Post Primary Percutaneous Coronary Intervention Research Articles

Nomogram-based prediction of MACE in older adults with STEMI

Abstract Introduction Despite the significant progress made in diagnosing and treating patients with ST elevation myocardial infarction (STEMI), high-risk subgroups such as older adults (those over 65 years-old) still face considerable residual risk of major adverse cardiovascular events (MACE) following treatment for their index event. Thus, it is crucial to create accurate, validated, and actionable tools to stratify patients according to their risk of MACE after admission for STEMI. Purpose Utilizing clinical data obtained from a registry of patients diagnosed with STEMI, this study aims to develop a nomogram that can reliably predict the likelihood of MACE incidence. Methods Using a large electronic single-center registry, all consecutive patients with STEMI, undergoing primary percutaneous coronary intervention (PCI), and aged 65 and above were identified. Demographic, laboratory, clinical and intra-procedural variables were examined. Univariate and multivariate logistic regression analyses were utilized to identify those factors which were independently associated with MACE incidence in the post PCI follow-up period. A nomogram was developed in a training set, and performance metrics such as receiver operating curves (ROC), calibration plots, and decision curve analysis were used for validation in a testing set. Analyses were performed using tidyverse and rms packages in R programming language. Results 1946 patients were included in the study and split into 70% training and 30% testing sets. Both groups were similar in terms of baseline demographic and clinical characteristics. Mean follow-up period was 17 months. Total MACE incidence in the post PCI follow-up period was 18%. Thirty-eight factors with limited missing information (<5%) were examined for their relationship with MACE incidence and after performing univariate and multivariate analysis 8 were selected for construction of the nomogram: left-ventricular ejection fraction (LVEF), serum creatinine, hemoglobin and fasting blood glucose levels, presence of valvular heart disease, post PCI TIMI flow grade, diameter of the stent placed in the culprit lesion, and presence of shock in the post PCI setting. The area under the curve (AUC) for MACE prediction in post PCI follow-up period showed acceptable discrimination (c-statistic=73%, 95%CI 71.2% to 76.3%). Calibration plots demonstrated that the nomogram model was well-calibrated, and its predictions were closely aligned with observed outcomes. Additionally, decision curve analysis indicated that the model exhibited strong discriminatory ability in predicting MACE. Conclusions A nomogram developed using a combination of laboratory, clinical, and procedural parameters reliably predicts future risk for MACE in older adults following STEMI. Future implementation of this model may identify the highest risk individuals to target more aggressive preventive efforts in a vulnerable cohort of patients.Plot 1Plot 2

Comparative Analysis of Ticagrelor and Clopidogrel Effects on Medication Adherence, Adverse Events, and Laboratory Parameters in Iranian Acute Coronary Syndrome Patients Post-PCI

Background: Acute coronary syndrome (ACS) remains a critical health concern, with patient outcomes significantly influenced by the selection of antiplatelet therapy post-percutaneous coronary intervention (PCI). Existing research suggests potential benefits of ticagrelor over clopidogrel in reducing cardiovascular events. However, there is limited comparative data within the Iranian population post-angiography. Objectives: This research aimed to compare laboratory findings, adherence rates, and side effects following the administration of ticagrelor and clopidogrel in ACS patients post-PCI. Methods: A case-control study was conducted to assess the impacts of antiplatelet therapy in 200 ACS patients undergoing PCI at Masih Daneshvari Hospital, Tehran, Iran. Patients were stratified into two groups, matched by age, gender, and type of cardiac disease. One group received clopidogrel, and the other received ticagrelor. Laboratory parameters, including HDL, LDL, and CRP, were evaluated at baseline and two months after treatment initiation. Additionally, adverse effects and medication adherence were assessed to evaluate the safety and efficacy of the two antiplatelet agents. Results: The study enrolled 200 ACS patients post-PCI, with 54% male and 46% female. The age range was 38 to 84 years, with a mean age of 63.07 ± 12.54 years. Of the patients, 76% had non-ST-elevation myocardial infarction (NSTEMI), while 24% had ST-elevation myocardial infarction (STEMI). Among STEMI patients, 56.25% were treated with fibrinolytics, and 43.75% underwent primary PCI. Common adverse events included dyspnea, bleeding, and gastrointestinal symptoms. Both the ticagrelor and clopidogrel groups showed reductions in LDL levels from baseline to the two-month follow-up. Conclusions: Ticagrelor and clopidogrel were both effective in reducing LDL levels after two months of treatment. However, ticagrelor demonstrated a more pronounced decrease in CRP levels, indicating potential anti-inflammatory benefits. These findings provide insight into antiplatelet therapy's role in managing ACS patients post-PCI.

