Primary Coronary Intervention Research Articles

Neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy in patients undergoing primary coronary intervention

Abstract Funding Acknowledgements None. Background Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury(AKI) . We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of contrast induced AKI (CI-AKI) among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). Methods We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of CI-AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels. Results Mean age was 62 ±13 years and 78% were men, and a total of 20 (15%) developed CI-AKI . Patients with CI-AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p < 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p < 0.001). There were no significant changes between NGAL 0 & 24 hours within the 2 groups( figure 1). According to the ROC curve analysis (figure 2), the optimal NGAL 0 level for CI-AKI prediction was >125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p < 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0<125 ng/mL was 94%. Conclusions Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of CI-AKI.NGAL 0 vs 24 according to CI-AKINGAL AUC

Establishing a Practical Loco-Regional Transfer System for Patients with Acute Cardiac Chest Pain

Cardiac disease is the second leading cause of mortality in Korea and the main cardiac disease is acute myocardial infarction (MI). Timely primary coronary intervention is the main treatment for acute MI and delay from symptom onset to intervention is the most important determinant of the prognosis and incidence of ischemic cardiomyopathy after acute MI. Treatment delay includes patient delay and system delay. The latter includes transfer and in-hospital delays. In-hospital delay improved greatly after introducing the critical pathway to Korea. However, there is still much room to improve patient and transfer delay.

Thrombus burden management during primary coronary bifurcation intervention: a new experimental bench model.

Management of thrombus burden during primary percutaneous coronary intervention (pPCI) is a key-point, given the high risk of stent malapposition and/or thrombus embolization. These issues are especially important if pPCI involves a coronary bifurcation. Herein, a new experimental bifurcation bench model to analyze thrombus burden behavior was developed. On a fractal left main bifurcation bench model, we generated standardized thrombus with human blood and tissue factor. Three provisional pPCI strategies were compared (n = 10/group): 1) balloon-expandable stent (BES), 2) BES completed by proximal optimizing technique (POT), and 3) nitinol self-apposing stent (SAS). The embolized distal thrombus after stent implantation was weighed. Stent apposition and thrombus trapped by the stent were quantified on 2D-OCT. To analyze final stent apposition, a new OCT acquisition was performed after pharmacological thrombolysis. Trapped thrombus was significantly greater with isolated BES than SAS or BES+POT (18.8 ± 5.8% vs. 10.3 ± 3.3% and 6.2 ± 2.1%, respectively; p < 0.05), and greater with SAS than BES+POT (p < 0.05). Isolated BES and SAS tended show less embolized thrombus than BES+POT (5.93 ± 4.32 mg and 5.05 ± 4.56 mg vs. 7.01 ± 4.32 mg, respectively; p = NS). Conversely, SAS and BES+POT ensured perfect final global apposition (0.4 ± 0.6% and 1.3 ± 1.3%, respectively, p = NS) compared to isolated BES (74.0 ± 7.6%, p < 0.05). This first experimental bench model of pPCI in a bifurcation quantified thrombus trapping and embolization. BES provided the best thrombus trapping, while SAS and BES+POT achieved better final stent apposition. These factors should be taken into account in selecting revascularization strategy.

Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery.

Vein grafts are the most used conduits in coronary artery bypass grafting (CABG), even though many studies have suggested their lower patency compared to arterial alternatives. We have reviewed the techniques and technologies that have been investigated over the years with the aim of improving the quality of these conduits. We found that preoperative and postoperative optimal medical therapy and no-touch harvesting techniques have the strongest evidence for optimizing vein graft patency. On the other hand, the use of venous external support, endoscopic harvesting, vein preservation solution and anastomosis, and graft configuration need further investigation. We have also analyzed strategies to treat vein graft failure: when feasible, re-doing the CABG and native vessel primary coronary intervention (PCI) are the best options, followed by percutaneous procedures targeting the failed grafts.

