Infarct-related Coronary Artery Research Articles

Dilation of the Infarct-Related Coronary Artery to Reduce the Incidence of the No-Reflow Phenomenon in STEMI Patients

Background: The pathogenesis of slow/no-reflow phenomena is a critical socio-medical problem due to high mortality and work disability rates in patients with ST-segment elevation myocardial infarction (STEMI). Slow/no-reflow phenomena are multifactorial involving 4 key elements: 1) distal embolization of the coronary bed of the infarct-related coronary artery; 2) ischemic damage to the myocardium; 3) reperfusion injury of the heart muscle; 4) individual (genetic) susceptibility of the microcirculation to injury. Objective: To analyze the outcomes of percutaneous coronary interventions (PCI) in patients with STEMI and TIMI 0 blood flow of an infarct-related coronary artery based on the strategy to restore antegrade blood flow (balloon predilation or dilation of an infarctrelated artery). Materials and methods: We analyzed treatment outcomes of 209 patients with STEMI and TIMI 0 blood flow. The patients were grouped based on the PCI strategy: group 1 included 147 patients who underwent balloon angioplasty to restore antegrade blood flow, and group 2 included 62 patients who underwent dilation of an infarct-related coronary artery. Results: Our study found that direct stenting in STEMI patients was associated with statistically significantly lower risk of slow/noreflow phenomena (P = 0.001, Pearson’s χ2) and, as a result, better functional outcomes of treatment (chronic heart failure grade classified according to Strazhesko-Vasilenko and by left ventricular ejection fraction) that were also statistically significant (P = 0.001, Pearson’s χ2). Conclusions: Our study demonstrated that the risk of slow/no-reflow phenomena in patients with TIMI 0 blood flow of an infarctrelated coronary artery was statistically significantly lower (P = .001, Pearson’s χ2) in the group of patients who underwent dilation of an infarct-related coronary artery to restore antegrade blood flow. Functional outcomes (chronic heart failure grade and overall survival) were also better in this group of patients (P = .001, Pearson’s Chi-square). Moreover, dilation of an infarct-related coronary artery was associated with preserved left ventricular ejection fraction compared with the group of patients who underwent balloon angioplasty to restore antegrade blood flow (P < 0.001, Pearson’s χ2).

SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROME AND DIABETES MELLITUS

ST-segment elevation myocardial infarction, stenting of the infarct-related coronary artery, silent (painless) myocardial ischemia, diabetes mellitus, 24-hour electrocardiographic monitoring.
 Introduction. Currently, approximately 422 million people in the world have diabetes mellitus, and over 1.3 million individuals in Ukraine are diagnosed with diabetes mellitus. Diabetic neuropathy is known to contribute to the development of atypical and painless variants of ischemic heart disease in individuals with diabetes. This poses a challenge for timely diagnosis and obscures the course of ischemic heart disease, as the prevalence of silent myocardial ischemia is significantly high in these patients. Therefore, the aim of this study is to investigate the occurrence of myocardial ischemia episodes in patients with ST-elevation myocardial infarction within the first day following stenting of the infarct-related coronary artery. Furthermore, we aimed to demonstrate the painless nature of these episodes in the presence of type 2 diabetes mellitus through a clinical case presentation.
 Materials and methods. 30 patients with ST-segment elevation myocardial infarction were examined, and 24-hour electrocardiographic monitoring was performed during the first day after the infarct-related coronary artery stenting. Results. Episodes of transient myocardial ischemia were registered in 50% of people. We found that the majority of episodes (80%) were painless. In the presence of diabetes mellitus, only episodes of painless myocardial ischemia were noted that is supported by the example of a clinical case. The study highlighted the informativeness of 24-hour electrocardiographic monitoring in identifying episodes of myocardial ischemia, particularly in its painless variant. The results demonstrate that patients with ST-elevation myocardial infarction (STEMI) experience episodes of transient myocardial ischemia within the first day after coronary artery stenting, with a majority of these episodes being painless. Furthermore, in the presence of diabetes mellitus, ischemic episodes tend to be painless. Therefore, 24-hour electrocardiographic monitoring serves as a valuable method for the detection of myocardial ischemia.

Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort.

Patients with ST-segment elevation typically feature total coronary occlusion (TCO) of the infarct-related artery (IRA) on angiography, which may result in worse outcomes. Yet, relying solely on electrocardiogram (ECG) findings may be misleading and those presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) may have TCO as well. Herein, we aimed to delineate clinical characteristics and outcomes of patients with ACS stratified by IRA location. A total of 4787 ACS patients were prospectively recruited between 2009 and 2017 in SPUM-ACS (ClinicalTrials.gov Identifier: NCT01000701). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at 1 year. Multivariable-adjusted survival models were fitted using backward selection. A total of 4412 ACS patients were included in this analysis, 56.0% (n=2469) ST-elevation myocardial infarction (STEMI) and 44.0% (n=1943) NSTE-ACS. The IRA was the right coronary artery (RCA) in 33.9% (n=1494), the left-anterior descending coronary artery (LAD) in 45.6% (n=2013), and the left circumflex (LCx) in 20.5% (n=905) patients. In STEMI patients, TCO (defined as TIMI 0 flow at angiography) was observed in 55% of cases with LAD, in 63% with RCA, and in 55% with LCx. In those presenting with NSTE-ACS, TCO was more frequent in those with LCx and RCA as compared to the LAD (27 and 24%, respectively, vs. 9%, P<0.001). Among patients with NSTE-ACS, occlusion of the LCx was associated with an increased risk of MACE during 1 year after the index ACS (fully adjusted hazard ratio 1.68, 95% confidence interval 1.10-2.59, P=0.02; reference: RCA and LAD). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher levels of high-sensitivity C reactive protein (hs-CRP) and high-sensitivity cardiac troponin T, lower eGFR, and notably a negative history of MI. In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.

High mobility group box 1 derived mainly from platelet microparticles exacerbates microvascular obstruction in no reflow

IntroductionNo reflow manifests coronary microvascular injury caused by continuous severe myocardial ischemia and reperfusion. Microvascular obstruction (MVO) has emerged as one fundamental mechanism of no reflow. However, the underlying pathophysiology remains incompletely defined. Herein, we explore the contribution of high mobility group box 1 (HMGB1), derived mainly from platelet microparticles exacerbating MVO in no reflow. Materials and methods44 STEMI patients undergoing successful primary percutaneous coronary intervention (PCI) were included in our study. Plasma HMGB1 levels in both the peripheral artery (PA) and infarct-related coronary artery (IRA) were measured by ELISA. Flow cytometry and confocal microscopy assessed the level of HMGB1+ platelet derived microparticles (PMPs) and platelet activation. Flow cytometry and western blot evaluated the procoagulant activity (PCA) and the release of inflammatory factors of human microvascular endothelial cells (HCEMCs). ResultsHMGB1 levels were significantly higher in the IRA in no-reflow patients. The levels of HMGB1+ PMPs were considerably higher in the IRA of patients with no reflow and were strongly associated with platelet activation. Moreover, our results show that HMGB1 interacts with human microvascular endothelial cells primarily through TLR4, inducing HCMEC proinflammatory, procoagulant phenotype, and monocyte recruitment, accelerating microvascular obstruction and facilitating the development of no reflow. ConclusionOur results illustrate a novel mechanism by which HMGB1, derived mainly from PMPs, plays a crucial role in the pathogenesis of no-reflow, revealing a novel therapeutic target.

Elevated Native T1 Values in the Remote Myocardium Supplied by Obstructive Non-Infarct Related Coronary Arteries in Post-STEMI Cardiac Magnetic Resonance

