Primary Percutaneous Intervention Research Articles

Incidence of left ventricle thrombus formation in patients with STEMI in the current era of antithrombotic treatment

Abstract Funding Acknowledgements None. Introduction Left ventricular (LV) thrombus formation is a serious complication of acute ST-segment elevation myocardial infarction (STEMI) which may result in ischemic stroke and systemic thromboembolism. There is limited evidence on the incidence and impact of LV thrombus in STEMI patients in the current era of antithrombotic treatment. Purpose To evaluate the incidence of LV thrombus formation in STEMI patients and to assess clinical predictor factors of LV thrombus formation leading to in-hospital major cardiac events (MACCE). Methods We prospective collected data from 504 STEMI patients treated with primary percutaneous intervention (PCI) in our large volume university hospital from April 2019 to September 2019. All patients underwent echocardiography examination at presentation and at hospital discharge. Results Mean age of the patients was 66.2 years and 78.8% were male. The incidence of LV thrombus formation was 5% in overall cohort and 9.4% in anterior STEMI. Among patients with LV thrombus, the majority had anterior STEMI (96% vs 48.4%; p<0.001), lower LV ejection fraction (LVEF)(35% vs 43%; P<0.001), more increased LV dimension /volume (36%vs7.3%; p<0.001), more apical aneurism/dyskinesia presence (36% vs 9%; p<0.001), longer ischemia time (25 hours vs 14 hours; p<0.002), more increased TPI values (p-0.22) and underwent less coronary angiography (p<0.02) and primary PCI (P=0.021). Increased LV dimension/volume was associated with 3.35 times higher risk of having LV thrombus (p=0.023). Also anterior STEMI was associated with 14 times higher risk of having LV thrombus=0.012. Patients with LV thrombus had a numerically higher incidence of in-hospital MACCE events (20% vs 13.5%; p=0.36). Conclusion The incidence of LV thrombus formation in STEMI still remain high regardless of primary PCI treatment and current antithrombotic treatment, and is higher in patients with anterior STEMI, lower LVEF, adverse ventricular remodeling, apical aneurism/dyskinesia presence, late hospital presentation and longer ischemia time. The presence of LV thrombus was independently associated with in-hospital MACCE events.

Ability of the coronary angiography-derived index of microcirculatory resistance to predict microvascular obstruction in patients with ST-segment elevation.

The coronary angiography-derived index of microvascular resistance (caIMR) correlates well with the index of microcirculatory resistance (IMR), which predicts microvascular obstruction (MVO). However, the relationship between caIMR and MVO remains unclear. To evaluate the predictive ability of caIMR of MVO after ST-segment elevation myocardial infarction (STEMI). CaIMR was calculated using computational flow and pressure simulation in patients with STEMI in whom MVO status had been assessed by cardiac magnetic resonance (CMR) after successful primary percutaneous intervention at Peking University First Hospital between December 2016 and August 2019. The clinical, biochemical, echocardiographic, and CMR characteristics were assessed according to MVO status. The predictive value of the clinical parameters and caIMR was evaluated. Fifty-three eligible patients were divided into an MVO group (n = 32) and a no-MVO group (n = 21). The caIMR tended to be higher in the MVO group (41.6 U vs. 30.1 U; p = 0.136). CaIMR and peak cardiac troponin-I (cTNI) were independent predictors of MVO (per 1-U increment in caIMR: odds ratio [OR] 1.044, 95% confidence interval [CI] 1.004-1.086, p = 0.030; per 1 ng/L increase in peak cTNI: OR 1.018, 95% CI 1.003-1.033, p = 0.022). In receiver-operating characteristic curve analysis, when a cut-off value of 45.17 U was used, caIMR had some ability to predict MVO (area under the curve 0.622, 95% CI 0.478-0.752, p = 0.127). CaIMR and peak cTNI were independent predictors of short-term MVO in patients with STEMI who had undergone successful primary percutaneous coronary intervention and may help to identify those at high risk of MVO.

Severe Intermittent Claudication. Medical Treatment or Primary Percutaneous Intervention?

Severe Intermittent Claudication. Medical Treatment or Primary Percutaneous Intervention?

Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome

To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

Реєстр перкутанних коронарних втручань: зміни за останні роки (2010–2022)

In 2022, the number of coronary angiograms in Ukrainian clinics was 51 084, which is 27.6 % more than in 2019, the number of stented patients is 27 513 for all forms of coronary artery disease (scheduled and urgent patients), which is 19.7 % more than in 2019 year and 16 847 stenting were performed in STEMI patients in the first day from the onset of symptoms, which is 12.9 % more than in 2019.During the period of the Register operation, the fact of creation of 66 reperfusion centers was recorded, which are the main part of Regional Reperfusion Networks (RRN) and strive to function in accordance with national unified protocols for the treatment of STEMI, NSTEMI and stable coronary syndromes.Today, the distribution of patients by time from the onset of symptoms to mechanical reperfusion in Ukraine is distributed as follows: in the first 12 hours from the onset of STEMI symptoms, 85 % are present (15 % are «late» patients who are hospitalized at 12–24 hours from the onset of symptoms or later, often requiring urgent coronary angiography and possibly primary stenting). Patients arriving in the «ideal» period for reperfusion (in the first 2 hours) is about 15 %, the largest group of STEMI patients who arrived at the clinic in the first 2–4 hours from the onset of symptoms is 30 %, and the number of patients with AMI in the period of 4–6 hours from the onset of symptoms, the average is 25 %, and the 6–12-hour group completes the analysis by 15 %, respectively.The number of procedures in STEMI patients increased annually, which led to a decrease in hospital mortality in reperfusion centers (55–60 % of patients in catheterization laboratories in Ukraine are STEMI patients) to an average of 4.7 %, and in the general group of AMI in Ukraine to 12.3 %. Unfortunately, 40–45 % of patients are currently hospitalized in clinics without the possibility of primary stenting.A ten-year observation of the dynamics of primary stenting revealed changes, which we called the «reperfusion paradox», which occurred in 2015–2016, which fully confirmed the correct vector of technology development and determined the trend of its development. This phenomenon is the beginning of a natural decrease in the number of fibrinolytic procedures from 27 % (2010 year) to 4.6 % (2021 year), respectively, and an increase in the number of primary procedures in STEMI patients from 4.0 % (2010 year) to 56.4 % (2022 year), which is quite natural and confirms the processes of active development and systemic transformations in interventional cardiology in Ukraine and around the world.As a result, it was found that we have increased 17 times the number of primary percutaneous interventions per million population over the last decade, while European countries have increased the number of similar procedures by only 14 %. This fact indicates the correct direction of development and the speed of movement in this direction.

Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis

Objective: Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The role of coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction remains controversial. In this study, we aimed to assess the predictive value of fQRS in-hospital mortality among acute STEMI patients undergoing emergency CABG for primary revascularization. Patients and Methods: Between 2010 and 2020, we retrospectively included 99 consecutive STEMI patients who were not eligible for primary percutaneous intervention and required emergency CABG. The study population was divided into two groups: survivors and non-survivors. We compared the two groups regarding demographic, clinical, and operative characteristics. Results: fQRS was identified as an independent predictor of in-hospital mortality (p = 0.037). Additionally, left ventricular ejection fraction (LVEF) was an independent predictor of in-hospital mortality (p = 0.028). Glomerular filtration rate (GFR), glucose levels, and Killip class ≥ III were significantly associated with in-hospital mortality (p = 0.002), (p = 0.001) and (p < 0.001). Conclusion: fQRS emerged as an independent predictor of in-hospital mortality among patients undergoing emergency CABG for primary revascularization in cases of STEMI.

Long-term prognosis and prognostic factors after primary prophylactic implantable cardioverter-defibrillator therapy

BackgroundLittle is known regarding which patients with ischemic cardiomyopathy (ICM) should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator (ICD), in the primary percutaneous intervention era. The aim of this study was to investigate the influence of non-sustained ventricular tachycardia (NSVT) on major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients. MethodsWe retrospectively analyzed patients of ICM and non-ICM who underwent ICD implantation at our institute from October 2006 to August 2020. MACE were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies. ResultsA total of 167 patients were enrolled [male, 138 (83 %); age, 62.1 ± 11.7 years; left ventricular ejection fraction, 23.5 ± 6.1 %; left ventricular diastolic diameter, 67.4 ± 9.0 mm; atrial fibrillation, 47 (28 %); NSVT, 124 (74 %); use of class III antiarrhythmic drugs, 55 (33 %); ischemic cardiomyopathy, 56 (34 %); cardiac resynchronization therapy, 73 (44 %)]. The median follow-up duration was 61 months. MACE occurred with 71 patients (43 %). When comparing baseline characteristics of the patients, left ventricular ejection fraction (p = 0.02) and atrial fibrillation (p = 0.04) were significantly associated with MACE. The multivariable Cox analysis for the target variable MACE identified atrial fibrillation (hazard ratio 2.00; 95 % confidence index 1.18–3.37; p = 0.01) as an independent predictor for MACE. ConclusionsPrior NSVT before ICD implantation was not an independent predictor of future MACE in patients with HFrEF with primary prophylactic ICD. In contrast, atrial fibrillation was associated with worse prognosis. To predict the prognosis of patients with primary prophylactic ICD, these factors should be assessed as comprehensive risk stratification factors for MACE.

Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry.

The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries.

Management of anterior ST-elevation myocardial infarction presenting more than 48 hours from symptom onset without reperfusion therapy in the cardiac care unit

ST-elevation myocardial infarction is a form of acute coronary syndrome that is the leading cause of death worldwide. Treatment with reperfusion therapy in the form of primary percutaneous intervention is the main treatment to reduce morbidity and mortality. However, reperfusion therapy is not recommended for patients presenting with symptoms onset of more than 48 hours. A 62-year-old male patient was diagnosed with anterior STEMI with symptoms onset of more than 48 hours based on complaints of anginal chest pain and shortness of breath. ST-segment elevation in V1-V4 and pathological Q in V1-V3 on ECG and increased hs-Troponin I was reported. The patient was not treated with reperfusion therapy based on treatment recommendations. The patient was given vasodilators, beta-blockers, statins, heparinization, and comorbid infection control in the cardiac care ward. Clinical improvement was obtained, and the patient was discharged after seven days of hospitalization and then was planned for Dobutamine Stress Echo during the follow-up visit. Conservative management and viability testing are the main options for patient management in STEMI with symptom onset of more than 48 hours without any complaints of chest pain, stable hemodynamics, and no life-threatening arrhythmia.

Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review

BackgroundRural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT. MethodsA systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting. ResultsAfter removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services. ConclusionsGiven the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.

Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention

Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Objective: To estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in the Sultanate of Oman. Methods: A cross-sectional retrospective study was conducted. All patients who presented to the emergency department at two public hospitals and underwent primary percutaneous interventions during the period of two years were included. Results: The sample included 426 patients. The median door-to-balloon time was 142 minutes. The result of bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were three times more likely to have a delayed DTB time compared with patients presenting with typical symptoms (OR = 3.003, 95% CI: 1.409–6.400, p = .004). In addition, patients who presented during off-hours were two times more likely to have a delayed DTB time compared with patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087, p = .005). Conclusion: To meet the door-to-balloon time recommendation, it is important to ensure that there is adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.&#x0D; Keywords: Acute Myocardial Infarction; Clinical Management; Door-to-balloon Time; Emergency Care Systems; Staffing and Scheduling; Oman.

ST-Segment Resolution after Primary Percutaneous Coronary Intervention (PCI) in Patients with Acute ST-Segment Elevation Myocardial Infarction (STEMI)

Objective: To assess the ST segment resolution &gt;50% in electrocardiogram taken after one hour of primary percutaneous intervention as compared to initial elevation as the predictor of successfulness of procedure. Study Design: Observational study. Place and duration: The study was conducted at PAF Hospital, Islamabad, Pakistan from February 2019 to January 2020 in one-year duration. Methodology: A total of 100 patients presenting with ST-segment elevation myocardial infarction (STEMI) were planned for primary percutaneous coronary intervention and were enrolled in the study. Baseline ECG was taken, and 2nd ECG was taken after one hour of PCI. ST resolution is the main outcome variable of the study. SPSS version 23 was used for data analysis. Results: ST-Resolution was noted in n=66 (66%) patients with (63.2-68.5%) 95% CI. Regarding the association of ST-Resolution with effect modifiers no statistically significant differences were found. The patients &gt;40 years of age had about 2 times more risks in non-ST-resolution, (1/0.51=1.96 OR). Conclusion: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, ST-segment resolution in electrocardiograms recorded 1 hour after primary PCI is a sign of a successful procedure and good perfusion.

Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI).

Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. The mean change of EF was 8.04±3.32% in group I versus -.39±5.09 % in group II (p<.001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p<.001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.

