Infarct-related Artery In Patients Research Articles

Using echocardiography based deep learning to early detect the infarct related artery in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with acute coronary syndrome (ACS), echocardiography detected regional wall motion abnormalities (RWMA) facilitates the recognition of ischemic heart disease and infarct related artery. Nevertheless, the differentiation of RWMA relies on the experiences of performers. Notably, in ACS patients without transmural infarction, RWMA may not be visible upon naked eyes. Purpose This study aims to investigate whether the application of 3D Convolution Neural Network could assist clinicians to differentiate patients with and without ACS based on echocardiography detected RWMA. Methods From 2018 to 2021, we collected echocardiographic imaging in 796 patients without ACS (Normal Control; NC), 759 with ACS and detectable RWMA (RWMA) and 267 with ACS but not detectable RWMA (uncertain; UC). The diagnosis of ACS was defined by the obstructive coronary arterial disease (CAD) in coronary angiography. Apical four, two and long chamber viewer were acquired and RWMAs were defined by cardiologists. Cardiac-Echo Net consists the techniques of 3D Convolution Neural Network and 3D MaxPooling. Results After exclusion echocardiographic imaging not qualified for analysis, we collected 40813 and 5928 images for establishing the model of Cardiac-Echo Net. In the final model, areas under the receiver operating characteristic curve are 98.9 and 89.2% for the training and validation, respectively. In the external validation dataset, the sensitivity was 81.8% and specificity was 81.6%. Notably, compared with cardiologists, Cardiac-Echo Net showed a superior accuracy in differentiating NC from RWMA (0.89 v.s. 0.815). Likewise, in differentiating NC from UC, Cardiac-Echo Net has a persistently higher accuracy than cardiologists (0.87 v.s. 0.65). Conclusions Superior to previous deep learning models, this novel one combined several neural-networking from different fields. Cardiac-Echo Net could spontaneously detect the subtle myocardial ischemia in ACS patients without eye-catching RWMA while further external validation is necessary.

CHA2DS2 - Vasc Score Predict No Reflow Phenomenon in Primary Percutaneous Coronary Intervention

Purpose: ST-Elevation Myocardial Infarction is the most acute manifestation of Coronary artery disease, with substantial morbidity and mortality. Early reperfusion (re-establishing the blood flow in the occluded artery) is the most effective way to preserve the viability of the ischaemic myocardium and limit infarct size. Early diagnosis of STEMI is crucial to initiate appropriate treatment and should ideally be made within 10 minutes of first medical contact. This study aimed to evaluate the CHA2DS2-VASc score as a simple tool for predicting the no-reflow among patients with STEMI who underwent primary percutaneous coronary intervention.
 Methodology: This was a case-control study which was conducted on 100 patients, diagnosed with acute STEMI and underwent primary PCI, who was admitted to Cardiology Department, Benha University Hospital and National Heart Institute. Patients were classified into two groups, control and no-flow, according to their final angiographic TIMI flow rates resulting from primary PCI. The control group: 78 patients with TIMI flow rate >2. The no-reflow group: 22 patients with TIMI flow rate ≤2, despite mechanical reopening of the infarct-related artery in patients without dissection of the coronary artery.
 Findings: In this study, LVEF was significantly lower in patients with no-reflow compared to patients with normal TIMI flow (p <0.001), but LVEDV was significantly higher (p =0.01). There was no significant difference in LVESV between patients with no-reflow compared to patients with normal TIMI flow. CHA2DS2VASC score was significantly higher in patients with no-reflow compared to patients with normal TIMI flow (p <0.001). CHA2DS2VASC score is a significant predictor of occurrence of no reflow phenomenon (AUC: 0.689, p =0.006). At a cut off value of ≥ 2it has a sensitivity of 68.2%, specificity of 58.9%, PPV of 31.9% and NPV of 86.8%.
 Recommendation: The study suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing primary PCI. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before primary PCI interventions in patients with STEMI. Thus we recommend using CHA2DS2-VASc score as it is very simple and a quick tool to predict no-reflow before primary PCI

The Relationship Between PRECISE-DAPT Score and Spontaneous Reperfusion of Infarct-Related Artery in Patients with ST-Segment Elevation Myocardial Infarction.

