Thrombolysis In Myocardial Infarction Research Articles

Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease.

The diagnosis of coronary microvascular disease (CMVD) remains challenging. Perfusion PET-derived myocardial blood flow (MBF) reserve (MBFR) can quantify CMVD but is not widely available. Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) is an angiography-based method that has been proposed as a measure of CMVD. Here, we compare TFC and PET-derived MBF measurements to establish the role of TFC in assessing for CMVD. We use coronary modeling to elucidate the relationship between MBFR and TFC and propose TFC thresholds for identifying CMVD. In a cohort of 123 individuals (age 58 ± 12.1, 63% women, 41% Caucasian) without obstructive coronary artery disease who had undergone perfusion PET and coronary angiography for clinical indications, we compared TFC and perfusion PET parameters using Pearson correlation (PCC) and linear regression modeling. We used mathematical modeling of the coronary circulation to understand the relationship between these parameters and performed Receiver Operating Curve (ROC) analysis. We found a significant negative correlation between TFC and MBFR. Sex, race and ethnicity, and nitroglycerin administration impact this relationship. Coronary modeling showed an uncoupling between TFC and flow in epicardial vessels. In ROC analysis, TFC performed well in women (AUC 0.84-0.89) and a moderately in men (AUC 0.68-0.78). We established an inverse relationship between TFC and PET-derived MBFR, which is affected by patient selection and procedural factors. TFC represents a measure of the volume of the epicardial coronary compartment, which is increased in patients with CMVD, and performs well in identifying women with CMVD.

Glycated Haemoglobin and TIMI Score as Risk Predictor in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability globally. The Thrombolysis in Myocardial Infarction (TIMI) score is calculated to assess the risk outcome among myocardial infarction patients. Researchers found that diabetic patients with myocardial infarction have relatively unfavourable outcomes when compared to myocardial infarction patients without diabetes. Aim: To evaluate Glycated Haemoglobin (HbA1c) levels, the TIMI score in Acute Myocardial Infarction (AMI) patients and compare them between ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI) patients. Materials and Methods: This cross-sectional study was conducted at the Intensive Care Unit (ICU) of the Department of Cardiology at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India, from July 2022 to June 2023. A total of 100 myocardial infarction patients were included and divided into two groups based on Electrocardiogram (ECG) findings and Creatine PhosphokinaseMB (CK-MB) values, with 50 STEMI and 50 NSTEMI. Patients blood samples were evaluated for HbA1c, total cholesterol, Triglycerides (TGL), High-density Lipoprotein Cholesterol (HDL-C), Low-density Lipoprotein Cholesterol (LDL-C), Very High-density Lipoprotein Cholesterol (VLDL-C), and CK-MB parameters. The TIMI score was calculated to evaluate the risk of developing complications among myocardial infarction patients. Pearson’s correlation was used to correlate biochemical parameters with the TIMI score. Results: A total of 100 myocardial infarction patients were analysed in the present study, with 50 being STEMI (mean HbA1c%: 8.0±0.2.8) and 50 being NSTEMI (mean HbA1c%: 7.2±2.0) with a p-value of <0.01*, a high TIMI score in STEMI patients (means 5.38±2.76) and 50 NSTEMI (mean 3.24±1.20) with a p-value of <0.0001*. Also, HbA1c was strongly positively correlated with the TIMI score in both the STEMI and NSTEMI groups, with r-value of 0.6 (p=0.0001*) and 0.7 (p=0.0001*), respectively. CK-MB was correlated with the TIMI score in both STEMI and NSTEMI, with r-value of 0.308 (0.03) and 0.375 (0.007). There was no correlation between the TIMI score and the lipid profile. Conclusion: The study concluded that HbA1c, along with the TIMI score, is a significant predictor of risk outcome in AMI patients.

Factors affecting TIMI (Thrombolysis In Myocardial Infarction) flow grade in patients undergoing primary PCI (Percutaneous Coronary Intervention).