Natural IgM Recognizing Oxidation-Specific Epitopes Attenuate NETosis Induced By Extracellular Vesicles

BACKGROUND Neutrophil extracellular traps (NETs) emerged as important contributors to thrombus formation. We have previously demonstrated the role of NETs in acute myocardial infarction (AMI). However, the mechanistic understanding of modulators of NETosis in the context of AMI is scarce. Levels of extracellular vesicles (EV) carrying lipid peroxidation-derived epitopes also called oxidation-specific epitopes (OSE), are increased at the culprit site in AMI. Importantly, natural IgM antibodies with specificity for OSE have been shown to inhibit the pro-coagulatory and pro-inflammatory effects of EV, and low plasma levels predict cardiovascular risk. We hypothesized that large EV, also called microvesicles (MV), induce NETosis during AMI, and that natural anti-OSE IgM are inhibiting this process. METHODS Patients were consented when the decision for primary percutaneous intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI) was made, and blood was aspirated from the culprit site and peripheral site as an in-patient systemic control (n=28). Myocardial function was assessed by cardiac magnetic resonance imaging (cMRI) 4±2 days and 195±15 days after pPCI. EV were isolated from patient culprit site plasma and cell culture supernatants and characterized by flow cytometry. Isolated EV were used for neutrophil stimulation in vitro, and in vivo using a murine injection model in the presence of the IgM LR04 recognizing the immunodominant OSE, malondialdehyde (MDA) epitopes, or an isotype control. NETs were visualized by immunofluorescence staining for DNA-histone, citrullinated histone 3 (citH3) and myeloperoxidase (MPO). NET markers and natural IgM recognizing OSE in murine and patient plasma were measured by ELISA. RESULTS Culprit site plasma contained more and proportionally higher levels of leukocyte-derived CD45+ MDA-EV compared to the peripheral site plasma. NET markers were associated with CD45+ MDA-EV at the site of occlusion. Decreased levels of MDA-specific IgM at the culprit site indicated consumption of protective IgM. EV isolated from AMI patient plasma induced NETosis in vitro and after injection into C57BL/6 mice in vivo, as determined by NET markers and fluorescence microscopy of histone citrullination in neutrophils. The malondialdehyde-specific IgM LR04, but not a control IgM, reduced the NETogenic effects of EV in vitro and in vivo. Higher circulating levels of EV and lower OSE-IgM were associated with reduced ejection fraction in AMI patients at follow-up. CONCLUSION EV from AMI patients induced NET formation in vitro and in vivo, and natural IgM recognizing malondialdehyde-epitopes attenuated this effect. In summary, the balance between OSE-EV and OSE-IgM at the culprit site during AMI may represent a potential prognostic and therapeutic target. Moreover, the modulatory effect of natural IgM may also apply to other pathologies where NETosis contributes to thrombus formation.

Current treatment of acute coronary syndromes in cancer patients: the need for improvement

Abstract Background Cancer patients can develop acute coronary syndromes (ACS) due to their oncological therapy exposure or shared risk factors between cancer and cardiovascular disease. Cancer patients have been reported to receive suboptimal treatment in this setting, with lower rates of coronary angiography and or primary percutaneous intervention, despite the clear benefit of these therapies in ACS. This disparity in the care of cancer patients can lead to worse cardiovascular outcomes. Purpose To describe the contemporary therapeutic approach in patients with a history of cancer or current cancer presenting with an acute coronary syndrome to a tertiary care cardiology hospital. Methods We performed an electronic chart review of patients admitted to the cardiac intensive coronary unit of a tertiary care Cardiology hospital in our city, from May 2021 to February 2023. Patients with a current or historical diagnosis of cancer and acute coronary syndrome (with and without ST segment elevation) were identified. We collected the following information: demographic data, oncological diagnosis, cancer treatment history, ACS type, and ACS management. Results Seventy-five patients had diagnosis of current or historical cancer in the selected period. Of them, 40 patients were admitted with diagnosis of acute coronary syndrome. Mean age was 69.8 + 10.0 years. Twenty-one patients (52.5%) had a historical diagnosis of cancer and nineteen patients had diagnosis of current cancer. Of patients with historical cancer the most common type was hematological, followed by prostate and renal cancer. The most common types of active malignancies were prostate, colon, and renal cancer. ST-segment elevation myocardial infarction (STEMI) was the most common type of ACS (27 patients). Notably, only half of the patients presenting with STEMI underwent primary percutaneous coronary intervention, four patients received fibrinolytic treatment, and one third of patients with STEMI did not receive reperfusion therapy. Among patients with STEMI, mean time from symptom onset to reperfusion therapy was 495 minutes. Regarding the 13 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), eight underwent an invasive strategy (coronary angiography) in the first 48 hours, of whom six had percutaneous coronary intervention, and one underwent coronary artery bypass graft surgery. Five patients with NSTEMI (38.4%) did not undergo coronary angiography during their hospitalization. Conclusions Patients with active or historical cancer presenting with STEMI receive late reperfusion treatment and up to one out of three do not receive reperfusion therapy. An important proportion of cancer patients presenting with NSTEMI do not even undergo invasive strategy. It is imperative to provide optimal care of cancer patients presenting with ACS.

