Postprocedural Thrombolysis In Myocardial Infarction Research Articles

Effect of Early Heparin Anticoagulation on Blood Flow and Cardiac Function in Patients with Acute ST Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Objective: This study aimed to investigate the effect of early administration of heparin anticoagulation on blood flow and cardiac function in patients with acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: A retrospective analysis was conducted on 730 patients with STEMI who underwent PPCI at the Department of Cardiology of the Chengdu Fifth People's Hospital of Chengdu from December 2017 to May 2023. According to the timing of heparin administration. The patients were divided into two groups based on the timing of heparin administration: the early group (3000 U unfractionated heparin administered immediately after the diagnosis of STEMI) and the delayed group (Intravenous injection of ordinary heparin 3000 U after successful interventional catheterization following the diagnosis of STEMI). The study compared general clinical data, myocardial injury markers (initial troponin, peak troponin, and tmax troponin), interventional related indicators (preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, stent length, and thrombus aspiration), and postoperative indexes ST segment resolution (STR), left ventricular ejection fraction (LVEF), n-terminal pro-brain natriuretic peptide (NT-proBNP), major adverse cardiovascular events (MACE), and bleeding events. Results: The early group had a lower proportion of TIMI 0–1 grade and a higher proportion of TIMI 2–3 grade compared to the delayed group (p < 0.05). The early group showed better ST segment resolution (p < 0.05). There was no significant difference in LVEF and NT-proBNP classification between the two groups (p > 0.05). Subgroup analysis suggested an interaction between early heparin anticoagulation and left anterior descending infarct-related artery (IRA) on cardiac function. There was no significant difference in the incidence of MACE and bleeding events between the two groups (p > 0.05). Logistic regression analysis revealed that early heparin anticoagulation was a predictor of immediate TIMI grade 2–3 flow, and TIMI grade 2–3 flow was negatively correlated with early heparin anticoagulation. Conclusions: Early heparin anticoagulation can improve the patency of the IRA and myocardial perfusion in patients with STEMI. Additionally, it can reduce myocardial injury and improve cardiac function without increasing the risk of in-hospital bleeding.

Association of Total Ischemia Time with No-Reflow Phenomenon in Patients Presenting with STElevation Myocardial Infarction, Undergoing Primary Percutaneous Coronary Intervention

Objective: To find out the association of total ischemic time with no-reflow phenomenon, in terms of Thrombolysis in Myocardial Infarction (TIMI) flow grade, in patients presenting with ST-Elevation Myocardial Infarction and undergoing Primary Percutaneous Coronary Intervention(PPCI). Study Design: Analytical Cross-Sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Nov, 2022 to Jan, 2023. Methodology: This analytical cross-sectional study was conducted on n=184 patients, recruited through consecutive sampling technique to collect data prospectively. Patients were divided into no-reflow and normal flow group. Patients’ total ischemic time was documented and pre & post-procedural TIMI flow was noted. SPSS version-24:00 was used to enter and analyze data. Chi-square, Fisher exact test and t-test were applied and p-value≤0.05 was taken as statistically significant. Results: Out of 184 study participants, 17(9.2%) were females as compared to 167(90.8%) males. The mean age was 60.23±10.28 years. No-reflow phenomenon was observed in 20(10.9%) patients. The mean age was higher in the no-reflow group than that of the normal flow group (62.65±11.61 vs 59.94±10.12 years). Total ischemic time, pre & post-procedural TIMI flow were found to be significantly associated with no-reflow phenomenon (p<0.05). Conclusion: There exists a strong association between total ischemic time and the occurrence of no-reflow phenomenon. Patients with delayed reperfusion present with greater frequency of no-reflow and low TIMI grade and vice versa.

