STEMI Patients Research Articles

Benefits of recombinant human brain natriuretic peptide to improve ventricular function and hemodynamics in patients with ST-elevation myocardial infarction.

Abstract. This study aimed to assess the impact of recombinant human brain natriuretic peptide (rh-BNP) on ventricular function and hemodynamics in post-ST-segment elevation myocardial infarction (STEMI). We compared the outcomes of 65 STEMI patients treated with rh-BNP to an equal cohort given tirofiban following percutaneous coronary intervention (PCI). Data collected pre- and post-intervention included biochemical markers, TIMI (Thrombolysis In Myocardial Infarction) grade, hemodynamics, thrombotic score (TS), left ven-tricular ejection fraction (LVEF), high-sensitivity C-reactive protein (CRP) levels, liver and kidney function, and ECG. The TIMI level (p=0.03), the ratio of TIMI myocardial perfusion grade III (p=0.04), and the thrombus score (p<0.001) in the rh-BNP group after the intervention markedly exceeded those in the tirofiban group. After correction, the TIMI frame count (CTFC) (p=0.02), the incidence of slow flow (p=0.02), thrombus score (p<0.001), stent length (p=0.02) as well as times of administration of sodium nitroprusside medication in the rh-BNP group were markedly below those in the tirofiban group (p=0.01). Creatine ki-nase (CK) (p<0.001), CK-MB (p=0.01), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) (p<0.02) in the rh-BNP group were markedly below those the in tirofiban group 24 hours after intervention; and the sum-STR (p<0.03) immediately after intervention markedly exceeded that in the tirofiban group. No significant differences were found in major cardiac adverse events (MACE) between the treatments. At the 30-day follow-up, rh-BNP showed a more effective enhancement of blood flow status, with the safety profiles of both treatments be-ing comparable. The findings suggest that the rh-BNP has significant potential for treating PPCI-related slow flow.

Circulating large extracellular vesicles from STEMI patients contribute to cardiovascular damage

Circulating large extracellular vesicles from STEMI patients contribute to cardiovascular damage

Shock Index and Modified Shock Index Are Predictors of Long-Term Mortality in STEMI and NSTEMI Patients

Background: Acute coronary syndromes (ACS), including STEMI and NSTEMI, are leading causes of mortality worldwide. The Shock Index (SI) and Modified Shock Index (MSI) are non-invasive markers traditionally used to assess hemodynamic status but their role in predicting long-term mortality in ACS patients is less understood. Objective: To evaluate the prognostic value of SI and MSI in predicting long-term mortality among patients with STEMI and NSTEMI. Methods: A prospective cohort study was conducted on 275 consecutive patients diagnosed with STEMI and NSTEMI at the Department of Cardiology, PIMS, Islamabad, between March 1, 2024, and July 31, 2024. Patients were divided into two groups: Group 1 (n=138) assessed using SI and Group 2 (n=137) using MSI. Follow-up for three years was conducted to record all-cause mortality. Data were analyzed using SPSS version 25.0, with Cox proportional hazards regression and Kaplan-Meier survival analysis employed to assess mortality risk. Results: During the three-year follow-up, mortality rates were 24.6% in the SI group and 26.3% in the MSI group. Higher SI and MSI values were significantly associated with increased mortality (SI HR=1.85, 95% CI: 1.35-2.54, p<0.001; MSI HR=2.10, 95% CI: 1.50-2.93, p<0.001). Conclusion: SI and MSI are significant predictors of long-term mortality in STEMI and NSTEMI patients and should be integrated into routine clinical assessments for better risk stratification.

