Balloon Time Research Articles

P1742Is time to telemedicine diagnosis (TTD) analogous to door to balloon time?

Abstract Background Telemedicine is a powerful, cost-efficient, and scalable tool for population-based AMI management. Traditional metrics of D2N, D2B do not gauge telemedicine effectiveness. We explored the utility of TTD in 784,947-screened patients within the Latin America Telemedicine Infarct Network (LATIN). Purpose To evaluate the competence of TTD as an efficiency indicator in telemedicine. Methods LATIN employed a spoke-hub strategy to expand access in Brazil, Colombia, Mexico, and Argentina. Small clinics (spokes) in remote areas were strategically connected to PCI-capable facilities (hubs). Experts at 4 remote locations provided urgent EKG diagnosis via tele-consultation, additionally, they triggered ambulance dispatch and implementation of guidelines-based protocols. Investing in updated telemedicine technology provided a system-wide TTD reduction. Results 714,450 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Within our territories 8,448 (1.08%) patients were diagnosed as STEMI; 3,911 (46.3%) were urgently reperfused, of those 3,049 (78%) underwent Primary PCI. TTD was 3 min, demonstrating 98.9% tele-accuracy. D2B was 51 min; in-hospital mortality 5.2%. We encountered a linear correlation between D2B and TTD. The latter was, also, inversely related to the number of screened patients - both associations are favorable for LATIN. Conclusions TTD is an important indicator of telemedicine efficiency. LATIN will continue to explore this value's strength and other important associations.

P3589New generation stents for primary percutaneous coronary intervention in patients with acute myocardial infarction: evidence from an individual patient data network meta-analysis of randomized clinical

Abstract Background Drug-eluting stents have shown their superiority in primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). No specific stent type has fully proven its superiority over others. Purpose We sought to compare the safety and efficacy of coronary artery stents in STEMI patients undergoing primary PCI through comprehensive network meta-analysis (NMA). Methods We performed an individual patient data (IPD) NMA of dedicated randomized trials in STEMI patients treated with coronary stents. The primary endpoint of interest was the composite outcome of cardiac death, any myocardial infarction (MI) or target lesion revascularization (TLR). Secondary outcomes were the individual component of the primary endpoint and definite or probable stent thrombosis. Outcomes were analyzed at the longest available follow-up. The primary analysis was performed using a one-stage random-effects meta-analysis. Results IPD from 15 randomized trials in STEMI patients were obtained including a total of 10,979 patients. Six different stent types were studied including bare metal stents (BMS), durable-polymer paclitaxel-eluting stents (DP-PES), durable-polymer sirolimus-eluting stents (DP-SES), durable-polymer zotarolimus-eluting stents (DP-ZES), durable-polymer everolimus-eluting stents (DP-EES) and biodegradable-polymer biolimus-eluting stent (BP-BES). Mean patient age was 60.7±11.9 years; 22.7% were female and 16.1% were diabetic. Median symptom onset to balloon time was 210 min. At a median follow-up of 3 years (interquartile range 2–4.9 years), patients treated with second-generation (DP-EES and BP-BES) or first-generation DES (DP-PES, DP-SES and DP-ZES) had significantly lower risk of the primary endpoint than patients treated with BMS (BMS vs. second-generation DES; HR 0.69, 95% CI 0.57–0.82, BMS vs. first-generation DES; HR 0.70, 95% CI 0.61–0.80). The differences were driven by the significant reduction of TLR associated with first- and second-generation DES compared with BMS. A trend towards lower risk of MI with second-generation DES compared with BMS or first-generation DES was observed (BMS vs. second-generation DES; HR 0.79, 95% CI 0.58–1.06, first- vs. second-generation DES; HR 0.75, 95% CI 0.54–1.03). Second-generation DES was associated with a significantly lower risk of definite or probable stent thrombosis compared with BMS (HR 0.62, 95% 0.40–0.97) and first-generation DES (HR 0.55, 95% CI 0.34–0.91). DP-EES and BP-BES had a similar risk of the primary endpoint, individual components of the primary endpoint, and definite or probable stent thrombosis. Conclusions In this larger-scale IPD NMA in STEMI patients, second-generation DES were superior to BMS with respect to long-term efficacy and safety outcomes. Second-generation DES were associated with a significant reduction of stent thrombosis compared with BMS and first-generation DES. Similar long-term outcomes were observed between DP-EES and BP-BES. Acknowledgement/Funding This study was funded by Biosensors International

