ST-segment Elevation Patients Research Articles

Iniciativa Stent-Save a Life! Argentina

The Stent-Save a Life! Initiative (SSL) is a European program that seeks to improve access of patients with acute myocardial infarction with ST-segment elevation (STEMI) to reperfusion therapies according to guideline recommendations, thus reducing morbidity and mortality. Objectives: To describe the results of the first three years of the SSL Initiative in Argentina. Methods: A mapping was carried out initially to analyze the local situation and a Door-to-Balloon Program (DBP) was developed for centers with primary percutaneous coronary intervention (pPCI) capability. Results: The lack of reperfusion culture with poor in-hospital organization was a common point in both public and private centers, triggering the development of the DBP. Since March-2016 to March-2018, 3041 patients with STEMI were included in 38 centers. Of these, 610 (20%) had their first medical contact (FMC) in emergency medical services. After excluding 184 (6%) patients without coronary lesions, reperfusion therapy was performed in 93% of the cases, mainly by pPCi. The total ischemic time was 117 minutes, with differences according to FMC. In-hospital mortality was 7%. Conclusions: Identification of barriers and the enhancement of in-hospital organization represent the first step to improve the care of STEMI patients. Integrated work is necessary to develop networks adapted to the local reality of each center and region.

Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram: an analysis of China Acute Myocardial Infarction (CAMI) registry.

Background:Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients.Methods:We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients’ characteristics and detailed symptomatology and compared these variables between two groups.Results:Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849–2.107).Conclusions:Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.Trial Registration:www.clinicaltrials.gov (No. NCT01874691).

More equity in Lazio region health care: results from the Regional Outcome Evaluation Program (PReValE), 2012-2017

to evaluate equity in the Lazio regional Health System, both in terms of unequal access to health care among individuals with different educational levels and of heterogeneity in hospital performance, between 2012 and 2017. retrospective cohort study. all patients living in Lazio region and discharged from a regional facility between 2012 and 2017 were enrolled. Three cohorts of hospitalizations were selected: acute myocardial infarctions with ST segment elevation (STEMI), hip fractures, and deliveries. the proportions of STEMIs with PCI within 90 minutes, of patients with a hip fracture who underwent surgery within 2 days, and of deliveries with primary caesarean section were evaluated, accounting for patient demographic characteristics and comorbidities that could affect the outcome under study. These proportions were calculated by education and by hospital of admission. The heterogeneity among facilities was assessed through the median odds ratio (MOR). in Lazio region, between 2012 and 2017, an improvement of the quality of care was observed: in 2017, 50.4% of STEMI patients underwent to a PCI within 90 minutes, 54.4% of patients with a hip fracture underwent surgery within 2 days, and 26.2% of women had a C-section. In 2012, when comparing the adjusted proportions of outcomes by educational level, the probability of being treated with a PCI within 90 minutes for STEMIs and with surgery within 2 days for hip fractures was higher for graduated patients than for those with the lowest education. In contrast, graduated women had the highest risk of having a C-section. In 2017, there was no difference anymore between classes of education in STEMIs and C-sections, while in patients with hip fracture the difference was decreased, but still present. For hip fractures, a reduction of heterogeneity of hospital performances was also detected. in Lazio region, a reduction in inequalities in access to health care was observed for different clinical areas. The "public disclosure" of the PReValE results and the management strategy applied in mid-2013 could have driven the overall improvement of the health system for the conditions under study, helping to achieve a fairer access to health.

