Angioplasty For Acute Myocardial Infarction Research Articles

The Recovery of Left Ventricular Function in Cases of Primary Angioplasty for Acute Myocardial Infarction

Background: This study is to investigate the recovery in left ventricular ejection fraction in the first 3 months after acute myocardial infarction treated with primary angioplasty. Left ventricular function (LVF) is the main predictor of long term prognosis in cases of survival after acute myocardial infarction. Study aims to investigate successful improvement in left ventricular ejection fraction after primary angioplasty.
 Methodology: A cross sectional study was conducted at Chaudhary Pervaiz Ellahi Institute of Cardiology, Multan from 1stSeptember 2019 to 30thSeptember 2020. Left ventricular ejection fraction was evaluated in 100 patients treated with primary angioplasty. Primary angioplasty is a very 1st treatment to re-open the locked artery after acute myocardial infarction. Ejection fraction was measured with Echocardiography Simpson’s biplane method at 3rd day and 3 months after angioplasty. Collected data was analyzed by using SPSS version 23. Chi square test was applied to see association among variables.
 Results: One hundred patients were included this study. The mean age and BMI of the patients was 59.45±6.01 years and 24.76±8.02 kg/m2, respectively. Male 70 (70%) and female 30 (30%) ratio was 7:3. LVEF at 3rd month was observed in ≤40% in 223 (23.0%) patients and >40% in 77 (77%) patients. Male patients were greater in number that’s why LVEF is also observed in greater in male gender (p<0.001). Increase in age also have no impact on procedure success (p>0.050).
 Conclusion: Results of this study reveal that primary angioplasty is successful treatment plan in patients with acute myocardial infarction. A significant recovery of left ventricular function during 3 months after primary angioplasty in acute Myocardial infarction (MI) patients was observed.

Congestive Heart Failure for the Primary Care Physician

Congestive heart failure is a clinical condition in which the heart cannot send enough blood to meet the body's metabolic needs due to pathological cardiac changes. In recent decades, a progressive increase in patients affected by this disease has been observed; this could be due to the increase in population age throughout the world, as it is a disease that mainly affects elderly individuals, a higher rate of general healing as a decrease in mortality results in a more significant number of patients affected by it, as well as more effective treatments for cardiac pathologies such as primary angioplasty in acute myocardial infarction, causing a more substantial number of patients with decreased cardiac function.

Thrombus aspiration from an ectatic coronary artery using SOPHIA plus catheter during primary angioplasty for acute myocardial infarction

Thrombus aspiration from an ectatic coronary artery using SOPHIA plus catheter during primary angioplasty for acute myocardial infarction

Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta-analysis.

We aim to define whether the timing of microaxial left ventricular assist device (IMLVAD) implantation might impact on mortality in acute myocardial infarction (AMI) cardiogenic shock (CS) patients who underwent primary percutaneous coronary intervention (PPCI). Despite the widespread use of PPCI, mortality in patients with AMI and CS remains high. Mechanical circulatory support is a promising bridge to recovery strategy, but evidence on its benefit is still inconclusive and the optimal timing of its utilization remains poorly explored. We compared clinical outcomes of upstream IMLVAD use before PPCI versus bailout use after PPCI in patients with AMI CS. A systematic review and meta-analysis of studies comparing the two strategies were performed. Effect size was reported as odds ratio (OR) using bailout as reference group and a random effect model was used. Study-level risk estimates were pooled through the generic inverse variance method (random effect model). A total of 11 observational studies were identified, including a pooled population of 6759 AMI-CS patients. Compared with a bailout approach, upstream IMLVAD was associated with significant reduction of 30-day (OR = 0.65; 95% confidence interval [CI] = 0.51-0.82; I2 = 43%, adjusted OR = 0.54; 95% CI = 0.37-0.59; I2 = 3%, test for subgroup difference p = 0.30), 6-month (OR = 0.51; 95% CI = 0.27-0.96; I2 = 66%), and 1-year (OR = 0.56; 95% CI = 0.39-0.79; I2 = 0%) all-cause mortality. Incidence of access-related bleeding, acute limb ischemia and transfusion outcomes were similar between the two strategies. In patients with AMI-CS undergoing PPCI, upstream IMLVAD was associated with reduced early and midterm all-cause mortality when compared with a bailout strategy.

