ST-segment Elevation Acute Myocardial Infarction Patients Research Articles

Association of sex and age and delay predictors on the time of primary angioplasty activation for myocardial infarction patients in an emergency department

Background: Time between Emergency Department (ED) and ST-segment elevation acute myocardial infarction (STEMI) activation time is a good indicator of ED quality. STEMI delays are of particular importance in some subgroups, such as women and the elderly. Objective: To determine the association of sex and age with activation time in STEMI patients admitted to the ED. Methods: An observational retrospective study was conducted including all patients admitted to the ED activated as a STEMI. The main variable was activation time. To evaluate the independent predictors of activation time, a multivariate logistic regression analysis was carried out, variables were sex, age, sex and age combined, chest pain, ST elevation in the electrocardiogram, and first medical contact (FMC) at the hospital's ED. Results: A total of 330 patients were included. They were classified by sex: 23.9% (78) women and 76.1% (249) men; and age: 51.1% (167) <65 yo and 48.9% (160) ≥65 yo. Women and elderly patients exhibited a more atypical presentation. Multivariate analysis shows that showed that elderly age (OR=1.976 95%; CI=1.257–3.104; p = 0.003) and FMC prior to attending the ED (OR=1.762; 95% CI=1.117–2.779; p = 0.015) were associated with a longer activation time. Women older than 65 years old showed the longest activation time. Conclusion: STEMI delays are longer in women and the elderly with atypical presentation. Age ≥65 and FMC outside the ED were associated with an increase in the activation time. This highlights the need to develop strategies to improve activation time for these specific patient groups.

Association between Endothelial Cell-Specific Molecule 1 and Galectin-3 in Patients with ST-Segment Elevation Myocardial Infarction: A Pilot Study.

The biomarkers galectin-3 (Gal-3) and endothelial cell-specific molecule 1 (ESM-1) reflect endothelial function and inflammation. As a consequence, they play an important role in both the diagnosis and characterization of ST-segment elevation myocardial infarction (STEMI). However, no prior study has explored the association between ESM-1 and Gal-3 in STEMI patients. This study is aimed at determining the ESM-1 and Gal-3 levels in the serum of STEMI patients and then exploring the correlation between the levels of these two biomarkers and their clinical significance in STEMI patients. The participants were divided into two groups: the ST group comprised 35 hospitalized STEMI patients while the control group comprised 24 people with normal coronary arteries. In all the patients, venous blood was taken from the middle of the antecubital fossa. The serum ESM-1 and Gal-3 concentrations were determined using an enzyme-linked immunosorbent assay. The results revealed that the ESM-1 and Gal-3 levels in the STEMI patients were 1.6 and 2.8 times higher, respectively, when compared with the controls (P < 0.001). Moreover, the ESM-1 and Gal-3 levels exhibited a positive linear correlation (r = 0.758, P < 0.001) in the acute STEMI patients. In conclusion, the ESM-1 and Gal-3 levels were found to be significantly elevated and correlated in the STEMI patients. Thus, combining these two biomarkers of endothelial dysfunction and inflammation might be useful for the diagnosis and assessment of STEMI.

LBODP047 Correlation Of Insulin Resistance And Short-term Outcome In Non-diabetic Patients With St Segment Elevation Myocardial Infarction

