Q-wave Myocardial Infarction Research Articles

Comparison of second- and first-generation drug eluting stent for percutaneous coronary chronic total occlusion intervention

BackgroundThe performance of contemporary second-generation drug-eluting stents (DESs) for percutaneous chronic total occlusion (CTO) intervention is not well established. The present study compared the efficacy and safety outcomes of second-generation DESs with those of first-generation DESs in CTO-percutaneous coronary intervention (PCI). MethodsThis retrospective analysis included 1049 consecutive CTO patients who underwent successful DES implantation (first-generation; 487 vs. second-generation; 562 patients) between March 2003 and August 2014. The primary endpoint was the composite of all-cause death, Q-wave myocardial infarction (MI), or target-vessel revascularization (TVR). ResultsDuring a follow-up of 3years, the primary endpoint incidence was 10.1% for second- and 7.7% for first-generation DES (p=0.30). After multivariable adjustment, there was no significant difference between these groups in terms of the risk of composite of death, Q-wave MI, or TVR (Hazard ratio [HR] 1.42, 95% confidence interval [CI] 0.88–2.28, p=0.15) nor in the individual risks of death (adjusted HR 1.33, 95% CI 0.69–2.56, p=0.39), Q-wave MI (adjusted HR 1.15, 95% CI 0.30–4.47, p=0.84) and TVR (adjusted HR 1.06, 95% CI 0.52–2.15, p=0.87). The incidence of definite/probable stent thrombosis was relatively low (0.5% vs.0.9%, p=0.17) throughout the follow-up period. ConclusionThe 3-year clinical outcomes of patients treated with second-generation DESs are comparable to those treated with first-generation DESs for CTO–PCI.

Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type

Although metallic coronary stents significantly reduce angina pectoris compared with optimal medical therapy, angina after percutaneous coronary intervention (PCI) remains frequent. We, therefore, sought to compare the incidence of any angina during the 1 year after PCI among the spectrum of commercially available metallic stents. Metallic stent type was classified as bare metal stent, Cypher, Taxus Express, Xience V, Promus Element, and Resolute. The primary end point was patient-reported angina within 1 year of PCI. Multivariable logistic regression was performed to assess the independent association of stent type with any angina at 1 year. Overall, 8,804 patients were queried in regard to angina symptoms; 32.3% experienced angina at some point in the first year after PCI. Major adverse cardiovascular events, a composite of all-cause mortality, target vessel revascularization, and Q-wave myocardial infarction, increased with angina severity: 6.8% for patients without angina, 10.0% for patients with class 1 or 2 angina, and 19.7% for patients with class 3 or 4 angina (p <0.001 for trend). After multivariable adjustment, there was no significant association between stent type and angina at 1 year after PCI. Baseline Canadian Cardiovascular Society class 3 or 4 angina, history of coronary artery bypass grafting, and history of PCI were associated with a higher likelihood of angina at 1 year; increasing age, male gender, presentation with acute coronary syndrome, and higher stented length were associated with less angina. In conclusion, metallic stent type is not associated with the occurrence of angina at up to 1 year after PCI.

Diastolic Heart Function and Myocardial Electrical Instability in Patients with Q-wave Myocardial Infarction

The study included 131 male patients between the ages of 30 and 69 (51.9±9.13 years) with primary Q-wave myocardial infarction (Q-MI). All patients underwent clinical examination, including a physical examination, medical history, ECG in 12 conventional leads, echocardiography, and 24-hour ECG monitoring from the 10 th to the 14 th day of MI. The progression of left ventricular diastolic dysfunction in Q-MI patients is associated with a longer history of coronary heart disease and arterial hypertension. With worsening diastolic dysfunction, a marked decrease in LV systolic function is revealed. The severe diastolic dysfunction in Q-MI patients is closely associated with myocardial electrical instability. (Int J Biomed. 2015;5(4):192-194.)

Main Predictors of Sudden Cardiac Death in Patients with Q-Wave Myocardial Infarction

The study included 131 patients (mean age 51.9±9.13 year) with Q-wave myocardial infarction (Q-MI). All patients underwent echocardiography and 24-hour ECG monitoring on the 10 th through the 14th days of MI. Treatment included thrombolytic therapy, early administration of beta-blockers, antiplatelet agents, anticoagulants, statins, ACE inhibitors, if needed - antiarrhythmics and aldosterone antagonists. Follow-up was 24 months. During the observation period, of the 131 study patients 17(13.0%) died suddenly. Our study suggests that the high risk of sudden cardiac death (in the first 2 years after MI) in patients with Q-MI is associated with anterior localization, early pathological left ventricular remodeling, low myocardial contractility, and development of AHF high Killip classes in the early period of MI, as well as the identification of high heart rate at rest, frequent premature ventricular contractions (mainly polymorphic), systolic dysfunction in the early stages of observation (on the 10 th through the 14th days), and older age of patients. (Int J Biomed. 2015;5(4):195-197.)