Introduction: Native T1 mapping values are elevated in acutely injured myocardium. We sought to study whether native T1 values, in the non-infarct related myocardial territories, might differ when supplied by obstructive or nonobstructive coronary arteries. Methods: Consecutive patients (N = 60, mean age 59 years) with the first STEMI following primary percutaneous coronary intervention, underwent cardiac magnetic resonance within 5 ± 2 days. A retrospective review of coronary angiography reports classified coronary arteries as infarct-related coronary artery (IRA) and non-IRA. Obstructive coronary artery disease (CAD) was defined as stenosis ≥50%. Native T1 values were presented using a 16-segment AHA model according to the three main coronary territories: left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Results: The cutoff native T1 value for predicting obstructive non-IRA LAD was 1,309 msec with a sensitivity and specificity of 67% and 82%, respectively (AUC 0.76, 95% CI: 0.57–0.95, p = 0.04). The cutoff native T1 value for predicting obstructive non-IRA RCA was 1,302 msec with a sensitivity and specificity of 83% and 55%, respectively (AUC 0.7, 95% CI: 0.52–0.87, p = 0.05). Logistic regression model adjusted for age and infarct size demonstrated that native T1 was an independent predictor for the obstructive non-IRA LAD (OR 4.65; 1.32–26.96, p = 0.05) and RCA (OR 3.70; 1.44–16.35, p = 0.03). Conclusion: Elevated native T1 values are independent predictors of obstructive non-IRA in STEMI patients. These results suggest the presence of concomitant remote myocardial impairment in the non-infarct territories with obstructive CAD.

The relationship between platelet indices and residual SYNTAX score in patients with ST-segment elevation myocardial infarction

Objectives: Our aim is to investigate the relationship between thrombocyte indices, which have previously been proven to be associated with many cardiovascular diseases and adverse events, and residual SYNTAX (SYNergy between percutaneous coronary interventionwith TAXus and cardiac surgery) score (rSS) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Our study included 534 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI between January 2018 and June 2021. In our study, only patients who underwent infarct-related coronary artery revascularization in the index procedure were evaluated. First of all, patients were compared as two groups as low rSS (rSS ≤ 8) and high rSS (rSS &amp;gt; 8). Our definition of platelet indices includes mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (Pct), MPV to platelet ratio (MPVPR), platelet to lymphocyte ratio (PLR), and MPV to lymphocyte ratio (MPVLR). Results: The mean age of the study patients was 56.4 ± 10.3 years and 78.8% were male. The high rSS group had higher C-reactive protein, lower lymphocyte count, and significantly higher platelet indices other than PLR and MPV. Among the platelet indices, MPVLR was found to have the best correlation with rSS (r: 0.398, p &amp;lt; 0.001). MPVLR (AUC: 0.820, 95% CI: 0.701-0.899) was determined as the best diagnostic power index with 5.08 cut-off value in predicting high rSS with 88% sensitivity and 76% specificity (Youden index: 0.64). Age, right coronary artery involvement as culprit lesion, ejection fraction, diabetes mellitus and MPVLR (OR: 5.966 [2.489-8.413], p &amp;lt; 0.001) and PDW were identified as independent risk factors for predicting high rSS. Conclusions: In conclusion, increased MPVLR is associated with high rSS in STEMI patients. There is a significant positive correlation between MPVLR and rSS. MPVLR is an independent predictor of high rSS.

Intra-aortic balloon pump in patients with myocardial infarction and cardiogenic shock of stages A and B

This article presents two clinical cases of patients with myocardial infarction and stage A (at risk) and B (beginning) cardiogenic shock who underwent intra-aortic balloon counterpulsation (IABP). In patients with a high risk of classic cardiogenic shock and/or the no-reflow phenomenon, stenting of the infarct-related coronary artery during this type of mechanical circulatory support was performed without complications. Theoretical and practical aspects of using IABP at different stages of cardiogenic shock are discussed.

Dynamics of the Indicators of Low Dose Dobutamine Stress-Echocardiography under the Influence of High Doses of Atorvastatin in Patients with ST Elevation Myocardial Infarction

