Coronary Intervention For Acute Myocardial Infarction Research Articles

Optical coherence tomography tissue coverage and characterization at six months after implantation of bioresorbable scaffolds versus conventional everolimus eluting stents in the ISAR-Absorb MI trial

PurposeData regarding vessel healing by optical coherence tomography (OCT) after everolimus-eluting bioresorbable scaffolds (BRS) or everolimus-eluting metallic stent (EES) implantation in acute myocardial infarction (AMI) patients is scarce. We compared OCT findings after BRS or EES implantation in patients with AMI enrolled in a randomized trial.MethodsIn ISAR-Absorb MI, AMI patients were randomized to BRS or EES implantation, with 6–8 month angiographic follow-up. This analysis includes patients who underwent OCT during surveillance angiography. Tissue characterization was done using grey-scale signal intensity analysis. The association between OCT findings and target lesion failure (TLF) at 2 years was investigated.ResultsOCT was analyzed in 103 patients (2237 frames, 19,827 struts) at a median of 216 days post-implantation. Of these, 70 were treated with BRS versus 32 with EES. Pre-(92.8 vs. 68.7%, p = 0.002) and post-dilation (51.4 vs. 12.5%, p < 0.001) were more common in BRS as compared to EES. Strut coverage was higher in BRS vs. EES (97.5% vs. 90.9%, p < 0.001). Mean neointimal thickness was comparable in both groups [85.5 (61.9, 124.1) vs. 69.5 (32.7, 127.5) µm, respectively, p = 0.20]. Mature neointimal regions were numerically more common in BRS (43.0% vs. 24.6%; p = 0.35); this difference was statistically significant in ST-elevation myocardial infarction patients (40.9% vs. 21.1%, p = 0.03).At two-years, 8 (7.8%) patients experienced TLF. Mean neointimal area [0.61 (0.21, 1.33) vs. 0.41 (0.11, 0.75) mm2, p = 0.03] and mean neointimal coverage [106.1 (65.2, 214.8) vs. 80.5 (53.5, 122.1) µm, p < 0.01] were higher, with comparable tissue maturity, in lesions with versus without TLF.ConclusionsIn selected patients who underwent OCT surveillance 6–8 months after coronary intervention for AMI with differing implantation characteristics depending on the device type used, vessel healing was more advanced in BRS compared with EES, particularly in the STEMI subgroup.

RADIAL ARTERY OCCLUSION FOLLOWING TRANSRADIAL CORONARY INTERVENTION

Objective: To determine the frequency of radial artery occlusion followingtransradial coronary intervention in acute myocardial infarction patients. Methodology: This cross-sectional study was conducted at cardiologydepartment Liaqat National Hospital Karachi from 22nd October 2016 to 21stApril 2017. Patients with myocardial infarction going for coronary interventionperformed through radial artery were recruited in this study. Radial artery waspalpated and coronary artery intervention was performed through radial arteryafter procedure patient was shifted to recovery, palpate radial artery after 6hrsand then Doppler ultrasonography was performed which shows no flow,impaired flow or normal laminar flow. Results: A total of 180 patients with myocardial infarction going for coronaryintervention performed through radial artery were recruited in this study. About79% of the patients were above 4 years of age. There were 55.56% male.Diabetes and hypertension were the commonest factor followed by smoking.Frequency of radial artery occlusion following transradial coronary interventionin acute myocardial infarction was observed in 18.89% cases. With respect toage stratification, rate of radial artery occlusion was observed in the range of14.3% to 23.7% in different age groups (p=0.734). Rate of radial arteryocclusion was approximate similar in male and female (p=0.96) while rate ofocclusion was significantly higher in obese (BMI >30 kg/m2) as compared to theoverweight and normal cases (p=0.011). Conclusion: The use of transradial PCI is not only beneficial to reduce bleedingbut also for ischemic complications and mortality in high-risk patientsundergoing coronary interventions. Key Words: Transradial coronary angiography, Radial artery occlusion, Acutemyocardial infarction.

The Differences in Cardiac Rehabilitation Outcomes by Age in Myocardial Infarction: A Preliminary Study.

ObjectiveTo determine the age-related changes in cardiac rehabilitation (CR) outcomes, which includes hemodynamic and metabolic factors, in patients with myocardial infarction (MI).MethodsCR was administered for 8 weeks to 32 men (mean age, 54.0±8.8 years) who underwent percutaneous coronary intervention for acute MI between July 2012 and January 2016. The exercise tolerance tests were performed before and after the CR. The results were stratified based on a cut-off age of 55 years.ResultsIn the whole patient group, the hemodynamic variables such as the resting heart rate (HRrest), systolic blood pressure (SBPrest), submaximal HR (HRsubmax), SBP (SBPsubmax), and rate pressure product (RPPsubmax) significantly decreased and the maximal HR (HRmax) and RPP (RPPmax) significantly increased. All metabolic variables displayed significant improvement, to include maximal oxygen consumption (VO2max) and ventilation (VEmax), anaerobic threshold (AT), and the maximal oxygen pulse (O2pulsemax). However, upon stratification by age, those who were younger than 55 years of age exhibited significant changes only in the HRrest and RPPsubmax and those aged 55 years old or greater displayed significant changes in all hemodynamic variables except diastolic BP. Both groups displayed significant increases in the VO2max, VEmax, and AT; the older group also exhibited a significant increase in O2pulsemax. The magnitude of the changes in the hemodynamic and metabolic variables before and after CR, based on age, did not differ between the groups; although, it tended to be greater among the older participants of this study's sample.ConclusionBecause the older participants tended to show greater hemodynamic and metabolic changes due to CR, a more aggressive CR program must be administered to elderly patients with MI.

