Elevation Myocardial Infraction Research Articles

Functional capacity evaluation in acute isquemic patients

Abstract Background An acute ischemic event may cause a functional deterioration even in previously autonomous patients. The determination of functional capacity is relevant to determine health indicators for rehabilitation nursing care, allowing at the same time to determine the patient's functional status throughout their health-disease cycle and to prescribe exercise-based rehabilitation for home-based programs. The six-minute walking test is widely used in studies involving cardiac patients, however, reference values for ischemic population after immediate clinical stabilization are not known. Also the 6MWT has a prognostic value for cardiac patients, being of utmost importance to evaluate it, after clinical stabilization in order to properly determine goals for patient´s rehabilitation process. Aim Determine the functional capacity level of ischemic patients, by gender and type of event, after clinical stabilization using the 6-minute walking test. Methods Using the 6-minute walking test, the functional capacity of ischemic inpatients was evaluated at discharge, after clinical stabilization. Patients with acute coronary syndrome with and without ST-segment elevation were included. All patients were accompanied by the rehabilitation nursing team during the in-hospital stay period and performed phase 1 cardiac rehabilitation. The 6MWT was performed based on the 2016 ATS guidelines and the expected value of the distance covered was determined based on the Enright equation. The sample was divided by gender, taking into account their widely known differences in functional capacity and also by event, namely ST elevation and Non ST-segment elevation myocardial infraction. The profile of modifiable cardiovascular risk factors (CRF) was also evaluated, being considered the following: Hypertension, Dyslipidemia, obesity, tobacco, sedentary lifestyle and stress. Results A total of 303 patients were studied (229 male), with a mean age of 62 years (men) and 62 (women). About 36% of men and 7% of women were admitted with ST elevation Myocardial Infraction, with a mean number of cardiovascular risk factors (CVRF) of 3.2 in men and 3.9 in women. The most prevalent CVRF in females is dyslipidemia and sedentary lifestyle, while in males it is dyslipidemia. The sample was divided in two groups by type of event, namely ST-elevation (group A) and NonST-elevation (group B) and in each group, data was evaluated by gender. A statistically significant difference (p<0.01 for males and p<0.02 for female) was found between the value of the 6MWT performed (441.2 meters – males; 369.5 meters - females) compared to the value estimated by the equation (559.9 males; 482.8 female gender). There is a very significant difference between the expected value and the value actually covered in the walking test. It may be pertinent to define reference values for this typology of patients, so that their functional capacity can be properly measured.

THROMBOLYSIS IN ST- ELEVATION MYOCARDIALINFRACTION PATIENTS: CLINICAL PREDICTORS OF REPERFUSIONAND ANGIOGRAPHIC OUTCOMES

Background: Thrombolysis is an alternative strategy for reperfusion in the management of ST- Elevation Myocardial Infraction (STEMI) patients, when percutaneous coronary intervention (PCI) cannot be performed. However, using clinical markers of reperfusion, thrombolysis is not always successful for all patients and immediate angiographicrescue PCI is indicated. Aim of the Work: Thegoal of this clinical study was to determinethe angiographic efficacy of thrombolysis in STEMI patients. Besides its correlation in successful or failed thrombolysis (FT) based on clinicalcriteria of reperfusion. Material/Methods: The study population included patients with acute STEMI within 12 hours of onset chest pain, who were admitted to The Cardiac Intensive Care Unit of cardiology department, atUniversityHospital Center Mohammed VI of Marrakech Morocco, receiving thrombolysis with Tenecteplase, during the period from January2021 to January2023. Repeated Electrocardiogram (EKG) at baseline, 90 minutes after Thrombolysis to define FT and PCIwereperformedfor all patients. Results:121 patients with a mean age of 56 years were recruited in the study. Successful thrombolysis was present in 60% of patients (n = 73) in Group I, while 40% of patients (n = 48) had FT in Group II. There was no significant difference between patients in both groups regarding gender, risk factors for coronary artery disease like dyslipidemia, diabetes mellitus, obesity, smoking, and myocardial infraction territory on the EKG. However, hypertension, delayed presentation after six hours of onset chest pain, and severe alteration of the systolic ejection fraction were mostly present in Group II. The TIMI III flow rates represent 76%(n = 93) of the patients in the study, with higher rates in both groups, at 80% versus 70% for groups I and II, respectively. Conclusion: The study confirmed that unsuccessful thrombolysisdoes not mean always-unsuccessful restoring of epicardial coronary flow.As a result, our current results clearly demonstrate the benefits of fibrinolysisfor STEMI patients when resources are limited for primary PCI. However, Additional clinical studies are also needed to investigate the recovery of microvascular and tissular perfusion to improve myocardial function and long-term clinical outcomes.