Spontaneous reperfusion (SR) presence and a low PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score in patients with acute coronary syndrome have been associated with favorable clinical outcomes. This study aimed to investigate the relationship between SR and this score. The study included 436 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Thrombolysis in myocardial infarction (TIMI) III blood flow presence in the infarct-related artery (IRA) before primary percutaneous coronary intervention (PCI) was defined as SR. Patients were categorized into two groups based on the presence (n = 49) or absence (n = 387) of SR. The PRECISE-DAPT score was computed for each patient using the web-based calculator. The group with SR had a lower frequency of hyperlipidemia and a higher ejection fraction (EF) at admission. Conversely, the group without SR presented with higher values of glucose, troponin, creatine kinase-myocardial band (CK-MB), and PRECISE-DAPT score. The no-reflow phenomenon and elevated SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX-I) scores were higher in the group without SR than in the one with SR. Multivariate regression analysis indicated that a high PRECISE-DAPT score was an independent predictor of the absence of SR (odds ratio: 0.96, P = 0.04). The PRECISE-DAPT score is an independent predictor of the presence of spontaneous reperfusion in patients who experienced STEMI.

Abstract 12220: Right Bundle Branch and Bifascicular Blocks: Insensitive Prognostic Indicators for Acute Myocardial Infarction

Introduction: The clinical significance of right bundle branch block (RBBB) or bifascicular block (BFB) in the setting of ST-elevation myocardial infarction (STEMI) is uncertain. Informed by studies demonstrating higher rates of complete occlusion of the infarct-related artery in patients presenting with RBBB, the latest guidelines on STEMI management suggest patients with persistent ischemic symptoms and RBBB be considered for emergent coronary angiography. However, there has been little study of the prognostic implication of either RBBB or BFB in the setting of undifferentiated acute chest pain, and even less of the degree of ST-elevation in concomitant RBBB. Methods and Results: A total of 7626 patient encounters presenting to the Baylor St. Luke’s Medical Center between July 2018 and July 2020 with a chief complaint of “chest pain” were identified via electronic health record query. Of these encounters, 211 (2.8%) patients were found to have RBBB. Of that cohort, 18 (8.5%) presented with acute coronary syndrome, with STEMI accounting for 6 (2.8%), non-STEMI 9 (4.3%), and unstable angina 3 (1.4%). New or presumed new RBBBs were found in 59 (28%) of total RBBB patients, of which only 5 (8.5%) were found to have acute coronary syndrome and only 2 (3.4%) STEMI specifically. Similarly, 90 (42.7%) patients with chest pain and RBBB were found to have a BFB. New or presumed new BFBs were found in 40 (19%) patients, of which only 4 (10%) were also found to have acute coronary syndrome. No patients with new-onset BFB had STEMI. Furthermore, real-time diagnosis of anterior STEMI was complicated in two patients presenting with acute coronary syndrome by the masking of ST elevation in leads V1-3 by concomitant RBBB. Conclusions: In a large cohort of undifferentiated patients who presented with chest pain and RBBB or BFB (regardless if new or presumed new), only a small fraction had acute coronary syndrome, and even fewer STEMI. These data suggest patients with undifferentiated chest pain and RBBB on ECG with clinical suspicion for acute myocardial infarction and any degree of ST-elevation in leads V1-3 be considered for emergent coronary angiography rather than RBBB or BFB without ST-segment elevation.