The aim of investigation: to study the effect of early administration high doses of atorvastatin in the acute period of STEMI on the indicators of low dose dobutamine stress-echocardiography and parameters of left ventricular remodeling. Material and Methods: The study included 164 patients with STEMI All patients underwent myocardial revascularization (TLT or PCI) within the first 6 hours. The 1st group included 82 patients who received basic therapy (atorvastatin 20 mg), the 2nd group included 82 patients who took a loading dose of atorvastatin (at a dose of 80 mg per day). Low dose dobutamine stress-echocardiography was performed to detect myocardial stunning after stabilization of the patients condition on 4–6 days of the disease. In addition to general clinical and conventional laboratory research methods, on the 1st day and on the 10th day of treatment, the level of CPK MB, ESR, the number of blood leukocytes, and the level of fibrinogen (FN) were determined. Results: On the 10th day of therapy in patients of both groups, there was a significant increase in ESR (in the 1st group by 2.1 times, in the 2nd - by 1.6 times) and a decrease in the level of CRP (by 3 and 2.65 times, respectively) compared to the first day. The dynamics of these indicators reflects the regular processes of the course of AMI. A more significant change in these parameters was recorded in patients of the 2nd group who took atorvastatin at a dose of 80 mg. At the same time, on the 10th day of AMI, the number of peripheral blood leukocytes significantly decreased in them (p&lt;0.05 when compared between groups). The number of dobutamine-responsive segments (segments with reversible dysfunction) in the group of patients treated with atorvastatin at a dose of 80 mg during myocardial reperfusion was significantly higher than in the control group (p&lt;0.05). Conclusion: It was revealed that conducting of myocardium reperfusion in infarct-related coronary artery with simultaneous use of atorvastatin’s high doses promoted the limitation of myocardial necrosis development, reducing ischemic and reperfusion injuries of myocardium and influenced on the formation of myocardial stunning zones which is a reversible disfunction. The use of atorvastatin in the dose of 80 mg/per day in the first hours after acute myocardial infarction development promotes the improvement of LV systolic indices, prevents the progressing of LV cavity postinfarction dilatation.

Variations in Blood Platelet Proteome and Transcriptome Revealed Altered Expression of Transgelin-2 in Acute Coronary Syndrome Patients.

Proteomic analyses based on mass spectrometry provide a powerful tool for the simultaneous identification of proteins and their signatures. Disorders detection at the molecular level delivers an immense impact for a better understanding of the pathogenesis and etiology of various diseases. Acute coronary syndrome (ACS) refers to a group of heart diseases generally associated with rupture of an atherosclerotic plaque and partial or complete thrombotic obstruction of the blood flow in the infarct-related coronary artery. The essential role in the pathogenesis of ACS is related to the abnormal, pathological activation of blood platelets. The multifactorial and complex character of ACS indicates the need to explain the molecular mechanisms responsible for thrombosis. In our study, we performed screening and comparative analysis of platelet proteome from ACS patients and healthy donors. Two-dimensional fluorescence difference gel electrophoresis and nanoscale liquid chromatography coupled to tandem mass spectrometry showed altered expressions of six proteins (i.e., vinculin, transgelin-2, fibrinogen β and γ chains, apolipoprotein a1, and tubulin β), with the overlapping increased expression at the mRNA level for transgelin-2. Dysregulation in protein expression identified in our study may be associated with an increased risk of thrombotic events, correlated with a higher aggregability of blood platelets and induced shape change, thus explaining the phenomenon of the hyperreactivity of blood platelets in ACS.

Improved prediction of electrical storm in patients with prior myocardial infarction and implantaImproved prediction of electrical storm in patients with prior myocardiable cardioverter defibrillator

Abstract Funding Acknowledgements Type of funding sources: None. Aims To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD). Methods Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation. Results During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p&amp;lt;0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p=0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%). Conclusion In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.

Arteriovenous shunt fraction as a marker for early diagnosis of acute respiratory distress syndrome against the background of cardiogenic pulmonary edema: a case report