The effect and safety of acupuncture as adjunctive therapy for STEMI patients after PCI: study protocol of a randomized controlled trial

BackgroundST-elevation myocardial infarction (STEMI) is a common acute ischemia heart disease that causes serious damage to human health worldwide. Even though morbidity and mortality have significantly decreased by percutaneous coronary intervention (PCI), an additional cardiac protection strategy is still required. Acupuncture therapy has presented a dominant cardiac protection in many studies lately. Thus, we aim to evaluate the effect and safety of acupuncture as an adjunctive therapy in STEMI patients after PCI through a randomized controlled trial.Methods/DesignThis study describes a protocol of multicenter, double-blinded, parallel-controlled, randomized controlled trial. Ninety-six patients with STEMI aged 18–85 years who undergoing PCI will be recruited from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, The Affiliated Third Hospital of Chengdu Traditional Chinese Medicine University/Chengdu Pidu District Hospital of Traditional Chinese Medicine, and Zhaotong Municipal Hospital of Traditional Chinese Medicine. Participants will be randomly assigned (1:1 ratio) to the verum acupuncture plus basic therapy (i.e., treatment) group or the sham acupuncture plus basic therapy (i.e., control) group. These participants will be treated for 5 days and then will be followed up for 24 weeks. Any adverse events will be recorded throughout the study to evaluate safety.DiscussionThe present study aims to investigate the effect and safety of acupuncture for patients with STEMI after PCI and set up standardized treatment programs for acupuncture of these patients.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400081117]), on February 22, 2024.

A mobile application for STEMI care optimization: Pilot implementation project report

BackgroundClinical outcomes of patients presenting with STEMI are significantly improved by reducing time from vessel occlusion to coronary blood flow restoration. In an effort to improve outcomes, we developed a secure mobile application, STEMIcathAID, and designed a pilot project implementing the app into the workflow for STEMI patients transfer. The aim of the study is to assess the impact of the app on key metrics for STEMI transfer before (historic) and after app launch. MethodsThe pilot project included physicians, nurses and technicians from the Emergency Medicine and Nursing Departments at the referring center, the catheterization laboratory and transfer center. From July 2021 to February 2023, the referring center activated STEMIcathAID alarms in parallel with the previously established STEMI activation with traditional phone call to transfer center. ResultsOne hundred eleven suspected STEMI calls were activated through the app with 66 accepted and 45 rejected cases; thirty-one STEMI cases with available device time were compared with 42 STEMIs activated through the traditional pathway before the app implementation. Median door-to-device time for STEMIcathAID-assisted transfer decreased from 106 to 86 min (p < 0.001). The significant improvement, 20 min (19%), of the key metric for interhospital transfer resulted in all STEMI cases meeting the AHA goal of door-to-device time ≤ 120 min. In addition, median door-in-door-out time at the referral hospital decreased from 56 to 50 min (p = 0.01). ConclusionsImplementation of a mobile app into STEMI workflow of a large urban healthcare system significantly improved the quality of care for transfer of STEMI patients. Trial registrationAHA Get With The Guidelines-Coronary Artery Disease® (GWTG-CAD) registry is a national quality improvement program and is not subject to the institutional review board approval.

Association of admission blood glucose and in- hospital outcome after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Background: The effects of glucose abnormalities on in-hospital outcome after Primary Percutaneous Coronary Intervention (PCI) in acute STEMI remain unclear. The study assessed the relationship of admission blood glucose level to in-hospital outcome in patients presenting with a STEMI and treated with Primary PCI. Methods: This prospective study was conducted in the department of cardiology, NICVD, Dhaka Bangladesh from May 2018 to April 2019.Total 80 patients with admission normal blood glucose and hyperglycemia with acute STEMI underwent Primary PCI were considered for the study. Results: Mean age of the studied patient was 44.0±9.1 years ranging from 30 to 61 years and the mean age of the group II patients was 48.0±7.8 years ranging from 37 to 61 years. Itwas found that acute heart failure occurred 10% in group II and 2.5% in group I patients with statistically significant (p=0.04) difference. Cardiogenic shock observed 2.5% patients in group II and 2.5% patients in group I with statistically no significant (p=0.56) difference. Significant arrhythmias were found 5% patients in group II and 2.5% in group I patients with statistically no significant (p=0.40) difference. No MI and CVA were occurred in both group of patients. In group II, 2.5% patients died and no patients died in group I with statistically no significant (p=0.31) difference. Conclusion: Admission hyperglycemia is a predictor of poor prognosis in STEMI patients undergoing primary PCI. Cardiovasc j 2024; 16(2): 70-77

Cardiac (tele)rehabilitation in routine clinical practice for patients with coronary artery disease: protocol of the REHAB + trial.

Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period. The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072. The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.

Myocardial strain combined with clinical risk factors in the prediction of in-hospital heart failure among patients with ST-segment elevation myocardial infarction

To investigate the predictive value of myocardial strain derived from cardiac magnetic resonance (CMR) combined with clinical indicators for in-hospital heart failure (HF) in STEMI patients. In all, 139 STEMI patients were included, with 28 in the heart failure group and 111 in the non-HF group, and clinical and laboratory data were collected. Left ventricular (LV) global radial strain (GRS), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), stroke volume (SV), and infarct size (IS) were assessed by CMR. The HF group had worse GRS, GLS, GCS, LVEF, SV, larger IS, longer symptom to balloon time (SBT) and higher levels of high-sensitivity C-reactive protein (hs-CRP) and neutrophil percentage (N%) than the non-HF group (P<0.05). There was a strong correlation between GRS and LVEF (r=0.741, P<0.001). After adjustment for CMR and clinical risk factors, GRS<15.6%, LVEF<37.7%, SBT>350 min, hs-CRP>11.45 mg/L, and N%>74% were independently associated with HF. Clinical model (SBT>350 min+hs-CRP>11.45 mg/L+N%>74%) were associated with a lower diagnostic accuracy for predicting in-hospital HF than GRS+clinical co-model and LVEF+clinical co-model (P<0.05), respectively. There was no significant difference in the area under the curve (AUC) between GRS+clinical co-model and LVEF+clinical co-model (P=0.620): AUC for clinical model=0.824, AUC for GRS+clinical co-model=0.895, and AUC for LVEF+clinical co-model=0.907. GRS may be effective in predicting in-hospital heart failure after STEMI compared to LVEF, a classical cardiac function parameter, and its combination with clinical risk factors, especially SBT, hs-CRP, and N%, may provide further evidence for early prognostic assessment.

Usefulness of Prehospital 12-Lead Electrocardiography System in ST-Segment Elevation Myocardial Infarction Patients in Oita - Comparison Between Urban and Rural Areas, Weekday Daytime and Weekday Nighttime/Holidays.

We have reported that a prehospital 12-lead electrocardiography system (P-ECG) contributed to transport of suspected acute coronary syndrome (ACS) patients to appropriate institutes and in this study, we compared its usefulness between urban and rural areas, and between weekday daytime and weekday nighttime/holiday.Methods and Results: Consecutive STEMI patients who underwent successful primary percutaneous coronary intervention after using P-ECG were assigned to the P-ECG group (n=123; 29 female, 70±13 years), and comparable STEMI patients without using P-ECG were assigned to the conventional group (n=117; 33 females, mean age 70±13 years). There was no significant difference in door-to-reperfusion times between the rural and urban cases (70±32 vs. 69±29 min, P=0.73). Door-to-reperfusion times in the urban P-ECG group were shorter than those in the urban conventional group for weekday nighttime/holiday (65±21 vs. 83±32 min, P=0.0005). However, there was no significance different between groups for weekday daytime. First medical contact to reperfusion time (90±22 vs. 105±37 min, P=0.0091) in the urban P-ECG group were significantly shorter than in the urban conventional groups for weekday nighttime/holiday, but were not significantly different between the groups for weekday daytime. P-ECG is useful even in urban areas, especially for patients who develop STEMI during weekday nighttime or while on a holiday.

Prevalence and prognostic implications of the no-reflux phenomenon in patients undergoing primary percutaneous coronary intervention at a university center in a middle-income country.

To analyze the prevalence of no-reflow and the 30-day mortality in a university center in a middle-income country. We analyzed 2463 patients who underwent primary PCI from January 2006 to December 2021. The outcome measure was 30-day mortality. Of a total of 2463 patients, no-reflow phenomenon was found in 413 (16.8%) patients, 30-day mortality was 16.7 vs. 4.29% (p < 0.001). Patients with no-reflow were older 60 (53-69.5) vs. 59 (51-66) (p = 0.001), with a higher delay in onset of symptom to emergency department arrival 270 vs. 247 min (p = 0.001). No-reflow patients also had had fewer previous myocardial infarction, 11.6 vs. 18.4 (p = 0.001) and a Killip class > 1, 37 vs. 26% (p < 0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4 vs. 47.8%; p = 0.005) and initial TIMI flow 0 (76 vs. 68%; p < 0.001). No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class > 1. No-reflow was associated with a higher mortality at 30-day follow-up.