The effect of ticagrelor and clopidogrel on angiographic parameters according to diabetic status in patients with ST elevation myocardial infarction

Aim. We aimed to compare post-interventional angiographic outcomes of ticagrelor versus clopidogrel according to glycosylated hemoglobin (HbA1c) levels in patients with ST-elevation myocardial infarction.Material and methods. The study included a total of 532 patients, with 334 receiving ticagrelor (62,8%) and 198 clopidogrel (37,2%). Diabetic status of the patients was assessed with HbA1c. TIMI flow grade and TIMI frame count were calculated and compared between two groups.Results. TIMI flow grade 3 was higher and TFC was lower after percutaneous coronary intervention of the infarct-related artery in patients treated with ticagrelor compared to clopidogrel (89,2% vs. 73,7%; p< 0,001, 20 vs. 24; p< 0,001). There was a positive correlation between the increases in HbA1c and TFC levels in the whole group (r=0,225; p=0,004). In subgroup analysis, higher HbA1c levels did not affect TFC in patients using ticagrelor (r=-0,060; p=0,326 for patients with noreflow, r=-0,133; p=0,321 for patients with TIMI-3 flow). While level of HbA1c did not affect TFC in patients with TIMI-3 flow, the presence of post-procedural no-reflow caused worsening of TFC in patients using clopidogrel as HbA1c levels increased (r=0,374; p=0,005).Conclusion. Ticagrelor was found to be better in terms of angiographic parameters regardless of diabetes.

Association of ectatic non-infarct-related artery with 1-month stent thrombosis in patients with ST elevation myocardial infarction

BackgroundEctatic infarct-related artery (IRA) has been shown to be associated with higher thrombus burden, no-reflow, stent thrombosis (ST) and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI)....

Predictive Utility of Reperfusion Criteria in Predicting Occluded Infarct-Related Artery in Patients With ST-Elevation Myocardial Infarction

Current guidelines recommend resolution of angina and >50% resolution in ST-elevation as criteria for successful fibrinolysis in ST-segment elevation myocardial infarction (STEMI). However, these criteria were determined from small studies during the streptokinase era and have not been re-validated in modern pharmacoinvasive regimens. This study sought to evaluate the predictive utility of reperfusion criteria following fibrinolysis to diagnose occluded infract-related artery (IRA) in contemporary STEMI management.

Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)-How Can We Identify These Patients?

Background and Objectives: Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain unclear. Aim: The study aimed to assess the incidence and predictors of TO of IRA in patients with NSTEMI, and its clinical significance. Material and Methods: The study was a single-center retrospective cohort analysis of 399 consecutive patients with NSTEMI (293 male, mean age: 71 ± 10.1 years) undergoing percutaneous coronary intervention. The study population was categorized into patients with TO and non-TO of IRA on coronary angiography. In-hospital and one-year mortality were analyzed. Results: TO of IRA in the NSTEMI population occurred in 138 (34.6%) patients. Multivariate analysis identified the following independent predictors of TO of IRA: left ventricular ejection fraction (odds ratio (OR) 0.949, p < 0.001); family history of coronary artery disease (CAD) (OR 2.652, p < 0.001); and high-density lipoprotein (HDL) level (OR 0.972, p = 0.002). In-hospital and one-year mortality were significantly higher in the TO group than the non-TO group (2.8% vs. 1.1%, p = 0.007 and 18.1% vs. 6.5%, p < 0.001, respectively). The independent predictors of in-hospital mortality were: left ventricular ejection fraction (LVEF) at admission (OR 0.768, p = 0.004); and TO of IRA (OR 1.863, p = 0.005). Conclusions: In the population of patients with NSTEMI, TO of IRA represents a considerably frequent phenomenon, and corresponds with impaired outcomes. Therefore, the utmost caution should be paid to prevent delay of coronary angiography in NSTEMI patients with impaired left ventricular systolic function, metabolic disturbances, and a family history of CAD, who are at increased risk of TO of IRA.

Pre-hospital heparin use for ST-elevation myocardial infarction is safe and improves angiographic outcomes.

