ST-segment Elevation Myocardial Infraction Research Articles

The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions.

(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.

Adjunct remote ischemic conditioning to PCI in ST-segment elevation myocardial infraction patients: Systematic review and meta-analysis

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) is the most dangerous presentation of the acute coronary syndrome (ACS). Throughout the last three decades, clinicians have been attempting to reduce the short and long-term major adverse cardiac events (MACE) associated with STEMI. Remote ischemic conditioning (RIC) is one of the new adjunctive modalities to PCI in treating STEMI patients whereby brief reversible episodes of ischemia and reperfusion are applied to the tissue (by alternative cycles of inflation and deflation of a blood pressure cuff on the upper or lower limb) confers global protection and renders remote tissues resistant to ischemia/reperfusion injury. This review aims to provide reliable evidence from published randomized controlled trials (RCTs) regarding whether RIC is beneficial for STEMI patients or not. Methods We followed the PRISMA guidelines during the preparation of this systematic review and meta-analysis. A computer literature search for (PubMed, Web of Science, Scopes, and Google Scholar) was carried out. We included RCT, comparing the remote ischemic conditioning, regardless of its timing of application to PCI, with either placebo or sham procedure, in terms of both short-term and long-term cardio protection. Outcomes of myocardial salvage index, myocardial infarction size, and left ventricular ejection fraction were pooled as the standardized mean difference between the two groups from baseline to endpoint. Results 11 RCTs (7151 patients), were included in this analysis. The overall effect on short-term outcomes, was in favor of PCI only in terms of myocardial salvage index(P value=0.04, 95% CI [0.00-0.08]), and left ventricular ejection fraction(P value=0.05, 95% CI [0.02,2.16]), while the adjunctive application of remote ischemic conditioning was beneficial in terms of: myocardial infarct size ( P value=0.004, 95% CI [-3.22,-0.62]). Regarding the long-term outcomes, the overall effect did not show any benefit in either of the two groups in terms of: major adverse cardiac and cerebrovascular events (MACCE) (P value=0.13, 95% CI [0.48,1.10]), hospitalization for heart failure (P value=1.00, 95% CI [0.83,1.20]), and cardiac death (P value=0.91, 95% CI [0.73,1.32]). Conclusion The adjunctive application of RIC to PCI during treatment of STEMI patients showed a beneficial effect only on short-term reduction of myocardial infarct size, nevertheless, it was not of benefit regarding the other short and long-term metrics of myocardial salvage and left ventricular function.

Can we optimize locations of hospitals by minimizing the number of patients at risk?

BackgroundTo reduce risk of death in acute ST-segment elevation myocardial infraction (STEMI), patients must reach a percutaneous coronary intervention (PCI) within 120 min from the start of symptoms. Current hospital locations represent choices made long since and may not provide the best possibilities for optimal care of STEMI patients. Open questions are: (1) how the hospital locations could be better optimized to reduce the number of patients residing over 90 min from PCI capable hospitals, and (2) how this would affect other factors like average travel time.MethodsWe formulated the research question as a facility optimization problem, which was solved by clustering method using road network and efficient travel time estimation based on overhead graph. The method was implemented as an interactive web tool and tested using nationwide health care register data collected during 2015–2018 in Finland.ResultsThe results show that the number of patients at risk for not receiving optimal care could theoretically be reduced significantly from 5 to 1%. However, this would be achieved at the cost of increasing average travel time from 35 to 49 min. By minimizing average travel time, the clustering would result in better locations leading to a slight decrease in travel time (34 min) with only 3% patients at risk.ConclusionsThe results showed that minimizing the number of patients at risk alone can significantly improve this single factor but, at the same time, increase the average burden of others. A more appropriate optimization should consider more factors. We also note that the hospitals serve also for other operators than STEMI patients. Although optimization of the entire health care system is a very complex optimization problems goal, it should be the aim of future research.

