non-Q Wave Myocardial Infarction Research Articles

Distant myocardial infarction: a case report

Currently, more and more cases of distant myocardial infarction are being registered. This pathological condition occurs due to an acute decrease in myocardial blood supply, which was provided by a donor artery, which blood supply system is anatomically not directly connected to the affected area. Cases of distant myocardial infarction are sporadic. Therefore, there are difficulties in choosing the right management strategy. During percutaneous coronary intervention, it is possible to perform recanalization of an artery with chronic occlusion, which anatomically supplies blood to the affected wall, and/or donor artery stenting, which supplies the infarction zone due to collaterals. The article presents a case of non-Q wave myocardial infarction of left ventricular anterior wall, which developed in a patient with 90% stenosis in the proximal left anterior descending (LAD) artery, chronic occlusion of the middle LAD segment, and 80% stenosis in the proximal right coronary artery. Direct stenting of the right coronary artery led to a significant increase in the contrast intensity in intersystem collaterals from the posterior interventricular artery to LAD artery. This was accompanied by an improvement in the clinical symptoms and a complete absence of angina throughout the patient’s hospital stay.

Wellens’ syndrome in clinical practice

Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.

Five-year clinical outcomes of a 2.25 mm sirolimus-eluting stent in Japanese patients with very small coronary artery disease: final results of the CENTURY JSV study

The aim of this study is to evaluate the long-term safety and efficacy of the 2.25 mm bioresorbable-polymer sirolimus-eluting Ultimaster stent in a Japanese patient population. Treatment of coronary artery disease in very small vessels is associated with an increased risk for cardiac events. The CENTURY JSV study is a prospective, multicenter, single-arm study. Seventy patients with stable and unstable coronary artery disease with a coronary lesion eligible for implantation with a 2.25 mm stent were enrolled in this study. Patients underwent clinical follow-up through 5-year after the PCI procedure. The mean age was 70.4 ± 9.2 years. The prevalence of diabetes mellitus was 37.1%, all not insulin dependent. The incidence of major adverse cardiac events, defined as cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization (CD-TLR) at 5 years was 5.7%. A non-Q wave MI was noted in 1.4% and 4.3% underwent a CD-TLR. There was no stent thrombosis during the entire follow-up period. No cardiac events were reported between 2 and 5 years. This is the first study to demonstrate safety and effectiveness for 5 years after treatment of very small coronary disease with 2.25 mm-diameter DES.Clinical trial registration: UMIN000012928

Regression of Q Waves and Clinical Outcomes After Primary Percutaneous Coronary Intervention in St Elevation Myocardial Infarction

Introduction: Pathological Q waves are correlated with infarct size, and Q wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association between Q wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after ST-elevation myocardial infarction (STEMI). Patients and Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 1553 patients, who presented to our hospital with chest pain and underwent primary percutaneous coronary intervention (p-PCI) with the diagnosis of STEMI and were retrospectively analyzed. ECGs were recorded before and 90 min after PCI, as well as at hospitalization discharge and 12 months of follow-up. The study population was divided into three groups as the Q wave regression group, the Q wave persistent group, and the non-Q wave MI group. Results: There were 502 (32%) patients with persistent Q waves (PQ group), 509 (33%) patients with Q wave regression (RQ group), and 542 (35%) patients with non-Q wave MI (NQ group). The degree of LVEF was significantly greater in the RQ group and NQ group than in the PQ group [(47.5 ± 10.1 vs. 49.2 ± 9.9) vs. 43.3 ± 10.5 respectively, p<0.01]. One-year mortality was significantly greater in the PQ group compared to the RQ and NQ groups [19 (3.78%) vs. 11 (2.16%) vs. 6 (1.1%) respectively, p<0.01]. Conclusion: In a population of STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion were associated with high one-year mortality, and low LVEF, while Q wave regression was associated with significantly lower risk of events.