Predictors of health related quality of life three years after myocardial infarction with ST segment elevation

Background/Aim. Health-related quality of life (HRQoL) is an important indicator of patient condition following myocardial infarction. It may serve as a predictor of mortality and new hospitalization. The aim of this study was to evaluate the association of selected sociodemographic and clinical characteristics with HRQoL in the Serbian cohort of patients with myocardial infarction with ST segment elevation (STEMI) that were treated with primary percutaneous coronary intervention (pPCI). Methods. Patients were recruited from the population of patients with STEMI who were hospitalized in the Clinical Center of Serbia in Belgrade, between 1st December, 2009 and 30th June, 2010. The study was conducted among 507 STEMI patients treated with pPCI. The HRQoL was assessed using the Questionnaire Short Form Health Survey (SF-36). Multivariate logistic regression models were used for each components score in order to determine independent predictors of HRQoL. Results. The patients with the lowest tertiles of Physical component score (PCS) and the Mental component summary score (MCS) were older, likely to be females, unpartnered, with a poor economic status, with diabetes, with prior myocardial infarction and with more extensive coronary artery disease. There were more employed and the individuals with smoking history in the group of patients with the higher scores. The characteristics of patients with lower PCS score were: the higher presence of hypertension, prior cerebrovascular insult and left anterior descending artery as infarct artery. This study demonstrated that HRQoL was significantly associated with patient?s age, gender, diabetes mellitus, a poor way of living and loneliness. Furthermore, the presence of previous cerebrovascular insult seems to affect the physical component score. Conclusion. Knowledge of predictors of HRQoL in the STEMI patients may provide indications for optimal treatment and anticipate their impact on the treatment outcome.

The acute coronary syndrome without ST segment elevation and concomitant essential hypertension clinical presentation features in men and women with Helicobacter pylori infection

The aim – to investigate the acute coronary syndrome without ST segment elevation and concomitant essential hypertension clinical presentation in men and women with Helicobacter pylori infection. Material and methods. 197 acute coronary syndrome without ST segment elevation patients (age 45–83 years) with essential arterial hypertension and dyspesia were investigated according to the current clinical protocols with total antibodies to Helicobacter pylori rate detection. The patients were divided by the groups of men and women, infected and uninfected with Helicobacter pylori. The clinical presentation of acute coronary syndromes was evaluated using the 13-item Acute coronary syndrome symptoms checklist and the dyspepsia symptoms were estimated by the Likert scale. Results. In case of Helicobacter pylori infection compared to uninfected patients a significantly higher severity of chest pain, shoulder pain and upper back pain had been revealed, while among women the chest discomfort, sweating and palpitations significantly prevailed. The intensity of dyspeptic symptoms, especially heartburn and nausea, was significantly higher among women infected with Helicobacter pylori. A significant progression of heart failure with higher prevalence of edema and liver enlargement were revealed in men infected with Helicobacter pylori versus uninfected and in men versus women regardless of Helicobacter pylori infection factor. Conclusions. The obtained link between the total antibodies to Helicobacter pylori titer and the patients’ age, male gender, myocardial infarction history, the prevalence of edema and liver enlargement might indicate a significant clinical course deterioration and heart failure progression in elderly male patients with acute coronary syndromes without ST segment elevation and essential hypertension in case of Helicobacter pylori infection.

Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI

Background and aimsWe compared the clinical impact of renin-angiotensin system inhibitors (RASI) on long-term clinical outcomes between ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) after successful percutaneous coronary intervention (PCI) with drug eluting stents (DES) because of the paucity of published data. MethodsA total of 24,960 acute myocardial infarction (AMI) patients who underwent PCI with DES and were prescribed the RASI were enrolled and divided into two groups, the STEMI group (n = 14,061) and the NSTEMI group (n = 10,899). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, cardiac death (CD), recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2 years. ResultsAfter propensity score-matched (PSM) analysis, two PSM groups (6762 pairs, n = 13,524, C-statistic = 0.682) were generated. All-cause death (hazard ratio [HR], 1.386; 95% confidence interval [CI], 1.114–1.725; p = 0.003) and CD (HR, 1.358; 95% CI, 1.041–1.770; p = 0.024) rates were significantly higher in NSTEMI patients. However, the incidence of MACE, re-MI, total revascularization, TLR, TVR, non-TVR was not significantly different between the two groups. In addition, old age (≥65years), decreased left ventricular ejection fraction (<50%), hypertension, creatine kinase isoenzyme level, cardiogenic shock, cardiopulmonary resuscitation on admission, and PCI within 24 h were common significant independent risk factors of all-cause death and CD. ConclusionsThe mortality reduction capability of RASI was more prominent in the STEMI patients compared with the NSTEMI patients.

