Intervention For ST-segment Elevation Myocardial Infarction Research Articles

Clinical Profile and Outcomes of Primary PCI in Patients with Acute STEMI

Aim: Coronary artery disease (CAD) is a significant health concern worldwide, with a notable increase in prevalence in developing nations. Acute ST-segment elevation myocardial infarction (STEMI) represents the most critical manifestation of CAD, often leading to high mortality rates. Primary percutaneous coronary intervention (PCI) is a cornerstone treatment for patients with STEMI, but accessibility and affordability continue to be significant considerations, affecting outcomes. Methodology: A descriptive case series study was conducted to evaluate the clinical outcomes of primary PCI in patients with acute STEMI. The study encompassed a six-month period at a leading cardiology institute. Inclusion criteria were met by patients who received informed consent and underwent reperfusion therapy through established medical approaches. Data on key outcomes like acute stent thrombosis, stroke, atrial fibrillation, and mortality rates were meticulously collected and analyzed. Results: The study comprised 400 individuals with an average age in the late fifties, predominantly male. A fraction of patients experienced acute stent thrombosis and stroke, while a slightly higher percentage developed atrial fibrillation. Notably, mortality was observed in a modest percentage of the patients, with a higher incidence in those above sixty years of age. Conclusion: Primary PCI is an effective treatment for acute STEMI, yet the outcomes, particularly acute stent thrombosis, stroke, atrial fibrillation, and mortality, are considerably high among the elderly population. These findings underscore the need for targeted strategies to improve the prognosis for this age group. Keywords: Coronary artery disease, Primary percutaneous coronary intervention, Acute STEMI, Clinical outcomes, Cardiology, Treatment accessibility.

Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction—What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?

Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.

Gender differences in ST-segment elevation myocardial infarction: an analysis on treatment, complications and acute-phase mortality

Abstract Funding Acknowledgements None. Background Primary angioplasty is the gold-standard treatment in ST-segment elevation myocardial infarction (STEMI). Previous studies have shown differences in the treatment of STEMI between men and women. Purpose To analyze the differences in the management of STEMI between both genders in a mediterranean settlement when it comes to angioplasty, timing of revascularization, complication rates and 30-day mortality. Methods A prospective, unicentric study of consecutive STEMI patients that were admitted to an Acute Cardiac Care Unit was performed from January 2010 to December 2022. We compared the differences between genders on timing of revascularization, complication rates and 30-day mortality. Results A total of 4616 patients were included between 01/01/2010 and 31/12/2022, 21.75% were women. Women were older than men (68.5 vs 61.4 years, p<0,001), but there were no differences on cardiovascular risk factors, infarct location or ejection fraction. Female sex was associated with higher Killip class (Killip ≥2 on admission 22.6% vs 17.9%, p=0.005), less angioplasty rates (88.4% vs 93.1%, p<0.001), longer timing of revascularization (median time 223 minutes vs 178 minutes, p<0.001), higher rates of heart failure during admission (16.2% vs 11.3%, p<0,001), mechanical complications (2.9% vs 1.4%, p=0.001) and higher 30-day mortality (8.8% vs 5.7%, p<0,001). Conclusions Women with STEMI are less likely to receive revascularization therapy, are admitted with a higher Killip class and have higher rates of post-STEMI complications and 30-day mortality than men.

Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI

Currently, mortality risk for patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) with an uncomplicated postprocedure course is low. Less is known regarding the risk of in-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF). To evaluate the risk of late VT and VF after primary PCI for STEMI. This cohort study included adults aged 18 years or older with STEMI treated with primary PCI between January 1, 2015, and December 31, 2018, identified in the US National Cardiovascular Data Registry Chest Pain-MI Registry. Data were analyzed from April to December 2020. Multivariable logistic regression was used to evaluate the risk of late VT (≥7 beat run of VT during STEMI hospitalization ≥1 day after PCI) or VF (any episode of VF≥1 day after PCI) associated with cardiac arrest and associations between late VT or VF and in-hospital mortality in the overall cohort and a cohort with uncomplicated STEMI without prior myocardial infarction or heart failure, systolic blood pressure less than 90 mm Hg, cardiogenic shock, cardiac arrest, reinfarction, or left ventricular ejection fraction (LVEF) less than 40%. A total of 174 126 eligible patients with STEMI were treated with primary PCI at 814 sites in the study; 15 460 (8.9%) had VT or VF after primary PCI, and 4156 (2.4%) had late VT or VF. Among the eligible patients, 99 905 (57.4%) at 807 sites had uncomplicated STEMI. The median age for patients with late VT or VF overall was 63 years (IQR, 55-73 years), and 75.5% were men; the median age for patients with late VT or VF with uncomplicated STEMI was 60 years (IQR, 53-69 years), and 77.7% were men. The median length of stay was 3 days (IQR, 2-7 days) for the overall cohort with late VT or VF and 3 days (IQR, 2-4 days) for the cohort with uncomplicated STEMI with late VT or VF. The risk of late VT or VF was 2.4% (overall) and 1.7% (uncomplicated STEMI). Late VT or VF with cardiac arrest occurred in 674 patients overall (0.4%) and in 117 with uncomplicated STEMI (0.1%). LVEF was the most significant factor associated with late VT or VF with cardiac arrest (adjusted odds ratio [AOR] for every 5-unit decrease ≤40%: 1.67; 95% CI, 1.54-1.85). Late VT or VF events were associated with increased odds of in-hospital mortality in the overall cohort (AOR, 6.40; 95% CI, 5.63-7.29) and the cohort with uncomplicated STEMI (AOR, 8.74; 95% CI, 6.53-11.70). In this study, a small proportion of patients with STEMI treated with primary PCI had late VT or VF. However, late VT or VF with cardiac arrest was rare, particularly in the cohort with uncomplicated STEMI. This information may be useful when determining the optimal timing for hospital discharge after STEMI.

DIGITALIZATION OF THE ELECTROCARDIOGRAM IN THE OPTIMIZATION OF THE TREATMENT OF ACUTE AND CHRONIC CORONARY SYNDROMES WITH THE USE OF RANOLAZINE

Aim – to evaluate the effectiveness of ranolazine in optimizing the treatment of acute and chronic coronary syndromes, using the capabilities of a differentiated electrocardiogram.Material and methods. 135 patients were involved in the study: 45 patients with ST-segment elevation myocardial infarction (STEMI) and 90 patients with stable angina pectoris (SA), functional class II-III. Depending on the treatment received, patients with STEMI were divided into group I, with inclusion in basic therapy of ranolazine (Pn), which consisted of 30 people, and control group II, which included 15 patients who received only basic therapy (K). People with SA were divided into three groups depending on the drugs included in the complex therapy (antiplatelet agents, statins and nitrates): group A - 30 patients additionally took lercanidipine and enalapril as part of the "polypill" drug (LE), group B - 30 people who received lercanidipine and enalapril as part of the "polypill" drug and ranolazine (LE+Rn), group V - 30 participants who took ramipril and ranolazine (Pm+Pn). The duration of treatment was 30 days. All patients were interviewed according to the EQ-5D-5L questionnaire with the EQ-VAS visual analog scale, carried out echocardiography and electrocardiogram (ECG) with digitalization of its indicators using the "Smart-ECG" medical software.Results. In patients with STEMI in group I (Rn) we noted increasing in quality of life (40.00 (30.00; 50.00), Δ +100.00%, p<0.001), left ventricular ejection fraction (LVEF) (50.50 (44.50; 55.00) %, Δ +6.93% (р<0.001) and the ratio of maximal speed (MSR) in the ischemic zone (0.64 (0.55; 0.71), Δ +76.56%, p<0.001). The frequency of increasing of MSR in the ischemic zone was significantly higher when ranolazine was included in the basic treatment (OR=7.000; 95% CI: 1.167; 42.001, p=0.020). An increase in the quality of life and a decrease in MSR in lead V2 (marker lead to assess LV hypertrophy) were observed in all groups of SA (in all cases p<0.05). In group B (LE+Rn), the greatest increase in LVEF was recorded (57.00 (55.25; 60.75) %, Δ +8.77 %, p<0.001). An increase of MSR in the ischemic zone was observed in group B (LE+Pn) (1.02 (0.62; 1.18), Δ +17.65%, p<0.001) and in group V (Pm+Pn) (0.86 (0.57; 1.05), Δ +12.79%, p<0.001). Conclusions. The addition of ranolazine in the treatment of STEMI and SA contributed to the improvement of the quality of life, the optimization of the contractile capacity of the myocardium due to the increase of LVEF, the increase of MSR indicator of the differentiated ECG in the ischemic zone, which confirmed the reduction of the electrical instability of the ischemic myocardium.