Инфаркт миокарда у молодых людей

В статье рассмотрена распространенность случаев острого инфаркта миокарда в мире и в Украине в частности. Подобные случаи, как правило, касаются пациентов взрослого возраста. Однако все чаще сообщается о таковом заболевании у лиц моложе 35 лет и даже у детей. В статье описан клинический случай возникновения острого не-Q-инфаркта миокарда у подростка. Трудная диагностика была обусловлена запоздалым обращением пациента и его матери за медицинской помощью и маскированием клинической картины заболевания токсическими факторами. Учитывая потенциальную возможность развития негативных последствий для пациентов, необходимо сохранять клиническую настороженность прежде всего работникам первого контакта — специалистам медицины неотложных состояний.

Rotational Atherectomy for the Management of Undilatable In-Stent Restenosis with Single or Multiple Stent Layers

BackgroundThere is no consensus on the best treatment of undilatable coronary in-stent restenosis (ISR) regardless of the number of stent layers. We aimed to evaluate the procedural and clinical outcomes of rotational atherectomy (RA) to treat undilatable coronary ISR with single or multiple stent layers. MethodsWe retrospectively evaluated consecutive patients treated with RA for undilatable ISR with single or multiple stent layers in the Mount Sinai catheterization laboratory between January 2016 and September 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE): a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Clinical outcomes were assessed at one-year post-procedure. ResultsA total of 26 patients were included in the study, in which 18 (69.2%) patients were with multiple stent layers. After RA, 9 (34.6%) were received a new drug-eluting stent, and 6 (23.1%) were treated with intravascular brachytherapy. Angiographic success was achieved in 24 (92.3%) patients, and procedural success was achieved in 22 (84.6%) patients. In-hospital MACE occurred in 4 (15.4%) patients, all due to periprocedural non-Q wave MI. Within one year, MACE occurred in 9 (34.6%) patients with 5 (19.2%) TLR. ConclusionsRA for undilatable ISR with single or multiple stent layers was performed with favorable procedural outcomes and a relatively high MACE rate driven by TLR within one year.

Factors affecting exercise tolerance in cardiac patients at the third phase of rehabilitation

Background. Cardiovascular diseases and their complications are the top cause of death and disability; the newly developed rehabilitation methods for these conditions have to be evaluated in terms of tolerability.
 Objective. To examine the factors affecting better exercise tolerance in cardiac patients at the third phase of rehabilitation.
 Methods. The study performed at IvGMA clinic involved 34 patients undergoing the 3rd phase of rehabilitation with a diagnosis of coronary heart disease: 5 (14%) with acute Q myocardial infarction with ST segment elevation, 3 (9%) without ST segment elevation, 3 (9%) non-Q wave myocardial infarction, 23 (68%) unstable angina pectoris. The age of patients was 4976 years (average 59.47 6.08 years), of which 23 were men and 11 women. Each patient underwent a complete clinical and functional examination to assess the anthropometric data, functional indicators of the respiratory and cardiovascular systems, mental functions, and posturography. The rehab course lasted 15 days and included exercise therapy, gym machine training according to an individually designed program, and dosed walking.
 Results. Based on the results of exercise tolerance tests, we formed two case groups: patients of group 1 (n = 14) showed an improvement in the functional class of chronic heart failure according to 6-minute walking test; patients of group 2 (n = 20) showed only insignificant dynamics. Comparison of clinical and functional indicators between the 2 groups revealed that patients of group 1 had more pronounced anxiety and depressive symptoms, and a better preserved function of the respiratory system. A correlation analysis of the total sample of patients detected a correlation relationship between exercise tolerance and functions of the respiratory and cardiovascular systems, anthropometric data, and stabilogram indicators.
 Conclusions. A better exercise tolerance in patients with heart problems was associated with better baseline functions of the respiratory and cardiovascular systems, a lower body mass index, and the optimal dose of statins taken. The exercise tolerance increased in parallel with improvement of stabilogram indicators, which suggests a positive effect of targeted individual training of the equilibrium function to improve the functional result of the cardiac rehabilitation process.

