Segment Elevation Myocardial Infarction Patients Research Articles

BIFURCATION: A CLINICAL CASE IN ACUTE CORONARY SYNDROME

Abstract Bifurcation A clinical case in acute coronary syndrome. Coronary bifurcation lesions are considered one of challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. There are limited data on the preferred treatment strategy in ST–segment elevation myocardial infarction (STEMI) patients with bifurcation lesions as most dedicated study excluded patients with acute coronary syndrome. In all comers population a 10–20% of STEMI patients had bifurcation culprit lesion. In 2018 guideline suggested a provisional approach by stenting the main vessel and implanting a second stent only if necessary as a bailout strategy. This reccomandation was supported by a large series of study that uniquely documented the superiority of one versus two stent technique. The same message could also be exported in the context of acute patients, as our clinical case, thanks to registry like COBIS 2 including ST–segment elevation patient. But this precious advice cannot be applied in all clinical subsets. Especially when we manage with a relevant side–branch and when the risk of loosing the side branch is very high. In this subgroup of patient, bifurcation lesion may benefit from a 2 stent approach. Different technical option are available. Among these, DK–crush and inverted Main Branch stenting across Side Branch (Invertend Culotte or inverted T technique) could be the best choice. Our patient was a young lady presenting with a lateral STEMI (D1 and aVL). The culprit lesion was a Medina 1.1.1 bifurcation lesion involving left anterior descending and first–diagonal. Since our side branch had thrombus inside, the vessel was relevant by definition. Other anatomical characteristique to take into account: relevant size and covering a large myocardial territory. Planning the strategy to treat our LAD–D1 bifurcation we consider the angle and the difference in size between main and side branch. We decided to proceed with DK–crush and its recent evolution DK–nano crush. In conclusion “do it provisional” guideline message is not always possible, 2 stent technique seems to be the best choice in presence of a relevant side–branch / high risk to loose it. Our take home message is, if the clinical scenario allow it, don’t hesitate to perform a multistep two vessel strategy technique and to try to reconstruct perfect anatomical carina even in STEMI context.

QUALITY OF CARE FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: RESULTS OF THE FIRST 3 MONTHS OF THE QUALITY IN CARDIOLOGY (QIC) PROJECT

Abstract Background Assessing the quality of care is the first step for improve the management of patients with acute myocardial infarction (AMI). The European Society of Cardiology (ESC) and the Acute Cardiovascular Care Association (ACCA) recently defined a set of quality indicators (QI) of care for AMI. Aim To evaluate the quality of care of patients admitted to the Cardiology ward of our first level hospital for an AMI using the ESC ACCA QI. Methods QiC project is a prospective quality improvement study in real–world practice on all patients admitted to our ward for an AMI from 1.5.2023 to 30.4.25 with six–monthly audit activities. Case record forms were filled in by doctors during admission and were attached to the patient’s discharge letter. Thirty–day mortality was assessed by telephone interviews. The ESC ACCA QI include 18 main and 8 secondary QI on centre organization, reperfusion and invasive strategy, risk assessment, antithrombotic treatment, secondary prevention discharge treatments, and patient experience. For each IQ was evaluated the percentage of QI assessable and attained. Results A total of 78 patients were admitted for AMI in our Cardiology Department in the first 3 months. No one patient denied consent, one died during hospitalization, 7 patients had to be transferred to another hospital, and 3 patients did not have their record form filled in. The median age of the 67 patients discharged alive was 66 (IQR 58–75) years, 45 (67.2%) were males, 35 (52.2%) had a ST–segment elevation myocardial infarction (STEMI) and 32 (47.8%) a non–ST–segment myocardial infarction (NSTEMI). The percentages of non–assessment, non–attainment and attainment for each QI are reported in the Figure: the degree of non–assessment of the 26 QI ranged from 0 to 22% and the degree of QI attainment from 25 to 100%. Conclusions Quality of care for acute myocardial infarction can be measured in the majority of patients admitted to our Cardiology Department using the ESC ACCA quality indicators. Although most quality indicators are met in our patients, a large room for improvement is present in the reperfusion and invasive strategy (mainly in timely reperfusion of STEMI patients) and in the patient’s satisfaction (discharge letter sent to patient).

