Balloon Time Research Articles

Predictors of Intracoronary Heavy Thrombus Burden in Patients with ST Elevation Myocardial Infarction Undergoing Primary PCI within 12 Hours from Chest Pain Onset

Abstract Background ST segment elevation myocardial infarction (STEMI) comprises approximately 25-40% of myocardial infarction (MI) presentation. The pathophysiology of acute coronary syndrome (ACS) is rupture or erosion of the fibrous cap overlying lipid rich plaques within the arterial tree. This event exposes pro-inflammatory substances, ultimately resulting in platelet aggregation and formation of obstructive thrombus. Aim of the Work Identify predictors of heavy thrombus burden in patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 12 hours from onset of chest pain. Patients and Methods Our study included 200 consecutive patients who presented with STEMI and were managed by primary PCI within 12 hours from onset of chest pain. All patients were subjected to thorough history taking ] e.g. Age, HTN, family history of premature coronary artery disease (CAD) and pain to balloon time [, clinical examination, electrocardiogram (ECG), biochemical biomarkers, PCI and transthoracic echocardiography (TTE). Results Our study showed that there was significant positive correlation between grading of thrombus burden with age (rho = 0.165; P = 0.020), HTN (rho = 0.143; P = 0.043), number of risk factors (rho = 0.253; P < 0.001), Killip classification (rho = 0.211; P = 0.003), pain to balloon time (rho = 0.453; P < 0.001), ST elevation score (rho = 0.185; P = 0.009), RDW (rho = 0.878; P < 0.001), TLC (rho = 0.445; P < 0.001), troponin (rho = 0.600; P < 0.001), CK-MB (rho = 0.661; P < 0.001) and CPK(rho = 0.533; P < 0.001) and N/L ratio (rho=0.563 ; P = <0.001) also, there was significant negative correlation between grading of thrombus burden with EF (rho = -0.397; P < 0.001). Conclusion There was significant positive correlation between age, number of cardiovascular risk factor, pain to balloon time, Killip classification, RDW, TLC, N/L ratio and grading of thrombus burden. Only pain to balloon and RDW were considered as independent predictors of heavy thrombus burden

R wave peak time and no reflow following primary percutaneous coronary intervention: Immediate and short-term outcomes.

No reflow (NR) remains an important constraint in management of ST elevation myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Most ECG parameters validated till date including ST resolution are postprocedural. R wave peak time (RWPT) is a dynamic parameter and reflects conduction delay in ischaemic myocardium in selected leads supplied by infarct related artery (IRA). The present study was undertaken to see whether preprocedural RWPT per se or RWPT following primary PCI can predict persistence of NR along with immediate and short-term clinical outcome. 200 patients were enrolled after exclusion. Clinical, Biochemical, ECG parameters including RPWT and angiographic parameters (pre- and post-procedure) were recorded. ECG papers was analysed using digital image processing software (http://imagej.nih.gov/ij/). All patients were followed up for 6months. NR was observed in 35% of the patients. Age, Diabetes, symptom to balloon time, higher thrombus burden, peak CPK-MB level (pre and post procedure) were significantly higher in NR group. On ECG analysis, baseline RWPT, QRS duration and pathological Q wave were significantly higher in NR group. On multivariate analysis, age (OR 1.10 CI 1.00-1.21 P=0.04), thrombus grade≥3 in IRA (OR 12.38 CI 2.08-73.58 P=0.006), symptom to balloon time (OR 2.18 CI 1.6-3.0 P<0.001) and baseline RWPT on ECG [OR 1.86 CI 1.24-2.78, P=0.003] were found to be independent predictors of NR. Increase in RWPT following primary PCI was found to both highly sensitive and specific for diagnosing persistence of NR after primary PCI. Follow up at the end of 6months has shown that patients with increased RWPT following primary PCI had worse short-term cardiovascular outcomes compared to those with decreased RWPT following primary PCI. Baseline RWPT is a significant predictor of NR in patients of STEMI undergoing primary PCI. A persistently increased RWPT following primary PCI is also a highly sensitive and specific ECG marker of persistence of NR which is associated with adverse short-term clinical outcome.