Changes in the Levels of Modern Biomarkers in Patients with Decompensated Heart Failure After Myocardial Infarction Under the Influence of Treatment with Succinic Acid and Arginine Preparations

The prevalence of heart failure in Europe and worldwide is high. This syndrome is a common cause of hospitalization and has a significant impact on morbidity, mortality and healthcare costs in highly developed countries. The study of biomarkers in heart failure is of wide interest as they can improve diagnosis, predict the development of heart failure and its decompensation, and help in assessing treatment outcomes. 
 The objective of the research was to study the feasibility of using multiple biomarker strategy for diagnosing decompensated heart failure in the post-infarction period and to assess changes in these markers after treatment with succinic acid and arginine preparations.
 Materials and Methods. There were examined 120 patients with Q-QS wave and non-Q wave myocardial infarction complicated by decompensated heart failure. All the patients were divided into 2 groups (depending on Q-QS wave and non-Q wave myocardial infarction) and 4 subgroups (depending on rehabilitation therapy) being homogenous by age and gender.
 Results. When studying the dynamics of changes in blood level of N-terminal pro-B-type brain natriuretic peptide and ST2, there was observed its significant reduction in all the patients with prior Q-QS wave myocardial infarction complicated by decompensated heart failure after treatment. The most significant changes were observed in the patients of Group IV who, on the background of basic therapy, received succinic acid and arginine preparations according to the proposed scheme. The combined use of arginine preparations and succinic acid in combination therapy for decompensated heart failure secondary to prior Q-QS wave myocardial infarction allowed reducing blood levels of N-terminal pro-B-type brain natriuretic peptide under conditions of graded exercises. Similar tendencies were observed when determining this indicator in the patients with non-Q wave myocardial infarction complicated by decompensated heart failure after rehabilitation treatment. 
 Conclusions. The use of succinic acid and arginine preparations when treating the patients with prior Q-QS wave and non-Q wave myocardial infarction complicated by decompensated heart failure allowed us to significantly reduce the level of immunological enzymes such as N-terminal pro-B-type brain natriuretic peptide and ST2, which indicate the presence and development of decompensated heart failure after myocardial infarction.

IMMUNOENZYMATIC AND ELECTROCARDIOGRAPHIC FINDINGS IN PATIENTS WITH DECOMPENSATED HEART FAILURE SECONDARY TO PRIOR ACUTE MYOCARDIAL INFARCTION BEFORE AND AFTER TREATMENT

Chronic heart failure (HF) remains a potentially dangerous fatal stage of any cardiovascular disease demonstrating a steady increase in the prevalence among the general population that is accompanied by a progressive increase in the health care costs for improving the patients’ health or clinical status, increasing their quality of life, reducing the risk of death. There is wide interest in studying biomarkers in HF as they can improve the diagnosis, predict the occurrence of its decompensation, as well as help in assessing treatment effects. 
 The objective of the study was to assess the value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction (MI) after treatment with succinic acid and arginine preparations under electrocardiographic control. 
 Materials and methods. There were examined 120 patients with Q-QS wave and non-Q wave MI, stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V.Kh. and Strazhesko M.D., the NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups.
 Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, that served as a basis for inclusion of patients in the study. 
 Results. There was analyzed the dynamics of changes in ECG indicators in the patients with decompensated HF and prior MI under the influence of therapy. At the beginning of controlled treatment, most patients developed signs of left ventricular hypertrophy (LVH) and reduced bioelectrical activity. Therapy applied helped reduce the incidence of sinus tachycardia cases.
 The studied preparations were shown to have the positive effect on the dynamics of heart rhythm disorders in the patients with decompensated HF and prior Q wave MI. During treatment of the patients with prior non-Q wave MI, the positive dynamics in ECG findings, namely reduction in cardiac bioelectrical activity and LHV, was observed. Myocardial bioelectrical activity had a clear tendency to reduce 1 month, and especially 2 months, after treatment. When analyzing the dynamics of changes in blood levels of NT-proBNP, there was observed its significant reduction in all the groups of the patients after the end of treatment. According to the data presented in Table 1, all the treatment schemes proposed led to a significant reduction in serum levels of this peptide after treatment ended. 
 Conclusions. Thus, we can conclude that the treatment of patients with decompensated HF secondary to prior Q-QS wave or non-Q wave MI with succinic acid and arginine preparations possessing anti-ischemic, antianginal, anti-hypoxic, angioprotective effects, allows providing adequate treatment of decompensated HF, as evidenced by the positive dynamics of changes in immunoenzymatic and electrocardiographic findings. Therefore, we plan to develop an algorithm for assessing the quality of therapy, as well as to determine the frequency and time periods of using these peptides for making therapeutic decisions. 