Analysis of the Prognosis Outcomes and Treatment Delay Among ST Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19

Analysis of the Prognosis Outcomes and Treatment Delay Among ST Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19

The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients after Primary Percutaneous Coronary Intervention.

Background: Our aim was to assess the relationship of the index of microvascular resistance (IMR) in left anterior descending (LAD) artery involved STEMI patients. Methods: Data of 316 STEMI patients who had undergone primary percutaneous coronary intervention (PCI) were collected from three cardiovascular centers from 2005 to 2015. In total, 246 patients with LAD STEMI were enrolled for IMR evaluation. Patients were divided into two groups respective of the cut-off IMR value of 30. All-cause mortality, left ventricular function, improvement of systolic function, and cardiac biomarkers were analyzed and compared. Results: A total of 246 patients were enrolled. The number of patients in the IMR above 30 group was 93 and below 30 was 153. The mean ages for each group were 57.91 ± 11.99 and 54 ± 10.63, respectively. The peak creatinine kinase (CK) (3936.85 ± 2827.32 IU/L vs. 2218.08 ± 2310.41 IU/L, p < 0.001) and CKmb (336.15 ± 195.08 mg/mL vs. 231.53 ± 179.53 mg/mL, p < 0.001) levels were higher for an IMR above the 30 group. The left ventricular ejection fraction (LVEF) (44.57 ± 6.685% vs. 47.35 ± 8.17%, p = 0.006) and improvement of LVEF (2.81 ± 7.135% vs. 5.88 ± 7.65%, p = 0.004) was lower in the IMR above 30 group. All-cause mortality (7.5% vs. 1.3%, p = 0.012) was higher in the IMR above 30 group, and a Cox regression analysis showed that an IMR above 30 was a poor prognostic factor regarding all-cause mortality (HR: 5.151, 95% CI 1.062-24.987, p = 0.042) even after adjusting for classical clinical risk factors. Conclusions: An elevated IMR value represented larger infarct size, more severe LV dysfunction, and higher mortality in LAD STEMI patients after successful PCI.

Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute ST-segment elevation myocardial infarction.

To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients. This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score. The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027). The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.

Clinical Outcome in Post-ST Segment Elevation Myocardial Infarction Patients Receiving β-Blocker and Angiotensin-converting Enzyme Inhibitor/Angiotensin Receptor Blocker versus Receiving Either Therapy Alone: A Prospective Observational Study

Clinical Outcome in Post-ST Segment Elevation Myocardial Infarction Patients Receiving β-Blocker and Angiotensin-converting Enzyme Inhibitor/Angiotensin Receptor Blocker versus Receiving Either Therapy Alone: A Prospective Observational Study

Lipid Content Distribution and its Clinical Implication in Patients with Acute Myocardial Infarction-Plaque Erosion: Results from the Prospective OCTAMI Study.

Plaque erosion (PE) is one of the main plaque phenotypes of acute coronary syndrome (ACS). However, the underlying plaque component and distribution have not been systematically analysed. This study aims to investigate the distribution of lipid and calcium content in culprit lesions assessed by optical coherence tomography (OCT) in patients with PE and explore its relationship with prognosis in a cohort of ST segment elevation myocardial infarction (STEMI) patients. A prospective cohort of 576 patients with STEMI was enrolled in our study. After exclusion, 152 PE patients with clear underlying plaque components were ultimately analysed. The culprit lesion was divided into the border zone, external erosion zone and erosion site in the longitudinal view. Each pullback of the culprit lesions was assessed by 3 independent investigators frame-by-frame, and the quantity and distribution of lipid and calcium components were recorded. Of the 152 PE patients, lipid and calcium contents were more likely to exist in the external erosion zone than in the other regions. In particular, a high level of lipid content proximal to the erosion site was significantly associated with plaque vulnerability and a higher incidence of MACEs. This study revealed that high level of lipid content in the proximal external erosion zone was related to high-risk plaque characteristics and poor prognosis, which provided a novel method for risk stratification and precise management in patients with plaque erosion.