Survival benefit of IABP in pre- versus post-primary percutaneous coronary intervention in patients with cardiogenic shock

BackgroundCardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock.ResultsTotal mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI–IABP group 40 (49.4%) versus Pre-PPCI–IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI–IABP group, while only 5 patients 6.0% died in the Pre-PPCI–IABP (P = 0.001).ConclusionsEarly IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.

Relationship of changes in QRS duration with left ventricular ejection fraction in patients with acute ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention

ObjectiveTo assess the changes in QRS duration (△QRSd) before and after primary percutaneous coronary intervention(PPCI) regarding the relation of left ventricular ejection fraction (LVEF) in patients after a first acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). MethodsA total of 244 patients with STEMI were enrolled, and clinical, biochemical, and angiographic parameters were compared between two groups based on LVEF at 6 months post-discharge. QRS duration (QRSd) was analyzed in relation to LVEF, and feature selection using least absolute shrinkage and selection operator(LASSO) regression was performed. Logistic regression analysis and receiver operating characteristic (ROC) curve evaluation were conducted to identify predictors and assess model efficacy. ResultsSignificant differences were observed between the two groups in terms of various parameters, including age, time from symptom onset to balloon dilation (STB), N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, Left ventricular end-diastolic volume(LVEDV) at baseline, left ventricular end-systolic volume(LVESV)at baseline, left ventricular end-diastolic diameter (LVDD)at baseline and six months, hospital length of stay(days), ST-segment resolution (STR), the left anterior descending artery as the infarction-related artery (IRA-LAD), frequency of TIMI 3 flow post PPCI, thrombus aspiration and/or intracoronary thrombolysis, the use of tirofiban, and the number of implanted stents(stents).In addition, postoperative QRSd and △QRSd were significantly higher in patients with left ventricular systolic dysfunction(LVSD). LASSO regression selected six variables as predictors of postoperative LVEF. Logistic regression analysis identified age, STB, NT-proBNP, LVESV at baseline,△QRSd, and stents, as independent factors associated with LVSD within six months for patients with a first occurrence of STEMI. The models achieved AUC values of 0.906 (using ΔQRSd),0.922(using 6 variables excluding ΔQRSd) and 0.962 (using 6 variables). ConclusionThis study identified ΔQRSd as a potential predictor of LVSD in patients with STEMI. The developed models showed good efficacy in predicting postoperative LVEF changes. These findings may contribute to risk stratification and individualized management strategies for STEMI patients.

Clinical characteristics and outcomes of Australian and Indian ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI)

