Thrombolysis In Myocardial Infarction Flow Research Articles

The comparison of procedural and clinical outcomes of thrombolytic-facilitated and primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI): Findings from PROVE/ACS study.

BACKGROUNDThere is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.METHODSIn this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.RESULTSThe mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.CONCLUSIONIf the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.

Analysis of short-term and long-term clinical outcomes in patients with acute myocardial infarction after one year of coronary stent implantation

Objective: To observe in-hospital and 1-year prognosis of patients with acute myocardial infarction after one year of coronary stent implantation. Methods: From January 2015 to February 2018, 329 patients with acute myocardial infarction (AMI) after 1 year of coronary artery stent implantation were enrolled and received coronary angiography. These patients were divided into two groups (very late stent thrombosis (VLST) group and denovo group) according to whether the occurrence of acute myocardial infarction was due to stent thrombosis (ST), and in-hospital and long-term (1 year) outcomes were compared between the two groups. The primary end points included cardiac death and recurrent acute myocardial infarction. The secondary study end points included target lesion revascularization (TLR), re-stent thrombosis, heart failure, and stroke. Results: In total, 72.9% of patients with AMI after one year of coronary stent implantation were caused by VLST. There were no significant differences of both primary and secondary end-point events between the two groups during in-hospital period (3.3% vs 3.4%, P=0.987; 5.4% vs 4.5%, P=0.956). After a mean follow-up of 1 year, there were no significant differences of the primary end-point events between the two groups. The secondary end-point events and TLR incidence were higher in the VLST group (16.3% vs 6.7%, P=0.026; 9.6% vs 2.2%, P=0.026). Kaplan and Meier survival analysis showed that there were no significant differences of the 1-year cumulative non-primary and non-secondary end-point survival rates between the two groups (P=0.124 and 0.004, respectively). COX regression analysis showed that heart function ≥Ⅲ level (Killip's) and VLST were independent predictive risk factors for end-point events, while postprocedural thrombolysis in myocardial infarction (TIMI) flow grade 3 was an independent protective factor. Conclusion: In-hospital end points show no significant differences between VLST and denovo groups patients. However, the VLST group patients have a poor prognosis and a higher proportion of TLR after 1 year follow-up. The patients with heart function ≥Ⅲ level (Killip's) or VLST have a poor prognosis, while the patients with postprocedural TIMI flow grade 3 have a good prognosis.

BMI, Infarct Size, and Clinical Outcomes Following Primary PCI: Patient-Level Analysis From 6 Randomized Trials

ObjectivesThe aim of this study was to examine the association between body mass index (BMI), infarct size (IS) and clinical outcomes. BackgroundThe association between obesity, IS, and prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction is incompletely understood. MethodsAn individual patient-data pooled analysis was performed from 6 randomized trials of patients undergoing pPCI for ST-segment elevation myocardial infarction in which IS (percentage left ventricular mass) was assessed within 1 month (median 4 days) after randomization using either cardiac magnetic resonance (5 studies) or 99mTc sestamibi single-photon emission computed tomography (1 study). Patients were classified as normal weight (BMI <25 kg/m2), overweight (25 kg/m2 ≤BMI <30 kg/m2), or obese (BMI ≥30 kg/m2). The multivariable models were adjusted for age, sex, hypertension, hyperlipidemia, current smoking, left main or left anterior descending coronary artery infarct, baseline TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 or 1, prior myocardial infarction, symptom–to–first device time, and study. ResultsAmong 2,238 patients undergoing pPCI, 644 (29%) were normal weight, 1,008 (45%) were overweight, and 586 (26%) were obese. BMI was not significantly associated with IS, microvascular obstruction, or left ventricular ejection fraction in adjusted or unadjusted analysis. BMI was also not associated with the 1-year composite risk for death or heart failure hospitalization (adjusted hazard ratio: 1.21 [95% confidence interval: 0.74 to 1.71] for overweight vs. normal [p = 0.59]; adjusted hazard ratio: 1.21 [95% confidence interval 0.74 to 1.97] for obese vs. normal [p = 0.45]) or for death or heart failure hospitalization separately. Results were consistent when BMI was modeled as a continuous variable. ConclusionsIn this individual patient-data pooled analysis of 2,238 patients undergoing pPCI for ST-segment elevation myocardial infarction, BMI was not associated with IS, microvascular obstruction, left ventricular ejection fraction, or 1-year rates of death or heart failure hospitalization.