Abstract Background Obviously, hyperglycemia and insulin resistance (IR) are common in patients with ST-segment elevation myocardial infarction (STEMI) in the hospital, and they are connected to poor clinical outcomes. Additionally, insulin resistance is a substantial risk factor for cardiovascular diseases. The case of acute myocardial infarction likewise has a bleak prognosis. The study aimed to evaluate the association between IR and short-term outcomes of acute STEMI patients without diabetes mellitus in the form of reperfusion success, the occurrence of heart failure, development of arrhythmias, and mortality. Method: A cross-sectional study was done from August 2021 to December 2021 in two cardiology centers in Al-Sadr teaching hospital and Basrah oil hospital in Basrah, southern Iraq. Sixty-one nondiabetic hospitalized patients with acute STEMI were included in the study. Clinical data were collected by direct interview with the patients, 25(41%) of them received thrombolytics and 36 (59%) were managed with percutaneous transluminal coronary angioplasty. From each patient, a fasting blood sample was taken for glucose, triglyceride, and insulin to measure IR in the form of the homeostasis model assessment for IR (HOMA-IR) and triglyceride glucose index (TyG index). Both measures were grouped into three tertiles, for HOMA-IR (tertile 1 &amp;lt; 2.5, tertile 2 2.5 - &amp;lt;5, and tertile 3 ≥5) and for TyG index (tertile 1 &amp;lt;4.73, tertile 2 4.73 - &amp;lt;4.87, and tertile 3 ≥4.87). The patients were evaluated within 1-week for (reperfusion success, echocardiography for calculation of the ejection fraction (EF), arrhythmias, and mortality), and within 4-weeks for mortality. Results Within the tertile 3 of HOMA-IR, the patients were significantly more likely to have EF &amp;lt; 55% (35%), and higher 4-weeks mortality (35%). Also for the TyG index and within the tertile 3 (≥ 4.87), there was a significantly higher 4-weeks mortality (30%). Pearson correlation also showed significant and negative correlations between both HOMA-IR and TyG index values and EF. While reperfusion success, arrhythmias, and 1-week mortality did not correlate significantly with both HOMA-IR and TyG index. Conclusion Insulin resistance as defined by HOMA-IR and TyG index was significantly associated with poor outcomes in patients with acute STEMI in the form of EF&amp;lt;55 and 4-weeks mortality. Presentation: No date and time listed

Diagnostic Model of In-Hospital Mortality in Patients with Acute ST-Segment Elevation Myocardial Infarction Used Artificial Intelligence Methods.

Background Preventing in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is a crucial step. Objectives The objective of our research was to develop and externally validate the diagnostic model of in-hospital mortality in acute STEMI patients used artificial intelligence methods. Methods We divided nonrandomly the American population with acute STEMI into a training set, a test set, and a validation set. We converted the unbalanced data into balanced data. We used artificial intelligence methods to develop and externally validate several diagnostic models. We used confusion matrix combined with the area under the receiver operating characteristic curve (AUC) to evaluate the pros and cons of the above models. Results The strongest predictors of in-hospital mortality were age, gender, cardiogenic shock, atrial fibrillation (AF), ventricular fibrillation (VF), third degree atrioventricular block, in-hospital bleeding, underwent percutaneous coronary intervention (PCI) during hospitalization, underwent coronary artery bypass grafting (CABG) during hospitalization, hypertension history, diabetes history, and myocardial infarction history. The F2 score of logistic regression in the training set, the test set, and the validation dataset was 0.81, 0.6, and 0.59, respectively. The AUC of logistic regression in the training set, the test set, and the validation data set was 0.77, 0.78, and 0.8, respectively. The diagnostic model built by logistic regression was the best. Conclusion The strongest predictors of in-hospital mortality were age, gender, cardiogenic shock, AF, VF, third degree atrioventricular block, in-hospital bleeding, underwent PCI during hospitalization, underwent CABG during hospitalization, hypertension history, diabetes history, and myocardial infarction history. We had used artificial intelligence methods developed and externally validated several diagnostic models of in-hospital mortality in acute STEMI patients. The diagnostic model built by logistic regression was the best. We registered this study with the registration number ChiCTR1900027129 (the WHO International Clinical Trials Registry Platform (ICTRP) on 1 November 2019).

