Anterior Wall ST-elevation Myocardial Infarction Research Articles

Concomitant percutaneous coronary intervention and transcatheter aortic valve replacement for aortic stenosis complicated with acute STEMI: a case report and literature review

Aortic stenosis (AS) complicated with acute ST-segment elevation myocardial infarction (STEMI) is a life-threatening emergency with high mortality. A 75-year-old male patient attended the emergency department of Wuhan Asia Heart Hospital in December 2021 with chest pain for 2 days and exacerbation for 1 h. The electrocardiogram (ECG) indicated atrial fibrillation with rapid ventricular response and ST-segment depression. Echocardiography showed severe AS and mild/moderate aortic insufficiency. The patient refused coronary angiography and further invasive procedures and then requested discharge, but he had recurrent chest pain on the third day. The ECG showed an extensive anterior wall STEMI. During preoperative preparation, he suffered from cardiogenic shock (CS). Concomitant percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) was performed, but he died of CS and multiple organ failure 4 days after surgery. Patients with AS and STEMI might be susceptible to CS during perioperative period of concomitant PCI and TAVR, which requires proactive prevention.

Abstract 15468: Factor VII Induced Coronary Thrombosis

Case Description: 69-year-old male with a history of factor VII deficiency and coronary artery disease (CAD) with a stent in the distal left anterior descending (LAD) artery, underwent diagnostic laparoscopy for suspected appendiceal carcinoma. He is a non-smoker, has good exercise tolerance and takes aspirin only three times a week, due to epistaxis. Post-surgery, he complained of 10/10 substernal chest pain. Initial troponin (TnI) was 0.11 ng/dL, peaking at >80 ng/dL in 2 hours. EKG was compatible with an anterior wall STEMI. An emergent coronary angiogram showed a patent distal LAD stent and a 99% occlusive lesion in the mid-LAD, which was treated with a drug-eluting stent. With careful clinical judgment and hematology consultation, dual antiplatelet therapy was continued despite a history of coagulopathy. On probing, it was discovered that the patient received two doses of recombinant factor VII (rVII) prior to the surgery to reduce operative bleeding. Discussion: Recombinant factor VII is known to cause serious arterial and venous thromboembolic events. This risk increases to almost 10% in patients who are elderly with concomitant vascular disease. In our patient with prior history of CAD and in the setting of acute surgical stress, exogenous factor VII unbalanced the coagulation system leading to a STEMI. Surgical teams should be aware of the detrimental consequences of administration of rVII in high cardiovascular risk patients and seek alternative hemostatic strategies. Prothrombotic agents should be used with caution and close monitoring for acute coronary syndromes, especially in patients with a high risk of CAD.

Risk Factors of Suboptimal Coronary Blood Flow after a Percutaneous Coronary Intervention in Patients with Acute Anterior Wall Myocardial Infarction.

Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589-0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1-1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1-1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271-0.9985, p = 0.04). Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure.

IN-HOSPITAL OUTCOMES OF PATIENTS PRESENTING WITH ANTERIOR WALL MYOCARDIAL INFARCTION WITH RIGHT BUNDLE BRANCH BLOCK

BACKGROUND: Acute myocardial infarction is a common heart disease associated with signicant morbidity and mortality. Data on the Clinical, Electrocardiographic and Angiographic prole of acute anterior wall ST-elevation myocardial infarction with Right Bundle Branch Block with q waves in leads v1, v2 are scarce. The aim of this study is to compare the mortality and in hospital outcomes of patients with anterior wall myocardial infarction with RBBB and without RBBB. The study design is a METHODS: retrospective study among the patients admitted with acute anterior wall STEMI with qRBBB and non qRBBB pattern on ECG during the time period March to August 2022. All relevant clinical and treatment data were collected from the medical records department, Government Royapettah Hospital. ECGs taken during the hospitalization of the patient were subjected to detailed analysis and their outcomes were recorded. RESULTS: Among the 50 patients with anterior wall myocardial infarction 11 patients presented with qRBBB pattern. Out of these 11patients, 7 patients had higher Killip score at presentation and 4 of them succumbed to death (57%).The in-hospital mortality rate was higher among those who had anterior wall myocardial infarction with qRBBB pattern when compared to non qRBBB pattern. There was a higher incidence of cardiogenic shock (54%) among patients with qRBBB pattern. Acute anterior wall MI wit CONCLUSION: h qRBBB myocardial infarction is a severe form of acute coronary syndrome with higher in-hospital mortality and morbidity necessitating early recognition and prompt institution of reperfusion therapy. Cardiogenic shock, ventricular tachycardia, higher Killip and TIMI scores at presentation are signicant predictors of inhospital mortality