Comprehensive safety profile evaluation of bivalirudin in Chinese ST-segment elevation myocardial infarction patients receiving percutaneous coronary intervention: a prospective, multicenter, intensive monitoring study

BackgroundThis prospective, multi-center, intensive monitoring study aimed to systematically assess the occurrence of adverse events (AEs) and adverse drug reactions (ADRs), especially thrombocytopenia and bleeding, as well as their risk factors in Chinese ST-segment elevation myocardial infraction (STEMI) patients receiving bivalirudin as anticoagulant for percutaneous coronary intervention (PCI).MethodsIn total, 1244 STEMI patients undergoing PCI and receiving bivalirudin as anticoagulant were enrolled in the present study. Safety data were collected from hospital admission to 72 h after bivalirudin administration; in addition, patients were further followed up at the 30th day with safety data collected at that time.ResultsAEs, severe AEs, ADRs and severe ADRs were reported in 224 (18.0%), 15 (1.2%), 49 (3.9%) and 5 (0.4%) patients, respectively. Importantly, 4 (0.3%) patients were submitted to hospitalization and 6 (0.5%) patients died due to AEs, while 1 (0.1%) patient was submitted to hospitalization but no (0.0%) patient died due to ADRs. Meanwhile, thrombocytopenia and bleeding occurred in 24 (1.9%) and 21 (1.7%) patients, respectively. Further multivariate logistic analysis identified several important independent factors related to AEs, ADRs, thrombocytopenia or bleeding, which included history of cardiac surgery and renal function impairment, high CRUSADE risk stratification, elective operation and combination with glycoprotein IIb/IIIa inhibitors. Moreover, 4 multivariate models were constructed based on the above-mentioned factors, which all showed acceptable predictive value for AEs, ADRs, thrombocytopenia and bleeding, respectively.ConclusionBivalirudin is a well-tolerant anticoagulant in Chinese STEMI patients undergoing PCI procedure.

In-hospital Outcome and Angiographic Profile of Elderly Patients with Non ST-Segment Elevation Myocardial Infraction

Background: Non ST - segment elevation myocardial infarction is heterogeneous in its presentation and is a major life-threatening cause of emergency medical care and hospitalization. Patients with non ST-segment elevation myocardial infarction are at risk for adverse cardiac events and if associated with increased age, it become a strong predictor of adverse cardiac events in patients with non ST-segment elevation myocardial infarction. Objective: To find out in - hospital outcome and severity of coronary artery disease of older patient with non - ST segment elevation myocardial infarction. Methods: This was a descriptive cross sectional study. The study was carried out in the department of cardiology, National Heart Foundation Hospital and Research Institute from June 2011 to May 2012. Patients of non ST - segment elevation myocardial infarction admitted at National Heart Foundation &amp; Research Institute who fulfill the inclusion criteria were the study population. Patients were recruited by nonrandom sampling. One hundred and thirty four patients were recruited in this study. Data were prospectively collected in a pre - designed data collection form and analyzed by using SPSS - 16 software. Results: In this study patients had a greater prevalence of hypertension, diabetes mellitus. Chest pain and shortness of breath were common presentations observed in study patient during admission. They had a lower left ventricular ejection fraction than their younger counter parts. Older group was associated with an increased risk of triple vessel disease. In-hospital complications were significantly higher in older patients. Duration of hospital stay was longer in older patients. Conclusion: Older patients with non- ST segment myocardial infarction strongly predicts adverse inhospital outcome and severe coronary artery disease profile. Older patients should alert physicians to an increased risk of morbidity and mortality, which may in turn support more judicious treatment including appropriate utilization of cardiovascular diagnostic tests and therapeutics used in current cardiovascular care to optimize outcomes in these high-risk patients. Bangladesh Heart Journal 2022; 37(1): 52-58