Safety of early discharge in low risk patients after acute ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Open label, randomized trial.

The length of hospital stay in patients with acute myocardial infarction and ST-segment elevation (STEMI) has been shortened in recent years with corresponding savings in costs, but there is limited available data on its implementation in clinical practice. The aim of this trial was to determine whether early discharge in selected patients after STEMI is feasible and safe. 151 patients with STEMI successfully treated with primary percutaneous coronary intervention (PCI) who fulfilled the inclusion criteria of low risk were randomly assigned to two groups on a 1:1 ratio: early (within 48-72 h of admission) and standard (after 72 h) discharge. The primary end point was the composite of death, myocardial infarction (MI), unstable angina, stroke, unplanned rehospitalization, repeated target vessel revascularization and stent thrombosis at 90 days after discharge. The study is registered with ClinicalTrials.gov (identifier NCT02023983). The primary end point occurred in 5 patients in the early group and 6 in the standard group (6.6% vs. 8.0%, P=0.765). There were no significant differences in the incidence of individual components of the primary end point at 90 days. The length of hospital stay was significantly shorter in the intervention group (60.8 ± 8.5 vs. 92.1 ± 12.1 h, P<0.0001). This study confirms that early discharge within 48-72 h in selected low risk patients after STEMI treated with successful primary PCI is feasible and safe, with outcomes comparable to the later discharge. This strategy applies to more than a quarter of all STEMI patients.

PP.09.27] DYNAMICS OF PARAMETERS OF CENTRAL PRESSURE DURING THE THERAPY WITH DIFFERENT DOSES OF ATORVASTATIN IN PATIENTS WITH STEMI

Objective: to study the effect of different doses of atorvastatin on the parameters of the central pressure in patients with acute myocardial infarction with ST segment elevation (STEMI). Design and method: The study included 85 STEMI patients aged 35 to 65 years in the first 24–96 hours of the onset of the disease. The control group (C) included 46 patients treated with atorvastatin 20 mg/day. Main group (A) consisted of 39 patients treated with atorvastatin 80 mg/day. Initially 7–9 hours from the onset of the disease, and after 24 weeks, patients underwent applanation tonometry by SphygmoCor (AtCorMedical, Australia). The following parameters were analyzed: aortic systolic (SBPao), diastolic (DBPao) and pulse pressure (PPao). Ultrasound of the common carotid artery (CCA) was performed using the high-frequency RF signal on the MyLab 90 (Esaote, Italy) on the following indicators: local systolic (LocPsys) and local diastolic (locPdia) pressure in the CCA. Results: In the group C office SBP initially was 113,1 ± 0,4, DBP - 70 (65;75) mmHg; at week 24 -115 (110;125) (p = 0,06), and 70 (70;80) mmHg (p = 0,2). SBPao increased from 101 ± 9,4 to 109,1 ± 12,0 mmHg (p < 0,01), PPao from 29,4 ± 6,2 to 34,2 ± 8,1 mmHg (p < 0,01). DBPao has not changed: initially - 71 (66;80); follow-up - 71,5 (71; 81) mmHg (p = 0,07). In group A office BP at baseline was 116,4 ± 9,5 and 75 (65;80) mmHg; 24 weeks later - 117,8 ± 10,1 (p = 0,3) and 75 (70;80) mmHg (p = 0,6). Aortic pressure parameters increased: SBPao from 103,9 ± 9,8 to 109,3 ± 9,9 mmHg (p < 0,01), PPao from 27,0 (24;31) to 32,9 ± 7,5 mmHg (p < 0,01). DBPao has not changed: baseline - 76 (66;86); at follow-up - 76,4 ± 9,4 mmHg (p = 0,7). In control group at baseline: LocPsys 103,4 (93,6;114,1); locPdia 70 (60;75) mmHg; at follow-up - 108,8 (101,7;119,5), and 70 (70;80) mmHg, respectively (p < 0,01). In group A at 7–9 day - LocPsys was 107,7 (100,9;115); locPdia - 75 (65;80) mmHg; after 24 weeks no significant dynamics has been identified: 105,7 (99,9;115,7) (p = 0,8), and 70 (70;80) mmHg (p = 0,9). Conclusions: An increase of SBPao and PPao was registered in both groups. In control group an increase in the pressure parameters in the OCA has been shown.