Serum ACSL4 levels in patients with ST-segment elevation myocardial infarction (STEMI) and its association with one-year major adverse cardiovascular events (MACE): A prospective cohort study.

In the present prospective cohort research, we aimed to explore the serum levels of Acyl-CoA synthetase long-chain family member 4 (ACSL4) in patients with ST-segment elevation myocardial infarction (STEMI) and its association with 1-year major adverse cardiovascular events (MACE). This prospective cohort study recruited 507 patients who underwent percutaneous coronary intervention for the treatment of STEMI at our hospital during August 2019 to July 2022. The serum ACSL4, tumor necrosis factor-α, interleukin (IL)-6, IL-1β, and C-reactive protein levels were measured by enzyme-linked immunosorbent assay. Demographic and clinical statistics were also collected. In addition, all patients were followed up for 1 year, and patients with MACE were defined as poor prognosis group. All data used SPSS 26.0 to statistical analyses. The poor prognosis group had significantly higher age and low-density leptin cholesterol (LDLC) levels compared to the favorable prognosis group (P < .05). STEMI patients exhibited significantly elevated serum levels of ACSL4, tumor necrosis factor-α, IL-6, IL-1β, and C-reactive protein (P < .05). Serum ACSL4 and IL-1β levels in the poor prognosis group were remarkably enhanced compared to the favorable prognosis group. Curvilinear regression analysis demonstrated that ACSL4 was associated with LDLC and IL-1β. Moreover, ACSL4 (B = 0.138, 95% CI 1.108-1.189, P < .001), LDLC (B = 2.317, 95% CI 5.253-19.603, P < .001), and IL-1β (B = 0.061, 95%CI 1.008-1.122, P = .025) levels were the risk factors for STEMI patients with 1-year MACE. This study showed that the serum ACSL4 levels was remarkably elevated in STEMI patients. This study might provide new targets and a comprehensive approach to cardiovascular protection in STEMI patients.

Ferroptosis, a Regulated Form of Cell Death, as a Target for the Development of Novel Drugs Preventing Ischemia/Reperfusion of Cardiac Injury, Cardiomyopathy and Stress-Induced Cardiac Injury.

The hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is about 6% and has not decreased in recent years. The leading cause of death of these patients is ischemia/reperfusion (I/R) cardiac injury. It is quite obvious that there is an urgent need to create new drugs for the treatment of STEMI based on knowledge about the pathogenesis of I/R cardiac injury, in particular, based on knowledge about the molecular mechanism of ferroptosis. In this study, it was demonstrated that ferroptosis is involved in the development of I/R cardiac injury, antitumor drug-induced cardiomyopathy, diabetic cardiomyopathy, septic cardiomyopathy, and inflammation. There is indirect evidence that ferroptosis participates in stress-induced cardiac injury. The activation of AMPK, PKC, ERK1/2, PI3K, and Akt prevents myocardial ferroptosis. The inhibition of HO-1 alleviates myocardial ferroptosis. The roles of GSK-3β and NOS in the regulation of ferroptosis require further study. The stimulation of Nrf2, STAT3 prevents ferroptosis. The activation of TLR4 and NF-κB promotes ferroptosis of cardiomyocytes. MiR-450b-5p and miR-210-3p can increase the tolerance of cardiomyocytes to hypoxia/reoxygenation through the inhibition of ferroptosis. Circ_0091761 RNA, miR-214-3p, miR-199a-5p, miR-208a/b, miR-375-3p, miR-26b-5p and miR-15a-5p can aggravate myocardial ferroptosis.

Efficacy and Safety of a Pharmaco-Invasive Strategy Using Half-Dose Recombinant Human Prourokinase in Patients with ST-Segment Elevation Myocardial Infarction During Hospitalization.