SMOKING PARADOX IN HYPERTENSIVE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS: 25-YEAR POPULATION-BASED STUDY

Objective: The main objective of our paper is to study the effect of smoking status on the outcomes of hypertensive patients presenting with ST-segment elevation myocardial infraction. Design and method: Patients with STEMI who were hospitalised in our coronary care unit during a 25-year period (since 1994) were included in a specific registry. Their in-hospital and follow-up data have been regularly updated. We selected only patients with known or newly diagnosed hypertension in our study. Then, we divided the population into two groups according to their smoking status. The primary endpoints were death, rehospitalization, non-fatal myocardial infarction. The secondary endpoints were in-hospital mortality, left ventricular dysfunction, life-threatening arrythmias, prolonged hospital stay and bleeding complications. Results: A total of 1609 patients were included during the study period. Among 489 patients having hypertension, 45.5% were smokers with male sex predominance (sex ratio 11/1). Baseline characteristics are detailed in table 1. Among the primary endpoint: One-year mortality was significantly more important in the non-smokers group (p = 0.012): there was no significant difference in non-fatal MI (p = 0,142) and in all cause rehospitalization (p = 0.093). As for the secondary endpoints, there was no significant difference between the two groups except for the in-hospital death (p &lt; 0.01). The results of the endpoints are detailed in table 1. Conclusions: Smoking seems to have a beneficial effect on the outcomes of STEMI of hypertensive patients.

Impact of Lubrizol factory fire in Rouen on coronary events: A retrospective study from the France PCI registry

On September 26, 2019, an industrial fire occurred in the Lubrizol factory in Rouen (France), exposing the population to the inhalation of many volatile toxic agents secondary to combustion. To assess its impact on the incidence of coronary artery events. All coronary angiography performed in Rouen (exposed) and Le Havre (unexposed) from January 2019 and December 2019 were extracted from the prospective FRANCE-PCI registry. To study the impact of the fire on coronary events, an interrupted time series analysis was performed in Rouen, with adjustment on Le Havre in an ARMA(1,1) model with the precision of one week. This statistical analysis has the advantage of taking into account a possible seasonal effect. The primary outcome was the incidence of all coronary events and the secondary outcome was the variation in incidence of ST-segment elevation myocardial infraction (STEMI). In the 21 weeks preceding the fire, there were a mean of 62.0 ± 10.1 coronary events per week in the exposed town, non-significantly increasing to 70.6 ± 10.5 in the 14 weeks following the fire, with an estimated increase of +5.5 events/week (95% CI: −6.0 to +16.9, P = 0.36). The mean number of STEMI events per week in Rouen changed from 6.19 ± 2.96 before to 7.93 ± 3.65 after the fire, with a difference estimated at +1.8 events/week (95% CI: −0.5 to +4.1, P = 0.13) ( Fig. 1 ). Our study did not find a significant effect of the Lubrizol factory fire on the incidence of coronary events. Further studies are needed to investigate the impact of industrial accidents on coronary events.

Epidemiological profile of very young STEMI patients : Post-hoc analysis of 25 year-long study

Coronary artery disease is often thought to be associated with older age. Nowadays the number of young adults suffering from CAD is increasing. Such pattern needs to be studied carefully to identify high risk patients. To study the epidemiological profile of the very young (≤ 40 years) adults presenting with ST-segment elevation myocardial infraction. Over the 25 years period, 1609 STEMI patients were admitted to our university hospital. This post-hoc analysis included patients aged 40 years old or less. Then we compared their characteristics to a control group of patients > 40 years. There were 90 patients meeting the inclusion criteria representing 5,59% of the total population. The mean age was 35 years. 91,1% were males and 77% were active smokers. Diabetes was found in 20% of patients, hypertension was found in 8,9%, dyslipidaemia was found in 11,1% and obesity in 65%. There was a significant difference in cardiovascular risk factors profile: older patients had more diabetes and hypertension whereas the very young group had more smokers. There was no significant difference in dyslipidaemia. Very young adults presenting with acute myocardial infarction have different characteristics compared to older subjects.

The effect of oxygen inhalation on cardiac biomarkers in patients presenting with acute ST-segment elevation myocardial infraction: A randomized clinical trial.