C77 GENDER GAP IN TIME TO ST–ELEVATION MYOCARDIAL INFARCTION DIAGNOSIS: A RETROSPECTIVE COHORT STUDY

Abstract Introduction Timely reperfusion with primary percutaneous coronary intervention (pPCI) in patients with ST–elevation myocardial infarction (STEMI) must be the standard of care, irrespective of gender. Current guidelines mandate a door–to–balloon time of less than 90 minutes from STEMI diagnosis to wire crossing. However, coronary artery disease is characterized by relevant gender differences in terms of anatomy, pathophysiology, and clinical presentation. Female’s symptoms could be deceitful, and diagnosis could be delayed. Aim of our study was to evaluate the presence of gender differences at our Centre in diagnosing and treating STEMI. Methods We retrospectively analyzed a cohort of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit of ASST Great Metropolitan Hospital Niguarda (Milan) between January 2014 and July 2022. Clinical parameters were collected and waiting times from symptoms onset and ECG recording to pPCI were compared between sexes. Results 489 STEMI patients were included in our study, 384 men and 105 women. Median age was higher in women (75 years vs 61 years, p &amp;lt; 0.05) as was the incidence of arterial hypertension (70% vs 52.9%, p &amp;lt; 0.05). Women smoked less frequently than men (20.9% vs 39.1%, p &amp;lt; 0.05). Median waiting times from symptoms onset to balloon and from ECG recording to balloon were higher in females (320 vs 240 min, p &amp;lt; 0.05 and 111 vs 80 min, p &amp;lt; 0.05). After stratifying patients by age, chest pain to balloon times were higher in women aged &amp;gt; 65 compared to men in the same age category (320 min vs 292 min, p &amp;lt; 0.05). Regarding younger patients, ECG to balloon and chest pain to balloon times were always longer in females but without reaching statistical significance. A trend towards increased in–hospital mortality was noticed in females (7.6% vs 3.3%, p = 0.05). Conclusion Our study suggests that a gender gap may exist in diagnosing STEMI, with longer times from symptoms onset to balloon and from ECG recording to balloon in female patients. This may lead to increased in–hospital mortality in women.

P142 EARLY MANAGEMENT OF STEMI PATIENTS DURING COVID–19 PANDEMIC: THE ROLE OF AN EMERGENCY DEPARTMENT–BASED CARDIOLOGY UNIT IN SAN RAFFAELE SCIENTIFIC INSTITUTE

Abstract During COVID–19 pandemic, a critical issue for cardiologists was to provide early access to the standard of care for patients with time–dependent diseases such as ST–segment elevation myocardial infarction (STEMI), while making efforts to prevent their exposure to SARS CoV–2. Aims: The aim of our research project was to evaluate the role of an Emergency Department–based operative unit directly managed by the Cardiology Department in providing a prompt cardiological evaluation to STEMI patients at first medical contact, which we assumed might positively impact on the reperfusion strategy and timing and thus on the extent of myocardial salvage. Methods We retrospectively included a group of STEMI patients admitted by our ED with a definitive diagnosis of STEMI from March 2020 to November 2021 and a control group admitted from January 2019 to February 2020. The groups were compared in terms of critical time intervals, rate of PCI or initial non–invasive conservative management, pre–discharge characteristics and in–hospital clinical outcomes, including all cause mortality and complications. Results Throughout the study period, a total of 211 patients were admitted to our institution with a diagnosis of STEMI. The number of patients presenting late (at least twelve hours since symptoms onset) was significantly higher and time from symptoms onset to hospital admission was significantly longer during the first COVID–19 pandemic peak, compared with the previous year. Almost all patients in both cohorts underwent invasive coronary angiography with subsequent primary PCI. Remarkably, despite the time–consuming hygiene practices and policies necessary to prevent patients’ exposure to SARS CoV–2 virus, door–to–balloon time was comparable between the two cohorts. No statistically significant differences were found regarding the occurrence of STEMI–related complications. The in–hospital mortality was comparable between the two cohorts, as was predischarge LVEF. The high–sensitivity Troponin–T peak was significantly lower after the introduction of the ED–based cardiology unit. Total in–hospital stay was shorter after the introduction of the ED cardiology unit. Conclusions Our experience has shed light on the potential advantages of an ED–based unit directly managed by the Cardiology Department: despite the confirmation of a longer time from symptoms onset to hospital admission, no significant differences were found in terms of hard outcomes between the groups.