Objective: To determine the causes of normal blood flow in coronary arteries in patients presenting with STEMI and receiving pPCI. Study Design: Observational study conducted retrospectively. Setting: National Institute of Cardiovascular Disease (NICVD) Karachi, Cath Lab. Period: August 17 2020 to November 2020. Material & Methods: Data was obtained from patients presented to the emergency department with STEMI and experienced primary PCI in last two years from January 2016 to Decemebr 2018.Social Sciences (SPSS) version 19 was used analyze these data.Th in those patients who had suboptimal coronary blood flow. Young patients <40 years of age had more (14%) normal coronary blood flow as compared to elders i.e >40 years. Diabetes mellitus, Hypertension, and smoking had no significant impact on coronary blood flow in these patients. Conclusion: In this study, it was found that most of the coronary arteries had abnormal blood flow during primary PCI. Multiple factors are affecting the blood flow in coronaries. The onset of symptoms and the time presented in the hospital was the main factors. Further studies are required to find more reasons for having normal blood flow in coronaries in STEMI.

Severity scale of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in myocardial infarction patients

Introduction: There is no scale that combines the traditional criteria of coronary microvascular obstruction (CMVO, no-reflow phenomenon) to effectively assess the severity and prognosis of this complication.Objective: To develop and evaluate the severity scale of CMVO during percutaneous coronary intervention (PCI) for myocardial infarction (MI).Methods: The cohort study included 203 patients diagnosed with type 1 MI and CMVO during PCI. The CMVO criterion was TIMI flow grade (TFG) <3 points. Using the proposed "CMVO Severity Scale" (CMVO-SS), three groups of patients were identified. CMVO grade 1 (mild): TFG 2 points, Myocardial blush grade (MBG) 2–3 points, ST segment resolution after PCI (rST) >70%. CMVO grade 2 (moderate): TFG 2 points, MBG 0–1 points or rST <70%. CMVO grade 3 (severe): TFG 0-1 points.Results: Distribution of groups with CMVO of the 1st, 2nd, and 3rd grade is 65 (32%) / 88 (43%) / 50 (25%) patients, respectively. Outcomes by group: acute heart failure grade 3–4 — 2 (3%) / 11 (13%) / 14 (28%), P < .001; ejection fraction — 48 [44; 53] % / 46 [40; 50] % / 42 [39; 49] %, P = .004; in-hospital death — 1 (1.5%) / 12 (13.6%) / 16 (32.0%), P < .001; two-year death — 8 (12.3%) / 19 (21.6%) / 22 (44.0%), P < .001. The multivariate analysis revealed a two-year death odds ratio for the CMVO-SS of 2.40 [95% CI 1.23–5.17], P = .009. Two-year survival probability with CMVO-SS grade 1 was 87.7%, grade 2 — 78.4%, grade 3 — 56.0% (P < .001).Conclusion: The proposed CMVO severity scale is associated with adverse in-hospital outcomes and two-year mortality. Received 15 May 2023. Revised 27 September 2023. Accepted 24 October 2023. Funding: The study was supported by the "Priority 2030" program. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Frolov, E.G. Sharabrin, I.G. PochinkaData collection and analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevStatistical analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevDrafting the article: A.A. Frolov, I.G. Pochinka, I.A. FrolovCritical revision of the article: I.G. Pochinka, A.S. Mukhin, E.G. Sharabrin, V.N. SinyutinFinal approval of the version to be published: A.A. Frolov, I.G. Pochinka, I.A. Frolov, K.V. Kuzmichev, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin

In-hospital Outcomes of Rotational Atherectomy in ST-Elevation Myocardial Infarction: Results From the Multicentre ROTA-STEMI Network

BackgroundAlthough the use of rotational atherectomy (RA) is off-label in the setting of ST-elevation myocardial infarction (STEMI), it can be the only option in severely calcified culprit lesions to achieve procedural success. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention (PPCI). MethodsThis was a retrospective observational study of patients who underwent RA during PPCI from 12 European centres. The main outcomes were procedural success (defined as successful stent implantation with final thrombolysis in myocardial infarction [TIMI] flow 3 and residual stenosis < 30%) and in-hospital mortality. A comparison of patients presenting with and without shock was performed. ResultsIn 104 patients with RA during STEMI, the mean age was 72.8 ± 9.1 years, and 35% presented with cardiogenic shock. Bailout RA was performed in 76.9% of cases. Mean burr size was 1.42 ± 0.21 mm. Procedural success was achieved in 86.5% of cases, with no difference between shocked and nonshocked patients (94.4% vs 82.4%; P = 0.13). In-hospital stent thrombosis occurred in 0.96%, perforation in 1.9% and burr entrapment in 2.9% of cases. In spite of equally high procedural success, in-hospital mortality was higher in shocked (50%) compared with nonshocked patients (1.5%; P < 0.0001). ConclusionsPatients presenting with STEMI requiring RA, represent a high-risk population, frequently presenting with cardiogenic shock. In this analysis of selected patients, RA was performed as a bailout strategy in the majority, and, as such, RA seems to be feasible with a high procedural success rate. In the absence of cardiogenic shock, RA-facilitated PCI seems to be associated with low in-hospital mortality.