Background: It is assumed giving oxygen to patients with acute myocardial infraction may increase the oxygenation of the ischemic tissue; however, the usefulness of oxygen in these patients has become a challenging topic. Thus, the present study aimed to determine the effect of oxygen inhalation on cardiac biomarkers in patients with acute myocardial infarction. Methods: This randomized clinical trial study was performed on 2 groups of intervention and control within 2 days of admission to critical care unit (CCU). A total of 64 patients with ST-segment elevation acute myocardial infarction who referred to Zeyaei hospital, Ardakan, were selected using simple random sampling. In the intervention group, the pulse oximetry was monitored and they only breathed regular air and received supplemental oxygen in case their oxygen level dropped below 94%. The levels of creatine kinase-MB and troponin I enzymes were measured. Data were analyzed using SPSS version 20 through repeated measure ANOVA, t test, and chi-squared test. Significance level was set at 0.05. Results: This study showed that during the 48 hours of hospitalization, there were no significant differences between the 2 groups regarding the levels of creatine kinase-MB (p=0.509) and troponin I (p=0.604). Conclusion: Since the level of cardiac biomarkers is a sign of the extent of infracted area, it is assumed receiving supplemental oxygen in patients with acute myocardial infarction has no effect on decreasing the infracted area.

Platelet-fibrin clot strength measured by thromboelastography could predict hypercoagulability and antiplatelet effects in patients after percutaneous coronary intervention.

It has been estimated that nearly one-fifth post-percutaneous coronary intervention (PCI) patients treated with clopidogrel continued to have recurrent thrombotic events, which implied the limitation of "one-size-fits all" strategy for antiplatelet therapy. From July 2017 to April 2019, patients with acute coronary syndrome [ACS, including unstable angina (UA), non-ST segment elevation myocardial infraction (NSTEMI), and ST segment elevation myocardial infraction (STEMI)] or old myocardial infarction (OMI), or patients without coronary heart disease (non-CAD) were retrospectively enrolled in this study. For CAD patients undergoing PCI, standard dual antiplatelet therapy (100 mg aspirin and 75 mg clopidogrel) was prescribed. After administration of dual antiplatelet agents for at least 5 days, whole blood samples were collected and platelet function was tested using thrombelastography (TEG). Thrombin-induced platelet-fibrin clot strength (MAthrombin) and ADPinduced platelet-fibrin clot strength (MAADP) were measured to assess the hypercoagulability and antiplatelet effects. A total of 571 patients, including 479 ACS patients, 21 OMI patients and 71 non-CAD patients were enrolled. Highest level of MAthrombin was detected in STEMI patients, while lowest MAthrombin level was observed in non-CAD patients (P1 <0.05 for OMI vs. non-CAD; P2 <0.001 for ACS vs. non-CAD; P3<0.05 among ACS). Higher MAADP was also observed in STEMI and NSTEMI patients compared with UA patients (P<0.001). When MAADP was divided into trisections (MAADP <31; 31-47; >47 mm), a considerable portion of 41.8% ACS patients were in the first trisection (MAADP <31 mm), containing 50.4% of UA patients, 35.7% of NSTEMI patients and 26.5% of STEMI patients, with significant difference being observed between UA patients and other ACS patients (P<0.05 for NSTEMI vs. UA; P<0.001 for STEMI vs. UA). Meanwhile, 27.6% of NSTEMI and 31.0% of STEMI patients were in the third trisection (MAADP >47 mm), which was significantly higher than that of UA patients (12.7%) (P<0.001 for NSTEMI or STEMI vs. UA). Considering various degrees of hypercoagulability and antiplatelet effects of clopidogrel among OMI and ACS patients post-PCI. More attention should be paid to personalized antiplatelet therapy according to individual's effects of P2Y12 receptor inhibitors.

Electrocardiography Interpretation Competency of Medical Interns: Experience from Two Ethiopian Medical Schools.

