Late Percutaneous Coronary Intervention Research Articles

A-59 | Comparison of early vs late percutaneous coronary intervention in cirrhosis patients admitted with NSTEMI

A-59 | Comparison of early vs late percutaneous coronary intervention in cirrhosis patients admitted with NSTEMI

Abstract 15135: Timing of Percutaneous Coronary Intervention and Risk of New-Onset Acute Ischemic Stroke in Non-ST Elevation Myocardial Infarction: An Insight of National Inpatient Sample 2016-2019

Introduction: Current guidelines recommend an early invasive strategy within 24 hours only in high-risk non-ST elevation myocardial infarction (NSTEMI). New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of the PCI and the risk of NAIS in NSTEMI is not well defined. Hypothesis: Late PCI is associated with NAIS risk in NSTEMI. Methods: NSTEMI patients who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late PCI (>72 h). Multivariable logistic regression models were used to determine the timing of PCI and NAIS, adjusted for demographics, comorbidities, and hospital characteristics. Results: Among 633,115 weighted hospitalizations in 2016-2019, late PCI patients had a higher incidence of NAIS (1.3%) compared to early (0.67%) and medium PCI (0.71%). Late PCI patients were older, more likely to be female, and had a higher prevalence of comorbidities (diabetes mellitus, congestive heart failure, chronic pulmonary and renal disease, and atrial fibrillation) than early and medium PCI. After adjustment, only late PCI was significantly associated with a 55% increased NAIS risk (adjusted OR: 1.55 [95% CI: 1.30-1.84]). There was heterogeneity in the magnitude of risk by age and gender. Younger people (<65 years) ( p for interaction <0.0001) and males (interaction -value p =0.0433) were more likely to encounter NAIS. The incidence of NAIS increased from 2016 to 2019 in both medium and late PCI. Conclusions: Late PCI over 72 hours was associated with a higher risk of NAIS than PCI performed within 24 hours, particularly among young and male people.

Effect of Colchicine in reducing MMP-9, NOX2, and TGF- β1 after myocardial infarction

BackgroundAccording to WHO 2020, CAD is the second leading cause of death in Indonesia with death cases reaching 259,297 or 15.33% of total deaths. Unfortunately, most of the patients of CAD in Indonesia did not match the golden period or decline to be treated with Percutaneous Coronary Intervention (PCI). Based on the recent study, there were increases in MMP-9, NOX2, and TGF-β1 in STEMI patients which contribute to cardiac remodeling. Moreover, there is controversy regarding the benefit of late PCI (12-48 hours after onset of STEMI) in stable patients. Lately, colchicine is widely used in cardiovascular disease. This study was conducted to explore the effect of colchicine to reduce MMP- 9, NOX2, and TGF-β1 levels after myocardial infarction in stable patients.MethodIn this clinical trial study, we assessed 129 STEMI patients, about 102 patients who met inclusion criteria were randomized into four groups. Around 25 patients received late PCI (12–48 h after the onset of chest pain), optimal medical treatment (OMT) for STEMI, and colchicine; 24 patients received late PCI and OMT; 22 patients didn’t get the revascularization (No Revas), OMT, and colchicine; and 31 patients received No Revas and OMT only. The laboratory test for MMP-9, NOX2, and TGF-β1 were tested in Day-1 and Day-5. The data were analyzed using Mann-Whitney.ResultsA total of 102 patients with mean age of 56 ± 9.9, were assigned into four groups. The data analysis showed significant results within No Revas + OMT + Colchicine group versus No Revas + OMT + Placebo in MMP-9 (Day-1: p = 0.001; Day-5: p = 0.022), NOX2 (Day-1: p = 0.02; Day-5: p = 0.026), and TGF-β1 (Day-1: p = 0.00; Day-5: p = 0.00) with the less three markers in OMT + Colchicine group than OMT + Placebo group. There were no significant differences within the late PCI + OMT + colchicine group and PCI + OMT + Placebo group.ConclusionsColchicine could significantly reduce MMP-9, NOX2, and TGF-β1 levels in stable STEMI patients. So that, colchicine could be a potential agent in STEMI patients and prevent cardiac remodeling events.

