Flow In Infarct-related Artery Research Articles

Neutrophil-to-high-density lipoprotein ratio: an independent predictor of infarct-related artery patency in patients with acute myocardial infarction

Aims: The definition of an infarct-related artery (IRA) is a coronary artery occluded by a thrombus or atheroma that causes ischemia during acute myocardial infarction (AMI). Early patency of the IRA is the primary goal of treatment in patients with AMI. The neutrophil/ high-density lipoprotein cholesterol (HDL-C) ratio (NHR) has been recognized as a new inflammatory marker. We aimed to show the possible relationship between NHR and preprocedural IRA patency.
 Methods: Four hundred patients were screened, and 318 were included in the study after exclusion criteria. IRA flow rate before the coronary procedure was determined according to the previously described thrombolysis in myocardial infarction (TIMI). TIMI current 0,1 and 2 patients were considered IRA non-patent, and TIMI-3 patients were considered IRA patent and were divided into two groups. Regression analysis was performed for possible parameters in predicting IRA patency, evaluated in univariable analysis, and those with p-value

Predictors of No-Reflow in Patients undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction at Tabba Heart Institute Karachi

Aim: To determine the predictors of no-reflow in patients undergoing Primary Percutaneous Coronary Intervention (PPCI) for acute ST elevation myocardial infarction (STEMI) at Tabba Heart Institute Karachi. Study duration: The study was carried out from September 2020 to September 2021. Methods: An observational study that was conducted at Tabba heart Institute Karachi. All patients with acute ST elevation myocardial infarction (STEMI) presenting within 12 hours of symptoms who undergoing primary PCI were included in the study. The patients were categorized Angiographically as no –reflow (with Thrombolysis in Myocardial Infarction (TIMI) <3 and reflow (TIMI-3) flow groups. The data regarding age and gender, type of MI, time from symptoms onset, co-morbid conditions like diabetes mellitus, hypertension, smoking, baseline Thrombolysis In Myocardial Infarction Trials (TIMI flow), infarct related artery (IRA), diameter of stent used, and the TIMI flow in IRA after the completion of procedure but before the use of intracoronary adenosine if needed, was recorded on a pre-designed proforma. The data was analyzed using SPSS 20.0. Results: Total 296 patients who underwent primary PCI after acute MI were enrolled in the study. Mean age of the study population was 57±11 years. No reflow was present in 31.4% of patients. No reflow was more common in patients with age more than 60 years, females, symptom onset to primary PCI time of more than 6 hours, LAD infarct, and baseline TIMI flow < 2. Conclusion: During primary PCI, no reflow occurs in a significant percentage of patients and is predictable by a number of factors which should be kept in mind to minimize the incidence of no reflow. Key words: No reflow, acute myocardial infarction, primary PCI