Association between post-procedural and long-term functional outcomes of jailed side branches in stented coronary bifurcation lesions assessed with side-branch murray law-based quantitative flow ratio

Abstract Background In coronary bifurcation lesions treated with percutaneous coronary intervention (PCI) using a 1-stent strategy, the occurrence of side branch (SB) compromise may lead to long-term myocardial ischemia in the SB territory. Murray law-based quantitative flow ratio (μQFR) is a novel angiography-based approach estimating fractional flow reserve from a single angiographic view, and thus more feasible to assess SB compromise in routine practice. However, its association with long-term SB coronary blood flow remained unknown. Aim To explore the association between post-procedural SB μQFR and long term SB coronary blood flow in non-left main (LM) coronary bifurcation lesions receiving 1-stent strategy. Methods A total of 146 patients with 313 non-LM bifurcation lesions receiving 1-stent strategy with drug-eluting stents was included in this retrospective study. These lesions had post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 in SBs, and documented angiographic images of index procedure and 6- to 24-month angiographic follow-up. The post-procedural SB μQFR was calculated. Long-term SB coronary blood flow was quantified with the TIMI grading system using angiograms acquired at angiographic follow-up. Results At follow-up, 8 (2.6%), 16 (5.1%), 61 (19.5%), and 228 (72.8%) SBs had a TIMI flow grade of 0, 1, 2, and 3, respectively. The incidences of SB TIMI flow grade <2 and <3 at follow-up both tended to decrease across the tertiles of post-procedural SB μQFR (TIMI flow grade <2: P=0.086; TIMI flow grade <3: P=0.052). In the multivariable logistic regression models, post-procedural SB μQFR was independently associated with SB TIMI flow grade <2 and <3 at follow-up, respectively (all P<0.05). The receiver operating characteristic curve analyses indicated that the area under the curve of post-procedural SB μQFR to identify SB TIMI flow grade <2 at follow-up was 0.6673 (95% CI, 0.5610-0.7737; P=0.0064), and the QFR limits to yield specificity and sensitivity >80% were 0.79 and 0.90, respectively. Conclusions Post-procedural SB μQFR in non-LM bifurcation stenoses was independently associated with impaired long-term SB coronary blood flow. Further investigations should focus on whether PCI optimization based on μQFR may contribute to improve SB flow in the long term.

Pan-Immune-Inflammation Value Is Independently Correlated to Impaired Coronary Flow After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Immune-inflammatory biomarkers have been shown to be correlated with impaired coronary flow (ICF) in ST-segment elevation myocardial infarction (STEMI). Herein, we assessed the relationship between a novel comprehensive biomarker, pan-immune-inflammation value (PIV), and ICF after primary percutaneous coronary intervention (pPCI) in STEMI. A total of 687 patients underwent pPCI between 2019 and 2023 were retrospectively analyzed. Blood samples were collected at admission. PIV and other inflammation parameters were compared. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. Post-procedural coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) classification. Patients were divided into two groups: a group with ICF defined as post-procedural TIMI 0-2 and a group with normal coronary flow (NCF) defined as post-procedural TIMI flow grade of 3. The mean age was 61±12 years and 22.4% were women. Compared to the NCF group (median 492, interquartile range [IQR] 275-931), the ICF group (median 1540, IQR 834-2909) showed significantly increased PIV (p<0.001). The optimal cutoff for the PIV was 804, as determined by receiver operating characteristic curve. The incidence of ICF was 17.0% in whole subjects, 6.4% in low PIV group (<804) and 34.2% in high PIV group (≥804). Multivariate analyses revealed that a baseline PIV ≥804 was independently associated with post-pPCI ICF (Odds ratio 5.226, p<0.001). PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in determining of ICF. In conclusion, a high PIV was significantly associated with an increased risk of ICF after pPCI. Moreover, PIV was a better indicator of ICF than other inflammatory markers.