Myocardial Infarction Related to Trauma.

Myocardial infarction (MI) secondary to acute coronary occlusion related to trauma is rare. A previously healthy man developed acute MI shortly after a motor vehicle accident. This case illustrates the feasibility of primary percutaneous coronary intervention for acute MI due to complete coronary artery occlusion related to trauma, including the use of manual thrombectomy, stents, and dual antiplatelet therapy. This approach requires the intervention of a multidisciplinary team in a Level 1 trauma center that can rapidly evaluate the patient and rule out other life-threatening injuries that could preclude antiplatelet therapy.

Clinical Predictors of No-Reflow in Percutaneous Coronary Intervention for Acute Myocardial Infarction

Background The no-reflow phenomenon in the setting of primary coronary intervention for acutemyocardial infarction (AMI) is relatively common and is associated with adverse outcomes.The detection of clinical variables associated with this phenomenon beforethe procedure might help to adopt preventive measures and thus improve the results. Objective The aim of this study was to identify clinical predictors of the no-reflow phenomenonin the setting of percutaneous coronary intervention for ST-segment elevation acutemyocardial infarction, prior to the procedure. Methods A total of 742 patients with AMI 60years, anterior infarction and delay to reperfusion > 3 hours as independent predictorsof no-reflow.ConclusionAdvanced age, anterior infarction and delay to reperfusion were independent clinicalpredictors of no-reflow. The confirmation of these findings in prospective studiesmight allow the implementation of strategies to prevent this phenomenon and eventuallyimprove the long-term clinical outcomes.

Angioplastia primária no infarto agudo do miocárdio: existe diferença de resultados entre as angioplastias realizadas dentro e fora do horário de rotina?

INTRODUCAO: Estudos demonstram que as angioplastias primarias realizadas fora do horario de rotina estao relacionadas a pior prognostico. E objetivo deste estudo avaliar os desfechos das angioplastias primarias realizadas dentro e fora do horario de rotina do servico de hemodinâmica. METODOS: Estudo de coorte prospectivo, incluindo 112 pacientes consecutivamente atendidos por infarto agudo do miocardio com supradesnivelamento do segmento ST (IAM) entre dezembro de 2009 e janeiro de 2010. Caracteristicas clinicas e angiograficas e evolucao hospitalar foram registradas em banco de dados especifico. Houve dois grupos para comparacao: grupo A, IAM tratado entre as 20 horas e as 8 horas e B, IAM tratado entre as 8 horas e as 20 horas. RESULTADOS: A amostra incluiu 44 pacientes no grupo A e 68 no grupo B. As caracteristicas basais foram semelhantes em ambos os grupos. O tempo porta-balao foi significativamente maior no grupo A (133 minutos vs. 90 minutos; P 0,99). O unico preditor do desfecho hospitalar combinado foi a frequencia cardiaca a admissao (razao de chance 1,02; P < 0,001). CONCLUSOES: Pacientes com IAM apresentam taxas de desfechos clinicos semelhantes, independentemente do horario de realizacao da angioplastia, porem o tempo porta-balao e significativamente maior nos pacientes tratados entre as 20 horas e as 8 horas.

Early Electrocardiographic Findings and MR Imaging-Verified Microvascular Injury and Myocardial Infarct Size

This study investigated early electrocardiographic findings in relation to left ventricular (LV) function, extent and size of infarction, and microvascular injury in patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI). The electrocardiogram (ECG) is the most used and simplest clinical method to evaluate the risk for patients immediately after reperfusion therapy for acute MI. ST-segment resolution and residual ST-segment elevation have been used for prognosis in acute MI, whereas Q waves are related to outcome in chronic MI. We hypothesized that the combination of these electrocardiographic measures early after primary PCI would enhance risk stratification. We prospectively included 180 patients with a first acute ST-segment elevation MI to assess ST-segment resolution, residual ST-segment elevation, and number of Q waves using the 12-lead ECG acquired on admission and 1 h after successful PCI. The ECG findings were related to LV function, infarction size and transmurality, and microvascular injury as assessed with cine and gadolinium-enhanced cardiac magnetic resonance 4 +/- 2 days after reperfusion therapy. Residual ST-segment elevation (beta = -2.00, p = 0.004) and the number of Q waves (beta = -1.66, p = 0.005) were independent ECG predictors of LV ejection fraction. Although the number of Q waves was the only independent predictor of infarct size (beta = 2.01, p < 0.001) and transmural extent of infarction (beta = 0.60, p < 0.001), residual ST-segment elevation was the only independent predictor of microvascular injury (odds ratio: 19.1, 95% confidence interval: 2.4 to 154, p = 0.005) in multivariable analyses. The ST-segment resolution was neither associated with LV function, infarct size, or transmurality indexes, nor with microvascular injury in multivariable analysis. In patients after successful coronary intervention for acute MI, residual ST-segment elevation and the number of Q waves on the post-procedural ECG offer valuable complementary information on prediction of myocardial function and necrosis and its microvascular status.

