Anterior ST Elevation Research Articles

Clinical implications of the morphological features of left ventricular intracavitary thrombi after anterior ST elevation myocardial infarction

Abstract Background Left ventricular thrombi (LVT) after an anterior ST elevation myocardial infarction (STEMI) are usually classified as protruding or laminar according to their morphological characteristics. However, it is unknown whether this morphology has any clinical implication. Purpose Determine prognostic between laminar or protruding LVT in the community of anterior STEMI. Methods An observational cohort study on patients with LVT after anterior STEMI detected by echocardiography between 2008 and 2019 was conducted. Laminar LVT was defined as those protruding <5mm inside the cavity. Results Of 1.215 anterior STEMI patients, 121 (10%) cases presented a LVT: 86 (71%) were protruding and 35 (29%) laminar. Mean follow-up was 323±116 days. No differences in baseline clinical and echocardiographic characteristics were detected between laminar or protruding LVT groups. However, protruding LVT patients were more frequently treated with triple therapy (71% vs 40%; p<0.001). Laminar LVT patients presented a lower stroke rate (3% vs 16%; P=0.042) and embolism-related rate (3% vs 19%; p=0.024) than protruding LVT cases. Kaplan-Meier analysis demonstrated significant differences in embolism-related event rate between the 2 groups (p=0.003) during the follow-up period. Laminar LVT was associated with lower embolism-related events during follow-up independently than left ventricular ejection fraction (LVEF) and age (HR=0.17; 95% CI,0.10–0.29; p<0.001). No differences were observed in laminar LVT patients in embolism-related events during follow-up between those treated with or without triple therapy (7% vs 0%; p=0.400). Conclusions Laminar LVT after anterior STEMI presented a lower rate of embolism-related complications during follow-up compared with protruding LVT regardless of LVEF, age and even with a lower rate of triple therapy. Figure 1. Kaplan-Meier curve showing cumulative probability of embolism-related event rate after anterior STEMI according to LVT morphology at 1 year. Funding Acknowledgement Type of funding source: None

Cardioprotective strategy in ST-elevation acute myocardial infarction patients after reperfusion with percutaneous coronary intervention

Abstract Objectives Reperfusion may cause no-reflow phenomenon. Both microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have been recognized as poor prognostic factors in myocardial infarction (MI) patients. The aim of the study was to evaluate hypothesis whether cardioprotective strategy prevent IMH in MI patients after primary percutaneous coronary intervention (PCI). Methods This multicenter open-label randomized clinical trial enrolled 143 patients with first acute anterior ST-elevation MI (STEMI) reperfused within 6 h after symptoms onset. Cardiac magnetic resonance (CMR) was performed to assess left ventricular (LV) function and microvascular injury in 23 patients within the first week (3.5±1.2 days) after STEMI. Nine patients were randomized into soluble intravenous form of quercetin (Q) group and 14 - to the control group. Q infusions were started before PCI and used during the next 5 days. MVO was visualized using early gadolinium enhancement (EGE) and IMH was detected by using T2-WI. Results The study groups did not differ in terms of demographic characteristics, time to admission and main clinical data. Initially, the number of LV myocardial segments with edema was similar - 7.8±1.7 in patients of Q subgroup versus 6.8±1.8 in patients of the control subgroup (p=0.245). However, patients of the Q subgroup tended to have greater number of segments with gadolinium accumulation and higher value of the transmural index (7.7±1.2 compared to 6.2±1.5; p<0.05) according to the late gadolinium enhancement (Area at Risk, gray zone of AMI). According to gadolinium enhancement MVO was detected in more than 90% patients of both groups, but IMH rate was higher in the control group (53.3 vs 11.1%; p=0.03). Additionally, Q limited final infarct size assessed by CK-MB AUC 18% compare to control group (p<0.021). Conclusion Detection of MVO and IMH by CMR can accurately demonstrate the severity of myocardial injury. Intravenous Q can decrease the rate of IMH additionally to infarct size limitation. Further investigations are needed to confirm our results and to determine whether prevention of IMH can impact on better prognosis. Funding Acknowledgement Type of funding source: None

Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction

BackgroundThe predictors of left ventricular thrombus (LVT) formation are not well defined in the contemporary era, especially in those patients at high risk. We aimed to evaluate whether the platelet/lymphocyte ratio (PLR) is valuable in the determination of LVT formation in patients with anterior ST-elevation myocardial infarction (STEMI) and left ventricular (LV) dysfunction.MethodsThe LVT group (n = 46) was identified from anterior STEMI patients with LV dysfunction who were treated with primary percutaneous coronary intervention (PCI) from January 2017 to December 2019 at the China-Japan Union Hospital of Jilin University. The no-LVT group (n = 92) were also selected from the same batch of patients and were age- and sex-matched to the patients with LVT. The PLR was determined at admission and was calculated as the ratio of the platelet count to the lymphocyte count using the complete blood count. The presence of LVT was determined by echocardiography.ResultsThe PLR were significantly higher in patients with LVT than in no-LVT group (p = 0.001). In a receiver operator characteristic curve (ROC) analysis, using a cut-off value of 118.07 (AUC 0.673, 95% CI: 0.574–0.771, P = 0.001), the PLR could independently predict the occurrence of LVT. Multivariate analysis showed that an increased PLR (OR = 1.011, 95% CI: 1.004–1.018, P = 0.002), the presence of a left ventricular aneurysm (OR = 46.350, 95% CI: 5.659–379.615, P < 0.001) and increased DTBT (OR = 1.005, 95% CI: 1.001–1.009, P = 0.012) were independent predictors of LVT formation.ConclusionsIn acute anterior STEMI patients with LV dysfunction, an increased PLR and DTBT and the presence of an LV aneurysm were independent predictors of LVT formation. A larger prospective study is warranted to evaluate this result.Trial registrationThis study was registered (May 4, 2019) on Chinese Clinical Trial Registry (ChiCTR-DDD-17011214).

Pulmonary Embolism Presenting as an Anterior ST-elevation Myocardial Infarction: A Case Report.

IntroductionWhile the electrocardiogram (ECG) for pulmonary embolism typically shows tachycardia or evidence of right heart strain, it can demonstrate ischemic changes similar to acute coronary syndrome.Case ReportThe patient in this case presented with syncope, chest pain, and an ECG showing an anterior acute myocardial infarction (AMI) without evidence of right heart strain. His cardiac catheterization showed no coronary artery occlusions, but some signs of pulmonary embolism (PE), which was confirmed on computed tomography angiography of the chest.ConclusionThis case demonstrates that PE should be high on the differential for AMI and describes an uncommonly encountered mimic for classic ST-elevation myocardial infarction ECG changes. Further diagnostics to confirm the diagnosis should be obtained when indicated.

Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review

ABSTRACT Background Takotsubo syndrome (TTS) and its differentiation from anterior wall ST-elevation myocardial infarction on electrocardiography (ECG) has been a debate. Methods Six studies comparing ECG changes in TTS and AW-STEMI were identified. The primary endpoint was reciprocal changes, presence of Q-waves, and QT-interval. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated using Review Manager (RevMan) 5.3. Results Six studies consisting of 1090 patients (TTS = 220, AW-STEMI = 870) were included. Reciprocal changes on ECG were less commonly associated with TTS than AW STEMI with OR of 0.05 and 95%CI- 0.02–0.11 (P-<0.00001). Q-wave presence on ECG was comparable between the groups with OR-0.68, 95%CI-0.08–5.63 (p-0.72). QT interval on ECG was comparable between the two groups with OR-1.09, 95%CI-0.63–1.54 (p-<0.00001). There was minimal publication bias among the studies. Conclusion AW STEMI is associated with reciprocal changes. Q-waves and QT interval has no differentiating significance between AW STEMI and TTS.