Influence of beta-adrenoblockers on structural-functional heart indices in patients with acute q-wave myocardial infarction

The problem of myocardium infraction (MI) remains actually. An early postinfraction period is characterized with intensive remodeling of the left ventricle (LV) and high risk of dangerous complications that is ten times more than the monthly number of complications during the next year. The aim of research was the study of an influence of beta-1 adrenoreceptors on the heart rhythm variability, ectopic heart activity, daily profile of arterial pressure, postinfraction remodeling in patients with an acute Q-myocardium infraction. Methods. There were examined 235 patients with Q-myocardium infraction. There was evaluated the risk of forming LV aneurism, dynamic indices of combined daily monitoring of arterial pressure and electrocardiogram, echocardiography under influence of the complex treatment using beta-1 adrenoreceptors blockers.Results. Under an influence of treatment there was established the growth of temporal indices of the heart rhythm variability (HRV), spectral indices that present the parasympathetic influence on the background of decrease of the spectral components of sympathetic origin and mean HR, decrease of ectopic heart activity, normalization of daily profile of arterial pressure, improvement of systolic and diastolic function of LV.Conclusions. The use of beta-1 adrenoreceptors in the complex treatment of patients with acute Q-MI decreases the risk of forming LV aneurism, favors an improvement of HRV indices, ectopic heart activity, daily profile of arterial pressure, intracardiac hemodynamics

Peculiarities of vegetative regulation of heart activity and diurnal profile of blood pressure in patients with acute myocardial infarction, complicated by left ventricle aneurysm

In patients with myocardial infarction indexes of vegetative regulation of heart activity and diurnal blood pressure profile are connected with complicated trend of the disease. Aim. To study peculiarities of heart activity vegetative regulation, violations of heart rhythm and diurnal profile of blood pressure. Methods and results. In 108 patients with acute Q-wave myocardial infarction were investigated indexes of combined diurnal monitoring of ECG and blood pressure in dependence of left ventricle aneurysm formation. Conclusions. Increasing of sympatic influence of vegetative nervous system, prevalence of ventricular arrhythmias of «high grade», QT-interval length and predominantly adverse type of diurnal blood pressure profile were noticed in patients with myocardial infarction, complicated by left ventricle aneurysm.

Independent predictors of left ventricle aneurysm formation in acute period of q-wave myocardial infarction

З ціллю визначити незалежні предиктори формування гострої аневризми серця обстежено 235 хворих на Q-інфаркт міокарда. Встановлено, що незалежними предикторами формування аневризми лівого шлуночка є тривалість інтервалу QT, індекс сферичності, індекс локальної скорочувальної здатності, час уповільнення потоку раннього діастолічного наповнення лівого шлуночка, рівень матриксної металопротеїнази-9, інтерлейкіну-6 та протеїну С

Factors associated with right ventricular dilatation in coronary artery disease patients with prior Q-wave myocardial infarction

Factors associated with right ventricular (RV) dilatation in patients with prior Q-wave myocardial infarction (MI) have been determined. Out of 16839 patients from Register of performed coronary angiography we selected those with prior Q-wave MI who had no congenital heart disease: 1263 patients without RV dilatation and 99 patients with RV dilatation. There were more males in the group with RV dilatation (97.0 vs 89.6%, p = 0.018). Mean body mass index (BMI) was higher in this group (31.05.1 vs 29.44.6 kg/m &lt;sup&gt;2&lt;/sup&gt;, p = 0.003). Patients with RV dilatation more often had a higher New-York Heart Association (NYHA) functional class (III/IV - 50.5 vs 17.4%) and arrhythmias (45.5 vs 17.8%, both p&lt;0.001). Mean left ventricular (LV) mass index determined by echocardiography was higher in patients with RV dilatation (168.444.5 vs 136.031.0 g/m &lt;sup&gt;2&lt;/sup&gt;). This group often demonstrated a reduced LV systolic function (71.7 vs 32.9%) and significant mitral regurgitation (52.5 vs 12.4%, all p&lt;0.001). There were less frequent lesions of the diagonal branch of the left circumflex artery in patients with dilated RV (5.1 vs 12.1%, p = 0.035). According to our mulrivariate analysis, RV dilatation was predominantly associated with male gender, increased BMI and parameters describing the severity of LV dysfunction and remodeling.