Predictors of in-hospital heart failure in patients with acute anterior wall ST-segment elevation myocardial infarction

BackgroundHeart failure (HF) is a severe complication of acute ST-segment elevation myocardial infarction (STEMI). Its incidence is associated with myocardial infarction location, and it occurs frequently after acute anterior wall STEMI due to the larger infarct size. However, predictors of in-hospital HF in patients with acute anterior wall STEMI are inadequately defined. We aimed to determine potential predictors of HF in patients with acute anterior wall STEMI during hospitalization. MethodsA total of 714 consecutive patients who were diagnosed with acute anterior wall STEMI and underwent primary percutaneous coronary intervention (pPCI) between January 2013 to August 2019 were enrolled retrospectively. We assigned the patients to HF and non-HF groups. The clinical parameters were subjected to univariate analysis and logistic regression analysis to obtain the independent predictors. ResultsAmong the 714 patients enrolled in the present study (mean age 61.0 ± 13.8 years, men 80.7%), 387 (54.2%) had in-hospital HF. According to a multivariate logistic regression analysis, ventricular fibrillation (VF, OR: 5.66, 95% CI: 2.25–14.23, P < 0.001) was the most striking independent predictor of in-hospital HF. Community-acquired pneumonia (CAP, OR: 4.72, 95% CI: 2.44–9.10, P < 0.001), age (OR: 1.03, 95% CI: 1.01–1.04, P < 0.001), left ventricular ejection fraction (LVEF, OR: 0.96, 95% CI: 0.93–0.97, P < 0.001), and peak N-terminal pro-brain natriuretic peptide (NT-pro-BNP, OR: 1.06, 95% CI: 1.02–1.11, P = 0.006) were also independently associated with in-hospital HF. ConclusionVF, CAP, age, LVEF, and peak NT-pro-BNP were independently associated with in-hospital HF in patients with acute anterior wall STEMI.

Determination of the prevalence and predictors of ventricular thrombus with assessment of the risk of systemic embolization to the CNS in patients after acute myocardial infarction using magnetic resonance imaging, echocardiography and cardiac markers - a prospective, unicentric, observational study.

Left ventricular thrombus (LVT) formation is one of the well-known and serious complications of acute myocardial infarction (AMI) due to the risk of systemic arterial embolization (SE). To diagnose LVT, echocardiography (TTE) is used. Late gadolinium-enhanced cardiovascular magnetic resonance (DE-CMR) is the gold standard for diagnosing LVT. The aim of this observational study was to determine the role of transthoracic echocardiography and cardiac markers in predicting the occurrence of LVT compared with a reference cardiac imaging (DE-CMR) and to determine the risk of systemic embolization to the CNS using brain MRA. Seventy patients after MI managed by percutaneous coronary intervention (localization: 92.9% anterior wall, 7% other; median age 58.7 years) were initially examined by transthoracic echocardiography (TTE, n=69) with a focus on LVT detection. Patients were then referred for DE-CMR (n=55). Laboratory determination of cardiac markers (Troponin T and NTproBNP) was carried out in all. Brain MRA was performed 1 year apart (n=51). The prevalence of LVT detected by echocardiography: (n=11/69, i.e. 15.9%); by DE-CMR: (n=9/55, i.e. 16.7%). Statistically significant parameters to predict the occurrence of LVT after AMI (cut off value): (a) detected by echocardiography: anamnestic data - delay (≥ 5 hours), echocardiographic parameters - left atrial volume index (LAVI≥ 32 mL/m2), LV EF Simpson biplane and estimated (≤ 42%), tissue Doppler determination of septal A wave velocity (≤ 7.5cm/s); (b) detected by DE-CMR: anamnestic data - delay (≥ 13 hours), DE-CMR parameters - left ventricular end-diastolic diameter (≥ 54mm). The value of cardiac markers (Troponin T and NTproBNP in ng/L) in LVT detected by echocardiography did not reach statistical significance. In LVT detected by DE-CMR, NTproBNP was statistically significantly increased at 1 month after AMI onset (no optimal cut-off value could be determined). There was no statistically significant association between the LVT detection (both modalities) and the occurrence of clinically manifest and silent cardioembolic events. Our study confirmed a relatively high prevalence of LVT in the high-risk group of patients with anterior wall STEMI. Due to the low prevalence of thromboembolic complications, no significant association between the LVT detection and the occurrence of a cardioembolic event was demonstrated.