P3590Impact of right ventricular branch slow flow phenomenon post percutaneous coronary intervention for acute coronary syndrome to predict sustained right ventricular dysfunction

Abstract Background Although Right Ventricular dysfunction (RVD) is one of the predictor of poor prognosis, it is believed that ischemic RVD after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) restores quickly. Because right ventricular perfusion has more ischemic preconditioning compared with left ventricle, due to their complex perfusion system. However, little is known about the time courses of RVD after ACS-PCI andtheir prognosis. We evaluated the relationship between right ventricular branch slow flow phenomenon (RVB-SF) post ACS-PCI in right coronary artery (RCA) and RVD at 6–8 months follow-up. Method We retrospectively analyzed consecutive 82 patients who underwent PCI for ACS in proximal or mid portion of RCA from August 2011 to March 2018 in our institution. Finally, both baseline and follow-up data were obtained from 70 patients. We analyzed TIMI frame count (TFC) to confirm the presence of RVB-SF (TFC ≥40 frame) after PCI. We also analyzed right ventricular fractional area change (RVFAC) at baseline and follow-up using echocardiography to detect sustained RVD (RVFAC ≤35%). Result We divided the patients into two groups (RVB-SF: 36 patients, RVB non-SF: 34 patients). Patient clinical characteristics were similar in both groups (sex, age, risk factors, medication, onset to balloon time, left ventricular stroke volume, max creatine kinase). Baseline RVFAC and follow-up RVFAC was significantly smaller in RVB-SF than in RVB non-SF, respectively. (27.1±1.7% vs. 38.3±1.8%, 31.4±1.0% vs. 48.7±1.1%, P<0.0001). However, ΔRVFAC (follow-up RVFAC – baseline RVFAC) was similar between groups. The size of inferior vena cava and systolic pulmonary artery pressure at follow-up were similar in both groups (12.1±0.6 mm vs. 11.7±0.7 mm, P=0.67, 25.7±1.5 mmHg vs. 25.2±1.5 mmHg, P=0.82). In RVB non-SF, 10 patients (29.4%) were diagnosed clinical RVAMI. However, follow-up RVFAC were similar and preserved in both groups (RVAMI: 48.1±1.3%, non-RVAMI: 49.9±1.9%, P=0.85). In RVB-SF, 19 patients (52.7%) were diagnosed clinical RVAMI. Follow-up RVFAC did not improved significantly in both groups (RVAMI: 30.4±1.4% vs. non-RVAMI: 32.6±1.5%, P=0.70). Multivariate analysis showed RVB-SF was the only independent predictor of sustained RVD at 6–8 months follow-up after ACS-PCI. Conclusion RVB-SF findings after ACS-PCI for RCA could predict sustained RVD at mid-term follow-up, which may indicate future prolonged RVD.

Safety of returning patients immediately to their originating hospitals after primary percutaneous coronary intervention

