Segment Elevation Myocardial Infarction Research Articles

Efficacy and safety of glycoprotein IIb/IIIa inhibitors in addition to P2Y12 inhibitors in ST-segment elevation myocardial infarction: A subanalysis of the POPular Genetics trial.

Glycoprotein IIb/IIIa inhibitors (GPI) are still used in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), although discussion about its clinical benefit is ongoing. GPI use was analyzed in this subanalysis of the POPular Genetics trial, which randomized STEMI patients to CYP2C19 genotype-guided treatment (clopidogrel or ticagrelor) or standard treatment with ticagrelor/prasugrel. The composite thrombotic endpoint consisted of cardiovascular death, myocardial infarction (MI), definite stent thrombosis, and stroke at 30 days. The combined bleeding endpoint consisted of Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding at 30 days. Univariable and multivariable analyses in addition to a propensity score-matched (PSM) analysis were conducted. In total, 2378 patients, of whom 1033 received GPI and 1345 did not, were included. In multivariable analysis, GPI administration was associated with fewer thrombotic events (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.09-0.55) and MIs (HR 0.24, 95% CI 0.08-0.73). Furthermore, GPI administration was associated with an increase in bleedings (HR 2.02, 95% CI 1.27-3.19), driven by minor bleedings (HR 2.32, 95% CI 1.43-3.76), without a significant difference in major bleedings (HR 0.69, 95% CI 0.19-2.57). In the PSM analysis, no significant association was found. In STEMI patients undergoing primary PCI, GPI administration was associated with a reduction in thrombotic events at a cost of an increase in (mostly minor) bleedings in multivariable analysis, while propensity score analysis did not show significant associations.

Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

What an Interventionalist Needs to Know About MI with Non-obstructive Coronary Arteries.

MI with non-obstructive coronary arteries (MINOCA) is caused by a heterogeneous group of vascular or myocardial disorders. MINOCA occurs in 5.15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. The diagnosis of MINOCA is made during coronary angiography following acute MI, where there is no stenosis ≥50% present in an infarct-related epicardial artery and no overt systemic aetiology for the presentation. Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging, coronary function testing and subsequent imaging to assess for myocardial disorders without coronary involvement. Although plaque-related MINOCA is currently managed with empirical secondary prevention strategies, there remains an unmet therapeutic need for targeted and evidence-based therapy for MINOCA patients and increased awareness of the recommended diagnostic pathway.

Reactive Hyperglycaemia Connected with Low Glycated Haemoglobin – Risk Factor for Cardiovascular Adverse Events

Introduction: Concomitance of glucose metabolism disturbances and ischemic heart disease is well known and connected to several times higher incidence of cardiovascular events resulted from atherosclerosis. Aim of this study was to assess impact of reactive hyperglycaemia accompanying chronic and not always optimally treated hyperglycaemia assessed with glycated haemoglobin level on cardiovascular prognosis among patient hospitalised in the course of acute myocardial infarction. Methods: 92 patients diagnosed with ST – segment elevation myocardial infarction (STEMI) qualified to primary percutaneous coronary intervention (pPCI) was included in the study. Study population was divided into subgroups, depending glucose level on admission (reactive hyperglycaemia) and HbA1c concentration: subgroup A (HbA1c <6.5%, Glc<7.8 mmol/l: n = 37; 40,2%), subgroup B (HbA1c <6.5%, Glc ≥.,8 mmol/l: n = 27; 29,3%), subgroup C (HbA1c ≥6.5%, Glc ≥7.8 mmol/l: n = 20; 21,7%) and subgroup D (HbA1c ≥6.5% Glc<7.8 mmol/l: n = 8; 8.7%). Level of myocardium damage was assessed on the basis of concentration of myocardial necrosis enzymes: creatine kinase (CK) and creatine kinase MB fraction (CK-MB) in the 0 and 90th minute and thereafter 8, 16, 24 and 48 hours after hospital admission and also echocardiographic examination. Prognosis in long and short term observation was assessed by major adverse cardiovascular events (MACE) such as death, myocardial infarction, stroke, heart failure requiring hospitalisation and repeated revascularisation and level of glucose metabolism disturbances in intrahospital phase, 4 months and 4 years follow up observation. Results: Results in study population revealed significant change of average value of creatine kinase (p<0,001) and its MB fraction (p<0,001) during first 48 hours of hospitalisation in particular subgroups of patients. Mean values of CK and CK-MB assessed in subsequent hours of hospitalisation (1,5, 8, 16 and 48 hours) were significantly higher in subgroup B (CKp=0,034 and CK-MB p=0,01, respectively). It means that area under curve was significantly higher for subgroup B. In 4 months and 4 year follow up observation, statistically significant difference in frequency of MACE in particular subgroups of patients has been shown (p=0,016; p=0,01). Conclusions: Patients with STEMI undergoing pPCI, who were diagnosed with disturbed carbohydrate metabolism, have inferior clinical outcomes in long term follow up observation. Noticeable difference was observed particularly in subgroup B (HbA1c <6.5%, Glc ≥7.8 mmol/l).

