Primary Percutaneous Transluminal Coronary Angioplasty Research Articles

Torsades De Pointes Complicating Acute Myocardial Infarction, Twisting the Prognosis

Introduction Torsades de pointes (TdP), a form of polymorphic ventricular tachycardia that manifests in the setting of an acquired or congenital QT interval prolongation. Polymorphic VT can occur in hyper acute phase or healing phase of an acute myocardial infarction. The presence of necrotic area caused by the infarction explains the existence of a possible circuit as well as the appearance of a re-entry arrhythmia. Aims and Objectives Our aim is to study the incidence of long Qt induced TdP in acute MI patients and its prognostic implications. We also want to analyze the impact of primary percutaneous transluminal coronary angioplasty in the management of these subset of patients. Methods In this cross-sectional observational study done from May 2021 to May 2022, We have studied 320 cases of acute MI, of which 6 were found to have TdP (1.9%). Four patients had inferior wall myocardial infarction and 2 patients had Non-ST elevation MI. Thrombolysis was done in 2 cases. Two cases underwent primary angioplasty. One case was recommended for coronary artery bypass grafting. All cases underwent appropriate electrolyte correction, besides cardioversion, as needed. Results All patients with TdP had prolonged QT interval. 50% of patients had mild hypokalemia. Two patients had complete heart block. Three patients had severe left ventricular dysfunction. Patients who underwent primary angioplasty survived. Thrombolysis had less impact on survival in Acute Mi with TdP. Conclusion Early percutaneous coronary angioplasty, combined with electrolyte correction, improves the prognosis in TdP complicating acute MI.

Prognostic Value of T peak-T end Interval on Surface ECG in Patients Undergoing Reperfusion Therapy for ST Segment Myocardial Infarction

Background: In post-ST-segment elevation myocardial infarction (STEMI) patients, the indices of repolarization on electrocardiogram (ECG) have shown promise for the prediction of death and malignant arrhythmias. In our study, we analyzed prospectively, in patients with STEMI undergoing reperfusion therapy, the acute effects of the reperfusion on the Tpeak-Tend (TpTe) and its predictive value for 30-day mortality, ventricular arrhythmias, and heart failure. Materials and Methods: We studied 75 STEMI patients aged 18–80 years admitted to Nizam’s Institute of Medical Sciences, Hyderabad, over 6 months. ECGs were taken before and 90 min after reperfusion. TpTe interval was measured before (pre-TpTe) and after reperfusion (post-TpTe). 24-h Holter monitoring was recorded within 72 h of reperfusion to look for any arrhythmias. Patients were followed up for a period of 30 days, and all the major adverse cardiac events (MACE) if any, were noted. Results: In the primary percutaneous transluminal coronary angioplasty (PTCA) group, the mean change in TpTe after intervention was 19.7 ± 16.7 ms, whereas in thrombolysis group, it was 10.7 ± 13.8; and the difference was statistically significant (P < 0.05), suggesting the superiority of primary PTCA compared to thrombolysis. When pre-TpTe interval was compared between who survived (69) and who succumbed (09), higher values were seen in patients who succumbed to death (115 ± 5.48) versus (88 ± 16.5) (P < 0.05). Pre-TpTe value of 105 had 100% sensitivity and 83% specificity in predicting mortality. Conclusion: Primary PTCA was superior to thrombolysis in reducing the TpTe interval and MACE events. The pre-TpTe interval could predict 30-day mortality and ventricular arrhythmias in the immediate and late period after revascularization in STEMI.

Acute myocardial infarction with left main coronary artery ostial negative remodelling as the first manifestation of Takayasu arteritis: a case report

BackgroundTakayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate.Case presentationA 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA.ConclusionHere, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.

Incidence of atrial fibrillation and its effects on long-term follow-up outcomes in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.

