ST-segment Elevation In Patients Research Articles

Percutaneous coronary intervention in patients admitted with acute coronary syndrome within 6 months after COVID-19 (retrospective single-center study)

BACKGROUND: Assessing clinical manifestations in patients during the period of destabilization of the course of coronary artery disease after COVID-19 coronavirus infection remains a clinical problem. Identifying features of coronary artery lesions in such patients will help to prevent the development of complications and may influence the tactics of active dynamic monitoring.
 AIM: To evaluate the structure of coronary artery lesions and clinical manifestations in patients with acute coronary syndrome that developed within 6 months after COVID-19 new coronavirus infection.
 MATERIALS AND METHODS: A comparative analysis of the results of coronary artery stenting in 157 patients admitted with acute coronary syndrome has been carried out. The 1st group included 69 patients who had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; in the 2nd — 88 patients without a history of COVID-19 (vaccinated — 42%). All the patients had drug-eluting stents implanted in the infarct-related artery. Long-term results have been observed in 151 (96.2%) patients.
 RESULTS: Before the development of acute coronary syndrome, dispnoe was more often observed in patients of the 1st group (36; 52%) than in patients of the 2nd group (13; 14.8%). There were no focal neurological symptoms in the patients of both groups. Dizziness more often preceded acute coronary syndrome in the patients of the 1st group (26; 38.2%) compared to the control group (5; 5.7%). Decreased motivation and fatigue were detected in 27 (67.5%) patients in the 1st group, which was more common than in the 2nd group (13; 32.5%). Acute coronary syndrome with ST elevation was treated in 47 % and 38.6% of the patients in the 1st groups and the 2nd, respectively. The development of acute coronary syndrome with ST segment elevation with previous clinical manifestations of post-covid syndrome in the 1st group was observed in 95.8%, whereas in the absence of post-covid syndrome in 53.3%. The mean value of LVEF in patients who had COVID-19 was 55.9 ± 14%, which was significantly lower than in the patients in the control group (63.2 ± 5.5%; р 0.001). During the course of coronavirus infection in the patients in the first group, lung damage of degrees I–II according to CT scan data was observed in 76.8% of the patients and in 23.2% of degrees III–IV. The frequency of lesions of the circumflex branch in the 1st group was 15.9%, in the 2nd — 11.4% (р = 0.403); of the right coronary artery — 33.3%, and 22.7% (р = 0.41); of the diagonal branch — 5.8%, and 3.4% (р = 0.47); of the left main coronary artery — 5.8%, and 6.8% (р = 0.79), of the left anterior descending branch — 52.2%, and 35.2% (р = 0.033), respectively. The incidence of vasospastic angina in the 1st group was 53.6%, in the 2nd — 15.9% (р 0.0001). ST segment elevation in lead AVR as a manifestation of subendocardial ischemia was registered in the 1st group — 40.6%, the 2nd — 11.4% (р 0.0001). All the patients had drug-eluting stents implanted in the infarct-related artery. Overall survival (in-hospital and long-term) was 100% for the first group and 100 % for the second one.
 CONCLUSIONS: In the structure of coronary arteries lesions after COVID-19 new coronavirus infection in patients with acute coronary syndrome, damage to the anterior interventricular artery dominates (52.2%). The likelihood of having a left anterior descending lesion during the development of acute coronary syndrome with ST segment elevation in patients who have had COVID-19 is 1.5 times higher. The structure of clinical manifestations after COVID-19 in patients before the development of acute coronary syndrome is dominated by shortness of breath (52 %) and decreased motivation and fatigue (67.5 %).

Protean Electrocardiographic Patterns of ST-Segment Elevation in Patients With Takotsubo Syndrome

Protean Electrocardiographic Patterns of ST-Segment Elevation in Patients With Takotsubo Syndrome

Absence of ST-Segment Elevation in Inferior and Lateral Leads in Patients With Complete Right Bundle Branch Block Is an Index of Underlying Cardiac Pathology

A recent report called attention to the nature of the ST-segment elevation (STSE) in some or all inferior and/or lateral electrocardiogram (ECG) leads (i.e., I, II, III, aVL, aVF, V5, and V6), which are frequently encountered in patients with stable or transient complete right bundle branch block (RBBB). These STSEs represent secondary repolarization changes due to late depolarization RBBB alterations; are stable over the course of many years in patients with RBBB; and do not reflect cardiac pathology, as the automated ECG interpretation algorithms erroneously indicate. Indeed, the absence of such STSEs in patients with RBBB suggests the presence of underlying acute or old myocardial infarction, acute myocardial ischemia, or left ventricular hypertrophy and thus constitute an as yet undescribed ECG index of cardiovascular pathology.