Inter-relation between hypoxic liver injury and killip classification in st segment elevation myocardial infarction patients

Abstract Purpose Hypoxic liver injury (HLI) and Killip classification are poor prognosticators of ST segment elevation myocardial infarction (STEMI) patients. We investigated the inter-relationship between hypoxic liver injury (HLI) and Killip classification. Materials and Methods 4 tertiary hospitals from Incheon-Bucheon province enrolled 1537 STEMI patients who had undergone percutaneous coronary intervention (PCI) from 2007 to 2014. They were divided into 4 groups according to their Killip classification presented at the emergency room (ER). HLI was defined as ≥2-fold increase of serum aspartate transaminase (AST). Results Incidence of HLI showed incremental tendency with respect to Killip classification (19.5%, 19.4%, 34.6%, 37.8%, p&amp;lt;0.001) respectively. Left ventricular ejection fraction (LVEF) was below 45% in symptomatic, overt heart failure patients (Killip class II, III and IV). Initial and peak AST level increased in accordance to Killip classification along with cardiac biomarkers. In-hospital mortality and Killip classification were in direct relation (2.3%, 7.3%, 16.3%, 29.2%) with statistical significance. Univariate and multivariate Cox regression analysis showed that both presence of HLI and combined Killip classification III and IV were poor prognosticators even after adjusting for conventional clinical risk factors. Receiver operating characteristics (ROC) analysis showed that combination of HLI and Killip classification was the most sensitive predictor of mortality (AUC 0.832, 95% CI 0.78-0.882). Kaplan-Meier curve showed that patients with HLI were at higher risk of death in both Killip class (I+II) and Killip class(III+IV) group. Conclusions Presence of HLI and Killip classification were in direct-relation translating to worst prognosis. Early recognition of HLI and thorough detection of accurate Killip classification is warranted whilst treating STEMI patients.

Diabetes mellitus and response to IL-1 blockade with Anakinra after ST-elevation myocardial infarction: a pooled analysis of the VCU-ART studies

Abstract Background ST segment elevation myocardial infarction (STEMI) elicits an intense inflammatory response which is thought to contribute to subsequent maladaptive myocardial healing and remodeling, ultimately leading to heart failure (HF). The interleukin-1 (IL-1) blocker anakinra administered during the first 14 days after STEMI patients has been shown to effectively dampen the inflammatory response and reduce the incidence of HF events in pilot randomized controlled trials. Diabetes mellitus is a condition of enhanced systemic inflammation. Purpose To assess the role of diabetes mellitus as a modulating factor in respect to the efficacy of anakinra treatment during the first 14 days after STEMI. Methods We conducted a pooled analysis of three previous proof of principle trials on anakinra in STEMI. Diabetes mellitus was defined based on clinical history, use of glucose-lowering medications, or elevated hemoglobin A1c &amp;gt;6.5% at time of enrollment and further characterized as type I or type II based on the available clinical assessment. The area-under-the-curve for C reactive protein (AUC-CRP) at 14 days was used as a measure of the systemic inflammatory response during STEMI. The clinical endpoint was composite of death, hospitalizations for HF and urgent HF visits. Results The study population included 139 patients, of whom 39 (28%) had a diagnosis of diabetes mellitus at time of enrolment, all with type II. Median age was 56 [49-63] and 56 [49-63] years in patients with and without diabetes, respectively (p=0.652). There were 29 (21%) female and 52 (37%) Black-African American patients among those with diabetes compared to 29 (21%) female and 52 (37%) Black-African American patients in those without diabetes (p=0.69 and p=0.16, respectively). Treatment with anakinra (N=84) significantly dampened acute inflammation associated with STEMI in patients with diabetes (AUC-CRP 223 [117-399] vs 76 [42-148] mg•day/L, p&amp;lt;0.001) and in those without diabetes (AUC-CRP 223 [117-399] vs 76 [42-148] mg•day/L, p&amp;lt;0.001 – Figure 1). No statistically significant interaction between diabetes status and treatment with anakinra on outcomes was detected (pint=0.92): treatment with anakinra was associated with a hazard ratio [HR] 0.28 [0.09-0.84](p=0.02) in non-diabetic patients and HR 0.26 [0.11-1.32](p=0.10) in diabetic patients – Figure 2. Conclusion In this pooled analysis of the VCU-ART trials, the presence of type II diabetes mellitus showed no interaction with the efficacy of the treatment with anakinra early after STEMI in reducing the systemic inflammatory response or preventing new onset heart failure, hospitalization for HF or death.Figure 1.Figure 2

Association between the neutrophil-to-lymphocyte ratio and risk of in-hospital heart failure and arrhythmia in patients with acute myocardial infarction.