Sudden cardiac arrest as a result of anterior and lateral myocardial infarction at 16 weeks of gestation - case report

Sudden cardiac arrest (SCA) is defined as a significant impairment of the mechanical function of the heart muscle, characterized by the patient's lack of response to stimuli, no perceptible pulse and apnea or agonal breathing, most often caused by acute coronary syndrome (ACS). ACS during pregnancy is a rare phenomenon and its incidence increases with the age of giving birth.The most common cause of ACS in pregnancy are typical changes in the etiology of atherosclerosis or coronary artery thrombosis. Other factors increasing the risk of a heart attack are arterial hypertension, diabetes, obesity and lipid disorders. To describe a rare clinical case and demonstrate the importance of maintaining cardiac vigilance in pregnant patients. A 32-year-old patient, at 16 weeks of gestation, hospitalized due to an anterior and lateral ST Elevation Myocardial Infarction (STEMI), complicated by SCA due to the mechanism of ventricular fibrillation. The patient was qualified for invasive reperfusion treatment which included left anterior descending (LAD) coronary artery surgery with drug eluting stent (DES) implantation and ballooning of the diagonal first coronary artery. Echocardiography done after treatment revealed apical hypokinesia and left ventricular ejection fraction of 70%. Subsequently the patient was kept under obstetrical and cardiological care. At 37 weeks of gestation, the pregnancy was finished by a successful caesarean section. Pregnancy is a state of hypercoagulability and decreased activity of the fibrinolytic system.The clinical management in this case does not differ from the clinical procedure adopted for non-pregnant women. It is important to make a diagnosis quickly and implement a life-saving procedure as soon as possible.

Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI

BackgroundSuboptimal coronary blood flow after primary percutaneous coronary intervention (PCI) is a complex multifactorial phenomenon. Although extensively studied, defined modifiable risk factors and efficient management strategy are lacking. This study aims to determine the potential causes of suboptimal flow and associated impact on 30-day outcomes in patients presenting with anterior ST-elevation myocardial infarction (STEMI).MethodsWe evaluated a total of 1104 consecutive patients admitted to our hospital from January 2016 to December 2018 with the diagnosis of anterior wall STEMI who had primary PCI.ResultsOverall, 245 patients (22.2%) had final post-PCI TIMI flow ≤2 in the LAD (suboptimal flow group) and 859 (77.8%) had final TIMI-3 flow (optimal flow group). The independent predictors of suboptimal flow were thrombus burden grade (Odds ratio (OR) 1.848; p < 0.001), age (OR 1.039 per 1-year increase; p < 0.001), low systolic blood pressure (OR 1.017 per 1 mmHg decrease; p < 0.001), total stent length (OR 1.021 per 1 mm increase; p < 0.001), and baseline TIMI flow ≤1 (OR 1.674; p = 0.018). The 30-day rates of major adverse cardiovascular events (MACE) and cardiac mortality were significantly higher in patients with TIMI flow ≤2 compared to those with TIMI-3 flow (MACE: adjusted risk ratio [RR] 2.021; P = 0.025, cardiac mortality: adjusted RR 2.931; P = 0.031).ConclusionFailure to achieve normal TIMI-3 flow was associated with patient-related (age) and other potentially modifiable risk factors (thrombus burden, admission systolic blood pressure, total stent length, and baseline TIMI flow). The absence of final TIMI-3 flow carried worse short-term clinical outcomes.

Coronary artery ectasia presenting with ST-elevation myocardial infarction in a young indigenous man: a case report

BackgroundCoronary artery ectasia (CAE) is often an incidental finding on angiography, however, patients can present with acute coronary syndrome due to a large thrombus burden requiring treatment with percutaneous coronary intervention or with emergency surgery.Case summaryA 26-year-old Indigenous Australian male was admitted with anterior ST-elevation myocardial infarction associated with an out of hospital ventricular fibrillation arrest. Coronary angiography demonstrated thrombotic occlusion of the proximal left anterior descending (LAD) artery with heavy thrombus burden and prominent vascular ectasia of all three coronary arteries. He was managed with surgical thrombectomy and coronary artery bypass graft of his LAD.DiscussionThis is the first case of triple CAE in an Indigenous Australian. The case highlights the lack of consensus approach in the management of CAE due to paucity of prospective studies.