Influence of diuretics with antialdosterone effect on the condition of extracellular matrix and early postinfarction remodeling of the left ventricle in patients with Q-wave myocardial infarction

Objective. Aldosterone receptor blockade regulate activity of matrix metalloproteinase system, increase survival in postinfarction period. Methods and results. In order to study the influence of aldosterone receptor blockade on the serum level of collagen of I and III types, condition of MMP/TIMP system, early postinfarction remodeling of the left ventricle after Q-wave myocardial infarction was studied in 89 patients. The next methods were used: immunoassay analysis of the serum levels of matrix metalloproteinase and its inhibitor, echocardiography. Also systolic and diastolic heart functions were assessed. Conclusion. Under the influence of the treatment it was showed that the intensity of the degradation of connective tissue matrix of the myocardium reduced, and was accompanied by improvement of the left ventricular systolic and diastolic function.

Remote ischemic conditioning in ST-elevation myocardial infarction as adjuvant to primary angioplasty (RIC-STEMI): study protocol for a randomized controlled trial.

BackgroundST-elevation myocardial infarction (STEMI) accounts for nearly one third of acute coronary syndromes. Despite improved STEMI patient care, mortality remains high, contributing significantly to the ischemic heart disease burden. This may partly be related to ischemia-reperfusion injury (IRI). Remote ischemic conditioning (RIC), through short cycles of ischemia-reperfusion applied to a limb, has been shown to reduce IRI in various clinical settings. Our primary hypothesis is that RIC will reduce adverse events related to STEMI when applied as adjunctive therapy to primary percutaneous coronary intervention (PCI).Methods/Design“Remote ischemic conditioning in ST-elevation myocardial infarction as adjuvant to primary angioplasty” (RIC-STEMI) is an ongoing prospective, single-center, open-label, randomized controlled trial to assess whether RIC as an adjunctive therapy during primary PCI in patients presenting with STEMI can improve clinical outcomes. After enrollment, participants are randomized according to a computer-generated randomization schedule, in a ratio of 1:1 to RIC or no intervention, in blocks of four individuals. RIC is begun at least 10 min before the estimated time of the first balloon inflation and its duration is 30 min. Ischemia is induced by three cycles of inflation of a blood pressure cuff placed on the left lower limb to 200 mmHg and then deflation to 0 mmHg for another 5 min. Primary endpoint is a combined endpoint of death from cardiac cause or hospitalization for heart failure (HF) on follow-up (including device implantation: implantable cardioverter defibrillator, cardiac resynchronization and left ventricular assist device). Secondary endpoints are myocardial infarction (MI) size (estimated by the 48 h area under the curve of serum troponin I levels), development of Q-wave MI, left ventricular function (assessed by echocardiography within the first 3 days after admission), contrast-induced nephropathy, in-hospital mortality, all-cause mortality and, finally, major adverse cardiovascular events. Patients will have a minimum follow-up period of 12 months. From 11 March 2013 to 31 December 2014, 324 patients have been enrolled and randomized. We expect to complete enrollment of the 494 patients deemed necessary within 3 years.Trial registrationClinicalTrials.gov identifier: NCT02313961; registered on 8 December 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0937-1) contains supplementary material, which is available to authorized users.

Women with Rheumatoid Arthritis: The Unspoken Risk Factor

Women with Rheumatoid Arthritis: The Unspoken Risk Factor

Influence of renin-angiotensin-aldosterone system block on the systemic inflammation activity and left ventricle remodeling in patients with Q-myocardial infarction after thrombolysis

Aim. Inflammatory cytokines play a role in adaptive postinfarction remodeling of the heart. In order to study the influence of treatment on the condition of systemic inflammatory markers, the incidence of post-infarction aneurysm and thrombus formation in the left ventricle of patients with Q-wave myocardial infarction after thrombolytic therapy serum levels of interleukin-6, interleukin-1-beta, von-Willebrand factor, fibrinogen were studied in 92 patients with immunoassay analysis. Results and discussion. Remodeling, systolic and diastolic function of the heart were evaluated with echocardiography. Under the influence of the treatment reduction of systemic inflammatory markers activity was showed, which accompanied by improvement of left ventricular systolic function and low frequency of left ventricle aneurysm and thrombus formation.