Effect of thrombus aspiration on microcirculatory resistance and ventricular function in patients with high thrombus burden

BackgroundStudies have not demonstrated consistent outcomes following thrombus aspiration in Primary Percutaneous Coronary Intervention (PPCI). We investigated the relationship between thrombus aspiration and microvascular obstruction as measured using Index of Microcirculatory Resistance (IMR) immediately following PPCI and Left Ventricle Function Improvement measured using Global Longitudinal Strain (GLS) six months following PPCI. Our aim is to determine microvascular obstruction and left ventricle function improvement six months following thrombus aspiration during PPCI.MethodsThis was a single-center, observational, prospective non-randomized study involving 45 patients with thrombus score 4–5 (defined as high thrombus burden) and Thrombolysis in Myocardial Infarction (TIMI) flow of 0–2 who subsequently underwent PPCI. Thrombus aspiration was conducted based on physician discretion. The IMR was measured immediately following the procedure. All patients underwent echocardiography to measure GLS at 24 h, 3 months and 6 months following PPCI.ResultsThirty-three (73%) patients underwent thrombus aspiration during PPCI and twelve (27%) patients underwent the conventional PPCI. No significant difference in IMR was found between the group that underwent thrombus aspiration and the group that underwent conventional PCI (51.9 ± 41.5 vs 47.1 ± 35.6 p = 0.723). TIMI flow after PPCI was worse in thrombus aspiration group (OR 5.2 [1.2–23.2], p = 0.041). There was no difference in GLS between two groups at 6-month follow-up (− 13.0 ± 3.4 vs − 12.8 ± 4.6, p = 0.912).ConclusionThis study indicates no benefit of thrombus aspiration during PPCI in reducing either microvascular obstruction or left ventricular function at 6-month follow-up for patients with high thrombus burden. Nevertheless, further studies are required before definite conclusions can be made.

Platelet-Derived Thrombogenicity Measured by Total Thrombus-Formation Analysis System in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Prompt and potent antiplatelet effects are important aspects of management of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We evaluated the association between platelet-derived thrombogenicity during PPCI and enzymatic infarct size in STEMI patients.Methods and Results:Platelet-derived thrombogenicity was assessed in 127 STEMI patients undergoing PPCI by: (1) the area under the flow-pressure curve for the PL-chip (PL18-AUC10) using the total thrombus-formation analysis system (T-TAS); and (2) P2Y12reaction units (PRU) using the VerifyNow system. Patients were divided into 2 groups (High and Low) based on median PL18-AUC10during PPCI. PRU levels during PPCI were suboptimal in both the High and Low PL18-AUC10groups (median [interquartile range] 266 [231-311] vs. 272 [217-317], respectively; P=0.95). The percentage of final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was lower in the High PL18-AUC10group (75% vs. 90%; P=0.021), whereas corrected TIMI frame count (31.3±2.5 vs. 21.0±2.6; P=0.005) and the incidence of slow-flow/no-reflow phenomenon (31% vs. 11%, P=0.0055) were higher. The area under the curve for creatine kinase (AUCCK) was greater in the High PL18-AUC10group (95,231±7,275 IU/L h vs. 62,239±7,333 IU/L h; P=0.0018). Multivariate regression analysis identified high PL18-AUC10during PPCI (β=0.29, P=0.0006) and poor initial TIMI flow (β=0.37, P<0.0001) as independent determinants of AUCCK. T-TAS-based high platelet-derived thrombogenicity during PPCI was associated with enzymatic infarct size in patients with STEMI.