30 day outcome after early discharge in low risk ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Current guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) encourage an early discharge (48-72 h) after a successful primary percutaneous coronary intervention (PCI) in selected low risk patients. Yet, this strategy is not routinely applied. The evidence on the relative outcome of patients discharged early compared to those discharged later, has been limited. Purpose To assess safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes relative to early and late discharge strategies. Methods We prospectively enrolled 109 patients presented with STEMI from April 2019 to September 2019, who were categorized as low risk according to Zwolle risk score. 60 (55%) patients were discharged after 48-72 hours and 49 (45%) after &amp;gt; 72 hours. We gathered clinical data at 30 days. Primary endpoints were occurrence of a major adverse event - a composite of death from any cause, nonfatal myocardial infarction and acute stent thrombosis. Secondary endpoints were acute angina and re-hospitalization. Results The mean age was 59.7 +/- 10.5 years in early discharge group compared to 62.8 +/- 10.5 years in late discharge group (p=0.132). 88 (80.7%) patients were male. 58 (53.2%) of them had inferior MI. Mean ejection fraction was 49.25% +/- 4.95%. Median symptom to balloon time was 9.3 +/- 6.7 hour. Median length of stay was 3.4 days +/-0.6. Primary endpoint occurred in one patient in the early discharge group, who had acute stent thrombosis and nonfatal myocardial infarction. No death from any cause was observed in both groups. Secondary endpoint occurred in 3 patients who had acute angina, 2 in late discharge group and 1 in early discharge group. Conclusion(s) Data from our study reveal that an early discharge strategy in selected low risk STEMI patients treated with successful primary PCI is not associated with a significant increase in major adverse events compared to late discharge strategy.

Evaluation of the Causes of Door-to-Balloon Time Delays in Patients with ST-Elevation Myocardial Infarction at Tehran Heart Center.

Coronary artery disease (CAD) is the leading cause of cardiovascular death globally, and the most severe form of CAD, ST-elevation myocardial infarction (STEMI), needs immediate treatment. This study aimed to report patient characteristics and the causes of door-to-balloon time (D2BT) delays in STEMI patients admitted to Tehran Heart Center with a D2BT exceeding 90 minutes. This cross-sectional study was conducted at Tehran Heart Center, Iran, from March 20th, 2020, through March 20th, 2022. Variables consisted of age, sex, diabetes mellitus, hypertension, dyslipidemia, smoking, opium, family history of CAD, in-hospital mortality, primary percutaneous coronary intervention results, culprit vessels, causes of delays, the ejection fraction, triglycerides, and low and high-density lipoprotein levels. The study population was composed of 363 patients (272 males [74.9]) at a mean (SD) age of 60±11.47 years. The leading causes of D2BT delays were the catheterization lab used in 95 patients (26.2) and misdiagnosis in 90 (24.8). Other causes were ST-elevation less than 2 mm in electrocardiograms in 50 patients (13.8) and referral from other hospitals in 40 (11.0). The catheterization lab in use and misdiagnosis were the leading causes of D2BT delays. We recommend that high-volume centers allocate an additional catheterization lab with an on-call cardiologist. Improved resident training and supervision in hospitals with many residents are also necessary.