Revascularization strategies in STEMI and multivessel disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction The main treatment for ST elevation myocardial infarction (STEMI) is the reestablishment of coronary flow of infarct related artery. However, 50% of cases present multivessel disease (MVD), negatively affecting mortality. Complete revascularization (CR) is currently advocated since it can reduce major adverse cardiovascular events (MACE). Objective Evaluation of revascularization strategy and its prognostic value in a Portuguese cohort of STEMI patients. Material and methods Retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010-19. Patients were divided in two groups regarding revascularization status: complete – group 1; incomplete – group 2. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. Results 3500 patients were included, mean age 65 ± 13 years, 77.7% male. A CR strategy was performed in 21.8%. G1 patients were younger (63 ± 12 vs 66 ± 13, p < 0.001), with less classic cardiovascular risk factors except for smoker status and family history of premature cardiovascular disease, and less previous cardiovascular and kidney disease. They were more hemodynamically stable (Systolic blood pressure 138 ± 30 vs 135 ± 31mmHg, p = 0.019) and have less kidney dysfunction (maximum creatinine 1 ± 0.5 vs 1.2 ± 0.9 mg/dl, p < 0.001) and anemia (hemoglobin 14.3 ± 1.8 vs 13.9 ± 1.9 g/dl, p < 0.001). Inferior STEMI was the most frequent location for both groups, however G1 patients presented lower Killip-Kimball (KK) class (KK class >I 12.7 vs 17.7%, p = 0.001) and BNP value (298 ± 550 vs 453 ± 819pg/ml, p < 0.001) and higher mean left ventricle ejection fraction (LVEF) (52 ± 13 vs 48 ± 12%, p < 0.001). Left anterior descendent (LAD) and right coronary were similarly the most prevalent culprit vessels: the first one in G1 and the second one in G2. 2-vessel disease was more prevalent in G1, having all patients being submitted to percutaneous intervention during hospitalization; and 3-vessel disease in G2 with 0.3% patients being submitted to surgical intervention. G1 patients needed less frequently advanced therapeutic devices and ventilatory support. In-hospital complications were, generally, more frequent in G2 especially HF (21.8% vs 13.9%, p < 0.001) and cardiogenic shock (8.7% vs 6.0%, p 0.005); and mortality was almost twice (3.3% vs. 5.8%, p < 0.001). Global 1-year mortality rate was 6.1% and rehospitalization for cardiovascular causes 13.6%, being CR associated with lower rates (p < 0.001). Predictor factors for this endpoint, evaluated through Cox multivariate regression were IR, tachycardia at admission, KK class > I, involvement of LAD, LVEF < 40%, in-hospital mechanical complication, at discharge medication with digoxin, nitrates and diuretics. Conclusion CR was a powerful prognostic biomarker for in-hospital and 1-year all-cause mortality and MACE.

Percutaneous management of reperfusion arrhythmias during primary percutaneous coronary intervention: a case report

BackgroundMyocardial reperfusion may cause profound electrophysiological alterations and can lead to serious reperfusion arrhythmias (RA). Management of RA and the accompanying electrical storm that may occur remains a problem. To our knowledge, the role of balloon re-inflation of the infarct-related artery (IRA) has never been addressed as a treatment modality for RA presenting as ventricular tachycardia (VT) with pulse or supraventricular tachycardia (SVT).Case presentationSix patients presenting with ST elevation myocardial infarction (STEMI) in the first 12 h, who underwent successful primary percutaneous coronary intervention (PCI), developed RA in the cathlab after restoration of flow in the IRA. The RA was in the form of VT with pulse, except in one patient who had SVT. In four patients, the RA was associated with hemodynamic instability. The mean age of the studied patients was 59.16 ± 7.94 years, and four were males. Coronary artery disease risk factors were prevalent, with four patients being hypertensive, two dyslipidemic, one diabetic, and 2 current smokers. One patient had a history of prior myocardial infarction (MI), and none had a history of congestive heart failure. The coronary angiography showed 100% occlusion of IRA in all patients and 2–3-vessel disease was present in 50%. PCI was successful with restoration of thrombolysis in myocardial infarction (TIMI) 2–3 flow in IRA in all cases. The mean time to revascularization from the onset of chest pain was 4.88 ± 2.68 h. In all cases, balloon re-inflation was successful in terminating the arrhythmias. None of the patients needed direct current cardioversion or anti-arrhythmic drugs for management of the acute arrhythmia.ConclusionBalloon re-inflation of IRA was successful in terminating RA that develop in the form of VT with pulse or SVT.

Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention

Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Our work aims at finding the relation between PLR and the prognosis of IRA in STEMI patients. Methodology: Two hundred cases presented with STEMI were included for the study. Patency of IRA was estimated by Thrombolysis in Myocardial Infarction (TIMI) grade. Patent IRA was defined as TIMI grade III flow and occluded IRA was defined as TIMI grade 0-II flow. Blood samples were withdrawn on admission at emergency department to calculate PLR. Results: Forty-one (20.5%) cases revealed TIMI 3 flow in IRA before pPCI. Occluded group showed significantly higher PLR than patent group with mean PLR 231.3±94.2 vs 100.95±37.7 respectively with P value <0.0001. Multivariate regression analysis demonstrated, both HTN [95% CI (- 0.135)-(-0.747)] & PLR ratio [95% CI (-0.001)-(-0.002)] together are the most independent predictors for TIMI flow in IRA (F-ratio=12.2, p<0.001). Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI.

