Primary ST-segment Elevation Myocardial Infarction Research Articles

Serum levels of GM-CSF, CCL11, CCL22 and TRAIL in patients with primary ST-segment elevation myocardial infarction and post-infarction heart remodeling

Aim: To study serum values of GM-GSF, CCL22, CCL11 and TRAIL in patients with primary ST-segment elevation myocardial infarction (STEMI) in early and late post-MI period and their relationship with heart remodeling in 12 months after acute myocardial infarction (MI) diagnosis.Materials and Methods. Eighty four patients with new-onset STEMI were enrolled in the study. Echocardiography was done on day 1 and in 12 months MI. Serum levels of GM-GSF, CCL22, CCL11, TRAIL and C-reactive protein (CRP), NT-pro-NP, troponin I, CK-MV were assessed on days 1 (T1), 7 (T2), in 6 (T3) and 12 months (T4). Patients with adverse left ventricle (LV) remodeling were classified as group 1, and patients with adaptive LV remodeling were classified as group 2 in 12 month of follow-up.Results. 64 patients underwent a 12-month follow-up, of which adverse LV remodeling developed in. Patients from group 1 showed significantly higher levels of markers of myocardial necrosis (CPK MB, troponin I) on the first day of MI and NT-proBNP at all points of the investigation than in patients from 2nd group, p < 0.05. Analysis of the chemokines revealed, that the serum concentration of GM-CSF at the points Т2, Т3, T4 and TRAIL at points T1, T4 were significantly higher, and CCL22 at all of the study and CCL11 at T1, T2, T3 significantly lower than patients from group 2, p < 0,05. According of multiple linear regression predictors of LV dilatation by the 12th month of MI were the serum levels of GM-CSF (p = 0,004), NT-pro-BNP (p = 0,009) on the 7th day of MI and the age of patients (p = 0,005).Conclusions. In patients with adverse LV remodeling have higher levels of circulating GM-GSF, TRAIL and lower levels CCL11, CCL22 in early and late post-MI period. Among the studied inflammatory biomarkers, only the level of GM-CSF on the 7th day of STEMI showed an independent relationship with late adverse LV remodeling.

Twenty-year changes in the clinical and echocardiographic characteristics of patients with early postinfarction remodeling after primary ST-segment elevation myocardial infarction

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10th day. Depending on the increase in LV end-diastolic volume (EDV) by >15% by the 7-10th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).Results. Patients of the 2nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p<0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p>0,05) and an increase in LVEF (p=0,03) before discharge.Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Evaluation of the effect of long-term lipid-lowering therapy on the dynamics of regional arterial stiffness in patients with primary ST-segment elevation myocardial infarction

Evaluation of the effect of long-term lipid-lowering therapy on the dynamics of regional arterial stiffness in patients with primary ST-segment elevation myocardial infarction

Phenomena of microvascular myocardial injury in patients with primary ST-segment elevation myocardial infarction: Prevalence and association with clinical characteristics