Association of Total Leucocyte Count and Neutrophil to Lymphocyte Ratio with Short Term Major Adverse Cardiac Events after Acute ST Elevation Myocardial Infarction in a Tertiary Care Centre in South India

Ischemic Heart Disease is a global health issue with developing countries bearing the brunt of the burden. The development of adverse cardiac events after an acute coronary event further aggravates the morbidity and mortality. In a developing country like India, employing inexpensive markers such as Total Leucocyte Count (TLC) and Neutrophil to Lymphocyte Ratio (NLR) can greatly aid prognostication in acute myocardial infarction. The study aimed at estimating the association of TLC and NLR with short term Major Adverse Cardiac Events (MACE) after acute STEMI. We also studied the association of Total Leucocyte Count and Neutrophil to Lymphocyte ratio with TIMI (Thrombolysis in Myocardial Infarction) score. This hospital based descriptive study that spanned over a year enrolled 270 patients admitted under General Medicine and Cardiology with STEMI. TLC and NLR were measured within 24 hours of admission. The subjects were followed up for MACE (namely heart failure hospitalization, compensated systolic dysfunction, arrhythmias, non-fatal reinfarction/stroke, and cardiovascular death) at the end of 1 week and 1 month. Among the 270 cases, 107 developed MACE after 1 week and 89 developed MACE after 1 month. The most common MACE was LV systolic dysfunction followed by arrhythmias. There was a significant association between NLR and MACE after 1 week (p value:0.04). Similarly, there was a positive association between NLR and TIMI score (p value:0.002). The association between total leucocyte count and MACE was not statistically significant. We concluded that NLR, a routine, easily available test was effective in predicting major adverse cardiac events after 1 week in acute STEMI. Keywords: Acute Coronary Syndrome; ST elevation myocardial infarction; Total leucocyte count; Neutrophil to Lymphocyte Ratio; Major Adverse Cardiac Events; Thrombolysis in Myocardial Infarction Score (TIMI score); LV systolic dysfunction

Association of Total Ischemia Time with No-Reflow Phenomenon in Patients Presenting with STElevation Myocardial Infarction, Undergoing Primary Percutaneous Coronary Intervention

Objective: To find out the association of total ischemic time with no-reflow phenomenon, in terms of Thrombolysis in Myocardial Infarction (TIMI) flow grade, in patients presenting with ST-Elevation Myocardial Infarction and undergoing Primary Percutaneous Coronary Intervention(PPCI). Study Design: Analytical Cross-Sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Nov, 2022 to Jan, 2023. Methodology: This analytical cross-sectional study was conducted on n=184 patients, recruited through consecutive sampling technique to collect data prospectively. Patients were divided into no-reflow and normal flow group. Patients’ total ischemic time was documented and pre &amp; post-procedural TIMI flow was noted. SPSS version-24:00 was used to enter and analyze data. Chi-square, Fisher exact test and t-test were applied and p-value≤0.05 was taken as statistically significant. Results: Out of 184 study participants, 17(9.2%) were females as compared to 167(90.8%) males. The mean age was 60.23±10.28 years. No-reflow phenomenon was observed in 20(10.9%) patients. The mean age was higher in the no-reflow group than that of the normal flow group (62.65±11.61 vs 59.94±10.12 years). Total ischemic time, pre &amp; post-procedural TIMI flow were found to be significantly associated with no-reflow phenomenon (p&lt;0.05). Conclusion: There exists a strong association between total ischemic time and the occurrence of no-reflow phenomenon. Patients with delayed reperfusion present with greater frequency of no-reflow and low TIMI grade and vice versa.

Performance of the Risk Scores for Predicting In-Hospital Mortality in Patients with Acute Coronary Syndrome in a Chinese Cohort.