Recurrent attack of acute myocardial infarction complicated with ventricular fibrillation due to coronary vasospasm within a myocardial bridge: a case report

BackgroundMyocardial bridge (MB) often an inoffensive condition that goes in one or more of the coronary arteries through the heart muscle instead of lying on its surface. MBs sometimes leads to myocardial ischemic symptoms such as chest pain, even an occurrence of myocardial infarction. However, reports of severe and recurrent cardiac adverse events related to the MBs are rare.Case presentationA 44-year-old male patient who suffered from a four-hour crushing chest pain ten years ago, was diagnosed as acute anterior ST-elevation myocardial infarction (STEMI). The initial findings of coronary angiography (CAG) showed MB was located in the middle part of the left anterior descending coronary artery (LAD). The patient was managed medically. Another re-attack of similar previous chest pain characteristics occured just after 3 days of discharge. Supra-arterial myotomy and CABG were the next adopted management. Postoperative progression was uneventful. However, 32 months after surgical treatment, the patient experienced an abrupt onset of chest pain accompanied by loss of consciousness. The ECG showed ventricular fibrillation (VF). After electrical cardioversion, an immediate CAG followed by CTA was performed which excluded thrombus or acute occlusion in the native coronary artery and an occlusion was observed at the end of the left internal mammary artery. An implantable cardioverter-defibrillator (ICD) was successfully performed for prevention of malignant arrhythmia. During ten years of follow-up, no complications have been identified.ConclusionsAlthough MB is mostly benign, it may lead to significant cardiovascular consequences. Supra-arterial myotomy is an appropriate treatment option for this patient who failed to optimal medical therapy. Furthermore, ICD implantation must be considered in order to prevent malignant ventricular arrhythmia caused by continuous spasm resulting in ischemia. Further investigations are required to confirm the clinical effectiveness of these procedures.

Chromogranin-A serum levels in patients with takotsubo syndrome and ST elevation acute myocardial infarction

BackgroundSympathergic hyperactivity is considered one of the main trigger precipitating takotsubo syndrome (TTS). Chromogranin-A (CgA), a prognostic biomarker of sympatho-adrenal activation, is markedly high in acute coronary syndrome (ACS) and heart failure (HF), but its role in TTS is unknown. MethodsCgA serum levels from patients with TTS and symptoms onset <24 hours were consecutively evaluated and compared with anterior ST-elevation myocardial infarction (STEMI) patients from November 2016 to December 2019. Short and long-term follow-up data were recorded. ResultsEleven women with TTS and 10 subjects with anterior STEMI were analyzed and compared; differences were not significant in terms of age, gender and cardiovascular risk factors. NT-pro-BNP levels were similar (9,887 ± 12,170 vs 8,969 ± 15,053 pg/ml, p = .88), while troponin-I levels were higher in patients with STEMI (4 ± 3.2 vs 13.3 ± 10 ng/dl, p = .03). CgA admission levels were significantly lower in TTS patients (2.2 ± 1.5 vs 7.3 ± 6.2 nMol/l, p = .017), even after multivariable correction for principal bias. CgA levels correlated with NTproBNP levels (p = .02) and were higher in subjects with in-hospital events (3.7 ± 1.1 vs 1.6 ± 1.2 nMol/l, p = .03), even after multivariable forward stepwise analysis (p < .01). CgA levels <3.25 nMol/l (AUC 0.754, 95% C.I. 0.54–0.968) were able to discriminate TTS from anterior STEMI (negative predictive power of 99%). ConclusionsSystemic CgA levels in the acute phase of TTS are lower than in anterior STEMI, possibly indicating a greater myocardial catecholamine release rather than adrenal.