Aim. The aim of this study was to evaluate the prevalence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), their combination, and relationship to the clinical and anamnestic characteristics in patients with primary STEMI after coronary reperfusion.Material and Methods. A single-center observational cohort study comprised a total of 60 patients with primary STEMI and successful coronary reperfusion within 12 hours of the onset of symptoms. All patients were studied using a contrast-enhanced cardiac magnetic resonance imaging (CE-MRI) at day 2 after STEMI. The study protocol was registered on ClinicalTrials.gov (Identifier: NCT03677466).Results. The total occurrence rate of MVO and IMH phenomena was 68.3% including MVO only in 17% of patients, IMH only in 15% of cases, combination of MVO and IMH in 36% cases, and without a microvascular myocardial injury in 32% of cases. The patients with MVO only and combination of MVO and IMH experienced a longer time of ischemia versus patients without these conditions: 205 (140–227) and 193 (95–400) versus 130 (91–160) min (p = 0.049). On the contrary, the time of myocardial ischemia did not differ between patients with IMH only (113 min) and patients without it. Then, patients were assigned to the group of pharmaco-invasive strategy of coronary reperfusion (PIS) (n = 39) and the group of primary percutaneous intervention (PPCI) (n = 21). The incidence of MVO only and IMH only was equal in PIS and PPCI groups: 17.9% versus 14.2% and 12.8% versus 19.1% in PIS and PPCI groups, respectively. The tendency to a decrease in the incidence of combined MVO and IMH was observed in PIS group compared to PPCI group: 30.8% versus 47.6% (p = 0.09).Conclusion. The combination of MVO and IMH phenomena in patients with primary STEMI after coronary reperfusion developed more often than each of these phenomena separately. The development of MVO only and combination of MVO and IMH was associated with a longer duration of myocardial ischemia. A total frequency of combination of MVO and IMH phenomena in patients with primary STEMI after coronary reperfusion was as high as 68.3%. Combination of these phenomena developed more frequently than each of them separately: 36% versus 17% (MVO only) and 15% (IMH only). No difference was observed in the duration of myocardial ischemia between the groups with MVO only and without it. The thrombolysis did not increase the occurrence of IMH in PIS group compared with PPCI group. There was a tendency to a decrease in the incidence of combination of MVO and IMH in PIS group compared to PPCI group: 30.8 versus 47.6% (р = 0.09).

New Ultrasound-Controlled Paclitaxel Releasing Balloon vs. Asymmetric Drug-Eluting Stent in Primary ST-Segment Elevation Myocardial Infarction - A Prospective Randomized Trial.

Application of drug-coated balloons (DCBs) is popular for the treatment of percutaneous coronary intervention (PCI). A new DCB has been designed as ultrasound-controlled paclitaxel releasing. This study was conducted to determine whether a DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary ST-elevation myocardial infarction (STEMI) patients, as well as determine the efficiency and safety of this new DCB.Methods and Results:Overall, 184 pretreated STEMI patients were randomized into DCB and DES groups with a 1:1 allocation. The main study end-point was late lumen loss (LLL) during the 9 months after PCI. Late lumen loss was reported to be 0.24±0.39 mm in the DCB group and 0.31±0.38 mm in the DES group (P=0.215). Diameter stenosis was 28.27±15.35% in the DCB group and 25.73±15.41% in the DES group (P=0.312). Major adverse cardiovascular events (MACEs) were reported in 3 patients (3.4%) in the DCB group and 4 patients (4.7%) in the DES group (P=0.718). TLR and TVR in the DCB group was 2.3%, 3.4% and 2.4%, 3.5% in the DES group (P=1.000), respectively. No cardiac death and stent thrombosis (ST) was found in the DCB group at 12 months clinical follow up. The DCB-only strategy showed good angiographic and clinical outcomes in the 9- and 12-month follow-up periods, respectively. The VasoguardTM DCB is safe and feasible to treat STEMI patients.

Using parameters of myocardial deformation as markers of pathological postinfarction remodeling