Introduction . In recent years, there has been a trend towards an increase in the use of mechanical ventilation (MV) in patients with acute myocardial infarction and cardiogenic shock. Probably, currently there is an underdiagnosis of acute respiratory distress syndrome (ARDS) against the background of cardiogenic pulmonary edema, which does not allow timely use of effective treatment strategies. We propose to use the pulmonary shunt fraction (Qs/Qt) as an additional diagnostic method. Case . A 70-year-old male patient entered the сardiovascular intensive care unit with acute ST-segment elevation myocardial infarction complicated by cardiogenic shock. Emergency percutaneous coronary intervention 50 minutes after hospitalization allowed revascularization of the infarct-related coronary artery and 1:1 intra-aortic balloon counterpulsation was initiated. Against the background of non-invasive ventilation, paraclinical signs of severe respiratory failure persisted — S/F (SpO 2 /FiO 2 ): 108, PaO 2 / FiO 2 (Horowitz index): 78-103, Qs/Qt: 27,3-48,3%). Therefore, MV was started. According to the obtained data (24 hours from the admission), severe ARDS was verified. Renal replacement therapy session was started for non-renal indications. On the 4th day of hospitalization, therapy improved the patient’s condition. A 63-hour session of renal replacement therapy was completed. Against the background of gradual weaning from mechanical ventilation, the patient was extubated. Conclusion . In the above case, the use of shunt fraction (Qs/Qt) contributed to the earliest possible verification of ARDS before the onset of full-scale clinical picture, an increase in biochemical markers and X-ray abnormalities, which made it possible to start targeted therapy in a timely manner.

Improved prediction of electrical storm in patients with prior myocardial infarction and implantable cardioverter defibrillator

AimsTo evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD). MethodsMulticenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation. ResultsDuring a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p < 0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p = 0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%). ConclusionIn a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.

Using parameters of myocardial deformation as markers of pathological postinfarction remodeling

Abstract Funding Acknowledgements Type of funding sources: None. Objective to predict pathological left ventricular (LV) remodeling using global parameters of strain and twisting. Methods the study included 114 people with primary ST-segment elevation myocardial infarction (STEMI): 14 women and 100 males aged 32 to 67 years (52.3 ± 8.4). STEMI has been confirmed by ECG data, cardiospecific biomarkers (troponin T, CPK-MB) and coronary angiography - the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography has been performed using a MyLab ultrasound scanner (Italy) on the 7th-9th day, 3rd, 6th and 12th months after the disease onset with the evaluation of standard parameters. On the 7th-9th days the parameters of global longitudinal (GLS,%), circumferential (GCS,%) strain, and LV twisting (Twist, °) have been analyzed using the X-Strain ™ software. The criterion for pathological LV remodeling has been considered to be an increase in EDVi ≥ 20% compared with the initial value. Prediction of pathological remodeling has been performed using ROC analysis by 3 criteria. To assess the quality of the model, the area under the curve (AUR –Area under ROC) has been determined with the calculation of 95% confidence intervals and the statistical significance of the point estimate of the area. Results Within 48 weeks pathological remodeling was developed in 45 (39.5%) patients. Three months after the index event, LV remodeling was detected in 24 (53.3%) patients of these 45; after 6 months - in another 15 (33.3%); after 12 months - in another 6 (13.4%). GLS - 11.7% with 96% sensitivity and 80% specificity, AUR 0.750 (95% CI 0.659 - 0.841), GCS - 12.4% with test sensitivity and specificity - 90% and 82%, respectively ((AUR 0.641 ( 95% CI 0.534 - 0.749)), Twist - 7.8 ° with a sensitivity of 93% and a specificity of 78%, AUR 0.657 (95% CI 0.558 - 0.757) predict the development of pathological postinfarction LV remodeling on the 7th-9th day. For all models the value of p ≤ 0.001. Conclusion Previously, LV remodeling has developed within 3 months after STEMI in 45 (39.5%) patients. The longitudinal strain, measured in the acute period of STEMI, has the greatest predictive ability in relation to the development of pathological postinfarction LV remodeling.

Diagnostic value of parameters of myocardial work in patients after myocardial infarction with ST segment elevation