Allopurinol pretreatment effects on coronary blood flow and revascularization outcomes in acute STEMI patients underwent emergency percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Isfahan University of Medical Sciences, Isfahan, Iran. Introduction Todays, acute ST-segment elevation myocardial infarction (STEMI) is considered as a most important component of acute coronary syndrome. In this regards, reperfusion therapy with percutaneous coronary intervention (PCI) is the most effective treatment for establishing coronary blood flow; which despite reperfusion of ischemic myocardium, it can also induce secondary injury as myocardial ischemia-reperfusion injury. The generation of reactive oxygen species by activation of xanthine oxidase (XO) enzymatic system is one of the major causes of ischemia-reperfusion injury in the ischemic myocardium and allopurinol, a XO inhibitor, has an inhibitory role on free radical productions in STEMI patients. Purpose In this study, we aimed to assess impact of allopurinol pre-treatment on revascularization outcomes, according to Thrombolysis in Myocardial Infarction (TIMI) flow and ST segment elevation recovery as well as clinical finding and major cardiac events incidence in STEMI patients underwent emergency PCI. Methods In this randomized double blind clinical trial, we enrolled 90 patients with acute STEMI in two equal groups. Allopurinol group received 600 mg allopurinol loading dose before the emergency PCI and the control group received the same shape medication as a placebo. Both groups also received the standard pretreatment protocol for PCI in acute STEMI setting. TIMI flow, ECG changes, Troponin level and major cardiac events (MACE) occurrence including death, myocardial infarction and ischemic stroke after 1 month follow up were assessed. In case group, allopurinol 100 mg daily and matched placebo pill for control group was continued for one month in addition to standard medications. Results Finally, 81 patients with acute STEMI has completed the study. The mean age of study population was 59.52 (11.31) and 61.3 (9.25) in case and control groups respectively (p = 0.49). Troponin level 48 hour after the PCI had not significant difference between the groups (p = 0.25). ECG ST-elevation regression also had not significant difference between the groups [75.0%1 vs 67.10% in case and control groups, respectively (p = 0.21)]. TIMI flow had improved in allopurinol group rather than placebo (p = 0.02). PCI success rate was 78.6% and 61.5% in allopurinol and control group respectively (p = 0.09). MACE and other clinically outcomes in follow up period were similar between groups (p &amp;gt; 0.05). Conclusions This study indicated that allopurinol pre-treatment loading dose could improve minimally revascularization outcomes based on TIMI flow in the patients undergoing primary or rescue PCI in acute STEMI setting.

Left ventricular thrombus after acute ST-segment elevation myocardial infarction: multi-parametric cardiac magnetic resonance imaging with long-term outcomes.

Left ventricular thrombus (LVT) after acute ST-segment elevation myocardial infarction (STEMI) are generally associated with poorer outcomes for patients at long-term follow-up. We hypothesis that tissue characteristics and strain parameters by cardiac magnetic resonance (CMR) imaging may indicate the interactions of LVT with ventricular myocardium remodeling at both acute stage and chronic stages in STEMI patients. This retrospective study included 111 consecutive STEMI patients (38 with LVT and 73 without LVT). All patients underwent CMR during acute stage (within 7days) and chronic stage (after at least 2months) periods after percutaneous coronary intervention (PCI). Left ventricular native T1, extracellular volume (ECV), radial, circumferential, and longitudinal strain were analyzed in both phases. Major adverse cardiac events (MACE, including cardiovascular death, myocardial reinfarction, and hospitalization for heart failure), thromboembolic and bleeding events, were the clinical endpoints of the study. During the acute stage, left ventricular ejection fraction (LVEF) (OR 0.77, P value = 0.01) and longitudinal strain (OR 1.90, P value < 0.001) were correlated with LVT formation. Strain parameters were reduced, while the native T1 and ECV values of both the infarcted area and remote myocardium were elevated in LVT patients. During the chronic stage, LVT resolved in 29 of 38 patients (76%). LVT remaining patients had lower LVEF, a larger LV, and higher ECV in the acute stage than those of the LVT-resolved patients. In the long-term follow up of 678days, LVT (HR 2.45, P value = 0.02), aneurysm (HR 1.81, P value = 0.04), and native T1 (HR 2.44, P value = 0.01) were identified as three independent predictors of MACE, the incidence of thromboembolic events and bleeding events by a multivariable stepwise Cox proportional hazards regression. STEMI patients developing LVT had worse LV function, myocardial infarction extent, strain, and higher T1 and ECV values than STEMI patients without LVT. The LVT-remaining patients in the chronic stage had poorer functional and mapping parameters beginning in the first week. During the acute stage, LVEF and global longitudinal strain were independent correlated with LVT formation. During the long-term follow up, LVT, aneurysm and elevated myocardial T1 were associated with adverse outcomes in acute STEMI patients.

Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00-1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95-1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86-1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects ( p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.

Comparing the efficacy of angiotensin receptor-neprilysin inhibitor and enalapril in acute anterior STEMI patients after primary percutaneous coronary intervention: a prospective randomized trial.