Recent Status in Brugada Syndrome.

Brugada syndrome was first described in 1992 as right precordial ST-segment elevation in patients with structurally normal hearts and sudden cardiac death. Brugada Syndrome is one of the most common reasons for sudden cardiac death (4-12%) and is a hereditary disease with an autosomal dominant pattern of transmission with nearly 300 pathogenic variants in 19 responsible genes published. The present review focuses on the diagnosis, genetics, risk stratification, and management of patients with Brugada Syndrome.

Association of aVR ST-elevation with outcomes in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Evaluation of the lead aVR in the diagnosis of acute coronary syndrome has been neglected before.1 However, there is evidence that an ST segment elevation in that lead correlates to a significant coronary artery disease.1,2 This study aimed to determine the association with clinical outcomes of an aVR ST elevation in patients with acute coronary syndrome. Purpose Identify patients who are at high risk on presentation at the emergency department. Methods This was a retrospective cohort study. Patients aged 19 years and above who were diagnosed with either unstable angina, non ST-elevation MI or ST elevation MI were eligible subjects. The medical records of patients in a tertiary referral government hospital were evaluated. The independent variable was the lead aVR ST elevation, while the primary outcome was the in-hospital mortality. Descriptive statistics was used to summarise the demographic and clinical characteristics of the patients. Frequency and proportion was used for categorical variables, median and inter quartile range for non-normally distributed continuous variables, and mean and standard deviation for normally distributed continuous variables. Independent Sample T-test and Fisher’s Exact test was used to determine the difference of mean and frequency, respectively, between patients with and without in-hospital outcomes. Odds ratio and corresponding 95% confidence intervals from binary logistic regression was computed to determine significant predictors of in-hospital outcomes. Missing variables was neither replaced nor estimated. Null hypotheses was rejected at 0.05α-level of significance. Results There were a total of 108 patients included. Most subjects were males and aged 57-62 years old. Majority had NSTE-ACS and STEMI at presentation. Lead aVR ST elevation group had an OR of 17 (95% CI 4.38-67.50 and p < 0.001) for in-hospital mortality, compared to the group without. On coronary angiogram, these patients had either a significant left main coronary artery disease or a multi-vessel coronary artery disease. Conclusion The presence of a lead aVR ST segment elevation in patients with acute coronary syndrome at presentation in the emergency department is associated with increased in-hospital mortality.

Abstract 13024: Excessive Slow Flow and Thick Boundary Layers Cause Non ST Segment Elevation in Patients With Patent Coronary Arteries

Introduction: Many patients arrived to emergency room with atypical chest pain, borderline ST segment elevation, troponin level significantly elevated however the coronary angiogram was normal. Why? Hypothesis: Based on damages by flow disturbances in pipes, our research is built on the hypothesis that flow abnormalities disrupt delivery of oxygenated blood to the myocardium. Our strategy is to use today’s practice of fluid mechanics to unlock the mechanism of non-ST Segment elevation myocardial infarction (non-NSTEMI) and patent coronary arteries. What coronary flow abnormalities were the culprit? Methods: Patients with non-STEMI were enrolled if the coronary arteries were patent. In our new dynamic angiographic protocol, contrast was injected until the index coronary artery was completely opacified. Once the manual injection stopped, the blood moved in, displacing the contrast. The movements and directions of the blood flow in “white” color on top of a “black contrast” background could be clearly analyzed. The main focuses were the types of flows and their duration, direction and length. Results: 12 patients with non-STEMI and patent coronary arteries were enrolled. 100% patients had severe slow flow with prolonged arterial phase (>1.8secs) compared with historical control (0.72 secs) (p<0.05). 83% patients had retention flow with thick stagnant boundary layers at the proximal and mid segment of right coronary artery. The retrograde flow was short (0.18secs). Two patients showed excessive contraction of left ventricle. 4 patients revealed history of intense emotional stress however no sign of adrenergic excess (elevated blood pressure, heart rate or extreme peripheral vasoconstriction). All patients recovered and remained asymptomatic after one year follow-up. Conclusions: In non-STEMI and patent coronary arteries, severe slow flow and prolonged retention of thick boundary layers were the culprits. Besides the ischemia caused by delayed delivery of new blood to myocardium, the prolonged retention of thick boundary layers could prevent the intima from absorbing new oxygenated blood and provoked local ischemia. These new discoveries open new management and preventive options for patients with non-STEMI and patent coronary arteries.