Intermittent isorhythmic dissociation after revascularization treatment in ST-elevation myocardial infarction

A 62-year-old male was admitted with anterior wall ST-elevation myocardial infarction, angiography reported a proximal lesion in the left descendant artery. Percutaneous coronary intervention was performed, with no complications, still, 72 h the electrocardiogram showed intermittent isorhythmic dissociation.

Anterior wall ST-elevation myocardial infarction complicated by a ruptured left ventricular aneurysm: a case report

ST-segment elevation myocardial infarction (STEMI) remains the most frequent cause of death worldwide. Nowadays, its management has been revised with the aim of rapid revascularization to avoid its fatal complications. Among its complications, mechanical complications, especially left ventricular aneurysm, have a high risk of death by rupture as illustrated in this case. We report the case of a 63-year-old male, who was referred to our tertiary hospital for shortness of breath and worsening chest pain evolving for 3 days after a delayed consultation. The electrocardiography (EKG) showed sequelae of anterior myocardial infarction with echocardiography of a giant apical aneurysm of the left ventricle. The evolution was rapidly marked by hemodynamic failure and cardiac arrest following rupture of the aneurysm. Until now, there is no proven benefit of aneurysm surgery yet, hence the importance of its prevention by urgent revascularization of any STEMI.

Chronic ischemia in Left anterior descending artery territory presenting as intractable hiccups: An unusual symptom of coronary artery disease.

Classical symptoms of ischemic heart disease include exertional chest pain associated diaphoresis, palpitations or shortness of breath. Yet, it can also present unusually with symptoms ranging from epigastric discomfort, fatigue and vomiting. A 48 years old male presented to the hospital with severe retrosternal chest pain for 6 hours duration. ECG showed acute anterior wall STEMI. Primary PCI to LAD was performed successfully. He had been complaining of intractable hiccups for the past one year for which he had been seen in gastroenterology clinics multiple times with no relief in hiccups. After we performed primary PCI to LAD, he had complete resolution of hiccups. He is still under regular follow up with us for the past 4 months with no active complaints of hiccups. This case conclude that Intractable hiccups can be the only symptomatic manifestation of coronary artery disease (CAD) in some patients. Therefore, a high suspicion of CAD should be kept in mind especially in patients with risk factors for CAD.&#x0D;