The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions.

(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.

Percutaneous Coronary Intervention InST Elevation Myocardial Infraction: Clinical Profile and Outcomes

Percutaneous Coronary Intervention InST Elevation Myocardial Infraction: Clinical Profile and Outcomes

Optimizing Door-to-Balloon Time for Patients Undergoing Primary Percutaneous Coronary Intervention at King Abdullah Medical City.

The acute myocardial infarction mortality risk rises by 8% per year for every 30-minute delay in early coronary intervention following the onset of symptoms. Thus, it is important to reduce the door-to-balloon time as much as possible, especially in hospitals where early coronary intervention is carried out within 90 minutes. The purpose of this study was to determine the impact of King Abdullah Medical City's strategies on balloon time for patients with ST elevation myocardial infraction. Prospective observational research was conducted in King Abdullah Medical City. This study included 67 patients who had a primary percutaneous coronary intervention. Data were collected in Hajj 2023 through direct observation using a checklist that included two parts: (I) patients' demographic characteristics and relevant time intervals. The data were analyzed using descriptive statistics (frequency and percentage; median and interquartile range) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test, Spearman correlation coefficient test). It was noted that the median overall door-to-balloon time was 68 minutes for direct admission patients and 100 minutes (median) for interhospital transferred patients, with a statistically significant P value of 0.001. DTBT had no significant correlation with either the length of stay or hospital mortality rates (P > 0.05). King Abdullah Medical City accomplished an international benchmark in door-to-balloon time for ST elevation myocardial infraction patients visiting the hospital for percutaneous coronary intervention during the hajj season. Healthcare organizations can take proactive steps to optimize the management of STEMI cases. This includes establishing efficient communication channels, standardizing protocols, and facilitating seamless transitions between healthcare facilities.

Adjunct remote ischemic conditioning to PCI in ST-segment elevation myocardial infraction patients: Systematic review and meta-analysis

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) is the most dangerous presentation of the acute coronary syndrome (ACS). Throughout the last three decades, clinicians have been attempting to reduce the short and long-term major adverse cardiac events (MACE) associated with STEMI. Remote ischemic conditioning (RIC) is one of the new adjunctive modalities to PCI in treating STEMI patients whereby brief reversible episodes of ischemia and reperfusion are applied to the tissue (by alternative cycles of inflation and deflation of a blood pressure cuff on the upper or lower limb) confers global protection and renders remote tissues resistant to ischemia/reperfusion injury. This review aims to provide reliable evidence from published randomized controlled trials (RCTs) regarding whether RIC is beneficial for STEMI patients or not. Methods We followed the PRISMA guidelines during the preparation of this systematic review and meta-analysis. A computer literature search for (PubMed, Web of Science, Scopes, and Google Scholar) was carried out. We included RCT, comparing the remote ischemic conditioning, regardless of its timing of application to PCI, with either placebo or sham procedure, in terms of both short-term and long-term cardio protection. Outcomes of myocardial salvage index, myocardial infarction size, and left ventricular ejection fraction were pooled as the standardized mean difference between the two groups from baseline to endpoint. Results 11 RCTs (7151 patients), were included in this analysis. The overall effect on short-term outcomes, was in favor of PCI only in terms of myocardial salvage index(P value=0.04, 95% CI [0.00-0.08]), and left ventricular ejection fraction(P value=0.05, 95% CI [0.02,2.16]), while the adjunctive application of remote ischemic conditioning was beneficial in terms of: myocardial infarct size ( P value=0.004, 95% CI [-3.22,-0.62]). Regarding the long-term outcomes, the overall effect did not show any benefit in either of the two groups in terms of: major adverse cardiac and cerebrovascular events (MACCE) (P value=0.13, 95% CI [0.48,1.10]), hospitalization for heart failure (P value=1.00, 95% CI [0.83,1.20]), and cardiac death (P value=0.91, 95% CI [0.73,1.32]). Conclusion The adjunctive application of RIC to PCI during treatment of STEMI patients showed a beneficial effect only on short-term reduction of myocardial infarct size, nevertheless, it was not of benefit regarding the other short and long-term metrics of myocardial salvage and left ventricular function.