Рідкісний випадок спонтанного тромболізису у пацієнтки з гострим інфарктом міокарда з елевацією сеґмента ST

In the pathogenesis of acute myocardial infarction an important role belongs to coronary sclerosis and coronary artery thrombosis. Endothelium plays an important role in a regulation of vascular tone, local inflammation, hemostasis, neovascularisation. An impairment of endothelial barrier function occurs after direct damage of endothelial cells as a result of an atherosclerotic plaque destabilization, injury, chronic inflammation or exposure to hazardous substances. Breakage of the endothelial surface causes an exposure of subendothelial collagen and triggers expression of adhesive proteins (e.g. tissue factor and von Willebrand factor) and decreases synthesis of prostacyclin and nitric oxide. In case of its damage and activation, thrombocytes adhere and aggregate to each other which leads to thrombosis and can cause an acute myocardial infarction.&nbsp; Aim.&nbsp;Our aim was to evaluate a cellular mechanisms of thrombosis as well as conditions that leads to spontaneous thrombolysis in acute myocardial infarction for treatment optimisation of acute coronary syndrome. &nbsp; Material and Methods.&nbsp;The case of acute myocardial infarction with ST segment elevation in 79 years old patient is presented that showed spontaneous coronary blood flow recovery.&nbsp; Results and Discussion.&nbsp;In described case in a patient with acute myocardial infarction a rapid regression of ECG changes were documented after medical treatment at home was provided. Those changes were most likely a results of spontaneous thrombolysis with subsequent recovery of coronary blood flow in infarct-related artery due to rarely occurring activation of fibrinolytic system. The fibrinolysis system was triggered by the release of plasminogen activator and affected newly formed thrombus. However unstable atherosclerotic plaque was thrombogenic enough and leaded to recurrence of myocardial infarction. Thus the patient received coronary artery stenting. Clinical and morphological data has shown that in those patients a major role in development of acute coronary syndrome plays not a coronary artery spasm but a coronary thrombosis with subsequent spontaneous thrombolysis and restoration of coronary blood flow which happened upon timely application of antiaggregants, anticoagulants and antianginals drugs. Coronary artery spasm typically occurs more distal from the obstruction place as a result of exposure to vasoconstrictors released after thrombocyte degranulation. Spontaneous thrombolysis by acute myocardial infarction is untypical, hence myocardial infarction with pathological Q wave develops.&nbsp; Conclusions.&nbsp;Patients with acute coronary syndrome, which exhibit spontaneous thrombolysis require angiography and stenting of coronary arteries as soon as possible to prevent recurrence of coronary thrombosis and development of acute myocardial infarction.

Gender-related differences in men and women with ST-segment elevation myocardial infarction and incomplete infarct-related artery flow restoration: a multicenter national registry.

IntroductionLittle is known about gender-related differences in ST-segment elevation myocardial infarction (STEMI) and incomplete infarct-related artery (IRA) reperfusion after primary percutaneous coronary intervention (pPCI).AimTo evaluate gender-related differences in clinical characteristics and prognosis in patients with STEMI and incomplete IRA reperfusion after pPCI.Material and methodsFrom 42,752 STEMI patients hospitalized between 2009 and 2011 in Poland we analyzed a group of 984 (36%) females and 1,746 (64%) males with less than Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow following pPCI.ResultsWomen were older than men (72.0 ±11.3 vs. 64.0 ±11.7 years; p < 0.0001) and in age-adjusted analysis they were more likely to present with hypertension (73.7% vs. 67%; p = 0.0003), diabetes (33% vs. 22.6%; p < 0.0001) and obesity (28.1% vs. 22.6%; p = 0.0016). Heart rate > 100 beats/min was more common in women, while men were more often smokers and presented with sudden cardiac arrest. The most common IRA in women was the left anterior descending artery, and the right coronary artery in men. After adjusting for age statistically significant differences in pharmacotherapy concerned only the use of insulin (OR = 1.31, 95% CI: 1.02–1.68). High risk of death, rehospitalization due to heart failure or cardiac causes, were observed in all patients during the 6-month and 12-month follow-up periods. The risk of heart failure was significantly higher in women than in men. The most significant decrease in survival rates was observed in the in-hospital period.ConclusionsAmong patients with STEMI and post-interventional TIMI flow grade < 3 women have unfavorable baseline characteristics and an adverse short- and long-term prognosis when compared to men.

