Patency Of Infarct-related Artery Research Articles

Two-year follow-up data from the STEPP-AMI study: A prospective, observational, multicenter study comparing tenecteplase-facilitated PCI versus primary PCI in Indian patients with STEMI

BackgroundA pharmacoinvasive strategy may alleviate the logistical and geographical barriers in timely reperfusion of ST-segment elevation myocardial infarction (STEMI), especially in a developing country like India. AimTo assess the safety and efficacy of pharmacoinvasive strategy versus primary PCI in STEMI patients at 2 years. MethodsPatients enrolled in STEPP-AMI, an observational, multicenter, prospective study of 200 patients presenting with STEMI, were followed up for 2 years. Group ‘A’ comprised of patients with pharmacoinvasive strategy (n=45), and patients who underwent primary PCI (n=155) formed group ‘B’. Primary endpoint was composite of death, cardiogenic shock, reinfarction, repeat revascularization of the culprit artery, or congestive heart failure at 30 days, with follow-up till 2 years. ResultsThe primary endpoint occurred in 11.1% and 17.8% in group A and in 3.9% and 13.6% in group B, at 30 days and 2 years, respectively (p=0.07, RR=2.87; 95% CI: 0.92–8.97 at 30 days and p=0.47, RR=1.31; 95% CI: 0.62–2.76). There was no difference in bleeding risk between groups, 2.2% in group A and 0.6% in group B (‘p’=0.4). The infarct-related artery patency varied at angiogram; it was 82.2% in arm A and 22.6% in arm B (‘p’<0.001). In group A, failed fibrinolysis occurred in 12.1%. ConclusionA pharmacoinvasive strategy resulted in outcomes that were comparable with primary PCI at 2 years, suggesting it might be a viable option in India. Larger studies are required to confirm these findings.

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

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

Prognostic Value of Area Flow Index in Patients with Acute st Elevation Myocardial Infarction: Clinical and Echocardiographic Outcomes

Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI. Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups: -Group I: severe LV systolic dysfunction EF 45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P 28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001). Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction.

Increased red cell distribution width predicts occlusion of the infarct-related artery in STEMI

ABSTRACT Objective Infarct-related artery (IRA) patency yields a better outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Red cell distribution width (RDW) emerges as a marker of adverse cardiovascular events and mortality in STEMI. Therefore, we aimed to assess the relationship between IRA patency and RDW value on admission in patients with STEMI undergoing primary PCI. Methods A total of 564 patients with STEMI undergoing primary PCI were recruited in this study. According to thrombolysis in myocardial infarction (TIMI) flow grade in the IRA before PCI, the study population was divided into two groups as TIMI 0 or 1 group (occluded IRA, n = 398) and TIMI 2 or 3 group (patent IRA, n = 166). Results RDW was significantly higher in the occluded IRA group (15.1 ± 1.7 versus 13.4 ± 1.3, p < 0.001) as compared to the patent IRA group. White blood cell (WBC) count, platelet count, creatine kinase-myocardial band (CK-MB) and troponin-I levels were also significantly higher in the occluded IRA group (p < 0.05). Moreover, RDW showed positive correlations with troponin-I (r = 0.397, p < 0.001), CK-MB (r = 0.344, p < 0.001) and WBC (r = 0.219, p < 0.001). In multivariate regression analysis, RDW (OR: 0.483, 95% CI: 0.412–0.567, p < 0.001) and WBC count were significantly and independently associated with IRA patency. Conclusions Our findings suggested that RDW value and WBC count on admission were independent predictors of IRA patency in patients with STEMI. As RDW is an easily available, simple and cheap biomarker, it can be used in daily practice as a novel predictor for IRA patency.

The usefulness of fQRS and QRS distortion for predicting reperfusion success and infarct-related artery patency in patients who underwent thrombolytic therapy.