No-reflow phenomenon and triglyceride-glucose index in acute myocardial infarction

&lt;b&gt;Objective: &lt;/b&gt;The objective of this research was to evaluate the association between the measured triglyceride/glucose index (TyG) and the occurrence of no-reflow phenomena in patients with acute ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI).&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This study comprised 242 patients who were treated with primary PCI for acute STEMI. The values of triglycerides and glucose at the time of admission were derived from the patient's file. Using coronary angiography records, the grade of post-procedural thrombolysis in myocardial infarction (TIMI) flow was determined.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; After PCI, patients were divided into two groups based on their TIMI flow grade: the normal coronary flow group (n=202) and the reduced coronary flow (no-reflow) group (n=40). The group with no-reflow had a poorer left ventricular ejection fraction and a higher prevalence of diabetes compared to the group with normal coronary flow. Individuals with a lower grade of TIMI flow had a substantially higher TyG index (9.7±0.25 vs. 8.8±0.5, p=0.001). The receiver operating characteristic (ROC) curve revealed that the optimal cut-off point of the TyG index for predicting no-reflow was &amp;gt;9.2 with specificity of 72.8% and sensitivity of 97.5% (area under the curve = 0.884; 95% confidence interval, 0.837-0.921; p=0.001).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; At admission, patients with STEMI who experienced no reflow after primary PCI had a higher TyG index. In such cases, the TyG index can be utilized as a predictor of no-reflow.

Role of Colchicine in Reduction of No Reflow Phenomenon in Patients with Acute ST-Segment Myocardial Infarction, Undergoing Primary Percutaneous Coronary Intervention

Abstract Aim and objectives The aim of this work is to study the efficacy of colchicine administration as a preventive tool for No Reflow in patients with STEMI undergoing primary PCI. Patients and Methods The study included 100 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received colchicine (1 mg) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation(63%). In the control group there were 19 patients with TIMI flow less than 3 and 20 patients with MBG less than 3. Meanwhile in the cases group there was 8 patients with TIMI flow less than 3 and 7 patients with MBG less than 3. This difference was statistically significant with a P value of 0.013. There were 40 patients in the cases group who received loading clopidogrel (600 mg) as premedications before Primary PCI (80%) vs 25 patients (50%) in the control group which was statistically highly significant with a P value of 0.002. In addition, Intracoronary medications (adrenaline, verapamil, tirofiban that where given during the procedure) used in 2 patients from the cases group vs 10 from the control group which was statistically significant with a P value of 0.014. There was not a statistically significant difference between the two groups regarding presenting balloon dilatation. Whereas, Post stenting balloon dilatation showed a statistically significant relationship of P value 0.014 which was done in 2 patients from the cases group vs 10 patients from the control group. Conclusion Colchicine loading before primary PCI resulted in improved postprocedural TIMI flow, MBG.

Post-procedural and long-term functional outcomes of jailed side branches in stented coronary bifurcation lesions assessed with side branch Murray law-based quantitative flow ratio.

In coronary bifurcation lesions treated with percutaneous coronary intervention (PCI) using a 1-stent strategy, the occurrence of side branch (SB) compromise may lead to long-term myocardial ischemia in the SB territory. Murray law-based quantitative flow ratio (μQFR) is a novel angiography-based approach estimating fractional flow reserve from a single angiographic view, and thus is more feasible to assess SB compromise in routine practice. However, its association with long-term SB coronary blood flow remains unknown. A total of 146 patients with 313 non-left main bifurcation lesions receiving 1-stent strategy with drug-eluting stents was included in this retrospective study. These lesions had post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 in SBs, and documented angiographic images of index procedure and 6- to 24-month angiographic follow-up. Post-procedural SB μQFR was calculated. Long-term SB coronary blood flow was quantified with the TIMI grading system using angiograms acquired at angiographic follow-up. At follow-up, 8 (2.6%), 16 (5.1%), 61 (19.5%), and 228 (72.8%) SBs had a TIMI flow grade of 0, 1, 2, and 3, respectively. The incidences of long-term SB TIMI flow grade ≤1 and ≤2 both tended to decrease across the tertiles of post-procedural SB μQFR. The receiver operating characteristic curve analyses indicated the post-procedural SB μQFR ≤0.77 was the optimal cut-off value to identify long-term SB TIMI flow grade ≤1 (specificity, 37.50%; sensitivity, 87.20%; area under the curve, 0.6673; P = 0.0064), and it was independently associated with 2.57-fold increased risk (adjusted OR, 2.57; 95% CI, 1.02-7.25; P = 0.045) in long-term SB TIMI flow grade ≤1 after adjustment. Post-procedural SB μQFR was independently associated with increased risk in impaired SB TIMI flow at long-term follow-up. Further investigations should focus on whether PCI optimization based on μQFR may contribute to improve SB flow in the long term.

Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction Patients After Percutaneous CoronaryIntervention:Influencing Factors and Intervention Strategies.

Aim We aim to explore the factors influencing myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI)and evaluate the effects of different intervention strategies on myocardial perfusion improvement. Methods A retrospective analysis was conducted on 300 patients withSTEMIwho underwent primary percutaneous coronary intervention (PPCI) at our hospital between January 2020 and December 2022. Based on post-procedural coronary angiography results using the thrombolysis in myocardial infarction (TIMI) blood flow grade and myocardial blush grade (MBG), patients were categorized into two groups: the normal perfusion group (TIMI grade 3 or MBG 2-3, n=180) and the impaired perfusion group (TIMI grades 0-2 or MBG 0-1, n=120). The impaired perfusion group was further divided using a random number table into the thrombus aspiration-only group (control group, n=60) and the thrombus aspiration combined with nicorandil group (nicorandil group, n=60). A 1:1 propensity score matching method was employed to adjust for baseline characteristics between the groups. Clinical characteristics, hematological parameters, coronary lesion features, and percutaneous coronary intervention (PCI) technical parameters were compared between the matched groups. Additionally, a multivariate logistic regression analysis was performed to identify independent risk factors influencing myocardial perfusion. Furthermore, the post-procedural myocardial perfusion, cardiac function, and clinical prognosis were compared between the control and nicorandil groups. Results After matching, the baseline characteristics of the two groups were compared. The impaired perfusion group had older age, higher proportion of male patients, higher rates of diabetes and hypertension, longer time from symptom onset to balloon dilation, higher peak cardiac troponin I (cTnI) levels, higher proportion of left main or multivessel involvement, heavier coronary lesion burden, and lower balloon inflation pressure (P<0.05). Multivariate logistic regression analysis revealed that age of ≥65 years (odds ratio {OR}=2.34, 95% confidence interval {CI}=1.23-4.46, P<0.01), time from symptom onset to balloon dilation of ≥6 hours (OR=3.12, 95% CI=1.67-5.83, P<0.01), peak cTnI level of ≥100 ng/mL (OR=4.27, 95% CI=2.18-8.36, P<0.01), left main or multivessel involvement (OR=2.86, 95% CI=1.51-5.41, P<0.01), and balloon inflation pressure of <8 atm (OR=3.45, 95% CI=1.79-6.65, P<0.01) were independent risk factors affecting myocardial perfusion. In the intervention analysis, the nicorandil group showed superior post-procedural TIMI blood flow grade, MBG, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification compared to the control group (P<0.05). During a six-month follow-up, the nicorandil group had a lower incidence of major adverse cardiovascular events (MACE) compared to the control group (P<0.05). Conclusion Age, time from symptom onset to balloon dilation, peak cTnI level, extent of coronary artery lesions, and balloon inflation pressure were identified as independent risk factors affecting myocardial perfusion in STEMI patients after PCI. Compared to simple thrombus aspiration, thrombus aspiration combined with nicorandil demonstrated better improvement in myocardial perfusion, cardiac function, and clinical outcomes for patients with impaired perfusion.

SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion.

SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.