IMMUNOENZYMATIC AND ELECTROCARDIOGRAPHIC FINDINGS IN PATIENTS WITH DECOMPENSATED HEART FAILURE SECONDARY TO PRIOR ACUTE MYOCARDIAL INFARCTION BEFORE AND AFTER TREATMENT

Chronic heart failure (HF) remains a potentially dangerous fatal stage of any cardiovascular disease demonstrating a steady increase in the prevalence among the general population that is accompanied by a progressive increase in the health care costs for improving the patients’ health or clinical status, increasing their quality of life, reducing the risk of death. There is wide interest in studying biomarkers in HF as they can improve the diagnosis, predict the occurrence of its decompensation, as well as help in assessing treatment effects. 
 The objective of the study was to assess the value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction (MI) after treatment with succinic acid and arginine preparations under electrocardiographic control. 
 Materials and methods. There were examined 120 patients with Q-QS wave and non-Q wave MI, stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V.Kh. and Strazhesko M.D., the NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups.
 Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, that served as a basis for inclusion of patients in the study. 
 Results. There was analyzed the dynamics of changes in ECG indicators in the patients with decompensated HF and prior MI under the influence of therapy. At the beginning of controlled treatment, most patients developed signs of left ventricular hypertrophy (LVH) and reduced bioelectrical activity. Therapy applied helped reduce the incidence of sinus tachycardia cases.
 The studied preparations were shown to have the positive effect on the dynamics of heart rhythm disorders in the patients with decompensated HF and prior Q wave MI. During treatment of the patients with prior non-Q wave MI, the positive dynamics in ECG findings, namely reduction in cardiac bioelectrical activity and LHV, was observed. Myocardial bioelectrical activity had a clear tendency to reduce 1 month, and especially 2 months, after treatment. When analyzing the dynamics of changes in blood levels of NT-proBNP, there was observed its significant reduction in all the groups of the patients after the end of treatment. According to the data presented in Table 1, all the treatment schemes proposed led to a significant reduction in serum levels of this peptide after treatment ended. 
 Conclusions. Thus, we can conclude that the treatment of patients with decompensated HF secondary to prior Q-QS wave or non-Q wave MI with succinic acid and arginine preparations possessing anti-ischemic, antianginal, anti-hypoxic, angioprotective effects, allows providing adequate treatment of decompensated HF, as evidenced by the positive dynamics of changes in immunoenzymatic and electrocardiographic findings. Therefore, we plan to develop an algorithm for assessing the quality of therapy, as well as to determine the frequency and time periods of using these peptides for making therapeutic decisions. 