Late Percutaneous Coronary Intervention is Associated with Better Prognosis of Patients with Acute Myocardial Infarction.

BackgroundThe optimal timing of invasive coronary revascularization in patients with late presentation of acute myocardial infarction (AMI) remains unclear.ObjectiveThis study aimed to investigate whether late percutaneous coronary intervention (PCI) is associated with the prognosis of AMI patients with HFpEF presenting >24h after symptom onset.MethodsWe enrolled 680 AMI patients with HFpEF. Patients were divided into 3 groups: early-PCI strategy (defined as the time to open IRA from symptom onset <24 h), late-PCI strategy (defined as the time of PCI-mediated reperfusion was >24 h) and non-revascularization group.ResultsA total of 144 (21.2%) experienced a MACE, including 118 (17.4%) all-cause deaths and 26 (3.8%) re-hospitalization for HF during a follow-up period of 30.20±15.62 months. After adjusting for gender, age, smoking, diabetes mellitus, NT-proBNP and eGFR, late-PCI was a significant and independent predictor of MACE (hazard ratio 0.367; 95% confidence interval 0.202–0.665; p<0.001). Kaplan–Meier analysis showed that late-PCI decreased cumulative risk of MACE (p< 0.001).ConclusionLate-PCI and early-PCI strategies are associated with a reduced risk of MACE in AMI patients with HFpEF presenting >24 h after symptom onset, compared to conservative strategies.

Long-term outcomes of delayed percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A propensity score-matched retrospective study.

The best time window of percutaneous coronary intervention (PCI) is within 12 hours for ST-segment elevation myocardial infarction (STEMI). However, there is limited evidence about the proper time of PCI for delayed STEMI patients.From June 2014 to June 2015, a total of 268 patients receiving PCI with second-generation drug-eluting stent in a Chinese hospital after 3 days of STEMI onset were enrolled in this retrospective study, who were divided into the early group (3–14 days) and the late group (>14 days). A propensity score match was conducted to reduce the baseline difference. The primary endpoint of all-cause death and secondary endpoints of major adverse cardiac and cerebrovascular event (myocardial infarction [MI], stroke, emergent revascularization, and rehospitalization due to heart failure) were compared using survival analysis.At last, 182 cases were matched after propensity score match, with no statistical difference in baseline characteristics and PCI data. Kaplan-Meier survival curve demonstrated no difference in all-cause death of the 2 groups (P = .512). However, the early group presented a higher incidence of MI than the late group (P = .036). The multivariate Cox regression analysis also demonstrated that the early PCI was an independent risk factor for MI compared with late PCI (hazard ratio = 3.83, 95%CI [1.91–8.82], P = .001). There was no statistical difference in other major adverse cardiac and cerebrovascular event, including stroke, emergent revascularization, and rehospitalization due to heart failure.Using the 2nd drug-eluting stent, early PCI (3–14 days) and late PCI (>14 days) have comparable efficacy and outcomes. However, patients receiving early PCI are subjected to a relatively higher risk of recurrent MI.