IntroductionThe incidence of STEMI and subsequent mortality has been reported to be higher in Indian populations compared to developed countries. However, there is limited data directly comparing contemporary primary percutaneous coronary intervention (pPCI) treatment strategies and clinical outcomes for STEMI patients between developed and developing countries. Materials and methodsWe compared population demographics, procedural characteristics, times to reperfusion and mortality in STEMI patients treated with pPCI between two tertiary referral centers in India and Australia respectively over a 3-year period (1st Jan 2017–31st Dec 2019). ResultsA total of 1293 STEMI presentations (896 Indian vs 397 Australian) were included. On average, Indian patients had lower median BMI than Australian patients (BMI 25.4 vs 27.8; p < 0.001), were significantly younger (mean age 56.0 vs 63.2 years; p < 0.001), more likely male (84 % vs 80 %; p = 0.046) and diabetic (48 % vs 18 %); p < 0.001). Radial access (50 % vs 88 %; p < 0.001) and TIMI III flow post PCI was also significantly lower (85 % vs 96 %; p < 0.001) with median door-to-balloon time significantly shorter in the Indian cohort (20mins vs 43mins; p < 0.001); however, median symptom to balloon time was significantly longer (245mins vs 160mins; p < 0.001). No significant differences in 30-day mortality (4.0 % vs 2.8 % Australian; p = 0.209) or 1-year mortality (6.5 % vs 4.3 %; p = 0.120) were observed. ConclusionSignificant differences in demographics and presentation characteristics exist between Indian and Australian STEMI patients treated with pPCI. Indian patients had significantly longer pre-hospital delays and lower achievement of TIMI III flow post PCI, yet shorter in-hospital time to treatment.

Restoring microvascular circulation with diagnostic ultrasound and contrast agent: rationale and design of the REDUCE trial

ObjectivesThis study aims to evaluate the efficacy and cost-effectiveness of sonothrombolysis delivered pre and post primary percutaneous coronary intervention (pPCI) on infarct size assessed by cardiac MRI, in patients presenting with STEMI, when compared against sham procedure. BackgroundMore than a half of patients with successful pPCI have significant microvascular obstruction and residual infarction. Sonothrombolysis is a therapeutic use of ultrasound with contrast enhancement that may improve microcirculation and infarct size. The benefits and real time physiological effects of sonothrombolysis in a multicentre setting are unclear. MethodsThe REDUCE (Restoring microvascular circulation with diagnostic ultrasound and contrast agent) trial is a prospective, multicentre, patient and outcome blinded, sham-controlled trial. Patients presenting with STEMI will be randomized to one of 2 treatment arms, to receive either sonothrombolysis treatment or sham echocardiography before and after pPCI. This tailored design is based on preliminary pilot data from our centre, showing that sonothrombolysis can be safely delivered, without prolonging door to balloon time. Our primary endpoint will be infarct size assessed on day 4±2 on Cardiac Magnetic Resonance (CMR). Patients will be followed up for 6 months post pPCI to assess secondary endpoints. Sample size calculations indicate we will need 150 patients recruited in total. ConclusionsThis multicentre trial will test whether sonothrombolysis delivered pre and post primary PCI can improve patient outcomes and is cost-effective, when compared with sham ultrasound delivered with primary PCI. The results from this trial may provide evidence for the utilization of sonothrombolysis as an adjunct therapy to pPCI to improve cardiovascular outcomes in STEMI. ANZ Clinical Trial Registration number: ACTRN 12620000807954

Lethal ventricular septal rupture post successful primary percutaneous coronary intervention of an anomalous right coronary artery.

Lethal ventricular septal rupture post successful primary percutaneous coronary intervention of an anomalous right coronary artery.

Impact of Reperfusion on Plasma Oxylipins in ST-Segment Elevation Myocardial Infarction.