Cytoprotective and metabolic therapy for patients with prior Q-QS wave or non-Q wave myocardial infarction complicated by decompensated heart failure on the background of graded exercises

The objective of the research — to determine the efficacy of rehabilitation treatment of the patients with decompensated heart failure (HF) in the early and late post-infarction period using succinic acid and arginine preparations, as well as to assess their effect on exercise tolerance. Material and methods. There were examined 120 patients with Q-QS wave or non-Q wave myocardial infarction (MI), stage II A-B decompensated chronic HF according to the classification by Vasylenko V. Kh. and Strazhesko M. D., the New York Heart Association (NYHA) functional class (FC) III–IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups. All the patients underwent the six-minute walk test (6 MWT) in a quiet 30–50-m long hospital corridor in the morning. Before performing the 6 MWT, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and the standard 12-lead electrocardiogram (ECG) was recorded. Criteria for immediate stopping the test included chest pain, severe shortness of breath, limb cramps, dizziness, unsteady gait, sweating, severe pallor, SpO2 < 86%. Results. When assessing the appearance of clinical signs during physical activity in the patients with prior Q wave MI, the signs such as chest pain, heart rhythm disorders and dizziness were found to increase in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and their combination contributed to a significant reduction in clinical signs of graded exercise inadequacy. Thus, chest pain that accompanied physical activity in 60%, 73.3%, 66.7% of the patients at the beginning of treatment, was observed in one-third of the patients — 20%, 26.7%, 13.3%, respectively, 2 months after the beginning of treatment. Similar tendency was observed when assessing a dynamic of dizziness and cyanosis/pallor cases. When analyzing a dynamic of clinical signs during physical activity in the patients with prior non-Q wave MI, an insignificant reduction in the signs such as chest pain, shortness of breath, heart rhythm disorders and dizziness was observed in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and especially their combination significantly reduced clinical signs of inadequate response to physical exercises. The patients of group 4, who walked (174.87±1.92) m before treatment, walked a distance of (369.00±4.71) m after two months of treatment (p<0.05). Similar tendency was observed when analyzing the indicators of the metabolic equivalent of task (MET) and O2 consumption. During a course of treatment of the patients with non-Q wave MI complicated by decompensated HF, a gradual increase in exercise tolerance and motor activity was observed in all the groups. According to the 6 MWT, in all the groups, there was observed a significant increase (p<0.05) in distance walked over a span of 6 minutes both one month and two months after the beginning of treatment. In addition, during the first and especially the second month of treatment, the 6 MWT was accompanied by a significantly less reduction in HR before and after the test. At the same time, despite the one-sidedness of probable dynamics of the characteristics indicated by the 6 MWT in case of standard treatment, a favorable dynamic was less significant. Similar tendency in HR response to physical activity was observed during the process of treating the patients of other groups. In general, a gradual reduction in resting HR and a significantly less increase in peak HR were observed. According to the dynamics of both SBP and DBP, the formation of favorable hemodynamic support of physical activity in the patients of all the groups was observed as well. Similar tendency was observed when analyzing the indicators of the MET and O2 consumption. These indicators were found to be significantly higher in the dynamics of treatment in all groups of the patients. Positive dynamics in the MET and O2 consumption indicators in the patients who, in addition to standard therapy, received a preparation of succinic acid and arginine preparations deserved special attention. Conclusions. In the patients with decompensated heart failure secondary to acute myocardial infarction, basic therapy including arginine and succinic acid preparations contributes to the improvement of the 6 minutes walk test indicators, its individual perception. Succinic acid and arginine preparations in combination with standard therapy for the patients with MI and decompensated HF allows improving clinical signs of performing physical activity there by improving functional class of heart failure.

Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI

BackgroundPathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after anterior STEMI. MethodsStandard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had regression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year. ResultsThere were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave regression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 ± 2784 IU/l vs. 3814 ± 2595 IU/l vs. 1733 ± 1583 IU/l respectively, p < 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09). ConclusionIn a population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.