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock.

AimsUrgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90‐day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined.Methods and resultsThis CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan–Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90‐day follow‐up, 66 (42%) patients died. Patients with one‐vessel disease (n = 49) had lower mortality than patients with two‐vessel (n = 59) or three‐vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post‐PCI) was achieved more often in survivors than non‐survivors (81% vs. 60%, P = 0.019). The median symptom‐to‐balloon time was 340 (196–660) minutes, with no difference between survivors and non‐survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI95% 1.29–5.18) and TIMI flow <3 post‐PCI (HR 2.41, CI95% 1.4–4.15) were associated with 90‐day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non‐survivors (31% vs. 42%, P = 0.21).ConclusionsMultivessel disease is associated with worse survival in ACS‐related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.

Association of mean platelet volume with angiographic thrombus burden and short-term outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Given it adverse prognosis, risk stratification of patients with an acute coronary syndrome (ACS) remains a challenging issue. In this regard, different biomarkers are becoming more and more important in the diagnosis, assessment and outcome prediction. For the development of atherothrombosis, platelets have a huge part to play. Mean platelet volume (MPV), a unique measure of platelet size, is an indicator of platelet reactivity and suggests that MPV could be a biomarker of the risk and prognosis of patients with STEMI. Aim and Objectives:to test the predictive value of MPV for angiographic thrombus burden and short term outcomes in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Patients and Methods all patients presented with acute STEMI to the cardiology department of Ain Shams university hospitals, with Pain to door time less than 12 hours and underwent PPCI. MPV was measured on admission. Angiographic thrombus burden and post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Patients were followed up for 3 to 6 months. Results This study included 72 patients with STEMI who underwent PPCI. The patients’ ages ranged between 33 and 73 years old (mean age 53.22 ± 9.96years). This study included 62 males and 10 females. The MPV of the studied cases was 9.97 ± 1.31 fl. MPV was higher among patients with HTB (11.42±1.007 vs. 9.53±1.039.P 0.00) and patients with (MBG (0-1) and TIMI flow&amp;gt;3) (10.59±1.839vs. 9.81±1.092, P 0.004 and 10.49±1.191vs. 9.81±1.309, P 0.04 respectively).with short term follow up12 patients had heart failure requiring hospitalization and they had a higher MPV (10.81 ± 1.21 vs. 9.74 ± 1.3, p 0.01). In binary logistic regression analysis, the MPV was an independent predictor of TG after STEMI (odds ratio 7.278, and P value (0.000), CI (2.518-21.036)). Conclusion MPV may be a useful biomarker that can help in identification of higher-risk patients with large intracoronary thrombus burden, who might require more potent antiplatelet therapy.

Predictors of No-Reflow Phenomenon in ST-Elevation Myocardial Infarction in Patients undergoing Primary Percutaneous Coronary Intervention

Abstract Background Functional single ventricle (FSV) is a spectrum of severe congenital heart disease, with multiple anatomic variations but similar surgical treatment strategies. FSV patients are living longer into adulthood compared to two or three decades ago, and they are more frequently undergoing imaging to assist in clinical and surgical management. Objective To assess the relation between admission eGFR, HDL, Monocytes, CRP &amp; albumin levels in patients presenting with acute STEMI and angiographic no-reflow after primary PCI. Material and Methods From October 2018 to February 2019, 60 patients with STEMI who underwent primary PCI in Ain-Shams University hospitals. All patients subjected to history, clinical examination, ECG pre and post pPCI, pre-pPCI eGFR, monocytes, HDL, CRP and albumin, echocardiography. Patients were divided into two groups based on post-pPCI Thrombolysis in Myocardial Infarction (TIMI) flow grade. No reflow was defined as TIMI flow grades ≤ 2, and normal reflow was defined as TIMI 3 flow grade. All the laboratory parameters were measured on admission before pPCI. Results The study population was divided into 2 groups: reflow (n = 31) and no-reflow (NR) (n = 29) groups. CRP over albumin ration “CAR” (7.9 [4.41-16.18] vs 1.74 [1.54-2.35] (P &amp;lt;.001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. However, eGFR and Monocytes over HDL ratio “MHR” didn’t show any statistical differences between the two groups. Conclusion No-reflow can be predicted by systemic inflammation markers including monocytes, CRP, albumin and HDL. CAR has the highest positive predictive value for no-reflow.