This study investigated the efficacy and safety of pharmaco-invasive strategy with half-dose recombinant human prourokinase (PHDP) during hospitalization for patients with ST-segment elevation myocardial infarction (STEMI) to provide references for the treatment of STEMI. Patients with STEMI who fulfilled the inclusion and exclusion criteria and attended Chengde Central Hospital, Hebei Province, China, between September 3, 2019, and December 28, 2021, were included in this study. The experimental group received PHDP and the control group underwent primary percutaneous coronary intervention (PPCI). This study enrolled 150 patients with STEMI, 75 in the experimental group and 75 in the control group. Coronary angiography revealed successful thrombolysis in 64 (85.33%) patients. Compared with the control group, the experimental group had shorter first medical contact-reperfusion time (P < 0.001), less slow flow/no-reflow (P < 0.001), and a lower utilization rate of Tirofiban (P < 0.001). Validity endpoints: no statistically significant differences between the two groups. Safety endpoints: no statistically significant differences between bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs), but the experimental group was more prone to arrhythmias (P = 0.040), particularly premature ventricular beats (PVB) (P = 0.008). In conclusion, the efficacy and safety of PHDP in the treatment of patients with STEMI were positive. Complete epicardial and myocardial reperfusion rates, risk for bleeding during hospitalization, and incidence of MACCEs were similar to those of the PPCI strategy. Although the PHDP group has a higher incidence of PVB, it does not increase the incidence of malignant arrhythmia. This study aimed to provide a new therapeutic strategy for the treatment of STEMI in hospitals without adequate PPCI resources condition.

Proposal for initial management of uncomplicated ST elevation myocardial infarction in centers without percutaneous coronary intervention capacity in Peru

ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.

Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI).

Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. The mean change of EF was 8.04±3.32% in group I versus -.39±5.09 % in group II (p<.001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p<.001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.

Myocardial Infarction: A Comprehensive Review

Myocardial infarction (MI), commonly known as a heart attack, is a critical medical condition resulting from the blockage of one or more coronary arteries. MI has been classified differently over time, with the most recent classification proposed by the European Society of Cardiology and the American College of Cardiology. This new classification considers various types of MI based on clinical presentations and underlying mechanisms. MI is a significant public health issue globally, with a high prevalence and a substantial impact on healthcare resources and the economy. The pathophysiology of MI is multifactorial, with factors such as atherosclerosis, thrombosis, and inflammation playing crucial roles. Complications of MI can include heart failure, cardiogenic shock, and arrhythmias. Diagnosis of MI involves clinical evaluation, imaging studies, and biomarker testing. Treatment of MI includes reperfusion therapy, medical management, and cardiac rehabilitation. Reperfusion therapy, including thrombolytic therapy and primary percutaneous coronary intervention, is the cornerstone of treatment for ST-segment elevation MI. Medical management involves antiplatelet and anticoagulation therapy, as well as beta-blockers, while cardiac rehabilitation can help improve cardiovascular function and reduce the risk of further cardiac events. Prompt diagnosis and appropriate treatment are essential for improving outcomes and reducing morbidity and mortality associated with MI.

Pan-Immune-Inflammation Value Is Independently Correlated to Impaired Coronary Flow After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Immune-inflammatory biomarkers have been shown to be correlated with impaired coronary flow (ICF) in ST-segment elevation myocardial infarction (STEMI). Herein, we assessed the relationship between a novel comprehensive biomarker, pan-immune-inflammation value (PIV), and ICF after primary percutaneous coronary intervention (pPCI) in STEMI. A total of 687 patients underwent pPCI between 2019 and 2023 were retrospectively analyzed. Blood samples were collected at admission. PIV and other inflammation parameters were compared. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. Post-procedural coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) classification. Patients were divided into two groups: a group with ICF defined as post-procedural TIMI 0-2 and a group with normal coronary flow (NCF) defined as post-procedural TIMI flow grade of 3. The mean age was 61±12 years and 22.4% were women. Compared to the NCF group (median 492, interquartile range [IQR] 275-931), the ICF group (median 1540, IQR 834-2909) showed significantly increased PIV (p<0.001). The optimal cutoff for the PIV was 804, as determined by receiver operating characteristic curve. The incidence of ICF was 17.0% in whole subjects, 6.4% in low PIV group (<804) and 34.2% in high PIV group (≥804). Multivariate analyses revealed that a baseline PIV ≥804 was independently associated with post-pPCI ICF (Odds ratio 5.226, p<0.001). PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in determining of ICF. In conclusion, a high PIV was significantly associated with an increased risk of ICF after pPCI. Moreover, PIV was a better indicator of ICF than other inflammatory markers.