Abstract Funding Acknowledgements Type of funding sources: None. Objective to reveal the differences in the global parameters of myocardial work of the left ventricle (LV) in patients with preserved LV ejection fraction (EF) after ST-segment elevation myocardial infarction (STEMI) and healthy individuals. Methods the study included 45 people with primary STEMI (group 1): 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). The control group (group 2) consisted of 70 healthy individuals aged 39.3 ± 8.9 years, including 34 men and 36 women. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography was performed on the 7th-9th day and 6 months after STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). Echocardiographic image analysis was performed using EchoPAC software version 202 (GE Healthcare). The standard echo parameters were determined: end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), LV myocardial mass index (LVMI, g / m2), EF by the Simpson biplane method,%. The preserved EF was considered the value of EF greater than or equal to 50%. The following indicators of myocardial work were assessed: global myocardial work index (GWI, mm Hg%), global constructive work (GCW, mm Hg%), global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing was performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results 6 months after STEMI, 26 subjects had an EF ≥50% (58.8 ± 5.8%). The mean LVEF in group 2 was 60.8 ± 4.6% (p = 0.12). EDV in group 1 was 122.5 [95% CI 104.4; 140.7] ml, in group 2 - 104.7 [95% CI 99.1; 110.3] ml (p = 0.003). ESV in group 1 - 83.8 [95% CI 28.5; 139.0] ml, in group 2 - 40.7 [95% CI 37.6; 43.7] ml (p = 0.02); in group 1, LVMI was 89.3 [95% CI 77.4; 101.1] g / m2, in group 2 - 67.4 [95% CI 63.7; 71.1] g / m2 (p = 0.03). GWI was 1890.1 [95% CI 1730.0; 2050.2] mm Hg% in group 1, in group 2 - 2039.8 [95% CI 1956.3; 2123.3] mmHg% (p = 0.002), GCW - 2132.4 [95% CI 1958.5; 2306.3] mmHg% and 2335.5 [95% CI 2251.7; 2419.4] mm Hg% (p = 0.003), respectively. GWE 95.4 [95% CI 94.1; 96.6] and 97.1 [95% CI 96.8; 97.4]% (p = 0.02), GWW 76.6 [95% CI 55.9; 97.3] and 50.0 [95% CI 44.0; 56.0] m Hg% (p = 0.06) in the corresponding groups. Conclusion Thus, despite the satisfactory values of LVEF, the indicators of myocardial work, except for global wasted work, had lower values in patients with STEMI compared with healthy individuals.

Assessment of the global work of the myocardium in myocardial infarction with ST segment elevation of various localization

Abstract Funding Acknowledgements Type of funding sources: None. Purpose To assess the degree of impairment of the global myocardial function of the left ventricle in different localization of myocardial infarction with ST segment elevation (STEMI) using speckle tracking echocardiography. Methods The study included 45 patients with primary STEMI aged 38 to 66 years (52.3 ± 7.4). Myocardial infarction was confirmed by ECG data, biomarkers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography has been performed 7-9 days after STEMI on a Vivid GE 95 Healthcare ultrasound scanner (USA) using EchoPAC software version 202 (GE Healthcare). In the automatic mode, the indicators of myocardial work have been calculated: the index of global myocardial work (GWI, mm Hg%.), Global constructive work (GCW, mm Hg.%.), Global wasted work (GWW, mm Hg.%.) %.), global work efficiency (GWE,%). Statistical data processing has been performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results Taking into account the localization of STEMI on the 7th-9th day, patients were divided into two groups: group 1, which included 29 patients (64.4%) with lesions of the anterior LV wall (LAD), group 2 - 16 patients (35, 6%) with LV posterior wall infarction (RCA and CA). The comparison of the indices of global myocardial work in the two groups, has found that the GWI in group 1 was 1219 [95% CI 1053.1; 1384.9] mm Hg%, in group 2 - 1550.8 [95% CI 1371.6; 1730] mm Hg%, (p = 0.02). The GWE parameter in group 1 was 88.2 [95% CI 85.5; 90.9]%, in group 2 - 94.3 [95% CI 92; 96.6]%, (p = 0.01). The GСW index had the following values: in group 1 - 1383 [95% CI 1205.1; 1560.9] mm Hg%, in group 2 - 1805.5 [95% CI 1576.2; 2034.8] mm Hg%, (p = 0.01). GWW in group 1 was 152.8 [95% CI 94.3; 211.3] mm Hg%, in group 1b - 73.3 [95% CI 47.6; 99.0] mm Hg%, (p = 0.02). Conclusion Thus, the localization of STEMI is reflected in the indicators of myocardial function. LV anterior wall infarction has lower GWI, GWE, and GCW values and higher GWW values than posterior wall infarction.