This study was to probe into the relationship between the neutrophil-to-lymphocyte ratio (NLR) and both in-hospital and long-term heart failure risk in patients with acute myocardial infarction (AMI). 990 patients with AMI, including 386 with non-ST-segment elevation myocardial infarction (NSTEMI) and 604 with segment elevation myocardial infarction (STEMI) were recruited between January 2019 and March 2022. The in-hospital acute heart failure (AHF) and arrhythmia events were recorded. The NLR was significantly greater in the AHF group in STEMI and NSTEMI patients, with a higher frequency of arrhythmia in comparison to the non-AHF group. A high NLR was related to a high level of myocardial injury markers, accompanied with more AHF and arrhythmia events. Multivariate logistic regression analyses revealed that high NLR is independently linked with increased in-hospital AHF and arrhythmia risk. Receiver operating characteristic curve analyses revealed that the prognostic value of NLR for in-hospital AHF was 0.704 in STEMI patients and 0.766 in NSTEMI patients. However, during a median follow-up of 28 months with 32 heart failure patients, there was no significant difference between the low NLR group (n = 18) and the high NLR group (n = 14). Further analysis showed that the two groups did not significantly differ in the occurrence of heart failure within 12 months of discharge. Our results indicate that NLR is an independent risk factor of in-hospital AHF in AMI patients. However, NLR has no value in predicting long-term heart failure.

Comparison between Deflated Balloon-Facilitated Direct Stenting and Balloon Pre-Dilatation in ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract Background PPCI is considered to be the preferred reperfusion strategy for acute coronary syndrome (ACS). The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery. Although no-reflow may occur regardless of the method of revascularization, it is easily diagnosed with certainty during acute percutaneous coronary intervention (PCI) in STEMI. Objective To evaluate the efficacy of Deflated Balloon-Facilitated Direct Stenting in comparison with routine Balloon Pre-dilatation in STEMI Patients undergoing PPCI. Patients and Methods It included 160 patients who were presented with ST segment elevation myocardial infarction (STEMI) and underwent primary PCI at Ain Shams University Hospitals and Misr University for Science and Technology (MUST) university hospital in the period of March 2021 to december 2021. Results In our study group 2 showed the best results as regards No-reflow (23.33% vs 6.67% vs 27.5% in group 1, 2 and 3 respectively) with p-value (0.011), final MBG (II-III) (76.67% vs 93.33% vs 72.5% in group 1, 2 and 3 respectively) with p-value (0.011) and final TIMI III (91.67% vs 95% vs 90% in group 1, 2 and 3 respectively) with p-value (0.838). It was found that group 1 showed the shortest procedure time (measured in minutes) (46.83±15.43 vs 52±13.54 vs 59.75±14.59, in group 1, 2 and 3 respectively) with p-value (0.054) and smallest contrast volume (measured in milliliters) (101±19.09 vs 120.67±28.99 vs 136.25±24.67, in group 1, 2 and 3 respectively) with p-value (&amp;lt;0.001). While group 3 had the worst outcomes among all groups. Conclusion Routine predilatation technique is associated with better results when compared with deflated balloon-facilitated direct stenting technique. One of the major disadvantages of deflated balloon-facilitated direct stenting is not being able to restore the flow distal to the lesion, which necessitate using balloon dilatation, leading to more incidence of no-reflow (we aquire the disadvantages of both techniques combined) Abbreviations ACS: Acute coronary syndrome; CAD: Coronary artery disease; CBC: Complete blood picture; CKD: Chronic kidney disease; CVS: cerebrovascular disease; DBDS: Deflated balloon facilitated direct stenting; DM: Diabetes Mellitus; DS: Direct stenting; ECG: Electrocardiogram; EF: Ejection fraction; FH: Family history; GP: Glycoprotein; HTN: Hypertension; IRA: Infarct related artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; MACE: Major adverse cardiac events; MBG: Myocardial blush grade; MI: Myocardial infarction; NR: No reflow phenomenon; PAD: Peripheral arterial disease; PCI: Percutaneous coronary intervention; PD: Predilatation; PPCI: Primary percutaneous coronary intervention; RCA: Right coronary artery; STEMI: ST-segment elevation myocardial; SWMA: Segmental wall motion abnormalities; TIMI: Thrombolysis in myocardial infarction risk score

