ST-segment Elevation Myocardial Infarction Patients Research Articles

Prognostic value of TIMI risk score combined with systemic immune-inflammation index and lipoprotein(a) in patients with ST-Segment elevation myocardial infarction after percutaneous coronary intervention.

Thrombolysis in Myocardial Infarction (TIMI) risk score in patients with ST-segment elevation myocardial infarction (STEMI) is associated with major adverse cardiovascular events (MACE). This study aimed to develop a prediction model based on the TIMI risk score for MACE in STEMI patients after percutaneous coronary intervention (PCI). We conducted a retrospective data analysis on 290 acute STEMI patients admitted to the Affiliated Hospital of Yangzhou University from January 2022 to June 2023 and met the inclusion criteria. The primary endpoint was the occurrence of MACE. Multivariate logistic regression was used to identify independent predictors that could predict the likelihood of MACE, and R software was utilized to construct and validate the prediction model. Systemic immune-inflammation index (SII), lipoprotein(a) [Lp(a)], and TIMI risk score were identified as independent risk factors for MACE in STEMI patients (p<0.05). A nomogram was constructed based on these factors. The area under the receiver operating characteristic curve values for the training and validation sets were 0.883 (95% CI: 0.836-0.930) and 0.841 (95% CI: 0.756-0.925), respectively. The calibration curves displayed a high consistency between prediction and observation in the training and validation sets. Additionally, decision curve analysis (DCA) demonstrated the clinical usefulness of the nomogram. SII, Lp(a), and TIMI risk score are independent risk factors for MACE within one year in STEMI patients after PCI. Incorporating SII and Lp(a) into the TIMI risk score enhances the predictive value for adverse outcomes, thereby supporting healthcare professionals in clinical decision-making.

Rationale and design of the STOP-IMH randomised trial: Safety of ticagrelor monotherapy after primary percutaneous coronary intervention for ST-elevation myocardial infarction and the effect on intramyocardial haemorrhage

BackgroundTicagrelor monotherapy after 1–3 months of dual antiplatelet therapy (DAPT) has shown to be effective and safe after percutaneous coronary intervention (PCI), including in patients with an ST elevation myocardial infarction (STEMI). Direct omission of aspirin could further reduce bleeding complications and may reduce the incidence and expansion of intramyocardial haemorrhage (IMH), a frequent complication after revascularisation for a STEMI. MethodsThis multicentre open label pilot study randomises 200 STEMI patients within 24 hours after primary PCI and before the first subsequent dose of aspirin to ticagrelor monotherapy or ticagrelor plus aspirin for twelve months. As IMH is more frequently observed after an anterior STEMI, IMH and infarct size will be determined with cardiac magnetic resonance (CMR) imaging in 60 anterior STEMI patients. In this subgroup, blood samples will be analysed for biochemical outcomes. ResultsThe primary safety endpoint consists of major adverse cardiac and cerebral events, and the primary efficacy endpoint is infarct size on CMR. Secondary efficacy endpoints consist of the incidence and extent of IMH determined by CMR, and of clinical bleeding events. Other endpoints include all-cause mortality and biochemical outcomes. ConclusionThe STOP-IMH pilot study compares ticagrelor monotherapy with ticagrelor plus aspirin directly after primary PCI in 200 STEMI patients. We aim to provide a signal of safety regarding ischemic events for the direct omission of aspirin after primary PCI, and to compare the infarct size by CMR between the two treatment strategies in the first week after primary PCI.

Outcomes Associated with Novel Oral Anticoagulants and Warfarin in Patients with Cardiac Thrombus Following STEMI