Background Electrocardiography (ECG) is the graphical display of electrical potential differences of an electric field originating in the heart. Interpretation of ECG is a core clinical skill in the department of emergency medicine. The main aim of this survey was to assess competency of ECG interpretation among 2018 graduating class medical students in Addis Ababa University and Haramaya University. Methodology. A cross-sectional survey was conducted on medical interns at Addis Ababa University and Haramaya University. Data had been collected from October 01, 2018, to October 30, 2018, by using structured questionnaires. Data were entered, cleaned, edited, and analyzed by using SPSS version 25.0 statistical software. Descriptive statistics, cross-tabs, chi-squared test, Mann–Whitney U test, and binary logistic regression were utilized. Results Two-hundred and two graduating medical students were involved on this survey, out of which 61.3% (95% CI 56.3–66.3%) and 32.75% (95% CI 28.25–37.25) were able to correctly interpret the primary ECG parameters and the arrest rhythm of ECG abnormalities, respectively. The ability to detect from common emergency ECG abnormalities of anterioseptal ST segment elevation myocardial infraction, atrial fibrillation, and first-degree atrioventricular block was 42.6%, 39.1%, and 32.1%, respectively. Conclusion This survey showed graduating medical students had low competency in ECG interpretations.

Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort

Acute coronary syndrome (ACS) in young adults seems to be not as low as expected. It presents one of the highly debated issues in cardiology according to the increasing number of those patients. The aim of our study was to describe the clinical and angiographic profile in young patient ≤ 40 years diagnosed with ACS. We performed a retrospective study including 74 patients younger than 40 years of age with clinical and electrocardiographic evidence of ACS, hospitalized in our cardiology department from January 2016 to Mach 2019. All patients underwent a coronary angiography. We analyzed the risk factors, clinical profile, type of ACS and angiographic features of these patients. Mean age was 33 ± 7 years old [26-40] and 94% of them were males (five women versus 70 men). All men were smokers, including four man addicted on cannabis, and only two women were non-smokers. The most common risk factors were diabetes mellitus (14 patients; 19%), systemic hypertension (10 patients; 13.5%), dyslipidemia (7 patients; 9.4%), obesity (7 patients; 9.4%) and a family history of premature coronary artery disease (5 patients; 6.7%). Ten patients (13.5%) were having ST segment elevation myocardial infraction, 13 patients (17.5%) were hospitalized for a non-ST segment elevation and 51 patients (69%) have a history of an unstable angina. The most common abnormal arteriography findings were the involvement of one vessel (23 patients; 31%), followed by double-vessel disease noticed in two cases (2.7%). There was one patient of our population with three-vessel disease (1.3%). The most common vessel to be involved was the left anterior descending (12 cases; 16%). Normal coronary angiography was noticed in 37 patients (50%). ACS in young patients has a huge impact on the patient, the society and the economic burden. It presents a real challenge that the cardiologist must be aware of in order to set on the ideal therapeutic strategy including the perfect clinical management and an early prevention program to control the cardiovascular risk factors.

P1723 Spectacular left ventricle post infarction aneurysm

Abstract Sixty six-y.o. woman 2 months after anterior wall ST-segment elevation myocardial infraction and PCI LAD + 3DES (TIMI 1) was re-admitted to the clinic because of progressive severe heart failure (NYHA III/IV). In admission NT-proBNP level was 14 000 pg/ml, INR 1,7, bilirubin 4,5mg/dl. The electrocardiogram showed persistent ST elevation on anterior leads. Transthoracic echocardiography (TTE) revealed spectacular finding: aneurysm of left ventricle (LV) involving ½ distal part of interventricular septum, apex, inferior, anterior and lateral wall with LVEF 24%, LVEDV 272ml. Thickness of intraventricular septum (IVS) on aneurysm level was only 2,5-3,5mm. In the middle part of IVS a minimal ventricular septal defect (VSD) was showed. Cardiac magnetic resonance examination confirmed TTE findings. The course of the disease was dynamic. The diameter of VSD was increased during consecutive days of hospitalization with maximum width 6,5mm. The patient was hemodynamical unstable, she needed pressure amines, diuretics and intra-aortic balloon pumping. The patient underwent several Heart Team consultations. She was disqualified from percutaneous VSD closing because of thickness of IVS and spiral shape of VSD. Due to potentially too small LV volume after LV plastic surgery the patient was also disqualified from that procedure. We reported the patient to heart transplantation (HTX). There was no transplant donor. In next days we observed progressive signs of a cardiogenic shock with right ventricle decompensation secondary to widening of VSD. Because of unstable stage and growing decompensation, no possibility of HTX patient had life—saving cardiac surgery of LV with mitral valve and tricuspid valve anuloplasthies. The patient survived operation. Abstract P1723 Figure.