Effects of cardiac rehabilitation on risk factor management and quality of life in patients with ischemic heart disease: A multicenter cross-sectional study

While cardiac rehabilitation (CR) improves survival outcomes in patients with ischemic heart disease (IHD), the long‑ term benefits of short term programs are still discussed. The aim of the study was to assess the impact of CR on risk factor management in a multicenter real‑ life registry of patients with IHD. We included patients aged 80 years or younger who had been hospitalized due to acute coronary syndrome or for a myocardial revascularization procedure and interviewed 6 to 18 months later. Control of risk factors was compared between patients who participated in CR and those who did not. Propensity score matching was used to account for differences in patient characteristics between the groups. Of 1012 interviewed patients (28.6% women), 35.6% were referred for CR and 76.1% of them completed the program. Those referred were younger (P <0.001), employed (P <0.001), have presented with ST‑ segment elevation myocardial infarction (P <0.001), had hypertension (P <0.001), and were current smokers (P <0.001). Logistics regression revealed that patients who participated in CR were more likely to stop smoking (odds ratio [OR], 2.42; 95% CI, 1.33-4.14), achieve acceptable glucose control (OR, 1.70; 95% CI, 1.02-2.83), and better quality of life (β = 0.12; 95% CI, 0.00-0.24) compared with those who did not participate in CR. Cardiac rehabilitation is moderately effective if performed only once and without a continuous support program. Further efforts to increase referrals for CR in patients with IHD must be accompanied by a long‑ term strategy to sustain the beneficial effects.

Association between the platelet-lymphocyte ratio and short-term mortality in patients with non-ST-segment elevation myocardial infarction.

BackgroundPrevious studies have shown that inflammation plays an important role in atherosclerosis and cardiovascular disease. Platelet to lymphocyte ratio (PLR) has been reported as a novel inflammatory marker. However, it is not clear whether PLR is associated with short‐term all‐cause mortality in critically ill patients with non‐ST‐segment elevation myocardial infarction (NSTEMI).MethodsThe data for the study is from the Medical Information Mart for Intensive Care III database. The primary outcome in our study was 28‐day mortality. Kapan‐Meier curve, lowess smoother curve, and multivariate Cox regression models were used to determine whether the association between PLR and 28‐day mortality of critically ill patients with NSTEMI.ResultsA total of 1273 critically ill patients with NSTEMI were included in this analysis. Kapan‐Meier curve and lowess smoother curve show that high PLR is associated with an increased risk of 28‐day all‐cause mortality. The study population is divided into two groups according to the cut‐off value of PLR level. In the Cox model, high PLR levels (PLR≥195.8) were significantly associated with increased 28‐day mortality (HR 1.54; 95%CI 1.09–2.18, p = .013). In quartile analyses, the HR (95% CI) for the third (183 ≤ PLR < 306) and fourth quartile (PLR≥306) was 1.55 (1.05–2.29) and 1.61 (1.03–2.52), respectively, compared to the reference group(111 ≤ PLR < 183). In subgroup analyses, there is no interaction effect in most of the subgroups except for respiratory failure and vasopressor use.ConclusionHigh PLR is associated with an increased risk of short‐term mortality in critically ill patients with NSTEMI.