Influence of atenolol on coronary artery spasm after acute myocardial infarction in a Japanese population

BackgroundJapanese patients with acute myocardial infarction (MI) have a greater incidence of coronary artery spasm than Caucasians. Some beta-blockers have been reported to aggravate coronary spasm. This study sought to assess the effects of beta-adrenoceptor blockade on coronary vasospasm in Japanese patients with acute MI who had been treated with primary angioplasty. MethodsIn 69 patients we analyzed the effect of atenolol 50 mg/day initiated the day after emergency primary angioplasty on the results of intracoronary ergonovine provocation test performed 4 weeks after onset. ResultsAmong 35 patients in the atenolol group, the drug was discontinued in 9 (26%) due to hemodynamic compromise. The remaining 26 in the atenolol group and 34 in the control group underwent the spasm provocation test. Atenolol did not significantly increase the incidence of coronary vasospasm (31% vs. 15% in the atenolol and control groups, respectively, p= 0.135). Multivariate analysis revealed that only the pre-provocation diameter of the distal segment of the infarct-related artery predicted coronary spasm whereas atenolol did not. ConclusionsThis study showed that atenolol 50 mg/day did not increase coronary spasm in Japanese acute MI patients. It is suggested that beta-blockers can be safely used soon after coronary intervention for acute MI without the risk of increasing coronary spasm; however, attention should be paid to hemodynamic change in the acute phase.

Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention

Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction (MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction (LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients (55%), LVEF was measured a second time at 6 months. Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7% (95% CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery (LAD)-related infarcts and to a decrease of 2.4% (95% CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts (P < .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8% (95% CI 4.2-5.3) for LAD and 2.4% (95% CI 1.7-3.1) for non-LAD-related infarcts (P < .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.

Primary percutaneous coronary intervention for acute MI: improving access and outcomes.

Patients with acute myocardial infarction (MI) with ST-segment elevation have better outcomes with primary percutaneous coronary intervention (PCI) than with fibrinolytic therapy. Multiple clinical trials in the past 10 years have addressed ways to improve PCI as primary therapy for acute MI. Logistic strategies to improve access to PCI are being studied.

Importance of mitral regurgitation inpatients undergoing percutaneous coronaryintervention for acute myocardial infarction: The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial

ObjectivesWe sought to determine the prognostic importance of mitral regurgitation (MR) in patients undergoing percutaneous coronary intervention for acute myocardial infarction (AMI). BackgroundMitral regurgitation has been associated with a poor prognosis in patients treated with thrombolytic therapy for AMI. The prognostic significance of MR in patients undergoing mechanical reperfusion therapy for AMI is unknown. MethodsLeft ventriculography was performed during the index procedure in 1,976 (95%) of 2,082 non-shock patients enrolled in a prospective, multicenter, randomized trial of mechanical reperfusion strategies in AMI. The severity of operator-assessed MR was divided into four strata: none (n = 1,726), mild (n = 192), and moderate/severe (n = 58). ResultsPatients with progressively more severe MR were older (p < 0.0001), were more often women (p < 0.0001), and had higher Killip class (p = 0.0007). More severe grades of MR correlated with triple-vessel disease (p < 0.0001) and lower left ventricular ejection fraction (LVEF) as measured during the index procedure (p = 0.0004). Increasingly severe MR was strongly associated with a higher mortality at 30 days (1.4% vs. 3.7% vs. 8.6%, respectively; p < 0.0001) and at one year (2.9%, 8.5%, 20.8%, respectively; p < 0.0001). By multivariate analysis, the presence of even mild MR was an independent predictor of long-term mortality (mild MR, relative risk [RR] = 2.40, p = 0.005; moderate/severe MR, RR = 2.82, p = 0.006). ConclusionsMitral regurgitation of any degree present on the baseline left ventriculogram during the index procedure is a powerful, independent predictor of mortality in patients undergoing mechanical reperfusion therapy for AMI. The presence of MR identifies high-risk patients in whom close out-patient follow-up is warranted, and who may benefit from aggressive adjunctive medical or surgical therapies.