Predictive Value of the Naples Score for InHospital Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is a significant contributor to mortality. The identification of high-risk patients holds great importance for prognosis. The development of a scoring system that incorporates both inflammatory and nutritional status components can provide valuable insights into prognosis. Patients and Methods: This is a retrospective observational study comprising 570 consecutive ST-elevation myocardial infarction patients who underwent primary coronary intervention between 2018 and 2020. Patient data were obtained from the electronic database of the hospital. Results: The incidence of in-hospital mortality rate was 4.9%. The entire group was then divided into two groups based on the presence of in-hospital mortality: 542 patients without in-hospital mortality constituted group 1, while 28 patients with in-hospital mortality formed group 2. In the multivariate logistic regression analysis, the Naples score was identified as an independent predictor of in-hospital mortality. Conclusion: A higher Naples score is associated with increased in-hospital mortality in patients with STelevation myocardial infarction who undergo primary coronary intervention.

Arg389Gly beta-1-adrenergic receptor polymorphism determines neutrophil-stunning-associated cardioprotection by metoprolol

Abstract Background Cardioprotective strategies to limit infarct size (IS) have become crucial. The damaged inflicted on the myocardium is the result of the processes of Ischemia and Reperfusion (I/R). In the clinical trial METOCARD-CNIC, it was shown that the intravenous (i.v.) pre-reperfusion administration of the β1-selective antagonist metoprolol reduces IS and improves long-term cardiac function in patients after acute myocardial infarction (1). However, the small sample size precludes a definite conclusion. Despite not having demonstrated a solid clinical benefit in terms of hard endpoints reduction, the clinical guidelines for the management of ST-Elevation Myocardial Infarction (STEMI) recommend the early administration of i.v. β-blockers in patients undergoing Primary Coronary Intervention. Additionally, our group has recently described that the beneficial effect of metoprolol against myocardial I/R injury is due to neutrophil stunning (2), which represents a one-of-a-kind property not shared by other i.v. β-blockers, such as atenolol or propranolol (3). Purpose Since β1-adrenergic receptor (ADRB1) is one of major targets of pharmacological therapy, great efforts are now underway to account for the relevance of the polymorphic variation. Here we explore whether the cardioprotection exerted by metoprolol is dependent on genetic polymorphisms in human ADRB1. Methods Patients included in the METOCARD-CNIC trial were grouped into the different variants for the ADRB1, rs1801252 and rs1801253 (SerGly49 and Arg389Gly, respectively), which might affect their response to the beta-1 modulation exerted by metoprolol on neutrophils and thus its cardioprotective effect. Additionally, the polymorphic-dependent effect of metoprolol on neutrophil migration was evaluated in healthy volunteers, whose neutrophils were exposed across the transwell filter to the CXCL1 in the presence or absence of metoprolol. Drug-receptor interaction properties were evaluated in silico. Results We found that Arg389Gly polymorphism of the human ADRB1 impacts the cardioprotective effect of metoprolol in STEMI patients. Therefore, Arg389 homozygosity was associated with lower infarcts (Figure 1) and better long-term left ventricle ejection fraction when metoprolol was intravenously administered prior reperfusion. Moreover, the disrupting effect of metoprolol on neutrophil migration was only observed in Arg389 homozygote volunteers (Figure 2). These differences were attributed to alterations in the drug-receptor complex stability when Gly residues are present in position 389 of the ADRB1. Conclusions From our perspective, these results are the first showing a polymorphic implication in drug response against myocardial I/R injury. All the data presented refine cardiovascular pharmacotherapy, and have major implications for the prospective clinical trial design aiming at positioning metoprolol as the beta-blocker of choice to reduce hard endpoints in STEMI patients.CardioprotectionNeutrophil migration

Abstract 365: Prehospital Electrocardiogram Integrated With Computer-Assisted Interpretation Shortens Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction

Introduction: Prehospital electrocardiogram (ECG) has been shown to expedite reperfusion therapy and reduce mortality in acute ST-elevation myocardial infarction (STEMI). The most challenge part for prehospital ECG is timely accurate interpretation and early activation for primary coronary intervention (PCI). In this study we aimed at constructing a prehospital ECG platform integrated with computer-assisted interpretation for strategic PCI activation in an Urban EMS system, and evaluating its efficacy and impact on door-to-balloon time in patients with STEMI. Methods: A prehospital ECG platform with computer-assisted interpretation and wireless transmission was constructed in 2018 in Taipei, together with EMT training for strategic triage of possible STEMI patients to primary PCI capable hospital. The primary outcomes were door-to-balloon time and scene-to-balloon time compared with those without prehospital ECG at the same period. The secondary outcomes were prehospital management time and transportation time. Results: From Feb. 2019 to July 2020, a total of 1670 patients meeting the predesignated criteria received prehospital ECG. Of these, 217 (13.0%) was interpreted as ST elevation out-of-hospital with notification of PCI capable hospital, and 65 (30.0%) was confirmed as STEMI thereafter. The sensitivity of computer-assisted interpretation of STEMI was 96% and specificity was 91%. Compared to the STEMI patients sent by EMS system to the same PCI hospital without prehospital ECG diagnosis and early activation, those with prehospital ECG showed no difference in prehospital management time and transportation time. However, the door-to-balloon-time (58.3 + 10.8 vs. 72.7 + 11.2, P &lt;0.01) and scene-to-balloon time (75.1 + 12.1 vs. 90.5 + 16.1, P &lt;0.05) were both significantly shorter. Conclusion: Prehospital ECG integrated with computer-assisted interpretation enhanced notification of PCI hospital and proper activation of cardiac catheterization team for STEMI patients in an Urban EMS system. Most importantly, it significantly shortens door-to-balloon-time and scene-to-balloon time without lengthening prehospital management and transportation times.

Correlation of Serum Uric Acid Levels with Coronary Flow in Patients with STsegment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention

Abstract Background Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing. STEMI is a significant cause of morbidity and mortality in patients with coronary heart disease. Aim of the Work Our study aimed to assess the impact of Uric acid level prior to primary PCI in patients presenting with acute STEMI on myocardial perfusion. Patients and Methods This is an interventional randomized controlled clinical trial conducted the coronary care units and coronary catheterization lab unit of the cardiology department and ER in Ain Shams University Hospitals between January 2021 and June 2021. The study was conducted in Ain Shams University hospitals on 80 patients presented from 2020 till the end of June 2021 with ST segment elevation myocardial infarction and underwent primary PCI. They were divided into two groups. The first group was hyperuricemic while the second group had normal uric acid blood level. Both groups received the standard care for acute STEMI patients which is the primary percutaneous intervention in addition to medications. Results Results for age, gender, hypertension, smoking, family history dyslipidemia, and diabetes did not show any statistical significance of value between the cases and control groups. In the control group, there were 19 patients with TIMI flow less than III and MBG less than III. Meanwhile, in the cases group, there were 8 patients with TIMI flow less than III and 7 patients MBG less than III. This difference was statistically significant with a P-value of 0.010 regarding TIMI flow score while a highly significant statistical difference of P-value 0.003 regarding MBG. Conclusion Our study concluded that normal uric acid level before primary PCI is associated with improved post-procedural TIMI flow and MBG.