CORONARY ARTERY DISEASE IN YOUNG PAKISTANIS: RISK FACTORS AND PATTERN OF DISEASE

Objectives: To determine the distribution of risk factors and pattern of coronary artery disease among young Pakistanis presenting with acute coronary artery syndrome. A cross sectional study conducted from August 2018 to October 2019 at Department of Cardiology Jinnah Hospital Lahore.&#x0D; Methodology: Total of 150 young patients up to 40 years of age with acute coronary syndrome (ACS) was included in this study. Risk factors were evaluated on patient’s current medication history for diabetes mellitus, hypertension, lipid lowering drugs and recent reports HbA1c, total body lipids. Data was entered and analyzed in SPSS version 21.0. Socio-demographic, clinical profile and risk factors were evaluated and presented as frequency and percentages. Cross tabulation was for ACS and risk factors. Statistical significance was assessed using Chi-square test with significant value of p &lt; 0.05.&#x0D; Results: Among 150 subjects mean age was 34.20 + 4.246 with minimum age of 23 years and maximum age of 39 years. 92.0 % were male and 56.0% were having acute anterior wall STEMI, 36.0% had acute inferior Wall STEMI, 2.0% suffered from acute lateral wall STEMI, 2.7% had acute inferoposterior wall STEMI and 3.3% had NSTE-ACS. Risk factor analysis shows that 22.0% had diabetes mellitus, 20.7% had hypertension, 33.7% had a positive history of IHD in family, 71.3% were smokers, 44.0% had obesity, 66.0% had reduced HDL and 44.0 % had elevated LDL levels. Regarding pattern of coronary artery disease, 70.7% patients were having one vessel CAD, 28.0% two vessels CAD and 1.3% had three vessels CAD.&#x0D; Conclusion: Mean age of acute coronary syndrome is low amongst young Pakistani population with male predominance and acute anterior and inferior wall STEMI being most frequent diagnosis. Smoking, dyslipidemia particularly low HDL, positive family history of ischemic heart disease, hypertension, diabetes mellitus, obesity, was identified as important risk factors. Most of the patients had one vessel CAD.

Abstract 10017: Which Thrombi at the Apex of the Left Ventricle Were More Prone for Embolization and Stroke?

Introduction: Patients with apical thrombus due to anterior wall ST segment Elevation Myocardial Infarction (AWMI) or dilated cardiomyopathy (DilCM) have high risk of emboli, including stroke. Hypothesis: Which factor of a thrombus at the apex of the left ventricle makes it vulnerable for or resistant to embolization? Is it its loose (or well organized) tissue formation as a fresh (or old) thrombus so it disintegrates quickly (or stays resistant) and becomes vulnerable for (or less prone to) embolization? Methods: Patients with AWMI or DilCM with apical thrombus by echo were consecutively enrolled. Patients with atrial fibrillation were excluded. The data to be collected included: (1) Time of discovery of apical thrombi by echo to time of stroke (2) result of treatment (thrombolysis with long term vit K antagonists vs novel oral anticoagulants (NOACs) and (3) pattern of recovery. Results: From 2010-2021, there were 32 patients identified with apical thrombus. 12 patients due to AWMI and 20 patients due to Dil CM. 3 AWMI patients developed stroke (25%) within a mean of 7.5 days after discovery while only 2 patients with Dil CM had stroke (10%) 21 days after discovery (p&lt;0.05). At the time of stroke, all apical thrombi of AWMI patients were small, of round shape, protruding out and of heterogenous consistency (mixed black and white intensity on echo). The patients responded well to thrombolysis and recovered near completely. While for patients with Dil CM, all apical thrombi were moderately large, of flat surface incorporating into the contour of the apex, non-protruding and of homogenous consistency. When these patients had stroke, the size of stroke was large and more resistant to thrombolysis. Their recovery was slow with a lot of deficits. Conclusions: For apical thrombi from AWMI, the thrombi were fresh so they disintegrated quickly and could cause more stroke however because of their smaller size and loose consistency, the recovery was more complete. The apical thrombi from Dil CM were more organized so they dissolved more slowly, caused less stroke however they were more resistant to thrombolysis. Their recovery was more limited. Larger database needs to confirm the above findings and their clinical implications.