Multiple irregularities and thrombus in a patient with COVID-19 presenting with ST-segment elevation myocardial infarction: a case report

Background: Multiple thrombi are likely to develop in Coronavirus Disease 2019 (COVID-19) patients. Hence, achieving successful outcomes following catheterization becomes quite challenging in such patients.
 Case presentation: We report a challenging case of a 36-year-old female with ST-Segment Elevation Myocardial Infarction (STEMI). Coronary angiography revealed multiple irregularities in the coronary tree as well as thrombi. Although computed tomography imaging of the thorax was normal, reverse transcription-polymerase chain reaction (RT-PCR) confirmed the diagnosis of COVID-19. The outcome was good TIMI flow after a successful Primary Angioplasty in Acute Myocardial Infarction (PAMI), and the patient was isolated and then switched to oral anticoagulants (clopidogrel) for dual antiplatelet therapy (DAPT) therapy. 
 Conclusion: This case emphasizes the management of a COVID-19 patient for PAMI.

Thin-strut bioresorbable-polymer sirolimus-eluting stent use for an optimal result of rescue coronary angioplasty in acute myocardial infarction failed thrombolytic therapy: the Bangladesh National Heart Foundation Annual Conference OCT-assisted live case.

Thin-strut bioresorbable-polymer sirolimus-eluting stent use for an optimal result of rescue coronary angioplasty in acute myocardial infarction failed thrombolytic therapy: the Bangladesh National Heart Foundation Annual Conference OCT-assisted live case.

A study to determine the influence of Gender on the efficacy, safety and short-term outcomes of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction

A study to determine the influence of Gender on the efficacy, safety and short-term outcomes of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction

Prophylactic use of intracoronary sodium nitroprusside decreases incidence of no reflow after primary angioplasty in acute myocardial infarction

Background: Intracoronary vasodilators are used in various stages of primary angioplasty, either to treat no reflow or prophylactically to prevent no reflow. Vasodilators were ineffective during primary angioplasty to treat no reflow likely because the drug was used after plaque modification. We evaluated the intracoronary use of sodium nitroprusside (SNP) before plaque modification and microembolization. Materials and Methods: We conducted a retrospective case–control study of all primary angioplasty cases done at Lourdes Hospital, Kerala, India, from March 2016 to May 2018 by two operators at the hospital. We retrospectively collected the data for primary angioplasty at the hospital and analyzed the data into two groups: one operator routinely used prophylactic intracoronary SNP in stable primary percutaneous coronary intervention (PCI) patients, whereas the other used it only if there was no reflow. The drug was delivered prophylactically through guiding catheter once at least TIMI I flow was present. We compared the effect of prophylactic vs. therapeutic use of intracoronary SNP on no reflow during primary percutaneous transluminal coronary angioplasty (PTCA). Results: Incidence of no reflow was significantly less in the group in which SNP was used at the onset of primary PTCA when compared with those patients in whom it was not used at the onset (6.5% vs. 28.4%, P < 0.001). The TIMI frame count (21.7 vs. 24, P = 0.22) and low TIMI myocardial perfusion grade (<2) (14% vs. 20%, P = 0.272) did not reach statistical significance. Conclusion: Prophylactic intracoronary use of SNP, before plaque modification, reduces the incidence of no reflow phenomenon after primary angioplasty.