Comparison between In-Hospital and Out-of-Hospital Acute Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study.

Risk factors and outcomes of in-hospital ST elevation myocardial infraction (STEMI) are well explored. Recent findings show that non-ST elevation myocardial infarction (NSTEMI) accounts for the majority of in-hospital infarctions (IHMIs). Our aim was to identify differences between IHMI and out-of-hospital myocardial infraction (OHMI) in terms of risk factors, treatment and outcomes, including both STEMI and NSTEMI. We analyzed the Regional Myocardial Infarction Registry of Saxony-Anhalt dataset. Patient characteristics, treatments and outcomes were compared between IHMI and OHMI. The association between clinical outcomes and myocardial infarction type was assessed using generalized additive models. Overall, 11.4% of the included myocardial infractions were IHMI, and the majority were NSTEMI. Patients with IHMI were older and had more comorbidities than those with OHMI. Compared to OHMI, in-hospital myocardial infarction was associated with higher odds of 30-day mortality (OR = 1.85, 95% CI 1.32-2.59) and complications (OR = 2.36, 95 % CI 1.84-3.01). We provided insights on the full spectrum of IHMI, in both of its classifications. The proportion of IHMI was one ninth of all AMI cases treated in the hospital. Previously reported differences in the baseline characteristics and treatments, as well as worse clinical outcomes, in in-hospital STEMI compared to out-of-hospital STEMI persist even when including NSTEMI cases.

Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study

The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis. This was a single-center, prospective randomized study including a total of 108 patients presenting at a tertiary care center within 3-24h post-thrombolysis and undergoing pharmacoinvasive PCI, and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up. Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p=1) but was significantly improved in complete revascularization PCI group (p=0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen for primary outcomes such as cardiac mortality (p=0.01), repeat MI/ACS (p=0.01) and refractory angina (p=0.038) along with repeat revascularization (p=0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference for CIN (p=0.567), CVA (p=0.153) and major bleeding (p=0.322) then culprit only revascularization group. In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.

Frequency of Non-ST-Elevation Myocardial Infarction (NSTEMI) among Patients Presenting with Atypical Presentation

Non-ST-Elevation Myocardial Infarction (NSTEMI) occurs when there is a partial or complete blockage of blood flow to the heart muscle. Atypical symptoms may also be more commonly observed in patients with non-obstructive coronary artery disease, which is characterized by the presence of plaque but without significant stenosis. Objective: To find the incidence of Non-ST-Elevation Myocardial Infarction (NSTEMI) among the patients with atypical presentation. It was a cross-sectional study conducted at Tabba Heart Institute, Karachi for the duration of six months from 19th December 2019 to 18th June 2020. Methods: The study was carried out on 257 patients. The average age of patients was 56.33 ± 8.07 years; mean height was measured as 162.89 ± 7.75 cm, mean weight was 72.51 ± 15.26 kg and average BMI of patients was 27.2 8 ± 5.25 kg/m2. In distribution of gender, out of 257 patients, 155 (60.3%) were male while 102 (39.7%) were female Results: Hypertension was noted in 155 (60.3%) patients, diabetes mellitus was documented in 109 (42.4%) patients. Positive family history of premature CAD was found to be in 31(12.1%) while 226 (87.9%) had negative family history. Non-ST elevation myocardial infraction was noted in 77 (30%) patients. Conclusions: As NSTEMI is linked with high chance of mortality and severe medical issues therefore, it was vital to study the underlying risk factors so that the burden of diseases can be lowered and optimization of the management strategies can be made for this already compromised cohort of patient.

Can previous therapy with statin be considered a protective factor in acute coronary syndrome?