Impact of Thrombus Aspiration one-year Cardiac Mortality During Primary PCI in STEMI Patients with total Occlusion; from Korea Acute Myocardial Infarction Registry National Institute of Health

Background: The clinical impact of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated to evaluate whether TA during primary PCI reduces one-year mortality. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI who were undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) and shown pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and November 2015 during one-year follow up. The patients were divided into two groups according to TA during primary PCI: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac events (MACE), defined as the composite of cardiovascular death (CVD), stroke or recurrent MI at one-year. The secondary efficacy end-point were all-cause of mortality and CVD at one-year. Results: PCI with TA did not reduce the risk of MACE (OR: 0.598, 95% CI: 0.737-1.160, p=0.499), all-cause mortality (OR: 0.898, 95% CI: 0.705-1.144, p=0.383) and CVD (OR: 0.893, 95% CI: 0.683-1.168, p=0.408) in all patients during one-year follow up. The trend did not change after propensity score matching. In subgroup analysis, there was no efficacy of clinical outcome during one-year follow up. Conclusions: Primary PCI with TA did not reduce MACE and all-cause mortality among patients with STEMI and pre-procedural TIMI flow 0,1 during one-year follow up.

Predictors of periprocedural complications in patients undergoing percutaneous coronary interventions within coronary artery bypass grafts.

During the first decade following the coronary bypass grafting, at least ten percent of the patients require percutaneous coronary interventions (PCI) due to graft failure. Saphenous vein grafts (SVG) are innately at a higher risk of periprocedural complications. The present study aimed to investigate predictors of periprocedural complications of PCI within coronary artery bypass grafts. This study analyzed data gathered in the Polish National Registry (ORPKI) between January 2015 and December 2016. Of the 221,195 patients undergoing PCI, data on 2,616 patients after PCI of SVG and 442 patients after internal mammary artery (IMA) were extracted. The dissimilarities in periprocedural complications between the SVG, IMA and non-IMA/SVG groups and their predictors were investigated. Patients in the SVG group were older (p < 0.001), with a higher burden of concomitant disease and differing clinical presentation. The rate of de-novo lesions was lower, while restenosis was higher at baseline in the SVG (p < 0.001). The rate of no-reflows (p < 0.001), perforations (p = 0.01) and all periprocedural complications (p < 0.01) was higher in the SVG group, while deaths were lower (p < 0.001). Among the predictors of no-reflows, it was found that acute coronary syndromes (ACS), thrombectomy and past cerebral stroke, while the complications included arterial hypertension, Thrombolysis in Myocardial Infarction (TIMI) flow before PCI and thrombectomy. Percutaneous coronary interventions of SVG is associated with increased risk of specific periprocedural complications. The ACS, slower TIMI flow before PCI and thrombectomy significantly increase the periprocedural complication rate in patients undergoing PCI of SVG.

Relationship between apical thrombus formation and blood viscosity in acute anterior myocardial infarction patients.