For patients with heart failure (HF), the effect of angiotensin receptor-neprilysin inhibitors (ARNIs, sacubitril/valsartan) on cardiac remodeling has been found to be superior to angiotensin-converting enzyme inhibitors (ACEI). However, little data have described the impact of early-initiation ARNI in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). In this prospective, randomized, double-blind, parallel-group trial, we enrolled 131 anterior STEMI patients who were treated with primary percutaneous coronary intervention (PCI) between February 2019 and December 2019. All patients received standard STEMI management and were divided into 2 groups (ARNI/enalapril). Primary efficacy outcomes were the between-group difference in change (from baseline to 4-, 12-, and 24-week) in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration, left ventricular ejection fraction (LVEF), and left ventricular end-systolic volumes and end-diastolic volumes (LVESV and LVEDV). Secondary outcomes were determined by a composite of death, reinfarction, outpatient HF or HF hospitalization, malignant arrhythmia, and stroke. Safety outcomes included worsening renal function, hypotension, hyperkalemia, angioedema and cough. We found that NT-proBNP concentration decreased more in the ARNI group than in the enalapril group [4 weeks: ratio of ARNI vs. enalapril 0.36, 95% confidence interval (CI): 0.24 to 0.52, P<0.001; 12 weeks: 0.54, 95% CI: 0.35 to 0.79, P<0.001; 24 weeks: 0.53, 95% CI: 0.32 to 0.83, P<0.001). When compared to the enalapril group, the ARNI group patients had a significant reduction in LVEDV (P<0.001) and LVESV (P<0.001), and an improvement in LVEF (P=0.011) at 24 weeks. Secondary outcomes occurred in 13 participants (20.3%) in the ARNI group and 22 participants (34.4%) in the enalapril group [hazard ratio (HR), 0.56; 95% CI: 0.28 to 1.12; P=0.102]. The incidence of outpatient HF or HF hospitalization in the ARNI group was significantly lower than that in the enalapril group (HR, 0.36; 95% CI: 0.14 to 0.94; P=0.037). There were no significant differences in the safety between the 2 groups. For patients with acute anterior STEMI undergoing primary PCI, early initiation of ARNI provided significant clinical benefits. Chinese Clinical Trial Registry (ChiCTR2100042944) registered on February 1, 2021.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction

ObjectiveTo investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention. MethodsConsecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function. ResultsA total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n = 98), the MVO group had significantly reduced LV global RS (t = −4.30, P < 0.001), global CS (t = 4.99, P < 0.001), and global LS (t = 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t = −3.38, P = 0.001; t = 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t = 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR = 4.10, 95%CI: 2.05 – 8.19, P < 0.001) and its size [OR = 1.38, 95% CI: 1.10–1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 – 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis. ConclusionThe infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.

Association between CD137 and ischemia-reperfusion injury in patients with acute ST-segment elevation myocardial infarction

Objective: To explore the relationship between the levels of serum soluble CD137 (sCD137) and membrane-bound CD137 (mCD137) and the occurrence of ischemia reperfusion injury (IRI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: This is a cross-sectional study. Consecutive patients with acute STEMI, who underwent emergency percutaneous coronary intervention (PCI) in the Department of Cardiology, Jiangsu University Affiliated Hospital from May 2019 to September 2020, were enrolled. According to the absence or presence of IRI, patients were divided into IRI group and non-IRI group. Clinical data of the two groups were collected and compared. sCD137 level was detected by enzyme linked immunosorbent assay. Ficoll density gradient centrifugation was used to separate peripheral blood mononuclear cells (PBMC) and RNA was extracted, mCD137 mRNA expression level was detected by PCR. Serum sCD137 levels and the mCD137 mRNA levels of PBMC before, after PCI and 24 hours after PCI were compared. The correlation between serum sCD137 level, PBMC mCD137 mRNA level and clinical indicators was observed. The univariate and multivariate logistic binary regression analyses were performed to evaluate the related risk factors of IRI. ROC curve was used to analyze the predictive value of defined parameters for IRI. Results: A total of 112 STEMI patients were enrolled. There were 42 cases (of which 33 were males (78.6%), mean age was (58.6±12.7) years) in non-IRI group and 70 cases(of which 56 were males (80.0%), mean age was (64.5±11.6) years) in IRI group. Compared with the non-IRI group, patients in the IRI group had longer hospital stays, older age, lower rates of obesity, lower systolic and diastolic blood pressure at admission, higher proportion of the the right coronary artery as culprit vessel, lower rate of the use of angiotensin-converting enzyme inhibitor/angiotensin-Ⅱ receptor blocker/angiotensin receptor neprilysin inhibitor, higher levels of urea nitrogen and creatinine, lower glomerular filtration rate, lower triglycerides, higher D-dimer and B-type natriuretic peptidemax, higher proportion of Killip grade Ⅳ and cardiovascular adverse events (all P<0.05). sCD137 levels at the preoperative, postoperative and 24 hours after surgery were significantly higher in the IRI group than in the non-IRI group, while the mRNA levels of CD137 was similar between the two groups. The level of sCD137 in patients after PCI was lower than that before operation, the level of mCD137 mRNA was higher than that before operation (P<0.05). Serum sCD137 levels were positively correlated with hospitalization days, age, B-type natriuretic peptide, creatinine, ischemic time, C Reactive protein (CRP) and CRP/albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate and albumin (P<0.05). The mCD137 mRNA expression level of PBMC was positively correlated with hospital stay, age, B-type natriuretic peptide, ischemic time, CRP and CRP/albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate, albumin (P<0.05). Multivariate logistic regression analysis showed that higher sCD137 (OR=1.038, 95%CI: 1.009-1.069), aspartate aminotransferase, (OR=1.029, 95%CI: 1.009-1.050) and lower albumin (OR=0.829, 95%CI: 0.703-0.829) before surgery were independent risk factors of IRI (P<0.05). Receiver operating characteristic curve showed that the area under the curve of sCD137 was 0.672 (95%CI: 0.574-0.770, P=0.002) for the prediction of IRI, the best cut-off value was 28.43×10-3 μg/L with sensitivity of 95.2% and specificity of 48.6%. Conclusion: The significantly increased level of sCD137 in acute STEMI patients is positively correlated with reperfusion injury, which is an independent risk factor of IRI and may be related to the prognosis of patients with IRI.