Acute coronary syndrome in nonagenarians: gender gap?

Abstract Funding Acknowledgements Type of funding sources: None. Background Ischemic heart disease in the elderly people has increased accordingly with rising hope of life. In patients with acute coronary syndrome (ACS) women have a higher mortality than men. However, it is unknown if these differences remain in nonagenarians. Purpose The aim of the study was to evaluate the therapeutic strategies and mortality at 1 year according to gender. Methods We retrospectively included in a multicenter study all consecutive patients &amp;gt; 90 yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) between 2005 and 2018. Strategies treatment and mortality at 1 year by gender were evaluated. Results 680 patients were included (92.6 ± 2.4 years, 59% women) (Table 1). Women presented a greater prevalence of hypertension arterial. Conservative treatment was more frequent in women (73.5% vs 66.2%, p = 0.04) (Image 1), in particular in STEMI subgroup (p = 0.01). They had less capacity functional evaluated by Barthel index (p &amp;lt;0.01) and higher number of infections during admission than men (17.45% vs. 11.7%, p &amp;lt;0.01). The mortality evaluated at 12 months was similar in both groups (p = 0.38), with a trend of better prognosis in women who underwent percutaneous coronary intervention (PCI) (p = 0.08). Conclusions Women had lower functional capacity than men, which could explain that they were more likely to be treated with conservative strategy. Mortality was similar in both genders, however, in the subgroup of patients undergoing PCI, was achieved a trend of lower mortality in women. WomenMenPPatients402.0 (59,1%)278.0 (40,9%)Age92.5 ± 2,292.6 ± 2,50.82STEMI189.0 (47%)120.0 (43%)0.32Hypertension331.0 (82,6%)208.0 (74,8%)0.01CKD84.0 (20,9%)59.0 (21,2%)0.91COPD17.0 (4,2%)54.0 (19,4%)&amp;lt;0.01Barthel index75.084.0&amp;lt;0.01Atypical symptoms82.0 (20,4%)42 (15,1%)0.08GRACE175.0171.00.02LDL97.086.0&amp;lt;0.07PCI44,8%54,3%0.04All cause mortality150.0 (37,3%)113.0 (40,6%)0.38Cardiovascular mortality97.0 (67,8%)63.0 (58,3%)0.12

Zero contrast optical coherence tomography-guided percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction and chronic kidney disease.

To investigate a strategy for ultra-low volume contrast percutaneous coronary intervention (PCI) with the aims of preserving renal function and observing the 90-day clinical endpoint in patients with non-ST-elevated myocardial infarction (non-STEMI) and chronic kidney disease (CKD). The feasibility, safety, and clinical utility of PCI with ultra-low radio-contrast medium in patients with non-STEMI and CKD are unknown. A total of 29 patients with non-STEMI and CKD (estimated glomerular filtration rate [eGFR] of ≤60 ml/min/1.73 m2 ) were included. Ultra-low volume contrast PCI was performed after minimal contrast coronary angiography using zero contrast optical coherence tomography (OCT) guidance. Pre- and post-PCI angiographic measurements were performed using quantitative flow ratio (QFR) for pre-perfusion assessment and verifying improvement. The median creatinine level was 2.1 (inter-quartile range 1.8-3.3), and mean eGFR was 48 ± 8 ml/min/1.73 m2 pre-PCI. During the PCI procedure, OCT revealed 15 (52%) cases of abnormalities post-dilation. There was no significant change in the creatinine level and eGFR in the short- or long-term, and no major adverse events were observed. In non-STEMI patients with high-risk CKD who require revascularization, QFR and no contrast OCT-guided ultra-low contrast PCI may be performed safely without major adverse events.