Abstract Funding Acknowledgements Type of funding sources: None. Objective to predict pathological left ventricular (LV) remodeling using global parameters of strain and twisting. Methods the study included 114 people with primary ST-segment elevation myocardial infarction (STEMI): 14 women and 100 males aged 32 to 67 years (52.3 ± 8.4). STEMI has been confirmed by ECG data, cardiospecific biomarkers (troponin T, CPK-MB) and coronary angiography - the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography has been performed using a MyLab ultrasound scanner (Italy) on the 7th-9th day, 3rd, 6th and 12th months after the disease onset with the evaluation of standard parameters. On the 7th-9th days the parameters of global longitudinal (GLS,%), circumferential (GCS,%) strain, and LV twisting (Twist, °) have been analyzed using the X-Strain ™ software. The criterion for pathological LV remodeling has been considered to be an increase in EDVi ≥ 20% compared with the initial value. Prediction of pathological remodeling has been performed using ROC analysis by 3 criteria. To assess the quality of the model, the area under the curve (AUR –Area under ROC) has been determined with the calculation of 95% confidence intervals and the statistical significance of the point estimate of the area. Results Within 48 weeks pathological remodeling was developed in 45 (39.5%) patients. Three months after the index event, LV remodeling was detected in 24 (53.3%) patients of these 45; after 6 months - in another 15 (33.3%); after 12 months - in another 6 (13.4%). GLS - 11.7% with 96% sensitivity and 80% specificity, AUR 0.750 (95% CI 0.659 - 0.841), GCS - 12.4% with test sensitivity and specificity - 90% and 82%, respectively ((AUR 0.641 ( 95% CI 0.534 - 0.749)), Twist - 7.8 ° with a sensitivity of 93% and a specificity of 78%, AUR 0.657 (95% CI 0.558 - 0.757) predict the development of pathological postinfarction LV remodeling on the 7th-9th day. For all models the value of p ≤ 0.001. Conclusion Previously, LV remodeling has developed within 3 months after STEMI in 45 (39.5%) patients. The longitudinal strain, measured in the acute period of STEMI, has the greatest predictive ability in relation to the development of pathological postinfarction LV remodeling.

Diagnostic value of parameters of myocardial work in patients after myocardial infarction with ST segment elevation

Abstract Funding Acknowledgements Type of funding sources: None. Objective to reveal the differences in the global parameters of myocardial work of the left ventricle (LV) in patients with preserved LV ejection fraction (EF) after ST-segment elevation myocardial infarction (STEMI) and healthy individuals. Methods the study included 45 people with primary STEMI (group 1): 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). The control group (group 2) consisted of 70 healthy individuals aged 39.3 ± 8.9 years, including 34 men and 36 women. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography was performed on the 7th-9th day and 6 months after STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). Echocardiographic image analysis was performed using EchoPAC software version 202 (GE Healthcare). The standard echo parameters were determined: end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), LV myocardial mass index (LVMI, g / m2), EF by the Simpson biplane method,%. The preserved EF was considered the value of EF greater than or equal to 50%. The following indicators of myocardial work were assessed: global myocardial work index (GWI, mm Hg%), global constructive work (GCW, mm Hg%), global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing was performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results 6 months after STEMI, 26 subjects had an EF ≥50% (58.8 ± 5.8%). The mean LVEF in group 2 was 60.8 ± 4.6% (p = 0.12). EDV in group 1 was 122.5 [95% CI 104.4; 140.7] ml, in group 2 - 104.7 [95% CI 99.1; 110.3] ml (p = 0.003). ESV in group 1 - 83.8 [95% CI 28.5; 139.0] ml, in group 2 - 40.7 [95% CI 37.6; 43.7] ml (p = 0.02); in group 1, LVMI was 89.3 [95% CI 77.4; 101.1] g / m2, in group 2 - 67.4 [95% CI 63.7; 71.1] g / m2 (p = 0.03). GWI was 1890.1 [95% CI 1730.0; 2050.2] mm Hg% in group 1, in group 2 - 2039.8 [95% CI 1956.3; 2123.3] mmHg% (p = 0.002), GCW - 2132.4 [95% CI 1958.5; 2306.3] mmHg% and 2335.5 [95% CI 2251.7; 2419.4] mm Hg% (p = 0.003), respectively. GWE 95.4 [95% CI 94.1; 96.6] and 97.1 [95% CI 96.8; 97.4]% (p = 0.02), GWW 76.6 [95% CI 55.9; 97.3] and 50.0 [95% CI 44.0; 56.0] m Hg% (p = 0.06) in the corresponding groups. Conclusion Thus, despite the satisfactory values of LVEF, the indicators of myocardial work, except for global wasted work, had lower values in patients with STEMI compared with healthy individuals.