Prognostic significance of QRS distortion and frontal QRS-T angle in patients with ST-elevation myocardial infarction

BackgroundQRS distortion (G3I) and frontal QRS-T angle (fQRS-T angle) are both electrocardiographic (ECG) signs of ongoing ischemia and depolarization–repolarization heterogeneity, which always occur in patients with ST-segment elevation acute myocardial infarction (STEMI). MethodsWe retrospectively collected 592 STEMI patients who underwent coronary angiography and follow-up for 42 months. 1. We divided the patients into two groups according to whether they had G3I on admission, compared the differences in examination data and endpoint events between these two groups. 2. Group patients according to whether the endpoint events happened in hospital, at 12 and 42 months, compare whether there is a difference in fQRS-T angle at the same time point, and find out the predictive cutoff value of all-cause death. 3. Combined G3I and fQRS-T angle together to enhance the predictive value. ResultsG3I and fQRS-T angle are both independent risk factors for all-cause death in STEMI patients within 12 months (G3I P = 0.014, fQRS-T angle P < 0.001) and within 42 months (P < 0.001). The cutoff values of fQRS-T angle for predicting all-cause death are 66.5° at 12 months and 90.5° at 42 months. When G3I and fQRS-T angle are combined used to predict the mortality, the specificity is significantly improved, but the sensitivity decreased. ConclusionsG3I and fQRS-T angles are valuable in the prognostic assessment of STEMI patients, especially when combined. These findings help clinicians to identify high-risk patients early for more aggressive treatment.

Optimized Machine Learning Models to Predict In-Hospital Mortality for Patients with ST-Segment Elevation Myocardial Infarction.

PurposeThis study aimed to optimize machine learning (ML) models for predicting in-hospital mortality in patients with ST-segment elevation acute myocardial infarction (STEMI).Patients and MethodsA total of 5708 STEMI patients were enrolled and divided into two groups according to patients’ hospital outcomes. Both groups were randomly split into a training set (75%) and a testing set (25%). Four ML models were trained with data, which applied random under-sampling (RUS). The performance of optimized ML models was evaluated with respect to accuracy, sensitivity, specificity, G-mean and AUC. Two sets of features in chronological order were considered: a full set that included all variables during hospitalization and a simplified set that only included variables prior to reperfusion therapy, and the performance of the prediction models trained with these two sets of features was compared.ResultsFor the comprehensive metric – G-mean, the models trained with RUS outperformed those without, 80.54% vs 23.31% on average in the full set and 75.72% vs 35.76% on average in the simplified set. For models trained with the full set, the SVM achieved the best performance with 85.62% accuracy, 84.21% sensitivity, 85.66% specificity, 84.93% G-mean and 0.919 AUC. For models trained with the simplified set, the SVM achieved 83.48% G-mean, which was comparable to the models trained using the full set. For the most critical metric – sensitivity, the SVM trained using the simplified set achieved 89.47%, which even exceed the SVM (84.21%), DT (81.58%) and RF (81.58%) trained using the full set.ConclusionApplying RUS can improve the performance of prediction models, and the models trained with simplified set, which only included variables prior to reperfusion therapy can accurately predict high-risk patients.