Изменения неспецифических протеиназ и провоспалительных цитокинов при остром инфаркте миокарда различной степени тяжести

to study changes of serum levels of nonspecific proteinases, their inhibitors, and proinflammatory cytokines during short term observation of patients with acute myocardial infarction (MI). We included in this prospective short-term study 82 patients (27 with uncomplicated non-Q wave MI, 30 with Q-MI complicated by Killip class I-II acute left ventricular failure [ALVF], 17 with Q-MI complicated by Killip class III-IV ALVF, and 8 non-survivors due to development of cardiogenic shock) and 12 healthy controls. Serum levels of interleukin (IL) - 1β, IL-6 and tumor necrosis factor (TNF)-α were measured by ELISA. Elastaselike (ELA) and trypsin-like (TLA) activities as well as characteristics of proteinase inhibitors (antitrypsin activity and acid-stable inhibitors) were also determined. Blood samples were taken at hospital admission within 24 hours after onset of symptoms. The GUSTO Score at admission was used for risk stratification. All cytokines levels were significantly elevated in MI patients in comparison to controls. Mean concentrations of IL-6 and TNF-α at baseline were higher among patients with MI complicated by ALVF than in the group with uncomplicated MI (27.45 vs 16.04 pikogram / mL, р.

Changes of nonspecific proteinases and their inhibitors in different clinical types of myocardial infarction

Purpose: to elucidate the relationships between serum levels of nonspecific proteinases and their inhibitors in patients with complications of myocardial infarction (MI). Material and methods. This prospective short-term study included 82 patients with uncomplicated non-Q wave MI (n=27), Killip I-II Q-MI complicated by acute left ventricular failure (ALVF) (n=30), Killip III-IV Q-MI, and Killip III-IV ALVF (n=17) as well as non-survivors due to development of cardiogenic shock (n=8) and healthy controls (n=12). Serum levels of elastase-like (ELA) and trypsine-like (TLA) activities and of proteinase inhibitors (antitrypsin activity and acid-stable inhibitors) was evaluated by enzymatic method within 24 hours, 3 and 14 days after the onset of symptoms. Risk stratification was done at admission according to the GUSTO Score. Results. The levels of all nonspecific proteinases were elevated in MI patients in comparison to controls. Mean baseline ELA (0.29 vs 0.37 nMol/mL min; р&lt;0.05) and TLA (0.33 vs 0.40 mcMol/mL min; р&lt;0.05) were higher in patients with MI complicated by ALVF than in those with uncomplicated MI. Non-survivors showed significantly higher ELA and TLA and lower levels of proteinase inhibitors than patients with uncomplicated MI. Discussion. Proteolytic enzyme activities varied parallel to the changes of proteinase inhibitor levels. Proteinase activities were much more elevated in non-survirvors than in patients with uncomplicated MI. Decreased proteinase inhibitor levels can be considered as a marker of imbalance of proteinase-inhibitor system. Conclusions. Increase of nonspecific proteinase serum levels within 24 hours after the onset of MI is associated with the development of ALVF and unfavorable prognosis; it suggests the involvement of the proteinase-inhibitor system in pathogenesis of MI.

Nobori-Biolimus-Eluting Stents versus Resolute Zotarolimus-Eluting Stents in Patients Undergoing Coronary Intervention: A Propensity Score Matching.

PurposeTo compare the 1-year outcomes of a durable polymer Zotarolimus-eluting stent (ZES) versus a biodegradable polymer Biolimus-eluting stent (BES) in patients undergoing percutaneous coronary intervention.Materials and MethodsA total of 2083 patients from 2 different registries, 1125 treated with BES in NOBORI registry and 858 received ZES in CONSTANT registry were included in this study. Clinical outcomes were compared with the use of propensity score matching (PSM). The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCEs) including cardiac death, myocardial infarction, clinically driven target lesion revascularization and stroke. Secondary end points were individual components of MACCEs as well as the incidence of stent thrombosis at 1-year follow-up.ResultsAfter PSM, 699 matched pairs of patients (n=1398) showed no significant difference between BES and ZES in the risk of composite MACCEs at 1 year (2.6% vs. 1.7%; p=0.36). Cardiac death was not statistically different between groups (0.7% vs. 0.4%, p=0.73). Target lesion revascularization rate was also similar between BES and ZES (1.1% vs. 0.7%, p=0.579). Non-Q wave myocardial infarction, as well as target-vessel revascularization rate, was similar between the two groups (0.14% for BES and 0.72% for ZES). Both stent types were excellent with no cases of stent thrombosis and rate of Q wave myocardial infarction reported during the follow-up period.ConclusionIn this cohort of patients treated with BES or ZES, the rate of MACCEs at 1 year was low and significantly not different between both groups.