Prognostic value of computed tomography derived fractional flow reserve

Abstract Introduction Cardiac computed tomography angiography (CCTA) derived fractional flow reserve (FFRCT) has been shown to add incremental diagnostic value by providing functional severity of coronary lesion in patients with coronary artery disease (CAD). Purpose We aimed to assess the prognostic value of FFRCT in patients with suspected CAD. Methods Consecutive patients who had clinically indicated CCTA and FFRCT determination at a tertiary care cardiology practice were included. FFRCT was determined off-site using computational flow dynamics. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and late percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) 90-days after imaging test.) Results A total of 667 patients with at least Coronary Artery Disease Reporting &amp; Data System (CAD-RADS) 2 were included. Mean age was 68±10 years, 37% were women, 73% had hypertension, 12% had diabetes and 61% had dyslipidemia. More than half (57%) of the patients had moderate (CAD-RADS 3) stenosis. FFRCT&amp;lt;0.8 was found in 59% of patients, with increasing percent across categories of CAD-RADS. After a median follow-up of 9 months, 52 patients (7.2%, 6.7 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models adjusted for age and sex, FFRCT &amp;lt;0.8 significantly predicted outcomes (HR 2.48 95% CI 1.26–4.87 p=0.008). Sensitivity analysis using lower thresholds of FFRCT failed to show similar results in intermediate stenosis. Conclusion Our results suggest that in a real-world cohort of patients with suspected CAD, FFRCT can identify patients at higher risk of incident cardiovascular outcomes. Funding Acknowledgement Type of funding sources: None.

Late primary angioplasty (beyond 12 h): are we sure it should be avoided?

Optimal management for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a hospital late remains uncertain since evidence and real-world data are limited. Patients who present late with a STEMI are a heterogeneous population, and the clinical decision regarding percutaneous coronary intervention (PCI) should not be the same for all. One randomized clinical trial, multiple mechanistic studies, and contemporary registries suggest a presumed benefit for a prompt restoration of coronary flow even in late presenting STEMI. Crucial elements in decision-making are the presence of haemodynamic or electrical instability, and ongoing ischaemic signs or symptoms to tip the scales toward PCI. Among clinically stable, late-presenting patients, myocardial viability assessment and functional testing can identify yet another subgroup that may benefit from late PCI

Invasive reperfusion after 12 hours of the symptom onset remains beneficial in patients with ST-segment elevation myocardial infarction: Evidence from a meta-analysis of published data.

Early myocardial reperfusion therapy (< 12 h) in patients with acute myocardial infarc-tion (AMI) can significantly improve their prognosis. However, the effect of late reperfusion (> 12 h) remains controversial. In this study, the effects of late reperfusion versus standard drug therapy on the outcomes of patients with AMI were evaluated by systematic review and meta-analysis. PubMed, Embase, Medline, Cochrane, Wanfang, and CNKI databases were searched for eligible studies for the present study. Meta-analysis was performed using RevMan 5.3.3 software. Rela-tive risk (RR) and the 95% confidence interval (CI) were used to compare the outcomes between the two groups. The main outcome measures were major adverse cardiac events (MACEs), all-cause mortality, recurrent myocardial infarction (MI), and heart failure. Eighteen studies were identified including 14,677 patients, of whom 5157 received late reperfusion with percutaneous coronary intervention (PCI) and 9520 received medication therapy (MT). Compared to MT, late PCI was associated with decreased all-cause mortality (RR 0.60, 95% CI 0.44-0.83; p = 0.002), MACEs (RR 0.67; 95% CI 0.50-0.89; p < 0.001), and heart failure (RR 0.76; 95% CI 0.60-0.97; p = 0.03), while there was also a trend toward decreased recurrent MI (RR 0.70; 95% CI 0.47-1.05; p = 0.08). However, subgroup analysis according to time to PCI showed that the clinical benefit was only from PCI after 12 h but not from 2 to 60 days of the onset of symptoms. The present meta-analysis suggested that PCI performed > 12 h but not 2-60 days after AMI is associated with significant improvement in clinical outcomes. However, these results need further rigorously designed large sample size clinical trials to be validated.

Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction

Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood.&#x0D; Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction.&#x0D; Methods: A total of 60 patients, &gt; 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period.&#x0D; Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) &amp; 44.1±17.6 ml after 3 months (p value &lt;0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) &amp; 47.6±5.9% after 3 months (p value &lt;0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months.&#x0D; Conclusion: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 90-93

Improvements in Regional Left Ventricular Function Following Late Percutaneous Coronary Intervention for Anterior Myocardial Infarction.