Pharmacoinvasive Therapy in Treating Acute STEMI Patients in Covid-19 Era

Background: Treating acute ST segment elevated myocardial infarction (STEMI) patients by primary PCI (pPCI) has dramatically fallen globally in covid era as there is chances of potential threat of spreading COVID among the non-COVID patients. Thereby, thrombolysis of acute STEMI patient in grey zone till COVID RT PCR report to come, was the mode of treatment of acute myocardial infarction patient in our hospital. We have carried out this prospective observational study to see the outcomes of thrombolysis and subsequent intervention. Methods: STEMI patient who presented to our emergency department with chest pain and ECG and hs-Troponin-I evidenced acute STEMI, were enrolled in the study. Total 139 patients enrolled (Male:120, Female :54); average age for Male: 54 yrs., female was: 56yrs. All patients were admitted in the grey zone of CCU where thrombolysis was done. COVID-19 patients were excluded from intervention and managed conservatively. Covid Negative patients were kept transferred to CCU green zone. On average 2.1 days after Fibrinolysis, elective PCI carried out. Data analysis from 48 patients who underwent pharmacoinvasive therapy was done. Results: Among the study population, Covid-19 positive was in 11 (7.9%) patients and Covid-19 was negative in 128 (92.1%) patients. Primary PCI was performed in 7 (5.03%) patients. Rest of the patients were managed by Pharmacoinvasive therapy. Thrombolysis by Tenecteplase (TNK) was done in 89 (64%) patients, and by Streptokinase in 25 (17.9%) patients, 18 (12.9%) patients did not receive any thrombolysis due to late presentation. Chest pain to needle time was 7.2 ±12.7hrs., thrombolysis to balloon time was 117.5 ±314.8hrs. More than 50% stenosis resolution observed in 20 (41.6%) patients, chest pain resolution within one hour of thrombolysis observed in 21 (43.8%) patients. Ten (20.8%) patients developed. Door to needle time was 30 mins. Total, 88 stents were deployed in 83 territories. CABG was recommended for 7 (5.03%) patients. Stented territory was LAD 37 (45.7%) and RCA 32 (39.5%) and LCX 12 (14.8%). Conclusion: In the era of COVID-19, in this prospective cohort study, on acute STEMI patient management, we found that Pharmacoinvasive therapy, reduced patients’ symptoms and ST resolution occurred partially. Cardiovasc j 2023; 15(2): 136-143

Numerical investigation on ballooning and rupture of a Zircaloy tube subjected to high internal pressure and film boiling conditions

Film boiling may lead to burnout of the heating element. Even though burnout does not occur, the heating element is subject to deformation because it is not sufficiently strong to withstand external loads. In particular, the ballooning and rupture of a tube under film boiling are important phenomena in the field of nuclear reactor safety. If the tube-type cladding of nuclear fuel ruptures owing to high internal pressure and thermal load, radioactive materials inside the cladding are released to the coolant. Therefore, predicting the ballooning and rupture is important. This study presents numerical simulations to predict the ballooning behavior and rupture time of a horizontal tube at high internal pressure under saturated film boiling. To do so, a multi-step coupled simulation of conjugated film boiling heat transfer and ballooning using creep model is adopted. The numerical methods and models are validated against experimental values. Two different nonuniform heat flux distributions and four different internal pressures are considered. The three-step simulation is enough to obtain a convergent result. However, the single-step simulation also successfully predicts the rupture time. This is because the film boiling heat transfer characteristics are slightly affected by the tube geometry related to creep ballooning.

Effect of chained one-stop emergency nursing combined with optimized triage path nursing on the rescue effect of chest pain patients in emergency department

ABSTRACT This study aimed to investigate the effect of chained one-stop emergency nursing combined with optimized triage path nursing on emergency chest pain patients. Data of 142 patients with chest pain in emergency department of our hospital were retrospectively analyzed, and from March to May 2022,71 patients with optimized triage route nursing were treated as control group, from June to August 2022, 71 patients with chain one-stop emergency care combined with optimized triage route care were selected as the observation group. Data of completion time of the first electrocardiogram (ECG) completion, troponin result giving time, door to balloon (D to B) time, length of hospital stay and rescue time (disease condition initial assessment time, preliminary examination time, first medical contact time of balloon dilation, D to B dilation time) were collected. The complication rate, adverse event rate and nursing satisfaction were compared between the two groups. The completion time of the first ECG, troponin result giving time, D to B time, initial condition assessment time, hospital stay and rescue time in the observation group were shorter than those in the control group, (all P<0.05). The incidence of complications and adverse events in the observation group were lower than control group (both P<0.05). The scores of nursing satisfaction in the observation group were evidently higher than those in the control group, (P<0.05). Chained one-stop emergency nursing combined with optimized triage path nursing has a good effect on emergency chest pain patients.

Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times.

To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P< 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P< 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P< 0.010). Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.

Abstract No. 27 The Effects of Patient and Procedural Variables of the Lutonix AV Global Registry: Results from the Arteriovenous Fistula Cohort

This is a post-hoc analysis of the results of the Lutonix AV Global Registry (outside the United Sates) focusing exclusively on arteriovenous fistulas (AVFs) with inclusion criteria consistent to those of the Lutonix IDE trial from the United States. Device under investigation was the Lutonix drug-coated balloon (DCB). 131 of the 320 subjects met criteria for inclusion in the analysis. 59.5% (78/131) were male. 50.5% were white and 45.7% Asian population. Among the exploratory outcome measures were safety (freedom from adverse events at 30 days), efficacy [target lesion primary patency (TLPP) at 6 months], effect of inflation time and pressure of the vessel preparation balloon. Primary safety endpoint at 30 days was 95.2%. TLPP at 6 months was 86.7% based on Kaplan-Meier survival analysis. Subjects with DCB inflation time between 2-3 minutes had a TLPP of 89.7% subjects while in those with 0–1 minute inflation time, TLPP was 78.6%. In subjects where vessel preparation pressure was >25atm, TLPP was 94.4%, while in those with < 25atm vessel preparation pressure, TLPP was 84.7%. Subjects whose lesion underwent vessel preparation and had inflation time >2 minutes, TLPP was 89.8%. Median time to event was 336 days. This post-hoc subgroup analysis suggests that in patients with arteriovenous stenotic lesions treated with DCB, procedural variables may influence outcomes. Subjects were reintervention-free for nearly a year.

ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction

BackgroundST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain.MethodsIn total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis.ResultsPatients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV.ConclusionsIn patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.

The effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention in patients with acute coronary syndrome: A large scale meta-analysis

AimWe aimed to study the effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). MethodA systematic literature search was performed in 2nd February 2022 updated in 12th December 2022 for recruiting relevant papers. The effect size was computed via the odds ratio (OR) for dichotomous data or standardized mean difference (SMD) for continuous data along with the 95% confidence interval (95%CI). ResultsAfter the screening of 1075 records, we found 11 relevant papers that included 2018 COVID-19 patients and negative controls 21,207. ACS patients with COVID-19 had a significant higher mortality rate (OR: 4.95; 95%CI: 3.92–6.36; p <0.01), long hospital stay (days) (SMD: 1.17; 95%CI: 0.92–1.42; p <0.01), and reduced post TIMI 3 score (OR: 0.55; 95%CI: 0.41–0.73; p <0.01) rather than controls. However, we found no significant differences in terms of thrombus aspiration prevalence (OR: 1.88; 95%CI: 0.97–3.65; p = 0.06) or door to balloon time (SMD: 0.11; 95%CI: -0.43–0.66; p = 0.7). ConclusionDespite that we found a significant association between COVID-19 and high mortality, more length of hospital stay and reduced post TIMI 3 score, in ACS patients after PCI, a rigorous analysis of the adjusted hazard ratio –that was absent in most of the included studies- by further meta-analysis is recommended to confirm this association. However, close monitoring of COVID-19 in patients with a high risk of developing ACS, is recommended due to the associated hypercoagulability of COVID-19 infection.