Abstract Funding Acknowledgements Type of funding sources: None. Background Statin therapy is nowadays a cornerstone in primary and secondary prevention of cardiovascular events. Purpose This retrospective observational study intends to characterise the influence of previous therapy with statins on clinical and electrocardiographic presentation of acute coronary syndrome (ACS) and on in-hospital morbidity and mortality. Methods We evaluated a population of 746 patients admitted in a Cardiac Care Intensive Unit diagnosed with ACS (D). We then considered two groups: patients with previous therapy with statins (D1) and patients without it (D2). We documented demographic factors, personal history, clinical and electrocardiographic presentation of ACS, coronary angiography and angioplasty. The following in-hospital complications were defined: heart failure (HF), cardiogenic shock, reinfarction, stroke, major bleeding and need for blood transfusion. In-hospital mortality was compared between both groups. Results D1 consisted of 37.5% of the population (N=280). These patients had a higher prevalence of hypertension (90.7% vs 65.4%, p &amp;lt;0.001), diabetes (45.0% vs 27.8%, p &amp;lt;0.001), dyslipidaemia (81.8% vs. 36.6%, p = 0.001), chronic renal failure (18.6% vs 7.6%, p = 0.001), stroke (10.7% vs. 4.5%, p = 0.003), previous myocardial infraction (MI) (45,0% vs 12,6%, p = 0.001) and previous coronary artery bypass graft (13.2% vs. 2.0%, p = 0.001). They also had more frequently smoking habits (37.4% vs 13.9%, p = 0.001). They were less frequently admitted with ST-elevation MI (24.6% vs 49.2%, p = 0.001) and more frequently with non-ST elevation MI (56.1% vs 40, 9%, p = 0.001) and unstable angina (10.7% vs 5.6%, p = 0.02). The rate of coronary angiography was similar, however patients receiving previous statin therapy underwent less angioplasty. During hospitalization, there were no differences in any of the complications considered, nor in in-hospital mortality between the 2 groups. Conclusions In patients with ACS, previous therapy with statins seems to influence the presentation of ACS but it does not affect in-hospital morbidity and mortality. An important percentage of patients with diabetes and of those with previous MI or stroke were not on statins therapy as recommended in the European guidelines.

The Correlation between QRS Dispersion and Coronary Artery Disease Severity in Patients with Non ST Elevation Myocardial Infraction

Non ST elevation myocardial infarction (NSTEMI) has been the subject of numerous studies. Risk stratification is a fundamental element for the management of NSTEMI; therefore, several scores have been established in this direction, particularly prognostic markers derived from the ECG.&#x0D; Aims: The aim of our study is to correlate the dispersion of the QRS with the severity of coronary lesions assessed by the GENSINI score in patients admitted for NSTEMI at the University Hospital of Marrakech.&#x0D; Methods: A retrospective study was conducted in the cardiology department of Mohammed VI university hospital of Marrakech from January 01, 2022 to March 31, 2022. Data was derived from the hospitalization register, including 30 patients (16 women and 14 men). Age ranged from 56 to 74 years with an average of 64.6 ± 9.3. Data was analyzed by SPSS, the level of significance set at p &lt;0.05.&#x0D; Results: We found, in our study, a highly significant positive correlation between QRS dispersion (considered important if &gt;20 ms) and admission heart rate (p=0.003) as well as the level of ultrasensitive troponins (p=0.003). There is also a very significant correlation between QRS dispersion and corrected QT interval (p=0.005), Moreover, we concluded that in patients admitted for NSTEMI, the greater the dispersion of the QRS, the higher the score of GENSINI (p&lt;0.0001).&#x0D; Conclusion: The dispersion of the QRS is a simple marker on the ECG that can have a predictive value in different clinical contexts, particularly in acute ischemic heart disease. Further studies are needed, however, to validate its usefulness in routine practice.

Can we optimize locations of hospitals by minimizing the number of patients at risk?

BackgroundTo reduce risk of death in acute ST-segment elevation myocardial infraction (STEMI), patients must reach a percutaneous coronary intervention (PCI) within 120 min from the start of symptoms. Current hospital locations represent choices made long since and may not provide the best possibilities for optimal care of STEMI patients. Open questions are: (1) how the hospital locations could be better optimized to reduce the number of patients residing over 90 min from PCI capable hospitals, and (2) how this would affect other factors like average travel time.MethodsWe formulated the research question as a facility optimization problem, which was solved by clustering method using road network and efficient travel time estimation based on overhead graph. The method was implemented as an interactive web tool and tested using nationwide health care register data collected during 2015–2018 in Finland.ResultsThe results show that the number of patients at risk for not receiving optimal care could theoretically be reduced significantly from 5 to 1%. However, this would be achieved at the cost of increasing average travel time from 35 to 49 min. By minimizing average travel time, the clustering would result in better locations leading to a slight decrease in travel time (34 min) with only 3% patients at risk.ConclusionsThe results showed that minimizing the number of patients at risk alone can significantly improve this single factor but, at the same time, increase the average burden of others. A more appropriate optimization should consider more factors. We also note that the hospitals serve also for other operators than STEMI patients. Although optimization of the entire health care system is a very complex optimization problems goal, it should be the aim of future research.

COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database.

The COVID-19 pandemic has impacted healthcare delivery to patients with non-ST-segment elevation myocardial infraction (NSTEMI). The aim of our retrospective study is to determine the effect of COVID-19 on inpatient NSTEMI outcomes and to investigate whether changes in cardiac care contributed to the observed outcomes. After multivariate adjustment, we found that NSTEMI patients with COVID-19 had a higher rate of inpatient mortality (37.3% vs. 7.3%, adjusted odds ratio: 4.96, 95% CI: 4.6−5.4, p < 0.001), increased length of stay (9.9 days vs. 5.4 days, adjusted LOS: 3.6 days longer, p < 0.001), and a higher cost of hospitalization (150,000 USD vs. 110,000 USD, inflation-adjusted cost of hospitalization: 36,000 USD higher, p < 0.001) in comparison to NSTEMI patients without COVID-19, despite a lower burden of pre-existing cardiac comorbidity. NSTEMI patients with COVID-19 also received less invasive cardiac procedures (coronary angiography: 8.7% vs. 50.3%, p < 0.001; PCI: 4.8% vs. 29%, p < 0.001; and CABG: 0.7% vs. 6.2%, p < 0.001). In our study, we observed increased mortality and in-hospital complications to be a combined effect of COVID-19 infection and myocardial inflammation as a result of cytokine storm, prothrombic state, oxygen supply/demand imbalance and alterations in healthcare delivery from January to December 2020.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry.

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Consecutively hospitalised adult NSTEMI patients (n=3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Association of body mass index with long-term outcomes after elective and semi-urgent percutaneous coronary intervention

Abstract Background While obesity is associated with cardiovascular mortality and morbidity, patients with higher body mass index (BMI) may have better outcomes post-percutaneous coronary intervention (PCI). This “obesity paradox” is controversial and needs clarification. Purpose We aimed to investigate the relationship between BMI and outcomes post-PCI in an Asian cohort. Methods A retrospective cohort study was performed on consecutive patients who underwent semi-urgent PCI for non-ST elevation myocardial infraction or unstable angina, and elective PCI for stable angina from January 2014 to December 2015 in a tertiary centre. Patients were underweight (BMI &amp;lt;18.5), normal weight (BMI 18.5–22.9), overweight (BMI 23–24.9), pre-obese (BMI 25–29.9) or obese (BMI ≥30), according to the WHO Asian classification. The primary endpoint was all-cause mortality. The secondary outcomes were subsequent events of stroke or transient ischemic attack, myocardial infarction (MI) and congestive cardiac failure (CCF). Results 1,610 patients were followed up for 3.71 (±0.97) years, 19.7% were female and mean age was 62.1 years (Table 1). BMI showed a U-shaped relationship with the incidence of death (p&amp;lt;0.001), MI (p=0.005), and CCF (p&amp;lt;0.001) (Figure 1A), which was also shown on Kaplan Meier analysis (Figures 1B-E). With reference to normal weight patients on multivariable Cox analysis, overweight (adjusted HR 0.64, 95% CI 0.42–0.97) and pre-obese (adjusted HR 0.55, 95% CI 0.38–0.80) patients had lower mortality. Underweight patients had higher risk (adjusted HR 2.12, 95% CI 1.01–4.46), while pre-obese patients had lower risk of MI (adjusted HR 0.56, 95% CI 0.34–0.92) compared to normal weight patients. Underweight and obese patients had higher risk of CCF (underweight: adjusted HR 3.05, 95% CI 1.45–6.42; obese: adjusted HR 1.86, 95% CI 1.03–3.35) compared to normal weight patients. Conclusion Patients at the lower and upper extremes of BMI demonstrated higher risk of mortality, MI and CCF post-PCI. Funding Acknowledgement Type of funding sources: None.