ST-segment elevation myocardial infarction (STEMI) occurs as a result of acute occlusion of the coronary artery. Despite successful reperfusion using primary percutaneous coronary intervention (PPCI), a large percentage of myocardial cells die after reperfusion, which is recognized as ischemia/reperfusion injury (I/R). There are rapid changes in plasma lipidome during myocardial reperfusion injury. However, the impact of coronary artery reperfusion on plasma oxylipins is unknown. This study aimed to investigate alterations in the oxylipin profiles of STEMI patients during ischemia and at various reperfusion time points following PPCI. Blood samples were collected from patients presenting with STEMI prior to PPCI (Isch, n = 45) and subsequently 2 h following successful reperfusion by PPCI (R-2 h, n = 42), after 24 h (R-24 h, n = 44), after 48 h (R-48 h, n = 43), and then 30 days post PPCI (R-30 d, n = 29). As controls, blood samples were collected from age- and sex-matched patients with non-obstructive coronary artery disease after diagnostic coronary angiography. High-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) using deuterated standards was used to identify and quantify oxylipins. In patients presenting with STEMI prior to reperfusion (Isch group), the levels of docosahexaenoic acid (DHA)-derived oxylipins were significantly higher when compared with controls. Their levels were also significantly correlated with the peak levels of creatine kinase (CK) and troponin T(TnT) before reperfusion (CK: r = 0.33, p = 0.046, TnT: r = 0.50, p = 1.00 × 10-3). The total concentrations of oxylipins directly produced by 5-lipoxygenase (5-LOX) were also significantly elevated in the Isch group compared with controls. The ratio of epoxides (generated through epoxygenase) to diols (generated by soluble epoxide hydrolysis (sEH)) was significantly lower in the Isch group compared with the controls. Following reperfusion, there was an overall reduction in plasma oxylipins in STEMI patients starting at 24 h post PPCI until 30 days. Univariate receiver operating characteristic (ROC) curve analysis also showed that an elevated ratio of epoxides to diols during ischemia is a predictor of smaller infarct size in patients with STEMI. This study revealed a large alteration in plasma oxylipins in patients presenting with STEMI when compared with controls. Total oxylipin levels rapidly reduced post reperfusion with stable levels reached 24 h post reperfusion and maintained for up to 30 days post infarct. Given the shifts in plasma oxylipins following coronary artery reperfusion, further research is needed to delineate their clinical impact in STEMI patients.

Sonothrombolysis delivered before percutaneous coronary intervention improves myocardial salvage in ST elevation myocardial infarction

Abstract Background Sonothrombolysis (STL) is the application of high mechanical index ultrasound whilst infusing an ultrasound contrast agent. Prior studies have shown that STL delivered pre &amp; post primary percutaneous coronary intervention (pPCI) can reduce infarct size, and improve myocardial salvage in the setting of ST Elevation Myocardial Infarction (STEMI). However, it remains unclear whether this benefit is proportionately dependent on the amount of STL delivered, and whether the timing of STL relative to pPCI is important. Purpose To determine if there is a dose and time dependent relationship between sonothrombolysis delivery and myocardial salvage in patients presenting with STEMI. Methods We conducted a double-blind, pilot randomised controlled trial of STEMI patients (symptoms &amp;lt;6 hrs, age 30-80). Patients were randomised (1:1:1) into 3 arms; Group 1 received STL pre &amp; post pPCI, Group 2 received sham echo pre and STL post pPCI, while Group 3 received Sham echo pre and post pPCI. Measured endpoints were Infarct Percent and Myocardial Salvage Index (MSI) assessed with CMR at day 4±2 and 6±1 months. We performed a regression analysis using R Version 4.2.2 to determine if the number of delivered STL cycles were associated with an improvement in myocardial salvage. Results 51 patients (Age 60, Male 82%) were recruited into Group 1 (n=16), Group 2 (n=19) or Group 3 (n=16). MSI was higher in Group 1 (79% [64, 85]) than Group 2 (51% [45, 70]) and Group 3 (48% [37, 73]) (p=0.047). Regression analysis (Figure 1) showed a non-significant trend towards improved myocardial salvage with more delivered cycles (β=0.32 [95%CI -0.15, 0.80]). Subgroup analyses of post pPCI STL (Figure 2) shows a fixed and sustained benefit in myocardial salvage with pre &amp; post pPCI STL delivery, compared to post pPCI STL delivery alone. Given the regression lines for Group 1 and 2 are approximately parallel, we compared alpha intercept values to determine that pre &amp; post PCI STL conferred an additional 17 percentage points (75% versus 58%) of myocardial salvage compared to post pPCI STL alone. No major adverse cardiac events occurred amongst included participants. Conclusion Pre pPCI sonothrombolysis appears to be an essential component of improving myocardial salvage in the REDUCE Pilot trial, and may improve myocardial salvage by an additional 17% compared to post pPCI STL alone. This benefit is independent of post pPCI sonothrombolysis duration.Figure 1:The relationship between numbeFigure 2:Group 1 and Group 2 sub-analys