Predictive value of elevated neutrophil gelatinase-associated lipocalin (NGAL) levels for assessment of in hospital adverse outcomes among myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Inflammatory biomarkers are known to rise and have significant predictive value for adverse outcomes in patients with acute coronary ischemia .Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein stored in mature neutrophil granules, is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. To date, very few studies have assessed the prognostic value of NGAL in this setting. Purpose We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI). Methods Blood samples for plasma NGAL were drawn immediately after admission. High NGAL was defined as values within the 4th quartile (&amp;gt;75percentile). Patients were assessed for major in-hospital adverse clinical events (MACE). These included reduced left ventricular ejection fraction, clinical heart failure findings and 30-day mortality. Multivariable logistic regression was used to evaluate the association between NGAL group and MACE. Receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of NGAL compared with other inflammatory biomarkers including white blood cell count(WBC), peak troponin level, peak C-reactive protein(CRP) and neutrophil/lymphocyte ratio(NLR) for the prediction of MACE. Results A total of 273 patients were included (mean age 66 ± 14 years, 81% males). Patients with high NGAL were at increased risk for MACE (62% vs. 19%; OR 6.88, 95%CI 3.77-12.54, p&amp;lt;0.001, Figure 1). After propensity score matching, 55 pairs of comparable patients were identified. Following matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, p=0.002; figure 1). In the multivariable logistic regression high NGAL level was independently associated with MACE (OR 9.25, 95%CI 4.33-19.76, P&amp;lt;0.001). The discrimination ability of NGAL to identify MACE (AUC 0.823) was significantly better (figure 2; p&amp;lt;0.001) than that of CRP (AUC 0.627), troponin (AUC 0.588), WBC (AUC 0.583) and NLR (AUC 0.601). Conclusions Among STEMI patients undergoing primary PCI, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.

Assessment of Tpeak-Tend/QT Ratio for Predicting Malignant Arrhythmias among ST Segment Elevation Myocardial Infarction Cases Undergoing Primary Coronary Intervention

Assessment of Tpeak-Tend/QT Ratio for Predicting Malignant Arrhythmias among ST Segment Elevation Myocardial Infarction Cases Undergoing Primary Coronary Intervention

TCTAP C-004 Kill Two Birds With One Stone: Primary Coronary Intervention for Acute Total Occlusion Left Anterior Descending and Right Coronary Arteries in ST-Segment Elevation Myocardial Infarction

TCTAP C-004 Kill Two Birds With One Stone: Primary Coronary Intervention for Acute Total Occlusion Left Anterior Descending and Right Coronary Arteries in ST-Segment Elevation Myocardial Infarction

Viddalena efektyvnist revaskuliaryzatsii miokarda u khvorykh pislia perenesenoho hostroho koronarnoho syndromu (literaturnyi ohliad; rezultaty vlasnykh doslidzhen)

Introduction. Acute coronary syndrome (ACS) is an urgent problem in the world. The vast majority of publications indicate the effectiveness of myocardial revascularization in this pathology. However, the effectiveness of this method of treatment in the remote period of GIMeST has not been sufficiently studied. The aim of the study. Analyze the long-term effectiveness of myocardial revascularization in patients after ACS based on literature publications and own results of conducted research. Materials and methods. 42 sources of published literature were used and the results of our own research on increasing the clinical effectiveness of coronary artery stenting by combining it with medical treatment in patients with post-STEMI with cardiovascular events were presented. Results. It has been proven that the 30-month survival rate of a patient with a hemodynamically significant lesion of the coronary artery trunk with drug therapy was 6.4 %, and with CABG – 80.0 %. The best results of myocardial revascularization were observed with CA p-value more than 70.0 % stenosis. It was found that primary coronary intervention in comparison with thrombolytic therapy contributes to a more complete restoration of epicardial impact (III degree according to the TIMI scale). Successful endovascular recanalization of infarct-induced KA helps to limit the area of necrosis and restore the reduced inotropic function of the hibernating myocardium up to 2 hours after the start of ACS. In the later periods of restoration of anterograde blood flow, the beneficial effect is manifested within a year. On the basis of our own research, positive dynamics of improvement in late LV remodeling and reduction of cardiac arrhythmias (SHE, AF, LVPH, and HF) are observed in patients with post-GIMeST after medical treatment. Conclusions. On the basis of the cited literary sources and our own research, it should be noted that in patients who underwent STEMI with cardiovascular events compared to those without cardiovascular events and underwent myocardial revascularization and outpatient drug treatment for two years, there was an increase in LVEF by 12.6 %, respectively, and a decrease in angina attacks by 6.6 %, CHF III and II FC – by 11.9 %, reduces SHE, AF and BLPNH and improves the quality of life. However, mortality 2 years after myocardial revascularization compared with medical treatment did not change significantly, and according to the literature, it decreased after CABG.

