Primary Percutaneous Coronary Angioplasty Research Articles

Role of aldosterone in the mid- and long-term left ventricular remodelling after acute myocardial infarction: the REMI study.

Whether aldosterone levels after myocardial infarction (MI) are associated with medium and long-term left ventricular (LV) remodelling in the era of systematic use of renin-angiotensin system inhibitors is uncertain. We prospectively investigated the relationship between aldosterone levels and mid- and long-term LV remodelling in patients with acute MI. AND RESULTS: Plasma aldosterone was measured in 119 patients successfully treated by primary percutaneous coronary angioplasty for a first acute ST-elevated MI (STEMI) 2-4 days after the acute event. LV volumes were assessed by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) in the same timeframe and 6 months later. LV assessment was repeated by TTE 3-9 years after MI (N=80). The median aldosterone level at baseline was 23.1 [16.8; 33.1] pg/mL. Higher post-MI aldosterone concentration was significantly associated in multivariable model with more pronounced increase in LV end-diastolic volume index (TTE: β ± SE: 0.113 ± 0.046, P =0.015; CMR: β ± SE: 0.098 ± 0.040, P =0.015) and LV end-systolic volume index (TTE: β ± SE: 0.083 ± 0.030, P=0.008; CMR: β ± SE: 0.064 ± 0.032, P =0.048) at 6-month follow-up, regardless of the method of assessment. This result was consistent also in patient with a LV ejection fraction (LVEF) >40%. The association between baseline plasma aldosterone and adverse LV remodelling did not persist at the 3-9 years follow-up evaluation. Aldosterone concentration in the acute phase was associated with adverse LV remodelling in the mid-term, even in the subgroup of patients with LVEF >40%, suggesting a potential role of the mineralocorticoid system in post-MI adverse remodelling. Plasma aldosterone was no longer associated with LV remodelling in the long-term. (NCT01109225) This article is protected by copyright. All rights reserved.

A Comparative Study between Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty on Left Ventricle Function in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction

Background: Ischemic heart disease is considered the most common cause of death, worldwide. It accounts for 1.8 million deaths annually in Europe alone. According to the center for disease control (CDC) it’s the most common cause of deaths in Egypt accounting for more than one fifth of the total death count per year (21%), followed by stroke, then cancer.
 Aim: This work aimed to study and assess the efficacy of a pharmacoinvasive strategy compared with a primary PCI strategy on the left ventricle function in treatment of patient with myocardial infarction.
 Methods: Our study was prospective non randomized which compares between two groups, both of which had first time acute STEMI admitted to our Tanta University Hospital within the accepted time, which are (group 1) patients who had primary PCI for the infract related artery as a reperfusion therapy and (group 2) patients who had thrombolytic followed by coronary angiography with a window to PCI (pharmacoinvasive technique). Coronary angiography was performed either immediately in case of failed thrombolytic therapy or within 3-24 hrs. Following thrombolytic in case of successful thrombolytic.
 Both groups presented to the hospital within the accepted time window for reperfusion therapy either (thrombolytic or primary PCI), within 12 hrs.
 Results: The study compared between the two groups in the acute stage during hospitalization of the patients and after discharge according to Clinical outcomes: (mortality, major adverse cardiac events (MACE) as heart failure symptoms, re-infarction and Cardiac death),angiographic findings (base line TIMI flow score and final TIMI score, single or multi-vessel disease), angiographic complications as dissection and no-reflow, occurrence of contrast induced nephropathy and cerebrovascular events and LV systolic function assessment by echocardiography.
 Conclusion: In this study, we highlighted the importance of total ischemic time and importance of patient and system related delays in influencing outcomes of STEMI.

One-year results from the Assessing MICRO-vascular resistances via IMR to predict outcome in ST-elevation myocardial infarction patients with multivessel disease undergoing primary PCI (AMICRO) trial.

In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce. We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling. The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up. A significant improvement of IRA-IMR values (from 47.9 to 34.2, p < 0.0001) was observed early after PPCI. Staged FFR-guided angioplasty was performed in 102 non-IRA lesions. We failed to find a correlation between IRA-IMR, clinical events and LV remodeling. Notwithstanding, in patients with anterior STEMI an inverse correlation between initial IMR values and LV function at follow-up was observed. After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI. https://clinicaltrials.gov/, identifier [NCT02325973].

Severe Impairment of Left Ventricular Regional Strain in STEMI Patients Is Associated with Post-Infarct Remodeling.