Association of ventricular-arterial interaction with left ventricular remodelling after acute myocardial infarction: a 2-year follow-up study

Abstract Background/Introduction Adverse left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure. Purpose We aimed to investigated the association of ventricular-arterial interaction with LV remodelling in patients with STEMI. Methods In 109 patients within 48 hours of myocardial infarction post-primary percutaneous coronary intervention and after 2 years, we measured: (1) pulse wave velocity (PWV-Complior), (2) LV global longitudinal strain (GLS) and left atrial strain, (3) PWV/GLS ratio as a marker of ventricular-arterial interaction, and (4) LV end-diastolic and end-systolic volumes. A &amp;gt;15% decrease in LV end-systolic volume at 2-years follow-up was considered as a criterion of reverse LV remodelling. Results Compared with baseline, all patients had reduced PWV, PWV/GLS, LV end-diastolic and end-systolic volumes, while GLS and reservoir left atrial strain were increased (p&amp;lt;0.05) after 2 years. Both baseline and percentage change of PWV/GLS ratio were associated with LV end-systolic volume percentage change at 2 years (r=0.43, p=0.012 and r=0.35, p=0.038, respectively). Patients with LV end-systolic volume reduction &amp;gt;15% had lower baseline PWV and PWV/GLS and higher GLS and left atrial strain than patients with LV end-systolic volume reduction &amp;lt;15% (p&amp;lt;0.05). Multivariable analysis revealed that PWV and PWV/GLS were independently associated with LV remodelling. A baseline value of PWV of 8.1m/s and PWV/GLS of -0.52m/s% had a sensitivity of 84% and 82% and a specificity of 80% and 77% respectively for prediction of LV remodelling (area under the curve: 0.751, p=0.001 and 0.779, p&amp;lt;0.001). Conclusion Ventricular-arterial interaction is an independent predictor of LV remodelling after 2 years of the ischemic event.

Incidence and risk factors of delirium post primary percutaneous coronary intervention

Incidence and risk factors of delirium post primary percutaneous coronary intervention

Association of aortic stiffness early post myocardial infarction with left ventricular remodelling.

Adverse left ventricular (LV) remodelling after myocardial infarction is associated with heart failure. We investigated whether aortic stiffness during acute ST-segment elevation myocardial infarction is associated with LV remodelling at long-term follow-up. In 109 patients within 48 h of myocardial infarction post-primary percutaneous coronary intervention and after 2 years, we measured: (a) carotid to femoral pulse wave velocity (PWV), (b) LV global longitudinal strain (GLS) and left atrial strain using speckle-tracking echocardiography, (c) PWV/GLS ratio as a surrogate marker of ventricular-arterial interaction, and (d) LV end-diastolic and end-systolic volumes. A > 15% decrease from the baseline in LV end-systolic volume at 2-year follow-up was considered as a criterion of reverse LV remodelling. Compared with baseline, all patients had reduced PWV, LV end-diastolic and end-systolic volumes while PWV/GLS, GLS and reservoir left atrial strain were improved (p < .05) after 2 years. Baseline values of PWV, GLS, PWV/GLS ratio and reservoir left atrial strain were associated with percentage change of LV end-systolic volume at 2 years (p < .05). Multivariable analysis revealed that lower baseline values of PWV and a less impaired GLS and PWV/GLS were independently associated with reverse LV remodelling at 2 years with a C-statistic of .748, .711 and .787, respectively. Aortic stiffness early post-infarction determines LV remodelling after 2 years of the ischemic event despite post successful revascularization. http://www. gov. Unique identifier: NCT03984123, 30/04/2020.

Factors Associated with Increased Length of Stay in Post Primary Percutaneous Coronary Intervention Patients: A Scoping Review.