Characteristics, in-hospital management and outcome of late acute ST-elevation myocardial infarction presenters.

Patients with delayed presentation of acute myocardial infarction with ST-segment elevation (STEMI) frequently have a poor prognosis but literature about acute complications in intensive cardiac care unit (ICCU) and in-hospital outcome are still limited. All STEMI patients admitted to our institution between June 2007 and December 2013 were divided into patients presenting more than 12 h after symptom onset (lateSTEMI) and within 12 h (STEMI). Baselines clinical features including details about treatment of choice were collected. Major acute complications in ICCU and in-hospital mortality were the main end-points. A total of 1372 patients were included, 147 (10.8%) were lateSTEMI. In ICCU lateSTEMI patients compared with STEMI patients experienced more frequently heart failure (75, 51.2% vs. 298, 24.3%; P < 0.001), atrial fibrillation (26, 17.7% vs. 130, 10.6%; P = 0.011), complete atrioventricular block (16, 10.9% vs. 63, 5.1%; P = 0.005), stroke (5, 3.4% vs. 5, 0.4%; P < 0.001), myocardial rupture (6, 4.1% vs. 3, 0.2%; P < 0.001), with higher administration of noninvasive ventilation support therapy (13, 9.8% vs. 44, 3.6%; P = 0.001) and the intra-aortic balloon counter-pulsation use (14, 10.3% vs. 102, 8.3%; P = 0.038). Intrahospital mortality was significantly higher in the lateSTEMI group (19, 13.4% vs. 69, 5.6%; P = 0.001). At the multiple regression analysis age [odds ratio (OR) 2.2 (1.46-2.92.; P = 0.01)], diabetes [OR 2.37 (1.38-4.07); P = 0.002] intra-aortic balloon counter-pulsation implantation [OR 2.78 (1.30-5.9); P = 0.03] and late presentation more than 12 h [2.52 (1.35-4.69); P = 0.001] resulted independently correlated with in-hospital mortality while a successful percutaneous coronary intervention procedure was protective [OR 0.15 (0.08-0.27); P = 0.003; all 95% confidence interval). Late presenters STEMI patients present a worse risk profile and prognosis compared with patients who arrive less than 12 h from onset of symptoms. Because of the presence of serious complications such as heart rupture or stroke a careful clinic and echocardiographic monitoring is strongly advisable in these population.

Distributed coordination of emergency medical service for angioplasty patients

In this paper we study the coordination of Emergency Medical Service (EMS) for patients with acute myocardial infarction with ST-segment elevation (STEMI). This is a health problem with high associated mortality. A "golden standard" treatment for STEMI is angioplasty, which requires a catheterization lab and a highly qualified cardiology team. It should be performed as soon as possible since the delay to treatment worsens the patient's prognosis. The decrease of the delay is achieved by coordination of EMS, which is especially important in the case of multiple simultaneous patients. Nowadays, this process is based on the First-Come-First-Served (FCFS) principle and it heavily depends on human control and phone communication with high proneness to human error and delays. The objective is, therefore, to automate the EMS coordination while minimizing the time from symptom onset to reperfusion and thus to lower the mortality and morbidity resulting from this disease. In this paper, we present a multi-agent decision-support system for the distributed coordination of EMS focusing on urgent out-of-hospital STEMI patients awaiting angioplasty. The system is also applicable to emergency patients of any pathology needing pre-hospital acute medical care and urgent hospital treatment. The assignment of patients to ambulances and angioplasty-enabled hospitals with cardiology teams is performed via a three-level optimization model. At each level, we find a globally efficient solution by a modification of the distributed relaxation method for the assignment problem called the auction algorithm. The efficiency of the proposed model is demonstrated by simulation experiments.