ST Segment myocardial infarction due to totally occluded unprotected left main coronary artery (TOULM): an insight from nationwide database

Abstract Objective This study sought to describe the clinical profile, management and short-term outcomes of patients with ST elevation myocardial infraction (STEMI) due to totally occluded unprotected left main coronary artery (TOULM). Methods This is a retrospective analysis of nationwide STEMI database of patients who underwent primary percutaneous intervention (PPCI). Patients with TOULM are defined as having 100% acute thrombotic occlusion of the left main artery or subtotal occlusion with no more than TIMI 1 flow. Results Between January 2011 and February 2022, 7107 patients underwent Primary Percutaneous Intervention for STEMI. 35 cases (0.5%) of all STEMI were due to TOULM. The average age of patients with TOULM was 51±14 years, predominantly male (94%) and had no prior cardiac history (94%). 11 patients (31%) suffered cardiac arrest and 16 (45%) were on mechanical ventilation prior to arrival to cardiac catheterization laboratory. The right coronary artery was the dominant vessel in 29 (89%) patients. Right to left collaterals were present in 15 (42%), absent in 8 (23%) and unknown (the right coronary artery was injected after TOULM intervention or not injected) in 12 (34%) patients. Mechanical circulatory support was used in 37% of the cases (IABP 8, ECMO 3 and ECMO plus IABP 2). Revascularization was achieved with PCI and stenting in 30 patients (86%). Five patients underwent urgent CABG after balloon angioplasty. Survival to hospital discharge was 55%. Conclusions STEMI due to TOULM is a rare occurrence and involved mainly male with no prior cardiac history. Despite all the patients in our series undergoing revascularization, the in-hospital mortality is almost 50%. One major limitations of our study is we had no post-mortem data of any patient who died prior to coronary angiography, which potentially will lead to higher recorded cases of TOULM related mortality. Funding Acknowledgement Type of funding sources: None.

Comprehensive safety profile evaluation of bivalirudin in Chinese ST-segment elevation myocardial infarction patients receiving percutaneous coronary intervention: a prospective, multicenter, intensive monitoring study

BackgroundThis prospective, multi-center, intensive monitoring study aimed to systematically assess the occurrence of adverse events (AEs) and adverse drug reactions (ADRs), especially thrombocytopenia and bleeding, as well as their risk factors in Chinese ST-segment elevation myocardial infraction (STEMI) patients receiving bivalirudin as anticoagulant for percutaneous coronary intervention (PCI).MethodsIn total, 1244 STEMI patients undergoing PCI and receiving bivalirudin as anticoagulant were enrolled in the present study. Safety data were collected from hospital admission to 72 h after bivalirudin administration; in addition, patients were further followed up at the 30th day with safety data collected at that time.ResultsAEs, severe AEs, ADRs and severe ADRs were reported in 224 (18.0%), 15 (1.2%), 49 (3.9%) and 5 (0.4%) patients, respectively. Importantly, 4 (0.3%) patients were submitted to hospitalization and 6 (0.5%) patients died due to AEs, while 1 (0.1%) patient was submitted to hospitalization but no (0.0%) patient died due to ADRs. Meanwhile, thrombocytopenia and bleeding occurred in 24 (1.9%) and 21 (1.7%) patients, respectively. Further multivariate logistic analysis identified several important independent factors related to AEs, ADRs, thrombocytopenia or bleeding, which included history of cardiac surgery and renal function impairment, high CRUSADE risk stratification, elective operation and combination with glycoprotein IIb/IIIa inhibitors. Moreover, 4 multivariate models were constructed based on the above-mentioned factors, which all showed acceptable predictive value for AEs, ADRs, thrombocytopenia and bleeding, respectively.ConclusionBivalirudin is a well-tolerant anticoagulant in Chinese STEMI patients undergoing PCI procedure.