Intravenous antiplatelet therapy with cangrelor vs. tirofiban in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract Background Intravenous antiplatelet drugs provide rapid and sustained inhibition of platelet aggregation and can mitigate the ischemic risk of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, there are few real-world studies comparing cangrelor to tirofiban in this patient population. Purpose The aim of this study was to evaluate the effectiveness and the safety of cangrelor compared to tirofiban in a real-world population of STEMI patients undergoing pPCI. Methods This was a prospective, multicenter, observational study including consecutive STEMI patients who received either cangrelor or tirofiban during pPCI at six Italian high-volume pPCI centers from January 2020 to January 2022. The study population was divided into two groups according the antiplatelet treatment received (cangrelor or tirofiban). The primary study outcome was impaired myocardial revascularization assessed by post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade &amp;lt;3. The secondary outcome measures were major bleeding, defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, and all-cause mortality during the hospitalization. Results A total of 478 STEMI patients received intravenous antiplatelet therapy during pPCI. Of them, 16 patients were excluded since they received both cangrelor and tirofiban as bailout strategy. Thus, the final study population included 462 patients (mean age 63.9±11.8 years; 79.7% males): 223 patients received cangrelor (48.3%), and 239 tirofiban (51.7%). Patients treated with tirofiban had higher prevalence of prior myocardial infarction (p=0.016) and prior PCI (p=0.048) than patients receiving cangrelor (Table 1); also, they showed higher SYNTAX score (p=0.038) than patients receiving cangrelor, and a higher proportion of stent thrombosis as culprit lesion (p=0.047; Table 2). Conversely, patients treated with cangrelor had worse Killip class (p&amp;lt;0.001), and underwent more frequently pPCI via femoral access. Post-procedural TIMI flow&amp;lt;3 was reported in 114 (24.7%) patients. At propensity score adjusted regression analysis, the use of cangrelor was associated with a lower probability of post-procedural TIMI flow&amp;lt;3 (aOR: 0.530; 95% CI: 0.313–0.900; p=0.019) than tirofiban. Major bleeding and all-cause death occurred in 28 (6.1%) and 19 (4.1%) patients. There was no difference in the risk of major bleeding (aOR: 1.626; 95% CI: 0.618–4.279; p=0.324) and death (aOR: 2.724; 95% CI: 0.719–10.318; p=0.140) between groups. Conclusions In this real-world population of STEMI patients undergoing pPCI, periprocedural use of cangrelor was associated with improved myocardial reperfusion compared to tirofiban, but with no differences in terms of major bleeding or death during the hospitalization. Funding Acknowledgement Type of funding sources: None.

Relationship between vitamin D deficiency and thrombus load in patients with ST-elevation myocardial infarction.

Clinical studies detecting the increase in thrombotic events with vitamin D deficiency note the relationship between vitamin D and thrombosis. This study aims at evaluating the relationship between serum vitamin D levels and coronary thrombus burden. We retrospectively evaluated 77 patients with ST-elevated myocardial infarction (STEMI). Serum vitamin D levels, degree of coronary thrombus, Thrombolysis in Myocardial Infarction (TIMI) frame count and the extent and severity of atherosclerosis in coronary arteries were also measured in all cases. Patients were divided into 2 groups, according to thrombus load. The rate of vitamin D deficiency in the study population was 79.22% (< 20 ng/mL). Vitamin D levels were significantly higher in patients with a mild thrombus load than in patients with a severe thrombus load (16 vs. 13.95 p = 0.018). Gensini scores were significantly higher in patients with a severe thrombus burden than in patients with a mild thrombus burden (42 vs. 54.5 p = 0.014). There was a low negative correlation between vitamin D levels and thrombus burden classification grades (r = -0.304, p = 0.007), Cx TIMI frame counts (r = -0.402, p < 0.001), and RCA TIMI frame counts (r = -0.479, p < 0.001). There was a moderate negative correlation between serum vitamin D levels and LAD TIMI frame count (r = -0.507, p < 0.001). The results of our study showed that low 25(OH)D3 levels are an independent predictor of high coronary artery thrombus load and post-procedural TIMI frame count increase in patients with STEMI undergoing primary percutaneous coronary intervention.