Aim: This study sought to investigate the predictive value of whole blood viscosity (WBV) to identify high-risk patients who will develop an apical thrombus during the acute phase of anterior transmural infarction. Materials & methods: Consecutive 1726 patients with first acute anterior myocardial infarction were evaluated. WBV was calculated according to the Simone's formula. Results: Patients with an apical thrombus had prolonged pain to balloon time, higher rate of post-PCI thrombolysis in myocardial infarction flow ≤1 and significantly higher mean WBV values at both shear rates than those without an apical thrombus. Conclusion: WBV values at both shear rates were found to be significant and independent predictors for early LV apical thrombus formation complicating a first-ever anterior wall myocardial infarction.

DoEs NTproBNP predict NO flow phenomenon IN patients undergoing coronary Angioplasty in IHD amongst Asian Indians? (DENOMINATE Study)

Context: No-flow phenomenon during percutaneous coronary intervention (PCI) is a complex and multifactorial phenomenon with often devastating complications during PCI, especially in acute coronary syndrome (ACS) settings. There is paucity of data on serological predictors of the same. Materials and Methods: This was an open-label, all-comers, observational, prospective study done on 175 patients covering the whole spectrum of coronary artery disease, undergoing PCI at the center. On admission detailed clinical history , general and systemic examination and laboratory investigations in form of hemoglobin, blood urea, serum creatinine, serum sodium, serum potassium, random blood sugar, electrocardiogram(ECG) and tropinin T were also done. Post procedure creatinine protein kinase MB (CPK MB) was done after 24 hrs, and thrombolysis in myocardial infarction (TIMI) flow was assessed during PCI in all patients by the operating interventional cardiologist. Results: The mean value of NT-proBNP among patients with TIMI flow Conclusion: Our study shows that higher NT-proBNP levels in patients with ACS who undergo PCI have higher likelihood of developing no-flow phenomenon during PCI.

Impact of Thrombus Aspiration on Clinical Outcomes in Korean Patients with ST Elevation Myocardial Infarction.

We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.

Role of polymorphisms of the endothelial nitric oxide synthase gene in predicting slow-flow phenomenon after primary percutaneous coronary intervention.

The aim of the present study was to examine the association between 2 polymorphisms of the endothelial nitric oxide (eNOS) gene (-786T>C and +894G>T) and the no-reflow/slow-flow phenomenon in post-primary percutaneous coronary intervention (PPCI) patients. A total of 103 post-PPCI patients were enrolled. Coronary no-reflow phenomenon was defined as a Thrombolysis in Myocardial Infarction (TIMI) flow grade 0-1 and coronary slow-flow phenomenon (CSFP) was defined as a TIMI flow grade ≤2. Due to the small number of post-PPCI patients with the no-reflow phenomenon (n=4), the primary comparison was made between CSFP (n=20) and normal flow (n=83) groups. There was a greater frequency of CSFP among carriers of the -786C allele of the eNOS -786T>C polymorphism (odds ratio [OR]: 3.90; 95% confidence interval [CI]: 0.87-17.45; p=0.07). However, no such association was detected between the +894T allele of the eNOS +894G>T and CSFP (OR: 0.92; 95% CI: 0.21-3.98; p=0.91). In the adjusted analysis, the -786T>C polymorphism did not reach statistical significance. There was no significant association between CSFP and 2 of the most common polymorphisms of the eNOS gene in post-PPCI patients.

Risk Factors of In-Hospital Lethal Arrhythmia Following Acute Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention - Insight From the J-MINUET Study.

Background: Lethal arrhythmias including ventricular tachycardia and fibrillation (VT/VF) are common complications of acute myocardial infarction (AMI). Predictors of in-hospital VT/VF after AMI, however, have not been thoroughly investigated. In this study, we sought to elucidate the predictors of in-hospital VT/VF events after AMI in the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET).Methods and Results: In-hospital VT/VF was defined as a hemodynamically unstable VT or VF in the first week of hospitalization, on which the patients were classified as the VT/VF group. Of the patients in the J-MINUET study, 3,175 were finally enrolled in this study. A total of 114 patients had VT/VF. On multivariate logistic analysis, maximum creatine kinase >3,000 IU/L (adjusted OR, 1.67; 95% CI: 1.085–2.572; P=0.02), Killip class III or IV (adjusted OR, 8.93; 95% CI: 5.668–14.082; P<0.0001), initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 (adjusted OR, 1.67; 95% CI: 1.035–2.709; P=0.03), and concomitant chronic kidney disease (CKD; adjusted OR, 1.80; 95% CI: 1.105–2.938; P=0.02) were identified as independent predictors for in-hospital VT/VF.Conclusions: From the J-MINUET study, extensive myocardial damage, cardiogenic shock, lower grade initial TIMI flow on coronary angiography, and concomitant CKD were independent predictors of in-hospital VT/VF after AMI.