In-hospital Outcome and Angiographic Profile of Elderly Patients with Non ST-Segment Elevation Myocardial Infraction

Background: Non ST - segment elevation myocardial infarction is heterogeneous in its presentation and is a major life-threatening cause of emergency medical care and hospitalization. Patients with non ST-segment elevation myocardial infarction are at risk for adverse cardiac events and if associated with increased age, it become a strong predictor of adverse cardiac events in patients with non ST-segment elevation myocardial infarction. Objective: To find out in - hospital outcome and severity of coronary artery disease of older patient with non - ST segment elevation myocardial infarction. Methods: This was a descriptive cross sectional study. The study was carried out in the department of cardiology, National Heart Foundation Hospital and Research Institute from June 2011 to May 2012. Patients of non ST - segment elevation myocardial infarction admitted at National Heart Foundation &amp; Research Institute who fulfill the inclusion criteria were the study population. Patients were recruited by nonrandom sampling. One hundred and thirty four patients were recruited in this study. Data were prospectively collected in a pre - designed data collection form and analyzed by using SPSS - 16 software. Results: In this study patients had a greater prevalence of hypertension, diabetes mellitus. Chest pain and shortness of breath were common presentations observed in study patient during admission. They had a lower left ventricular ejection fraction than their younger counter parts. Older group was associated with an increased risk of triple vessel disease. In-hospital complications were significantly higher in older patients. Duration of hospital stay was longer in older patients. Conclusion: Older patients with non- ST segment myocardial infarction strongly predicts adverse inhospital outcome and severe coronary artery disease profile. Older patients should alert physicians to an increased risk of morbidity and mortality, which may in turn support more judicious treatment including appropriate utilization of cardiovascular diagnostic tests and therapeutics used in current cardiovascular care to optimize outcomes in these high-risk patients. Bangladesh Heart Journal 2022; 37(1): 52-58

Impact of Lubrizol factory fire in Rouen on coronary events: A retrospective study from the France PCI registry

On September 26, 2019, an industrial fire occurred in the Lubrizol factory in Rouen (France), exposing the population to the inhalation of many volatile toxic agents secondary to combustion. To assess its impact on the incidence of coronary artery events. All coronary angiography performed in Rouen (exposed) and Le Havre (unexposed) from January 2019 and December 2019 were extracted from the prospective FRANCE-PCI registry. To study the impact of the fire on coronary events, an interrupted time series analysis was performed in Rouen, with adjustment on Le Havre in an ARMA(1,1) model with the precision of one week. This statistical analysis has the advantage of taking into account a possible seasonal effect. The primary outcome was the incidence of all coronary events and the secondary outcome was the variation in incidence of ST-segment elevation myocardial infraction (STEMI). In the 21 weeks preceding the fire, there were a mean of 62.0 ± 10.1 coronary events per week in the exposed town, non-significantly increasing to 70.6 ± 10.5 in the 14 weeks following the fire, with an estimated increase of +5.5 events/week (95% CI: −6.0 to +16.9, P = 0.36). The mean number of STEMI events per week in Rouen changed from 6.19 ± 2.96 before to 7.93 ± 3.65 after the fire, with a difference estimated at +1.8 events/week (95% CI: −0.5 to +4.1, P = 0.13) ( Fig. 1 ). Our study did not find a significant effect of the Lubrizol factory fire on the incidence of coronary events. Further studies are needed to investigate the impact of industrial accidents on coronary events.

SMOKING PARADOX IN HYPERTENSIVE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS: 25-YEAR POPULATION-BASED STUDY

Objective: The main objective of our paper is to study the effect of smoking status on the outcomes of hypertensive patients presenting with ST-segment elevation myocardial infraction. Design and method: Patients with STEMI who were hospitalised in our coronary care unit during a 25-year period (since 1994) were included in a specific registry. Their in-hospital and follow-up data have been regularly updated. We selected only patients with known or newly diagnosed hypertension in our study. Then, we divided the population into two groups according to their smoking status. The primary endpoints were death, rehospitalization, non-fatal myocardial infarction. The secondary endpoints were in-hospital mortality, left ventricular dysfunction, life-threatening arrythmias, prolonged hospital stay and bleeding complications. Results: A total of 1609 patients were included during the study period. Among 489 patients having hypertension, 45.5% were smokers with male sex predominance (sex ratio 11/1). Baseline characteristics are detailed in table 1. Among the primary endpoint: One-year mortality was significantly more important in the non-smokers group (p = 0.012): there was no significant difference in non-fatal MI (p = 0,142) and in all cause rehospitalization (p = 0.093). As for the secondary endpoints, there was no significant difference between the two groups except for the in-hospital death (p &lt; 0.01). The results of the endpoints are detailed in table 1. Conclusions: Smoking seems to have a beneficial effect on the outcomes of STEMI of hypertensive patients.