TCTAP A-021 Prognostic Significance of Invasive Strategy Timing in Acute Coronary Syndrome Without ST Segment Elevation Patients According to Renal Failure Status

TCTAP A-021 Prognostic Significance of Invasive Strategy Timing in Acute Coronary Syndrome Without ST Segment Elevation Patients According to Renal Failure Status

Oxidative Profile of Patients with ST Segment Elevation Myocardial Infarction.

Patients with ST-segment elevation (STEMI) have totally occluded vessels, while patients with non-ST-segment elevation (NSTEMI) present partial vessel occlusion, which may generate different levels of Reactive Oxygen Species (ROS). Objectives: The aim of this study was to compare the oxidative profile in AMI patients with ST segment elevation and non-STEMI as well as control subjects. This study was carried with 46 AMI patients divided into STEMI and NSTEMI. The control group consisted of 40 healthy subjects. Oxidative stress profile was evaluated analyzing carbonyl protein (PCO), lipid peroxidation (TBARS), ischemia-modified albumin (IMA), vitamin C (VIT C), superoxide dismutase (SOD) and catalase (CAT). Serum PCO (p < 0.001), plasma TBARS (p < 0.01), serum IMA (p < 0.0001) levels, erythrocytes CAT (p < 0.001), and SOD activities (p < 0.05) were significantly higher in STEMI patients when compared with the control group (p < 0.001). No difference in the IMA levels and oxidative stress parameters was observed between conditions of AMI. Only plasma VIT C in STEMI patients was significantly lower when compared with NSTEMI patients and control group (p < 0.001). Results suggest that the oxidative profile generated by STEMI and NSTEMI is similar regardless of the size of arterial occlusion generated by thrombus.

Features of the in-hospital course of myocardial infarction in patients with glucose metabolism disorders

Aim. To study the clinical course of acute myocardial infarction (MI) with ST segment elevation (STEMI) and the features of inpatient treatment in patients with and without diabetes mellitus (DM). Material and methods. STEMI patients (n=83), who were hospitalized in 2014, were included into the study. The patients were divided into two groups according to the presence or absence of glucose metabolism disorders: Group 1 (patients with type 2 DM; n=38) and Group 2 (patients without glucose metabolism disorders; n=45). Baseline demographic, clinical, laboratory and instrumental characteristics of the patients, along with the features of hospital treatment, were studied. Results. In group 1 compared with group 2 hypertension was detected significantly more frequently (73.7% vs 49%; p<0.05), and a class of acute heart failure (Killip) at admission was higher (1.46±0.6 vs 1.23±0.57; p<0.05). STEMI was complicated by an acute left ventricular aneurysm 12% more often in patients of group 1 (p<0.05). The duration of inpatient treatment was also higher in patients of group 1 (18±4.1 vs 16±3.6 days; p<0.05). Conclusion. Only 21% of the patients with DM and STEMI had adequate treatment of ischemic heart disease and a quarter of the patients in this group had no adequate DM therapy before the admission. Patients with DM had a higher incidence of in-hospital STEMI complications and a higher duration of inpatient treatment.

Implementacija inicijative 'Stent for life' i četvorogodišnji rad angiosale Opšte bolnice Užice