Background: Measures of global left ventricular (LV) systolic function have limitations for the prediction of post-infarct LV remodeling (LVR). Therefore, we tested the association between a new measure of regional LV systolic function—the percentage of severely altered strain (%SAS)- and LVR after acute ST-elevation myocardial infarction (STEMI). As a secondary objective, we also evaluated the association between %SAS and clinical events during follow-up. Methods: Of 177 patients undergoing echocardiography within 24 h from primary percutaneous coronary angioplasty, 172 were studied for 3 months, 167 for 12 months, and 10 died. The %SAS was calculated by dividing the number of LV myocardial segments with ≥−5% peak systolic longitudinal strain by the total number of segments. LVR was defined as the increase in end-diastolic volume >20% at its first occurrence compared to baseline. Results: LVR percentage was 10.2% and 15.8% at 3 and 12 months, respectively. Based on univariable analysis, a number of clinical, laboratory, electrocardiographic and echocardiographic variables were associated with LVR. Based on multivariable analysis, %SAS and TnI peak remained associated with LVR (for %SAS 5% increase, OR 1.226, 95% CI 1.098–1.369, p < 0.0005; for TnI peak, OR 1.025, 95% CI 1.004–1.047, p = 0.022). %SAS and LVR were also associated with occurrence of clinical events at a median follow-up of 43 months (HR 1.02, 95% CI 1.0–1.04, p = 0.0165). Conclusions: In patients treated for acute STEMI, acute %SAS is associated with post-infarct LVR. Therefore, we suggest performing such evaluations on a routine basis to identify, as early as possible, STEMI patients at higher risk.

Health-Related Quality of Life After Complete Versus Infarct Artery-only Percutaneous Coronary Revascularization in Multi-Vessel Disease with St Segment Elevation Myocardial Infarction

Objective: The purpose of this study was to compare the HRQoL of patients who had complete revascularization at the time of the first admission to those who underwent revascularization of the infarct artery alone using the EQ-5D (European quality of life-5 dimensions) self-report questionnaire. Background: The effect of revascularization procedures on health-related quality of life (HRQoL) in patients with multivessel disease who undergo primary percutaneous coronary intervention is the subject of controversy (P-PCI). Methods and Results: There was a significant difference between individuals with STEMI who received revascularization of the infarct-related artery alone and those who got total revascularization. we divided the group by the extent of complete revascularization (n=147) or the extent of IRA-only revascularization (n = 153) during the index admission Mobility, self-care, routine activity, pain or discomfort, anxiety, and sadness were all evaluated using the EQ-5D scale. The prevalence of heart failure and the gender of patients were different at baseline. Patients who had full revascularizations had lower mean ±SD (EQ-VAS and EQ-5D) utility ratings than those who had infarct artery revascularizations alone after 2 years of follow-up. (70.00 (±19.9) vs. 51.04 (±17.8), P &lt; 0.04, and 0.71 (±0.03) vs0.61 (±0.03), P&lt;0.005, respectively). Conclusion: Complete revascularization produced clinically significant increases in quality of life when compared to treating just the IRA at 24 months. Keywords: Complete Revascularization, Infarct-related artery, Primary percutaneous coronary angioplasty, ST-segment elevation.

Reducing the Wire Crossing Time in Primary Percutaneous Coronary Angioplasty: A Study From a Tier II City in India.

Acute coronary syndrome is a major cause of morbidity and mortality all over the world. Timely intervention in ST-elevation myocardial infarction (STEMI) in the form of primary angioplasty is the gold standard of treatment to reduce mortality and morbidity. “Time is muscle” is the phrase to impress upon the importance of time in treating patients with STEMI. Traditional treatment target included “door to balloon time” of 90 min or less. This “door to balloon time” is now rephrased as the “wire crossing time” (WCT). The European Society of Cardiology (ESC) updated its guidelines further, reducing the target of wire crossing time to 60 min.The present study is a brief report on the door to wire crossing time status in one of the tertiary care centers of a nonmetro city. Retrospective analysis of case records was done for 79 patients admitted with acute MI who underwent primary angioplasty between November 2018 and June 2019 (pre-corrective action group). Various reasons for the delay, right from the time of the patient reaching the emergency room (ER) to the time of wire crossing, were analysed and measures were taken to reduce the delay. The post-corrective action group comprised 77 patients. The major causes of a prolonged WCT in our setup were delayed diagnosis of STEMI in ER, delay in giving consent by the patient’s relatives, financial issues, and availability of cath lab technicians during the off-duty hour. The delay in WCT in our center was 121 min. Remedial actions were taken to mitigate the problems at each step, which resulted in a reduction of delay by 20 min, i.e., to 101 min leading to a significant difference in the outcome in view of morbidity and mortality.