SEVERE CORONARY ARTERY SPASM WITH CARDIAC ARREST IN A PATIENT WITH COVID-19

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: SARS-CoV-2 has been associated with cardiac complications, especially in patients with pre-existing cardiovascular disease. We present a case of a patient without any history of coronary artery disease (CAD), who contracted COVID-19 and developed severe coronary artery spasms resulting in cardiac arrest. CASE PRESENTATION: A 55-year-old man with past medical history of tobacco use of 30 years was admitted with severe COVID-19 pneumonitis with acute hypercapnic and hypoxemic respiratory failure, requiring invasive mechanical ventilation. On hospital day 9, he had intermittent episodes of polymorphic ventricular tachycardia. An EKG showed acute ST elevations in leads II, III, aVF and V1-V3 with troponin T rise to 0.83 ng/mL. He developed cardiac arrest due to polymorphic ventricular tachycardia. Successful resuscitation was achieved after 5 minutes including defibrillation and 2 cycles of CPR. An emergent left heart catheterization revealed insignificant CAD, normal left ventricular systolic function and no wall motion abnormalities with a presumptive diagnosis of coronary artery spasm (CAS) as the most likely cause for his cardiac arrest. He was started on a nitroglycerin patch, and his vasopressor support was switched from norepinephrine to epinephrine. The previously observed EKG changes resolved within five hours and troponin levels started to decline. A head CT showed diffuse cerebral edema with early uncal herniation and following goals of care discussion, the patient was transitioned to comfort with terminal extubation. DISCUSSION: Rarely does CAS result in polymorphic ventricular tachycardia with cardiac arrest, in patients without CAD. Initial reports showed that patients with COVID-19 and ST segment elevations are found to have myocardial injury with non-obstructive coronary arteries (MINOCA), however there are no reports of COVID-19 patients with CAS resulting in cardiac arrest. The pathophysiology of CAS is not completely understood however, the current literature has described multiple mechanisms including endothelial dysfunction, systemic inflammation, oxidative stress and smooth muscle hyperreactivity, amongst others. CONCLUSIONS: More studies are required to elucidate the mechanism of myocardial injury associated with COVID-19 infection in order to risk stratify those patients at increased risk of CAS and arrthymias and possibly tailor their management;including choice of vasopressor support and use of nitrates to lower the risk of life-threatening complications. REFERENCE #1: Bangalore S, Sharma A, Slotwiner A, et al. ST-Segment Elevation in Patients with Covid-19 — A Case Series. N Engl J Med. 2020;382(25):2478-2480. doi:10.1056/NEJMc2009020 REFERENCE #2: Matta A, Bouisset F, Lhermusier T, et al. Coronary Artery Spasm: New Insights. J Intervent Cardiol. 2020;2020:1-10. doi:10.1155/2020/5894586 REFERENCE #3: Rivero F, Antuna P, Cuesta J, Alfonso F. Severe coronary spasm in a COVID -19 patient. Catheter Cardiovasc Interv. Published online August 2020:ccd.29056. doi:10.1002/ccd.29056 DISCLOSURES: No relevant relationships by Andres Cordova Sanchez, source=Web Response No relevant relationships by Markus Gutsche, source=Web Response No relevant relationships by Matthew Kovach, source=Web Response No relevant relationships by Jasmine Sandhu, source=Web Response

ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION SECONDARY TO COVID-19

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus disease (COVID-19) is known to cause severe respiratory pathology such as acute respiratory distress syndrome. Although the pathophysiology of this lethal virus is still not fully understood, it has been suspected to attach to the ACE2 receptors leading to its deadly pathogenesis. Found to be the cause of venous thrombotic and embolic events, arterial thrombotic events such as ST-segment elevation myocardial infarction (STEMI) have been an unusual phenomenon. CASE PRESENTATION: A 37-year-old female with a past medical history of COVID-19 infection 12 days prior to admission presented to the emergency department (ED) complaining of shortness of breath for 2 to 3 days prior to admission. In the ED she was hypoxic with an oxygen saturation of 80% on room air for which she was placed on 90% FiO2 via OptiFlow and nonrebreather mask. Her D-Dimer on admission was noted to be 506 ng/mL (normal value 80.00 ng/mL (normal value <0.04 ng/mL). The decision was made to proceed with cardiac catheterization for which complete stenosis of the left anterior descending (LAD) artery was noted. She received one drug eluding stent to the proximal LAD and due to severe cardiogenic shock an Impella was placed for hemodynamic support. Despite aggressive intervention and multiple vasopressors and Impella support she continued to decompensate and ultimately succumbed to her condition. DISCUSSION: STEMI is a rare complication of COVID-19 infection with an incidence of about 1%. The pathophysiology of STEMI in this setting is still not yet understood;however, COVID-19 infection is known to cause a hypercoagulable state through cytokine and complement activation as well as endothelial damage. CONCLUSIONS: Although uncommon, COVID-19 should be considered as a cause for arterial thrombotic events such as STEMI. It is imperative that clinicians are aware of the complications of this deadly virus and aggressively manage the hypercoagulable state observed in these patients to prevent morbidity and mortality. REFERENCE #1: Lodigiani C, Iapichino G, Carenzo L, et al. Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. doi: 10.1016/j.thromres.2020.04.024. REFERENCE #2: Abou-Ismail MY, Diamond A, Kapoor S, at al. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-115. REFERENCE #3: Bangalore S, Sharma A, Slotwiner A, et al. ST-Segment Elevation in Patients with Covid-19 - A Case Series. N Engl J Med. 2020;382(25):2478-2480. doi:10.1056/NEJMc2009020 DISCLOSURES: No relevant relationships by Nasam Alfraji, source=Web Response No relevant relationships by Abbas Alshami, source=Web Response No relevant relationships by Eric Costanzo, source=Web Response No relevant relationships by Steven Douedi, source=Web Response No relevant relationships by matthew meleka, source=Web Response No relevant relationships by Matthew Saybolt, source=Web Response

ST-Segment Elevation: One Sign, Many Shadows

ST-segment elevation in patients sedated with propofol may be a sign of imminent malignant arrhythmias. Although propofol infusion syndrome-electrocardiographic abnormalities are usually described as Brugada-pattern, in unique cases nearly ubiquitous and extensive J-point and ST-segment elevation may be observed. These patients should undergo an ajmaline test following recovery. (Level of Difficulty: Beginner.)

ST-segment elevation in patients with COVID-19: a systematic review.

Coronavirus disease 2019 (COVID-19) can cause a wide range of cardiovascular diseases, including ST-segment elevation myocardial infarction (STEMI) and STEMI-mimickers (such as myocarditis, Takotsubo cardiomyopathy, among others). We performed a systematic review to summarize the clinical features, management, and outcomes of patients with COVID-19 who had ST-segment elevation. We searched electronic databases from inception to September 30, 2020 for studies that reported clinical data about COVID-19 patients with ST-segment elevation. Differences between patients with and without obstructive coronary artery disease (CAD) on coronary angiography were evaluated. Forty-two studies (35 case reports and seven case series) involving 161 patients were included. The mean age was 62.7 ± 13.6 years and 75% were men. The most frequent symptom was chest pain (78%). Eighty-three percent of patients had obstructive CAD. Patients with non-obstructive CAD had more diffuse ST-segment elevation (13% versus 1%, p = 0.03) and diffuse left ventricular wall-motion abnormality (23% versus 3%, p = 0.02) compared to obstructive CAD. In patients with previous coronary stent (n = 17), the 76% presented with stent thrombosis. In the majority of cases, the main reperfusion strategy was primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was 30% without difference between patients with (30%) or without (31%) obstructive CAD. Our data suggest that a relatively high proportion of COVID-19 patients with ST-segment elevation had non-obstructive CAD. The prognosis was poor across groups. However, our findings are based on case reports and case series that should be confirmed in future studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11239-021-02411-9.