Impact of Initial Platelet Count on Baseline Angiographic Finding in Patients with Acute ST- Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

AbstractBackground: Platelets play an important role in cardio-vascular disease both in the pathogenesis of atherosclerosis and in the development of acute thrombotic events. Rupture of atheromatous plaque and subsequent occlusive thrombus formation are believed to be responsible for most acute myocardial ischemic events.Aim of Study: The aim of this study is to assess the relation and effect of initial platelet count on baseline angiographic findings in patients presented with acute ST Segment Elevation Myocardial Infraction (STEMI) undergoing Primary Percuta-neous Coronary Intervention (pPCI).Patients and Methods: This study was conducted at the Department of Cardiovascular Medicine, Tanta University Hospital at the period between June 2017 to December 2017, It was carried out on 150 patients diagnosed definitively with acute STEMI and treated with pPCI. Blood samples were collected from the patient on admission to show initial platelet count before coronary intervention followed by assessment of the angiographic findings before wiring of the infract related artery by TIMI flow grade system and scoring of the coronary anatomy with SYNTAX score.The patients were divided into two groups, group (1): Included patients who had TIMI flow grade 0 (82 patients) representing 54.7% and group (2): Patients who had TIMI flow grade 1-3 (68 patients) 45.3%.Results: Group (1) who showed total occlusion of infract related artery (TIMI 0) patients had higher initial platelet count with a mean of (255.74±72.01) X 103/mm3 compared to group (2) (TIMI 1-3) in which patients had lower initial platelet count with a mean of (194.94±47.54) X 103/mm3. There was no significant difference between the two groups as regarding of complexity of coronary arteries anatomy calculated by SYNTAX score.Conclusion: Initial platelet count in patients presented with acute STEMI had a role in predicting pre-interventional angiographic findings, higher initial platelet count is associated with higher incidence of total occlusion of infract related artery in STEMI patients treated with primary PCI, there was no significant relation between initial platelet count and SYNTAX score grade, initial platelet count alone has no effect on SYNTAX flow grade of coronary arteries. It seems that it is affected by multiple risk factors.

GW29-e1890 Effects of ischemic postconditioning on outcomes of patients with ST-segment elevation myocardial infraction undergoing primary percutaneous coronary intervention: a meta-analysis

GW29-e1890 Effects of ischemic postconditioning on outcomes of patients with ST-segment elevation myocardial infraction undergoing primary percutaneous coronary intervention: a meta-analysis

Cangrelor for the treatment of patients with Arterial Thrombosis

ABSTRACTIntroduction: All oral P2Y12 receptor blockers are associated with some degree of delayed onset and offset of pharmacodynamic (PD) effects in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Although intravenous glycoprotein IIb/IIIa inhibitors are associated with rapid onset of action, they are also associated with delayed offset and other limitations such as elevated bleeding risk and thrombocytopenia.Areas covered: In this review, the authors focus on cangrelor, an intravenous, reversible P2Y12 receptor blocker with fast onset and offset of effects. The authors also describe the pharmacologic effects of cangrelor and its pharmacologic interaction with other P2Y12 receptor inhibitors. Finally, the authors discuss the large-scale clinical trials that compared the efficacy and safety of cangrelor with clopidogrel.Expert opinion: In ACS patients undergoing PCI, cangrelor is most desirable to effectively prevent periprocedural ischemic events and to avoid excessive bleeding. Indeed, any high-risk patient with ST-segment elevation myocardial infraction or patient who is unable to take oral medications is a potential candidate for intravenous cangrelor therapy. Furthermore, stable patients with coronary artery disease, who are considered for ad hoc PCI following coronary angiography, may be considered for treatment with cangrelor to reduce post-PCI thrombotic events.