Perkütan Koroner İşlem Sonrası Zayıf TIMI Akımı Olan ST Elevasyonlu Miyokart İnfarktüsü Hastalarında Soluble ST2 ve N Terminal-Pro Brain Natriüretik Peptid Kombinasyonunun Kısa Dönem Mortaliteyi Öngördürebilirlik Değeri

Introduction: The increase in soluble ST2 (sST2) and N Terminal-Pro Brain Natriuretic Peptide (NT-proBNP) in ST-elevation myocardial infarction (STEMI) is well established, however, the existing data regarding the combination of sST2 and NT-proBNP values as prognostic markers after STEMI are limited, particularly in the case of those with failed percutaneous coronary intervention (PCI). This study aimed to assess the clinical significance of the sST2 and NT-proBNP combination in predicting short-term mortality in STEMI patients with post-procedural poor thrombolysis in myocardial infarction (TIMI) flow. Patients and Methods: A total of 104 patients with post-procedural poor TIMI flow were included in the study. Failure to provide a 3 flow grade was accepted as post-procedural poor TIMI flow. The study population was grouped according to the sST2 and NT-proBNP levels. Independent predictors of short-term mortality were investigated. Results: A 30 day mortality was observed in 15 (14.4%) patients. sST2 (46.9 ± 23.8 ng/mL vs. 32.5 ± 12.0 ng/ mL, p= 0.001) and NT-proBNP (2387.2 ± 2255.5 pg/mL vs. 1217.1 ± 1588.8 pg/mL, p= 0.015) levels were higher in patients with mortality. Multivariate regression analysis concluded that high serum sST2 (OR: 5.024, 95% CI 1.132-22.308, p= 0.034) independently predicted short-term mortality, while NT-proBNP did not (OR: 4.059, 95% CI 0.894-18.427, p= 0.070). Furthermore, when a high sST2 level was combined with a high NT-proBNP level, the odds ratio of the 30-day mortality was found to be the highest (13.02, 95% CI 5.41-31.23, p< 0.001). Conclusion: These results suggest that the combined sST2 and NT-proBNP level are essential predictors of short-term mortality in STEMI patients with post-procedural poor TIMI flow.

Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analyses.

There is little evidence to recommend the optimal invasive mechanical ventilation (IMV) modes and ideal positive end-expiratory pressure stress levels for acute myocardial infarction-cardiogenic shock (AMI-CS) patients. The aim of this study was to compare the mortality outcome in patients with AMI-CS who were treated with percutaneous coronary intervention (PCI) assisted by intra-aortic balloon pump (IABP) + IMV with historical controls. From January 1, 2016 to June 1, 2017, 60 patients were retrospectively enrolled at Tianjin Chest Hospital. Out of these, 88.3% of patients achieved thrombolysis in myocardial infarction (TIMI) flow 3 after PCI. The all-cause mortality rate in-hospital and at 1 year was 25% (95% CI: 0.14–0.36) and 33.9% (0.22–0.46), respectively. A systematic review followed by meta-analysis was performed with four historical studies of patients treated by PCI + IMV with partial IABP, which found an in-hospital mortality rate of 66.0% (95% CI: 0.62–0.71). Recently, a meta-analysis of patients receiving PCI + IABP with partial IMV showed that the 1 year mortality rate was 52.2% (95% CI: 0.47–0.58). In Cox regression analysis of patient data from the current study, lactic acid level ≥4.5 mmol/L, hyperuricemia, and TIMI flow <3 were independent predictors of death at 1 year. All-cause mortality, in-hospital and at 1 year, in patients with AMI-CS treated with PCI + IABP and IMV was lower than in those treated with PCI + partial IABP or IMV. Larger, longer-term direct comparisons are warranted.