Introduction: Coronary artery disease is the most common cause of death worldwide. Initiative 'Stent for Life' (SFL) was launched in 2009 with the objectives to: increase the treatment of patients with myocardial infarction with ST segment elevation (STEMI) undergoing primary percutaneous coronary intervention (PPCI) to more than 70%, raise the rate of PPCI to more than 600 procedures per million people a year, organize a network of catheterization laboratories which will be non-stop available. Catheterization laboratory in General Hospital (GH) Užice was opened 12.12.2011. Methods: This publication included all patients from our catheterization laboratory in the period from 12.12.2011. to 01.08.2015. taking special notice on patients with diagnosis of STEMI. This was done with objective to observe implementation of SFL initiative in our everyday practice. Results: During the following period 3547 procedures were performed, of which 2270 diagnostic coronary angiography, 595 PPCI, 665 elective PCI. The number of procedures is growing by 5% a year. There were 1029 patients with diagnosis of myocardial infarction, of which 805 was STEMI and 224 NSTEMI. 732 (90.94%) patients with STEMI were treated with reperfusion therapy (mechanical or pharmacological), of which 595 (73.9%) undergoing PPCI. Overall mortality in patients with STEMI is 5.83%. Coronary angiography was performed within the same hospitalization for patients with NSTEMI in 89% of cases. Conclusion: The opening catheterization laboratory in GH Užice has achieved first of the three goals of the SFL initiative in the form of raising the percentage of patients with STEMI who were treated with PPCI to more than 70%. The remaining two objectives will be obtained by achieving non-stop availability of PPCI. All secondary objectives in terms of increasing the number of interventions, establishing cooperation with surrounding municipalities, education in prehospital treatment of STEMI patients, were achieved.

Acute myocardial infarction complicated by shock: outcome analysis based on initial electrocardiogram

Objectives. To assess the relation between initial ECG findings, presence of risk factors, coronary angiography findings, and clinical outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS). Design. Data from a total of 5572 acute myocardial infarction patients admitted to the four tertiary hospitals during a period of 3 years were analyzed. CS on admission was present in 358 patients (6.4%). They were divided into four groups based on the admission ECG: ST-segment elevation (STEMI), ST-segment depression (STDMI), bundle branch block (BBBMI), and other ECG acute myocardial infarction. Results. CS developed most frequently among BBBMI patients (in 12.1% of all BBBMIs, p < 0.001 vs. STEMI), followed by STEMI (6.7%), STDMI (4.4%), and other ECG acute myocardial infarction (2.3%). The risk of CS development was similar in patients with left bundle branch block (LBBB) (13.3%) and right bundle branch block (RBBB) (11.2%). The one-year mortality was highest among RBBBMI patients (66.7%, p < 0.001), followed by LBBBMI (48.6%), other ECG (47.1%), STEMI (41.7%), and STDMI patients (38.1%). Conclusions. RBBB on admission ECG is associated with the highest risk of CS development, frequent left main coronary artery affection, and unsuccessful revascularization. It is also an independent predictor of one-year mortality.

Role of plasminogen activator inhibitor and free fatty acids in diagnosis of insulin resistance in patients with myocardial infarction

Purpose: To access the insulin resistance markers dynamics in ST-segment elevation patients with MI with presented and non-presented T2DM in acute and post-acute rehabilitation periods. Methods: 95 patients with myocardial infarction and 60 patients with MI and associated T2DM were included in the study; the control group consisted of 30 healthy subjects. The concentration of serum FFA, glucose, C-peptide and insulin were measured on the 1st and 12th days of the study. MI was diagnosed according to the 2007 National Scientific Cardiology Society. The study design was approved by the Institutional Review Board. The insulin resistance level was estimated using a mathematical model incorporating fasting serum insulin and glucose measurement with the QUICKI calculation. The results were statistically processed using non-parametric criteria; differences were considered to be statistically significant in p < 0.05. Results: Blood glucose level increased in the Group 1 and on the 1st day after MI onset. An elevation of glucose level was noticed in the Group 2 during the whole follow-up period, whereas in the Group 1 blood glucose level decreased on the 12th day. Postprandial glucose level increased in the Group 2 in comparison with the control values on the 12th day from the MI onset. In contrast, fasting serum insulin and C-peptide level tended to increase in both groups on the 1st and 12th days from the MI onset. Postprandial insulin level raised equally in both groups compared to the control group. In the Group 1, the QUICKI indices were 0,316±0.005 and 0,319±0.005 on the 1st and 12th days after the MI onset, respectively, and they were interpreted as breakpoint values between severe and moderate IR. In the Group 2, the QUICKI indices were 0,296±0.009 and 0,300±0.005, that verified a pronounced tissue insulin resistance. FFA levels in the Group 1 and in the Group 2 exceeded the control group values. PAI-1 concentration was higher in the Group 1 and higher in the Group 2 compared to the control group on the 1st day. In addition, PAI-1 concentration significantly reduced in both groups on the 12th day. Postprandial insulin positively correlated to FFA levels (R=0,47, p=0.02) and QUICKI index negatively correlated to FFA levels (R=-0,229, p=0,006). Moreover, a negative correlation between PAI-1 concentration and QUICKI index was reported in Group 2 and in Group 1 (R= -0,77, p=0,005; R= -0,47, p=0,005, respectively). Conclusion: Elevated FFA and PAI-1 levels are significant indicators of impaired insulin sensitivity under the conditions of acute MI compared to the postprandial glycemia and insulinemia.