Several studies identify factors affecting increased length of stay (LOS) in patients with post-primary percutaneous coronary intervention (PCI). However, there has not been a review study that synthesizes these results. This study aimed to describe the duration of LOS and factors associated with increased LOS among patients with STEMI after PPCI. This study used scoping review using EBSCO-host Academic Search Complete, PubMed, Scopus, Taylor & Francis, and Google Scholar databases. The keywords used in English were "adults OR middle-aged" AND "length of stay OR hospital stay" AND "primary percutaneous coronary intervention OR PPCI" AND "myocardial infarction OR coronary infarction OR cardiovascular disease". The inclusion criteria for articles were: the article was a full-text in English; the sample was STEMI patients who had undergone a PPCI procedure; and the article discussed the LOS. We found 13 articles discussing the duration and factors affecting LOS in patients post-PPCI. The duration of LOS was the fastest 48 hours, and the longest of LOS was 10.2 days. Factors influencing LOS are categorized into three predictors: low, moderate, and high. Post-procedure complications after PPCI was the most influential factors in increasing the LOS duration. Professional health workers, especially nurses, can identify various factors that can be modified to prevent complications and worsen disease prognosis to increase LOS efficiency.

One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study

ObjectiveKnowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD...

Impact of Cardiac Rehabilitation Programs Post Primary Percutaneous Coronary Intervention on Functional Capacity and Metabolic Profile Through Different Age Groups.

Modern cardiac rehabilitation (CR) is a thorough approach including multiple arms that aim at improving quality of life and functional capacity. To study the impact of age on the benefits of cardiac rehabilitation program post-successful primary percutaneous coronary intervention (PCI). This retrospective study includes 250 patients post primary percutaneous coronary intervention (PCI) who underwent a complete 12-week cardiac rehabilitation program. Functional capacity, metabolic profile, and parameters of diastolic function were assessed and compared at baseline and after completing the program. Four age strata were compared in terms of improvement of the various parameters studied. In the whole patient group, the workload achieved in metabolic equivalents (METS) and maximum exercise time significantly increased. Regarding metabolic profile, body mass index (BMI), total cholesterol, low-density lipoprotein (LDL), and Triglycerides significantly decreased. While high-density lipoproteins (HDL) increased but didn't reach significance. Echo data reflecting diastolic dysfunction also improved significantly. We found that the magnitude of improvement in all the earlier-mentioned parameters showed no statistically significant difference among the four age groups studied. Cardiac rehabilitation program post primary percutaneous coronary intervention (PCI) significantly improves functional capacity, metabolic profile, and diastolic function. It is never too old or too young to join the CR program. Different age groups benefit equally from rehabilitation.

Delays in first medical contact to primary interventional therapy and left ventricular remodelling in ST-segment elevation myocardial infarction.

Early reperfusion and early evaluation of adverse cardiovascular events have become important aspects of treatment for ST-segment elevation myocardial infarction post-primary percutaneous coronary intervention (PPCI). However, emergency medical service (EMS) delays always occur, especially in developing countries. The aim of this study was to investigate the impact of EMS delays on short-term predictions of the severity of myocardial injury in STEMI patients after PPCI. A total of 151 STEMI patients who underwent successful PPCI and two postoperative cardiac magnetic resonance (CMR) imaging examinations (1week and 4months postoperatively) were retrospectively analysed. CMR cine and late gadolinium enhancement (LGE) images were analysed to evaluate left ventricular (LV) function, LV global longitudinal peak strain (GLS) and scar characteristics. The time from first medical contact to balloon (FMC2B) and door-to-balloon (D2B) time, expressed in minutes, were recorded and compared with the recommended timelines. Unadjusted and multivariable analyses were used to assess the impact of EMS delays on short-term left ventricular remodelling (ALVR). EMS delays (FMC2B time > 90min) led to larger infarct size (IS) and microcirculation obstruction (MVO) and poor recovery of the LV ejection fraction and GLS (all p < 0.05). Logistic regression analysis showed that an FMC2B time > 90min (p = 0.028, OR = 2.661, 95% CI 1.112-6.367) and baseline IS (p = 0.016, OR = 1.079, 95% CI 1.015-1.148) were independent predictors of short-term ALVR. Delays in FMC2B time were strongly associated with short-term ALVR; shorter ischaemic times may improve the cardiac function and prognosis of patients.