Análisis de una red de atención al IAMCEST: impacto pronóstico del tipo de primer contacto médico

Introduction and objectivesPrognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial. MethodsWe performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC). ResultsWe included 18 332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P <.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P <.05) and were less frequent in the PCC group (P <.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82 minutes); the EMS group achieved the shortest total ischemic time (median 151 minutes); CH had the longest reperfusion delays (P <.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P=.048), and OR, 1.17 (95%CI 1.02-1.36; P=.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR, 0.71 (95%CI 0.58-0.86; P <.001). ConclusionsFMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.

Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility

Introduction and objectivesPrognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial. MethodsWe performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC). ResultsWe included 18 332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P <.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P <.05) and were less frequent in the PCC group (P <.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82 minutes); the EMS group achieved the shortest total ischemic time (median 151 minutes); CH had the longest reperfusion delays (P <.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P=.048), and OR, 1.17 (95%CI 1.02-1.36; P=.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR, 0.71 (95%CI 0.58-0.86; P <.001). ConclusionsFMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.

Effect of selected cardiovascular factors on mortality in patients with ST-segment elevation myocardial infarction treated with primary coronary intervention.

This work was aimed at analyzing in-hospital, 30-day and 1-year mortality rates, impact of selected cardiovascular factors on mortality of patients with ST-segment elevation myocardial infarction (STEMI) manifested on electrocardiogram (ECG) and treated by the percutaneous coronary intervention (PCI) at our cardiac center, comparing the subgroup of non-shock (survivors and deceased) patients after STEMI and evaluating how these patients differ from each other. In total, 270 patients with STEMI manifested on ECG and treated by PCI were enrolled between April 1, 2018, and March 31, 2019, at our cardiologic center. Our study sought to determine the risk of death after acute myocardial infarction with carefully selected factors and parameters such as the presence of cardiogenic shock, ischemic time, left ventricular ejection fraction (LVEF), post‑PCI TIMI (thrombolysis in myocardial infarction) flow and serum levels of cardio‑specific markers, namely troponin T, creatine kinase and N-terminal pro-brain natriuretic peptide (NT-proBNP). Further evaluation included in-hospital, 30-day and 1-year mortality rates in shock and non-shock patients and determination of factors that influence the survival separately in each subgroup. The follow-up was carried out for 12 months after the myocardial infarction in form of outpatient examinations. After 12 months of follow-up, the collected data were statistically evaluated. Shock and non-shock patients differed in mortality and several other parameters including NT-proBNP values, ischemic time, TIMI flow defect and LVEF. In all outcomes (in-hospital, 30-day and 1-year mortality rates) the shock patients did worse than non-shock patients (p < 0.001). In addition, age, gender, LVEF, NT-proBNP and post‑PCI TIMI flow less than 3 were found to be important factors influencing the overall survival. In shock patients, the survival was associated with age, LVEF and TIMI flow, while in non-shock patients, the factors predicting survival were age, LVEF, level of NT-proBNP and troponin levels. Shock patients differed in terms of mortality in post-PCI TIMI flow, while non-shock patients varied in troponin and NT-proBNP levels. Despite early intervention, certain risk factors might affect the clinical outcome and prognosis of patients with STEMI treated by PCI (Tab. 5, Fig. 1, Ref. 30). Text in PDF www.elis.sk Keywords: myocardial infarction, primary coronary intervention, shock, mortality, cardio‑specific markers.

Modification of HEART Pathway for Patients With Chest Pain: A Korean Perspective.

The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m² with the conventional threshold of 30 kg/m² in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.

Left Anterior Descending Coronary Artery Ligation for Ischemia-reperfusion Research: Model Improvement via Technical Modifications and Quality Control.