Comprehensive meta-analysis of radial vs femoral approach in primary angioplasty for STEMI

Primary angioplasty has improved survival as compared to thrormbolysis. However, bleeding complications still represent the Achille's heel, mainly related to access site. Although the radial approach is getting larger consensus for elective percutaneous procedures, its safety and advantages in the setting of ST-segment elevation (STEMI) is controversial. Therefore, the aim of the current study was to perform a comprehensive meta-analysis of randomized and non randomized trials comparing radial vs transfemoral approach in primary angioplasty for STEMI. The literature was scanned by formal searches of electronic databases (MEDLINE, Pubmed) from January 1990 to October 2012. No language restrictions were enforced. A total of 27 trials were finally included, with 29,194 patients (4685 enrolled in 11 randomized trials and 24,509 in 15 non randomized trials). A total of 10,052 patients underwent radial approach and 19,142 patients underwent femoral approach. A total of 2499 patients (8.6%) had died at follow-up. Radial approach was associated with a significant reduction in short-term mortality (5.2% vs 10.3%, OR [95% CI]=0.55 [0.40, 0.76], p<0.001, p het=0.97) (primary endpoint). Significant benefits were observed in both randomized (2.7% vs 4.7%, OR [95% CI]=0.55 [0.40, 0.76], p<0.001, p het=0.97) and observational studies (5.9% vs 11.1%, OR [95% CI]=0.48 [0.43, 0.54, p<0.001, p het=0.44]). Major bleeding complications were observed in a total of 808 patients (2.8%). Radial approach was associated with a significant reduction in major bleeding complications as compared to femoral approach (1.9% vs 4.7%, OR [95% CI]=0.38 [0.31, 0.47], p<0.0001, p het=0.17), similarly in both randomized (2.7% vs 5%, OR [95% CI]=0.51 [0.37, 0.70], p<0.001, p het=0.87) and observational studies (1.4% vs 4.6%, OR [95% CI]=0.32 [0.25, 0.42], p<0.0001, p het=0.32). Both benefits in death and major bleeding complications were not related to baseline risk profile. This meta-analysis of randomized and non-randomized trials showed that among STEMI patients undergoing primary angioplasty the radial approach is associated with a consistent reduction in mortality and major bleeding complications and. Therefore, routine use of radial approach should be strongly encouraged in primary angioplasty.

001: Temporal trends in pre-hospital management of ST segment elevation myocardial infarction from 2002 to 2010: Data from the RICO Survey (Observatoire des Infarctus de Cote d’Or)