The treatment of cardiac thrombus after ST-segment elevation myocardial infarction (STEMI) is anticoagulation. There is conflicting data on effectiveness and safety of novel oral anticoagulants (NOACs) vs. warfarin. Using the national Medicare data, we identified patients with an admission diagnosis of STEMI and cardiac thrombus within six months after STEMI. Patients were divided into two groups based on initial type of anticoagulation medication (NOACs vs. warfarin). The two main outcomes were ischemic stroke/transient ischemic attack (TIA) and bleeding. Follow-up was performed through the end of 2023. Kaplan-Meier (KM) Curves and Cox proportional hazard models were utilized. Of 881 patients prescribed anticoagulation after STEMI with subsequent cardiac thrombus, 496 patients were prescribed NOACs (56.3%) and 385 patients (43.7%) warfarin. For ischemic stroke, the median follow-up time was 177 days (95% CI: 148-193) for warfarin and 266 days (95% CI: 204-326) for NOACs. There was significantly lower risk of ischemic stroke or TIA in cardiac thrombus patients treated with NOACs compared to warfarin [HR 0.73 (0.57-0.93)]. For bleeding, the median follow-up time was 192 days (95% CI: 175-232) for warfarin and 277 days (95% CI: 212-332) for NOACs. There was also a lower risk of bleeding in patients treated with NOACs compared to warfarin [HR 0.78 (CI 0.66-0.92)]. In conclusion, STEMI patients with cardiac thrombus had lower risk of ischemic stroke and bleeding when treated with NOACs compared to warfarin. Prospective randomized studies are needed to confirm these findings and further examine the comparative effectiveness of different anticoagulant strategies.

Predictive model for ejection fraction improvement at one year in patients with acute ST-segment elevation myocardial infarction complicated with heart failure with reduced ejection fraction

Objective: To develop a predictive model for improvement of ejection fraction 1 year after heart failure with reduced ejection fraction (HFrEF) following acute ST-segment elevation myocardial infarction (STEMI). Methods: This nested case-control study included STEMI patients diagnosed with HFrEF from a prospective multicenter multimodality imaging cohort between August 2014 and March 2021. Based on the improvement of left ventricular ejection fraction (LVEF) at baseline and 1-year follow-up, the patients were classified into the heart failure with improved ejection fraction (HFimpEF) group and the persistent HFrEF group. The clinical data were collected, and cardiac histological changes were assessed using cardiac magnetic resonance imaging. Multivariate logistic regression analysis was performed to identify factors associated with ejection fraction improvement at one year, and a predictive model was developed and internally validated. The performance and clinical applicability of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Results: A total of 117 STEMI patients (102 males and 15 females) aged (61.6±11.6) years were included in the study. At the 1-year follow-up, there were 61 patients (52.1%)in the HFimpEF group,and 56 patients (47.9%) in the HFrEF group . Compared with persistent HFrEF group, patients in HFimpEF group had smaller baseline left ventricular end-systolic diameter (LVESD) [33.0 (30.0, 36.0) mm vs 35.5 (32.0, 39.0) mm], smaller infarct size [26.1% (20.3%, 36.0)% vs 40.6% (33.0%, 45.4)%], lower peak B-type natriuretic peptide (BNP) level [340.0 (190.5, 692.5) ng/L vs 636.0 (318.5, 1 188.8) ng/L], lower peak level of soluble suppression of tumorigenicity 2 (sST2) [36.7 (25.8, 60.5) μg/L vs 62.4 (30.6, 120.7) μg/L], and higher hematocrit [(43.5%±3.5%) vs (40.8%±5.6%)] (all P<0.05). Multivariate logistic regression analysis revealed that smaller baseline LVESD (OR=0.825, 95%CI: 0.745-0.914), smaller infarct size (OR=0.967, 95%CI: 0.939-0.995), peak BNP level≤400 ng/L (OR=3.062, 95%CI: 1.283-7.306), peak sST2 level≤35 μg/L (OR=2.600, 95%CI: 1.040-6.501), and higher hematocrit (OR=1.109, 95%CI: 1.030-1.193) were predictors of LVEF improvement in STEMI patients with HFrEF. The predictive model formula: logit (P)=2.619-0.034×infarcted myocardium percentage (%)+1.119×(peak BNP level≤400 ng/L)+0.956×(peak sST2 level≤35 μg/L)+0.103×hematocrit (%)-0.192×LVESC (mm) (where peak BNP level≤400 ng/L and peak sST2 level≤35 μg/L are binary variables: Yes=1, No=0). The area under the ROC curve (AUC) was 0.805 (95%CI: 0.723-0.887), indicating good predictive ability. Calibration curves and decision curve analysis indicated good model consistency and clinical utility. Conclusions: Smaller LVESD, smaller infarct size, peak BNP level≤400 ng/L, peak sST2 level≤35 μg/L and higher hematocrit are predictive factors for LVEF improvement after STEMI. The predictive model has good performance for predicting HFimpEF.