A study to determine the influence of Gender on the efficacy, safety and short-term outcomes of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction

A study to determine the influence of Gender on the efficacy, safety and short-term outcomes of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction

Our first encounter with a COVID-19 patient in cardiology ward: Lessons learned

COVID-19 is an ongoing global pandemic caused by a betacoronavirus named SARS-CoV-2. Within few months after the first index case is identified in Wuhan city of China, it attained a global pandemic status due to its unique epidemiology and pathophysiology. It typically presents with signs and symptoms of viral pneumonia. Patients with cardiac disease are at increased risk of COVID disease and create a diagnostic dilemma in differentiating from respiratory illnesses for the cardiologists. Furthermore, ST-segment changes in electrocardiogram and troponin elevation which form a key diagnostic point in the diagnosis of acute coronary syndromes are frequently seen in COVID-19 patients. This is a matter of utmost concern as the diagnostic dilemma caused may lead to many patients who may not have epicardial coronary artery disease that may be taken up for invasive angiography. Moreover, the prejudice caused by the COVID-19 is leading to fewer admissions for acute coronary syndromes and fewer primary percutaneous transluminal coronary angioplasty leading to inappropriate management of deserving patients with genuine acute coronary syndromes. These patients form a very important chunk of population as on the one hand, they are more likely to spread the infection if they are improperly triaged, and on the other hand, they are less likely to receive proper guideline-directed treatment of cardiovascular syndromes increasing the mortality from primary cardiac pathology. The following case highlights the above-mentioned issues faced in triaging and treating a patient who presented a diagnostic dilemma. Our patient a 53-year-old lady who is a known case of chronic coronary syndrome with effort-induced angina on exertion for the last 4 months on medical management presented to the emergency department, after being rejected admission by three hospitals, with features of chest pain at rest 5 days prior to admission associated with dyspnea and nonproductive cough along with elevated troponin and ST elevation. She was initially diagnosed as acute coronary syndrome with acute heart failure and was taken up to the cardiology ward where a proper clinical examination suggesting right middle lobe localized crackles and chest X-ray findings prompted the suspicion of COVID-19, testing for which by a viral RNA-based test came as positive. This case illustrated the unique challenge posed by the COVID-19 for the cardiologist and the importance of clinical examination and a high index of suspicion needed along with prompt isolation of any suspected case. She was shifted to the COVID ward from where she was discharged after 5 weeks.

Study of primary angioplasty in hospital not having onsite cardiac catheterization facility

Objectives: The aim of this study is to evaluate the appropriateness of use and quality as well as outcomes of primary angioplasty for acute myocardial infarction (MI) in a single center without percutaneous coronary intervention (PCI) capability. Background: Primary percutaneous transluminal coronary angioplasty (PTCA) increases the rates of patency of the infarcted artery, improves survival rates, and reduces the rates of reinfarction and strokes as compared to thrombolysis. Methods: This is a hospital-based prospective study involving 77 patients. Primary PTCA was done by emergency transfer to PCI center at earliest. Results: Male patients outnumbered females (77% vs. 22%). Patients in the age group of 45–69 years constituted around 70.0% of the total ST-elevation MI patients. Majority of the patients (90%) presented with chest pain. During coronary angiography, it was found that the major culprit coronary was the right coronary (42.85%) followed by the left anterior descending artery (36.36%). A majority of the patients in the study group were found to have single-vessel disease (57.14%), and only five of the patients had triple-vessel disease (06.49%). Glycoprotein IIb/IIIa inhibitors were given to 41 patients (53.24%) as an adjuvant therapy. Conclusion: Primary angioplasty is very appropriate and feasible with a good outcome for the management of patients with acute ST-elevation MI even in a center where the facility of cardiac catheterization is not available. Our patients with acute ST-elevation myocardial infarction who were shifted to a center having cardiac catheterization laboratory and subsequently managed with primary angioplasty showed good response and outcome in terms of mortality and morbidity over a follow-up of 1 year.

100.52 Primary Percutaneous Transluminal Coronary Angioplasty in Diabetic Versus Non-Diabetic Patients. Independent Predictors of Suvival and Event-Free Survival

Some studies showed that the diabetic patients (D) group (DG) had worse outcomes when compared to the nondiabetic (ND) patients group (NDG) after primary percutaneous coronary intervention (PCI). We aimed to compare mortality and major adverse coronary events (MACE) at 30 days and 1 year in DG and

PO156 Primary Percutaneous Transluminal Coronary Angioplasty In Diabetic Versus Non Diabetic Patients. Independents Predictors of Suvival and Event-Free Survival

PO156 Primary Percutaneous Transluminal Coronary Angioplasty In Diabetic Versus Non Diabetic Patients. Independents Predictors of Suvival and Event-Free Survival

Assessing the feasibility of GIS multimethod approach to ascertain territorial accessibility to hemodynamics rooms in Spain mainland

