive value. Conclusion The higher increase of PTX3 level 24-hour after pPCI appeared to have a potential value in independently predicting the incidence of 1-year MACCEs in STEMI patients, especially for coronary revascularization.
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Affiliation(s)
- Sheng-Yu Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lei Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ding-Kun Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiao-Song Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wei-Ping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, People’s Republic of China
- Correspondence: Wei-Ping Li; Hong-Wei Li, Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People’s Republic of China, Tel +86-13810267817; +86-13801396679, Email ;
| | - Hong-Wei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, People’s Republic of China
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Guo Y, Wang J, Wang Z, Li L, An J. Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study. Arch Med Sci 2023; 19:242-249. [PMID: 36817677 PMCID: PMC9897106 DOI: 10.5114/aoms/157287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/09/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION This study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were undergoing primary percutaneous coronary intervention (PPCI). METHODS The study is a prospective, natural, and selective interventional trial based on real-world data for 482 AMI patients. RESULTS At the end of the follow-up, the two groups demonstrated similar major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding rates. After propensity score matching (PSM), the fondaparinux group showed greater advantages in reducing MACCE and bleeding events. CONCLUSIONS The anticoagulation strategy of bivalirudin bridging fondaparinux seems to be superior to that of bivalirudin bridging enoxaparin in patients with AMI undergoing PPCI.
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Affiliation(s)
- Yanqing Guo
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Jingping Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Zhixin Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Li Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
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Wang J, Yan CY, Wang W, Wang TZ. Preventive Effect of Moderate Altitude on Non-Culprit Lesion Progression in Patients with Acute Myocardial Infarction. High Alt Med Biol 2022; 23:345-351. [PMID: 36178459 DOI: 10.1089/ham.2021.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Wang, Jian, Cheng-Ying Yan, Wu Wang, and Tian-Zhen Wang. Preventive effect of moderate altitude on non-culprit lesion (NCL) progression in patients with acute myocardial infarction. High Alt Med Biol. 23:345-351, 2022. Background: Ischemic postconditioning may prevent NCL progression in patients with acute myocardial infarction. Moderate altitude (1,500-2,500 m) resembles ischemic postconditioning; however, the preventive effect of moderate altitude on NCL progression is unknown. Methods: We investigated the preventive effect of moderate altitude on NCL progression in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). This study was an observational study. Two-hundred patients with STEMI living in Beijing, which is an average of 43.5 m above sea level (a low-altitude region), who underwent PPCI were enrolled (the control group). A further 200 patients with STEMI living in Xining, which is an average of 2,261 m above sea level (moderate-altitude region), who underwent PPCI were enrolled (the moderate-altitude group). NCL progression and related clinical factors were compared between the two groups. Results: The rate of NCL progression 12 months after PPCI in the moderate-altitude group was significantly lower compared with the control group (p < 0.01). There were 158 patients without NCL progression (group A) and 42 patients with NCL progression (group B) in the control group and 186 patients without NCL progression (group C) and 14 patients with NCL progression (group D) in the moderate-altitude group. Serum adrenaline and noradrenaline concentrations in group B were significantly higher compared with group A (p < 0.001), and serum adrenaline and noradrenaline concentrations in group D were significantly higher compared with group C (p < 0.001). Serum adrenaline, noradrenaline, and C-reactive protein concentrations in patients without NCL progression (n = 344) were significantly lower compared with patients with NCL progression (n = 56) (p < 0.01). Conclusions: Moderate altitude may prevent NCL progression. Moderate altitude may be useful for clinical rehabilitation in patients with STEMI after PPCI.