The early dynamic of ECG in Takotsubo syndrome presenting with ST-elevation: A comparison with age and gender-matched ST-elevation myocardial infarction

BackgroundTakotsubo syndrome mimics acute myocardial infarction (MI) at presentation. ObjectivesTo explore differences in ECG time-course that could further help distinguish the two conditions. MethodsSerial ECG's (day 0–4) of 27 acute takotsubo and 37 MI patients, all presenting with anterior ST-elevation, were analysed for detailed morphology and timing of de/re-polarisation. All underwent cardiac magnetic resonance. ResultsThe presenting ECG (day 0) showed significantly fewer total abnormal leads (p = .001), comparable number of ST-elevation leads but lesser total magnitude of ST-elevation (p = .003), smaller sum of positive T wave amplitude (p = .006) and lesser number of pathological Q waves (p = .005) in takotsubo vs the MI group. After day 0, takotsubo patients developed more widespread T wave inversion (p = .001, day 3) and/or deeper T waves compared to MI, (sum of the T-wave amplitude slope of change between days 0–3: −43.1 ± 9.6 vs − 16.6 ± 5.4 mm, p = .02). Although there was no difference in mean QTc between the groups on any day, between days 0–3 there was a progressive increase in QTc in takotsubo vs a decrease in MI (34.1 ± 12.2 vs −29.5 ± 9.3 ms, slope of change p < .001). There was significantly more myocardial oedema (native T1 mapping) in takotsubo vs MI (p = .02), which resulted in increased left ventricular mass index in takostubo (p = .04). ConclusionsThe differences in presenting (day 0) ECG between takotsubo and MI are significant but subtle, reinforcing the importance of acute cardiac catheterisation for accurate diagnosis. During the next 3 days there is progressive increase in the depth and spread of T-waves and QTc duration in takotsubo vs MI - these may aid the diagnostic confidence in patients with bystander non-obstructive coronary disease.

A study on occurrence of cardiovascular complications among adult patients with ST elevation anterior wall myocardial infarction in the presence or absence of reciprocal lead ECG changes

Acute anterior wall ST elevation MI with reciprocal lead changes are associated with more extensive ischemic area or larger infarction & more complications. The present research was thus conducted to study the occurrence of cardiovascular events in ST elevation anterior wall myocardial infarction in the presence or absence of reciprocal lead ECG changes.

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus.

AimsLeft ventricular (LV) thrombus is increasingly detected in patients with and without ischaemic heart disease due to the increased availability of cardiac magnetic resonance imaging. Risk factors include anterior ST elevation myocardial infarction, delayed reperfusion therapy, and non‐ischaemic cardiomyopathy with severe LV systolic dysfunction. We aimed to report the characteristics and outcomes of patients with LV thrombus treated with either vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC) with a view to describing differences in efficacy, specifically, subsequent thromboembolic events, thrombus resolution, and also side effects of therapy including clinically significant bleeding.Methods and resultsWe conducted a retrospective, observational cohort study of patients diagnosed with LV thrombus between 1 December 2012 and 30 June 2018 and treated with either DOAC or VKA. We recorded patient demographics, past medical history, prescribed medications, and baseline investigations. The primary outcomes were rates of thromboembolism and clinically significant bleeding, with secondary outcomes of thrombus resolution on repeat cardiac imaging, repeat hospitalization, and all‐cause mortality. During the study period, 84 patients were diagnosed with and managed for LV thrombus. Of these, 62 received VKA and 22 DOAC including 13 prescribed rivaroxaban, eight apixaban, and one dabigatran. Most patients 75 (89%) were male with an average age of 62 ± 14 years. Ischaemic heart disease was the cause of LV impairment in 73 (87%) patients. Baseline characteristics were similar between groups at baseline. Most n = 55 (65%) were co‐prescribed a single antiplatelet agent and 32 (38%) received dual‐antiplatelet therapy. During an average follow‐up of 3.0 ± 1.4 years, there were no statistically significant differences between VKA and DOAC in rates of stroke (2% vs. 0%, P = 0.55), other thromboemboli (2% vs. 0%, P = 0.55), or clinically significant bleeding (10% vs. 0%, P = 0.13). The average interval to cardiac imaging follow‐up was 233 ± 251 days and was not different between groups (P = 0.83), and there was no difference in the rate of resolution of thrombus (76% vs. 65% P = 0.33). Rehospitalization (50% vs. 45%: P = 0.53) and all‐cause mortality (10% vs. 14%; P = 0.61) were also similar.ConclusionsOur data suggest that DOACs are likely to be at least as effective and safe as VKA for stroke prevention in patients with LV thrombus and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting. The optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high‐risk patients, should be tested in prospective, randomized trials.