Perfect optimization during coronary stent implantation - is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Chyrchel M, Maruszak N, Pilch W, Pawlik A, Bartuś S. Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2022. doi:10.5114/aic.2022.120373. APA Chyrchel, M., Maruszak, N., Pilch, W., Pawlik, A., & Bartuś, S. (2022). Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. https://doi.org/10.5114/aic.2022.120373 Chicago Chyrchel, Michał, Natalia Maruszak, Weronika Pilch, Artur Pawlik, and Stanisław Bartuś. 2022. "Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. doi:10.5114/aic.2022.120373. Harvard Chyrchel, M., Maruszak, N., Pilch, W., Pawlik, A., and Bartuś, S. (2022). Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. https://doi.org/10.5114/aic.2022.120373 MLA Chyrchel, Michał et al. "Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 2022. doi:10.5114/aic.2022.120373. Vancouver Chyrchel M, Maruszak N, Pilch W, Pawlik A, Bartuś S. Perfect optimization during coronary stent implantation – is it always beneficial? Staged primary percutaneous coronary angioplasty in a young patient with acute myocardial infarction. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2022. doi:10.5114/aic.2022.120373.

Prognostic value of frontal QRST angle and in hospital outcome in ST- Segment Elevation Myocardial Infarction patients undergoing primary percutaneous coronary angioplasty

Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance. Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 (&gt;90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3(&gt;90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant. Conclusion: Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.

Assessment of no-reflow phenomenon by non-constrast computed tomography in patients with acute myocardial infarction undergoing primary percutaneous coronary angioplasty

Funding AcknowledgementsType of funding sources: None.Background Coronary no-reflow phenomenon after primary percutaneous coronary angioplasty (pPCI) is an independent predictor of adverse clinical outcomes after AMI regardless of infarct size. The incidence of no-reflow varies widely depending on the diagnostic methods used. PurposeShowing whether non-contrast CT performed after pPCI might be usefull as a diagnosis of no-reflow phenomenon.MethodsSix STEMI patients (mean age = 68.3 y/o) underwent revascularization by pPCI and stent placement within 6 hours after onset of angina and within less than 90 minutes of door-to-balloon time. Due to the outbreak of SARS-Cov-2, chest CT scanning was indicated in all patients before coronary unit admission (192 ± 102 mins after pPCI). Results Three patients with a higher time than the mean angina time and than the mean door-to-ballon time (190 ± 149.3 versus 170 ± 107.5 and 63 ± 6.08 vs 56 ± 11.5, respectively) developed an interventional type of no-reflow phenomenon (Table 1) and CT scanning showed regional myocardial contrast retention related to the culprit coronary artery (Figure 1). On the other hand, three patients with a lower time than the mean angina time and than the mean door-to-ballon time showed TIMI III flow after pPCI (Table 1) and CT scanning showed no regional myocardial contrast retention (Figure 2). ConclusionMyocardial regional contrast retention, evaluated by non-contrast and non-ECG-gated computed tomography after pPCI, might be usefull for no-reflow diagnosis.TABLE 1AGE ANGINA-TIME DOOR-TO-BALLON-TIME BASAL/cTnT POST-pPCI/cTnT CHANGE/cTnTPTS 68 ± 17y/o 170 ± 107mins 56 ± 11mins 1635 ± 2549ng/L 9621 ± 4586ng/L 588% (N = 6)NO-REFLOWPATS 65 ± 25y/o 190 ± 149mins 63 ± 6mins 761 ± 837ng/L 11151 ± 2787ng/L 1465%(N = 3)TIMI-III FLOWPTS 72 ± 9y/o 117 ± 76mins 49 ± 12mins 2219 ± 3653ng/L 18091 ± 6148ng/L 364%(N = 3) Figure 1 Figure 2

Primary percutaneous coronary angioplasty in octogenarians and over. The experience of a high-volume hub center