Abstract 15478: Obscure Back Pain - A Case of Spontaneous Retroperitoneal Bleed

Introduction: We present a case of spontaneous retroperitoneal bleed that presented as back pain until it required multiple transfusions. Case presentation: A 66-year-old gentleman with past medical history of only dyslipidemia, presented with chest pain and was found to have an anterior wall ST-elevation myocardial infarction. He underwent stenting to proximal LAD and was found to be in cardiogenic shock with elevated biventricular filling pressures and ejection fraction of 5-10%. IABP was inserted, which had to be upgraded to axillary Impella 5.5 the next day, and LVAD workup was initiated. He gradually improved with decreasing Impella needs when he started complaining of back pain 5 days into his admission. At the same time, his Impella requirements started to go up. He went on to develop sweating, pallor &amp; hemodynamic compromise. Since he was on anticoagulation due to Impella, a CT scan was obtained, which showed a spontaneous left-sided retroperitoneal bleed (F1) (IABP had been on the right side) and drop in hemoglobin from 15.8 mg/dl on admission to 7.2 mg/dl. He went on to develop hemorrhagic shock requiring massive blood product transfusion with subsequent vessel embolization by interventional radiology. Afterwards, he continued to improve, and Impella was eventually removed. Later in the course, he had another drop in hemoglobin &amp; was taken back for CT, which showed expanding retroperitoneal hematoma (F2). Hematology team was consulted due to 2 spontaneous bleeds; however, no underlying bleeding disorder was suspected. He stabilized; was weaned off of Impella and, was subsequently discharged on milrinone infusion. Conclusions: We conclude that providers highly suspect retroperitoneal bleeds in the proper clinical setting for optimum patient care.

Abstract 15016: Inferior ST Segment Depression Identifies Proximal Left Anterior Descending Culprit Lesions in Anterior ST Elevation Myocardial Infarction

Introduction: Anterior wall ST elevation myocardial infarction (STEMI) is caused by occlusion of the left anterior descending (LAD) coronary artery. Proximal LAD occlusions are associated with larger infarcts and more complications. However, there is limited data demonstrating a relationship between ECG changes and the location of the LAD culprit lesion. Objective: To determine if patterns of ST elevations (STE)/depressions (STD) on the 12 lead ECG can predict if the culprit lesion in an anterior STEMI is in the proximal LAD. Methods: We performed a retrospective chart review of ECGs obtained from a database of patients diagnosed with myocardial infarction at Robert Wood Johnson University Hospital from January 2009 to December 2016. Lesions, defined as proximal or non-proximal with respect to the first diagonal of the LAD, were assigned according to the Bypass Angioplasty Revascularization Investigation (BARI) Protocol. Each lesion was assigned to one of the 4 ECG patterns described in Table 1. An analysis of variance was used to determine if the difference in ECG characteristics between groups was significant. Results: Of 447 ECGs denoted as anterior wall STEMIs, 227 met inclusion criteria. In total, 104 lesions were defined as proximal and 123 were non-proximal. There was a difference in the ECG pattern of proximal versus non-proximal culprits category (p = 0.006). Proximal culprit lesions were more likely to have STE in the precordial leads combined with STD in the inferior leads, whereas non-culprit lesions were more likely to have STE in the precordial leads without any STE or STD in the limb leads. Conclusions: In anterior STEMIs, proximal culprit lesions were more likely to exhibit ST elevations in precordial leads and ST depressions in inferior leads, compared to non-proximal culprit lesions, which were more likely to have ST elevations in only the precordial leads. Concomitant STE in lateral leads without inferior STD did not distinguish between the 2 groups.

Culprit Lesion Morphology of Rapidly Progressive and Extensive Anterior-Wall ST-Segment Elevation Myocardial Infarction.

Rapidly progressive, extensive myocardial injury/infarction (RPEMI) beyond the concept of wave-front phenomenon can be observed even when achieving timely reperfusion; however, the pathogenesis of RPEMI remains unknown. This retrospective study investigated clinical and lesion characteristics of RPEMI, focusing on culprit-lesion morphology (CLM). Among patients with extensive anterior-wall ST-segment elevation myocardial infarction due to proximal left anterior descending artery lesions who had reperfusion within 3 hours of symptom onset, 60 patients undergoing both intravascular ultrasound and cardiac magnetic resonance imaging were enrolled. Myocardial injury/infarction before reperfusion therapy was assessed by QRS scores at hospitalization electrocardiogram, and the extent of myocardial injury/infarction was evaluated by cardiac magnetic resonance imaging, which measured area at risk, infarct size, myocardial salvage index, microvascular obstruction, and left ventricular ejection fraction. RPEMI was defined as lower left ventricular ejection fraction (less median value) with microvascular obstruction. Despite comparable onset-to-door and onset-to-reperfusion times and area at risk, patients with RPEMI showed higher QRS scores at hospitalization (5 [4.3-6] versus 3 [2-4], P<0.001) and infarct size (26.5±9.1 versus 20.4±10.5%, P=0.04), and a tendency toward lower myocardial salvage index (0.27±0.14 versus 0.36±0.20, P=0.10) compared with those without. Patients with versus without RPEMI more frequently observed specific CLM on intravascular ultrasound, characterized by the combination of vulnerable plaques, plaque ruptures, and/or large thrombi. When stratified by CLM-score composed of these 3 criteria, higher CLM-scores were or tended to be associated with higher QRS scores and incidence of RPEMI. In multivariate analyses including no-reflow phenomenon and final coronary-flow deterioration, increased CLM-score (≥2) was independently associated with high QRS scores and RPEMI (odd ratio 11.25 [95% CI, 2.43-52.00]; P=0.002). Vulnerable CLM was a consistent determinant of advanced myocardial injury/infarction both before and after reperfusion therapy and may play a pivotal role in the development of RPEMI.