Impact of lactate levels on admission in STEMI patients with cardiogenic shock treated with IMPELLA.

The concomitant use of IMPELLA and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) (ECPELLA) has been increasingly used to treat severe cardiogenic shock. However, the relationship between severity of heart failure on admission and prognosis based on differences in the mechanical circulatory support (MCS) is not fully understood. This study evaluated the association between lactate levels on admission and clinical outcomes based on differences in MCS. We identified 852 patients (median age 71years; 78% male) with cardiogenic shock due to ST-elevation myocardial infarction (STEMI) from the Japanese Registry for Percutaneous Ventricular Assist Devices. The primary endpoint was the in-hospital mortality rate. Additionally, patients were classified into three groups based on lactate levels according to the SCAI SHOCK classification for the assessment of in-hospital mortality: group 1 (lactate level < 2mmol/L), group 2 (lactate level 2-8mmol/L), and group 3 (lactate level ≥ 8mmol/L). The in-hospital mortality rate was 41.8%. The rate of V-A ECMO combined with IMPELLA use was 37.6%. The in-hospital mortality rates of the IMPELLA alone and ECPELLA group were 30.1% and 61.3%, respectively. The median lactate level was significantly higher in non-survivors than in survivors (5.7mmol/L vs. 3.5mmol/L, p < 0.0001). The in-hospital mortality rate with IMPELLA alone was significantly higher in group 3 compared to groups 1 and 2; however, there was no difference in in-hospital mortality with ECPELLA among the three groups. A lactate cut-off value of 6.9mmol/L showed the best discrimination for in-hospital mortality. Patients classified as the SCAI SHOCK stage E have a higher mortality rate with IMPELLA support alone. Further research is needed to optimize management strategies for this high-risk group.

Assessment of Reperfusion Efficacy of Altelyse Versus Actilyse in Patients with Acute Myocardial Infarction: A Phase 3, Randomized, Double-Blinded, Non-inferiority Clinical Trial.

Primary percutaneous coronary intervention (PPCI) and fibrinolytic or thrombolytic therapy are common treatments for ST-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is more effective than thrombolytic therapy, but fibrinolytic therapy is still a preferable option for patients with limited access to healthcare. Alteplase is a tissue plasminogen activator (tPA) used to treat acute myocardial infarction, acute ischemic stroke, and pulmonary embolism. This study aims to compare the efficacy and safety of Altelyse (bio-similar Alteplase, Arena Life Science Company, Tehran, IRAN) versus the brand name Actilyse® (Boehringer Ingelheim, GERMANY) in patients with STEMI. In this phase 3, double-blind, randomized trial, we assigned patients with STEMI to receive Altelyse or Actilyse, an intravenous bolus of 15 mg followed by an infusion of 0.75 mg/kg over 30 min (with a maximum dose of 50 mg) and continued with 0.50 mg/kg over 60 min (with a maximum dose of 35 mg). The primary endpoint was total ST-segment resolution (STR) in all leads with ST-segment elevations after 90 min of receiving fibrinolytic therapy. A total of 153 STEMI patients received Actilyse (79 patients) or Altelyse (74 patients). The mean total STR in all leads with ST elevation after 90 min was -45.89 ± 32.92% and -37.11 ± 35.28% in the Altelyse and Actilyse groups, respectively (the mean difference [95% confidence interval]: -8.77 [-19.92, 2.36]; p-value for non-inferiority: 0.0004). Among patients with STEMI, Altelyse was non-inferior to Actilyse with respect to STR after 90 min. Trial Registration Number, Date: IRCT20190729044366N1, 2019-05-25.

Changes in Coagulation Factor XI Activity Levels in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI.