Between 1981 and 2001 health competencies in Spain passed from the Central Government to the Autonomous Communities (AC). Those issues conducted to a not heterogeneous health services in continental Spain. This is undoubtedly aggravated high-tech health equipment provision, as in the case of hemodynamics rooms that perform primary balloon percutaneous transluminal coronary angioplasty (PTCA), used to deal with acute myocardial infarction. In this regard, the present study aims to assess the territorial accessibility to these rooms of the potential population that may suffer an acute myocardial infarction, in each Spanish municipality, on continental Spain.The study has used a large amount of methodologies and research tools, related to accessibility based on Geographic information Systems (GIS). Among the used methods, should be highlighted the spatial interaction model. This particular method has been based on the three-step floating catchment area (method-3SFCA). Nevertheless, the authors have developed a specific methodology, increasing the mentioned method, with the goal to assess, in a more accurate way, the spatial distribution of the hemodynamics rooms, and the impacts this distribution might have on people's life quality.The results obtained by means of thematic maps allowed us to identify the municipalities with greater and less health equipment provision, the differences in health coverage between Autonomous Communities, and the municipalities where this health coverage is going to increase, if patients could be moved to other Autonomous Communities. The developed analysis enabled us to present a detailed view of the problem identifying the regions where it must be improved in order to achieve a more equitable access to the high-tech health (HTH) services, presenting a framework which indicator how these dispersions may be overcome.

A real life registry to evaluate patient profile, diagnostic and practice patterns in Acute Coronary Syndrome in Turkey: TURK-AKS study

Background and objectiveEvaluation of patient characteristics and the patterns of diagnostic therapeutic practices of acute coronary syndromes (ACS) in Turkey. MethodsA total of 3695 ACS patients (mean age: 60±12years, 73% males) were included in this prospective, multicenter, non-interventional registry. ResultsST-segment elevation and non-ST segment elevation myocardial infarction (NSTEMI) were identified in 57% and 43% of patients, respectively. In 65% of cases admission was directly to the index hospital. Ambulance transport was higher in rural sites comparing to urban areas (53.4 vs. 38.4%, p<0.001).Admission to a hospital within the first 2h of symptom onset was 42% while after 12h was 24%. Spontaneous anginal relief (44%) was the leading cause of late hospital admission. Fibrinolytic treatment was administered in 23% of the patients. The most common in-hospital interventions were coronary angiography for NSTEMI (18%), primary percutaneous transluminal coronary angioplasty for STEMI (17.5%) and coronary angiography after lytic therapy (12.1%). ConclusionsIn a representative sampling for Turkish population five years ago, this registry of ACS revealed the predominancy of male gender, urban settlement, and presentation with STEMI. The delay between onset of symptoms and hospital admission was more prominent in rural sites, among females and in NSTEMI patients when compared to urban areas, males and STEMI patients.

Effect of Thrombus Aspiration on Angiography and Outcome in Patients Undergoing Primary Coronary Angioplasty

Thrombus exerts a major impact on the performance and outcome of primary and rescue interventions in acute ST-elevation myocardial infarction. Although the optimal treatment of thrombotic lesions is still controversial, thrombus aspiration provides an effective method to achieve successful reperfusion during primary angioplasty. We compared clinical and angiographic outcomes in 286 patients with acute ST-elevation myocardial infarction undergoing primary percutaneous transluminal coronary angioplasty (PTCA) and thrombus aspiration with those who underwent conventional PTCA without thrombus aspiration. Thrombus aspiration during primary percutaneous coronary intervention in patients with high thrombus burden resulted in better Thrombolysis in Myocardial Infarction (TIMI) 3 flow in the infarct-related artery and helped achieve faster ST-segment resolution on the electrocardiogram compared with conventional angioplasty without thrombus aspiration.