Long-term outcomes with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in ST-segment elevation myocardial infarction: 5-year follow-up of the BIOSTEMI randomised superiority trial

Biodegradable polymer sirolimus-eluting stents improve early stent-related clinical outcomes compared to durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. The long-term advantages of biodegradable polymer sirolimus-eluting stents after complete degradation of its polymer coating in patients with STEMI remains however uncertain. BIOSTEMI Extended Survival (BIOSTEMI ES) was an investigator-initiated, follow-up extension study of the BIOSTEMI prospective, multicentre, single-blind, randomised superiority trial that compared biodegradable polymer sirolimus-eluting stents with durable polymer everolimus-eluting stents in patients with STEMI undergoing primary percutaneous coronary intervention at ten hospitals in Switzerland. All individuals who had provided written informed consent for participation in the BIOSTEMI trial were eligible for this follow-up study. The primary endpoint was target lesion failure, defined as a composite of cardiac death, target vessel myocardial re-infarction, or clinically indicated target lesion revascularisation, at 5 years. Superiority of biodegradable polymer sirolimus-eluting stents over durable polymer everolimus-eluting stents was declared if the Bayesian posterior probability for a rate ratio (RR) of less than 1 was greater than 0·975. Analyses were performed according to the intention-to-treat principle. The study was registered with ClinicalTrials.gov, NCT05484310. Between April 26, 2016, and March 9, 2018, 1300 patients with STEMI (1622 lesions) were randomly allocated in a 1:1 ratio to treatment with biodegradable polymer sirolimus-eluting stents (649 patients, 816 lesions) or durable polymer everolimus-eluting stents (651 patients, 806 lesions). At 5 years, the primary composite endpoint of target lesion failure occurred in 50 (8%) patients treated with biodegradable polymer sirolimus-eluting stents and in 72 (11%) patients treated with durable polymer everolimus-eluting stents (difference of -3%; RR 0·70, 95% Bayesian credible interval 0·51-0·95; Bayesian posterior probability for superiority 0·988). In patients undergoing primary percutaneous coronary intervention for STEMI, biodegradable polymer sirolimus-eluting stents were superior to durable polymer everolimus-eluting stents with respect to target lesion failure at 5 years of follow-up. The difference was driven by a numerically lower risk for ischaemia-driven target lesion revascularisation. Biotronik.

Natural History and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction Without Stent Insertion

After restoration of coronary perfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI), discrete severe stenotic coronary lesions are not always apparent. There remains ambiguity whether drug-eluting stent (DES) insertion or initial medical management is best practice. Assess short-term clinical outcomes in patients presenting with STEMI without initial stent insertion. Patients who underwent percutaneous coronary intervention for STEMI between 2014 and 2020 were prospectively enrolled and assessed for inclusion. Patients presenting with in-stent restenosis or stent thrombosis, or who did not survive to hospital discharge were excluded. Of 13,871 patients presenting, 456 (3.3%) were treated without initial stenting. These patients were older than those treated with DES (66.1 ± 13.6 vs 62.3 ± 12.4years, p <0.001) and had higher rates of diabetes (23.5% vs 16.0%, p <0.001) and previous revascularization with either percutaneous coronary intervention (14.0% vs 7.3%, p <0.001) or coronary artery bypass graft (3.5% vs 1.8%, p = 0.008). Thirty-day mortality rate was elevated in patients treated without stenting compared with the rate in those receiving DES (4.2% vs 0.9%, p <0.001), as were rates of myocardial infarction (1.3% vs 0.5%, p = 0.026) and major adverse cardiac events (10.5% vs 2.4%, p <0.001). After propensity matching, a trend toward increased mortality remained (4.2% vs 2.0%, p = 0.055). In conclusion, a no-stenting initial strategy, compared with DES insertion, is associated with increased 30-day mortality in those presenting with STEMI without severe stenosis. These data suggest when appropriate, current-generation DES insertion should be undertaken.

The effects of prophylactic intravenous injection of rhBNP on prognosis in patients with STEMI undergoing PPCI.