IntroductionThe objective of this study was to evaluate the safety and feasibility of the immediate return of patients with ST-elevation myocardial infarction (STEMI) to their originating hospitals after primary percutaneous coronary intervention (PPCI). MethodsThis was a prospective study, conducted between January 2014 and December 2017. All patients with STEMI who were transferred for PPCI and returned back to their referring hospitals (RB group) were included and compared to the onsite STEMI population (OS group). Patient’s demographics, PPCI data, bleeding and adverse cardiovascular events (ACEs) occurring during transfer, hospital stay, and at 1-month follow-up were recorded. ResultsA total of 156 patients in the OS group were compared against 350 patients in the RB group. We found that first medical contact to balloon time and onset of symptoms to balloon time were significantly longer in the RB group than in the OS group [110 ± 67 min vs. 46 ± 35 min (p < 0.0001) and 366 ± 300 min vs. 312 ± 120 min (p = 0.04)], respectively. There were no differences between the RB and OS groups in in-hospital ACEs: 0.3% versus 0% (p = 0.8) for death, 0.3% versus 0.6% (p = 0.79) for reinfarction, 0.6% versus 2% (p = 0.72) for bleeding, and no reported cases of repeat revascularization; and 30-day ACEs: 0.3% versus 0.6% (p = 0.82) for death, 0.3% versus 1.2% (p = 0.68) for reinfarction, 0.6% versus 2% (p = 0.74) for bleeding, and 1.1% versus 1.2% (p = 0.9) for repeat revascularization. ConclusionThe immediate return of patients with noncomplicated STEMI after PPCI to their referring hospitals is safe and feasible, and can be used as part of an effective reperfusion strategy.

Observatoire Vendéen indépendant des syndromes Coronarien aigus avec sus-décalage du segment ST (Registre OVISCA). Évaluation départementale, évolution démographique, mortalité, délais de prise en charge

AimMortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée. Patients and MethodsFrom 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2). ResultsBetween the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The “door-to-balloon” time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05). ConclusionsIn vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.

Predictive risk factors of early onset left ventricular aneurysm formation in patients with acute ST-elevation myocardial infarction

BackgroundLeft ventricular aneurysm (LVA) is a severe complication of ST-elevation myocardial infarction (STEMI) and is associated with poor prognosis due to high mortality. However, predictors of LVA formation in early period are inadequately defined. ObjectivesThe purpose of this study is to determine potential predictors of LVA formation in early period (<15 days after admission) after acute STEMI. MethodsThe present study was retrospectively conducted involving 1823 STEMI patients based on the AMI database of our clinic between January 2013 and April 2019. Among STEMI patients with regional wall motion abnormality (RWMA), the baseline, angiographic, procedural characteristics of patients with early-onset LVA and controls without LVA were compared. The controls were matched 2:1 with LVA cases for the admission date. Patients with prior myocardial infarction, non-ischemic cardiomyopathy, severe heart valve disease, and patients without coronary angiography were excluded. The odds ratio (OR) and confidence interval (CI) were obtained by logistic regression analysis and all statistical analysis were performed by SPSS 25.0. ResultsAmong 1823 STEMI patients who underwent coronary angiography, 103 eligible patients (median age 67 years) had LVA and were compared to 206 patients without LVA (median age 60 years). In multivariate analysis, RWMA in the left ventricular anterior wall (OR 13.17, 95%CI 2.21–78.57, p=0.005) was found to be the most striking predictor of LVA, followed by RWMA in the apex (OR 7.93, 95%CI 2.22–28.30, p=0.001). Female sex (OR 3.91, 95%CI 1.54–9.93, p=0.004), peak N-terminal pro brain natriuretic peptide (NT-pro BNP,OR 1.08, 95%CI 1.01–1.16, p=0.031), time between onset of pain and balloon time (OR 1.01, 95%CI 1.00–1.01, P=0.016), and presence of QS-waves on initial electrocardiogram (OR 3.06, 95%CI 1.49–6.27, P=0.016) were independently associated with LVA formation. ConclusionThis study indicated that female sex, peak NT-pro BNP, the time between the onset of pain and balloon time, presence of QS-waves on initial electrocardiogram, RWMA of left ventricular anterior wall and apex were the independent predictors of early-onset LVA in patients with acute STEMI.

The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy.