The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

Association between pan-immune-inflammation value and no-reflow in patients with ST elevation myocardial infarction undergoing percutaneous coronary intervention

Noreflow is a condition associated with a poor prognosis in ST segment elevation myocardial infarction patients. It has been shown that many inflammatory markers and index such as procalcitonin, C-reactive protein, neutrophil to lymphocyte ratio, systemic immune inflammatory index (SII), are associated with noreflow. We used a brand-new index pan-immune-inflammation value (PIV) to retrospectively evaluate the relationship between PIV and noreflow. A total of 1212 patients were included for analysis. Noreflow was observed in 145 patients. In multivariate analysis, PIV (odds ratio (OR): 1.025; [1.002–1.115], p < 0.001), baseline ejection fraction (OR: 0.963; [0.934–0.993], p = 0.015), stent length (OR: 1.032; [1.010–1.054], p = 0.004), age (OR: 1.034; [1.014-1.053], p = 0.001) and pain to PCI time (OR: 1.003 [1.002–1.005], p < 0.001) were observed to be the independent predictors of noreflow. ROC curve analysis showed that the best cut off value of PIV for predicting noreflow was ≥889 with 77.2% sensitivity and 77.5% specificity (AUC, 0.828; 95% CI [0.806-0.849]). A ROC curve comparison analysis was performed to compare PIV and SII. The predictive power of PIV was higher than SII (differences between areas: 0.154; p < 0.001). According to our findings, an increase in PIV is an independent predictor of noreflow in patients with STEMI.

Comparative Analysis of Early and Late Angiography Post - Fibrinolysis in ST - Segment Elevation Myocardial Infarction Patients

Comparative Analysis of Early and Late Angiography Post - Fibrinolysis in ST - Segment Elevation Myocardial Infarction Patients

Left atrial function index predicts poor outcome in STEMI patients treated with percutaneous coronary intervention

The prognostic value of the left atrial function index (LAFI) in acute ST segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study sought to determine whether the LAFI predicts prognosis in STEMI patients treated with PCI. Patients with newly diagnosed STEMI who were treated with PCI in Hunan Provincial People's Hospital from March 2020 to October 2020 were prospectively enrolled. All patients underwent transthoracic echocardiography at baseline and follow-up. The endpoint events included rehospitalization due to unstable angina, nonfatal myocardial infarction, rehospitalization due to heart failure and cardiovascular death. A total of 156 STEMI patients treated with PCI were studied with a median follow-up of 14 months. Forty-eight patients had endpoint events. The LAFI had the highest area under the receiver operating characteristic curve (AUC) predicting the endpoint events, with an AUC of 0.90 (95% CI 0.84–0.94). Multivariate Cox analysis demonstrated that only the LAFI (HR: 0.91, 95% CI 0.87–0.96, P < 0.0001) was independently predictive of endpoint events. Kaplan‒Meier survival curves showed that patients with an LAFI ≤ 42.25 cm/cc/m2 had more events than patients with an LAFI > 42.25 cm/cc/m2 (HR: 19.15, 95% CI 8.90–41.21, P < 0.001). The LAFI is a strong and independent predictor of events in STEMI patients treated with PCI.