The prognosis of patients with acute coronary syndrome (ACS) varies greatly, and risk assessment models can help clinicians to identify and manage high-risk patients. While the Global Registry of Acute Coronary Events (GRACE) model is widely used, the clinical pathways for acute coronary syndromes (CPACS), which was constructed based on the Chinese population, and acute coronary treatment and intervention outcomes network (ACTION) have not yet been validated in the Chinese population. Patients with ACS who underwent coronary angiography or percutaneous coronary intervention from 2011 to 2020, were retrospectively recruited and the appropriate corresponding clinical indicators was obtained. The primary endpoint was in-hospital mortality. The performance of the GRACE, GRACE 2.0, ACTION, thrombolysis in myocardial infarction (TIMI) and CPACS risk models was evaluated and compared. A total of 19,237 patients with ACS were included. Overall, in-hospital mortality was 2.2%. ACTION showed the highest accuracy in predicting discriminated risk (c-index 0.945, 95% confidence interval [CI] 0.922-0.955), but the calibration was not satisfactory. GRACE and GRACE 2.0 did not significantly differ in discrimination (p = 0.1480). GRACE showed the most accurate calibration in all patients and in the subgroup analysis of all models. CPACS (c-index 0.841, 95% CI 0.821-0.861) and TIMI (c-index 0.811, 95% CI 0.787-0.835) did not outperform (c-index 0.926, 95% CI 0.911-0.940). In contemporary Chinese ACS patients, the ACTION risk model's calibration is not satisfactory, although outperformed the gold standard GRACE model in predicting hospital mortality. The CPACS model developed for Chinese patients did not show better predictive performance than the GRACE model.

Association of Red Cell Distribution Width with Thrombus Burden in Patients of ST Elevation Myocardial Infarction Undergoing Primary PCI

Objective: To study the association of Red Cell Distribution Width (RDW) with thrombus burden in patients of ST Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PPCI). Study Design: Analytical Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, Pakistan, from Aug 2022 to Dec 2022. Methodology: Using non-probability consecutive sampling, three hundred and sixty-nine (n=369) patients were included in the study. RDW values were obtained from complete blood count sent at presentation in emergency department. Thrombolysis in Myocardial Infarction (TIMI) thrombus grading was used to determine the angiographic thrombus burden. For quantitative variables, means and standard deviations were calculated, while frequencies and percentages were calculated for qualitative variables. Receiver Operating Characteristic (ROC) curve for RDW values for predicting thrombus burden was plotted. Correlation between RDW with thrombus burden was established. Eta, Chi-square and independent samples t-test was used to determine p-value. Results: The study included 369 STEMI patients, out of which 287(77.8%) were males and 82(22.2%) were females. 203(55.0%)patients had high thrombus burden while 166(45.0%) patients had low thrombus burden. Patients in the high RDW groupmore frequently had ventricular arrhythmias, and heart blocks. Mean RDW was 13.57±0.71 in low thrombus burden groupwhile it was 14.67±1.21 in high thrombus burden group. Area under the curve derived from ROC curve for RDW forpredicting high thrombus burden was 0.79(CI=0.74-0.83, p&lt;0.001) Conclusion: The study demonstrates that high RDW is a sensitive and specific predictor of high angiographic thrombus bur..........

Favorable factors for the survival of ST-segment elevation myocardial infarction patients with medium- and high-risk thrombolysis in myocardial infarction scores

ObjectiveST-segment myocardial infarction (STEMI) is a time-sensitive emergency. This study screened the favorable factors for the survival of STEMI patients with medium- and high-risk thrombolysis in myocardial infarction (TIMI) scores.MethodsAccording to the TIMI scores at admission, 433 STEMI patients were retrospectively and consecutively selected and allocated into low-/medium-/high-risk groups, with their general information/blood routine/biochemical indicators/coagulation indicators documented. The factors influencing the in-hospital survival of STEMI patients were analyzed using univariate and multivariate logistic regression analyses. Moreover, the predictive value of favorable factors was analyzed by receiver operating characteristics (ROC) curve, and patients were assigned into high/low level groups based on the cut-off value of these factors, with their in-hospital survival rates compared.ResultsThe in-hospital survival rate of the medium-/high-risk groups was lower than that of the low-risk group. Emergency percutaneous coronary intervention (PCI), lymphocyte (LYM), total protein (TP), albumin (ALB), and sodium (Na) were independent favorable factors for in-hospital survival in the medium-/high-risk groups. Besides, LYM > 1.275 × 109/L, TP > 60.25 g/L, ALB > 34.55 g/L, and Na > 137.9 mmo1/L had auxiliary predictive value for the survival of STEMI patients with medium-/high-risk TIMI scores. Patients with high levels of LYM, TP, ALB, and Na exhibited higher in-hospital survival rates than patients with low levels.ConclusionFor STEMI patients with medium- and high-risk TIMI scores, accepting emergency PCI and normal levels of LYM, TP, ALB, and Na were more conducive to in-hospital survival.