Background:Late revascularization following a myocardial infarction has questionable clinical benefit.Methods:We studied 13 patients with anterior wall myocardial infarction who underwent percutaneous coronary intervention within 2 weeks of the primary event, by quantitative analysis of 2-dimensional echocardiographic images. Endocardial segmentations of the left ventricular (LV) endocardium from the 4-chamber views were studied over time to establish cumulative wall displacements (CWDs) throughout the cardiac cycle.Results:Left ventricular end-systolic volume decreased to 42 ± 8 mL/body surface area (P = .034) and LV ejection fraction improved to 52% ± 7% (P = .04). Analysis of LV endocardial CWD demonstrated significant improvements in mid-systolic to late-systolic phases in the apical LV segments, from 3.5 ± 0.32 to 5.89 ± 0.43 mm (P = .019). Improvements in CWD were also observed in the late-diastolic phase of the cardiac cycle, from 1.50 ± 0.42 to 1.76 ± 0.52 mm (P = .04).Conclusions:In our pilot patient cohort, following late establishment of infarct-related artery patency following an anterior wall myocardial infarction, regional improvements were noted in the LV apical segments during systole and late diastole.

GW27-e0495 Effect of late percutaneous coronary intervention in patients with acute myocardial infarction on ventricular remodeling

GW27-e0495 Effect of late percutaneous coronary intervention in patients with acute myocardial infarction on ventricular remodeling

The Relation between the Timing of Percutaneous Coronary Intervention and Outcomes in Patients with Acute Coronary Syndrome with Routine Invasive Strategy - Data from Taiwan Acute Coronary Syndrome Full Spectrum Data Registry.

Several large trials have indicated that a routine invasive strategy was favored for high-risk patients with non-ST-elevation acute coronary syndromes. However, the optimal timing for this intervention is unclear. We included patients with unstable angina or non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) from the Taiwan acute coronary syndrome registry. Thrombolysis in Myocardial Infarction (TIMI) score was used to stratify our patients into three groups: low (TIMI 0-2), intermediate (TIMI 3-4) and high risk (TIMI 5-7).We analyzed outcomes according to the timing of PCI. Overall, 984 patients were included in this study. For primary outcomes including cardiac death and recurrent myocardial infarction, early PCI within 24 hours did not show benefits over late PCI (24-72 or > 72 hours) (p > 0.05) in the low and intermediate risk groups. However, in the high risk group, patients who underwent PCI after 72 hours had significantly worse primary outcomes than those who underwent PCI within 24-72 hours. For secondary outcomes including non-cardiac death, unplanned revascularization, and major bleeding, the events rate was significantly higher for early or delayed PCI in low-risk patients when compared with patients who underwent PCI within 24-72 hours. In our study, for high-risk NSTE-ACS patients, PCI within 24-72 hours from symptom onset is demonstrably the optimum time for PCI. Delayed PCI over 72 hours is associated with the worst outcomes and should be avoided. For patients with low risks, routine early PCI < 24 hours after PCI is not beneficial. Acute coronary syndrome; Early invasive strategy.

Clinical impacts of inhibition of renin–angiotensin system in patients with acute ST-segment elevation myocardial infarction who underwent successful late percutaneous coronary intervention