Studying the efficacy of low-dose colchicine on clinical outcomes of patients with STEMI: a randomized controlled trial

BackgroundNumerous studies have underscored the essential role of inflammation across all stages of atherosclerosis. While various anti-inflammatory interventions have been implemented to mitigate inflammation-induced injuries, outcomes have been conflicting. Given the essential role of inflammation in these patients and limited data regarding the efficacy of low-dose Colchicine as an anti-inflammatory drug, we aimed to study the efficacy of low-dose Colchicine on clinical outcomes of patients with STEMI in Iran.ResultsParticipants presented with STEMI and qualified revascularization at Shahid Beheshti Hospital in Qom during 2022 and 2023 were included into the study. This study included 172 STEMI patients (114 males and 58 females) within the mean age of 58.93 ± 7.79. Results indicate that colchicine (2 mg for loading dose and 0.5 mg daily for 30 days) and placebo group were not significant differences in identical profiles regarding age and gender. Analyses revealed no significant differences in clinical outcome after the 40-day follow-up period.ConclusionsThis study revealed that the addition of colchicine did not yield a significant benefit in enhancing the outcomes of patients with STEMI.Clinical trial registration: This study was prospectively registered on Iranian registry of clinical trials, with registration number (IRCT20231001059578N1).

Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI

Abstract Background Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients. Aim of the Work To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade. Patients and Methods a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients) Results As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 . Conclusion Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.

Efficacy and safety of colchicine use on LV systolic function using speckle – tracking Echocardiography in patients with anterior ST segment elevation myocardial infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention

Abstract Background acute ischemia causes myocardial necrosis with subsequent endogenous inflammation, leading to myocardial damage, ventricular dilatation, dysfunction, cardiac remodeling and dysfunction. Colchicine is a substance with potent anti- inflammatory properties, which allows for safe use in patients with cardiovascular disease, STE-based GLS can be used to assess global and regional LV function. The aim of this work is to study the efficacy and safety of colchicine administration on LV systolic function in patients with STEMI underwent primary PCI by using 2D speckle tracking Echocardiography. Methods The study included 200 STEMI patients divided into 2 equal subgroups; colchicine group, and control group. speckle tracking echocardiography was done to the whole subjects to asses LV systolic function. Results Assessment of LV systolic function (EF%) as calculated by Simpson’s method showed higher significant improvement in colchicine group (P-value = 0.011) and highly statically significant average GLS by speckle tracking echocardiography during follow up after 6 months, also colchicine was non inferior to placebo regarding acute and chronic complication. Conclusion the safety and efficacy of colchicine in anterior STEMI patients underwent PPCI. It significantly improve LV systolic function measured by Ejection fraction and average GLS speckle tracking Echocardiography after 6 months follow up.

Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI

Abstract Background Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients. Aim of the Work To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade. Patients and Methods a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients) Results As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 . Conclusion Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.

Prognostic Utility of Ratio of Systolic Blood Pressure to Left Ventricular End- Diastolic Pressure Post Successful Primary Percutaneous Coronary Intervention in Prediction of Major Adverse Cardiac Events in Patients with ST-segment Elevation Myocardial Infarction