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Affiliation(s)
- Jian Wang
- Department of Cardiology, Beijing Geriatric Hospital, Beijing, China.,Department of Cardiology, Xining First People's Hospital, Xining, Qinghai, China
| | - Cheng-Ying Yan
- Department of Cardiology, Xining First People's Hospital, Xining, Qinghai, China
| | - Wu Wang
- Department of Cardiology, Xining First People's Hospital, Xining, Qinghai, China
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Wang Y, Liu Z, Wu Y, Li Z, Wang Y, Wang S, Xu R, Zhang L, Wang Y, Guo J. Early prevention of radial artery occlusion via distal transradial access for primary percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:1071575. [PMID: 36531698 PMCID: PMC9747753 DOI: 10.3389/fcvm.2022.1071575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/10/2022] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Conventional transradial access (TRA) has been the preferred access for coronary intervention. Recently, distal radial access (DRA) is introduced as an alternative choice to reduce radial artery occlusion (RAO) risk. The study sought to assess the impact of DRA on early RAO using Doppler ultrasound in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS This is a prospective, single-center, open-label randomized clinical trial in which patients with indications for primary PCI from January 2022 to September 2022 were assigned to DRA or TRA group with 100 cases in each group. The primary endpoint was the incidence of forearm RAO, evaluated by Doppler ultrasound before discharge. RESULTS The rate of access success was comparable between the DRA and TRA groups (98.0 vs. 94.0%, P = 0.279). Compared with the TRA group, longer puncture time was observed in the DRA group [2.4 (1.7-4.2) min vs. 1.7 (1.4-2.3) min; P < 0.001] whereas the door-to-wire time was not delayed in primary PCI [71 (54-88) min vs. 64 (56-82) min, P = 0.103]. Shorter hemostasis time was required in the DRA group [3.1 (2.7-3.3) h vs. 6.2 (5.9-6.4) h; P < 0.001]. Significant reduction of the incidence of forearm RAO was observed in the DRA group (2.0 vs. 9.0%, P = 0.030). Local hematomas ≤ 5 cm was similar in both groups (4.0 vs. 6.0%, P = 0.516), while those > 5 cm were significantly more frequent in the TRA group (0 vs. 6.0%, P = 0.029). CONCLUSION Distal radial access is associated with a comparable lower incidence of forearm RAO, shorter hemostasis time, and lower rate of vascular complications compared to TRA in primary PCI. SYSTEMATIC REVIEW REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR2200061841].
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jincheng Guo
- Division of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Chen Y, Gao YF, Wang YF, Wang CJ, Du Y, Ding YH. Influence of Stent Length on Periprocedural Outcomes After Primary Percutaneous Coronary Intervention in Patients with ST Segment Elevation Myocardial Infarction. Clin Interv Aging 2022; 17:1687-1695. [PMID: 36467316 PMCID: PMC9717423 DOI: 10.2147/cia.s389302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/19/2022] [Indexed: 08/26/2023] Open
Abstract
PURPOSE A longer stent is associated with adverse events after percutaneous coronary intervention (PCI). However, little information is available on the relationship between stent length and periprocedural prognosis in patients with ST segment elevation myocardial infarction (STEMI). We aimed to assess the target vessel stent length influence on angiographic outcomes and in-hospital major adverse cardiovascular event (MACE) during primary PCI in patients with STEMI. PATIENTS AND METHODS This single-center retrospective observational study included 246 patients with STEMI admitted to the Zhejiang Provincial People's Hospital between January 2019 and December 2021, who underwent primary PCI and successful stent implantation. The exclusion criteria included left main lesion, multiple diseased vessel-stenting, bleeding disorders, contrast allergy, and incomplete data. Patients were divided into two groups based on the median stents length: group A (≤29 mm, n=125) and group B (>29mm, n=121). Periprocedural outcomes were slow flow/no-reflow (SF-NR) and in-hospital MACE, which included acute heart failure, malignant arrhythmia, cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and urgent revascularization. Multivariate logistic analyses were used to explore the correlation between stent length and SF-NR. RESULTS A total of 246 patients (82.9% males) with a mean age of 59.9±12.6 years were included in the analysis. The incidence of SF-NR was significantly higher in group B than in group A (36.4% vs 23.2%, p=0.024). However, the in-hospital MACE incidence rate was similar between the two groups (7.2% vs 7.4%, p=0.943). Multivariate logistic regression analysis showed that stent length and diameter, and peak troponin I level were independent risk factors for SF-NR. CONCLUSION Excessive stent length is an independent risk factor for SF-NR, without any significant influence on the risk of MACE during hospitalization.