Rationale and design of the OPTIMAL-REPERFUSION trial: A prospective randomized multi-center clinical trial comparing different fibrinolysis-transfer percutaneous coronary intervention strategies in acute ST-segment elevation myocardial infarction.

Primary percutaneous coronary intervention (PPCI), the preferred reperfusion strategy for all acute ST‐segment elevation myocardial infarction (STEMI) patients, is not universally available in clinical practice. Pharmacoinvasive strategy has been proposed as a therapeutic option in patients with STEMI when timely PPCI is not feasible. However, pharmacoinvasive strategy has potential delay between clinical patency and complete myocardial perfusion. The optimal reperfusion strategy for STEMI patients with anticipated PPCI delay according to current practice is uncertain. OPTIMAL‐REPERFUSION is an investigator‐initiated, prospective, multicenter, randomized, open‐label, superiority trial with blinded evaluation of outcomes. A total of 632 STEMI patients presenting within 6 hours after symptom onset and with an expected time of first medical contact to percutaneous coronary intervention (PCI) ≥120 minute will be randomized to a reduced‐dose facilitated PCI strategy (reduced‐dose fibrinolysis combined with simultaneous transfer for immediate invasive therapy with a time interval between fibrinolysis to PCI < 3 hours) or to standard pharmacoinvasive treatment. The primary endpoint is the composite of death, reinfarction, refractory ischemia, congestive heart failure, or cardiogenic shock at 30‐days. Enrollment of the first patient is planned in March 2021. The recruitment is anticipated to last for 12 to 18 months and to complete in September 2023 with 1 year follow‐up. The OPTIMAL‐REPERFUSION trial will help determine whether reduced‐dose facilitated PCI strategy improves clinical outcomes in patients with STEMI and anticipated PPCI delay. This study is registered with the ClinicalTrials.gov (NCT04752345).

Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population

ObjectiveST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and...

Large Coronary Intramural Hematoma Presenting as Acute Coronay Syndrome

Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial– adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is infrequent and serious coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both diagnostics and treatment strategy. We report a case of intramural coronary hematoma in a patient presenting with non ST- -segment elevation myocardial infarction.

Prognosis of Patients With Left Circumflex Artery Acute Myocardial Infarction in Relation to ST-Segment on Admission Electrocardiogram.

Total thrombotic occlusion of the left circumflex (LCX) artery may present without ST-segment elevations; the clinical outcomes of such patients remain unclear. To examine the difference in clinical outcomes between patients with acute myocardial infarction (MI) due to LCX occlusion or stenosis with and without ST-segment elevation. The present study is based on an observational, retrospective cohort comprising all patients admitted to 2 centers between 2009 and 2019 with MI due to LCX disease. Clinical outcomes included recurrent percutaneous coronary intervention (PCI), hospitalization due to acute coronary syndrome (ACS), and mortality. Risk factors for mortality were assessed using logistic regression analysis. During the study period, a total of 897 patients with LCX-related MI were treated. Most (56.6%) presented with non-ST segment elevation MI (NSTEMI), which was associated with higher rates of 1-year hospitalization for ACS (15.8% vs 11.1%; P=.05) and PCI (20.9% vs 14.4%; P=.05) compared with ST-segment elevation MI (STEMI) patients. STEMI was associated with higher 30-day mortality compared with NSTEMI (3.9% vs 1.7%, respectively; P=.05), with no difference in mortality after 1 year (6.7% vs 5.6%, respectively; P=.55). Multivariate analysis found left dominant circulation (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.4-4.7) and diabetes mellitus (OR, 2.13; 95% CI, 1.2-3.6) to be independent predictors for 1-year mortality. Patients suffering from NSTEMI and STEMI related to LCX occlusion or stenosis have similar 1-year mortality. Left dominant circulation was associated with higher short- and long-term mortality. These results suggest that a substantial population of patients who present as NSTEMI should be treated as promptly and aggressively as STEMI patients.