This study aims to evaluate if pre-hospital heparin administration by paramedics is safe and improves clinical outcomes. Using the multicentre Victorian Cardiac Outcomes Registry, linked with state-wide ambulance records, we identified consecutive patients undergoing primary percutaneous coronary intervention for STEMI between January 2014 and December 2018. Information on thrombolysis in myocardial infarction (TIMI) flow at angiography was available in a subset of cases. Patients receiving pre-hospital heparin were compared to those who did not receive heparin. Findings at coronary angiography and 30-day clinical outcomes were compared between groups. Propensity-score matching was performed for risk adjustment. We identified a total of 4720 patients. Of these, 1967 patients had TIMI flow data available. Propensity-score matching in the entire cohort yielded 1373 matched pairs. In the matched cohort, there was no observed difference in 30-day mortality (no-heparin 3.5% vs. heparin 3.0%, P = 0.25), MACCE (no-heparin 7% vs. heparin 6.2%, P = 0.44), and major bleeding (no-heparin 1.9% vs. heparin 1.4%, P = 0.64) between groups. Propensity-score analysis amongst those with TIMI data produced 552 matched pairs. The proportion of cases with TIMI 0 or 1 flow in the infarct-related artery (IRA) was lower among those receiving pre-hospital heparin (66% vs. 76%, P < 0.001) compared to those who did not. In this multicentre, propensity-score matched study, the use of pre-hospital heparin by paramedics was safe and is associated with fewer occluded IRAs in patients presenting with STEMI.

Profilin 1 and Mitochondria-Partners in the Pathogenesis of Coronary Artery Disease?

Atherosclerosis remains a large health and economic burden. Even though it has been studied for more than a century, its complex pathophysiology has not been elucidated. The relatively well-established contributors include: chronic inflammation in response to oxidized cholesterol, reactive oxygen species-induced damage and apoptosis. Recently, profilin 1, a regulator of actin dynamics emerged as a potential new player in the field. Profilin is abundant in stable atherosclerotic plaques and in thrombi extracted from infarct-related arteries in patients with acute myocardial infarction. The exact role of profilin in atherosclerosis and its complications, as well as its mechanisms of action, remain unknown. Here, we summarize several pathways in which profilin may act through mitochondria in a number of processes implicated in atherosclerosis.

Electrocardiogram predictors of multivessel disease in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Objective: The objective was to study the role of 12-lead electrocardiogram (ECG) changes in predicting the association of severe stenosis of other coronary arteries along with infarct-related artery in patients who presented with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: We studied the admission ECG, clinical records, and coronary angiography of 201 patients with STEMI who underwent primary PCI within the first 12 h of symptoms. Patients with first episode of STEMI and coronary angiogram showing coronary artery disease between January 2015 and July 2016 were included in this study. Results: Most of the patients in this study were males (82.1%). The mean age of the patients was 55.20 ± 11.79 years. Diabetic mellitus (37.8%), hypertension (37%), and smoking (49.7%) were the main risk factors. This study had 117 (58.2%) patients of anterior wall myocardial infarction (MI) (Group I) while inferior wall MI was present in 84 (41.8%) patients (Group II). In Group I, 83 (70.9%) patients had single-vessel disease (SVD) while 34 (29.1%) patients had multivessel disease (MVD). The presence of ST-segment depression ≥0.1 mV in leads I, aVL, and V6 significantly correlated with the presence of MVD (P = 0.001, 0.001, and 0.001, respectively). In Group II, 39 (51.3%) patients had SVD while 37 (48.7%) patients had MVD. The presence of ST-segment depression in leads aVL, V5, and V6 significantly correlated with the presence of MVD (P = 0.049, 0.001, and 0.001, respectively). Conclusion: The presence of ST-segment depression of ≥0.1 mv in leads I, aVL, and V6 on admission ECG in the setting of acute anterior wall STEMI and in leads aVL, V5, and V6 on admission ECG in the setting of acute inferior wall STEMI was associated with MVD.