Myocardial infarction with ST segment elevation (STEMI) is a medical emergency requiring specific management aiming to achieve reperfusion as early as possible. We aimed to evaluate the temporal trends between 2002 and 2010 in STEMI management and time delays in an eastern region of France (Cote d’Or). All consecutive patients admitted for a first STEMI in the RICO survey (Observatoire des Infarctus de Côte d’Or) from 1st January 2002 to 31st december 2010 have been included. We analysed trends in pre-hospital and hospital management times and reperfusion. 4114 STEMI patients were included over the study period. Mean age and GRACE risk score increased from 2002 to 2010 (64 to 67 y, p=0,001 and 152 to 155 p=0,049). At symptom onset, there was an increase in the rate of patients who called the emergency number (dial 15) and a decrease in the rate of call to GP as first medical contact (from 24.8 to 39.4% and from 57.1 to 34.2%, respectively). However, prehospital times including patient time (from onset of symptoms to call for medical seeking) remained stable over time. There was a significant difference in time to first medical contact according to age, with patients aged under 50 years getting help on average 40 to 100 minutes earlier than patients aged over 50 years. (p=0.019). The average time from first medical contact to reperfusion decreased significantly from 339 minutes in 2002 to 239 minutes in 2010 (p=0.009). Over the study period, there was an inversion in the distribution of reperfusion strategies, with a decrease in fibrinolysis and an increase in primary PCI (from 35% to 27% and from 23.1 to 36.7%, respectively). The rate of patients without acute reperfusion dropped from 41,9 to 36,3% (p<0,001). We found a marked improvement in time to reperfusion including fibrinolysis and door to balloon time (from 150 to 120 min and from 70 to 45 min, respectively). Between 2002 and 2010, despite marked improvements in management including reperfusion strategies, there is still a room for improvement in order to achieve earlier reperfusion in STEMI patients.

Circulating Cell and Plasma microRNA Profiles Differ between Non-STSegment and ST-Segment-Elevation Myocardial Infarction

BackgroundDifferences in plasma and whole blood expression microRNAs (miRNAs) in patients with an acute coronary syndrome (ACS) have been determined in both in vitro and in vivo studies. Although most circulating miRNAs are located in the cellular components of whole blood, little is known about the miRNA profiles of whole blood subcomponents, including plasma, platelets and leukocytes in patients with myocardial ischemia.MethodsThirteen patients with a ST-segment-elevation (STEMI) or non-ST-segment elevation (NSTEMI) myocardial infarction were identified in the University of Massachusetts Medical Center Emergency Department (ED) or cardiac catheterization laboratory between February and June of 2012. Whole blood was obtained from arterial blood samples at the time of cardiac catheterization and cell-specific miRNA profiling was performed. Expression of 343 miRNAs was quantified from whole blood, plasma, platelets, and peripheral blood mononuclear cells using a high-throughput, quantitative Real-Time polymerase-chain reaction system (qRT-PCR).ResultsMiRNAs associated with STEMI as compared to NSTEMI patients included miR-25-3p, miR-221-3p, and miR-374b-5p. MiRNA 30d-5p was associated with plasma, platelets, and leukocytes in both STEMI and NSTEMI patients; miRNAs 221-3p and 483-5p were correlated with plasma and platelets only in NSTEMI patients.ConclusionsCell-specific miRNA profiles differed between patients with STEMI and NSTEMI. The miRNA distribution is also unique amongst plasma, platelets, and leukocytes in patients with ischemic heart disease or ACS. Our findings suggest unique miRNA profiles among the circulating subcomponents in patients presenting with myocardial ischemia.

SYNTAX scale estimates of coronary stenosis severity and outcomes of various revascularisation strategies in patients with ST segment elevation myocardial infarction and multi-vessel coronary pathology

Aim. To assess 30-day and long-term outcomes of various revascularisation strategies in patients with myocardial infarction and ST segment elevation (STEMI) and multi-vessel coronary pathology (MVCP), in regard to the severity of coronary stenosis, as assessed by the SYNTAX scale. Material and methods. The 30-day and long-term outcomes of various strategies of primary percutaneous coronary intervention (PCI) were assessed in 227 STEMI patients, in regard to the severity of their coronary stenosis (as assessed by the SYNTAX scale). Group 1 included 40 patients who underwent multi-vessel stenting (MVS) as a part of their primary PCI, while Group 2 included 187 patients with indications for staged revascularisation (SR). Results. At baseline, the MVS and SR subgroups with severe coronary stenosis (SYNTAX score