Abstract Background Of all causes of Cardiovascular disease (CVD), ischemic heart disease (IHD) remains the major contributor, accounting for half of all CVD-associated morbidity and mortality. IHD as measured by the Global Burden of Disease project is driven predominantly by acute myocardial infarction (MI) and, to a lesser extent, angina. Aim of the Work To evaluate the prognostic utility of the ratio of SBP/LVEDP at the time of PPCI in prediction of MACE both in-hospital and during 3-months follow up in patients presented with STEMI with a single vessel disease. Patients and Methods This was a prospective study that was conducted on 153 patients presented with STEMI and underwent successful PPCI for a single vessel disease in Ain-Shams University Hospitals and Nasr City Health Insurance Hospital in the period from March 2019 to March 2021. Results Our results demonstrated, that SBP/LVEDP ratio can be used to predict MACE occurrence at a cutoff level of ≤ 3.9, and can be used to predict patients who are MACE-free at cutoff level of ≥ 9.2. The lower ratio of SBP/LVEDP (≤3.9) was detected at 27 patients (17.6%) from the whole study population (153 patients) with higher statistical significance difference of older age group. Different risk factors and positive family history showed no statistical significance difference with lower ratio. In this study, lower ratio showed higher statistical significant difference in anterior STEMI group, lower EF% “Simpson”, higher LVESV, DD grade II, higher WMSI, with the culprit lesion vessel when its LAD, with higher LVEDP, lower invasive SBP, and lower invasive DBP. This study found that lower ratio had a better prognostic ability with a higher AUC (0.880) when compared to the widely used GRACE and TIMI risk scores. Lower ratio ≤3.9 showed higher statistical significant difference with higher GRACE RS and higher TIMI RS when compared with higher ratio. Our ratio had a strong prognostic ability in prediction of MACE with lower ratio with higher statistical significant difference of occurrence of MACE in 26 patients (96.3%, P = 0.000) when compared with patients with the same ratio but without occurrence of MACE in 1 patient (3.7%). Conclusion Our study concluded that SBP/LVEDP is an easily rapidly determined ratio at the time of PPCI that can provide important prognostic information regarding risk stratification of STEMI patients, with a high predictive ability for occurrence of MACE at a cutoff point of ≤ 3.9, during hospital stay and short term follow up.

The Predictive Value of Estimation of N Terminal - Pro B- Type Natriuretic Peptide in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention for the Outcome of Myocardial Reperfusion

Abstract Background Primary PCI is considered to be the preferred reperfusion strategy for STEMI. The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery. Aim of the work The aim of this study was to evaluate the predictive value of NT-pro BNP before primary PCI in patients presenting with STEMI, for myocardial reperfusion assessed by the degree of ST resolution in the ECG 90 minutes post primary PCI, the TIMI flow and the MBG post primary PCI. Patients and Methods This study included 40 patients who presented to emergency departments of Ain Shams University hospitals and Misr University for Sciences and Technology hospital from September 2021 till June 2022, diagnosed with STEMI and had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. Serum samples for NT-pro BNP level were obtained before primary PCI to be correlated with the TIMI flow grade, the MBG, and the ST resolution post primary PCI. Results Our study had demonstrated that a higher baseline NT-pro BNP level is significantly associated with higher risk of poor myocardial reperfusion following primary PCI expressed by ST resolution less than 50%, TIMI flow grade less than 3 as well as MBG less than 3 and was also associated with higher incidence of No Reflow. Conclusion Initial NT-pro BNP level in STEMI patients correlates with myocardial reperfusion following primary PCI. This supports the potential use of NT-pro BNP as an early marker for risk stratification of patients with STEMI. High risk patients will be in need of more aggressive complementary treatment strategies to improve microvascular perfusion and optimization of the medical therapies to help decrease the development of heart failure.

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction.

CaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients. One hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non-CMD groups according to the caIMR value. The baseline information, patient-related examinations, and the occurrence of MACE at the 12-month follow-up were collected to investigate risk factors in patients with STEMI. We divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non-CMD. A total of 21 MACE occurred during the 1 year of follow-up. Compared with non-CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non-culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50). CaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.

Cluster analysis of clinical, angiographic, and laboratory parameters in patients with ST-segment elevation myocardial infarction