Predictive role of intracoronary electrocardiography for procedural success in patients with ST-elevation myocardial infarction developing coronary no-reflow

Abstract Background The no-reflow phenomenon (NRP) is associated with increased mortality and development of heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Although there is no definitive method for NRP treatment in current guidelines, methods to predict the success of procedures with NRP are also limited. There is a need for a practical, real-time method for predicting the outcome of procedures in NRP patients. Intracoronary electrocardiography (ic-ECG) which is simple, cost-effective, and a bedside indicator of myocardial ischemia, is proposed as a potential solution in this study. Purpose The aim of this study was to examine the potential of ic-ECG in predicting the success of primary percutaneous intervention (pPCI) in patients with STEMI and the development of coronary no-reflow. Methods This was a prospective investigation that included 71 patients diagnosed with acute anterior STEMI and underwent pPCI between November 2021 and May 2022. The patients were separated into two groups based on the Thrombolysis in Myocardial Infarction (TIMI) flow grade criteria, with those having a grade of less than 3 defined as NRP. The NRP group was further analyzed to determine the relationship between the percentage of ST-segment resolution (STR) in the ic-ECG records taken during pPCI and short-term major adverse cardiovascular events rates and left ventricular ejection fraction (LVEF) recovery status. Results A total of 71 patients, with a mean age of 56.8 years and 76.1% of them being male, were included in the study. Of these patients, 26 were found to have developed NRP, while TIMI-3 flow was observed in 45 patients. In the NRP group, various parameters were found to be associated with LVEF recovery, such as peak troponin value (6267.8±2488.4 ng/ml vs 3244.6±3183 ng/ml, p=0.013) basal low-density lipoprotein cholesterol (LDL-C) (138.8±29.9 mg/dl vs 104.5±40 mg/dl, p=0.021), total cholesterol value (222.7±69.2 mg/dl vs 167.5±44.5 mg/dl, p=0.024), and ic-ECG STR level (21±22.3% vs 65.5±17%, p&amp;lt;0.001). The results of the multivariate analysis and subsequent ROC analysis showed that an ic-ECG STR ratio greater than 42% (sensitivity 100%, specificity 84.6%) was an independent predictive factor for LVEF improvement (Table 1). Conclusions The results showed that the STR rate measured by ic-ECG was significantly associated with LVEF recovery and was an independent predictive factor for LVEF recovery with a sensitivity of 100% and specificity of 84.6%. The study highlights the usefulness of ic-ECG in predicting pPCI success in NRP patients and supports its integration into clinical practice.

Abstract 17879: Assessing the Safety of an Early Repatriation Strategy for Uncomplicated ST-Elevation Myocardial Patients After Primary Percutaneous Intervention

Introduction: Repatriation of patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is common in Canadian regional health care programs. However, the safety of early repatriation after PPCI in uncomplicated STEMI patients remains unknown. We aimed to compare the outcomes between uncomplicated STEMI patients repatriated early (transfer to home hospital ≤4hrs of PPCI completion) vs. those who remained at the PPCI-hospital until discharge. Methods: We performed a retrospective, cohort study examining consecutive, uncomplicated STEMI patients treated with PPCI between 2016-2018 in the Fraser Health Authority. Patients were designated as uncomplicated if there was no evidence of cardiogenic shock, prolonged cardiac arrest or congestive heart failure requiring mechanical ventilation. Outcomes of interest included discharge with guideline-based medical therapy (GBMT) and a composite of 1-year major cardiovascular events. Results: A total of 787 patients were included for analysis, with 62% (n=492) being repatriated early. Early repatriated patients were similar in age and baseline characteristics when compared with those discharged from the PPCI-based hospital. Interestingly, early repatriated patients were more likely to be discharged on GBMT (89% vs. 83%, p=0.015) In multivariate analysis, early repatriation was not associated with worsened 1-year cardiovascular outcomes (OR 1.05, 95% CI 0.6782,1.6521, p=0.80). Independent predictors of 1-year major cardiovascular outcomes included hypertension (OR 1.75, 95% CI 1.0918-2.8349, p=0.02) and discharge with GBMT (OR 0.49, 95% CI 0.2831-0.8465, p=0.01). Amongst the subset of early repatriated patients, primary treatment by cardiologist vs internist did not result in differences in 1-year outcomes (10% vs. 8%, p=0.23) or discharge with GBM (87% vs. 83%, p=0.09). Conclusions: Early repatriation of uncomplicated STEMI patients after PPCI was associated with outcomes similar to those having ongoing care at the PPCI-based hospital. Therefore, early repatriation serves as a safe treatment strategy for regional STEMI programs and may be particularly relevant for PPCI centres with limited bed capacity.