Correlation of new and traditional indicators of myocardial contractility in ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Purpose to assess the relationship of indicators of global myocardial work of the left ventricle (LV) in patients with ST-segment elevation myocardial infarction (STEMI) with hemodynamic and deformation parameters that traditionally characterize the systolic function of the heart. Methods 45 people with primary STEMI were included: 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). Myocardial infarction was confirmed by ECG, biomarkers (troponin I, CPK-MB) and by the results of coronary angiography. Echocardiography has been performed on the 7-9th day of STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). EchoPAC software version 202 (GE Healthcare) has been used. The end-diastolic volume index (EDVi, ml / m2), end-systolic volume index (ESVi, ml / m2), LV ejection fraction (EF,%) have been assessed using the Simpson biplane method. The global longitudinal strain (GLS,%) has been determined using the speckle-tracking echocardiography method. The indicators of myocardial work have been automatically calculated: the index of global myocardial work (GWI, mm Hg%), global constructive work (GCW, mm Hg%), and global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing has been performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results the average values of the determined parameters were the following: LVEF - 49.4 ± 6.7%, EDVi - 62.8 ± 12.7 ml / m2, ESVi - 32 ± 8.9 ml / m2, GLS - (-13, 5) ± 4%, GWI - 1192.4 ± 416.2 mm Hg%, GWE - 88.9 ± 6.5%, GCW - 1362.1 ± 442.5 mm Hg%, GWW - 98.5 (69; 130) mm Hg%. The values of the correlation coefficient GWI were: with EF (r = 0.26; p = 0.19), with EDVi (r = -0.3; p = 0.12), with ESVi (r = -0.35; p = 0.07), with GLS (r = 0.85; p = 0.000002). GWE had the following correlation coefficient values: with EF (r = 0.17; p = 0.39), with EDVi (r = -0.42; p = 0.026), with ESVi (r = -0.4; p = 0.025), with GLS (r = 0.74; p = 0.00001). The correlation coefficient of GCW with EF was 0.24 (p = 0.24), with EDVi - (-0.26) (p = 0.19), with ESVi - (- 0.3) (p = 0.1), with GLS - 0.85 (p = 0.000004). The correlation coefficient of GWW with EF was -0.02 (p = 0.9), with EDVi - 0.26 (p = 0.17), with ESVi - 0.2 (p = 0.3), with GLS - 0.37 (p = 0.06). Conclusion the analysis of the correlations between the indicators of myocardial work and the determined parameters revealed that GWE had a moderate correlation with EDVi, ESVi. Parameters GWI, GWE, GCW had a strong correlation with GLS.

Fibrosis biomarkers and global myocardial strain in the diagnosis and prediction of diastolic dysfunction in patients with myocardial infarction and preserved ejection fraction

Aim. To assess the correlation of fibrosis biomarkers with parameters of diastolic function (DF) in assessing global longitudinal strain in patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular ejection fraction (EF).Material and methods. We examined 50 patients (100%) with primary STEMI and preserved LVEF at the end of hospitalization. On the 1st day of MI, standard diagnostic investigations were carried out. On the 12th day, the serum concentration of procollagen type I carboxy-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), and galectin-3 was determined, as well as echocardiography was performed to assess left ventricular DF. After 1 year, all participants underwent reassessment of PICP, PIIINP, and galectin-3 serum levels. Echocardiography was also performed with an assessment of DF and LV global longitudinal strain.Results. According to speckle-tracking echocardiography, LV global longitudinal strain was visualized in 30 patients (60%), who were included in the final analysis. In the rest of the patients (40%), the limitations did not allow the technique to be performed. During the hospitalization, signs of diastolic dysfunction (DD) were detected in 5 (16,6%) patients; after 1 year, their number increased by 7 (23,3%). During the 1-year follow-up, the total number of patients with echocardiographic signs of DD was 20 (67%). At the same time, global strain parameters indicated the presence of DD in 23 (77%) patients. However, comparison of the incidence of DD according to echocardiography and using the speckle-tracking technology did not show significant differences (p=0,283). Throughout the entire follow-up period, the concentration of the studied fibrosis markers significantly exceeded the control group values. We recorded associations of global strain parameters with biochemical markers of fibrosis and LV DF indicators.Conclusion. Fibrosis biomarkers (PICP, PIIINP, galectin-3), assessed in the subacute period of MI in patients with preserved EF, correlated with indicators of global myocardial strain, which indicates the potential value of their determination for predicting and detecting DD in the postinfarction period.

Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation.

To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI). The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002). The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

Effect of intramyocardial haemorrhage on structural and functional echocardiographic parameters of myocardium after ST-segment elevation myocardial infarction with

Aim. To analyze the effect of intramyocardial haemorrhage (IMH) on the structural and functional echocardiographic parameters of myocardium in patients with primary ST-segment elevation myocardial infarction (STEMI).Material and methods. The study included 60 patients with primary STEMI reperfused within 12 hours after symptom onset. On the second day after the event, all subjects underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). IMH was visualized as T2-weighted hypointense areas. Subsequently, all patients underwent the standard echocardiography on the 7th day after MI.Results. IMH was revealed in 31 patients (51,6%). In 22 patients (70,9%), IMH was accompanied by microvascular obstruction (MVO). In the remaining 9 patients (29%), an isolated IMH phenomenon was visualized. Lower values of left ventricular ejection fraction (LVEF) and LV volume parameters were associated with a combination of MVO and IMH. At the same time, the indices of volumetric characteristics and LVEF in isolated IMH were the same as in the group without IMH and MVO. It was demonstrated that the IMH occupies 1% (1-3%) of the LV myocardium. Correlation analysis showed a moderate inverse correlation between the IMH area and LV contractile function: the larger the area, the lower the LVEF (R=-0,35; p=0,007).Conclusions. The analysis of the influence of different IMH phenotypes on the structural and functional echocardiographic parameters of myocardium in the short-term period after STEMI has shown that the combination of IMH with MVO and isolated IMH have different effects on LV contractile function. The combination of IMH with MVO is a predictor of a decrease in LVEF and increase of end-systolic volume (ESV), while an isolated IMH does not affect these parameters. Correlations between the IMH area and a decrease in LVEF, as well as an increase in ESV, have been demonstrated.

Prognostic Value of New-Generation Troponins in ST-Segment-Elevation Myocardial Infarction in the Modern Era: The RUTI-STEMI Study.

BackgroundIn ST‐segment–elevation myocardial infarction (STEMI), troponins are not needed for diagnosis: symptoms and ECG data are sufficient to activate percutaneous coronary intervention. This study explored the prognostic value of new‐generation troponins in a real‐life cohort contemporarily treated for STEMI.Methods and ResultsWe studied 1260 consecutive patients with primary STEMI treated with percutaneous coronary intervention between February 22, 2011, and August 31, 2015. We collected data on clinical characteristics and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days and 1 year. Peak high‐sensitivity troponin T and sensitive‐contemporary troponin I levels were recorded. MACCEs occurred in 75 patients (6.1%) by day 30 and in 124 patients (10.8%) between day 31 and 1 year. A short‐term (0–30 days) multivariable Cox regression analysis revealed that age, Killip‐Kimball class, and left ventricular ejection fraction were independent predictors of MACCEs. In adjusted analysis, peak high‐sensitivity troponin T and sensitive‐contemporary troponin I were not significant (hazard ratio, 1.23 [95% confidence interval, 0.98–1.54] [P=0.071]; and hazard ratio, 1.15 [95% confidence interval, 0.93–1.43] [P=0.200], respectively). A long‐term (31 days–1 year) multivariable Cox regression analysis revealed that age, female sex, diabetes mellitus, prior coronary artery disease, Killip‐Kimball class, and left ventricular ejection fraction were statistically significantly associated with MACCEs. However, peak high‐sensitivity troponin T and peak sensitive‐contemporary troponin I were not significantly associated with MACCEs (hazard ratio, 1.03 [95% confidence interval, 0.88–1.20] [P=0.715]; and hazard ratio, 0.99 [95% confidence interval, 0.85–1.15] [P=0.856], respectively).ConclusionsIn the modern era, new‐generation troponins do not provide significant prognostic information for predicting clinical events in STEMI. We should reconsider the value of serial troponin measurements for risk stratification in STEMI.