The prognostic value of myocardial infarct size measured by cardiovascular magnetic resonance in patients with acute ST-segment elevation myocardial infarction

Objective: To investigate the prognostic value of infarct size (IS) in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). Methods: A total of 104 patients with acute STEMI who underwent primary PCI treatment in Shengjing Hospital of China Medical University from February 2017 to November 2018 were included in the present study. All patients underwent cardiovascular magnetic resonance (CMR) within one week after primary PCI treatment. The subjects were followed up for two years. Major adverse cardiac events (MACE) included new onset congestive heart failure and/or recurrent nonfatal myocardial infarction and/orcardiac death. The optimal IS cutoff value for MACE was determined by receiver operating character (ROC) curve. Based on the IS cutoff value, the patients were divided into the high IS group and the low IS group. Clinical characteristics between the two groups were compared. A cox regression model was used to analyze the prognostic value of IS in acute STEMI patients treated with primary PCI for the adverse events. Results: The IS cutoff value determined by ROC curve was 13.55%. 50 patients were in the high IS group (IS≥13.55%) and 54 patients were in the low IS group (IS<13.55%). More female patients [14 cases (28.0%) vs. 6 cases (11.1%)] were in the IS group, and a higher proportion of patients in the high IS group had anterior myocardial infarction [27 cases (54.0%) vs. 16 cases (29.6%)] or microvascular obstruction [32 cases (64.0%) vs. 16 cases (29.6%)]. White blood cell counts [11.25(8.90, 13.38) ×109/L vs. 9.25(7.58, 11.00) ×109/L], troponin I levels [50.63(16.56, 76.30)μg/L vs. 16.58(2.66, 38.42)μg/L] and brain natriuretic peptide levels [178.10(79.70, 281.95)μg/L vs. 79.60(42.83, 183.90)μg/L] in the high IS group were higher than those in the low IS group (P<0.05), and left ventricular ejection fraction [(45.15±10.65)% vs. (51.95±12.91)%] in the high IS group was lower than that in the low IS group (P<0.05). Multivariate Cox regression analyses showed that IS was independently associated with the risk of cardiac death in patients with acute STEMI two years after primary PCI(P=0.033, HR=1.075, 95%CI1.006-1.148). Every 1% increase in IS was associated with a 7.5% increase in cardiac death. Conclusions: Infarct size, measured by CMR within one week after primary PCI, is strongly associated with cardiac death in patients with acute STEMI two years after primary PCI. IS could be used as an index for the prognosis of patients with acute STEMI.

Telemedicine Improves the Short-Term Medical Care of Acute ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention.

Objectives: Telemedicine appears to be a promising tool for healthcare professionals to deliver remote care to patients with cardiovascular diseases especially during the COVID-19 pandemic. We aimed in this study to evaluate the value of telemedicine added to the short-term medical care of acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).Methods: Two hundred acute STEMI patients after primary PCI were randomly divided into two groups. One hundred patients in group A (study group) received a monthly videoconferencing teleconsultation using a smartphone application for 3 months starting 1 week after discharge and at least a single face-to-face (F2F) clinic visit. We reviewed in each virtual visit the symptoms of patients, adherence to healthy lifestyle measures, medications, smoking cessation, and cardiac rehabilitation. Group B (control group) included 100 patients who received at least a single F2F clinic visit in the first 3 months after discharge. Both groups were interviewed after 4 months from discharge for major adverse cardiac events (MACE), adherence to medications, smoking cessation, and cardiac rehabilitation. A survey was done to measure the satisfaction of patients with telemedicine.Results: There was no significant difference between both groups in MACE and their adherence to aspirin, P2Y12 inhibitor, and beta-blockers. However, group A patients had better adherence to statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, smoking cessation, and cardiac rehabilitation. Sixty-one percent of patients stated that these videoconferencing teleconsultations were as good as the clinic visits, while 87% of patients were satisfied with telemedicine.Conclusions: Telemedicine may provide additional benefit to the short-term regular care after primary PCI to STEMI patients through videoconferencing teleconsultations by increasing their adherence to medications and healthy lifestyle measures without a significant difference in the short-term MACE. These virtual visits gained a high level of satisfaction among the patients.