Abstract 13478: Causes of Long-Term Mortality in Patients With Microvascular Obstruction Following ST-Segment Elevation Myocardial Infarction

Introduction: The presence of microvascular obstruction (MVO) following ST-segment elevation myocardial infarction (STEMI) portends a poor prognosis and is associated with adverse left-ventricular (LV) remodeling and an increase in mortality in the subsequent year of follow-up. However, the long-term effects of MVO on mortality have not been previously described. Methods: We analyzed the long-term follow-up and cardiac MRIs of 475 patients (Average age = 60 years, 76% male) for the presence (n=337) or absence (n=138) of MVO at a single institution following STEMI and successful reperfusion with primary percutaneous intervention (PCI). Causes of death were determined from the patient's electronic medical record or death certificate. Results: The infarct-related artery was more likely to be the LAD in patients with MVO and the RCA in patients without MVO. Patients with MVO had greater ischemic times (159 vs. 141 mins; p = 0.012) and were more likely to have TIMI 0 flow on presentation (71 vs 54%; p &lt;0.002). Patients with MVO had greater infarct size by cardiac enzymes resulting in greater LV end-diastolic volume index (LVEDVI) (80 vs.75 ml/m2), LV end-systolic volume index (LVESVI) (39 vs 30 ml/m2) and LV mass (146 vs 134 g) and reduced LVEF (48 vs 58 %; all p &lt; 0.01) by cardiac MRI performed 1-3 days following STEMI and PCI . During long-term follow-up a total of 56 patients with MVO died compared to 18 patients without MVO. Patients with MVO died sooner after STEMI (5.9 vs 7.8 years) and were more likely to die from cardiovascular causes such as progressive heart failure or sudden cardiac death (Table). LVEF before death was lower in the MVO group (46 vs 52%). Conclusions: There is significant long-term mortality associated with MVO following STEMI with the majority of patients dying from cardiovascular causes. In contrast, patients with STEMI without MVO rarely died from a cardiac etiology but from cancer and natural causes.

Real-World Evaluation of a Pharmacoinvasive Strategy for STEMI in Latin America: A Cost-Effective Approach with Short-Term Benefits.

While pharmacoinvasive strategy (PI) is a safe and effective approach whenever access to primary percutaneous intervention (pPCI) is limited, data on each strategy's economic cost and impact on in-hospital stay are scarce. The objective is to compare the cost-effectiveness of a PI with that of pPCI for the treatment of ST-elevation myocardial infarction (STEMI) in a Latin-American country. A total of 1747 patients were included, of whom 470 (26.9%) received PI, 433 (24.7%) pPCI, and 844 (48.3%) NR. The study's primary outcome was the incremental cost-effectiveness ratio (ICER) for PI compared with those for pPCI and non-reperfused (NR), calculated for 30-day major cardiovascular events (MACE), 30-day mortality, and length of stay. For PI, the ICER estimates for MACE showed a decrease of $-35.81/per 1% (95 confidence interval, -114.73 to 64.81) compared with pPCI and a decrease of $-271.60/per 1% (95% CI, -1086.10 to -144.93) compared with NR. Also, in mortality, PI had an ICER decrease of $-129.50 (95% CI, -810.57, 455.06) compared to pPCI and $-165.27 (-224.06, -123.52) with NR. Finally, length of stay had an ICER reduction of -765.99 (-4020.68, 3141.65) and -283.40 (-304.95, -252.76) compared to pPCI and NR, respectively. The findings of this study suggest that PI may be a more efficient treatment approach for STEMI in regions where access to pPCI is limited or where patient and system delays are expected.