Prospective study one-year clinical outcomes of the Calypso coronary stent in patients presenting with acute coronary syndrome

Aim. To evaluate the effectiveness of the stent use Calypso Angiolain Russia with primary percutaneous transluminal coronary angioplasty (PTCA).Methods. The study prospectively included 150 patients who underwent PTCA in acute coronary syndrome (ACS) for the period from January to December 2015. During the one-year follow-up period were evaluated indicators insolvency target lesion (cardiac death, myocardial infarction in the pool target artery, target lesion revascularization when clinically indicated), major adverse cardiac events (death from any cause, myocardial infarction, repeat revascularization as clinically indicated). Results. In one year, the incidence of target lesion failure was 6.66% for cardiac death rate of 1.33%, myocardial infarction in the target artery 3.33% and target lesion revascularization at 5.3%. The frequency of cardiac major adverse cardiac events was 12% at mortality 2.66%, myocardial infarction 4% and revascularization when clinically indicated 8.66%. Conclusion. The use of stents in primary PTCA Calypso is possible, the percentage of cardiovascular complications is comparable with the data of clinical trials.Received 31 January 2017. Accepted 17 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

Evaluation of Learning Curve of Trans- Radial Percutaneous Coronary Angioplasty in Stemi- A Single Centre, Observational Study

Background: Percutaneous Transluminal Coronary Angioplasty (PTCA) through radial route is known to have a steep learning curve. The impact of this results in hesitation of performing PTCA through radial route by conventional femoral access operators. Objective: This study was designed to evaluate the difficulties and problems related to learning of radial PTCA by a team trained with PTCA by femoral route. Methods: In this prospective longitudinal study, over duration of 6 months we enrolled consecutive patients of acute STEMI (ST segment elevation myocardial infarction). All patients presenting within the window period of primary PTCA (up to 12 hours from onset of chest pain) or patients with ongoing chest pain or new ECG changes or hemodynamic compromise beyond 12 hours after the onset of chest pain were considered eligible for primary PTCA and were enrolled for transradial intervention. Thrombolysed patients were excluded. The team members involved in the study was trained for trans-femoral PTCA and was doing transfemoral PTCA for both primary and elective cases for 3 years to 6 years. Results: Over duration of 6 months, primary PTCA was performed in total of 30 patients of acute STEMI. Success rate of the trans-radial PTCA procedure was 97%. Cross-over rate to trans-femoral PTCA was 3%. The mortality rate was 3%, which was the incidence of radial artery stenosis. Conclusion: The study documents the ease of PTCA through trans-radial route even with operators trained with conventional femoral approach. Although our data is exclusively from primary PTCA in STEMI, but it can be applicable to routine elective PTCA also.

The Results of the Method Percutaneous Intracoronary Intervention in Patients of Both Male and Female

To assess gender differences among patients subjected to percutaneous coronary intervention (PCI) according to data of the "Register of performed operations of percutaneous transluminal coronary angioplasty (PTCA)". The Register was conducted from 1996 to 2012 years and comprised 4890 patients (4121 men and 769 women). Women compared to men were older (58.2+/-8.6 vs 53.4+/-8.3 years; <0.001), had higher body mass index (31.4+/-5.3 vs 29.0+/-4.4 kg/m2; <0.001), level of total cholesterol (5.6+/-1.5 vs 5.3+/-1.3 mmol/l%; <0.001), systolic (141.1+/-22.2 vs 135.1+/-20.8 mmHg, <0.001) and diastolic blood pressure (86.5+/-11.8 vs 85.4+/-12.0 mmHg; =0.014). Compared to male cohort females more often had diabetes mellitus (22.5% vs 10.0%; <0.001), arterial hypertension (92.1 vs 75.6%; <0.001), family history of ischemic heart disease (IHD) (31.3 vs 23.4%; <0.001). Moreover, severe functional classes of effort angina (class III-IV 62.8 vs 50.0%; <0.001) and heart failure (NYHA class III-IV 28.1 vs 13.4%; <0.001) were more often detected in women. In men more frequent were smoking (45.4 vs 9.9%; <0.001), alcohol consumption (26.6 vs 9.0%; <0.001) and history of myocardial infarction (51.8 vs 40.2%; <0.001). Linear heart dimensions were larger in men. Men had more severe left ventricular (LV) asynergy (15.9+/-15.1 vs 13.7+/-14.7%; <0.001) and lower LV ejection fraction (54.5+/-8.7 vs 55.4+/-8.6 %; =0.03). As compared with men, portion of women subjected to primary PTCA was higher (14.3 vs 9.2%; <0.001), likewise coronary stenting was more often performed in women (93.6 vs 88.5%; <0.001). Optimal angiographic results were more frequently achieved in women (97.9 vs 96.4%; =0.04). Incidence of post-punctional hematoma was higher in female cohort (15.0 vs 4.6%; <0.001). There were no significant differences between men and women in post-operative mortality and rate of major adverse noncardiac events after primary and planned PTCA. Despite the detected clinical, functional, and echocardiographic gender differences both for men and women PCI was safe and highly efficient method of IHD treatment.