Association Between C-Reactive Protein to Albumin Ratio and Left Ventricular Thrombus Formation Following Acute Anterior Myocardial Infarction

Left ventricular thrombus (LVT) is associated with inflammatory response in survivors with anterior ST-elevation myocardial infarction (STEMI). The C-reactive protein to albumin ratio (CAR) has been proposed as a marker of inflammation. However, there is a lack of data with respect to the role of CAR in LVT development. We investigated the relationship between CAR and LVT development in patients with anterior STEMI treated percutaneously; 955 consecutive patients were enrolled and LVT was observed in 126 (13.2%) patients. Clinical, demographic, and laboratory parameters were recorded. The CAR was significantly higher in patients with LVT (12.6 [8.6-16.1] vs 18.1 [11.5-23], P < .001). Other independent predictors for LVT development were lower ejection fraction, the presence of left ventricular apical aneurysm, proximal left anterior descending lesion location, glycoprotein IIb/IIIa inhibitors treatment, >1 diseased arteries, higher total protein level, neutrophil count, and peak creatine kinase myocardial band activity. In conclusion, the CAR may be useful as a simple tool for predicting LVT development among survivors of anterior STEMI.

Thrombolysis in Myocardial Infarction (TIMI) Risk Score Assessment for Complications in Acute Anterior Wall ST Elevation Myocardial Infarction

Introduction and objectiveEffective risk stratification is integral to the management of acute coronary syndromes. The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is based on eight high-risk parameters that can be used at the bedside for risk stratification of patients presenting with STEMI. This study was designed to determine the frequency of cardiac complications of anterior wall STEMI assessed on TIMI risk score and to compare the rate of cardiac complications according to the TIMI score.Materials and methodsAn observational case series study was conducted in the Department of Cardiology at Sandeman Provincial Hospital in Quetta, Pakistan. The study duration was six months, from September 22, 2016 to March 23, 2017. A total of 369 patients were selected who had anterior wall myocardial infarction and received thrombolytic therapy, according to the inclusion and exclusion criteria. The TIMI score was calculated by proforma at the time of admission. Patients were divided into three groups: low-risk, moderate-risk, and high-risk TIMI groups. The frequency of complications of anterior wall myocardial infarction at the time of discharge was compared among these groups.ResultsThe study included 285 male patients (77.2%) and 84 (22.8%) female patients. A total of 174 (47.2%) patients were smokers, 79 (21.4%) were obese, and 93 (25.2%) had hyperlipidemia. Of the 369 patients, 205 (55.6%) were included in the low-risk group, 150 (40.7%) in the moderate-risk group, and 14 (3.8%) in the high-risk group. Post-myocardial infarction arrhythmias were noted in 33 (16.09%) patients in the low-risk group and six (4%) patients in the moderate-risk group. Left ventricular dysfunction was noted in 158 (77.07%) patients in the low-risk group, 78 (52%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group. Cardiogenic shock occurred in seven (3.41%) patients in the low-risk group, 47 (31.33%) patients in the moderate-risk group, and 0 (0%) patient in the high-risk group. Death occurred in seven (3.41%) patients in the low-risk group, 19 (12.66%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group.ConclusionTIMI scoring provides a better assessment in terms of complications caused by STEMI. The complications include the mechanical and electrophysiology of the heart.