Study of primary angioplasty in hospital not having onsite cardiac catheterization facility

Objectives: The aim of this study is to evaluate the appropriateness of use and quality as well as outcomes of primary angioplasty for acute myocardial infarction (MI) in a single center without percutaneous coronary intervention (PCI) capability. Background: Primary percutaneous transluminal coronary angioplasty (PTCA) increases the rates of patency of the infarcted artery, improves survival rates, and reduces the rates of reinfarction and strokes as compared to thrombolysis. Methods: This is a hospital-based prospective study involving 77 patients. Primary PTCA was done by emergency transfer to PCI center at earliest. Results: Male patients outnumbered females (77% vs. 22%). Patients in the age group of 45–69 years constituted around 70.0% of the total ST-elevation MI patients. Majority of the patients (90%) presented with chest pain. During coronary angiography, it was found that the major culprit coronary was the right coronary (42.85%) followed by the left anterior descending artery (36.36%). A majority of the patients in the study group were found to have single-vessel disease (57.14%), and only five of the patients had triple-vessel disease (06.49%). Glycoprotein IIb/IIIa inhibitors were given to 41 patients (53.24%) as an adjuvant therapy. Conclusion: Primary angioplasty is very appropriate and feasible with a good outcome for the management of patients with acute ST-elevation MI even in a center where the facility of cardiac catheterization is not available. Our patients with acute ST-elevation myocardial infarction who were shifted to a center having cardiac catheterization laboratory and subsequently managed with primary angioplasty showed good response and outcome in terms of mortality and morbidity over a follow-up of 1 year.

Comparison of 0.9-mm and 1.4-mm catheters in excimer laser coronary angioplasty for acute myocardial infarction

Excimer laser coronary angioplasty (ELCA) is a unique revascularization modality that can vaporize plaque and thrombus. Compared to thrombus aspiration therapy, ELCA is reported to provide better microcirculation and reduced peripheral embolism in treatment for acute coronary syndrome. Excimer laser catheters come in various sizes, and we sought to compare the 0.9- and 1.4-mm-diameter catheters. We retrospectively enrolled 90 acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention with excimer laser from August 2013 to March 2017 in our hospital. Patients were grouped by diameter of catheter that had been used, the 0.9 mm group (n = 51) and 1.4 mm group (n = 39). We evaluated myocardial perfusion, procedural success rate, short-term outcome, lesion crossability, and complications between the two groups. The percentage of patients whose final thrombolysis in myocardial infarction (TIMI) grade was 3 (0.9 mm 86.3% vs 1.4 mm 89.7% p = 0.75) and final myocardial blush grade (MBG) was 3 (0.9 mm 72.5% vs 1.4 mm 69.2% p = 0.82) was similarly high for both groups. Procedural success rate, in-hospital major adverse cardiac events (MACE), lesion crossability, and complications were also similar. This study showed that efficacy of 0.9 and 1.4 mm excimer laser catheter was equivalent in ELCA for AMI patients. If one takes into account lesion crossability, debulking effects, and the stunned platelets phenomenon, the 0.9 mm excimer laser catheter is sufficient for ELCA in AMI patients.

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling.

IntroductionSpontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes.AimTo investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling.Material and methodsOf 155 STEMI patients with patent IRA, 19 (12.3%) patients with TIMI-2 (T2Res) and 85 (54.8%) with TIMI-3 (T3Res) had further STE resolution following PCI, 20 (12.9%) with TIMI-3 did not require PCI (T3noPCI) and 31 (20.0%) with TIMI-2/3 had reSTE of ≥ 1 mm following PCI as compared with pre-PCI recordings (T23reSTE). LV ejection fraction (LVEF, %) and LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI, ml/m2) were measured by echocardiography 2 days and 6 months following PCI.ResultsIn 6-month observation the improvement of LVEF in T3Res (by 3.9 ±5.1%) and in T3noPCI (by 5.7 ±6.1%) patients was higher as compared with T23reSTE (0.2 ±7.0%, p < 0.05 versus both). LVEDVI increased in T23reSTE patients by 6.6 ±12.6 ml/m2, but decreased in T3Res by 3.8 ±9.7 ml/m2 and in T3noPCI by 2.4 ±6.2 ml/m2 (for both p < 0.05 vs. T23reSTE). LVESVI increased in T23reSTE patients (by 3.8 ±10.8 ml/m2), did not change in T2Res (by 0.1 ±9.0 ml/m2), but decreased in T3Res (by 4.2 ±7.2 ml/m2, p < 0.05 vs. T23reSTE) and in T3noPCI patients (by 4.7 ±7.7 ml/m2, p < 0.05 vs. T23reSTE). ReSTE was an independent predictor of LVEF, LVEDVI and LVESVI changes (p < 0.001 for all).ConclusionsReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.