Prevalence and clinical significance of totally occluded infarct-related arteries in patients with non-ST-segment elevation acute coronary syndromes

Background Seemingly conflicting findings exist regarding the prognostic impact of totally occluded infarct-related arteries (oIRA) in non-ST elevation acute coronary syndromes (NSTE-ACS).Methods Retrospective analysis of prospective multicenter registry data comprising a single-center NSTE-ACS cohort, aimed at assessing the impact of occluded (TIMI flow 0/1) versus patent culprit vessels (pIRA, TIMI flow 2/3) on the composite endpoint of all-cause death and cardiogenic shock events at 30 days.Results Of 568 patients, 183 (32.5%) had oIRA. Male sex, refractory angina, ECG suggestive of multivessel or left main disease, and larger infarct sizes with inferior/posterolateral wall involvement, were identified as highly specific markers of oIRA. Successful culprit-lesion revascularization occurred more frequently in patent than in oIRA (90% vs. 96%; P = 0.013). Conversely, patients with oIRA more frequently achieved successful revascularization of concurrent non-IRAs including chronic total occlusions than did those with pIRA (28% vs. 3%; P = 0.0005). Multivariate analysis revealed neutral effects of oIRA on outcomes and identified incomplete revascularization as a powerful predictor of mortality. Moderation analysis revealed a significant interaction between completeness of revascularization and IRA patency, whereby among the incompletely revascularized patients, those with oIRA enjoyed a significant survival advantage over their counterparts with pIRA (11.8% vs. 28%, adjusted OR 0.34; 95% CI 0.10–0.73; Pinteraction = 0.012).Conclusions Approximately one third of NSTE-ACS patients in this cohort had oIRA. However, compared with pIRA, the occurrence of oIRA did not portend poor outcomes, likely resulting from the higher rate of incomplete revascularization and increased risk of subsequent mortality in patients with pIRA. These exploratory findings warrant further investigation.

Does pre-angiography Total ST-segment resolution reliably predict spontaneous reperfusion of the infarct-related artery in patients with acute myocardial infarction?

BackgroundST resolution (STR) after AMI is a non-invasive indicator of IRA reperfusion. We investigated whether pre-angiography STR predicted spontaneous IRA reperfusion in STEMI patients.MethodPatients with STEMI undergoing primary PCI were recruited. Standard 12-lead ECG tracings were recorded at first medical contact, immediately prior to arterial puncture and 60 min after PCI. STR was classified as total (≥70%; group I), partial (≥30 and < 70%; group II) or none (< 30%; group III). Patients were followed up for 1-year.ResultsThe final analysis included 349 patients (n = 77, 160 and 112 for groups I, II and III, respectively). Compared with groups I/II, pre-procedural TIMI flow in group III was less frequently grades 2 or 3 (P < 0.001). Pre-PCI STR ≥70% was an independent predictor of pre-PCI TIMI-3 flow (OR: 2.8; P < 0.001). Pre-PCI STR < 30% was independently associated with pre-PCI TIMI flow 0–2 (OR: 3.1; P < 0.001). STR = 35.55% seems to be an optimal cut off for pre-procedural TIMI-3 flow prediction with sensitivity 0.943, specificity 0.456, Youden index 0.399, P = 0.027. STR prior to PCI was inversely correlated with 1-year combined CV events rate. STR > 70% may predict a better clinical outcome.ConclusionsAssessment of STR could potentially be used to stratify risk in patients with STEMI before PCI.

Association of Serum Copeptin Levels with Patency of Infarct-Related Arteries in Patients with ST-Segment Elevation Myocardial Infarction.