BackgroundSuccessful percutaneous coronary intervention (PCI) of the occluded infarct-related artery (IRA) in latecomers may improve long-term survival mainly by reducing left ventricular remodeling. It is not clear whether inhibition of renin–angiotensin system (RAS) brings additional better clinical outcomes in this specific population subset. MethodsBetween January 2008 and June 2013, 669 latecomer patients with acute ST-segment elevation myocardial infarction (STEMI) (66.2±12.1 years, 71.0% males) in Korea Acute Myocardial Infarction Registry (KAMIR) who underwent a successful PCI were enrolled. The study population underwent a successful PCI for a totally occluded IRA. They were divided into two groups according to whether they were prescribed RAS inhibitors at the time of discharge: group I (RAS inhibition, n=556), and group II (no RAS inhibition, n=113). ResultsDuring the one-year follow-up, major adverse cardiac events (MACE), which consist of cardiac death and myocardial infarction, occurred in 71 patients (10.6%). There were significantly reduced incidences of MACE in the group I (hazard ratio=0.34, 95% confidence interval 0.199–0.588, p=0.001). In subgroup analyses, RAS inhibition was beneficial in patients with male gender, history of hypertension or diabetes mellitus, and even in patients with left ventricular ejection fraction (LVEF) ≥40%. In the baseline and follow-up echocardiographic data, benefit in changes of LVEF and left ventricular end-systolic volume was noted in group I. ConclusionsIn latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF.

Association between time to percutaneous coronary intervention and hospital mortality in non–STEMI: a prospective multicenter observational study

ObjectivesThis study aimed to investigate the association between time to percutaneous coronary intervention (PCI) and hospital mortality in non–ST-elevation myocardial infarction (NSTEMI). MethodsAdult patients with NSTEMI were enrolled from November 2007 to December 2012 at 28 emergency departments (EDs) in Korea, excluding those who met the following criteria: age less than 20 years, PCI not performed or performed after 72 hours, cardiac arrest at ED presentation, and unknown outcome. Exposure variable was defined as early PCI (<6 hours after ED arrival) and late PCI group (≥6 hours). The primary outcome was hospital mortality. The adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for late vs early PCI on mortality were calculated in original data set and propensity score–matched data set using multivariable logistic regression models with/without interaction term (PCI group and time from symptom to ED arrival within 12 hours, or S2D). ResultsA total of 4363 patients were analyzed as early (n = 1109) and late (n = 3254) PCI groups. The mortality rates were 2.4%, 5.4%, and 1.5% for the total, early, and late PCI groups, respectively. Adjusted ORs (95% CIs) of late PCI for hospital mortality were 0.36 (0.22-0.61) in the original cohort and 0.29 (0.27-0.48) in the propensity score–matched cohort, respectively. Adjusted ORs (95% CIs) in the propensity score–matched subset were 0.28 (0.17–0.45) in the short S2D group and 0.50 (0.18-1.37) in the long S2D group, respectively. ConclusionsPercutaneous coronary intervention earlier than 6 hours after ED presentation was associated with higher hospital mortality than PCI 6 hours later in NSTEMI. However, the effect disappeared in the long S2D group.

Prognostic Value of Speckle Tracking Echocardiography in Patients with ST-Elevation Myocardial Infarction Treated with Late Percutaneous Intervention.

Left ventricular remodeling (LVr) is common after ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the prognostic value of speckle tracking echocardiography (STE) for predicting LVr 6-9 months after late percutaneous coronary intervention (PCI) in patients with STEMI. Patients with first STEMI who accepted late PCI were enrolled. Echocardiography was performed within 48 hours of admission. Six to nine months after MI, an echocardiography examination was repeated. LVr was defined as >15% increase in LV end-systolic volume (LVESV) after 6 months. One hundred and twenty-seven patients were divided into two groups: 86 patients without LVr and 41 patients with LVr. There were significant differences in the global longitudinal strain (GLS), SD of time to peak longitudinal systolic strain (longitudinal Ts-SD), longitudinal postsystolic index, radial strain (RS), and SD of time to peak radial systolic strain (Radial Ts-SD). In multivariate logistic regression analysis, the GLS(odds ratio [OR] = 0.39, 95% confidence interval [CI] = 0.26-0.57, P < 0.01), and RS(OR = 1.07, 95% CI = 1.02-1.13, P = 0.01) were determinants of LVr. A receiver operating characteristic curve showed that the GLS predicted LVr with an optimal cutoff value of -10.85 (sensitivity: 89.7%, specificity: 91.7%). During clinical follow-up for 16.9 ± 1.6 months, death or congestive heart failure developed in 12 patients (9.4%), and the baseline ejection fraction (OR = 1.91, 95% CI = 1.18-3.1, P = 0.009) and GLS (OR = 0.56, 95% CI = 0.34-0.91, P = 0.02) were independent predictors. In patients with STEMI treated with late percutaneous coronary intervention, the GLS as measured by STE is a strong predictor of LVr and adverse events.