Background - Although Factor XI (FXI) inhibitors are currently tested for the prevention of thrombotic events, their early treatment could prevent thrombus consolidation in ST-segment elevation myocardial infarction (STEMI). This study aims to characterize coagulation FXI levels and their variations in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods - Patients with STEMI were prospectively enrolled between December 2023 and May 2024. FXI activity (FXIa) levels were measured at admission and after PCI (i.e., before discharge). Variations in FXIa levels were evaluated. Differences in indicators of thrombotic risk between groups with high and low FXIa variability were analyzed, and predictors of high FXIa variability were identified. Results - After screening, 54 patients with STEMI were included. The median FXIa level was 0.865 IU/mL (interquartile range [IQR] 0.554-0.978) at admission and 1.161 IU/mL (IQR 0.982-1.317) before discharge, with a median difference of +34.2% (p-value < 0.001). No significant differences were found in indicators of thrombotic risk between groups at high and low FXIa variability, except for the days intercurred between the essays (p-value = 0.016). Neither this nor other variables emerged as independent predictors of high FXIa variability. Conclusions - This study firstly reported an increase in FXIa levels from admission to discharge in STEMI patients undergoing PCI. Common indicators of thrombotic risk were not associated with FXIa levels or their variability. These findings aim to stimulate further research into anticoagulant therapies tailored to the patient's coagulative state and disease.

Association between neutrophil to high-density lipoprotein ratio and no-reflow after coronary intervention: A cross-sectional study.

Inflammatory responses and lipid metabolism disorders are key components in the development of coronary artery disease and contribute to no-reflow after coronary intervention. This study aimed to investigate the association between the neutrophil to high-density lipoprotein ratio (NHR) and no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI). This study enrolled 288 patients with STEMI from September 1st, 2022 to February 29th, 2024, in the Zhengzhou Central Hospital Affiliated to Zhengzhou University. According to postoperative thrombolysis in myocardial infarction flow grades, there were 221 patients in the normal flow group and 67 patients in the no-reflow group. Comparing the clinical data of the 2 groups, the independent risk factors of no-reflow phenomenon in STEMI patients after PPCI were determined by multivariate logistic regression analysis. Additionally, we assessed the diagnostic value of NHR for no-reflow using receiver operating characteristic curve analysis. The no-reflow phenomenon was observed in 67 patients with STEMI following PPCI, representing a prevalence of 23.26%. Compared with the normal group, NHR, as well as the rates of intracoronary thrombolysis and thrombus aspiration, were significantly elevated, while lymphocyte and albumin were lower (P < .05). Multivariate logistic regression analysis revealed that NHR was an independent risk factor for no-reflow (OR = 1.241, 95% CI: 1.142-1.349, P < .001). In the receiver operating characteristic curve of NHR diagnosis of no-reflow, the area under the curve (AUC) was 0.740 (95% CI: 0.671-0.809, P < .001), and the optimal critical value was 7.88, which indicates sensitivity and specificity were 71.6% and 71.50%. NHR may serve as a risk mark for STEMI patients with no-reflow after PPCI, and has diagnosis value for its occurrence.

Prediction of microvascular obstruction from angio-based microvascular resistance and available clinical data in percutaneous coronary intervention: an explainable machine learning model

Angio-based microvascular resistance (AMR) as a potential alternative to the index of microcirculatory resistance (IMR) and its relationship with microvascular obstruction (MVO) and other cardiac magnetic resonance (CMR) parameters still lacks comprehensive validation. This study aimed to validate the correlation between AMR and CMR-derived parameters and to construct an interpretable machine learning (ML) model, incorporating AMR and clinical data, to forecast MVO in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We enrolled 452 STEMI patients from Nanjing Drum Tower Hospital between 2018 and 2022, who received both PPCI and CMR. After PPCI, AMR measurements and CMR-derived parameters were recorded, and clinical data were gathered. The ML workflow comprised feature selection using the Boruta algorithm, model construction with seven classifiers, hyperparameter optimization via ten-fold cross-validation, model comparison based on the area under the curve (AUC), and a Shapley additive explanations (SHAP) analysis to analyze the significance of different features. 32.29% of patients showed inconsistency between AMR and MVO, but we successfully constructed a predictive model for MVO. Among the classifiers, Extreme gradient boosting (XGBoost) post hyperparameter optimization displayed superior performance, achieving an AUC of 0.911 and 0.846 in the training and validation sets, respectively. SHAP analysis identified AMR as a pivotal predictor of MVO. Although we observed the inconsistency between AMR and MVO but the ML-based construction of MVO prediction model is feasible, which brings the possibility of timely prediction of patients with MVO and timely imposition of interventions during PPCI.