Impact of acute infarct-related artery patency before percutaneous coronary intervention on 30-day outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in the EUROMAX trial.

Early infarct-related artery patency has been associated with improved outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. However, it is unknown whether this relationship persists in contemporary practice with pre-hospital initiation of treatment, use of novel P2Y12 inhibitors and frequent use of drug-eluting stents. The purpose of the study was to determine the impact of early infarct-related artery patency on outcomes in the contemporary EUROMAX trial. A total of 2218 patients were enrolled. The current analysis was done on 1863 patients who underwent percutaneous coronary intervention and had infarct-related artery patency data. Thirty-day outcomes were compared according to infarct-related artery flow before percutaneous coronary intervention (Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 vs. TIMI flow 2/3), and interaction with antithrombotic strategy was examined. A patent infarct-related artery (TIMI flow 2/3) was present in 707 patients (37.9%) and was associated with a higher rate of final TIMI 3 flow grade (98.9 vs. 92.6%; p<0.001). At 30 days, a patent infarct-related artery was associated with lower rates of cardiac death (1.3% vs. 2.9%; p=0.026) and the composite of death or myocardial infarction (2.7% vs. 4.6%; p=0.039). There were no interactions between antithrombotic treatment and the impact of infarct-related artery patency on cardiac death, myocardial infarction, or the composite of death or myocardial infarction (Breslow-Day interaction p-values of 0.21, 0.33 and 0.46, respectively). Despite evolution in primary percutaneous coronary intervention strategies, early infarct-related artery patency is still associated with higher procedural success and improved clinical outcomes. The choice of antithrombotic strategy did not interact with the benefits of a patent infarct-related artery at presentation.

ACUTE MYOCARDIAL INFARCTION

Objectives: To determine Post streptokinase TIMI flow grade (rate) in infarctrelated artery (IRA) in ST elevated myocardial infarction patients. Study Design: A nonrandomizedprospective study. Period: Dec-2014 to Dec-2015. Setting: Sheikh Zayed MedicalCollege and Hospital Rahim Yaar Khan. Methods: 113 patients were selected to see poststreptokinase TIMI flow grade in infarct related artery (IRA). The data was analyzed using SPSSVersion 20. Descriptive statistics was used to see and analyze the data. Results: Mean ageof patients was 50.43±9.81 years. There was more males (87.61%) as compared to females(12.39%). After thrombolyzation with streptokinase 23.01% patients were with TIMI grade 0/1(failed perfusion), 45.13% (51) patients with TIMI grade 2 (partial perfusion) and 31.86% patientswith TIMI grade 3 (full perfusion) in infarct related artery. In our study TIMI flow improved tograde 2/3 (partial to complete perfusion) in 76.99% patients. There were 11.73% patients withTIMI 0/1 with 50% ST segment resolved, 8.85% patients with TIMI 0/1 with persisted 50% STsegment, 32.74% patients with TIMI 2 with 50% ST segment resolved, 11.5% (13) patients withTIMI 2 with 50% ST segment persisted, 32.74% patients with TIMI 3 with 50% ST segmentresolved and 4.42% patients with TIMI 3/1 with 50% ST segment persisted. Post streptokinasethere was no coronary artery thrombus in 91.07 % patients. While 6.25% patients had thrombusin left coronary artery and 2.84% patients had right coronary artery thrombus. Conclusion:Thrombolyzation with streptokinase improves perfusion in infarct related artery and increasesTIMI flow grade in STEMI patients. It reduces the risk of recurrent myocardial infarction byrestoration of blood flow in infarct related artery.