Correlation between endothelial dysfunction and occurrence of no-reflow in patients undergoing post-thrombolysis early invasive percutaneous intervention for ST-elevation myocardial infarction

BackgroundEndothelial dysfunction and no-reflow share microcirculatory obstruction as a common pathophysiological mechanism. This study evaluated the relationship between systemic peripheral endothelial dysfunction assessed by flow-mediated dilatation (FMD) of the brachial artery and no-reflow in patients with ST-segment elevation myocardial infarction (STEMI) who received successful fibrinolysis.ResultsThis study included 150 patients managed by the percutaneous coronary intervention (PCI) after successful fibrinolysis. Patients were divided according to coronary angiographic success into normal flow versus no-reflow groups. According to FMD measured through brachial artery ultrasound, patients were divided based on their endothelial function into endothelial dysfunction versus normal endothelial function. No-reflow occurred in 44 patients (29.3%). No-reflow patients had longer pain to door time (6.52 ± 1.82 vs 5.19 ± 1.85 h), more Killip class II (36.4% vs 16%, p = 0.006), and lower FMD (7.26 ± 1.92 vs 8.23 ± 2.76%, p = 0.036). Also, they showed more endothelial dysfunction; however, this difference was statistically nonsignificant (97.7% vs 87.7%, p = 0.055). One hundred and thirty-six patients (90.7%) had endothelial dysfunction. They were older (57.51 ± 5.92 vs 50.86 ± 4.55 years, p value ≤ 0.001), more smokers (41.2% vs 14.3%, p = 0.04). Patients with normal endothelial function had a more myocardial blush grade (MBG) 3 (78.6% vs 26.5%, p value = 0.001) in comparison with more MBG 2 in those with endothelial dysfunction (41.9% vs 14.3%, p value = 0.001). Endothelial dysfunction patients had nonsignificant more no-reflow (31.6% vs 7.1%, p-value: 0.06). There was a significant weak positive correlation between thrombolysis in myocardial infarction (TIMI) flow and FMD (r = 0.174, p = 0.033) and a significant moderate positive correlation between MBG and FMD (r = 0.366, p < 0.001). Patients with TIMI I flow had significantly lower FMD compared with patients with TIMI II and TIMI III flow post-PCI. FMD ≤ 6% could predict post-procedural TIMI I flow.ConclusionsIn STEMI patients who underwent PCI within 24 h after successful fibrinolysis, those who had no-reflow showed worse peripheral systemic endothelial function as they had lower brachial artery FMD. Also, FMD showed a significant positive correlation with the post-procedural angiographic flow (TIMI flow and MBG). FMD ≤ 6% could predict TIMI I flow.

Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial.

In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI. Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III. The study population was comprised of 122 patients, allocated to the oversized group (N.=61) and the non-oversized group (N.=61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05±55.12 vs. 64.64±23.28; P=0.056). The troponin ratio, CK-MB ratio, and 6-month follow-up outcome - defined as target lesion revascularization, heart failure, and cardiovascular death - were comparable between the 2 groups. Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.

Effect of high dose statin preloading on TIMI flow in patients presenting with ST-Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention

Abstract Aim and objectives The aim of this study was to assess the impact of high intensity statins used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received high intensity statins (40-80mg of atorvastatin or 20-40mg of rosuvastatin) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy, and high intensity statins after going back to the coronary care unit after primary PCI. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded and ST-segment resolution was measured. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation. In the control group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the cases group there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction measured by M-mode had values of Mean+-SD of 45.91 ± 5.49 in cases group vs 43.01 ± 8.80 in control group which was statistically significant with a P value of 0.011. There was not a statistically significant difference between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion High intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution and ejection fraction as measured by M-mode but did not decrease incidence of in-hospital MACE.

Heterogeneity of the No-Reflow Group After Primary Percutaneous Coronary Intervention Due to ST-Segment Elevation Myocardial Infarction - Are There Sex Differences?