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME OF HYPERTENSIVE PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Objective: There is little information on the incidence and prognostic significance of hypertension in ST segment elevation myocardial infarction (STEMI) patients, especially in Bangladeshi population. The study aimed to compare the demographic &amp; clinical characteristics and in-hospital outcome of hypertensive versus non-hypertensive patients with STEMI. Design and method: This prospective observational study was conducted from January 2015 to December 2022 at National Heart Foundation Hospital &amp; Research Institute. Patients were divided into two groups: hypertensive and non-hypertensive groups. Results: A total of 10378 patients were enrolled in this study. Of them 65.6% (6813) patients were hypertensive, and 34.4% (3565) patients were non-hypertensive. Mean age of the hypertensive group was 55.89 ± 11.18 years and the non-hypertensive group was 53.49 ± 12.25 years (p = 0.001). In hypertensive group, 84.1% patients were male and 15.9% were female &amp; in non-hypertensive group, 90.4% patients were male and 9.6% were female (p = 0.001). Compared to non-hypertensive patients, hypertensive patients were predominantly non-smoker (49.1% vs 39.9%; p = 0.001), diabetic (68.3% vs 32.1%; p = 0.001), dyslipidemic (80.7% vs 77.3%; p = 0.001), obese (37.8% vs 32%; p = 0.001), have positive family history of ischemic heart disease (IHD) (29% vs 22.4%; p = 0.001), prior history of percutaneous coronary angioplasty (3.7% vs 2.1%; p = 0.001), prior history of myocardial infarction (5.8% vs 4.6%; p = 0.007), and chronic kidney disease (48.2% vs 40.2%; p = 0.001). Hypertensive patients had more multi-vessel disease (49.3% vs 42.6%; p = 0.001), higher in-hospital complications (acute left ventricular failure-24.4% vs 21.9%; p = 0.005) and in-hospital death (4.8% vs 4%; 0.04). Conclusions: Hypertensive patients with STEMI were predominantly non-smoker, diabetic, dyslipidemic, obese, have positive family history of IHD, chronic kidney disease and had higher in-hospital complications &amp; in-hospital death.

P142 EARLY MANAGEMENT OF STEMI PATIENTS DURING COVID–19 PANDEMIC: THE ROLE OF AN EMERGENCY DEPARTMENT–BASED CARDIOLOGY UNIT IN SAN RAFFAELE SCIENTIFIC INSTITUTE

Abstract During COVID–19 pandemic, a critical issue for cardiologists was to provide early access to the standard of care for patients with time–dependent diseases such as ST–segment elevation myocardial infarction (STEMI), while making efforts to prevent their exposure to SARS CoV–2. Aims: The aim of our research project was to evaluate the role of an Emergency Department–based operative unit directly managed by the Cardiology Department in providing a prompt cardiological evaluation to STEMI patients at first medical contact, which we assumed might positively impact on the reperfusion strategy and timing and thus on the extent of myocardial salvage. Methods We retrospectively included a group of STEMI patients admitted by our ED with a definitive diagnosis of STEMI from March 2020 to November 2021 and a control group admitted from January 2019 to February 2020. The groups were compared in terms of critical time intervals, rate of PCI or initial non–invasive conservative management, pre–discharge characteristics and in–hospital clinical outcomes, including all cause mortality and complications. Results Throughout the study period, a total of 211 patients were admitted to our institution with a diagnosis of STEMI. The number of patients presenting late (at least twelve hours since symptoms onset) was significantly higher and time from symptoms onset to hospital admission was significantly longer during the first COVID–19 pandemic peak, compared with the previous year. Almost all patients in both cohorts underwent invasive coronary angiography with subsequent primary PCI. Remarkably, despite the time–consuming hygiene practices and policies necessary to prevent patients’ exposure to SARS CoV–2 virus, door–to–balloon time was comparable between the two cohorts. No statistically significant differences were found regarding the occurrence of STEMI–related complications. The in–hospital mortality was comparable between the two cohorts, as was predischarge LVEF. The high–sensitivity Troponin–T peak was significantly lower after the introduction of the ED–based cardiology unit. Total in–hospital stay was shorter after the introduction of the ED cardiology unit. Conclusions Our experience has shed light on the potential advantages of an ED–based unit directly managed by the Cardiology Department: despite the confirmation of a longer time from symptoms onset to hospital admission, no significant differences were found in terms of hard outcomes between the groups.

The effect of SGLT2i on in-hospital acute heart failure risk in acute myocardial infarction patients-a retrospective study.

The roles of sodium-glucose cotransporter 2 inhibitor (SGLT2i) in acute heart failure (AHF) risk after acute myocardial infarction (AMI) remain unclear. In this study, we explored the correlation between SGLT2i administration and short-term in-hospital AHF risk in AMI patients. This single-center, retrospective, and observational study included 990 AMI patients comprising 386 non-ST-segment elevation myocardial infarction (NSTEMI) and 604 segment elevation myocardial infarction (STEMI) patients enrolled from January 2019 to March 2022. Demographic information, clinical characteristics, medical treatment, and laboratory examination results during hospitalization were extracted from an electronic medical record system. The primary outcome was defined as all-cause AHF during hospitalization. In NSTEMI patients, a significantly lower proportion received SGLT2i treatment in the AHF group compared with the non-AHF group. During hospitalization, SGLT2i significantly reduced brain natriuretic peptide levels both in STEMI and NSTEMI patients. Multivariate logistic regression and stratification analyses suggested that SGLT2i is associated with reduced in-hospital AHF risk, and has a strong protective effect against AHF in NSTEMI patients with hypertension. Furthermore, SGLT2i significantly reduced the risk of in-hospital AHF for both patients with diabetes and non-diabetes. SGLT2i can reduce the risk of AHF in AMI patients during hospitalization.