Coronary heart disease is the leading cause of death globally. Complete cessation of blood flow in coronary arteries causes ST-segment elevation myocardial infarction (STEMI), resulting in cardiogenic shock and fatal arrhythmia, which are associated with high mortality. Primary coronary intervention (PCI) for recanalizing the coronary artery significantly improves the outcomes of STEMI, but advancements made in shortening the door-to-balloon time have failed to reduce in-hospital mortality, suggesting that additional therapeutic strategies are required. Left anterior descending coronary artery (LAD) ligation in rats is an animal model for acute myocardial IR research that is comparable to the clinical scenario in which rapid coronary recanalization through PCI is used for STEMI; however, PCI-induced STEMI is a technically challenging and complicated operation associated with high mortality and great variation in infarction size. We identified the ideal position for LAD ligation, created a gadget to control a snare loop, and supported a modified surgical maneuver, thereby reducing tissue damage, to establish a reliable and reproducible acute myocardial ischemia-reperfusion (IR) research protocol for rats. We also propose a method for validating the quality of study results, which is a critical step for determining the accuracy of subsequent biochemical analyses.

The Outcome of Intracoronary Tirofiban Administation at Primary Percutenous Coronary Intervention in ST-Elevation Myocardial Infarction Patients

Background and Aim: Thrombosis within the coronary arteries causes ST-elevation myocardial infarction. STEMI can be vascularized by primary PCI, which is class-I indication and the gold standard. The present study aimed to assess the outcome of pericardial tirofiban administration in patients with ST-level myocardial infarction following primary percutaneous coronary intervention. Patients and Methods: This cross-sectional study was conducted on 228 ST-elevation myocardial infarction (STEMI) patients in the Bahawalpur Heart Center, Bahawalpur for the duration of Six months from March 2022 to September 2022. Patients of both gender having an age range 25 to 65 years with STEMI were enrolled and categorized into two groups based on Tirofiban administration are as follows: Group-I comprised of Tirofiban group and Group-II control (non-tirofiban group). All the patients underwent primary percutaneous coronary intervention (PCI). Major bleeding, MACE, TIMI Grade flow, hematoma, myocardial blush, minor bleeding, and mortality were different variables measured. SPSS version 28 was used for data analysis. Results: The overall mean age was 42.82± 10.26 years. Of the total 228 STEMI patients, there were 166 (72.8%) male and 62 (27.2%) were females. The mean age of group-I (n=114) and group-II (n=114) was 41.74 ± 11.62 years and 43.9± 8.9 years. The age-wise distribution of patients were as follows: 74 (32.5%) in 25-35 years, 70 (30.7%) in 36-45 years, 64 (28.1%) in 46-55 years, and 20 (8.8%) in 56-65 years. The prevalence of hypertension, diabetes, and smoker in Tirofiban and non-tirofiban group was 32 (28.1%) vs. 34 (29.8%), 24 (21.1%) vs. 28 (24.6%), and 31 (27.2%) vs. 33 (28.9%) respectively. A p-value of 0.05 indicated that there was an independent difference in TIMI flow grades between the two groups. Based on clinical outcomes, the incidence of partial reperfusion TIMI flow grade, normal myocardial blush grade, major bleeding, MACE, hematoma, minor bleeding, and mortality was found in 72 (31.6%), 146 (64%), 60 (26.3%), 68 (29.8%), 61 (26.8%), 52 (22.8%), and 8 (3.5%) respectively. Conclusion: The present study found that patients with severe thrombus burden and STEMI who underwent emergency coronary intervention received intracoronary tirofiban treatment that was simple, safe, and effective. A significant difference in TIMI flow and myocardial blush grades was observed when intracoronary Tirofiban was administered to STEMI patients undergoing percutaneous coronary intervention compared with patients who did not receive intracoronary Tirofiban. Keywords: Intracoronary Tirofiban, Percutaneous coronary intervention, ST-elevation myocardial infarction, Outcomes

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions.

Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI. Data from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized. Out of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. Despite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.