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Affiliation(s)
- Yan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Ya-Fang Gao
- Graduate Department, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Yun-Fan Wang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Cheng-Jian Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ying Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya-Hui Ding
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
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Bibi S, Khan A, Khan AH, Khan MN, Mushtaq S, Rashid SA. Primary percutaneous coronary intervention in CAD patients: A comparison of major adverse cardiovascular events of second- and third-generation drug-eluting stents. Front Pharmacol 2022; 13:900798. [PMID: 36467026 PMCID: PMC9709248 DOI: 10.3389/fphar.2022.900798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
Background: Biodegradable polymer (BP) drug-eluting stents (DES) have been introduced as a novel solution to the problems of durable polymer (DP) stents. In Pakistan, very few studies are available for the treatment intervention in post-primary percutaneous coronary intervention (PPCI) patients. Our study will compare the major adverse cardiovascular events (MACEs) and their predictors in patients with coronary artery disease (CAD) undergoing PPCI with second- or third-generation DES. Methodology: An observational, retrospective, cohort study was carried out on CAD patients undergoing PPCI with either second- (DP-XIENCE Prime/XIENCE Xpedition) or third-generation (BP-BioMatrix NeoFlex/BioMatrix Alpha) DES. MACEs were assessed after 1 year of PPCI procedure in 341 patients and screened as per inclusion/exclusion criteria (167 in the second-generation group and 174 in the third-generation group). Results: The number of male patients (86.2%) was more than female patients in our study population. MACEs were reported in 4.19% patients after 1 year duration, and the percentage of MACEs was more in the second-generation DES group (4.77%) than in the third-generation group (3.44%); however, statistical analysis has not found any significant difference (p = 0.534). The rate of myocardial infarction (1.19% vs. 0.57%) and stent thrombosis (1.8% vs. 1.15%) was more in the second-generation DES group. However, restenosis (1.19% vs. 1.15%) and cardiac death (0.59% vs. 0.57%) were almost same in both groups. A significant association was found between MACEs and diabetes mellitus (p = 0.025), hypertension (p = 0.035), smoking (p = 0.008), and a family history of CAD (p = 0.018). Conclusion: BP-BioMatrix and DP-XIENCE DES have comparable clinical outcomes. Findings of the current study will assist the policy makers and healthcare providers in the rationalization of scarce resources and evidence-based patient care. However, longer follow-up studies are required for convincing results.
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Affiliation(s)
- Salma Bibi
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Penang, Malaysia
| | - Muhammad Niaz Khan
- Department of Interventional Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Sheikh Abdur Rashid
- Gomal Center of Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, D.I.Khan, Pakistan
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Abstract
Reducing thrombus burden would improve patient's outcomes. Low-dose intracoronary thrombolytic agent administration has been considered to improve myocardial microcirculation, cardiac function, and major adverse cardiovascular events in patients presenting with ST-segment elevation myocardial infarction and high thrombus burden. This paper discusses published meta-analyses on intracoronary thrombolysis in primary percutaneous intervention.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdul Rahman Arabi
- Department of Cardiology, Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
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Yu XF, Chen HW, Xu J, Xu QZ, Zhang XH, Li BB, Xu BL, Ma LK. Bivalirudin vs. heparin on a background of ticagrelor and aspirin in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A multicenter prospective cohort study. Front Cardiovasc Med 2022; 9:932054. [PMID: 36386368 PMCID: PMC9649932 DOI: 10.3389/fcvm.2022.932054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/05/2022] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Current guidelines recommend potent P2Y12 inhibitors such as ticagrelor over clopidogrel as part of the dual antiplatelet therapy (DAPT) after ST-segment elevation myocardial infarction (STEMI), irrespective of final management strategy. The aim of this multicenter prospective cohort study was to examine the efficacy and safety of bivalirudin with background ticagrelor and aspirin therapy in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). METHODS A total of 800 patients with STEMI who were undergoing PPCI and receiving treatment with aspirin and ticagrelor from three Hospitals between April 2019 and September 2021 were included in this study. The patients were assigned, according to the perioperative anticoagulant, to the bivalirudin group (n = 456) or the heparin group (n = 344). In this study, the primary endpoint was 30-day net adverse clinical events (NACEs), a composite of major adverse cardiac or cerebral events (MACCEs, a composite of cardiac death, recurrent myocardial infarction, ischemia-driven target vessel revascularization, or stroke), or any bleeding as defined by the Bleeding Academic Research Consortium (BARC) definition (grades 1-5). RESULTS The patients were followed up for 30 days after PPCI. The incidence of NACE was significantly lower in the bivalirudin group than in the heparin group (11.2 vs. 16.0%, P = 0.042), and this significance was mainly a consequence of the reduction in BARC 1 bleeding events in the bivalirudin group compared to the heparin group (3.2 vs. 7.1%, P = 0.010). Results from multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACE (HR: 0.676, 95% CI: 0.462-0.990, P = 0.042) and BARC1 bleeding events (HR: 0.429, 95% CI: 0.222-0.830, P = 0.010). No significant between-group differences were observed for MACCE, all-cause mortality, cardiac death, recurrent myocardial infarction, stroke, target vessel revascularization, stent thrombosis, and BARC2-5 bleeding events at 30 days. CONCLUSION In patients with STEMI who were undergoing primary PCI and receiving treatment with aspirin and ticagrelor, bivalirudin was associated with decreased rates in NACE and minimal bleeding events without significant differences in the rates of MACCE or stent thrombosis when compared with heparin. Nevertheless, large randomized trials are warranted to confirm these observations. CLINICAL TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (ChiCTR, http://www.chictr.org.cn; identifier [ChiCTR1900022529]). Registered on 15 April 2019. Registration title: Effect of bivalirudin combined with ticagrelor in patients with ST-segment elevation myocardial infarction during primary percutaneous coronary intervention.