Comparison of ticagrelor and clopidogrel in primary percutaneous coronary intervention patients: a single-center retrospective study.

It is uncertain whether ticagrelor is more effective and safer than clopidogrel in ST-segment elevation myocardial infarction (STEMI) patients in the East Asian population in the real world. This study compared the clinical outcomes of ticagrelor and clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention (PCI). We retrospectively enrolled 1124 patients diagnosed with STEMI in Nanjing First Hospital from July 2011 to April 2019. Propensity score matching was used to balance baseline covariates between the ticagrelor and clopidogrel groups. The primary efficacy endpoint was all-cause death, and the primary safety endpoint was major bleeding, defined as Bleeding Academic Research Consortium type 3-5 bleeding. We enrolled 1124 STEMI patients in the analysis. After propensity score matching, 420 patients were included in each group. There was a lower incidence of all-cause death in the ticagrelor group when compared with the clopidogrel group during the follow-up (8.3 vs. 17.1%; hazard ratio: 0.481; P < 0.001). Ticagrelor was also associated with reduced myocardial infarction, cardiovascular death, and stent thrombosis. However, no difference was detected in major bleeding. Multivariate Cox regression analysis showed that age, Killip classification, creatinine, low-density lipoprotein, left ventricular ejection fraction, single vessel disease, inhospital intra-aortic balloon pump implantation, β-blockers, and ticagrelor were independent predictive parameters of all-cause death. Compared with clopidogrel, ticagrelor reduced all-cause death but did not increase the incidence of major bleeding in primary PCI patients. Therefore, ticagrelor may be considered a viable substitute for clopidogrel.

Short-term effects of upstream high bolus dose of tirofiban in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

No-reflow following primary percutaneous coronary intervention (PPCI) is challenging to treat. The objective of this study is to evaluate the efficacy and safety of upstream high-bolus-dose tirofiban administration in ST-segment elevation myocardial infarction (STEMI) cases undergoing PPCI on top of dual antiplatelet therapy, including ticagrelor, in comparison to selective bailout administration. This hospital-based, randomized, single-blinded prospective interventional study was conducted on 150 patients at Assiut University Heart Hospital. Patients with STEMI within 12 h after symptom onset who underwent PPCI were randomized to an upstream group (n = 75) and a selective bailout group (n = 75) based on the timing of the tirofiban bolus administration (25 µg/kg intravenously over 5 min). The bailout group's thrombolysis in myocardial infarction (TIMI) frame count was higher than the upstream group's, despite comparable TIMI flow and myocardial blush grade between the two groups, but only approached statistical significance [14.4 (4-36) vs 12.2 (5-55), P = 0.08]. The enzymatic infarct size tended to be lower in the upstream group. All echocardiographic findings were comparable between the two studied groups, with no significant difference (P > 0.05). There was no significant difference between the two groups regarding clinical outcomes. Compared to selective bailout administration, upstream high bolus dose of tirofiban in STEMI patients undergoing primary coronary intervention did not significantly affect angiographic outcomes, left ventricular remodeling, or function, despite smaller infarction size.

The Role of Magnesium Levels in the Progression of Contrast-Induced Nephropathy in Patients With STEMI Undergoing Primary PCI.

Contrast-induced nephropathy (CIN) poses a significant risk following primary percutaneous coronary intervention (pPCI) in patients with ST-Elevation Myocardial Infarction (STEMI). Magnesium (Mg²⁺) deficiency has been associated with renal dysfunction and cardiovascular diseases, yet its role in CIN development remains unclear. This study represents the first investigation exploring the relationship between Mg²⁺ levels and CIN in this context.We conducted a retrospective study involving 2306 consecutive STEMI patients undergoing pPCI. Serum Mg²⁺ levels were measured on admission. Logistic regression and Receiver Operating Characteristic (ROC) analysis were employed to assess the association between Mg²⁺ levels and CIN development. Of the enrolled patients, 691 (30%) developed CIN post-pPCI. Mg²⁺ levels were significantly lower in the CIN group (P < .001). Multivariate analysis identified Mg²⁺ <2.03 mg/dL, age >68 years, left ventricular Ejection Fraction (EF) <49%, and post-procedure Thrombolysis In Myocardial Infarction (TIMI) flow grade <2 as independent predictors of CIN. ROC analysis revealed an Mg²⁺ cutoff of 2.03 mg/dL, Area Under the Curve (AUC): 0.711, sensitivity: 69%, specificity: 68%). Our study demonstrates a significant correlation between low Mg²⁺ levels and CIN in STEMI patients undergoing pPCI, highlighting Mg²⁺ <2.03 mg/dL as an independent risk factor for CIN.