The aim of this study is to determine whether the presence of fragmented QRS (fQRS) and QRS distortion on admission ECG can be used to predict the success of treatment before beginning thrombolytic therapy (TT). Two hundred and three eligible patients with acute ST elevation myocardial infarction who received TT consecutively between 1 January 2009 and 1 July 2013 were enrolled. The presence of fQRS and QRS distortion was analyzed at admission ECG. The electrocardiographic criteria of reperfusion were defined as 50% or more of ST resolution (STR), whereas the angiographic criteria of reperfusion were defined as thrombolysis in myocardial infarction 2/3 flow in the infarct-related artery. fQRS was detected in 63 (31%) patients. Compared with patients with non-fQRS, STR was lower (46.1±17.7 vs. 73.6±20.9, respectively; P<0.001), thrombolysis failure was higher (44.4 vs. 9.3%, respectively; P<0.001), and thrombolysis in myocardial infarction 0/1 flow was more common (39.7 vs. 10.7%, respectively; P<0.001) in patients with fQRS. Higher numbers of fQRS derivations were significantly related to low percentages of STR (r=-0.615, P<0.001). In predicting occluded infarct-related artery, we found no difference between the negative predictive values of fQRS and inadequate STR after TT (89.3 vs. 95.1%; P>0.05). However, there was no relationship between QRS distortion and failed thrombolysis. fQRS was detected in just 31% of the patients, but we found that it can be used to predict thrombolytic failure. Patients who have this simple marker on admission ECG may be directed to percutaneous interventions as a first-line therapy without any delay.

Correlation of myocardial viability in nuclear perfusion scan and patency of infarct related artery in patients of ST elevation myocardial infarction with late presentation

Correlation of myocardial viability in nuclear perfusion scan and patency of infarct related artery in patients of ST elevation myocardial infarction with late presentation

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

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

Association of different blood parameters with the early patency of Infarct related artery in ST elevation Myocardial Infarction, a comparative analysis

Background and Aims: ST-segment elevation myocardial infarction(STEMI), a severe form of coronary heart disease signifies total occlusion of a coronary artery leading to myocardial necrosis, however about 10-20% of patient’s presents with a patent infarct-related artery on the initial angiogram. The availability of reliable markers for prediction of patency in infarct-related artery is very limited.Methods: We conducted a single centered retrospective study of STEMI patients undergoing primary percutaneous coronary intervention, to determine how various factors such as blood parameters differ in patients with patent infarct related artery to patients with total occlusion at the time of initial angiography done within 24hours of onset of symptoms and how they affect in outcome of the disease.Results: Mean Platelets Volume level (11.96 fL vs. 10.92 fL, p &lt; 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l, p &lt; 0.001), CK-MB (290.2 vs. 190.98, p &lt; 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p &lt; 0.02) in total occlusion group were higher than in the patent infarct related artery group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent infarct related artery group (p&lt;0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent infarct related artery group (p &lt; 0.01).Conclusions: Mean Platelet Volume, Lipoprotien(a), Total cholesterol, and CK-MB levels may play role in predicting patency of Infarct related artery in STEMI.Nepalese Heart Journal 2015;12(2):73-77

Decision-making microRNAs (miR-124, -133a/b, -34a and -134) in patients with occluded target vessel in acute coronary syndrome.

Coronary artery occlusion does not always manifest with ST-elevation, and some patients can have patent coronary vessel. We evaluated circulating microRNA (miRNA) profiles to discriminate subjects with infarct-related artery (IRA) occlusion. Patients (n = 43) with uncomplicated acute coronary syndrome and positive troponins were classified with respect to patent vs. occluded IRA or ST-elevation vs. non-ST elevation MI (STEMI vs. NSTEMI). Expression levels of serum miRNAs (miR-1, -16, -34a, -122, -124, -208b, -133a/b, -375, and -499) were analysed. Out of 16 STEMI and 27 NSTEMI patients, IRA occlusion was noted in 12 and 15 patients, respectively. The remaining four STEMI and 12 NSTEMI patients had patent IRA. STEMI patients had higher troponin T levels and a 3.83-fold higher miR-134 expression (p < 0.025). Patients with the occluded vs. patent IRA had higher levels of miR-133a (fold change: 7.00), miR-133b (4.57), miR-34a (5.50), miR-124 (2.55), and miR-134 (3.45) but no difference in troponin T levels. Receiver operator characteristic analysis identified decision-making miRNAs in occluded vessels: miR-124 (AUC: 0.787, p < 0.001), miR-133b (AUC: 0.704, p = 0.006), and miR-134 (AUC: 0.686, p = 0.016). With respect to STEMI, only miR-134 showed a discriminating value (AUC: 0.725, p = 0.002). The degree of IRA occlusion determines circulating miRNA expression, and specific miRNAs may be useful in indicating patients requiring urgent coronary revascularisation.