English

Objectives: To determine Post streptokinase TIMI flow grade (rate) in infarct related artery (IRA) in ST elevated myocardial infarction patients. Study Design: A non- randomized prospective study. Period: Dec-2014 to Dec-2015. Setting: Sheikh Zayed Medical College and Hospital Rahim Yaar Khan. Methods: 113 patients were selected to see post streptokinase TIMI flow grade in infarct related artery (IRA). The data was analyzed using SPSS Version 20. Descriptive statistics was used to see and analyze the data. Results: Mean age of patients was 50.43±9.81 years. There was more males (87.61%) as compared to females (12.39%). After thrombolyzation with streptokinase 23.01% patients were with TIMI grade 0/1 (failed perfusion), 45.13% (51) patients with TIMI grade 2 (partial perfusion) and 31.86% patients with TIMI grade 3 (full perfusion) in infarct related artery. In our study TIMI flow improved to grade 2/3 (partial to complete perfusion) in 76.99% patients. There were 11.73% patients with TIMI 0/1 with 50% ST segment resolved, 8.85% patients with TIMI 0/1 with persisted 50% ST segment, 32.74% patients with TIMI 2 with 50% ST segment resolved, 11.5% (13) patients with TIMI 2 with 50% ST segment persisted, 32.74% patients with TIMI 3 with 50% ST segment resolved and 4.42% patients with TIMI 3/1 with 50% ST segment persisted. Post streptokinase there was no coronary artery thrombus in 91.07 % patients. While 6.25% patients had thrombus in left coronary artery and 2.84% patients had right coronary artery thrombus. Conclusion: Thrombolyzation with streptokinase improves perfusion in infarct related artery and increases TIMI flow grade in STEMI patients. It reduces the risk of recurrent myocardial infarction by restoration of blood flow in infarct related artery.

Post-procedural TIMI flow grade 2 is not associated with improved prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization (PL-ACS registry).

The impact of final Thrombolysis in Myocardial Infarction (TIMI) flow in the infarct-related artery (IRA) on outcomes in non-ST-segment elevation myocardial infarc-tion (NSTEMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study aimed to evaluate the impact of post-procedural TIMI flow in IRA on outcomes in NSTEMI patients undergoing percutaneous coronary revascularization. We analyzed 2,767 patients with first NSTEMI from the Polish Registry of Acute Coronary Syndromes (PL-ACS) who underwent PCI. The patients were divided according to post-procedural culprit vessel TIMI (0-1: 90, 3.26%; 2: 61, 2.20%; 3: 2,616, 94.54%). The following mortality values were obtained in TIMI 0-1, 2, and 3 groups, respec-tively: in-hospital, 12.22%, 13.11%, 1.72% (p < 0.0001); 1-month, 13.33%, 13.11%, 3.44% (p < 0.0001); 12-month, 15.56%, 16.39%, 6.50% (p < 0.0001); 36-month, 25.56%, 21.31%, 13.91% (p = 0.0007). Mortality rates in patients with final TIMI 0-1 and 2 were not signifi-cantly different. Optimal TIMI 3 was independently associated with baseline TIMI 2-3 (OR ± ± 95% CI: 7.070 [4.35-11.82]), p < 0.0001; higher ejection fraction (1.30 [1.03-1.63]), p = 0.0038; and family history of coronary artery disease (2.83 [1.17-8.11]), p = 0.0294. Type C lesion, previous heart failure, and PCI without stenting independently predicted suboptimal TIMI 0-2. Only achieving final TIMI 3 in IRA improves outcomes in NSTEMI patients treated with percutaneous coronary revascularization. The mortality rate of near-normal TIMI 2 is comparable to that of TIMI 0-1 after PCI. (.