Platelet Indices and Intracoronary Thrombus Grade as Predictors of In-Hospital Major Cardiovascular Events in Patients with ST Elevation Myocardial Infarction Post Primary Percutaneous Coronary Intervention

Background: The high mortality rate of ST Elevation Myocardial Infarction (STEMI) is caused by its complications, especially in-hospital major cardiovascular events (MACE). This study aims to determine the relationship between platelet indices and intracoronary thrombus grade as predictors of in-hospital MACE and the interaction of the combination of both predictors in patients with STEMI post-primary percutaneous coronary intervention (PCI). Methods: This prospective cohort study was conducted with STEMI patients who underwent primary PCI. Data was analyzed by SPSS 24.0.0.0 version. Results: There were 71 samples: 46 patients (64.8%) with a high platelet index and 48 patients (67.6%) with a high intracoronary thrombus grade. During in-hospital follow-up, there were found that 42 patients (59.2%) experienced MACE. The cut-off value used classifies high platelet index for PDW 11.25 fl (AUC 0.892; CI 95% 0.786-0.999; p&lt;0.001) and MPV 10.15 (AUC 0.901; CI 95% 0.812-0.990; p&lt;0.001). The Cox regression backward log-rank model showed both high platelet indices (adjusted HR 38.13; CI 95% 5.16-282.03; p&lt;0.001) and high Intracoronary Thrombus Grade (adjusted HR 31.67; CI 95% 4.28-234.54; p=0.001) played an independent role as predictors of MACE during hospitalization, regardless of the influence of coronary angiography results, Killip class, smoking and consumption of acetosal and clopidogrel. The combination of two predictors of high platelet indices and high Intracoronary Thrombus Grade based on SEM analysis showed that 95.2% experienced in-hospital MACE (Mantel-Haenzel Common Estimate 17.48; Breslow-Day Homogeneity p=0.772; Cochran’s and Mantel-Haenszel p=&lt;0.001), had better predictive ability as seen from the comparison of the respective AUC values, namely the combination, high platelet indices and high Intracoronary Thrombus Grade (0.942; 0.902; 0.873; p&lt;0.001). Conclusion: High platelet indices and high intracoronary thrombus grade can be used as additional information for risk stratification of in-hospital MACE of STEMI patients post-primary PCI, especially when both variables were combined.

Preoperative lymphocyte to C-reactive protein ratio: A new prognostic indicator of post-primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

The lymphocyte-to-C-reactive protein ratio (LCR) is a novel inflammatory biomarker for many diseases. This study aimed to examine the association between LCR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention. A total of 382 patients with STEMI were included in this study; these patients were enrolled from January 2014 to January 2016 at a single center, and the LCR was calculated for each patient. During the in-hospital and long-term follow-up period, MACEs included cardiovascular death, new-onset non-fatal myocardial infarction, heart failure, malignant arrhythmias, revascularization in unstable angina, and new-onset atrial fibrillation. Using receiver operating characteristic curves, we assessed the predictive impact for MACEs using a combination of six inflammatory markers in patients with STEMI and focused on LCR to elucidate its prognostic value. Univariate and multivariate Cox proportional hazard models were used to define the factors associated with MACEs. Among the assessed variables, preoperative LCR showed the highest accuracy in predicting hospitalized (AUC:0.71) and long-term follow-up(AUC:0.602) MACEs in patients with STEMI. Decreased preoperative LCR was significantly associated with the Gensini score (P<0.05) and no-reflow (P<0.05). Multivariate Cox analysis showed that a high preoperative LCR (cutoff threshold=112.4) was an independent protective factor for hospitalized MACEs in patients with STEMI (hazard ratio, 0.409; 95% confidence interval, 0.283-0.590; P<0.001). A high preoperative LCR (cutoff threshold=106.3) was an independent protective factor for long-term follow-up MACEs in patients with STEMI (hazard ratio, 0.552; 95% confidence interval, 0.369-0.740; P<0.001). Preoperative LCR is a novel and valuable prognostic marker to determine the occurrence of MACEs in hospitals and long-term follow-up after primary percutaneous coronary intervention in patients with STEMI.