IntroductionST-segment elevation myocardial infarction (STEMI) represents the most harmful clinical manifestation of coronary artery disease. Risk assessment plays a beneficial role in determining both the treatment approach and the appropriate time for discharge. Hierarchical agglomerative clustering (HAC), a machine learning algorithm, is an innovative approach employed for the categorization of patients with comparable clinical and laboratory features. The aim of the present study was to investigate the role of HAC in categorizing STEMI patients and to compare the results of these patients.MethodsA total of 3205 patients who were diagnosed with STEMI at the university hospital emergency clinic between 2015 and 2023 were included in the study. The patients were divided into 2 different phenotypic disease clusters using the HAC method, and their outcomes were compared.ResultsIn the present study, a total of 3205 STEMI patients were included; 2731 patients were in cluster 1, and 474 patients were in cluster 2. Mortality was observed in 147 (5.4%) patients in cluster 1 and 108 (23%) patients in cluster 2 (chi-square P value < 0.01). Survival analysis revealed that patients in cluster 2 had a significantly greater risk of death than patients in cluster 1 did (log-rank P < 0.001). After adjustment for age and sex in the Cox proportional hazards model, cluster 2 exhibited a notably greater risk of death than did cluster 1 (HR = 3.51, 95% CI = 2.71–4.54; P < 0.001).ConclusionOur study showed that the HAC method may be a potential tool for predicting one-month mortality in STEMI patients.

Clinical characteristics and predictors of in-hospital mortality of patients hospitalized with myocardial infarction before and during COVID-19 pandemic.

The COVID-19 pandemic has impacted many acute coronary syndrome (ACS) care aspects. The aim was to compare the patient profile, ACS characteristics, and the outcomes in patients referred to the invasive cardiology department before (March 2019 - February 2020) and during the COVID-19 pandemic (March 2020 - February 2021). Clinical and demographic features, comorbidities, laboratory parameters at admission, and periprocedural data were recorded. The relationship of these parameters with in-hospital mortality was assessed. Before the COVID-19 pandemic, 664 patients were admitted due to ACS (mean age 67.16 ± 11.94 years, females 32.1%), and during the COVID-19 pandemic 545 ACS patients were recorded [mean age 66.02 ± 12.02 years (p = 0.463), females 31% (p = 0.706)]. A 17.8% decrease in the ACS rate was observed. During the pandemic, there were more STEMI patients (44.3% vs. 52.1%, p < 0.001) and fewer patients treated conservatively (24.9% vs. 8%, p < 0.001). Most lesions were located in the left anterior descending artery (53.4% vs. 54.7%), but post-percutaneous coronary intervention TIMI 3 was observed more frequently before the pandemic (83.9% vs. 75.1%, p < 0.001). Periprocedural complication rates did not differ between the groups. In-hospital outcomes did not differ between analyzed periods regarding all-cause death nor cardiac death rates, 5.3% vs. 4.6% (p = 0.598) and 4.5% vs. 3.7% (p = 0.473), respectively. Based on the analysis of 1209 patients, a decrease in ACS patients admitted during the pandemic was recorded, but in-hospital mortality remained similar.

Intracoronary adenosine compared with adrenaline and verapamil in the treatment of no-reflow phenomenon following primary PCI in STEMI patients

Backgroundno-reflow can complicate up to 25% of pPCI and is associated with significant morbidity and mortality. We aimed to compare the outcomes of intracoronary epinephrine and verapamil with intracoronary adenosine in the treatment of no-reflow after primary percutaneous coronary intervention (pPCI). Methods108 STEMI patients had no-reflow during pPCI were assigned into four groups. Group 1, in which epinephrine and verapamil were injected through a well-cannulated guiding catheter. Group 2, in which same drugs were injected in the distal coronary bed through a microcatheter or perfusion catheter. Group 3, in which adenosine was injected through a guiding catheter. Group 4, in which adenosine was injected in distal coronary bed. Primary end point was the achievement of TIMI III flow and MBG II or III. Secondary end point was major adverse cardiovascular and cerebrovascular events (MACCEs) during hospital stay. ResultsThe study groups did not differ in their baseline characteristics. Primary end point was achieved in 15 (27.8%) patients in the guide-delivery arm compared with 34 (63%) patients in the local-delivery arm, p < 0.01. However, the primary end point did not differ between the epinephrine/verapamil group and the adenosine group (27 (50%) vs 22 (40.7%), p = 0.334). The secondary end points were similar between the study groups. ConclusionLocal delivery of epinephrine, verapamil and adenosine in the distal coronary bed is more effective in achieving TIMI III flow with MBG II or III compared with their guide-delivery in patients who suffered no-reflow during pPCI. There was no difference between epinephrine/verapamil Vs. adenosine.