Data on the efficacy of excimer laser coronary atherectomy (ELCA) for patients with ST-elevation myocardial infarction (STEMI) are limited. Therefore, we sought to evaluate the impact of ELCA on myocardial salvage using nuclear scintigraphy in patients with STEMI. Between September 2014 and April 2017, we retrospectively enrolled 316 consecutive patients undergoing primary PCI (p-PCI) after their first STEMI in our institute. Of those, 72 patients with STEMI, an initial thrombolysis in myocardial infarction (TIMI) flow-0/1, and an onset to balloon time (OBT) < 6 h were included (ELCA, n = 32; non-ELCA, n = 40). The endpoint was the myocardial salvage index (MSI) based on a 17-segment model with a 5-point scoring system. MSI was calculated as: MSI = (∑123I-BMIPP defect score at 3-7days after p-PCI - ∑99mTc-tetrofosmin defect score at 3-6months after p-PCI)/∑123I-BMIPP defect score × 100 (%) at 3-7days after p-PCI. The groups were compatible except in age (ELCA: 62.9 ± 12.4years vs. non-ELCA: 69.8 ± 11.0years) and loading antiplatelet drug (prasugrel: 100% vs. 40.0%). Direct implantation of shorter stents more frequently occurred in the ELCA group than in the non-ELCA group. MSI seemed to be better in the ELCA group compared with the non-ELCA group (57.6% vs. 45.6%, p = 0.09). This trend was emphasized when the final TIMI-3 flow was achieved (67.1% vs. 45.7%, p = 0.01). The nuclear scintigraphy results showed that ELCA can potentially improve myocardial salvage in patients with STEMI with OBT < 6 h and initial TIMI flow-0/1.

Development and Validation of Risk Nomogram Model Predicting Coronary Microvascular Obstruction in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Catheterization.

BackgroundCoronary microvascular functional and structural obstruction (CMVO) remains a major complication in patients with ST-segment elevation myocardial infarction (STEMI). This study was designed to develop and validate a nomogram model to predict CMVO risk during primary percutaneous catheterization procedure.Material/MethodsStarting January 2014 to December 2016, a cohort of eligible candidates were enrolled and divided into a training or a validation database. Each database was divided into MO or NMO subgroups based on TIMI myocardial perfusion grade results after recanalization. Independent factors were identified by multivariate logistic regression, from which the nomogram was plotted. The echocardiography measurement of the left ventricular ejection fraction (LVEF) was arranged within 7 days after the procedure.ResultsA nomogram was built for CMVO risk prediction for the first time. There were 446 participants in the training database with 319 cases in the NMO subgroup and 127 participants in the MO subgroup. The validation database included 99 participants with 25 cases in the NMO subgroup and 74 in the MO subgroup. The risk model was developed by 6 independently significant factors: age, symptom onset to balloon time, Killip classification, admission activated clotting time, neutrophil/lymphocyte ratio, and glucose value. Internal receiver operating characteristic displayed favorable performance with concordance index of 0.925, while external validation area under curve was 0.939. There were significant differences in LVEF values during hospitalization between the subgroups of each database (both P<0.001).ConclusionsThe nomogram model consisting of 6 factors could predict CMVO risk accurately for STEMI patients undergoing primary percutaneous catheterization.

Gender but not diabetes, hypertension or smoking affects infarct evolution in ST-elevation myocardial infarction patients \u2013 data from the CHILL-MI, MITOCARE and SOCCER trials

BackgroundInfarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important to consider for accurate management and treatment of patients with ST-elevation myocardial infarction (STEMI).The aim of this study was therefore to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients.MethodsPatients (n = 301) with first-time STEMI from the three recent multi-center trials (CHILL-MI, MITOCARE and SOCCER) underwent cardiac magnetic resonance (CMR) imaging to determine myocardium at risk (MaR) and infarct size (IS). Myocardial salvage index (MSI) was calculated as MSI = 1-IS/MaR. Pain to balloon time, culprit vessel, trial treatments, age, TIMI grade flow and collateral flow by Rentrop grading were included as explanatory variables in the statistical model.ResultsWomen (n = 66) had significantly smaller MaR (mean difference: 5.0 ± 1.5% of left ventricle (LV), p < 0.01), smaller IS (mean difference: 5.1 ± 1.4% of LV, p = 0.03), and larger MSI (mean difference: 9.6 ± 2.8% of LV, p < 0.01) compared to men (n = 238). These differences remained significant when adjusting for other explanatory variables. There were no significant effects on MaR, IS or MSI for diabetes, hypertension or smoking.ConclusionsFemale gender is associated with higher myocardial salvage and smaller infarct size suggesting a pathophysiological difference in infarct evolution between men and women.