Human relaxin gene expression delivered by bioreducible dendrimer polymer for post-infarct cardiac remodeling in rats

In consensus, myocardial infarction (MI) is defined as irreversible cell death secondary to prolonged ischemia in heart. The aim of our study was to evaluate the therapeutic potential of anti-fibrotic human Relaxin-expressing plasmid DNA with hypoxia response element (HRE) 12 copies (HR1) delivered by a dendrimer type PAM-ABP polymer G0 (HR1/G0) after MI on functional, hemodynamic, geometric, and cardiac extracellular matrix (ECM) remodeling in rats. HR1/G0 demonstrated significantly improved LV systolic function, hemodynamic parameters, and geometry on 1 wk and 4 wks after MI in rats, compared with I/R group. The resolution of regional wall motional abnormalities and the increased blood flow of infarct-related coronary artery supported functional improvements of HR1/G0. Furthermore, HR1/G0 polyplex showed favorable post-infarct cardiac ECM remodeling reflected on the favorable cardiac ECM compositions. Overall, this is the first study, which presented an advanced platform for the gene therapy that reverses adverse cardiac remodeling after MI with a HR1 gene delivered by a bioreducible dendrimer polymer in the cardiac ECM.

0113: Factors associated with infarct-related artery patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction: results from the FAST-MI 2010 registry

Early infarct-related artery (IRA) patency is associated with better clinical outcomes in STEMI patients. Using the FAST-MI 2010 ST-elevation myocardial infarction (STEMI) cohort, we investigated factors related to IRA patency (TIMI 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention (PCI). FAST-MI 2010 is a nationwide French registry including 4,169 Acute MI patients. Of 1452 STEMI patients with primary PCI, 466 (32%) had TIMI 2/3 flow of IRA before the procedure. Mean age (62±14 years in both groups), GRACE score (141±31 vs 142±34) and time from onset to angiography (472±499 vs 451±479min) did not differ according to IRA patency (TIMI2/3 vs TIMI 0/1). Using multivariate logistic regression analysis, IRA patency was more frequently found in patients having called earlier (<75min, median time from symptom onset: OR: 1.60; 95% CI 1.26-2.04), or receiving antiplatelet therapy (APT) before angiography. Increasing time from diagnostic ECG to angiography was also associated with IRA patency (>90min, OR: 1,38; 95%IC 1.08-1.77). The results were confirmed by propensity score analyses. Pre-procedural IRA patency is observed in one third of STEMI patients; it is more frequently found in patients having received APT prior to angiography, as well as in patients having called early. Higher IRA patency with increasing time delays from qualifying ECG to angiography suggests an additional role of spontaneous or medication-mediated fibrinolysis.

Factors Associated With Infarct-Related Artery Patency Before Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (from the FAST-MI 2010 Registry)

Early infarct-related artery (IRA) patency is associated with better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Using the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated factors related to IRA patency (thrombolysis in myocardial infarction [TIMI] 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention. FAST-MI 2010 is a nationwide French registry including 4,169 patients with acute MI. Of 1,452 patients with STEMI with primary percutaneous coronary intervention, 466 (32%) had TIMI 2/3 flow of IRA before the procedure. Mean age (62 ± 14years in both groups), Global Registry of Acute Coronary Event score (141 ± 31 vs 142 ± 34), and time from onset to angiography (472 ± 499 vs 451 ± 479minutes) did not differ according to IRA patency (TIMI 2/3 vs TIMI 0/1). Using multivariate logistic regression analysis, IRA patency was more frequently found in patients having called earlier (time from onset to electrocardiogram [ECG] <120minutes; odds ratio [OR] 1.49; 95% confidence interval [CI] 1.17 to 1.89), or receiving rapid-onset of action (prasugrel or glycoprotein IIb-IIIa) antiplatelet therapy in the prehospital setting (OR 1.59, 95% CI 1.14 to 2.21). Increasing time from diagnostic ECG to angiography was also associated with IRA patency (>90minutes; OR 1.37, 95% CI 1.08 to 1.75). In conclusion, preprocedural IRA patency is observed in one third of patients with STEMI, it is more frequently found in patients having received fast-acting antiplatelet therapy before angiography, and in patients having called early. Higher IRA patency with increasing time delays from qualifying ECG to angiography suggests an additional role of spontaneous or medication-mediated fibrinolysis.

The Relationship Between Epicardial Adipose Tissue Thickness and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction.