This experiment was carried out to observe the application value of recombinant human brain natriuretic peptide (rhBNP) in patients with ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), to provide reference for the future treatment of STEMI. In this study, we selected STEMI patients who underwent PPCI treatment in our hospital from October 2019 to December 2021 were selected as the study subjects, of which 46 received intravenous injections of rhBNP (research group), and 36 STEMI patients underwent PPCI (control group). There was no difference in clinical efficacy between the two groups (P>0.05). After treatment, high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB) and plasma N-terminal pro-BNP (NT-proBNP) levels decreased in both groups, with the research group lower than the control group; cardiac output (CO), cardiac index (CI) and mean arterial pressure (MAP) of the research group were lower than the control group's (P<0.05). The left ventricular ejection fraction (LVEF) in the research group was higher than that in the control group at 1 week and 1 month after treatment, while left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were lower than those in the control group (P<0.05). There was also no difference in the rate of prognostic risk events between the two groups at 6 months of follow-up (P>0.05). Combining the results of these experiments above, we believe that the intravenous injection of rhBNP in STEMI patients undergoing PPCI treatment can improve cardiac function and promote the recovery of hemodynamics.

Microvascular Obstruction in Acute Myocardial Infarction, a Potential Therapeutic Target.

Microvascular obstruction (MVO) is a recognised phenomenon following mechanical reperfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI). Invasive and non-invasive modalities to detect and measure the extent of MVO vary in their accuracy, suggesting that this phenomenon may reflect a spectrum of pathophysiological changes at the level of coronary microcirculation. The importance of detecting MVO lies in the observation that its presence adds incremental risk to patients following STEMI treatment. This increased risk is associated with adverse cardiac remodelling seen on cardiac imaging, increased infarct size, and worse patient outcomes. This review provides an outline of the pathophysiology, clinical implications, and prognosis of MVO in STEMI. It describes historic and novel pharmacological and non-pharmacological therapies to address this phenomenon in conjunction with primary PCI.

Comparison of myocardial reperfusion between intracoronary versus intravenous cangrelor administration in patients undergoing primary percutaneous coronary intervention.

Myocardial reperfusion is the main target of treatment in patients with ST-segment elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal micro-embolization. Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The primary endpoint was ST-segment elevation resolution (STR) ≥ 50% after 30 min from the end of the PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at 30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion. Moreover, acute and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated. More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds ratio: 3.586; 95% confidence interval: 1.134-11.335; p = 0.030). The incidence of Bleeding Academic Research Consortium 3-5 bleedings was 15.5% and mortality was 4.2% without any significant difference between the two groups. In conclusion the results of the study do not show any advantages in the administration of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.

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

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

Examining the Effects of COVID-19 Pandemic on ST Segment-elevation Myocardial Infarction Treatment Strategies with the Impact of Event Scale

Examining the Effects of COVID-19 Pandemic on ST Segment-elevation Myocardial Infarction Treatment Strategies with the Impact of Event Scale

Recovery From the Impact of COVID-19 on Treatment Times and Clinical Outcomes of Patients With ST-Segment Elevation Myocardial Infarction: An Interim Analysis

Previous studies have documented a negative impact of the COVID-19 pandemic on emergent percutaneous treatment of patients with ST-segment elevation myocardial infarction (STEMI), but few have examined recovery of healthcare systems in restoring prepandemic STEMI care. Retrospective analysis was performed of data from 789 patients with STEMI from a large tertiary medical center treated with percutaneous coronary intervention between January 1, 2019, and December 31, 2021. For patients with STEMI presenting to the emergency department, median time from door to balloon was 37 minutes in 2019, 53 minutes in 2020, and 48 minutes in 2021 (P < .001), whereas median time from first medical contact to device changed from 70 to 82 to 75 minutes, respectively (P = .002). Treatment time changes in 2020 and 2021 correlated with median emergency department evaluation time (30 to 41 to 22 minutes, respectively; P = .001) but not median catheterization laboratory revascularization time. For transfer patients, median time from first medical contact to device changed from 110 to 133 to 118 minutes, respectively (P = .005). In 2020 and 2021, patients with STEMI had greater late presentation (P = .028) and late mechanical complications (P = .021), with nonsignificant increases in yearly in-hospital mortality (3.6% to 5.2% to 6.4%; P = .352). COVID-19 was associated with worsening STEMI treatment times and outcomes in 2020. Despite improving treatment times in 2021, in-hospital mortality had not decreased in the setting of a persistent increase in late patient presentation and associated STEMI complications.