High-throughput targeted proteomics discovery approach and spontaneous reperfusion in ST-segment elevation myocardial infarction

BackgroundAlthough spontaneous reperfusion (SR) prior to primary percutaneous coronary intervention (pPCI) is associated with improved outcomes, its pathophysiology remains unclear. The objective of the study was to explore associations between SR in ST-segment elevation myocardial infarction (STEMI) using a multimarker cardiovascular proteins strategy MethodsWe evaluated STEMI patients from the Assessment of Pexelizumab in Acute Myocardial Infarction trial treated with pPCI within 6 hours from symptom onset. SR was core laboratory–defined as pre-PCI Thrombolysis in Myocardial Infarction flow 2 or 3. Ninety-one cardiovascular disease–related serum biomarkers drawn prior to PCI were analyzed using a high-throughput “targeted discovery” panel. Expression levels for individual biomarkers were compared between patients with/without SR. A hierarchical clustering method of biomarkers identified clusters of biomarkers that differentiated the 2 groups. Associations between individual biomarkers and clusters with SR were further evaluated by multivariable logistic regression. ResultsOf 683 patients studied, 290 had spontaneous reperfusion; those with compared to without SR were more likely noninferior STEMI and had lower clinical acuity and lower baseline levels of troponin and creatine kinase. SR was associated with a lower occurrence of 90-day composite of death, heart failure, or cardiogenic shock. Fifty-two of 91 individual biomarkers were significantly univariably associated with SR. Forty-five remained significant with adjustment for false discovery rate. Using cluster analysis, 26 biomarkers clusters were identified, explaining 72% of total covariance, and 13 biomarker clusters were significantly associated with SR after multivariable adjustment. SR was associated with higher mean expression levels of proteins in all 13 clusters. The cluster most strongly associated with SR consisted of novel proteins across various distinct, yet interlinked, pathobiological processes (kallikrein-6, matrix extracellular phosphoglycoprotein, matrix mettaloproteinaise-3, and elafin). ConclusionsSpontaneous reperfusion prior to pPCI in STEMI was associated with a lower risk of adverse clinical events. These exploratory data from a targeted discovery proteomics platform identifies novel proteins across diverse, yet complementary, pathobiological axes that show promise in providing mechanistic insights into spontaneous reperfusion in STEMI. Condensed abstractSpontaneous reperfusion has been established with improved STEMI outcomes, yet its pathobiology is unclear and appears to involve diverse physiological processes. Using a 91-biomarker high-throughput proteomics platform, we studied 683 STEMI patients in the APEX AMI trial (290 had core laboratory–adjudicated pre-PCI TIMI 2/3 flow) and identified 52 proteins that univariably associate with spontaneous reperfusion. Cluster analysis identified 26 biomarker clusters (explaining 72% of total variance), 13 of which, after multivariable adjustment, were significantly associated with spontaneous reperfusion. Four proteins (kallikrein-6, matrix extracellular phosphoglycoprotein, matrix mettaloproteinaise-3, and elafin) across diverse, yet complementary, pathways appear to be associated most strongly with spontaneous reperfusion.