Unusual presentation of an unusual complication after rescue angioplasty for acute myocardial infarction

Hemorrhagic pericarditis and pericardial tamponade occurring in the setting of acute myocardial infarction (MI) are very uncommon. Even rare is its presentation as acute liver failure. We describe a patient who presented with acute liver failure postangioplasty and stenting of left anterior descending and right coronary artery in the setting of a large transmural anterior wall MI. Acute liver failure in this case was attributable to a hemorrhagic pericardial effusion and tamponade. It completely resolved following pericardiocentesis. This unusual presentation of an unusual complication and its management is discussed.

Clinical outcomes of patients undergoing primary angioplasty for acute myocardial infarction treated with prasugrel versus ticagrelor at the end of 1 month & 1 year

Clinical outcomes of patients undergoing primary angioplasty for acute myocardial infarction treated with prasugrel versus ticagrelor at the end of 1 month & 1 year

Bundle branch blocks and/or hemiblocks complicating acute myocardial ischemia or infarction.

Despite the bulk of anatomical and histologic evidence supporting the existence of three fascicules in the left branch of the His bundle, the concept of a bifascicular system proposed by Rosenbaum and his school has been adopted by the cardiological community as a practical teaching tool. Left anterior hemiblock (LAH) refers to block of the antero-superior branch of the left branch which is small and left posterior hemiblock (LPH) to block of the postero-inferior branch which is larger. The LAH is more common that the LPH and often associated with a complete right bundle branch block (RBBB). Coronary artery disease (CAD) is a major cause of hemiblocks. In this review article, we discuss various aspects of the relation of hemiblocks with CAD. We looked at the prevalence of LAH in consecutive patients undergoing coronary angiography and who had a significant coronary lesion in one vessel or more. In all patients with LAH, a significant lesion of the left anterior descending coronary artery was present, with in the majority of patients, an impairment of the left ventricular function. Bifascicular block (RBBB with LAH or LPH) can complicate acute myocardial infarction and is often associated with a poor prognosis and the presence of heart failure. Thrombolysis and or early angioplasty in acute myocardial infarction have significantly improved the prognosis and reduced the mortality associated with bifascicular block. Left anterior hemiblock pattern was also observed during angina pectoris occurring at rest or induced by exercise or atrial pacing. In these circumstances, LAH is transient and is likely to be due to ischemia in the anterolateral wall related to a lesion of the main trunk or the proximal left anterior descending coronary artery with the postero-inferior wall being first depolarized. The presence of bifascicular block in acute myocardial infarction still is associated with an unfavorable prognosis as compared to non-bundle branch block patients because of the common association with heart failure and other comorbidities.

P5566Two-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours

P5566Two-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours

Impact of acute hyperglycemia after primary angioplasty for acute myocardial infarction