Прогностичне значення асиметричного диметиларгініну щодо розвитку ускладнень в госпітальному періоді гострого інфаркту міокарда з елевацією сегмента ST у хворих на цукровий діабет 2 типу

The purpose of the study was to determine the prognostic value of asymmetric dimethylarginine in the development of complications in the hospital period of acute myocardial infarction with ST segment elevation in patients with type 2 diabetes mellitus. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups. Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus (n=70), group 2 included patients with acute myocardial infarction without concomitant type 2 diabetes mellitus (n=50). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р&lt;0.05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was 45.17±2.88 years). The patients were divided into 3 tertiles according to the level of аsymmetric dimethylarginine (ADMA): ADMA ⩽1.45 μmol/l – 1st tertile; 1.45 μmol/l&lt; ADMA ⩽1.98 μmol/l - 2nd tertile; ADMA &gt;1.98 μmol/l - 3rd tertile. Results and discussion. The obtained results showed that the level of ADMA in patients with acute myocardial infarction in combination with type 2 diabetes was by 2.57 times (p &lt;0.05) higher compared to patients without concomitant type 2 diabetes. In particular, the ADMA level was at 1.57±0.11 μmol/l in patients with acute myocardial infarction in combination with concomitant type 2 diabetes, while in patients with acute myocardial infarction without concomitant type 2 diabetes it was at 0.61±0.06 μmol/l. The ADMA value at &gt;1.13 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes is a predictor of acute left ventricular failure. The ADMA tertiles were used to determine the acute myocardial infarction severity class based on the Killip scale. It is noteworthy that severer classes of acute myocardial infarction on the Killip scale were observed in a patient whose ADMA value belonged to the 3rd tertile group. We determined the ADMA value of A &gt;2.08 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes, which was a predictor of a life-threatening condition of cardiogenic shock. Conclusion. The asymmetric dimethylarginine exhibits the following predictor properties: in relation to the development of acute left ventricular failure – at &gt;1.13 μmol/l; in relation to the development of cardiogenic shock - at &gt;2.08 μmol/l during the hospital period of acute myocardial infarction with ST-segment elevation in patients with concomitant type 2 diabetes. It is advisable to continue studying the marker of endothelial dysfunction (asymmetric dimethylarginine) as a predictor of adverse myocardial infarction in combination with concomitant type 2 diabetes

Clinical features of the acute period of myocardial infarction with ST segment elevation in patients after reperfusion therapy

Aim: to determine the clinical features of the course of myocardial infarction with ST segment elevation in the acute period in patients after reperfusion therapy.Materials and methods. The clinical and instrumental examination data of 100 patients with ST-elevation myocardial infarction (STEMI) in the acute period were analyzed. The patients were divided into 3 groups: group 1 – patients (n = 46) who underwent primary percutaneous coronary intervention (PCI) or thrombolytic therapy (TLT) followed by PCI in the acute period of myocardial infarction (MI), group 2 – patients (n = 33) who underwent TLT, group 3 – patients (n = 21) who received standard drug therapy.Results. The left ventricular (LV) end-systolic diameter and LV myocardial mass index were significantly smaller by 5.73 % (P = 0.0471) and 10.06 % (P = 0.0076), respectively, in group 1 patients than in group 3. Among the group 1 patients, pulmonary hypertension, local hypokinesia and LV systolic dysfunction were significantly less often detected by 17.72 % (P = 0.028), 26.15 % (P = 0.0293) and 1.99 % (P = 0.0135), respectively, compared with group 2, and zones of LV dyskinesia were much less identified by 19.46 % (P = 0.027) than in group 3. Among the group 2 patients, there was a tendency towards the prevalence of ventricular fibrillation and extrasystolic arrhythmia occurrence. Acute LV failure (ALVF) was less common in group 2 as compared with group 1 and 3, by 24.34 %, P = 0.0067 and 7.7 %, P = 0.0049, respectively.Conclusions. Reperfusion syndrome (RS) after restoration of coronary blood flow, manifested in ALVF and arrhythmias, was transient and sometimes required short-term symptomatic therapy. A common manifestation of RS after TLT was extrasystolic arrhythmia, in contrast to RS after PCI with more common ALVF (Killip III). In patients who did not undergo reperfusion therapy, systolic and diastolic myocardial function violation as well asLV aneurysm formation occurred more frequently. Restoration of coronary blood flow using PCI had advantages over TLT, such as less pronounced clinical manifestations of systemic inflammation, dilatation, local and global contractility impairment and indicators ofLV afterload.