Non-invasive pressure volume loops provide incremental value to age, sex, and infarct size for predicting adverse cardiac remodeling after ST-elevation myocardial infarction

Abstract Aims This study aimed to assess the predictive value of non-invasive pressure volume (PV)-loop variables by cardiovascular magnetic resonance (CMR) for determining development of adverse remodeling 3-months after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methods and results In total, 181 STEMI-patients examined with CMR during the index admission (baseline) after primary PCI and at 3-months follow-up in The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3) study were retrospectively analyzed. A time-varying elastance model for generating PV-loops from CMR volumetry and brachial blood-pressure was used to calculate contractility, arterial elastance, stroke work, potential energy, efficiency, external power, ventriculoarterial coupling, and energy per ejected volume. Adverse remodeling was seen in 28 patients (15%), defined as a concomitant increase in end-diastolic- and end-systolic volume of ≥12% from baseline to follow-up. Pressure volume loop variables measured at baseline showed predictive value for adverse remodeling, independent of age, sex and infarct size (IS) by a logistic regression analysis: contractility (OR 4.6, 95% CI 1.8-12.4), and efficiency (OR 1.05, 95% CI 1.00-1.11). Furthermore, females showed a higher increase in contractility between the timepoints (ΔContractility=0.4±0.4mmHg/mL vs 0.1±0.4mmHg/mL, p&amp;lt;0.0001). A higher energy expenditure was seen at baseline in LAD-infarctions compared to LCx- and RCA-infarctions. Conclusion Non-invasive PV-loop variables by CMR have incremental predictive value to age, sex, and IS for determining development of adverse cardiac remodeling in STEMI patients treated with primary PCI. Furthermore, the PV-loop variables show significant differences in post-infarct cardiovascular adaptation between sexes and culprit vessels.

Association between Admission Blood Glucose and In-Hospital MACE in Non-Diabetic STEMI (Killip I) Patients Undergoing Primary PCI

Background: The increase in major adverse cardiovascular events (MACE) in patients with diabetes after primary percutaneous coronary intervention (pPCI) is significantly correlated with the admission blood glucose (ABG). However, it is unclear whether ABG in non-diabetic patients is related to MACE after pPCI. We aimed to explore the relationship between ABG and in-hospital MACE in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients with Killip class I treated with pPCI. Methods: The Chinese STEMI pPCI Registry (NCT04996901) enrolled 5586 STEMI patients undergoing pPCI from January 2015 to August 2021. Patients were divided into three groups after excluding those with hyperglycemia (ABG ≥11 mmol/L) and a history of diabetes. MACE was defined by re-infarction, stroke, and cardiovascular death. The association between ABG and in-hospital MACE was assessed using Logistic regression analysis. Results: 2890 non-diabetic STEMI patients with Killip class I treated with pPCI were identified. Patients were divided into three groups based on ABG (Q1: 2.5–5.72 mmol/L; Q2: 5.73–7.0 mmol/L; Q3: 7.01–11.0 mmol/L). After multivariate adjustment for age, gender, Diastolic Blood Pressure (DBP), Heart Rate (HR), smoking, and hypertension, the OR of MACE in Q2 and Q3 were 1.43–1.62 times of Q1 in the calibration Model II to IV. Subgroup analysis showed that the OR of Q2 was 3.52-fold of Q1 in females and 1.54-fold in the elder (≥60 years). Sensitivity analysis showed that after excluding patients with ABG less than 4 mmol/L, elevated ABG was still associated with a significant increase in the risk of MACE. The area under the ROC curve of ABG in predicting the occurrence of MACE after pPCI was 0.668, and the C-index was 0.666. The cubic spline confirmed MACE risk decreased significantly with ABG below 6.3 mmol/L. Conclusions: Elevated ABG is associated with increased risk of in-hospital MACE in non-diabetic STEMI patients treated with pPCI, particularly females and the elderly. This retrospective observational study was registered in Clinical Trials (NCT04996901).

Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients

Interrelation between hypoxic liver injury and Killip classification in ST-segment elevation myocardial infarction patients

ST-elevation myocardial infarction incidence in a high-risk seismic zone.

Earthquakes are unpredictable natural events that can elicit acute physiological responses, potentially triggering cardiovascular events. This study investigates the association between seismic activity and ST-elevation myocardial infarction (STEMI) admissions in a tertiary care hospital in an earthquake-prone region over 19years. We analyzed STEMI admissions at a tertiary center in Mexico City from October 2005 to August 2024. Earthquakes with a magnitude ≥6.0 and geographic relevance to Mexico were identified using the USGS database. Admission rates were compared for ±7days surrounding each earthquake and control periods derived from the same date in the previous year, adjusted for overlaps and seismic events. Poisson regression analyses were used to compare admission rates. Among 9611 STEMI patients, 904 admissions occurred near earthquake periods, with 863 during controls. Post-earthquake admissions rose significantly on the day earthquake (day 0) with an incidence rate ratio (IRR)=1.49 (95% CI 1.17-1.89, P=0.001), and in the post-quake (+1 to +7days) IRR=1.19 (95% CI 1.03-1.36, P=0.015) compared to the pre-quake (-7 to -1days) period. Notably, admissions on days +1 and+2 (IRR=1.54 [95% CI 1.11-2.14] and 1.58 [95% CI 1.07-2.34]) showed a significant increase compared to controls. Elevated systolic blood pressure was observed post-quake, while demographics, severity, and mortality showed no significant differences. Our findings suggest a significant association between earthquake events and increased STEMI admissions within the days following an earthquake in a high-seismic area. Compared to pre-earthquake and control periods, the observed rise in post-earthquake admissions indicates that seismic stress may contribute to STEMI events.

Monocyte count as an independent predictor of high thrombus burden in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis.

Due to the lack of a prior comprehensive review and meta-analysis, the relationship between monocyte count and thrombus load in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) has not been adequately established. This was a systematic review and meta-analysis of multiple cohorts (retrospective and prospective) and cross-sectional studies.We queried electronic databases (PubMed, Google Scholar, and Cochrane Central) from their inception to April 2022. The included studies had patients who had undergone PCI treatment and were classified using thrombolysis in myocardial infarction thrombus grading. Dichotomous outcomes from the studies were presented as odds ratios with 95% confidence intervals while means ± standard deviation were presented for continuous outcomes. Means ± standard deviation of monocyte levels and odds ratios were pooled using an inverse variance-weighted random-effects model. I² statistics are used to evaluate heterogeneity across studies and subgrouping was performed to reduce the heterogeneity. Five eligible studies, consisting of 1426 patients were included, out of which 776 had a high thrombus burden. Pooled results after subgroup analysis showed a significant relationship between raised monocyte count and high thrombus burden (odds ratios = 1.44; 95% confidence interval = 1.06-1.96; P = .02; I2 = 71%). Post-subgroup pooled analysis revealed a statistically significant correlation between high thrombus burden and raised monocyte count. STEMI patients with a high thrombus burden show an increased monocyte count. A high monocyte count upon admission is a major indication of increased intracoronary thrombus burden in STEMI patients with PCI procedures.

MIR-155 as a potential biomarker for disease severity in st-segment elevation myocardial infarction: insights from a university-affiliated cardiovascular center.