Proinflammatory cytokines changes in clinical course of acute myocardial infarction

Purpose: to evaluate the interrelationships of proinflammatory cytokines serum levels with the development of acute myocardial infarction (MI) complications. Materials and methods. Eighty two patients with AMI were studied. Prospective short-term study included, patients with uncomplicated non-Q wave MI (n = 27), patients with Q-wave MI complicated by acute left ventricular insufficiency Killip class I–II (n = 30), patients with Q-wave MI complicated by acute left ventricular insufficiency Killip class III–IV (n = 17), non-survivors due to development of cardiogenic shock (n = 8) and age and gender matched healthy controls (n = 12). Serum levels of IL-1β, IL-6 and TNF-α had been evaluated by means of ELISA method. Blood samples had been drawn on admission to the hospital within 18–28 hours from the onset of symptoms, at 3d and 14th days of MI. Risk stratification was assessed on admission according to the GUSTO Score. Results. All cytokines levels were significantly elevated in MI patients in comparison to controls. Mean concentrations of IL-6 at baseline were higher among patients with MI complicated by cardiogenic shock than in group with uncomplicated MI (27,45 vs 16,04 pg/mL; р < 0,001). The same was revealed in concentration of TNF-α (24,74 vs 19,58 pg/mL; р < 0,01), while mean concentration of IL-1β did not differ significantly between these two groups. Non-survivors also showed significantly higher levels of IL-6, TNF-α than all groups of survived patients. Conclusions. Increased levels of IL-6 and TNF-α at 1-st day of MI are associated with the development of acute left ventricular insufficiency and unfavorable prognosis.

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days. Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis. Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05). Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy.

Pathological Q wave as an indicator of left ventricular ejection fraction in acute myocardial infarction

Background: Q-wave myocardial infarction (QMI) has higher mortality and lower myocardial viability than non-Q-wave myocardial infarction (NQMI), suggesting the existence of pathological Q waves reflects the worse ventricular function. The aim of the study is to determine difference in left ventricular ejection fraction (LVEF) between QMI and NQMI.Methods: The study design was cross-sectional analysis conducted in patients with AMI that were hospitalized and undergone echocardiography in Abdul Wahab Sjahranie County General Hospital Samarinda during February 2014 to March 2015. Standard 12-lead electrocardiograms (ECG) were recorded at presentation, 1 day and 2 days after the onset of AMI as well as using the classical criteria for pathological Q wave. LVEF assessment was performed using echocardiography after the second day since the onset of AMI. Independent-T test was used to determine difference in LVEF using PSPPIRE 0.8.4.Results: There were 34 subjects comprising 16 QMI patients and 18 NQMI patients. QMI had a lower LVEF (42±13%) compared to NQMI (60±11%, p&lt;0.001). The presence of pathological Q waves was associated with LVEF ≤40% (p=0.002).Conclusion: QMI had a lower LVEF than NQMI, provides information about the role of pathological Q wave as an indicator of LVEF.

AB1047 Autoimmune Diseases in Patients with Acute Coronary Syndrome Subject to Coronary Angiography

BackgroundThere is growing evidence that atherosclerosis (ATE) is not explained only by traditional cardiovascular (CV) risk factors and that chronic inflammation should be considered as an additional cause1,2,3. Autoimmune diseases...

PS-099 Pharmaceutical intervention: enoxaparin use recommendations in patients with renal impairment

BackgroundEnoxaparin is a low molecular weight heparin used in the treatment and prophylaxis of thromboembolic disease. It is metabolised in the liver and its elimination is mainly renal. Renal impairment...