An analysis of the "door to signature" time and its influencing factors in STEMI patients

Objective To investigate the delay of door to signature time in primary percutaneous coronary intervention (PCI) and its influence in patients with ST segment elevation myocardial infarction (STEMI), therefore to provide a scientific basis for further effective shortening the time of primary PCI in patients with STEMI. Methods A total of 226 patients who diagnosed with STEMI and underwent primary PCI at Henan Provincial People's Hospital from June 2016 to December 2017 were enrolled in the study. Observation indicators include: (1) baseline data of patients; (2) time segments in primary PCI: total ischemic time (TIT), door to balloon time (DTΒT), door-to-signature time (DTST), signature to balloon time (STΒT); (3) the demographic characteristics of the family members who signed informed consent; and (4) the psychological factors and coping strategies of family members before signing informed consent. All data was analyzed using SPSS software (version 22.0). Multiple linear regression analysis was used to analyze the influencing factors of delay of DTST. A P<0.05 was considered statistically significant. Results In this study, 226 patients with STEMI who were first diagnosed in our hospital had a mean age of 55.23±10.80 years, and 181 (80.1%) were male. The median of TIT, DTΒT, DTST, STΒT were 312 min, 166 min, 82 min, and 80 min. The ratio of DTST in DTBT and TIT was 50% and 28.5%, respectively. The multiple linear regression analysis showed that the number of direct family members (P<0.001), the degree of educational in middle school and below (P=0.010), high school/technical secondary school (P=0. 029), families worrying about the high cost of medical care (P=0.020), families consulted each other repeatedly (P=0.022), and consulted the other medical staff (P=0.022) are risk factors of DTST delay, and city residence (P=0.048) is the protection factor of DTST delay. Conclusions The long time of DTS is a reality of the practice of primary PCI in China. The factors that lead to longer DTST include demographic characteristics, psychological factors and coping strategies of family members. The STBT of primary PCI in China should be taken into the value while emphasizing the DTBT. Key words: ST segment elevation myocardial infarction; Door-to-signature time; Influence factor

TCTAP A-017 Door to Balloon Time and Causes of Delay of Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction Patients: A Single Center Prospective Study

The goal of door to balloon time (DTB) during the primary percutaneous coronary intervention (PCI) is < 90 minutes. In India, there has been a paucity of data regarding DTB time and its causes of delay. Thus, this study was conducted to determine the DTB time in acute STEMI patients and to determine

TIME TO THINK BEYOND DOOR TO BALLOON TIME: SIGNIFICANCE OF TOTAL ISCHEMIC TIME IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION

Door to balloon (DTB) time is a well established determinant of in-hospital outcome and long-term morbidity and mortality in the ST Elevation Myocardial Infarction (STEMI), however, significance of total ischemic time (TIT) is debatable. Therefore, aim of this study was to evaluate the association

Impact of Time Delay on Short Term Outcome of Primary Percutaneous Coronary Intervention (PCI) in Bangladeshi Population