Primary coronary angioplasty (PCI) is the reference treatment for acute ST-elevation myocardial infarction (STEMI), but elderly patients (>80 years) are underrepresented in clinical trials that support the guideline recommendations. The aim of this study was to assess in-hospital and 1-year total mortality of octogenarians and over treated with primary PCI at a large referral center. Single-center analysis of all consecutive patients with STEMI aged ≥80 years treated with primary PCI between 2010 and 2016. Patients were divided into three age groups: 80-84 years, 85-89 years, and ≥90 years. For each group, clinical and procedural data, in-hospital and 1-year mortality were analyzed. During the study period, 2127 patients were treated with primary PCI, 463 of them (22%) were aged ≥80 years (mean 85 ± 3 years). Of these, 51% were aged ≥80 and ≤84 years, 32% were aged ≥85 and ≤89 years, and 17% were aged ≥90 years. An increase of female gender prevalence and a decrease of risk factor prevalence as well as PCI success were observed with ageing. In-hospital and 1-year total death rates increased with age as well, mainly after 85 years. Primary PCI for STEMI among octogenarians and over is feasible and has good procedural results. Nevertheless, in-hospital and 1-year total mortality is high, with a marked deterioration after 85 years of age, when it doubles. Considering population demographics, specific studies in this very elderly population are needed to improve treatment and outcomes.

Adverse Events in Primary Percutaneous Coronary Angioplasty With Drug-Eluting Stents Compared With Drug-Coated Balloons: A Retrospective Outlook.

ObjectiveTo compare drug-eluting stents (DES) with drug-coated balloons (DCBs) in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in patients who have undergone primary percutaneous coronary intervention (PPCI).MethodologyOut of 210 angioplasties in six months, 80 patients were included; 40 in DES and 40 in DCB, respectively. All had a successful PPCI. It was defined as the achievement of thrombolysis in myocardial infarction (TIMI) grade II/III with <20% residual stenosis for the DES and TIMI grade II/III with <30% residual stenosis for the DCB. Any subsequent MACCE during the ensuing six months were assessed from emergency/outpatient records during their subsequent hospital visits, hospital registry, and telephonic interviews.ResultsThe mean age in the DES group was 54.83 + 8.72 years while it was 56.8 + 8.9 years in the DCB group. The left anterior descending artery (LAD) was the culprit artery in the majority of the cases in both groups. The mean diameter of DES and DCB was 3.17 + 0.38 mm and 2.75 + 0.53 mm, respectively. Overall, 15 adverse events were seen in the DES group and 16 in the DCB group. The difference was insignificant (P-value = ≥ 0.999). There were nine hospitalizations due to chest pain in the DES group and eight in the DCB group. Total vessel revascularization (TVR) was seen in two patients in the DES group and three patients in the DCB group. None of the patients suffered a stroke. All variables of MACCE were non-significant (P-value = ≥ 0.999).ConclusionDCB appears to be non-inferior to DES in PPCI at a median follow-up of six months.

Contrast-induced encephalopathy after primary percutaneous coronary angioplasty mimicking a subarachnoid hemorrhage

Contrast-induced encephalopathy (CIE) is a rare temporary phenomenon after intravenous injection of contrast media. The prognosis is generally good. Neurological symptoms develop within hours and resolve spontaneously over days. Global syndromes such as confusion can also be seen with cortical and subcortical deficits. There is a good correlation between the volume of contrast extravasation and clinical picture. In addition, this extravasation can be confused with intracranial hemorrhage in the early stage with imaging. In this case, we presented a 62-year-old male patient who developed CIE after coronary angioplasty mimicking subarachnoid hemorrhage and spontaneously recovered on the 2nd day of the event.

Dlaczego bardziej chorzy rezygnują z szansy na wyzdrowienie? Paradoks podejmowania decyzji o udziale w rehabilitacji kardiologicznej

Introduction. Coronary heart disease is the leading cause of death in industrialised countries. Cardiac rehabilitation allows improvement of functioning after acute coronary syndrome (ACS). It is important to identify the factors that have an impact upon treatment and rehabilitation decisions. We aimed to assess the impact of the clinical characteristics of ACS pts upon the decision to participate in an early inpatient cardiac rehabilitation programme (ICR). Material and methods. 137 patients after ACS (70% ST-elevation myocardial infarction) treated with primary percutaneous coronary angioplasty were enrolled in the study. Quality of life questionnaire (EuroQol-5D with Visual Analogue Scale) and depression score (Beck Depression Inventory) was collected at discharge from cardiology department (5 ± 2 days after ACS). All patients were asked to participate in a three-week-long ICR programme. Depending on approval or refusal, the patients were divided into two subgroups. Results. The group without ICR had lower median values of red blood count, haemoglobin and haematocrit compared to the rehabilitation group. The objectors had higher total cholesterol, low-density lipoproteins cholesterol, and Gensini score (40 ± 22.6 vs. 35 ± 24.3, p = 0.02). There was a strong trend towards a lower median depression level in the ICR group compared to controls (8 ± 8.8 vs. 12 ± 8.5, p = 0.06). No other statistically significant differences were identified between the groups. Conclusions. Patients who refuse cardiac rehabilitation had a worse clinical profile compared to those who accepted ICR. A higher depression score was a borderline significant predictor of refusing ICR. Paradoxically, sicker patients are less willing to take part in rehabilitation and require more encouragement as part of their individualised treatment.