Gender and age peculiarities of content changes of protein C, von Willebrand factor, vascular cell adhesion molecules sVCAM-1 in patients with acute left ventricle Q-wave myocardial infarction

Markers of hemostasis have an influence on the state of postinfarction remodeling processes.Aim. In order to study the gender and age peculiarities, to determine the predictive value of the protein C, von Willebrand factor and vascular cell adhesion molecules sVCAM-1 concentration, we examined 76 patients with acute Q-wave myocardial infarction.Methods and results. On the 1st day of the disease, higher concentrations of protein C were detected in young women, vascular cell adhesion molecules sVCAM-1 - in men of any age. On the 10th day of the disease, both in men and women increase in the content of protein C, reducing the concentration of von Willebrand factor and vascular cell adhesion molecules sVCAM-1 were detected.Conclusion. Protein C has the highest prognostic potential in relation to the formation of heart aneurysm after Q-wave myocardial infarction in women of young age, and von Willebrand factor and vascular cell adhesion molecules sVCAM-1 - in older men.

Prominent T wave in V2 with respect to V6 as a sign of lateral myocardial infarction

BackgroundIn the absence of confounding electrocardiographic features, a prominent R wave in leads V1–V2 reflects a lateral myocardial infarction (MI). We hypothesized that repolarization abnormalities in V1–V2 could also reflect a lateral MI. MethodsWe retrospectively selected a group of 57 patients with a recent or previous first Q-wave MI involving left ventricular (LV) inferior and/or lateral wall at contrast-enhanced cardiac magnetic resonance (CMR). The location and extent of the MI at CMR were compared with electrocardiographic features. ResultsThe infarction was located in the inferior wall in 12 patients (21%), in the lateral wall in 8 (14%), and in both walls in 37 patients (65%). Infarct size corresponded to 16.8 (SD 9.0%) of LV myocardium. Infarct extent in the inferior and lateral wall (8.3%, SD 7.2% vs. 8.4%, SD 7.5% of LV myocardium) did not differ significantly. Using multiple linear regression analysis, inferior Q-waves and inferior negative T waves were directly associated with infarct extent in the inferior wall (p=0.014 and p=0.010, respectively). A prominent R wave in V1 and a prominent anterior T wave (expressed by the T wave amplitude in V2 minus its amplitude in V6) were directly associated with MI extent in the lateral wall (p=0.008 and p=0.018), while inferior negative T waves were negatively associated (p=0.006). ConclusionsIn patients with MI of the inferior and/or lateral wall, a prominent T wave in V2 with respect to V6 reflects greater infarct extent in the lateral wall.

Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial.

The ORBIT I trial, a first-in-man study, was conducted to evaluate the safety and performance of the orbital atherectomy system (OAS) in treating de novo calcified coronary lesions. Fifty patients were enrolled between May and July 2008 based on several criteria, and were treated with the OAS followed by stent placement. The safety and performance of the OAS were evaluated by procedural success, device success, and overall major adverse cardiovascular event (MACE) rates, including cardiac death, myocardial infarction (MI) and need for target lesion revascularization (TLR). Our institution enrolled and treated 33 of the 50 patients and continued follow-up for 5 years. Average age was 54 years and 91% were males. Mean lesion length was 15.9 mm. Device success was 100%, and average number of orbital atherectomy devices (OAD) used per patient was 1.3. Stents were placed directly after OAS in 31/32 patients (96.9%). All stents (average stent per lesion 1.1) were successfully deployed with 0.3% residual stenosis. The overall cumulative MACE rate was 6.1% in-hospital, 9.1% at 30 days, 12.1% at 6 months, 15.2% at 2 years, 18.2% at 3 years and 21.2% at 5 years (4 total cardiac deaths). None of the patients had Q-wave MIs. Angiographic complications were observed in 5 patients. No flow/slow flow due to distal embolization was observed. The ORBIT I trial suggests that OAS treatment continues to offer a safe and effective method to change compliance of calcified coronary lesions to facilitate optimal stent placement in these difficult-to-treat patients.

Drug-eluting stent thrombosis in the treatment of chronic total coronary occlusions: Incidence, presentation and related factors. Data from the CIBELES trial

Introduction and ObjectivesThe aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. MethodsData from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. ResultsStent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. ConclusionsThe rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign.

The impact of anesthesiologists on coronary artery bypass graft surgery outcomes.