Markers of Autolysis in Acute ST Elevation Myocardial Infarction – A Comparative Analysis

The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary. We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease. MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01. MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.

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

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

VALIDATION OF ECG CRITERIA OF SUCCESSFUL THROMBOLYSIS

Objective: To determine the frequency of TIMI (Thrombolysis in MyocardialInfarction) grade 3 on angiography in patients presenting with acute STEMI whofulfill ECG criteria of successful thrombolysis after being thrombolysed withstreptokinase. Methodology : This descriptive study was conducted at Chaudhry Pervaiz ElahiInstitute of Cardiology, Multan from August 2013 to March 2014. Patients withacute STEMI who were thrombolysed with streptokinase and whom ECGs weremeeting criteria of successful thrombolysis (showing ST segment resolution of50% from J point) were included. These patients under went coronaryangiography to evaluate the frequency of TIMI grade 3 flow. Data was analysedusing SPSS version 16. Results: A total of 178 patients were studied. Males were 84.8% (n=151). Meanage was 47.06±1.26 years(25-65 years). TIMI grade 3 flow on angiography wasachieved in 82.6%(n=147) while 17.4% (n=31) patients did not. There was nostatistically difference of TIMI grade 3 between males and females (81.5% vs.88.9%, p=0.348). In comparison to non-diabetics, less number of diabeticpatients achieved TIMI grade 3 flow (88.5% vs. 66.7%,p=0.001). Similarly, nonhypertensivehave got more TIMI grade 3 vs. hypertensive patients(92.2% vs.65.1%,p=0.000). There was no statistical difference between the patients withfamily history of IHD and those without family history of IHD (74.4% vs.85.2%,p= 0.105). Surprisingly, smokers had got more TIMI grade 3 ascompared to non-smokers (88.1% vs. 75.3%, p = 0.026). Conclusion: We concluded that ECG criteria of successful thrombolysis is verygood predictor of infarct related artery patency.

Eroded Versus Ruptured Plaques at the Culprit Site of STEMI: In Vivo Pathophysiological Features and Response to Primary PCI

ObjectivesThe aim of this study was to evaluate the pathophysiological features and response to primary percutaneous coronary intervention (PCI) of nonruptured/eroded plaque versus ruptured plaque as a cause of ST-segment elevation myocardial infarction (STEMI). BackgroundAutopsy series identified nonruptured/eroded plaque and ruptured plaque as the principal pathological substrates underlying coronary thrombosis in STEMI. The real incidence of different plaque morphologies, associated biological factors, superimposed thrombus, and their interaction with primary PCI remain largely unknown. MethodsIn a prospective study, 140 patients with STEMI underwent optical coherence tomography of the infarct-related artery (IRA) before PCI, after everolimus-eluting stent implantation and at 9-month follow-up. Histopathology and immunohistochemistry of thrombus aspirates and serum biomarkers were assessed at baseline. ResultsCulprit plaque morphology was adjudicated in 97 patients: 32 plaques (33.0%) with an intact fibrous cap (IFC), 63 (64.9%) plaques with a ruptured fibrous cap (RFC), and 2 (2.1%) spontaneous dissections. Patients with an IFC and RFC had similar clinical characteristics, and serum inflammatory and platelets biomarkers. An IFC presented more frequently with a patent IRA (56.2% vs. 34.9%; p = 0.047), and had fewer lipid areas (lipid-rich areas: 75.0% vs. 100.0%; p < 0.001) and less residual thrombus before stenting (white thrombus: 0.41 mm3 vs. 1.52 mm3; p = 0.001; red thrombus: 0 mm3 vs. 0.29 mm3; p = 0.001) with a lower peak of creatine kinase-myocardial band (66.6 IU/l vs. 149.8 IU/l; p = 0.025). At the 9-month optical coherence tomography, IFC and RFC had similar high rates of stent strut coverage (92.5% vs. 91.2%; p = 0.15) and similar percentage of volume obstruction (12.6% vs. 10.2%; p = 0.27). No significant differences in clinical outcomes were observed up to 2 years. ConclusionsIn the present study, an IFC was observed at the culprit lesion site of one-third of STEMIs. IFC, compared with RFC, was associated with higher rates of patent IRA at first angiography, fewer lipid areas, and residual endoluminal thrombus. However, no difference in vascular response to everolimus-eluting stent was observed. (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty [OCTAVIA]; NCT01377207)