EVALUATION OF THE RELATION BETWEEN PLATELET COUNT AFTER PRIMARY PCI AND LEFT VENTRICULAR ANEURYSM IN PATIENTS WITH ACUTE ANTERIOR ST ELEVATION MYOCARDIAL INFARCTION

Objective: To evaluate the relationship between platelet count after primary percutaneous coronary intervention (p-PCI) and left ventricular aneurysm (LVA) in patients with acute anterior ST-elevation myocardial infarction(STEMI). Methodology: This descriptive study was performed on a population of patients with acute anterior STEMI, who had undergone p-PCI. Sampling was carried out by a consecutive survey of patients, who were admitted to the Medical Center in summer and fall of 2018. Blood samples were collected intravenously from all the patients at admission to the emergency department before and after p-PCI. Echocardiographic examinations were routinely performed by a specialist assistant as the co-author 8 to 12 hours after p-PCI and at follow-up (10 to 14 months after acute MI). The TIMI flow was observed immediately after p-PCI. In all the patients undergoing p-PCI, the location of left anterior descending (LAD) artery involvement during coronary arteries angiography was divided into three sections based on LAD artery length. Results: The mean WBC and PMN before p-PCI were statistically higher in the group of patients with LVA compared to individuals without LVA (p&lt;0.001). Based on multivariate analysis platelet count (OR=0.999, age (OR=1.07), PMN before P-PCI (OR=1.001) had a significant additive effect on the probability of LVA formation. Conclusion: Platelet count can be used for prediction of the risk of future LVA formation in acute STEMI patients. Key words: ST-segment elevation myocardial infarction; platelet count; mortality; percutaneous coronary intervention; left ventricular aneurysm

IT'S IN THE DIFFERENTIAL: MASSIVE PULMONARY EMBOLISM PRESENTING AS ANTERIOR STEMI

The ECG in acute pulmonary embolism (PE) can simulate that of STEMI A 69-year old woman presented with chest pressure and a prehospital ECG showing anterior ST elevation. Repeat ECG also suggested anterior STEMI (fig. A). The patient was hypotensive (86/61 mmHg) and bradycardic (pulse 44/min). She

PROPHYLACTIC RIVAROXABAN THERAPY FOR PREVENTION OF LEFT VENTRICULAR THROMBUS AFTER ANTERIOR ST-ELEVATION MYOCARDIAL INFARCTION

Anterior ST-Elevation myocardial infarction (STEMI) is associated with an increased risk of left ventricular thrombus (LVT) formation and systemic thromboembolism. However, the role of prophylactic anticoagularion in the current practice is a matter of debate. We conducted the study to determine the

CLINICAL OUTCOMES OF ANTERIOR STEMI PATIENTS ELIGIBLE FOR THE DOOR TO UNLOAD TRIAL

The Door to Unload Trial is a novel interventional trial proposing to treat anterior ST-elevation myocardial infarction (STEMI) by unloading the left ventricle (LV) with impella for 30 minutes prior to performing percutaneous coronary intervention (PCI). Our goal was to identify patients (pts) who

Effect of Von Willebrand Antigen on Mortality and Major Adverse Cardiac Events in Diabetic and Non-diabetic Patients with Anterior ST Elevated Myocardial Infarction

Background: Coronary artery disease (CAD) is one of the main causes of mortality in the world. The role of Von Willebrand Factor (VWF) is very important in platelet adhesion, microcirculation, and acute stenosis and it contributes to the development of atherothrombotic processes. Objectives: We decided to evaluate the level of VWF in diabetic and non-diabetic patients as an effective factor in CAD. Methods: This study was performed on 65 patients (32 diabetic patients and 33 non-diabetic patients), who referred to an Echocardiography and Angiography Department. They were evaluated for the VWF level, blood group, and fasting blood glucose. Patients underwent echocardiography, angiography, and, if necessary, percutaneous coronary intervention (PCI) during the hospitalization. They also underwent coronary artery bypass grafting (CABG) if they needed the surgery. After 40 days, we evaluated the anterior ST-elevation myocardial infarction (STEMI), mortality, major adverse cardiac events (MACE), heart failure, and limb ischemia. Results: The VWF level was significantly higher in diabetic patients (P < 0.0001). Also, the increased VWF levels were significantly more frequent in diabetic patients under CABG than in non-diabetic patients under CABG (P = 0.013). There was a significant relationship between positive MACE and increased VWF levels. Conclusions: The level of VWF in diabetic patients increases cardiovascular problems. Therefore, it seems that these patients can benefit from VWF-reducing drugs. Clinical research can be promising in this field.