Background: Now-a-days primary percutaneous coronary intervention (pPCI) is being increasingly done in our country as the treatment of acute ST elevation myocardial infarction (STEMI). Time until treatment is paramount in the management of STEMI. But the time delay to pPCI how much influencing the outcome in our setting is mostly unknown.So we evaluated the influence of total ischemic time on myocardial reperfusion and short term clinical outcome in patients with STEMI treated with primary PCI.&#x0D; Materials and methods: This prospective observational study was conducted from August 2016 to March 2017in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Forty-eight (48) acute STEMI patients were selected by purposive sampling based on inclusion and exclusion criteria dividing into two groups as early treatment group (group-A) in whom pain to pPCI time was &lt;6 hours and late treatment group (group-B) in whom pain to pPCI time was 6-12 hours. Angiographic (TIMI flow grade 3 &amp; MBG 3) &amp; short term clinical outcome (MACE, heart failure, major bleeding, minor bleeding, cardiogenic shock, significant arrhythmia, instent thrombosis) were observed and compared between these two groups.&#x0D; Results: The relationship between total ischemic time and 30-day mortality &amp; morbidity were assessed and compared with early and late pPCI group. The overall 30-day mortality rate was 4.2%, heart failure was 6.2%, cardiogenic shock was 4.2%, major bleeding was 2.1% and minor bleeding was 14.6%. Mortality and morbidity were higher in longer ischemic time group than shorter ischemic time group. In multivariate regression analysis, the factors independently influencing the adverse short term outcome were advance age (OR 1.51, 95% CI 1.105 to 4.101, p=0.03), hypertension (OR 2.44, 95% CI 1.102 to 4.281, p=0.02), diabetes mellitus (OR 2.51, 95% CI 1.200 to 4.987, p=0.02), anterior MI (OR 1.38, 95% CI 1.001 to 2.872, p=0.03), multivessel disease (OR 2.35, 95% CI 1.010 to 5.371, p=0.02), pain to door time (OR 1.66, CI 1.099 to 2.2.722, p=0.04), and total ischemic time (OR 2.67, 95% CI 1.122 to 5.784, p=0.02). Even after correction for predictive baseline and procedural variables of the univariate analysis, longer total ischemic time was the most significant independent predictor (OR 2.67, p=0.02) of short term adverse outcome of primary PCI. The current status of time delay in our country revealed symptom onset to door time was 5.6±2.4 hours, door to balloon time was 1.9±1.1 hours and total ischemic time was 7.3±2.6 hours.&#x0D; Conclusion: According to this study finding, there is prognostic implication of time delay in patients with STEMI undergoing primary PCI. Therefore, all efforts should be made to shorten total ischemic time, including reduction in patient related delays, to improve clinical outcome of STEMI patients.&#x0D; University Heart Journal Vol. 14, No. 2, Jul 2018; 77-82

Less than 30 Minutes of Door to Balloon Time can Completely Alter the Clinical Course of the Right Ventricular Myocardial Infarction

Inferior MI complicated with right ventricular MI has a higher mortality rate than isolated inferior MI. Early revascularization is the key to reduce mortality rates in this high-risk subset.

ST-Segment Elevation Myocardial Infaction Alert During the Night Shift, A Misfortune for the Patient or an Overstatement?

BackgroundConflicting data exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on intervention timings. It is believed that short staffing at night hours may lead to a lapse in the delivery of effective, efficient and timely medical intervention.MethodsA retrospective single-center study was performed, and a total of 436 patients were randomized into two groups. Group A had 279 patients who had the heart catheterization done during the daytime (between 6 am and 6 pm), while group B had 157 patients who had the same intervention performed at night (between 6 pm and 6 am).ResultsDoor to balloon (DTB) time during the day was about 16 min shorter than the DTB time at night (81.29 ± 3.26 vs. 97.30 ± 8.54) with no statistical difference (P = 0.051). The mean troponin rise during the day was 1.94 ± 10.60 SEM (95% confidence interval (CI): -22.70 to 18.90) higher than night troponin levels (71.75 ± 7.18 vs. 69.80 ± 7.18), but P value was 0.85. The left ventricular ejection fraction (LVEF) fall for daytime was 0.93% vs. 0.90% for night time patients (P = 0.94).ConclusionThere is no significant difference in the mean DTB time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient’s time of presentation between the two groups.

Can QRS duration predict microvascular reperfusion after primary percutaneous coronary intervention?