Comparison of Efficacy and Outcome of Primary Percutaneous Coronary Intervention to Pharmacoinvasive Strategy in Management of ST-Segment Elevation Myocardial Infarction

Introduction: Primary percutaneous coronary intervention (PPCI) is the best reperfusion option in ST-segment elevation myocardial infarction (STEMI) when performed timely but PPCI is not universally available. Hence, Pharmacoinvasive (PhI) reperfusion strategy is recommended for STEMI patients. However, there are very few studies in Bangladesh for the comparison of efficacy and outcome of PPCI and PhI Strategy. The aim of this study is to compare the efficacy and outcome of PPCI and PhI strategies in patients of Bangladesh. Methodology and Materials: This was a prospective observational comparative study. A total of 783 acute STEMI patients were included in Enam Medical College Hospital, Savar, Dhaka, Bangladesh during December-2015 to April-2019. Among them, 103 patients underwent Primary PCI and 184 patients underwent PhI strategy. Data were collected prospectively using a standardized case report form. Chai-squared tests were done to compare the ratio of the frequency of the groups and t-tests were done to compare the mean of the groups with 95% CI where pResults: Among the studied patients, access site complications in PPCI were hematoma, occlusion and pseudo-aneurysm being observed 03(2.91%), 05(4.85) and (0%), whereas, in PhI strategy were 09(4.89%), 08(4.34%), and 02(1.08%) respectively (P>0.05). In hospital, primary composite cardiovascular outcome of death, reinfarction, stroke and CHF were noted insignificant in both the strategies (p>0.05). On follow-up at 01 month, 06 month and 12 month, the composite cardiovascular outcome of death, reinfarction, stroke and CHF) were 03(3.84%), 04(5.12%), and 05(6.41%), in PPCI and 04(2.81%), 09(6.33%), and 07(4.92%) respectively in PhI strategy (P>0.05). Conclusion: Similar clinical, in hospital, and followed up outcomes were found when comparing the efficacy and safety Primary PCI to PhI Strategy in patients with STEMI who were eligible for reperfusion. So, both Primary PCI and Pharmacoinvasive strategies are safe and effective in management of patients with STEMI.

Comparison of Outcomes of Patients with vs without Previous Coronary Artery Bypass Graft Surgery Presenting with ST-Segment Elevation Acute Myocardial Infarction

The outcomes of patients with previous coronary bypass graft surgery (CABG) presenting with ST-segment elevation acute myocardial infarction (STEMI) have received limited study. We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without previous CABG in a contemporary multicenter STEMI registry between 2003 and 2020. The primary outcomes of the study were mortality and major cardiac adverse events (MACE: death, MI or stroke). Survival curves were derived using the Kaplan-Meier method and compared with the log-rank test. Of the 13,893 patients included in the analyses, 7.2% had previous CABG. Mean age was 62.4 ± 13.6 years, most patients (71%) were men and 22% had diabetes. Previous CABG patients were older (69.0 ± 11.7 vs 61.9 ± 13.6 years, p <0.001) and more likely to have diabetes (40% vs 21%, p <0.001) compared with patients without previous CABG. Previous CABG patients had higher mortality and MACE at 5 years (p <0.001). Outcomes were similar with saphenous vein graft vs native coronary culprits. Previous CABG remained associated with mortality from discharge to 18 months (p=0.044) and from 18 months to 5 years (p <0.001) after adjusting for baseline characteristics. Long term outcomes after STEMI were worse among patients with previous CABG compared with patients without previous CABG, even after adjustment for baseline characteristics.

Investigation of IgG anti-oxLDL antibody levels and HDL and LDL subclasses in patients with ST-segment elevation acute myocardial infarction