Degree of ST-segment elevation in patients with STEMI reflects the acute ischemic burden and the salvage potential

BackgroundST-segment elevation myocardial infarction (STEMI) is clinically diagnosed by significant ST-segment elevation (STE) in the electrocardiogram (ECG). The importance of the sum of significant ST-segment elevation (∑STE) before primary percutaneous coronary intervention (PPCI) – considered an indicator of the degree of ischemia - is sparse. We evaluated the association of ∑STE before PPCI with respect to area at risk, infarct size and myocardial salvage. MethodsA total of 503 patients with STEMI and available cardiac magnetic resonance (CMR) were included. CMR was performed at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 88–96). The ECG before PPCI with the most prominent STE was used for analysis. Results∑STE divided into quartiles were progressive linearly associated with area at risk (p < 0.001), final infarct size (p < 0.001) and extent of microvascular obstruction (p < 0.001) and inverse linearly associated with final myocardial salvage (p < 0.001). Similar results were found for linear regression analyses. However, ∑STE was not associated with final myocardial salvage in patients with pre-PCI TIMI (thrombolysis in myocardial infarction) flow 0/1 (p = 0.24) in contrast to patients with pre-PCI TIMI flow 2/3 (p ≤ 0.001). ConclusionIn patients with STEMI presenting within 12 h of symptom onset, the degree of STE in the ECG before PPCI is a marker of the extent of myocardium at risk that in turn affects the infarct size in patients with pre-PCI TIMI flow 0/1, whereas the degree of STE in patients with pre-PCI TIMI flow 2/3 is a marker of the extent of the myocardium at risk as well as myocardial salvage – both affecting the myocardial damage.

Transient ST Segment Elevation in a Patient with COVID-19 and a Normal Transthoracic Echocardiogram.

Transient ST elevation may occur in critically ill COVID-19 patients.Early recognition is important to avoid unnecessary intervention or thrombolytic therapy.

The effect of therapy on the clinical course of acute myocardial infarction with st-segment elevation in patients after percutaneous coronary intervention

The aim: to investigate the effectiveness of the use of ranolazine and quercetin in patients with acute IMEST after percutaneous coronary intervention and their impact on long-term results of treatment.Materials and methods: The study involved 105 patients with acute myocardial infarction with ST-segment elevation, who underwent percutaneous coronary intervention. Patients were divided into three study groups: patients who received standard medical therapy (control group), patients who were prescribed an intravenous form of quercetin according to the scheme (Basic 1) and patients received oral form of ranolazine according to the standard therapy (Basic 2). The state of myocardial perfusion after PCI, EchoCG, KDI, CSI and FV dynamics, and long-term results of treatment after 1 year were evaluated. The combined endpoint included a non-fatal recurrent myocardial infarction, a nonfatal stroke, a second hospitalization for angina reflux, and a sudden cardiovascular death.Results. Analyzing the state of myocardial perfusion in patients of the studied groups, it was found that in 18 patients (17.1%) the degree of restoration of blood flow at the level of microcirculation remained unsatisfactory. EchoCG after 9.3±1.2 days after PCI showed less KDI in the Primary 2 group and less CSI in the Primary 1 group compared with the control group (p&lt;0.05). After 8.3±0.6 months CSI and KDI in the Primary 1 and Primary 2 groups, respectively, remained lower, and the EF in the Primary 1 group was higher than in the control group. A decrease in the frequency of onset of the total combined endpoint in the group of patients with FNC (OR=0.029; CI: 0.001–0.574; p&lt;0.05) was recorded. Patients of the Primary 2 group had a lower re-hospitalization rate for angina pectoris (OR = 0.158; CI: 0.032–0.777; p &lt;0.05) and the frequency of reaching the combined end point for the group as a whole (OR=0.244; CI: 0.081 0.730; p&lt;0.05), as well as among patients with poor myocardial perfusion after PCI (OR=0.048; CI: 0.002–1.041; p&lt;0.05).Conclusions: ranolazine and quercetin in patients with acute myocardial infarction contributes to the positive dynamics of KDI, XI and FV. Ranolazine and querсetin reduces the frequency of repeated hospitalizations for the renewal of angina during the year