ST-Segment Elevation Myocardial Infarction

Patients with acute coronary syndrome fall into two groups: those with unstable angina or non—ST segment elevation (formerly non—Q wave) myocardial infarction (NSTEMI) and those with acute ST segment elevation (formerly Q wave) myocardial infarction (STEMI). STEMI is the focus of this chapter. The epidemiology, pathophysiology, diagnosis, differential diagnosis, and complications of STEMI are elaborated. Reperfusion therapy (including time to reperfusion; diagnostic coronary angiography; primary, facilitated, rescue, and late percutaneous coronary intervention [PCI]; thrombolytic therapy and choice of thrombolytic agent; early invasive strategy; coronary artery bypass grafting; and therapeutic hypothermia), medical therapy (including aspirin, P2Y12 inhibitors, glycoprotein IIb/IIIa inhibitors, anticoagulants, nitrates, beta blockers, inhibition of the renin-angiotensin-aldosterone system, oxygen, analgesia, lipid-lowering therapy, prophylactic antiarrhythmics, and magnesium), risk stratification, secondary prevention, and post-STEMI care are also covered. Tables delineate classifications of MI as defined by proximal cause of myocardial ischemia, Killip classification of acute MI and mortality rates, differential diagnosis of ST segment elevation, contraindications for administering thrombolytic agents, and major recommendations for antithrombotic therapy in patients with STEMI treated with primary PCI and thrombolysis. Algorithms indicate a diagnostic approach to acute coronary syndromes and corresponding pathology and reperfusion strategies. Electrocardiogram changes in STEMI and corresponding territory of myocardium are depicted. A variety of graphs are included. This review contains 11 highly rendered figures, 6 tables, and 151 references.

Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: A pooled analysis of cardiovascular magnetic resonance studies

The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR). The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6-12 months. Late PCI with OMT led to improved LVEF (+5 ± 7% vs. -1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (-11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (-7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion. In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Impact of Acute Renal Failure on In-Hospital Outcomes Following Percutaneous Treatment of Acute Myocardial Infarction

ABSTRACT Background Acute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI). Methods Single-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated. Results Mean age was 60.7 ± 12.6 years and 67% were male. The populaton had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P 76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion. Conclusions Acute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.

A guideline based approach of percutaneous coronary intervention in acute myocardial infarction: Single center experience

To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) according to PCI guidelines. This study was conducted between January 2008 and December 2010. A total of 450 patients presenting with STEMI underwent PCI: 288 patients underwent primary PCI, and 162 patients underwent non-primary PCI. The mean age at presentation was 55 ± 11.10 years and 89.8% were male. The door-to-balloon time was 60 min in primary PCI group (288 patients). The median time between end of failed thrombolytic therapy and the rescue PCI was 420 min (95 patients) versus 810 min after successful thrombolytic therapy (35 patients). Only 32 patients underwent late PCI ⩾ 24 h and ⩽48 h without thrombolytic therapy; median time was 2160 min. In-hospital, 30 days and 6-months mortality were respectively 2.1%, 0.7% and 1.1% in primary PCI group while 2.5%, 3.2% and 2.6% in non-primary PCI group. In-hospital, 30 days and 6-months reinfarction occurred in 0.3%, 1.1% and 0.7% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. In-hospital, 30 days and 6-months TVR occurred in 0.7%, 0.7% and 1.1% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. This is the first report from Egyptian hospital to provide a comprehensive review of patient characteristics and outcomes of PCI for STEMI. We reported a high initial success rate, excellent short and intermediate-term outcomes.