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Affiliation(s)
- Xiao-Fan Yu
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Hong-Wu Chen
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Jie Xu
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Qi-Zhi Xu
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Xiao-Hong Zhang
- Department of Cardiology, The First People's Hospital of Hefei City, Hefei, China
| | - Bin-Bin Li
- Department of Cardiology, The First People's Hospital of Hefei City, Hefei, China
| | - Bang-Long Xu
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li-Kun Ma
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
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Zhang Q, Hu M, Ma S, Niu T. New R 2-CHA 2DS 2-VASc score predicts no-reflow phenomenon and long-term prognosis in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:899739. [PMID: 36312233 PMCID: PMC9609412 DOI: 10.3389/fcvm.2022.899739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Evaluating the prognostic validity of new R2-CHA2DS2-VASc score for no-reflow phenomena and long-term prognosis in patients following primary percutaneous coronary intervention (PCI) with ST-elevation myocardial infarction (STEMI). Materials and methods From January 2017 to December 2018, a total of 401 patients with STEMI were continuously enrolled. According to the cut-off value, the patients were separated into two groups: R2-CHA2DS2-VASc < 3 group (n = 275) and R2-CHA2DS2-VASc ≥ 3 group (n = 126). Results With a sensitivity of 52.6% and a specificity of 73.1%, the optimal cut-off value for predicting no-reflow is R2-CHA2DS2-VASc ≥ 3. R2-CHA2DS2-VASc ≥ 3 as the ideal cut-off value for predicting major adverse cardiovascular events (MACE) with an area under the curve (AUC) of 0.781 [95% Confidence interval (CI): 0.738–0.801, P 0.001], a sensitivity of 50%, and a specificity of 91.1%. The incidence of MACE, death from all causes, and worsening heart failure was greater in the R2-CHA2DS2-VASc ≥ 3 group, although there was no significant difference in the incidence of repeated revascularisation procedures following PCI between the two groups. R2-CHA2DS2-VASc ≥ 3 was also an independent predictor of MACE (hazard ratio = 2.48, 95% confidence interval CI: 1.33–4.62, P = 0.04). Moreover, this score has a greater sensitivity (66.7%) and specificity (88.7%) for predicting the progression of heart failure. Conclusion R2-CHA2DS2-VASc ≥ 3 was independently associated with no-reflow phenomenon and poor clinical outcomes for patients in STEMI after primary PCI.
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Dai C, Liu M, Zhou Y, Lu D, Chen Z, Qian J, Ge J. Aortic valve calcification predicts poor outcomes after primary percutaneous coronary intervention. Eur J Clin Invest 2022; 52:e13828. [PMID: 35748527 DOI: 10.1111/eci.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aortic valve calcification (AVC) is associated with increased cardiovascular risk in the general population. We sought to investigate whether AVC identified by transthoracic echocardiography could be a predictor of long-term adverse events after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. METHODS Patients undergoing primary PCI were consecutively enrolled in this cohort study between 1 January 2009 and 31 December 31 2018. The presence of AVC was identified by transthoracic echocardiography one to three days after PCI. The primary endpoint was major adverse cardiovascular and cerebral events (MACCE) during follow-up. Propensity score matching was adopted to adjust for the baseline differences between groups. RESULTS Of 2117 patients enrolled in the study, 566 (26.7%) were found to have AVC. Patients with AVC were older, more likely to be women, and disposed to have comorbidities and complex lesions. During a median follow-up period of 6.1 years, 699 cases of MACCE occurred, including 243 (42.9%) cases in patients with AVC and 456 (29.4%) cases in patients without AVC. After 1:1 propensity score matching, the presence of AVC increased the risk of MACCE (adjusted hazard ratio: 1.442, 95% confidence interval: 1.186 to 1.754, p < 0.001). This difference persisted when sensitivity and subgroup analyses were made. CONCLUSIONS AVC identified by transthoracic echocardiography independently increased the long-term risk of MACCE after primary PCI in patients with acute myocardial infarction. This imaging feature will contribute to better risk stratification in this population.
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Affiliation(s)
- Chunfeng Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Muyin Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - You Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Danbo Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
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