Circulating Long Noncoding RNA LIPCAR Acts as a Novel Biomarker in Patients with ST-Segment Elevation Myocardial Infarction.

BackgroundLong noncoding RNAs (lncRNAs) recently have been implicated in the pathological processes of cardiovascular diseases. In this study, LncRNADisease database and PubMed database were used to screen myocardial infraction (MI)-related lncRNAs and to investigate the diagnostic role of lncRNAs in ST-segment elevation myocardial infraction (STEMI).Material/MethodsForty-six patients with STEMI and 40 healthy controls were included in the study. Venous blood samples acquired at different time points and the expression levels of lncRNAs in plasma were measured by qRT-PCR. In addition, other blood samples were collected before and after percutaneous coronary intervention (PCI). Correlation analysis and receiver operating characteristic (ROC) curve were used to assess the diagnosis value of the markers. All included patients were followed up for 12±1 months.ResultsNine MI-related lncRNAs were selected from the database. The qRT-PCR results showed that the expression of hypoxia inducible factor 1A antisense RNA 2 (aHIF), member 1 opposite strand/antisense transcript 1 (KCNQ1OT1), and mitochondrial long noncoding RNA uc022bqs.1 (LIPCAR) were significantly increased in patients with STEMI compared to the control patients. The ROC curve showed that LIPCAR (AUC=0.782, 95% CI: 0.707–0.0.894) had better diagnostic accuracy. Moreover, correlation analysis indicated that LIPCAR were positively correlated with myocardial enzymes and negatively correlated with left ventricular ejection fraction. The level of LIPCAR in STEMI patients after PCI was lower (P<0.05). Multivariate regression analysis indicated that higher levels of LIPCAR were independent predictors of major adverse cardiovascular events in patients with STEMI (HR=5.93; 95% CI, 1.46–9.77; P=0.001).ConclusionsHighly expressed LIPCAR in plasma may serve as a warning sign for the diagnosis of STEMI.

MIF mRNA Expression and Soluble Levels in Acute Coronary Syndrome.

Acute coronary syndrome (ACS) describes any condition characterized by myocardial ischaemia and reduction in blood flow. The physiopathological process of ACS is the atherosclerosis where MIF operates as a major regulator of inflammation. The aim of this study was to assess the mRNA expression of MIF gene and its serum levels in the clinical manifestations of ACS and unrelated individuals age- and sex-matched with patients as the control group (CG). All samples were run using the conditions indicated in TaqMan Gene Expression Assay protocol. Determination of MIF serum levels were performed by enzyme-linked immunosorbent assay and MIF ELISA Kit. ST-segment elevation myocardial infraction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) showed 0.8 and 0.88, respectively, less expression of MIF mRNA with regard to CG. UA and STEMI presented more expression than NSTEMI 5.23 and 0.68, respectively. Otherwise, ACS patients showed significant higher MIF serum levels (p=0.02) compared with CG. Furthermore, the highest soluble levels of MIF were presented by STEMI (11.21 ng/dL), followed by UA (10.34 ng/dL) and finally NSTEMI patients (8.75 ng/dL); however, the differences were not significant. These novel observations further establish the process of MIF release after cardiovascular events and could support the idea of MIF as a new cardiac biomarker in ACS.

TCTAP A-019 Clinical Impact of D-dimer Level on Admission in Predicting Coronary Slow-flow Phenomenon and In-hospital Major Adverse Cardiac Events in Patients Presenting with ST-segment Elevation Myocardial Infraction

D-dimer, which gives indirect estimation of the thrombotic burden, is useful and easy evaluated laboratory findings in daily clinical settings. However, it’s still remain unclear that the relationship between D-dimer level and the incidence of the short-term clinical adverse event in patients

GW25-e0788 The effect of thrombus-aspiration combined tirofiban in the patients with ST-segment elevation myocardial infraction (STEMI) after the direct percutaneous coronary intervention

GW25-e0788 The effect of thrombus-aspiration combined tirofiban in the patients with ST-segment elevation myocardial infraction (STEMI) after the direct percutaneous coronary intervention