Prevalence and characteristics of non-ST-segment elevation in acute myocardial infarction with insignificant coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): King Chulalongkorn Memorial Hospital Background Acute myocardial infarction is mostly associated with obstructive coronary artery disease. 8% to 12% of patients have insignificant coronary artery disease. Prognosis for patients with insignificant coronary artery disease is better than patients with obstructive coronary artery disease who presented with non-ST elevation myocardial infarction (NSTEMI). Prevalence of patients with non-ST elevation myocardial infarction (NSTEMI) related insignificant coronary artery disease in Thailand remains unknown. Method A retrospective cohort analysis was performed in all patient who admitted for NSTEMI and underwent coronary angiography presenting to our hospital in admission (January 2018 to October 2020). The primary end point was to study the prevalence of insignificant coronary artery disease in NSTEMI patients, the secondary end point was to find associated factors of the insignificant coronary artery disease and create new scoring system for predicting insignificant coronary artery disease. Result A total 522 subjects were enrolled. 74 patients (14.2%) had insignificant coronary artery disease. The median age was 68.37 years (female 37.4%), smoking 14%, diabetes 46.7%, hypertension 85.1%, dyslipidemia 78%, history of stroke 8.4% and ESRD 7.3%. There are many predictors of insignificant coronary artery disease in NSTEMI patients: Absence of regional wall motion abnormalities from echocardiogram had the strongest association with insignificant coronary artery disease (OR = 5.057, 95% CI, 2.54-10.06 ; p-value &amp;lt; 0.001). Other variables were; no ST segment deviation in the ECG (OR = 4.29, 95% CI, 2.16-8.52 ; p-value &amp;lt; 0.001), female sex (OR = 3.43, 95% CI, 1.77-6.66 ; p-value &amp;lt; 0.001) and the absence of dyslipidemia (OR = 2.48, 95% CI, 1.23-4.97 ; p-value = 0.01). By using multivariate analysis, a scoring system was made to predict insignificant coronary artery disease, which consist of 2 points for female, 2 points for not having history of dyslipidemia, 3 points for no ST segment deviation form the ECG and 3 points for no regional wall motion abnormalities from the echocardiogram. As shown in the ROC curve, the AUC = 0.804 and 5 is the cut point score with 72.1% sensitivity, 72.3% specificity and 72.3% accuracy. Conclusion Prevalence of non-ST-segment elevation acute myocardial infarction with insignificant coronary artery disease is 14.2%. Absence of regional wall motion abnormalities from echocardiogram, no ST segment deviation in the ECG, female sex and absence of dyslipidemia were all statistically associated with insignificant coronary artery disease. With the predicting score ≥5, the patient may be considered not to proceed the coronary angiogram.

Diagnosis of coronary artery rethrombosis after effective systemic thrombolytic therapy in patients with ST-segment elevation myocardial infarction

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with...

Pathophysiology, Diagnosis, and Management of Coronary No-Reflow Phenomenon.

Coronary no-reflow phenomenon is a lethal mechanism of ongoing myocardial injury following successful revascularization of an infarct-related coronary artery. Incidence of this phenomenon is high following percutaneous intervention and is associated with adverse in-hospital and long-term outcomes. Several mechanisms such as ischemia-reperfusion injury and distal microthromboembolism in genetically susceptible patients and those with preexisting endothelial dysfunction have been implicated. However, the exact mechanism in humans is still poorly understood. Several investigative and treatment strategies within and outside the cardiac catheterization laboratory have been proposed, but they have not uniformly shown success in reducing mortality or in preventing adverse left ventricular remodeling resulting from this condition. The aim of this article is to provide a brief and concise review of the current understanding of the pathophysiology, clinical predictors, and investigations and management of coronary no-reflow phenomenon.