Background: In patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) was associated with early and sustained restoration of blood flow compared to fibrinolytic therapy. Impaired myocardial blush grade (MBG) may be present in many after successful PCI. Prolonged QRS was found to be associated with an increased morbidity and mortality after STEMI. Aim: This study aims to find out if prolonged QRS in STEMI patients can predict low MBG after primary PCI. Patients and Methods: Sixty STEMI patients were included in our study. History taking, clinical examination, electrocardiography with measuring of QRS duration, primary PCI, and echocardiography were done to them. QRS duration was measured before and after PCI, and the change was calculated. Results: Patients with low MBG (0–1) had significantly higher QRS duration before and after PCI and significantly lower change after PCI (P < 0.00001 for each). Independent predictors for MBG were in order of significance: QRS duration before PCI (P < 0.00001), QRS duration after PCI (P < 0.00001), troponin level (P < 0.00001), symptom to balloon time (P = 0.0063), and creatine kinase MB level (P = 0.015). QRS duration 89 ms could predict low MBG with sensitivity 82.6%, specificity 86.5%, positive predictive value 79.2%, and negative predictive value 88.9%. Conclusion: In STEMI patients undergoing primary PCI, prolonged QRS duration was associated with a low MBG, a sign of impaired microvascular reperfusion. QRS duration before and after PCI were found to be independent predictors for low MBG (0–1).

Predictors of Short Term Outcomes of Primary Percutaneous Coronary Intervention

Background: Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in our country also. But the factor influencing the outcome of primary PCI in our setting are mostly unknown. The present study was conducted to investigate factors that influencing the short term outcomes of primary PCI.&#x0D; Materials and methods: This prospective observational study was conducted from September 2014 to January 2016in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. 48 patients were selected by purposive sampling. Patients with acute STEMI treated with primary PCI were included in the study based on inclusion and exclusion criteria. Effect of factors including advanced age, male sex, diabetes mellitus, hypertension, dyslipidemia, serum creatinine, left ventricular ejection fraction, anterior myocardial infarction (MI), thrombolysis in myocardial infarction (TIMI) flow, multi vessel disease, angiographic severity score (Leaman score), thrombus aspiration, door to balloon time and total ischemic time on major adverse cardiac events (MACE) i.e. death, post procedural MI, target vessel revascularization (TVR), stroke as well as, on other adverse events like heart failure, cardiogenic shock, major bleeding, significant arrhythmia and stent thrombosis were studied.&#x0D; Results: The overall incidence of MACE was 2.1%, major bleeding 2.1%, heart failure 4.2% and cardiogenic shock 2.1%. In multivariate analysis, the factors independently influencing the adverse short term outcomes (MACE and other adverse events) were diabetes mellitus (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.180 to 4.124, p=0.02), anterior MI (OR 1.48, 95% CI 1.020 to 1.926, p=0.04), total ischaemic time (OR 1.49, 95% CI 1.044 to 2.444, p=0.04), multivessel coronary artery disease (OR 1.77, 95% CI 1.26 to 3.261, p=0.03) and Leaman score (OR 2.5, 95% CI 1.100-4.504, p=.03).&#x0D; Conclusion: According to our finding, diabetes mellitus, anterior myocardial infarction, total ischemic time, multivessel coronary artery disease and high Leaman score are predictors of adverse short term outcomes of primary PCI&#x0D; Bangladesh Heart Journal 2018; 33(2) : 112-120

Ballons ACT chez la femme : évolution de l’efficacité au cours des 24 mois suivant l’implantation

To analyze the functional outcomes over time of ACT balloon in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). All patients with SUI secondary to ISD who underwent bilateral ACT balloon implantation between September 2008and November 2015and regularly monitored for a period of at least 24months were eligible. The results were studied at 6, 12and 24months. Efficacy was defined as: Success - maximum 1safety pad per day and visual analogue scale (VAS) rating≥9/10. Improvement - decrease in the number of pads used per day and VAS≥5/10. Failure - increase or stability of the number of pads used per day and/or VAS<5/10. Failure was considered as primary when it occurred without any success or improvement. It was considered as secondary when it occurred after an initial period of success or improvement. 18patients were monitored during 24months. The success rate was respectively 17%, 33% and 33% at 6, 12and 24months of follow-up. The improvement rate was respectively 61%, 39% and 17% at 6, 12and 24months of follow-up. The primary failure rate was 22%. The secondary failure rate was 6% at 12months and 33% at 24months of follow-up. ACT balloon efficacy tends to decrease with time requiring a long-term follow-up of implanted patients. 4.