Impact of COVID-19 outbreak on patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention in a regional emergency center in Seoul, Korea

The corona virus disease 2019 (COVID-19) outbreak may have delayed the treatment of patients with ST-segment elevated myocardial infarction (STEMI) in the emergency department (ED). This study aimed to determine the causes for treatment delay and evaluate the outcomes of such delays in STEMI patients undergoing primary percutaneous coronary intervention. This was a single-center retrospective observational study. Hospital records of STEMI patients who received primary percutaneous coronary intervention from 01 January 2019, to 31 December 2020, were assessed. The pre-COVID-19 period was set before 01 January 2020, and the COVID-19 period was set after 01 January 2020, following which the data between these two periods were compared. During the COVID-19 period, there was a decrease in the reported incidence of STEMI patients compared with during the pre-COVID-19 period (incidence rate ratio, 0.74; 95% confidence interval, 0.55–0.99; p = 0.04). After arrival at ED, the time from door to balloon significantly differed between the pre-COVID-19 and COVID-19 period (78.0 min vs. 102.0 min, p &lt; 0.001). Also, the time to alert a cardiologist (16 min vs. 9 min), puncture time after cardiologist arrival (57 min vs. 42 min), and puncture to balloon time (19 min vs. 14 min) were significantly longer during the COVID period. However, the time from alert to cardiologist arrival was similar. Compared to the pre-COVID 19 period, more patients suffered from major adverse cardiac events during the COVID-19 period (n = 20 (25.3%) vs. n = 12 (11.2%), p = 0.012). In both periods, the number of patients admitted to the intensive care unit and died (106 vs. 79, 9 vs. 10, respectively) and the number of days spent in the ICU were similar. Early recognition of critically ill patients and appropriate response in the ED can lower misdiagnosis rates and increase prompt and correct treatments, thereby improving patient prognosis.

Thyroid Functions Are Associated with All-Cause Long-Term Mortality in Elderly Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction. Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed. The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: -0.253, P = 0.001) and creatinine (R: -0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan-Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01). In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.

Model for determining rupture area in Zircaloy cladding under LOCA conditions

The dispersal of nuclear fuel through a cladding rupture opening during a transient event is the primary safety concern preventing the United States nuclear industry from extending burnup beyond a peak rod average burnup of 62 GWd/tU. The majority of research thus far has prioritized understanding, or at a minimum prioritized quantifying, fuel fragmentation and pulverization as a function of burnup and to a lesser extent onset temperature. Early high burnup loss-of-coolant accident tests performed at the Halden Boiling Water Reactor evaluated the impact of relocation on cladding temperature, whereas historical and recent cladding burst tests focused primarily on generating data related to cladding balloon and burst timing. However, very little effort has been put forth to develop a relationship for determining the rupture opening dimensions for Zircaloy cladding tubes bursting during a simulated light water reactor loss-of-coolant accident. This is significant because high burnup loss-of-coolant accident data suggest dispersal could be limited by the size of the rupture opening or rupture dimensions, thereby minimizing the safety concern. Therefore, the purpose of this research is to build a database composed of all simulated loss-of-coolant accident data to develop an empirical model that conservatively captures the rupture opening dimensions and translates those dimensions to rupture area. Analysis of the experimental data indicates the rupture dimensions are strongly correlated to the peak balloon strain. This relationship is leveraged to develop a rupture length empirical correlation as a function of peak balloon strain and a rupture width empirical correlation as a function of rupture length. Outliers in the experimental data are identified and discussed. Finally, the rupture opening empirical model is presented in such a way for general implementation into high fidelity fuel performance codes or fuel performance codes used for safety analyses.

Frequency and outcomes of STEMI patients presenting between 12 and 24 hafter symptom onset: Late-presenting STEMI.

To assess the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late-presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. Using a two-center registry-based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3-6, 6-12, and 12-24 h (late presenters). Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid-19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door-to-balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In-hospital and 1-year death risks were comparable between late and earlier presenters. Despite the unfavorable risk profile and longer door-to-balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome.

The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear. Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time. Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, P < 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, P=0.007), hypertension (94.7% vs. 75.6%, P=0.02), and subclavian artery calcification (73.7% vs. 34.2%, P < 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (ρ = -0.51, P < 0.001) and total procedural time (ρ = -0.32, P=0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees (β = 0.45, P < 0.001). Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.