Reverse Remodeling and Non-Contrast T1 Hypointense Infarct Core in Patients With Reperfused Acute Myocardial Infarction.

Non-contrast T1 hypointense infarct cores (ICs) within infarcted myocardium detected using cardiac magnetic resonance imaging (CMR) T1 mapping may help assess the severity of left ventricular (LV) injury. However, because the relationship of ICs with chronic LV reverse remodeling (LVRR) is unknown, this study aimed to clarify it. We enrolled patients with reperfused AMI who underwent baseline CMR on day-7 post-primary percutaneous coronary intervention (n=109) and 12-month follow-up CMR (n=94). Correlations between ICs and chronic LVRR (end-systolic volume decrease ≥15% at 12-month follow-up from baseline CMR) were investigated. We detected 52 (47.7%) ICs on baseline CMR by non-contrast-T1 mapping. LVRR was found in 52.1% of patients with reperfused AMI at 12-month follow-up. Patients with ICs demonstrated higher peak creatine kinase levels, higher B-type natriuretic peptide levels at discharge, lower LV ejection fraction at discharge, and lower incidence of LVRR than those without ICs (26.5% vs. 73.3%, P<0.001) at follow-up. Multivariate logistic regression analysis showed that the presence of ICs was an independent and the strongest negative predictor for LVRR at 12-month follow-up (hazard ratio: 0.087, 95% confidence interval: 0.017-0.459, P=0.004). Peak creatine kinase levels, native T1 values at myocardial edema, and myocardial salvaged indices also correlated with ICs. ICs detected by non-contrast-T1 mapping with 3.0-T CMR were an independent negative predictor of LVRR in patients with reperfused AMI.

Primary percutaneous coronary intervention in CAD patients: A comparison of major adverse cardiovascular events of second- and third-generation drug-eluting stents.

Background: Biodegradable polymer (BP) drug-eluting stents (DES) have been introduced as a novel solution to the problems of durable polymer (DP) stents. In Pakistan, very few studies are available for the treatment intervention in post-primary percutaneous coronary intervention (PPCI) patients. Our study will compare the major adverse cardiovascular events (MACEs) and their predictors in patients with coronary artery disease (CAD) undergoing PPCI with second- or third-generation DES. Methodology: An observational, retrospective, cohort study was carried out on CAD patients undergoing PPCI with either second- (DP-XIENCE Prime/XIENCE Xpedition) or third-generation (BP-BioMatrix NeoFlex/BioMatrix Alpha) DES. MACEs were assessed after 1year of PPCI procedure in 341 patients and screened as per inclusion/exclusion criteria (167 in the second-generation group and 174 in the third-generation group). Results: The number of male patients (86.2%) was more than female patients in our study population. MACEs were reported in 4.19% patients after 1year duration, and the percentage of MACEs was more in the second-generation DES group (4.77%) than in the third-generation group (3.44%); however, statistical analysis has not found any significant difference (p = 0.534). The rate of myocardial infarction (1.19% vs. 0.57%) and stent thrombosis (1.8% vs. 1.15%) was more in the second-generation DES group. However, restenosis (1.19% vs. 1.15%) and cardiac death (0.59% vs. 0.57%) were almost same in both groups. A significant association was found between MACEs and diabetes mellitus (p = 0.025), hypertension (p = 0.035), smoking (p = 0.008), and a family history of CAD (p = 0.018). Conclusion: BP-BioMatrix and DP-XIENCE DES have comparable clinical outcomes. Findings of the current study will assist the policy makers and healthcare providers in the rationalization of scarce resources and evidence-based patient care. However, longer follow-up studies are required for convincing results.