OR3. Admission blood glucose and ischemic time are associated with successful fibrinolysis in combined assessment of ST-segment resolution, myocardial infarction flow grade, and myocardial perfusion grade

Abstract Background and Aims Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanisms of hemodynamic, clinical, biochemical, and mechanical parameters. This study aimed to find out predictors of complete reperfusion after FT based on Thrombolysis in Myocardial Infarction (TIMI) 3 flow, Myocardial Blush Grade (MBG) 3, and ST-segment resolution. Method and Results This retrospective study was held in Saiful Anwar, Malang Hospital during 2017-2021, including total of 142 patients. All patients received FT and coronary angiographic evaluation post-FT. Those were divided into 3 groups, which included R0,1 (0/1 highest measure of reperfusion), R2 (2 highest measures of reperfusion), and R3 (3 highest measures of reperfusion). Admission blood glucose (ABG) (OR 0.99 [95%CI -0.16;-0.001]; p = 0.025), ischemic time (OR 0.82 [95%CI -0.491;-0.137]; p = 0.001), and triglycerides (OR 0.98 [95%CI 0.23;-0.006]; p = 0.001) were negatively correlated to the complete restoration of reperfusion (R3). ABG&amp;lt;140 mg/dL (AUC 0.701 [95%CI 0.612-0.790]; p = 0.000) and ischemic time&amp;lt;5 hours (AUC 0.742 [95%CI 0.645-0.839]; p = 0.000) were significant predictors for R ≥ 2. Coronary characteristics were not related to measure of reperfusion (p = 0.25). Conclusion ABG&amp;lt;140 mg/dL and ischemic time&amp;lt;5 hours are important predictors of successful reperfusion post FT (R ≥ 2), along with triglycerides. Early assessment of patients who are likely to have low parameter reperfusion (R &amp;lt; 2) would help promptly preparing for primary PCI.

Abstract 13267: The Shifted Balance of Arginine Metabolites in Patients With Acute Myocardial Infarction and Its Association With the Composition of the Infarct-Related Culprit Lesion

Introduction: We hypothesize that acute phase of myocardial infarction (MI) is associated with suppression of nitric oxide synthase (NOS) and enhanced arginase activity. Moreover, this altered metabolic balance might correlate with the composition of vulnerable culprit lesion in the infarct-related coronary artery (IRA). Methods: Arginine metabolites (μM) including ornithine, citrulline, proline, spermine, spermidine, agmatine, homoarginine, creatine, asymmetric dimethylarginine (ADMA) and monomethyl-L-arginine acetate were measured using liquid chromatography and tandem mass spectrometry in 85 consecutive MI patients upon admission and at 6-month follow-up and were compared with the composition of the IRA culprit lesion assessed with optical coherence tomography (OCT). Results: The concentration of ornithine in acute phase of MI was higher by 44% and homoarginine by 62% whereas level of arginine was lower by 39% and citrulline by 64% (P&lt;0.001 for all), when compared to 6-month stable conditions. Following ischemia, the ratios of citrulline/arginine (0.10 [0.08; 0.14] vs 0.22 [0.18; 0.28]) and citrulline/ornithine (0.09 [0.07; 0.12] vs 0.47 [0.36; 0.55]) were decreased while the indices of ornithine/arginine (1.48 [1.08, 2.39] vs 0.50 [0.41, 0.60]) and homoarginine/arginine (0.17 [0.12; 0.22] vs 0.04 [0.03; 0.05]) were higher as compared with 6-month results (P&lt;0.001 for all). Both, concentrations of arginine metabolites and their ratios were not associated with the mechanism of IRA occlusion, the amount of calcium or lipids and the presence of intramural hematoma. However, in patients with (n=67) versus without (n=18) thin-cap fibroatheroma (TCFA) in OCT the higher median concentrations of ornithine (10.24 [7.86; 12.52] vs 7.82 [4.38; 9.57]), ADMA (0.40 [0.29; 0.49] vs 0.29 [0.23; 0.42]), homoarginine (1.02 [0.81; 1.27] vs 0.74 [0.62; 1.00]) and a higher ornithine/arginine ratio (1.73 [1.29; 2.54] vs 1.18 [1.01; 2.07]) with a lower citrulline/ornithine ratio (0.07 [0.09; 0.11] vs 0.13 [0.09; 0.15]) were found (P&lt;0.05 for all). Conclusions: During acute phase of MI the altered balance of arginine metabolites indicates NOS suppression and enhanced arginase activation and is associated with the presence of TCFA in IRA culprit lesion.