Inter-facility transfer for patients with STEMI in Bahrain: Characteristics and timings

Background: The outcomes of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention (PCI) facility is strongly related to certain demographic and clinical factors, important timelines, door-to-electrocardiography (ECG) time, door-in door-out (DIDO) time, door to balloon time (DTBT), the use of emergency medical services (EMS), and the existence of a STEMI network. In the study, we examined the inter-facility transfer for patients with STEMI analyzing certain characteristics and timings between the involved institutions. Method: This was a retrospective observational study on the inter-facility transfer of patients with STEMI admitted between January 01, 2018, and December 31, 2019. The electronic medical records of both the institutions were used to collect data on patient demographics, clinical characteristics and scores, ECG manifestations, laboratory values, treatment interventions, and outcomes with a major focus on the timelines for door-to-ECG, DIDO, and DTBT. Results: A total of 141 patients with STEMI who were transferred to a PCI center were included in this study. Their mean age was 52.26 ± 12.45 years and were mainly men (87.9%, p &lt; 0.001). Men developed STEMI at a younger mean age (53.15 ± 12.53 years, p = 0.003). Chest pain was the most common notable symptom (129, 91.5%). Diabetes mellitus (DM) and hypertension were noted to be the comorbid factors in a majority of patients (70, 49.6%). Only 47 patients (33.3%, p &lt; 0.001) were brought by EMS. Mean door-to-ECG and DIDO times were 8 minutes (IQR: 4–12) and 32.5 minutes (IQR: 24–46), respectively. Only 112 patients (79.4%) underwent PCI on arrival with a DTBT of 90 minutes (IQR: 70.5–105). Only door-to-ECG time and DTBT could be attained as required in this study (p &lt; 0.001). Conclusion: This study reveals a few beneficial statistics for the inter-facility transfer of patients with STEMI concerning their demographics, clinical characteristics, and important timelines. The door-to-ECG time, DTBT, and DIDO time were in the considerable recommended time, and this reflects the importance of establishing a STEMI network.

Abstract 13857: Reduction of Infarct Size in Anterior ST Segment Elevation Myocardial Infarction (STEMI) With LAD Occlusion and LV Unloading Using a Micro-Axial Pump for 30 Minutes Before PCI: A Per Protocol Analysis of the STEMI DTU Pilot Study

BACKGROUND: The STEMI-DTU pilot trial was the first exploratory study to identify that LV unloading and delaying reperfusion is safe and feasible in anterior STEMI without cardiogenic shock. We now report new findings in patients who met all protocol inclusion and exclusion criteria (per protocol cohort). Methods: In a multicenter, prospective, randomized safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). Cardiac magnetic resonance (CMR) imaging assessed infarct size normalized to the area at risk (IS/AAR) 3-5 days after PCI. Patients without CMR at 3-5 days (n=10; 5/arm), without PCI of a culprit LAD lesion (n=2; 1/arm) and without STEMI (n=5; 4 in U-IR, 1 in U-DR) were not per protocol and thus excluded from this analysis. Results: A total of 33 patients met all inclusion and exclusion criteria (U-IR n=15; U-DR n=18) with respective door-to-balloon times of 75±26 and 89±23 minutes (p=.10) and mean unload-to-balloon times of 10±5 and 34±3 (p&lt;0.01). In the total cohort, IS/AAR was significantly associated with microvascular obstruction (MVO), 30-day IS normalized to total LV mass, 90 day LVEF, and 90dday LV end systolic volume with or without a delay to reperfusion (Table, R&gt;0.5, p&lt;0.005 for all). Despite longer symptom to balloon times in the U-DR arm (174±59 vs 228±78, p&lt;0.01), IS/AAR was lower in the U-DR arm (62±16 vs 48±16, p=0.04) and remained significantly lower irrespective of the magnitude of precordial STE. MVO was significantly lower in the U-DR arm among patients with the highest precordial STE (Figure). Conclusion: A per protocol analysis of the STEMI-DTU Pilot trial identified a significant reduction in infarct size among patients with unloading and delayed reperfusion irrespective of precordial STE magnitude. These findings are currently under investigation in the STEMI-DTU Pivotal trial.