OP-041 Platelet to Lymphocyte Ratio can be a Predictor of Infarct-related Artery Patency in Patients with ST-segment Elevation Myocardial Infarction

OP-041 Platelet to Lymphocyte Ratio can be a Predictor of Infarct-related Artery Patency in Patients with ST-segment Elevation Myocardial Infarction

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

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

Six months outcome of rescue percutaneous coronary intervention compared to conservative treatment in patients with ST-segment elevation myocardial infarction with failed fibrinolytic therapy

Abstract Background: Fibrinolytic therapy restores patency of infarct related artery in about half of patients with STEMI. This study was designed to evaluate 6 months outcome after rescue

Abstract 17491: Impact of Prehospital Administration of Antithrombotic Medications on Infarct-related Artery Patency in ST-elevation Myocardial Infarction: Results from the FAST-MI 2010 Registry

Rationale: The role of prehospital (PH) antithrombotic medications in STEMI is debated; real-world data are scarce. We used the FAST-MI 2010 data to assess TIMI flow before PCI, in relation to PH administration of antithrombotic medications and timing of coronary angiography. Methods and Results: FAST-MI is a nationwide French registry including consecutive AMI patients in 213 centers in November 2010. Of 2364 STEMI patients, 2035 had TIMI flow assessed pre-intervention (1458 primary PCI, 289 lysis, 288 no reperfusion therapy); 41% had TIMI flow 2/3. PH use of antithrombotics was: ASA 52%, clopidogrel 37%, prasugrel 7%, GP IIb-IIIa 4%; unfractionated heparin 24%, other anticoagulants 22%. Mean age, risk factors, medical history, GRACE score, location of infarct did not differ between patients with TIMI 2/3 vs 0/1 flow. IRA patency was higher with time from onset to call less than 120min (45% vs 35%, P&lt;0.001), and time from ECG to angio over 120 min (48% vs 33%,P&lt;0.001). In the whole population, % TIMI flow 2/3 was higher with PH lytics (78% vs 42%, P&lt;0.001) and differed according to PH antithrombotic use: no antiplatelet 42%, ASA alone 39%, clopidogrel 53.5%, prasugrel 58%, GPIIb-IIIa 40%; no anticoagulant 43%, UFH 46%, other anticoagulants 55%. Lysis (OR 5.67, 3.67-8.77), and combination of dual antiplatelets and anticoagulants (OR 1.59, 1.20-2.12) were independent correlates of higher patency. In patients with primary PCI, individual medications were not significantly correlated with IRA patency. Combined dual antiplatelet and anticoagulants, however, was a significant correlate of higher TIMI2/3 flow (adjusted OR 1.43, 1.05-1.96), as were shorter duration from onset to call (OR 1.53, 1.13-2.08) and longer time from ECG to angio (OR upper tertile vs lower tertile 1.65, 1.14-2.37). ST-segment resolution, reinfarction, stent thrombosis and TIMI major bleeding did not differ according to PH antithrombotics. Conclusion: In the whole population of STEMI patients (including lytic-treated patients), as in patients with primary PCI, PH administration of combined antiplatelet and anticoagulants is associated with increased IRA patency. In contrast, none of the individual antithrombotic medications significantly improved IRA patency.