Influence of balloon temperature and time to pulmonary vein isolation on acute pulmonary vein reconnection and clinical outcomes after cryoballoon ablation of atrial fibrillation.

BackgroundLimited data exist on indicators of durable pulmonary vein isolation (PVI) undergoing cryoballoon ablation (CBA) for atrial fibrillation (AF). We investigated whether balloon temperature and time to PVI can be used to predict early PV reconduction (EPVR), including residual PV conduction and adenosine triphosphate‐induced dormant conduction and the relation between touch‐up ablation of EPVR sites and mid‐term recurrence of AF.MethodsWe obtained procedural and outcome data from the records of 130 consecutive patients who underwent CBA and followed up for 13.4 months.Results EPVR was identified in 86 (17%) PVs of 61 (47%) patients. Balloon temperatures during 30 seconds (−27 ± 5.7°C vs −31 ± 5.5°C), 60 seconds (−36 ± 5.6°C vs −41 ± 5.4°C), and at the nadir point (−41 ± 7.4°C vs −49 ± 7.0°C) were significantly higher, and the time to PVI was longer (90 ± 50 seconds vs 52 ± 29 seconds) in PVs with EPVR than in those without (P < 0.0001 for all). Among PVs without EPVR, the time to PVI was longer and balloon temperature was lower for the left superior pulmonary vein/ right inferior pulmonary vein (LSPV/RIPV) than for the right superior pulmonary vein/left inferior pulmonary vein (RSPV/LIPV) (time: 60 ± 25/73 ± 37 seconds vs 41 ± 31/45 ± 20 seconds, P < 0.0001) (temp: −39.2 ± 11.3/−39.4 ± 8.3°C vs −33.8 ± 10.6/−33.6 ± 6.8°C, P = 0.0023). AF recurrence rates were equivalent between patients with and without EPVR (13% [8/69] vs 15% [9/61], P = 0.845).ConclusionsCryoballoon temperature and time to PVI appear to be useful in predicting durable PVI, that is, prevention of EPVR, but the balloon temperature and time required for PVI differ between PVs. Although EPVR does not predict AF recurrence, high success rates can be expected when touch‐up ablation of EPVR sites is performed.

Correction to: From Cardiologist to Patient…

HomeCirculation: Cardiovascular Quality and OutcomesVol. 11, No. 8Correction to: From Cardiologist to Patient… Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: From Cardiologist to Patient… Originally published17 Aug 2018https://doi.org/10.1161/HCQ.0000000000000048Circulation: Cardiovascular Quality and Outcomes. 2018;11:e000048This article corrects the followingFrom Cardiologist to Patient…In the article by Craig Alguire, “From Cardiologist to Patient…,” which appeared in the July 2018 issue of the journal (Circ Cardiovasc Qual Outcomes.2018;11:e004991), two corrections were needed.In the fourth paragraph, “If this were a STEMI. I was going to have a door to balloon time of 10 minutes” should read “If this were a STEMI, I was going to have a door to balloon time of 10 minutes”.In the final paragraph, “So I am remain grateful for every day that I am still alive, but greedy because I want more” should read “ So I remain grateful for every day that I am still alive, but greedy because I want more”.These corrections have been made to the article, which is available at https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004991Footnoteshttps://www.ahajournals.org/journal/circoutcomes Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesFrom Cardiologist to Patient…Craig Alguire,Circulation: Cardiovascular Quality and Outcomes. 2018;11 August 2018Vol 11, Issue 8 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/HCQ.0000000000000048PMID: 30354379 Originally publishedAugust 17, 2018 PDF download Advertisement