Safety and performance of the EverProTM everolimus-eluting coronary stent system with biodegradable polymer in a real-world scenario.

BACKGROUNDThe EverProTM (Sahajanand Laser Technology Ltd., India) everolimus-eluting coronary stent system (EES) is a second-generation drug-eluting stent with a biodegradable polymer.AIMTo determine the safety and performance of the EverProTM EES in patients with coronary artery disease (CAD) during a 1-year clinical follow-up.METHODSThis observational, retrospective, single-center study enrolled patients who had been implanted with the EverProTM stent between June 1, 2018 and January 31, 2019, and had completed a 1-year follow-up period after the index procedure. The primary clinical endpoint was major adverse cardiac events (MACE) at 6 mo defined as the composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). Secondary endpoints were the incidence of TLR at 1, 6 and 12 mo follow-up, MACE at 1 and 12 mo follow-up, and stent thrombosis up to 1 year after the index procedure.RESULTSThe study population comprised 77 patients (98 lesions). A total of 37 (48.1%) patients had comorbid hypertension. In total, 26 (33.8%) patients presented with ST segment elevation MI and 10.4% patients with non-ST segment elevation MI. Treated lesions were located mainly in the left anterior descending artery (49%) followed by the right coronary artery (29.6%), left circumflex (12.2%) and obtuse marginal (9.2%) arteries. The majority of patients were with single-vessel disease (79%), 22.2% of lesions had a mild to severe thrombus load, and 94.9% were American College of Cardiology/American Heart Association type B or C. De novo stenting was performed in 96.9% of patients and 3% were treated for in-stent restenosis. Procedural success was attained in all patients. In-hospital or follow-up MACE and stent thrombosis were not reported during the 1-year follow-up period.CONCLUSIONThese findings suggest that the EverProTM EES is a safe and effective treatment option with no MACE or stent thrombosis reported during the 1-year study period in patients with CAD.

Safety and feasibility of low-dose ticagrelor in patients with ST-segment elevation myocardial infarction.

BackgroundPrevious studies have confirmed the safety and feasibility of half‐dose ticagrelor in Chinese patients with acute coronary syndrome, but currently there is no plan for the use of ticagrelor for Chinese ST‐segment elevation myocardial infarction (STEMI) patients.HypothesisIt is safe and feasible of low‐dose ticagrelor in patients with STEMI.MethodsThe STEMI patients who were undergoing emergency intervention and taking ticagrelor were enrolled. Patients whose level of platelet aggregation rate (PAR) less than 30% after 7‐day treatment with standard‐dose ticagrelor were randomly divided into low‐dose group (LD group, 45 mg twice daily) and standard‐dose group (SD group, 90 mg twice daily). The changes of levels of platelet parameters were compared between the two groups. The incidence of major adverse cardiac events (MACE), bleeding events were compared between the two groups within 6 months of follow‐up.ResultsThe levels of PAR in the SD group decreased compared with baseline, and was lower than those of LD group at the same time point. The levels of platelet distribution width in both groups decreased from the baseline values (all p < .05) at 1, 3, and 6 months after grouping treatment, but there was no significant difference between the two groups. The incidence of MACE was similar between the two groups of patients. There were decreasing trends in the incidences of minimal bleeding event, minor bleeding event, dyspnea, and gout in the LD group.ConclusionIt is safe and feasible of low‐dose ticagrelor for patients with STEMI based on the monitoring of PAR.