Copeptin is widely used as a predictor of an adverse prognosis in many clinical conditions. Reduced antegrade coronary flow in an infarct-related artery (IRA) is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate whether copeptin level on admission was associated with IRA patency in STEMI patients. A total of 88 patients were enrolled into the study and divided into two groups according to TIMI flow grade in the IRA before primary percutaneous coronary intervention. White blood cell count (p = 0.015), neutrophils (p = 0.047), N-terminal pro-brain natriuretic peptide (NTproBNP) (p < 0.001), copeptin (p < 0.001) and peak troponin I (p = 0.001) were significantly higher in the occluded IRA group with a significantly lower serum sodium level (p < 0.001). Age- and gender-adjusted multivariate analysis revealed that copeptin (OR = 1.970; p = 0.001), peak troponin I (1.055; p = 0.005) and NTproBNP (OR = 1.003; p = 0.010) were independent predictors of an occluded IRA. A copeptin cut-off value of > 6.8 ng/mL was found to predict an occluded IRA with a sensitivity of 80% and specificity of 100% (area under the curve: 0.917; p < 0.001). Performance ranking of the biomarkers that could predict an occluded IRA showed copeptin > peak troponin I = NTproBNP. Copeptin levels were higher in the patients with an occluded IRA and STEMI. Higher levels of copeptin predicted an occluded IRA in the patients with STEMI who were admitted to the emergency department during the first three hours of chest pain.

Serum apelin predicts spontaneous reperfusion of infarct-related artery in patients with ST-segment elevation myocardial infarction.

Spontaneous reperfusion (SR) was associated with significant myocardial salvage, decreased mortality rates, better clinical outcomes, and lower incidences of major adverse cardiovascular events. It was found that apelin inhibited thrombin-induced and collagen-induced platelet activation and aggregation. This study was carried out to assess whether serum apelin correlates with SR of the infarct-related coronary artery in ST-elevation myocardial infarction (STEMI) patients. Blood samples were obtained on admission in 280 consecutive patients with STEMI before primary percutaneous coronary intervention. Blood chemistry and apelin levels were tested. Coronary arteriography and echocardiography were performed after admission. Frequencies of the patients with preinfarct angina, history of smoking, and pathoglycemia were higher in the non-SR group than in the SR group (P=0.03, 0.001, and 0.002, respectively). Peak values of plasma troponin-I and frequencies of the patients with Killip 2-3 were significantly higher in the non-SR group (P<0.05, respectively) compared with the SR group. Left ventricular systolic and diastolic functions improved markedly in the SR group compared with the non-SR group. Gensini scores were lower in the SR group than the non-SR group (P=0.02). Serum apelin was significantly higher in patients with SR compared with patients with non-SR (0.82±0.34 vs. 0.35±0.22 ng/ml, P=0.04). A cut-off value of 0.75 ng/ml had a predictive value of 77% to identify patients with SR. In the non-SR group, patients who died in the hospital had much lower apelin levels compared with those who survived (P<0.001). Apelin level in the high thrombus load group was much lower compared with the other group (P<0.001). Apelin level in the group undergoing successful reperfusion was much higher than that in the group without successful reperfusion (P<0.001). Patients with SR have better cardiac systolic function and improved diastolic function. An increased serum apelin level is an independent and novel predictor of SR for STEMI patients.

Value of fibrinogen to albumin ratio on predicting spontaneous recanalization of infarct-related artery in patients with acute ST-segment elevation myocardial infarction

Objective: To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization. Results: There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all P>0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, P<0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, P=0.004). Multivariate logistic regression analysis showed that FAR (OR=0.492, 95%CI 0.354-0.686, P<0.001), serum uric acid (OR=0.994, 95%CI 0.989-0.999, P=0.018) and high-sensitivity C-reactive protein (OR=0.774, 95%CI 0.614-0.975, P=0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95%CI 0.630-0.758, P<0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%. Conclusion: The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.

TCTAP C-029 Percutaneous Coronary Intervention for the Chronic Total Occlusion in a Non Infarct-related Artery Prior to Intervention for Infarct-related Artery in Patients with Acute ST-elevation Myocardial Infarction

TCTAP C-029 Percutaneous Coronary Intervention for the Chronic Total Occlusion in a Non Infarct-related Artery Prior to Intervention for Infarct-related Artery in Patients with Acute ST-elevation Myocardial Infarction

The influence of plasma 25-(OH) vitamin D levels in acute ST elevation myocardial infarction.