One of every 150 hospitalized patients experiences a lethal adverse event; nearly half of these events involves surgical patients. Although variations in surgeon performance and quality have been reported in the literature, less is known about the influence of anesthesiologists on outcomes after major surgery. Our goal of this study was to determine whether there is significant variation in outcomes between anesthesiologists after controlling for patient case mix and hospital quality. Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 7920 patients undergoing isolated coronary artery bypass graft surgery. Multivariable logistic regression modeling was used to examine the variation in death or major complications (Q-wave myocardial infarction, renal failure, stroke) across anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality. Anesthesiologist performance was quantified using fixed-effects modeling. The variability across anesthesiologists was highly significant (P < 0.001). Patients managed by low-performance anesthesiologists (corresponding to the 25th percentile of the distribution of anesthesiologist risk-adjusted outcomes) experienced nearly twice the rate of death or serious complications (adjusted rate 3.33%; 95% confidence interval [CI], 3.09%-3.58%) as patients managed by high-performance anesthesiologists (corresponding to the 75th percentile) (adjusted rate 1.82%; 95% CI, 1.58%-2.10%). This performance gap was observed across all patient risk groups. The rate of death or major complications among patients undergoing coronary artery bypass graft surgery varies markedly across anesthesiologists. These findings suggest that there may be opportunities to improve perioperative management to improve outcomes among high-risk surgical patients.

Clinical outcomes of first- and second-generation drug-eluting stents in patients undergoing rotational atherectomy for heavily calcified coronary lesions.

There is paucity of data regarding the clinical outcome of second generation drug- eluting stents (DES) post rotational atherectomy (RA) for heavily calcified coronary lesions (HCCL). The study cohort comprised 99 (116 lesions) consecutive patients who underwent RA for HCCL at our institution and received either a first generation DES (40 patients, 53 lesions) or a second generation DES (59 patients, 63 lesions). The analyzed clinical parameters were the 12-month rates of death (all cause and cardiac), Q-wave MI, target lesion revascularization (TLR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, Q-wave MI, or TLR. The two groups were well matched for their baseline characteristics except for a lower left ventricular ejection fraction in the second generation DES group (46.0±23.0% vs. 55.0±9.0%; p=0.02). The group receiving second generation DES had more type C lesions (81.0% vs. 58.8%; p=0.01), shorter stent length (19.9±6.1 mm vs. 22.7±7.3 mm; p=0.04) and was more likely to undergo stent postdilatation (52.4% vs. 23.1%; p=0.001). The 1-year analyzed clinical parameters were similar in the two groups: all cause death (8.5% vs. 10.3%; p=1.0), cardiac death (8.5% vs. 2.5%; p=0.40), Q-wave MI (0% vs. 0%), TLR (3.6% vs. 2.7%; p=1.0), ST (0% vs. 0%), and MACE (11.9% vs. 12.8%; p=1.0). The 1-year MACE-free survival rate was also similar in the two cohorts. The use of second generation DES, following RA for HCCL, is associated with similar short and long-term clinical outcomes to first generation DES.

Modifications of humoral factors, indicators of early postinfarction heart remodeling under influence of anticoagulant therapy in patients with Q-wave myocardial infarction

The role of humoral factors in the process of early postinfarction heart remodeling, left ventricle aneurism and thrombus formation in acute period of Q-wave myocardial infarction is an actual problem of modern cardiology. In order to investigate condition of coagulation and aggregation nexuses of hemostasis, matrix metalloproteinases and their inhibitor system, indexes of heart remodeling under influence of different anticoagulation agents, 97 patients with Q-wave myocardial infarction were examined. The treatment led to a decrease of matrix metalloproteinase concentration and an increase of tissue inhibitor of metalloproteinase-1 serum level, a decrease of blood serum procoagulant properties and activation of fibrinolytic processes, decrease of immune-inflammatory reactions and improvement of endothelial function.

Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis.

The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. The optimal treatment for bare-metal in-stent restenosis remains controversial. The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES=3.5%, PES=4.6%, SES=4.2%; p=0.94), MI (EES=3.5%, PES=6.3%, SES=2.1%; p=0.31), TLR (EES=9.8%, PES=9.5%, SES=5.7%; p=0.42), TVR (EES=14.3%, PES=11.1%, SES=11.3%; p=0.74), definite ST (EES=0.9%, PES=3.1%, SES=3.5%; p=0.38) and MACE (EES=14.0%, PES=15.4%, SES=10.5%; p=0.54). Male gender (hazard ratio=0.47; 95% confidence interval=0.25-0.88) and number of treated lesions (hazard ratio=1.47; 95% confidence interval=1.06-2.05) were found to be independent predictors of MACE. The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.