AimsAssessment of the diversity in the no-reflow population after primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI). Are there any gender-related differences? Material and methodsAnalysis of 1063 STEMI patients with Thrombolysis in Myocardial Infarction (TIMI) grade 0 or 1 following pPCI. The study group consisted of 685 patients with TIMI grade 0 and of 378 patients with TIMI grade 1. We analyzed clinical characteristics, in-hospital mortality and 2-year follow-up in both groups. ResultsAmong women with the TIMI grade 1 an atrial fibrillation, tachycardia and impaired ejection fraction were more common than in men. The vessel responsible for myocardial infarction was most commonly the left anterior descending (LAD) in women, whereas the right coronary artery (RCA) in men. These differences were not observed in group with TIMI grade 0. We observed a higher incidence of in-hospital death in the population with TIMI grade 0 compared with TIMI grade 1 (21.9% vs 17.2%; p 0.0189). In the TIMI grade 1 group there was significantly higher incidence of in-hospital mortality in women compared to men (13.2% vs 22.7%; p 0,0159). Among women with postprocedural TIMI grade 0 in all periods of long-term follow-up the mortality was significantly higher compared to men (9.5% vs 17%; p 0,0111; 11.8% vs 19.7%; p 0.0139 and 16.7% vs 23.9%; p 0.043 for 6-,12-months and 2-years of follow up respectively). ConclusionsPatients with no-reflow phenomenon in infarct related artery after pPCI constitute a more diverse group than previously thought. Some differences are most likely gender-specific. The female sex might have an adverse effect on in-hospital mortality in case of TIMI grade 1 and on the long-term prognosis among patients with TIMI grade 0.

Platelet-Lymphocyte ratio is a predictor for the development of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction after thrombus aspiration.

BackroundWe aimed to evaluate the utility of the preprocedural platelet–lymphocyte ratio (PLR) for predicting the no‐reflow phenomenon after thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST‐segment elevation myocardial infarction (STEMI).MethodWe retrospectively analyzed postprocedural thrombolysis in myocardial infarction (TIMI) flow grades and myocardial blush grades (MBG) of 247 patients who underwent a PCI procedure with thrombus aspiration.We divided these patients into two groups according to whether they had no‐reflow (TIMI < 3, MBG < 2) or not (TIMI 3, MBG ≥ 2).ResultsNo‐reflow developed in 43 (17%) patients.Preprocedural PLR was significantly higher in the no‐reflow group (183.76 ± 56.65 vs 118.32 ± 50.42 p < 0.001).Independent predictors of no‐reflow were as follows: higher preprocedural platelet‐lymphocyte ratio (PLR) (OR = 1.018; 95% CI = 1.004, 1.033; p = 0.013),mean corpuscular volume (MCV) (OR = 1.118; 95% CI = 1.024, 1.220; p = 0.012) and SYNTAX Score‐2 (OR = 1.073; 95% CI = 1.005, 1.146; p = 0.036). PLR of 144 had 79% sensitivity and 75% specificity for the prediction of no‐reflow.ConclusionPLR is a reliable predictor for no‐reflow in STEMI patients undergoing thrombus aspiration.

Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial

Background In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI. Methods Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III. Results The study population was comprised of 122 patients, allocated to the oversized group (n = 61) and the non-oversized group (n = 61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05 ± 55.12 vs 64.64 ± 23.28; P = 0.056). The troponin ratio, CK-MB ratio, and 6-month follow up outcome-defined as target lesion revascularization, heart failure, and cardiovascular death-were comparable between the 2 groups. Conclusions Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.

Effect of high-intensity statin preloading on TIMI flow in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundAcute ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (PCI) has improved the outcomes from STEMI and improved myocardial perfusion. However, there is still room for medical therapy to help perfuse the myocardium. The aim of this study was to assess the impact of high-intensity statins used prior to primary PCI in patients presenting with acute STEMI on myocardial perfusion. The study included 170 patients who presented with acute STEMI to Ain Shams University Hospitals and underwent primary percutaneous coronary intervention (PCI). They were divided into two groups where the first group received high-intensity statins (80 mg of atorvastatin or 20 mg of rosuvastatin) besides guideline-recommended therapy before primary PCI and the second group served as a control group and received guideline-recommended therapy, and high-intensity statins were given as usual after going back to the coronary care unit after primary PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded, and ST-segment resolution was measured.ResultsThe LAD was the culprit vessel for the majority of patients in both groups. In the control group, there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II, and 68 with TIMI III flow and MBG III. Meanwhile, in the cases group, there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II, and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs. 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction had values of mean ± SD of 45.91 ± 5.49 in the cases group vs. 43.01 ± 8.80 in the control group which was statistically significant with a P value of 0.011.ConclusionHigh-intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution, and ejection fraction.