A prospective, observational, multicentre study comparing tenecteplase facilitated PCI versus primary PCI in Indian patients with STEMI (STEPP—AMI)

ObjectiveTo compare the efficacy of pharmacoinvasive strategy versus primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Primary PCI is the preferred treatment for STEMI, but...

Neutrophil to Lymphocyte Ratio in Acute ST-Segment Elevation Myocardial Infarction

BackgroundSpontaneous early patency of infarct-related artery (IRA) on arrival for primary percutaneous coronary intervention is associated with better short- and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate whether the hemographic parameters on admission are associated with spontaneous IRA patency. MethodsThis was a retrospective study of 1,625 patients with acute STEMI who underwent primary percutaneous coronary intervention <12hours after the onset of symptoms. ResultsAngiography showed patent IRA (prethrombolysis in myocardial infarction [TIMI] grade 3 flow) in 160 (9.8%) patients. Neutrophil count on admission (7.8 ± 2.4 × 103/μL versus 9.7 ± 3.8 × 103/μL; P < 0.001) was significantly lower and lymphocyte count (2.4 ± 1.0 × 103/μL versus 1.9 ± 1.1 × 103/μL; P < 0.001) on admission was significantly higher in the patent IRA group. Neutrophil to lymphocyte ratio (NLR) was significantly lower in the patent IRA group (4.1 ± 3.2 versus 6.9 ± 5.5; P < 0.001). Admission leukocyte counts (13 ± 4.0 × 103/μL versus 12 ± 3.4 × 103/μL; P < 0.001) and NLR (7.2 ± 5.8 versus 5.5 ± 4.4; P < 0.001) of the patients with TIMI thrombus score ≥4 were significantly higher than patients with TIMI thrombus score <4. In the multivariate analysis, NLR ≥4.5 (3.17 [95% confidence interval: 2.04-4.92]; P < 0.001) was found to be independently predicting an occluded IRA on initial angiography with a sensitivity of 62.7% and a specificity of 70%. ConclusionsNLR on admission is significantly related to angiographic thrombus burden and spontaneous early IRA patency in patients with acute STEMI.

Impact of Timing of Eptifibatide Administration on Preprocedural Infarct-Related Artery Patency in Acute STEMI Patients Undergoing Primary PCI.

The appropriate timing of eptifibatide initiation for acute ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. This study aimed to analyze the impact of timing of eptifibatide administration on infarct-related artery (IRA) patency in STEMI patients undergoing primary PCI. Acute STEMI patients who underwent primary PCI (n = 324) were enrolled in this retrospective study; 164 patients received eptifibatide bolus ≤ 30 minutes after emergency department (ED) admission (group A) and 160 patients received eptifibatide bolus > 30 minutes after ED admission (group B). The primary endpoint was preprocedural IRA patency. Most patients in group A (90%) and group B (89%) were late presenters (> 2 hours after symptom onset). The two groups had similar preprocedural thrombolysis in myocardial infarction 2 or 3 flow of the IRA (26 vs. 24%, p = not significant [NS]), similar creatine kinase-MB (CK-MB) levels at 8 hours after admission (339 vs. 281 U/L, p = NS), similar left ventricular ejection fraction (LVEF) (52 vs. 50%, p = NS), and similar 30-day mortality (2 vs. 7%, p = NS). Compared with group B, patients in group A had shorter door-to-device time (p < 0.001) and shorter procedural time (p = 0.004), without increased bleeding risk (13 vs. 18%, p = NS). Earlier intravenous administration of eptifibatide before primary PCI did not improve preprocedural IRA patency, CK-MB level at 8 hours after admission, LVEF and 30-day mortality compared with patients who received intravenous eptifibatide that was administered later.