IntroductionDyslipidemia, inflammation and immunological processes play a key role in the development of atherosclerosis. This study investigates the relationship of different phenotypes of low-density lipoprotein (LDL) and high-density lipoprotein (HDL), human antibodies G classes against oxLDL (IgG anti-oxLDL antibodies) and inflammatory marker pentraxin-3 (PTX3) in patients with ST-segment elevation acute myocardial infarction (STEMI). Among STEMI patients with different Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score, we analyzed predictive abilities of these biomarkers to assess disease outcome.Material and methodsIn 69 STEMI, 21 patients with stable angina pectoris (AP) and 67 healthy controls, IgG anti-oxLDL antibodies and PTX3 were determined by ELISA. Gradient gel electrophoresis was used for lipoprotein subclasses separation.ResultsWe found significantly lower HDL and LDL diameters (p&lt;0.001 and p&lt;0.001, respectively) and higher PTX3 concentration (p&lt;0.001) in patients than in controls. Control subjects with small-sized HDL and LDL B phenotype had significantly higher IgG anti-oxLDL antibody levels (p=0.015), whereas STEMI patients with the same profile had higher PTX3 concentration (p=0.005). STEMI patients with intermediate SYNTAX score had lower levels of IgG anti-oxLDL antibodies (p=0.008). Multivariate logistic regression analysis showed that smaller LDL diameter was an independent predictor of intermediate SYNTAX score (OR=0.370; p=0.019).ConclusionsSmaller LDL and HDL particles are associated with elevated IgG anti-oxLDL antibodies in healthy subjects, but with increased PTX3 level in STEMI patients. In addition, we found that smaller LDL size was independent predictor of higher SYNTAX score. Further studies are needed to expand our preliminary observations.

Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters

AimWe aimed to investigate the comparative prognostic value of left ventricular ejection fraction (LVEF), mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by cardiac magnetic resonance (CMR) in patients after ST-segment elevation myocardial infarction (STEMI).Methods and resultsThis observational cohort study included 445 acute STEMI patients treated with primary percutaneous coronary intervention (pPCI). Comprehensive CMR examinations were performed 3 [interquartile range (IQR): 2–4] days after pPCI for the determination of left ventricular (LV) functional parameters and infarct characteristics. Primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as composite of death, re-infarction and congestive heart failure. During a follow-up of 16 [IQR: 12–49] months, 48 (11%) patients experienced a MACE. LVEF (p = 0.023), MAPSE (p < 0.001), LAS (p < 0.001) and GLS (p < 0.001) were significantly related to MACE. According to receiver operating characteristic analyses, only the area under the curve (AUC) of GLS was significantly higher compared to LVEF (0.69, 95% confidence interval (CI) 0.64–0.73; p < 0.001 vs. 0.60, 95% CI 0.55–0.65; p = 0.031. AUC difference: 0.09, p = 0.020). After multivariable analysis, GLS emerged as independent predictor of MACE even after adjustment for LV function, infarct size and microvascular obstruction (hazard ratio (HR): 1.13, 95% CI 1.01–1.27; p = 0.030), as well as angiographical (HR: 1.13, 95% CI 1.01–1.28; p = 0.037) and clinical parameters (HR: 1.16, 95% CI 1.05–1.29; p = 0.003).ConclusionGLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as angiographical and clinical characteristics with superior prognostic validity compared to LVEF.Graphic abstract

The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

BackgroundLeft ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling.MethodsWe recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively.ResultsIn the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007).ConclusionsIn the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

BackgroundTo evaluate the predictive value of the index of microcirculatory resistance (IMR) for long-term cardiac systolic function after primary percutaneous coronary intervention (pPCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI).MethodsA total of 53 acute anterior wall STEMI patients were included and followed up within 1-year. IMR was measured to evaluate the immediate intraoperative reperfusion. IMR > 40 U was defined as the high IMR group and ≤ 40 U was defined as the low IMR group. Left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 h, 1 month, 3 months, and 1 year after PCI to analyze the correlation between IMR and cardiac systolic function. Heart failure was estimated according to classification within one year.ResultsThe ratio of TMPG (TIMI myocardial perfusion grade) 3 (85.7% vs. 52%, p = 0.015) and STR (ST-segment resolution) > 70% (82.1% vs. 48%, p = 0.019) were significantly higher in the low IMR group. The LVEF in the low IMR group was significantly higher than that in the high IMR group at 3 months (43.06 ± 2.63% vs. 40.20 ± 2.67%, p < 0.001) and 1 year (44.16 ± 2.40% vs. 40.13 ± 3.48%, p < 0.001). IMR was negatively correlated with LVEF at 3 months (r = − 0.1014, p = 0.0040) and 1 year (r = − 0.1754, p < 0.0001).ConclusionsThe IMR showed significant negative correlation with the LVEF value after primary PCI. The high IMR is a strong predictor of heart failure within 1 year after anterior myocardial infarction.