Percutaneous Coronary Intervention for Chronic Total Occlusion—The Michigan Experience: Insights From the BMC2 Registry

ObjectivesThe aim of this study was to describe the performance and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Michigan. BackgroundCTO PCI has been associated with reduction in angina, but previous registry analyses showed a higher rate of major adverse cardiac events with this procedure. MethodsTo study uptake and outcomes of CTO PCI in Michigan, patients enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry (2010 to 2017) were evaluated. CTO PCI was defined as intervention in a 100% occluded coronary artery ≥3 months old. ResultsAmong 210,172 patients enrolled in the registry, 7,389 CTO PCIs (3.5%) were attempted, with 4,614 (58.3%) achieving post-procedural TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. The proportion of PCIs performed on CTOs increased over the study period (from 2.67% in 2010 to 4.48% in 2017). Thirty of 47 hospitals performed >50 CTO interventions in 2017. Pre-procedural angina class ≤2 was present in one-quarter, and functional assessment for ischemia was performed in 46.6% of patients. Major complications occurred in 245 patients (3.3%) and included death (1.4%), post-procedural stroke (0.4%), cardiac tamponade (0.5%), and urgent coronary artery bypass graft surgery (1.3%). Procedural success improved modestly from 44.5% in 2010 to 54.9% in 2017 (p for trend < 0.001). Rates of in-hospital mortality (p for trend = 0.247) and major adverse cardiac event (p for trend = 0.859) for CTO PCI remained unchanged over the study period. ConclusionsThe rate of CTO PCI in Michigan increased over the study period. Although the success rate of CTO PCI has increased modestly in contemporary practice, it remained far below the >80% reported by select high-volume CTO operators. The rate of periprocedural major adverse cardiac events or death remained unchanged over time. These data suggest room for improvement in the selection and functional assessment of CTO lesions before subjecting patients to the increased procedural risk associated with CTO PCI.

Analysis of short-term and long-term clinical outcomes in patients with acute myocardial infarction after one year of coronary stent implantation

Objective: To observe in-hospital and 1-year prognosis of patients with acute myocardial infarction after one year of coronary stent implantation. Methods: From January 2015 to February 2018, 329 patients with acute myocardial infarction (AMI) after 1 year of coronary artery stent implantation were enrolled and received coronary angiography. These patients were divided into two groups (very late stent thrombosis (VLST) group and denovo group) according to whether the occurrence of acute myocardial infarction was due to stent thrombosis (ST), and in-hospital and long-term (1 year) outcomes were compared between the two groups. The primary end points included cardiac death and recurrent acute myocardial infarction. The secondary study end points included target lesion revascularization (TLR), re-stent thrombosis, heart failure, and stroke. Results: In total, 72.9% of patients with AMI after one year of coronary stent implantation were caused by VLST. There were no significant differences of both primary and secondary end-point events between the two groups during in-hospital period (3.3% vs 3.4%, P=0.987; 5.4% vs 4.5%, P=0.956). After a mean follow-up of 1 year, there were no significant differences of the primary end-point events between the two groups. The secondary end-point events and TLR incidence were higher in the VLST group (16.3% vs 6.7%, P=0.026; 9.6% vs 2.2%, P=0.026). Kaplan and Meier survival analysis showed that there were no significant differences of the 1-year cumulative non-primary and non-secondary end-point survival rates between the two groups (P=0.124 and 0.004, respectively). COX regression analysis showed that heart function ≥Ⅲ level (Killip's) and VLST were independent predictive risk factors for end-point events, while postprocedural thrombolysis in myocardial infarction (TIMI) flow grade 3 was an independent protective factor. Conclusion: In-hospital end points show no significant differences between VLST and denovo groups patients. However, the VLST group patients have a poor prognosis and a higher proportion of TLR after 1 year follow-up. The patients with heart function ≥Ⅲ level (Killip's) or VLST have a poor prognosis, while the patients with postprocedural TIMI flow grade 3 have a good prognosis.