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil-lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI.

10. Human Mesenchymal Stem Cell (hMSC) Delivery System Induces Favorable Post-Infarct Cardiac Remodeling with an Increase in Coronary Artery Blood Flow

[Background] Myocardial infarction (MI) caused by coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. We are at a crucial juncture where novel therapeutic approaches for reversing adverse cardiac remodeling are solely needed. The beneficial effects of multipotent mesenchymal stem cells (MSCs) are primarily mediated via combined paracrine, endocrine, and homing actions. Human MSCs are one of the best candidates for inducing favorable cardiac remodeling after MI. Recently, we constructed porous PLGA/PEI1.8k biodegradable microspheres (PPP) for the delivery of hMSCs using electrostatic attraction and structural entrapment. These MSC–loaded PPP particles showed increased in vivo engraftment rates and maintained better stemness characteristics of hMSCs in comparison with hMSCs–alone in rats 2 wks after intramyocardial injections.[Aim] We hypothesized that human MSCs delivered with a biocompatible porous scaffold would produce cardio-protective effects on post-infarct cardiac remodeling.[Results] hMSCs–alone and PPP loaded with 3 different amounts of hMSC (High, Medium, and Low) demonstrated improved systolic function and preserved cardiac geometry compared with ischemia-reperfusion (I-R) group in rats 1 wk after post-infarct intramyocardial administration. The functional improvement of hMSC–loaded PPP groups was sustained 4 wks after MI and comparable between groups. However, the hMSCs–alone group didn't maintain functional improvement. The functional improvement of hMSC–loaded PPP groups was supported by reduced infarct size, ameliorated cardiac fibrosis, protection from cardiomyocyte loss, and decreased apoptotic activity. Also, the increased angiogenesis and decreased myofibroblast density in the border zone of the infarct support the cardio-protective effects of hMSC–loaded PPP. Interestingly, hMSC–loaded PPP groups enhanced blood flow of infarct-related coronary artery.[Conclusion] These results suggest that an hMSC–loaded PPP delivery system would provide amplification and decrease costs of hMSC therapy, especially in ex vivo preparation.

Platelet to Lymphocyte Ratio Can be a Predictor of Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction.

Patency of infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (pPCI) is associated with lower mortality and better clinical outcome. However, there were little data regarding the predictors of IRA patency before pPCI in the setting of STEMI. We aimed to assess the association of platelet to lymphocyte ratio (PLR) with IRA patency in STEMI. A total of 452 patients were enrolled and categorized as occluded or patent IRA. Patency IRA was assessed by the thrombolysis in myocardial infarction (TIMI) flow grade. Blood samples were obtained on admission to calculate PLR. Of all patients, 92 (20.4%) patients revealed pre-pPCI TIMI 3 flow in IRA. The PLR was significantly higher in occluded IRA group (138.4 ± 51.4 vs 95.4 ± 43.5, P < .001). Glucose, troponin I, and neutrophil to lymphocyte ratio (NLR) levels were also higher in occluded IRA group (P < .05). Multivariate regression analysis demonstrated the PLR (odds ratio [OR]: 0.987; 95% confidence interval [CI]: 0.978-0.995, P = .002) and NLR (OR: 0.758; 95% CI: 0.584-0.985, P = .038) on admission as independent predictors of IRA patency. In conclusion, a higher PLR is a powerful and independent predictor of IRA patency in patients with STEMI before pPCI.

The relationship between TIMI flow grade and hematological parameters in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention

ST-segment elevation myocardial infarction (STEMI) is among the most important causes of mortality and morbidity. The relationship between hematological parameters and cardiovascular diseases is well known. In patients with STEMI, ensuring blood flow in infarct-related artery at early stages improves ventricular performance and reduces mortality. In our study, we aimed to reveal the relationship between the blood flow in infarct-related artery thrombolysis in myocardial infarction (TIMI) flow and hematologic parameters in patients presenting with acute STEMI and having coronary angiography and revascularization. Our study has a retrospective observational design. One hundred and forty one patients, 108 male and 33 female, who presented with acute STEMI and underwent percutaneous coronary intervention (PCI), participated in our study which was based on one center. The patients were divided into two groups; namely the spontaneous re-canalization of the infarct related artery and totally occluded infarct related artery. The relationship between hematological parameters and TIMI flow was investigated. Red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values in the group of patients with totally occluded infarct related artery were found significantly higher than the group of patients with spontaneous re-canalization [respectively, 13.8 (13.1 – 15.2) vs. 13.6 (13.1 – 14.3); P = 0.041, 4.0 (2.3 – 7.8) vs. 2.9 (1.8 – 4.9); P = 0.002, 123.0 (74.6 – 237.4) vs. 112.3 (79.2 – 149.3) P = 0.013]. The multivariate logistic regression analysis revealed a relation between elevated NLR and RDW values and total occlusion of infarct related artery. In our study, we found that hematological parameters, NLR and RDW, were independent predictors of patency of infarct related artery in patients with STEMI.

A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level.

IntroductionPrevious studies have reported a relationship between serum bilirubin levels and coronary artery disease (CAD). However, data are rare up to now regarding the relation of bilirubin levels with infarct-related artery (IRA) patency in the setting of ST-segment elevation myocardial infarction (STEMI). Moreover, previous studies reported that increased bilirubin was related to impaired post-intervention coronary flow. To our knowledge, the association between serum total bilirubin (TB) levels and pre-primary percutaneous coronary intervention (PCI) with patency of IRA flow in STEMI patients has not been investigated.AimTo evaluate the association of TB with pre-primary PCI, coronary flow and in-hospital major adverse cardiac events (MACE) in patients with STEMI.Material and methodsA total of 360 consecutive patients with STEMI (mean age = 61.4 ±13.7 years) admitted within 12 h from the time of symptom onset were enrolled. Patients were divided into 2 groups based on the serum TB levels. We defined normal flow as pre-PCI TIMI 3 flow, while impaired flow was defined as pre-PCI TIMI ≤ 2 flow.ResultsPre-PCI impaired flow was higher in the TB group than pre-PCI normal flow (p < 0.001). In-hospital mortality and MACE were significantly higher in the high TB group (p = 0.002, p < 0.001 respectively). In the receiver operating characteristic curve analysis, TB > 0.825 mg/dl predicted impaired IRA flow before p-PCI with a sensitivity of 79% and specificity of 71%.ConclusionsThe TB is an inexpensive and readily available marker for STEMI patients undergoing PCI. It can be used for risk stratification in this patient population.

Reducing Needle‐To‐Balloon Time by Using a Single Guiding Catheter during Transradial Primary Coronary Intervention

It is unknown whether using a single guiding catheter for both nonculprit and culprit vessel angiography and intervention during transradial primary percutaneous coronary intervention (PCI) is feasible. This single-center study enrolled 242 consecutive patients with ST segment elevation myocardial infarction (STEMI) who received primary PCI. Among them, 102 patients received primary PCI via transfemoral approach (TFI), 109 patients received primary PCI via transradial approach using conventional technique (Conventional TRI), and 31 underwent primary TRI using a single guiding catheter (Single Guiding TRI). The catheter used for this purpose was 6 Fr RM® 3.5 guiding catheter. Using a single guiding catheter, both coronary artery angiograms and intervention were successful in 30 of 31 patients (96.7%). Needle-to-balloon time (from puncture to first balloon) and door-to-balloon (D2B) time were similar between TFI and Conventional TRI groups and significantly lower in the Single Guiding TRI group (13.8 [TFI] and 14.1 [Conventional TRI] vs. 7.6 minutes, P < 0.001; 89.5 [TFI] and 91.0 [Conventional TRI] vs. 68.5 minutes, P = 0.008, respectively), whereas proportion of patients achieving D2B time within 90 minutes increased significantly in the Single Guiding TRI group from 51.0% for TFI and 49.5% for Conventional TRI to 74.2% (P = 0.023). Primary transradial PCI using a single guiding catheter is feasible and highly successful and might allow timely restoration of blood flow in infarct-related artery.