Abstract 13686: Implementing a Regionalized Integrated Network for ST-segment-Elevation Myocardial Infarction (STEMI) Care is Associated With Higher Use of Evidence-Based Medication and Better Survival Among STEMI Patients: Long-Term Results From the RESISST Registry

Introduction: We have shown that implementing a Regional Network in developing countries is feasible. Purpose: Describe temporal trends in 30-Day mortality among STEMI patients enrolled in a prospective registry in Brazil. Methods: From Jan 2011 to Aug 2013, 520 patients received primary STEMI care at 23 non-specialized public health units (7 general hospitals; 16 community-based emergency units) with the option to be transferred to one of two public cardiology reference centers (CRC). These patients were identified through a Regional STEMI Network supported by telemedicine and the local prehospital emergency medical service. Results: Mean age was 62.0 ± 12.2y, and most patients were men (55.6%). Mean GRACE score was 145 ± 34. Overall mortality at 30 days was 15.0%. The median pain-to-admission time was 180 (IQR 66-430) min and admission-to-ECG, 159 (IQR 70-379) min. We analyzed the differences of results over 2.5 year period, separating the patients in 5 6-month periods from 1/2011 to 1/2013. There were no differences in pain-to-admission or admission-to-ECG times and no difference in GRACE score over time. Use of several acute medical treatments increased significantly from baseline to period 5: dual antiplatelet therapy (1/2011, 61.8%; 1/2013, 93.6%; p<0.001) and statin (1/2011, 60.4%; 1/2013, 79.7%; p<0.001). Rates of primary reperfusion also increased (1/2011, 29.1%; 1/2013, 53.8%; p<0.001) and more patients were transferred to CRC (1/2011, 44.7%; 1/2013, 76.3%; p=0.001). 30-day mortality rates decreased from 20.4% in 1/2011 compared with 7.5% in 1/2013 (p<0.001) (Figure). Conclusion: Implementation of a regional STEMI system was associated with lower mortality rates at 30 days and higher use of evidence-based treatment. Our findings highlight opportunities to improve the care of STEMI patients in developing countries.

Role of aldehyde dehydrogenase 2 Glu504lys polymorphism in acute coronary syndrome

This study aimed to investigate the association of the aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphism, which exists in 30–50% of East Asians, and risk of acute coronary syndrome (ACS). We enrolled 1092 unrelated Han Chinese, including 546 with ACS and 546 age- and sex-matched controls. Subjects with ALDH2 mutant genotypes showed significantly higher ACS than did controls (46.7% versus 31.9%, P < 0.001). Logistic regression analysis revealed the ALDH2 mutant independently associated with ACS (odds ratio [OR] 1.95, 95% confidence interval [CI]: 1.31–2.92, P = 0.001), but the association was weaker on adjusting for alcohol consumption (OR 1.82, 95% CI: 1.23–2.70, P = 0.003). Similar results were found in a subgroup analysis of patients with primary ST-segment elevation myocardial infarction (STEMI). The ALDH2 mutant was significantly associated with level of high-sensitivity C-reactive protein (hs-CRP) in patients with ACS (P = 0.002) and in controls (P = 0.009) and number of circulating endothelial progenitor cells (EPCs) (P = 0.032); furthermore, inclusion of hs-CRP level and EPCs number as independent variables in regression analysis reduced the importance of ALDH2 polymorphism in ACS or primary STEMI. However, ALDH2 polymorphism was not associated with number of coronary arteries with significant stenosis, Gensini score or flow-mediated dilation of the brachial artery. Our results suggest that ALDH2 mutation is a genetic risk marker for ACS, which is explained in part by alcohol consumption, inflammation and number of circulating EPCs.