In Hospital Outcomes of Patients with ST Segment Elevation Myocardial Infarction, Late for Thrombolysis

Background: Myocardial infarction (MI) especially with ST segment elevation MI (STEMI) is a highly morbid and fatal entity and can result in various electrophysiological and mechanical complications during in hospital stay. Objective: To determine the in hospital outcomes of patients with ST segment elevation myocardial infarction, late for thrombolysis. Material and methods: This descriptive cases series was conducted at Rehmatul Lil Alameen Institute of Cardiology, PESSI, Lahore during 01-06-2018 to 31-12-2018. The cases of both genders with age 30 years or more, having ST elevation MI who were late for thrombolysis were included. The patients were looked for various outcomes like cardiogenic shock, left ventricular thrombus, heart block, death or discharge from the hospital. Results: In this study out of 105 cases, 74 (70.5%) males and 31 (29.5%) females. The mean age was 58.40 ± 11.19 years and mean duration of hospital stay was 6.77 ± 3.34 days. LV clot was seen in 7 (6.67%) of the cases, cardiogenic shock in 23 (21.9%) and complete heart block in 4 (3.81%) of the cases. Out of 105 cases, 9 (8.57%) died while rest were discharged. Regarding different types of MI, death was seen in 5 (8.1%) cases in AWMI, 4 (10%) in IWMI and none in LWMI out of their respective groups with p= 0.81. Conclusion: STEMI is a highly morbid entity in cases those are late from thrombolytic and cardiogenic shock is the most common complication observed.

Impact of chronic total occlusion and revascularization strategy in patients with infarct-related cardiogenic shock: A subanalysis of the culprit-shock trial

The impact of coronary artery chronic total occlusion (CTO) and its management with percutaneous coronary intervention (PCI) in the setting of myocardial infarction (MI) related cardiogenic shock (CS) remains unclear. This is a pre-specified analysis from the culprit-lesion-only PCI vs multivessel PCI in CS (CULPRIT-SHOCK) trial which randomized patients presenting with MI and multivessel disease complicated by CS to a culprit-lesion-only or immediate multivessel PCI strategy. CTO was defined by central core-laboratory evaluation. The independent associations between the presence of CTO and adverse outcomes at 30 days and 1 year were assessed using multivariate logistics models. A noninfarct related CTO was present in 157 of 667 (23.5%) analyzed patients. Patients presenting with CTO had more frequent diabetes mellitus or prior PCI but less frequently presented with ST segment elevation MI as index event. The presence of CTO was associated with higher rate of death at 30 days (adjusted Odds ratio 1.63; 95% confidence interval [CI] 1.01-2.60). Rate of death at 1 year was also increased but did not reach statistical significance (adjusted Odds ratio 1.62; 95%CI 0.99-2.66). Compare to immediate multivessel PCI, a strategy of culprit-lesion-only PCI was associated with lower rates of death or renal replacement therapy at 30 days in patients with and without CTO (Odds ratio 0.79 95%CI 0.42-1.49 and Odds ratio 0.67 95%CI 0.48-0.96, respectively), without significant interaction (P = .68). In patients with MI-related CS and multivessel disease, the presence of CTO is associated with adverse outcomes while a strategy of culprit-lesion-only PCI seems beneficial regardless of the presence of CTO.

Comparison of quantitative flow ratio, Pd/Pa and diastolic hyperemia‐free ratio versus fractional flow reserve in non‐culprit lesion of patients with non ST‐segment elevation myocardial infarction

AbstractObjectivesTo investigate the correlation between quantitative flow ratio (QFR), Pd/Pa, diastolic hyperemia‐free ratio (DFR) and fractional flow reserve (FFR, gold standard) in non‐culprit lesion (NCL) of patients with non ST‐segment elevation myocardial infarction (NSTEMI).BackgroundThe non‐hyperemic pressure ratio (NHPR) and the angiography‐based indexes have been developed to overcome the limitation of the use of the FFR.MethodsBetween January and December 2019, 184 NCL from 116 NSTEMI patients underwent physiologic assessment and were included in the study. NCLs were investigated with QFR, Pd/Pa, DFR, and FFR. Mean values of QFR, Pd/Pa, DFR and FFR were 0.85 ± 0.10, 0.92 ± 0.07, 0.93 ± 0.05 and 0.84 ± 0.07, respectively.ResultsDFR and FFR showed a good correlation (r = 0.76). Bland and Altman plot showed a mean difference of 0.080. DFR Diagnostic accuracy was 88%. The area under the ROC curve (AUC) for DFR was 0.946 (95%CI 0.90–0.97, p = .0001). Similar findings were reported for Pd/Pa (r = 0.73; mean difference 0.095, diagnostic accuracy 84%, AUC 0.909 [95%CI 0.85–0.94, p = .0001]) and QFR (r = 0.68; mean difference 0.01; diagnostic accuracy 88%, AUC 0.964 [95% CI 0.91–0.98, p = .0001]). FFR, QFR, Pd/Pa and DFR identified 31%, 32%, 30% and 32% potentially flow‐limiting lesions, respectively.ConclusionsIn NSTEMI patients, QFR, Pd/Pa and DFR showed equivalence as compared to gold standard FFR in the discrimination of non‐culprit lesions requiring revascularization.

Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report.

BackgroundAccelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF).Case summaryA 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death.DiscussionDelayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.

Abstract 17426: Acute Myocardial Infarction Due to Right Coronary Artery Occlusion Following Blunt Thoracic Trauma

Blunt thoracic wall trauma can rarely lead to acute coronary artery injury and occlusion , and mostly involves the left anterior descending artery due to its vulnerable anterior anatomic positioning. Herein, we present a case of a young man who presented as a ST segment elevation MI (STEMI) with right coronary artery (RCA) occlusion after a blunt thoracic wall trauma. Clinical Vignette: A 37-year-old man with no previous medical history was brought to our ER with blunt chest wall trauma following a motor vehicle collision. Initial workup showed multiple fractures, a right pneumothorax and a pelvic hematoma. EKG performed for chest pain showed STEMI in the inferior and lateral leads. A 2D echocardiogram then showed inferolateral wall hypokinesis. Serial troponin I levels trended up sharply from 0.4 initially. After initiating intravenous heparin and cangrelor, the patient underwent emergent coronary angiography which revealed a rare, RCA occlusion with a thrombus. The patient then successfully underwent aspiration thrombectomy with restoration of TIMI grade III blood flow. Discussion: Hence, we presented a rare case of RCA occlusion resulting from blunt thoracic wall trauma. While musculoskeletal pain may mask the symptoms of myocardial hypoperfusion, a high index of suspicion for coronary artery thrombosis can lead to desirable outcomes in such patients.

Clinical impact of complete atrioventricular block in patients with ST-segment elevation myocardial infarction.

Complete atrioventricular block (CAVB) is a common complication of ST‐segment elevation myocardial infarction (STEMI). Although STEMI patients complicated with CAVB had a higher mortality in the thrombolytic era, little is known about the impact of CAVB on STEMI patients who underwent primary percutaneous coronary intervention (PCI). The study aimed at evaluating the clinical impact of CAVB on STEMI patients in the primary PCI era. We consecutively enrolled 1295 STEMI patients undergoing primary PCI within 24 hours from onset. Patients were divided into two groups according to the infarct location: anterior STEMI (n = 640) and nonanterior STEMI (n = 655). The outcomes were all‐cause death and major adverse cardiocerebrovascular events (MACCE) with a median follow‐up period of 3.8 (1.7–6.6) years. Eighty‐one patients (6.3%) developed CAVB. The incidence of CAVB was lower in anterior STEMI patients than in nonanterior STEMI (1.7% vs 10.7%, p < .05). Anterior STEMI patients with CAVB had a higher incidence of all‐cause deaths (82% vs 20%, p < .05) and MACCE (82% vs 25%, p < .05) than those without CAVB. Although higher incidence of all‐cause deaths was found more in nonanterior STEMI patients with CAVB compared with those without CAVB (30% vs 18%, p < .05), there was no significant difference in the incidence of MACCE (24% vs 19%). Multivariate analysis showed that CAVB was an independent predictor for all‐cause mortality and MACCE in anterior STEMI patients, but not in nonanterior STEMI. CAVB is rare in anterior STEMI patients, but remains a poor prognostic complication even in the primary PCI era.