The Value of Sacubitril/Valsartan in Acute Anterior Wall ST-Segment Elevation Myocardial Infarction before Emergency Percutaneous Coronary Intervention

Background: Many patients present with heart failure with reduced ejection fraction (HFrEF) after acute anterior wall ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to evaluate the effect of preprocedural sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and left ventricular ejection fraction (LVEF) in patients with acute anterior STEMI undergoing percutaneous coronary intervention (PCI). Methods: We enrolled patients with acute anterior wall STEMI who underwent emergency PCI at The Affiliated Hospital of Putian University from January 2019 to January 2021. Prior to PCI, patients were randomized to receive sacubitril/valsartan or valsartan. Nonculprit lesion vessels that require PCI were excluded. The primary endpoints included changes in NT-pro-BNP, LVEF, and rehospitalization for heart failure (HF) during the follow-up period. Results: Out of 109 patients who were randomized, 55 were assigned to receive sacubitril/valsartan and 54 were assigned to receive valsartan. The decrease in NT-pro-BNP concentrations and the increase in LVEF were significantly greater in the sacubitril/valsartan group than in the valsartan group. Conclusions: In patients with acute anterior wall STEMI undergoing emergency PCI, preprocedural initiation of sacubitril/valsartan therapy increased LVEF and lower NT-pro-BNP concentrations compared with valsartan therapy.

Impact of COVID-19 on mechanical complications in ST elevation myocardial infarction

Abstract Background Mechanical complications (MC) give a poor prognosis for ST elevation myocardial infarction (STEMI). Its prevalence had decreased in the era of primary angioplasty, at the expense of free wall rupture (FWR). Purpose To analyse the prevalence of post-STEMI MC for two periods, before and after the COVID-19 pandemic. Methods Unicentric prospective registration of patients with STEMI admitted between January-2018 and December-2021. They are classified into two groups according to the onset of the pandemic by COVID-19: Pre-COVID: January-2018 to December-2019, and Post-COVID: January-2020 to December-2021. The prevalence of post-STEMI MC is analysed, including ventricular septal rupture (VSR), papillary muscle rupture (PMR) and FWR, and 30-day mortality. Results 1507 consecutive patients with STEMI (Pre-COVID n=775, Post-COVID n=732) are included. Age 62.9 years vs 63.3 years (p=0.5097). Men 78.1% Vs 79.5% (p=0.493). No differences in cardiovascular risk factors, previous heart infarction or anterior wall STEMI. Primary angioplasty was similar in both groups (92%). The Post-COVID group has a higher prevalence of Killip&amp;gt;I (21.7% vs 17.2% p=0.025) and LVEF ≤40% (27.2% vs 20% p=0.001), and longer symptom onset to balloon dilatation interval (316 min vs 257 min p=0.0004). MC are most developed in Post-COVID (2.6% vs 1.2% p=0.039), at the expense of FWR (1.91% vs 0.3% p=0.001). No significant changes in VSR and PMR prevalence or 30-day mortality. Multivariate analysis identifies the independent predictors of FWR: Age (OR 1.05, p=0.024), Primary angioplasty (OR 0.09, p&amp;lt;0.001), and Post-COVID (OR 6.8, p=0.013). Conclusions The COVID-19 pandemic is independently associated with a higher prevalence of FWR, probably due to delayed reperfusion. Funding Acknowledgement Type of funding sources: None.