Clinical and epidemiological profile of ST-segment elevation myocardial infarction patients in a megacity of west of Iran.

Low- and middle-income nations account for at least three-quarters of cardiovascular disease deaths worldwide. This study aimed to obtain real knowledge about ST segment elevation myocardial infarction (STEMI) patients and provide the context for developing a principles for care quality improvement. This cross-sectional study was conducted from July 2018 through December 2019. The study sample consisted of1169 eligible patients based on inclusion criteria. The data were collected using the standard EROP and three specialized, trained questionnaires. The collected data were checked by the quality control officer and analyzed using Stata Version 14. Patient baseline characteristics showed that body mass index, low-density lipoprotein, high-density lipoprotein, total cholesterol, and triglyceride levels were higher in women. Also, females recorded a considerable history of diabetes mellitus, hypertension, and hypercholesterolemia compared to men. The results also showed that most men were smokers (46.80%). Aspirin (94.27%), statins (91.48%), and clopidogrel (90.68%) were the common medications used at hospital discharge for patients. The present study suggests that identifying and managing modifiable risk factors can improve cardiovascular disease outcomes. Also, considering the early identification of STEMI patients with new therapies can effectively decrease the rate of cardiovascular disease and its attributed health outcomes.

Pharmacoinvasive Therapy in Treating Acute STEMI Patients in Covid-19 Era

Background: Treating acute ST segment elevated myocardial infarction (STEMI) patients by primary PCI (pPCI) has dramatically fallen globally in covid era as there is chances of potential threat of spreading COVID among the non-COVID patients. Thereby, thrombolysis of acute STEMI patient in grey zone till COVID RT PCR report to come, was the mode of treatment of acute myocardial infarction patient in our hospital. We have carried out this prospective observational study to see the outcomes of thrombolysis and subsequent intervention. Methods: STEMI patient who presented to our emergency department with chest pain and ECG and hs-Troponin-I evidenced acute STEMI, were enrolled in the study. Total 139 patients enrolled (Male:120, Female :54); average age for Male: 54 yrs., female was: 56yrs. All patients were admitted in the grey zone of CCU where thrombolysis was done. COVID-19 patients were excluded from intervention and managed conservatively. Covid Negative patients were kept transferred to CCU green zone. On average 2.1 days after Fibrinolysis, elective PCI carried out. Data analysis from 48 patients who underwent pharmacoinvasive therapy was done. Results: Among the study population, Covid-19 positive was in 11 (7.9%) patients and Covid-19 was negative in 128 (92.1%) patients. Primary PCI was performed in 7 (5.03%) patients. Rest of the patients were managed by Pharmacoinvasive therapy. Thrombolysis by Tenecteplase (TNK) was done in 89 (64%) patients, and by Streptokinase in 25 (17.9%) patients, 18 (12.9%) patients did not receive any thrombolysis due to late presentation. Chest pain to needle time was 7.2 ±12.7hrs., thrombolysis to balloon time was 117.5 ±314.8hrs. More than 50% stenosis resolution observed in 20 (41.6%) patients, chest pain resolution within one hour of thrombolysis observed in 21 (43.8%) patients. Ten (20.8%) patients developed. Door to needle time was 30 mins. Total, 88 stents were deployed in 83 territories. CABG was recommended for 7 (5.03%) patients. Stented territory was LAD 37 (45.7%) and RCA 32 (39.5%) and LCX 12 (14.8%). Conclusion: In the era of COVID-19, in this prospective cohort study, on acute STEMI patient management, we found that Pharmacoinvasive therapy, reduced patients’ symptoms and ST resolution occurred partially. Cardiovasc j 2023; 15(2): 136-143