The preventive role of acute occurring of collateral circulation (AOCC) to infarct related artery (IRA) in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) is well known. Therefore, we aimed to investigate whether there is an association between admission plasma 25-hydroxyvitamin D (25(OH)D3) levels and grade of collateralization in patients with STEMI. We prospectively included 369 STEMI patients within the first 12 h of symptoms onset. Patients were divided into two groups according to their Rentrop collateralization grade to IRA: poorly developed collateral (PDC) group (Rentrop grade ≤ 1, 272 patients) and well developed collateral (WDC) group (Rentrop grade ≥ 2, 97 patients). We observed that AOCC grade to IRA was negatively correlated with high sensitive C-reactive protein (hs-CRP), N terminal pro-B-type natriuretic peptide (NT-proBNP), as well as peak troponin T levels, yet positively correlated with admission plasma 25(OH)D3 level (p < 0.05, for all). In multi¬variate analysis, 25(OH)D3 levels (OR 1.246, 95% CI 1.185-1.310, p < 0.001), together with hs-CRP, NT-proBNP, and peak troponin T levels were found independent predictors of AOCC to IRA in patients with acute STEMI. Admission level of plasma 25(OH)D3 levels together with cardiac risk biomarkers (troponin T, NT-proBNP, hs-CRP) are associated with collateralization grade to IRA in acute STEMI patients. In addition, 25(OH)D3 may be a promoter of AOCC in patients with acute STEMI.

P2712Impact of total occlusions of infarct related artery in patients with acute myocardial infarction without ST elevation on in-hospital mortality: a multicenter analysis

P2712Impact of total occlusions of infarct related artery in patients with acute myocardial infarction without ST elevation on in-hospital mortality: a multicenter analysis

Deferred versus conventional stent implantation in patients with acute ST-segment elevation myocardial infarction: An updated meta-analysis of 10 studies

BackgroundWe sought to evaluate safety and efficacy of the deferred stenting versus immediate stent implantation of infarct-related arteries in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MethodsA meta-analysis using random-effects models were conducted. The primary outcome, major adverse cardiac events (MACE), was a composite of all-cause mortality, myocardial infarction (MI), any unplanned target vessel revascularization (TVR), and hospitalization due to cardiac cause. Periprocedural composite events were composed of acute re-occlusion, no-reflow/slow flow, or distal embolization. ResultsSeven non-randomized registries and three randomized trials comparing outcomes of deferred versus immediate stenting in infarct-related arteries of 2281 STEMI patients were selected. Risk of MACE between deferred or immediate stenting did not differ significantly (rates, 12.8% vs 15.0%; pooled RR=0.68, 95% CI: 0.43–1.06; p=0.087; I2=26.8%). Deferred stenting was associated with significantly reduced risk of periprocedural composite events (rates, 5.3% vs 10.2%; pooled RR=0.36, 95% CI: 0.18–0.69; p=0.002; I2=68.0%) and flow abnormality in infarct-related arteries (rates, 3.8% vs 8.4%; pooled RR=0.29, 95% CI: 0.14–0.61; p=0.001; I2=58.1%). However, clinical outcomes including all-cause mortality, MI, or any unplanned TVR, were unaffected. Meta-regression indicated a significant relationship between prolonged total ischemic and reduced risk of MACE after deferred stenting (OR=0.994, 95% CI: 0.990–0.998; p=0.027; I2 residual 0.0%, adjusted R2=100.0%). ConclusionsAlthough deferred stenting carried significantly lower risk of periprocedural composite events and abnormal flow in patients undergoing primary PCI for STEMI, such benefits had no impact on MACE, which did not differ significantly by timing of stent placement.