P2722Does regression of ST-segment elevation in patients undergoing pharmaco invasive strategy adequately predict complete reperfusion?

P2722Does regression of ST-segment elevation in patients undergoing pharmaco invasive strategy adequately predict complete reperfusion?

Chest pain associated with ST segment elevation in patient undergoing the transseptal procedure for radifrequency catheter ablation

Chest pain associated with ST segment elevation in patient undergoing the transseptal procedure for radifrequency catheter ablation

The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

The predictive significance of ST-segment elevation (STE) in lead V4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4 R in patients with anterior STEMI. A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1mm) in lead V4 R at admission and/or 60min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4 R STE (Group 1), early but not late V4 R STE (Group 2) and late V4 R STE (Group 3). In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p<.001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p<.001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). Late V4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V4 R in patients with anterior STEMI has an important prognostic value.

Predictors and Clinical Implications of Minimal ST-Segment Elevation in Patients with ST-Segment Elevation Myocardial Infarction

Objectives: Some patients with suspected ST-segment elevation (STE) myocardial infarction (STEMI) show STE that does not fulfill the current criteria for STEMI. The purpose of this study was to investigate the characteristics and prognoses of patients with minimal STEMI. Methods: Between November 2007 and December 2011, 546 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were enrolled. Results: The minimal STE group had a higher proportion of women (30.2 vs. 21.0%, p = 0.031), better pre-PCI antegrade flow (Thrombolysis in Myocardial Infarction flow 2-3, 30.2 vs. 18.8%, p = 0.006) and better collateralization (Rentrop score 2-3, 27.4 vs. 18.1%, p = 0.024) compared to the definite STE group. Multivariate analysis showed that each of them were independent predictors for minimal STE. However, 1-year mortality of the minimal STE group did not differ from that of the definite STE group (7.1 vs. 9.3%, log-rank p = 0.315). Conclusions: Female gender, good collateral flow and good pre-PCI antegrade flow were independent predictors for minimal STE in patients with STEMI. However, minimal STE was not related to a good prognosis in patients with STEMI.

Intracoronary electrocardiogram ST-segment elevation in patients with non-ST-segment elevation myocardial infarction and its association with culprit lesion location and myocardial injury

An intracoronary electrocardiogram (IC-ECG) is a sensitive method to detect local myocardial ischaemia. We investigated the prevalence of IC-ECG ST-segment elevation (STE) with respect to culprit lesion location in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and its relationship with elevated levels of cardiac biomarkers. We examined 87 NSTEMI patients who underwent IC-ECG recording by locating the insulated polymer-coated guidewire distal to the culprit lesion before percutaneous coronary intervention (PCI). Cardiac biomarkers were serially examined. IC-ECG STE was observed in 24 patients (27.6%) before PCI, and was significantly more frequent in patients with LCx culprit lesions (LAD vs. LCx vs. RCA, 12.1% vs. 53.3% vs. 16.7%; p<0.001). Peak cardiac troponin I (cTnI) values were associated with IC-ECG STE, ejection fraction (EF), cTnI values on admission, and type B2/C lesions. In multivariate analysis, IC-ECG STE (odds ratio [OR], 5.04; 95% confidence intervals [CI]: 1.51-16.85; p=0.009), and EF (OR, 0.95; 95% CI: 0.90-1.00; p=0.043) were predictors of greater peak cTnI values. IC-ECG STE was not uncommon in NSTEMI patients, particularly those with LCx culprit lesions. IC-ECG monitoring before PCI may help identify NSTEMI patients with high risk of greater myocardial injury.