Abstract
The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary. We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease. MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01. MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.
Highlights
The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary
Total of 871 patients underwent primary PCI during this period, among whom 584 patients were excluded for following reasons: with documented history of coronary artery disease; development of accelerated idioventricular rhythm, a new bundle branch block; with history of thyroid related disorders, chronic systemic illness and other comorbid conditions; patients admitted to the hospital after 24 hours period from the onset of symptoms; patients undergoing thrombolysis before CAG
The proportion of male patient in total occlusion group was higher as compare to that in patent IRA group (88.2% vs. 78.6%, P < 0.05, Table 1), while the age and different occupations among two groups has no significant differences (Table 1 and 2)
Summary
The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary. Over seven million people die every year from coronary heart disease, accounting for 12.8% of all deaths.[1] In China, Cardiovascular diseases (CVD) cause one third of all deaths, and the number is expected to be double by 20202. Acute myocardial infarction (AMI) is caused by complex interaction among the atherosclerotic plaque, platelet activation, thrombus formation and coronary vasospasm.[3] ST-segment elevation myocardial infarction (STEMI) signifies total occlusion of a coronary artery leading to myocardial necrosis. 10-20% of patients with acute STEMI presents with a patent infarct-related artery on the initial angiogram showed spontaneous coronary recanalization before angioplasty and the prognosis of these patients is significantly better.[4] there are numerous research predicting different kinds of factors and its role in development of coronary artery disease (CAD), the study about factors that causes the autolysis of coronary thrombosis in patient with STEMI during its early stage, are very limited
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