Inhomogeneous Distribution of Regional Myocardial Work Efficiency Predicts Early Left Ventricular Remodeling After Acute Anterior Myocardial Infarction Treated With Primary Percutaneous Intervention.

BackgroundThis study aimed to investigate the hypothesis that specific pattern of myocardial work (MW) distribution in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) could provide prognostic value for predicting left ventricular (LV) remodeling.MethodsA total of 98 first anterior wall STEMI patients treated with primary percutaneous coronary intervention [85 men (86.7%), mean age: 58 ± 12 years] were enrolled. Transthoracic echocardiography was performed 24–72 h after angioplasty and during 3-month follow-up. MW was estimated from the left ventricular pressure–strain loop derived from speckle tracking echocardiography and simultaneous noninvasive brachial artery cuff pressure. The primary endpoint was early LV remodeling, defined as an increase in LV end-diastolic volume ≥20% compared with baseline at 3 months after STEMI. Major adverse cardiac events and combined clinical outcomes were recorded.ResultsLV remodeling was present in 32 patients (33%), who exhibited lower global and culprit-regional work index (WI), constructive work (CW), work efficiency (WE), and specifically, greater differences of WE (delta-WE) and CW (delta-CW) between the culprit and non-culprit region than those without LV remodeling both at the acute phase and follow-up (all P < 0.0125). During follow-up, all global and regional WI, CW, and WE were improved (P < 0.0125 compared with baseline), with less improvement in patients with LV remodeling. In multivariate analysis, baseline delta-WE (odds ratio: 2.304; 95% CI: 1.093–4.856, P = 0.028) and peak troponin I level (odds ratio: 1.035; 95%CI: 1.008–1.063, P = 0.010) were independently associated with early LV remodeling. Patients with greater delta-WE at baseline were associated with a higher incidence of heart failure and combined clinical outcomes during follow-up.ConclusionAfter reperfused acute anterior STEMI, patients with LV remodeling presented with more inhomogeneous MW distribution. The absolute difference of WE between culprit and non-culprit territory at the acute phase is an independent predictor for early LV remodeling.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT05107102.

Preventive Effect Observation of Dapagliflozin on Middle and Later Ventricular Remodeling in Patients with Acute ST Segment Elevation Anterior Wall Myocardial Infarction: A Single-Center, Retrospective Cohort Study.

Objective: This study aimed to observe the effect of dapagliflozin on left ventricular ejection function (LVEF) and left ventricular end-diastolic volume (LVEDV) in patients with acute anesthesia ST segment elevation myocardial infarction (ASTEMI) and explore the effect of prophylactic treatment on ventricular remodeling (VR). Methods. A retrospective cohort design was employed to collect 188 patients with anterior wall STEMI who received emergency percutaneous coronary intervention (PCI). The patients were divided into dapagliflozin group and control group. The baseline data, the results of echocardiography at 6 months and on admission, and the proportion of VR were compared between the two groups. Echocardiography followed up for the two groups for 6 months after PCI and VR (LVEDV increased ≥20%) were considered the main clinical outcomes. Single-factor and multifactor logistic regression was conducted to explore the preventive effect of dapagliflozin on VR in patients with anterior wall STEMI. Results. There were significant differences in gender, history of diabetes, glycosylated hemoglobin (Hb1AC), admission LVEF, Killip grade of heart failure, and brain natriuretic peptide (BNP) between the dapagliflozin group and the control group regarding the baseline data. Compared with the results of echocardiography at admission and 6 months, the decrease in LVEDV and the increase of LVEF at 6 months in the dapagliflozin group were significantly higher than those in the control group. During the follow-up of 6 months, the VR rate in the dapagliflozin group was significantly lower than that in the control group. Multifactor logistic regression analysis suggested that the risk of VR was reduced by taking dapagliflozin after the adjustment of the confounding factors. Additionally, the combined use of dapagliflozin, ACEI/ARB, and β-block can further reduce the risk. Conclusion. Regular taking of dapagliflozin has a positive effect on the improvement of middle and LVEF and left ventricular volume enlargement in patients with anterior wall STEMI, as well as the prevention of the occurrence of VR.

Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization.

Although myocardial contrast echocardiography (MCE) can evaluate microvascular perfusion abnormalities, its prognostic value is uncertain in acute anterior wall ST-Segment elevation myocardial infarction (STEMI) with successful epicardial recanalization. Therefore, the study aims to investigate the prognostic role of qualitative and quantitative MCE in acute anterior wall STEMI with successful epicardial recanalization. 153 STEMI patients were assessed by MCE within 7days after successful epicardial recanalization. Qualitative perfusion parameters (microvascular perfusion score index, MPSI) and quantitative perfusion parameters (A, β, and Aβ) were acquired using a 17-segment model. And corrected A and Aβ were calculated. Patients were all followed for major adverse cardiovascular events (MACEs). During median follow-up of 27 (4) months, 39 (25.49%) patients experienced MACEs, while 114 (74.51%) were free from MACEs. Patients with MACEs had higher MPSI (1.65 ± 0.13 vs. No-MACEs 1.35 ± 0.20, P < 0.001), lower β (1.09 ± 0.19s-1 vs. No-MACEs 1.34 ± 0.30s-1, P < 0.001), corrected A (0.17 ± 0.03dB vs. No-MACEs 0.19 ± 0.04dB, P = 0.039) and lower corrected Aβ (0.19 ± 0.06dB/s vs. No-MACEs 0.25 ± 0.08dB/s, P < 0.001). MPSI of 1.44 provided an area under the curve (AUC) of 0.872, while β of 1.18s-1 and corrected Aβ of 0.22dB/s provided AUCs of 0.759 and 0.724, respectively. The combination of MPSI, β and corrected Aβ provided an increased AUC of 0.964 (all P < 0.05). Time-dependent ROC analysis showed that the AUCs of the MPSI, β, corrected Aβ and the combination at 1, 1.5 and 2years indicated a strong predictive power for MACEs (AUC = 0.900/0.894/0.881 for MPSI, 0.648/0.704/0.732 for β, 0.674/0.686/0.722 for corrected Aβ, and 0.947/0.962/0.967 for the combination, respectively). Patients with MPSI < 1.44, β > 1.18s-1, or corrected Aβ > 0.22dB/s had lower event rate (all Log Rank P ≤ 0.001). MPSI, β, corrected Aβ, GLS and WBC were independent predictors of MACEs with adjusted hazard ratio of 34.41 (8.18-144.87), P < 0.001 for MPSI; 39.29 (27.46-65.44), P < 0.001 for β; 8.93 (1.46-54.55), P = 0.018 for corrected Aβ; 10.88 (2.83-41.86), P = 0.001 for GLS; and 1.43 (1.16-1.75), P = 0.001 for WBC. Qualitative and quantitative MCE can accurately predict MACEs in acute anterior wall STEMI with successful epicardial recanalization, and their combined predictive value is higher.

Anomalous Right Coronary Artery Originating from Mid Left Anterior Descending ArteryAn Unexpected Encounter during Primary Percutaneous Coronary Intervention

The appearance of single coronary artery with anomalous Right Coronary Artery (RCA) originating from left coronary artery is an extremely rare encounter. Here, the authors report one such case of a 34-year-old male, who was serendipitously encountered with a single coronary artery with anomalous RCA arising from mid Left Anterior Descending (LAD)artery. He presented with anterior wall ST-elevation Myocardial Infarction (STEMI) and developed complete heart block. His mid LAD supplying anomalous RCA was totally occluded which was successfully recanalised using drug-eluting stent. The computed tomographic angiography confirmed single coronary artery with anomalous RCA arising from mid LAD across the stent.Thus, if RCA is not seen during traditional coronary angiography, the interventionalist should keep in mind that RCA can originate from LAD.