De Winters modified electrocardiogram pattern.

A 59-year-old patient with a family history of coronary artery disease and no other risk factors arrived at the emergency department with typical angina chest pain lasting for 60 minutes. The admission electrocardiogram showed 1 mm upsloping ST-segment depression at the J point in leads V3–V6 without peaked T waves (Fig. 1a). The patient underwent primary percutaneous transluminal coronary angioplasty where a kissing ostium was found and proximal anterior descending artery (LAD) occlusion was identified and stented with a drug-eluting stent (Fig. 1b), with successful reperfusion. The patient’s stay in hospital was uneventful.

Entrapment of guidewire in left anterior descending artery: Surgical management

Entrapment of a guidewire during coronary artery interventions is rare and requires prompt treatment. A 52-year-old man underwent a primary percutaneous transluminal coronary angioplasty to the left anterior descending artery. A fractured guidewire was retained in the distal left anterior descending artery, which caused left ventricular dysfunction and total occlusion of the left anterior descending artery. He underwent endarterectomy with removal of the guidewire and bypass grafting. He had a normal postoperative period. The modalities for management of an entrapped guidewire are discussed.

Primary percutaneous coronary intervention for acute myocardial infarction in a patient with situs inversus dextrocardia

Situs inversus with dextrocardia is a rare congenital anomaly of development characterized by a mirror-image position of the heart and abdominal viscera. It occurs rarely in the general population, with an estimated incidence of 1:8000 to 1:10,000. Very few case reports exist of successful primary percutaneous transluminal coronary angioplasty (PTCA) and stenting in such patients. Here we report a case with dextrocardia and coronary artery disease (CAD) who underwent Primary PTCA and successful stenting of the culprit lesion.

Care of acute myocardial infarction in the coronary care units of Piedmont in 2007

The treatment of acute myocardial infarction (AMI), both with ST-segment elevation [ST-elevation myocardial infarction (STEMI)] and non-ST-segment elevation [non-ST-elevation myocardial infarction (NSTEMI)], is evolving in Piedmont, with an increase in interventional procedures and hub-and-spoke networks. This new region-wide survey provides updated assessment of the management of STEMI and unprecedented data on NSTEMI. In 30 coronary care units in Piedmont, all patients with AMI symptoms of duration less than 48 h, between January and March 2007, were included. Of 921 patients, 447 had STEMI and 474 NSTEMI. Diabetes was present in 35% and chronic kidney disease in 38%. Hospital mortality was 4.7% [95% confidence interval (CI) 3.3-6.1]: age 75 years or older, Killip class higher than 1 and known diabetes or abnormal blood glucose on admission were multivariate predictors. Thrombolysis and primary percutaneous transluminal coronary angioplasty (pPTCA) were performed in 17.6 and 53.1% of 391 patients, respectively, with STEMI of 12 h or less, and 29.3% had no reperfusion therapy, notably 52% of patients aged 75 years or older and 51% of those reaching non-24/24 h interventional centres. Mortality after pPTCA was 2.5% and onsite door-to-balloon time was less than 90 min in 67.5%. Overall mortality after STEMI was 5.4% (95% CI 3.2-7.6). In NSTEMI, use of antithrombotic treatments was extensive, but invasive treatment within 72 h was limited to 8% of patients in centres without interventional facilities and independent of patient's risk profile. Mortality after NSTEMI was 4.0% (95% CI 2.2-5.8) and was predicted by both the Global Registry of Acute Coronary Events risk score and diabetes. There is room for improvement in the treatment of AMI in our region, with more extensive use of reperfusion therapy in STEMI, especially in the elderly, and early revascularization and optimal medical treatment in higher-risk NSTEMI.

FIRST EXPERIENCE WITH PRIMARY ANGIOPLASTY WITHIN THE EMERGENCY DEPARTMENT

Primary percutaneous transluminal coronary angioplasty (PTCA) is the treatment of choice in treating acute ST elevation myocardial infarction (STEMI), and shorter door-to-balloon time is associated with lower mortality. The question remains: will performing primary PTCA within the Emergency