Climate changes and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty

BackgroundThe impact of seasonal changes on the incidence of acute myocardial infarction has been incompletely appraised, especially in the modern era of primary percutaneous coronary intervention (PPCI). We aimed to appraise the overall and season-specific impact of climate changes on the daily rate of PCCI. MethodsDetails on PPCI and climate changes were retrospectively collected in three high-volume Italian institutions with different geographical features. The association between rate of PPCI and temperature, atmospheric pressure (ATM), humidity and rainfall was appraised with Poisson models, with overall analyses and according to season of the year. ResultsDetails on 6880 days with a total of 4132 PPCI were collected. Overall adjusted analysis showed that higher minimum atmospheric pressure 3 days before PPCI were associated with lower risk (regression coefficient = 0.999 [95% confidence interval 0.998–1.000], p = 0.030). Focusing on season, in Winter PPCI rates were increased by lower same day mean temperature (0.973 [0.956–0.990], p = 0.002) and lower rainfall (0.980 [0.960–1.000], p = 0.049). Conversely, in Spring greater changes in atmospheric pressure 3 days before PPCI were associated with increased risk (1.023 [1.002–1.045], p = 0.032), with similar effects in Summer for minimum temperature on the same day (1.022 [1.001–1.044], p = 0.040). ConclusionsClimate has a significant impact on the risk of PPCI in the current era, with a complex interplay according to season. Higher risk risk is expected with lower minimum atmospheric pressure in the preceding days, lower rainfall in Winter, greater changes in atmospheric pressure in Spring, and higher temperatures in Summer. These findings have important implications for prevention strategies.

Comparative Study between Safety and Efficacy of Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction

Comparative Study between Safety and Efficacy of Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction

A rare association of congenital mid-muscular ventricular septal defect with acute anterior wall myocardial infarction in the elderly: Clinical and hemodynamic implications

We report a rare association of acute myocardial infarction (AMI) in an elderly patient who had undiagnosed mid-muscular ventricular septal defect (VSD). The patient underwent primary percutaneous coronary angioplasty of the left anterior descending artery. It is uncommon to survive with VSD at this age, and the association of it with AMI is still rare. Whether the presence of congenital heart disease poses them for the increased risk of coronary artery disease is a matter of further investigation. Furthermore, the presence of VSD while they incur myocardial infarction affects the prognosis of the patient is not clear.

PO145 Presto Score: Simple Score For Early Discharge of Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Angioplasty

PO145 Presto Score: Simple Score For Early Discharge of Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Angioplasty

ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention.

BackgroundThe early identification of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) with high risk features is particularly important. Acute inferior STEMI may be associated with ST-segment depression in the left precordial leads (V4–V6). This study assessed prognostic value of ST-segment depression in these left precordial leads during the admission of patients with acute inferior STEMI treated with primary percutaneous coronary intervention.MethodsThis retrospective study enrolled 1,374 patients with acute inferior STEMI who underwent primary percutaneous coronary angioplasty between March 2011 and June 2014. The patients were divided into two groups: one group (n = 687) with left precordial ST-segment depression and the other (n = 687) without such ST-segment changes.ResultsThe patients with left precordial ST-segment depression were older and had higher incidence of hypertension, diabetes mellitus, and higher levels of troponin. In-hospital mortality was higher in patients with left precordial ST-segment depression. Advanced coronary artery disease was more observed in these patients.ConclusionIn patients with acute inferior STEMI treated with primary coronary intervention, left precordial ST-segment depression during admission of ECG is associated with more advanced coronary artery disease, and worse in-hospital clinical outcomes.

P1724PRESTO score: simple score for early discharge of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty

P1724PRESTO score: simple score for early discharge of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty

Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

BackgroundOutcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. ObjectivesThis comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. MethodsOver duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n=90), Non-smokers (n=60)] of the study population. There was no difference in procedure in two groups. ResultsIn the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value=0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p=0.001) respectively. Smokers tended to have higher thrombus burden (p=0.06) but less multi vessel disease (p=0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p=0.261) and 5.33% vs 2.66% (p=NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. ConclusionThe study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.