P4611Colchicine before percutaneous coronary intervention in acute myocardial infarction

Abstract Aims Myocardial perfusion could determine the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the impact of colchicine on myocardial perfusion in this population. Methods In a double-blind, randomized trial, we assigned 196 patients with STEMI undergoing PCI to two groups: the colchicine group (N=95) and the control group (N=101). The primary endpoints were the thrombolysis in myocardial infarction (TIMI) score; TIMI myocardial perfusion grade (TMPG), and TIMI frame count (TFC). The major adverse cardiovascular events (MACEs) were recorded after one month of PPCI. Results The Final TIMI flow grade, TMPG and TFC were not significantly different between the 2 groups (p=0.75, p=0.533, p=0.161; respectively). MACE include Mortality, Non-fatal myocardial infarction, target lesion/vessel revascularization were similar between the 2 groups (p=0.058). Study outcomes Characteristics Colchicine Group (n=95) Control Group (n=101) P value Discharge status Deceased 2 (2.1%) 2 (2%) 1 Alive 93 (97.9%) 99 (98%) TIMI flow grade after PCI 0 2 (2.1%) 1 (1%) 0.747 1 2 (2.1%) 4 (4%) 2 17 (17.9%) 21 (20.8%) 3 74 (77.9%) 75 (74.3%) TIMI myocardial perfusion grade 2.39±0.89 2.31±0.95 0.533 ST segment resolution Below 50 Percentage 23 (27.1%) 27 (32.1%) 0.71 Between 50 to 70 Percentage 8 (9.4%) 6 (7.1%) Above 70 Percentage 54 (63.5%) 51 (60.7%) MACE.1.Month 10 (9.9%) 3 (3.2%) 0.058 MACE.1.Month(Mortality) 4 (4.0%) 2 (2.1%) 0.451 MACE.1.Month(Non.Fatal.MI) 2 (2.0%) 0 (0%) 0.168 MACE.1.Month(TLR) 2 (2.0%) 1 (1.1%) 0.597 MACE.1.Month(TVR) 5 (5.0%) 1 (1.1%) 0.113 Conclusion In STEMI patients treated by PPCI, the effect of colchicine before PPCI was not revealed on myocardial perfusion markers.

Thrombus aspiration catheter improve the myocardial reperfusion of STEMI patients with high thrombus load during the emergency PCI operation

ObjectiveThis study aims to discuss the efficacy and safety of the application of thrombus aspiration catheters during emergency PCI operations for acute ST-elevation myocardial infarction (STEMI) patients with high thrombus load.MethodsA total of 204 patients diagnosed with acute STEMI and high thrombus load in the Sixth Affiliated Hospital of Guangxi Medical University from July 1, 2016 to June 30, 2017 were selected for the present study. These patients were randomly divided into two groups: thrombus catheter aspiration group (group A, n = 101), and balloon dilatation group (group B, n = 103). The blood flow of the culprit coronary artery in the thrombolysis in myocardial infarction (TIMI) immediately after the emergency PCI operation in these two groups of patients was recorded. Then, an echocardiogram was performed to determine the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) after the operation, and data on major adverse cardiovascular events (MACE) during the 30 days of postoperative follow-up were collected.ResultsThe comparative difference between these two groups of patients in terms of hypertension, smoking, diabetes, usage rate of GPIIb/IIIa receptor antagonist, time from hospitalization to balloon dilatation (D2B) and other basic clinical data was not statistically significant (P > 0.05). The postoperative TIMI flow grade of these two groups of patients improved, and the comparative difference between the data obtained from these two groups was statistically significant (P < 0.05). The comparative difference between these two groups in terms of LVEDD and LVEF at 7 days after the operation was not statistically significant (P > 0.05). There was a difference in the occurrence rate of MACE in these two groups of patients during the 30 days of postoperative follow-up, but the comparative difference between these two groups was not statistically significant (P = 0.335).ConclusionThe application of thrombus aspiration catheter during the emergency PCI operation of STEMI patients with high thrombus load can better improve the myocardial reperfusion. There is no basis for increasing the stroke occurrence risk. However, it obviously fails to improve the recent prognosis and more studies need to explore its effect on myocardial remodeling and major adverse cardiovascular events.