MiR-155 plays a role in inflammatory pathways and cardiovascular diseases, though its relationship with inflammation, atherosclerosis, and outcomes in ST-elevation myocardial infarction (STEMI) is not well established. To investigate associations between miR-155 levels, inflammation, atherosclerotic burden, and major adverse cardiovascular events (MACE) in STEMI patients. Sixty-nine STEMI patients and 16 healthy controls were recruited from a specialized university-affiliated cardiovascular center. MiR-155 expression and serum interleukin (IL)-1β, IL-6, and tumor necrosis factor levels were measured. Patients were grouped into tertiles based on miR-155 expression. Clinical data, atherosclerotic burden (through cardiac catheterization), and in-hospital MACE were recorded. MiR-155 levels were significantly lower in STEMI patients compared to controls (median 54.2, vs. 152.8 arbitrary units; p = 0.003). Higher miR-155 tertiles were associated with a greater prevalence of three-vessel occlusion (34% vs. 13% vs. 4%; p = 0.007) and increased incidence of pulmonary edema (13% vs. 0% vs. 0%; p = 0.030). No significant correlation was found between miR-155 and inflammatory or myocardial markers. Dysregulated miR-155 expression in STEMI patients may influence disease severity and MACE risk, independent of inflammation or myocardial damage markers.

Short-term predictive value of sST2 in patients with STEMI following primary PCI: a prospective observational study

AimThe objective of this study was to investigate the level of soluble suppression of tumorigenicity-2 (sST2) in patients with acute ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI), and to provide a new biomarker for clinical management and prognosis assessment.MethodThis was a prospective study. 148 STEMI patients following primary PCI were enrolled and divided into 2 groups by the median value of sST2 and afterwards followed up for 30 days to access the occurrence of major adverse cardiac events (MACEs), which were defined as cardiovascular death, heart failure and recurrent MI.ResultssST2 ranged from 20.57 to 98.96 ng/mL. High sST2 group had higher MACEs rate compared to low sST2 group (28.8% vs. 8.0%, P = 0.001). sST2 was positively correlated with age (r = 0.181, P = 0.027), SYNTAX score (r = 0.257, P = 0.002), high-sensitive C-reactive protein (hs-CRP) (r = 0.225, P = 0.006), B-type natriuretic peptide (BNP) (r = 0.225, P = 0.006) and negatively with left ventricle ejection fraction (LVEF) (r = -0.197, P = 0.016). After adjustment for clinical variables, sST2 level (OR 3.680, P = 0.015) and LVEF (OR 0.880, P < 0.001) remained independent predictors of 30-days MACEs. In receiver operating characteristic curve (ROC) analyses, the area under the curve (AUC) of sST2 for predicting 30-days MACEs was 0.755(P < 0.001). The AUC of sST2 combining hs-CRP and LVEF for prediction was 0.828(95%CI [0.743–0.912], P < 0.001).ConclusionsST2 level after primary PCI was an independent risk factor of MACEs in STEMI patients through 30 days follow-up.

Impact of different glycoprotein IIb/IIIa inhibitor infusion routes on infarct size and microvascular obstruction in patients with high thrombotic risk ST elevation myocardial infarction

Objective Current guidelines recommend the use of glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) only as a bail-out therapy. However, drug penetration to the jeopardised area may not be achieved due to impeded blood flow and increased microvascular resistance. Aim of our study is to investigate the impact of distal intracoronary GpIIb/IIIa inhibitor agent infusion in STEMI patients. Primary endpoints were microvascular obstruction (MVO) and infarct size. Methods Patients with STEMI who have high thrombus burden or slow-flow/NR phenomenon and undergoing primary percutaneous coronary intervention (pPCI) were enrolled. Tirofiban was the preferred GpIIb/IIIa inhibitor. Patients were assigned to the systemic intravenous infusion group and intracoronary infusion group in whom bolus dose of tirofiban was distally infused to the infarct related artery. MVO and size of the infarct size were assessed via cardiac MRI. Results We prospectively included 75 patients and mean follow-up duration was 383 days. Baseline characteristics were similar between groups except a lower rate of diabetes in distal intracoronary infusion group (p = .006). There was no significant difference in localisation of myocardial infarction, ischaemia duration and preloading of P2Y12 inhibitor between groups. MVO (p = .048) and infarct size (p = .030) were significantly lower in distal intracoronary infusion group. Conclusions Cardiac MRI based assessment revealed that intracoronary administration of GpIIb/IIIa inhibitors distal to the culprit lesion was associated with reduced MVO and infarct size in high thrombotic risk STEMI patients undergoing pPCI.