Hyperglycemia (HG) has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). Investigate the relationship between acute HG and angiographic and clinical outcome after primary or rescue angioplasty for STEMI. We retrospectively included 489 patients who underwent revascularization for STEMI. We compared hospital outcomes of patients with HG (HG+) with those without HG (HG−) and outcomes of diabetic with non-diabetic patients in the HG+ group. Plasma glucose was measured at hospital admission. HG was defined as plasma glucose > 11 mmol/L (198 mg/dL). Among the overall population, 184 (37.6%) patients had HG. Procedural success was significantly lower in the HG+ group (86% vs. 92%, P = 0.05) with lower rates of ST segment resolution at 24 hours (47.3% vs. 61.4%, P = 0.006). Hospital outcomes were worse in the HG+ group with a higher mortality (20% vs. 10.4%, P = 0.008). Predictive factors for intrahospital mortality in the overall cohort were: procedural failure (OR: 4.76; 95% CI [1.65–13.7]; P = 0.004), heart failure at admission (OR: 9.75; 95% CI [4.14–22.87]; P < 0.001), anemia (OR: 4.22; 95% CI [2.06–8.63]; P < 0.001), high serum creatinine level (OR: 1.09; 95% CI [1.03–1.14]; P = 0.001), high glycemia (OR: 2.66; 95% CI [1.2–5.9]; P = 0.016). Diabetes did not predict hospital mortality ( P = 0.64) even in the group of patients with hyperglycemia. In non-diabetic patients ( n = 260), HG was associated with larger infarct size ( P = 0.001) and more adverse outcome ( P = 0.009). In the same group, HbA 1c was associated with one year mortality ( P = 0.02). In patients with STEMI, HG is an important predictor of worse outcomes with an increased mortality risk even beyond 11 mmol/L. In non-diabetic patients, both elevated glucose and HbA1c levels were associated with adverse outcomes.

Effect of age on cardiac output after coronary angioplasty in patients of acute myocardial infarction

Background: Although most of the acute coronary syndrome (ACS) patients are elderly, less data available on the effect of age on outcome after percutaneous coronary interventions (PCI) and major adverse cardiovascular events. In this study, we evaluated the effect of age on clinical outcomes in patients with ACS undergoing PCI because it is a well-known fact that the ages of patients influence clinical outcomes in ACS. Aims and Objectives: The aim of the study was to find out the effect of age on outcome of angioplasty in acute myocardial infarction (AMI) patients. Materials and Methods: It is a cross-sectional, self-control, interventional study. In this study, cardiac output (CO) of 52 patients of AMI was measured by echocardiography before and after angioplasty. CO is calculated with the help of end diastolic volume, end systolic volume, and left ventricular outflow tract diameter. Statistical software IBM SPSS version 16 was used for analysis of data. Results: A negative and statistically significant coefficient of correlation (r = −0.384 and P = 0.005) was found between age of patients and the value of CO after coronary angioplasty. Linear regression analysis was also done taking CO after coronary angioplasty as dependent variable and age of the patient as the independent variable. It can be hypothesized that as the age advances, CO after angioplasty deteriorates. Conclusion: Advancing age is associated with deterioration in outcome after coronary angioplasty in AMI patients.

TIMI (Thrombolysis In Myocardial Infarction) flow in direct and conventional stenting during primary angioplasty for acute myocardial infarction, our experience

TIMI (Thrombolysis In Myocardial Infarction) flow in direct and conventional stenting during primary angioplasty for acute myocardial infarction, our experience

P537The prediction of myocardial hemorrhage by contrast delayed enhancement with multidetector computed tomography (MDCT) immediately after coronary angioplasty in acute myocardial infarction

P537The prediction of myocardial hemorrhage by contrast delayed enhancement with multidetector computed tomography (MDCT) immediately after coronary angioplasty in acute myocardial infarction

Percutaneous transluminal coronary angioplasty for acute myocardial infarction: the impact on sexual function in men.

The aim of this study was to evaluate changes in men's sexual function after percutaneous transluminal coronary angioplasty (PTCA) treatment for acute myocardial infarction (MI). Sixty men aged 18-70 years old were included in the study. All patients had acute MI and underwent PTCA. They underwent two post PCTA visits: 3 days and between 4 and 6 months after PTCA. During the first and second visit a standard medical interview was carried out and sexual function data collected using Changes in Sexual Functioning Questionnaire and International Index of Erectile Function (IIEF-15). The results showed no statistical differences in IIEF and CSQF scores before and after PTCA. However, when cutoff points were used, a significant decrease in severe erectile dysfunction (ED) prevalence according to IIEF (25.0% vs 16.7%; P=0.02) was observed. Based on the results, we concluded that sexual function significantly improved in the subset of men with severe ED who underwent PTCA as a treatment for acute MI, 4-6 months after the procedure.