A New Inflammatory Marker of the No-reflow Phenomenon after Percutaneous Coronary Intervention (PCI) to Saphenous Venous in Patients with Coronary Artery Disease

Background: Although numerous mechanisms regarding the no-reflow phenomenon (NRP) have been mentioned, they have not yet been fully elucidated. The NRP can impact the success rate even in a technically flawless percutaneous coronary intervention (PCI), which can be annoying. Before the procedure, there is no specific parameter or index that can assess a significant factor such as NRP that has a direct impact on the success of the PCI. Objectives: The present study aimed to evaluate the relationship between the systemic immune-inflammation index (SII) and NRP in patients who underwent PCI for saphenous vein graft (SVG). Methods: In this retrospective cohort study, 312 coronary artery bypass grafting (CABG) patients admitted to primary or elective SVG and those who underwent PCI between January 2014 and December 2021 were selected. Routine blood samples were taken from the patients at the time of admission, and SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. The reperfusion rates after PCI were evaluated according to the thrombolysis in myocardial infarction (TIMI) grade flow and myocardial blush grade (MBG). Following the procedure, those with an angiographic TIMI flow grade of ≤ 2 or TIMI flow grade of 3 and a final MBG of &lt; 2 were considered NRP. Results: The number of 85 patients (27.2%) were diagnosed with NRP. The SII and ST-elevation myocardial infarction were found to be independent predictors for NRP in multivariate logistic regression analysis (P&lt;0.05). The SII predicted NRP with a sensitivity of 86% and a specificity of 80% (AUC: 0.866, 95% CI: 0.823 to 0.910, P&lt;0.001) using a cut-off point of 13.45. Conclusion: The SII is an independent predictor that can be easily calculated from the whole blood test to predict no-reflow development, which is a frustrating complication in patients following the PCI to the saphenous vein. This predictor can enable us to pre-evaluate the non-operational reasons affecting the procedure's success.

Experience and Outcomes of Primary Percutaneous Coronary Intervention in a Tertiary Care Hospital in South Punjab, Pakistan.

Primary percutaneous coronary intervention (PCI) is the emergency procedure and gold standard for the treatment of ST-Elevation Myocardial Infarction (STEMI). To share the experience and outcomes of primary PCI in a tertiary care hospital in South Punjab, Pakistan. A descriptive cross-sectional study was planned from the 1st of April, 2023 to the 30th of September, 2023. All patients presenting with acute STEMI undergoing primary PCI were included in the study. Data regarding patient demographics, risk factors, procedural characteristics, time variables, and in-hospital events was observed. A total of 1132 patients were included in the study. There were 934 (82.5%) males. Smoking is the most common risk factor among all the patients. Anterior wall myocardial infarction is the most common STEMI and the left anterior descending artery is the culprit vessel in 58.3% (n=660) of patients. Single vessel disease was present in 34.6% (n=392) of the patients. Thrombolysis in Myocardial Infarction (TIMI )Flow III was achieved in 80% (n=906) of patients after primary PCI. The average total ischemic time of the patients included in the study was 5 hours and 48 minutes, with a standard deviation of 3 hours and 55 minutes. Our mortality was 3.5% (n=40). Our patients take a longer time to present to the PCI-capable centers. Despite their late presentation, primary PCI has better outcomes for treating acute STEMI.

Validity of TIMI Risk Score and HEART Score for Risk Assessment of Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction Presented to an Emergency Department in Jordan.

To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA). Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome. Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5-8% higher event rate than predicted. Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.

“A Longitudinal Study of KILLIP Class, Thrombolysis In Myocardial Infarction (TIMI), Global Registry Of Acute Coronary Events (GRACE), Risk Scores For Prediction Of Cardio Vascular Outcomes In Patients Presenting With Acute ST Elevation Myocardial Infarction in a Tertiary Care Centre.”

“A Longitudinal Study of KILLIP Class, Thrombolysis In Myocardial Infarction (TIMI), Global Registry Of Acute Coronary Events (GRACE), Risk Scores For Prediction Of Cardio Vascular Outcomes In Patients Presenting With Acute ST Elevation Myocardial Infarction in a Tertiary Care Centre.”

The predictive value of microvascular obstruction for adverse left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a prospective study

Objectives: Microvascular obstruction (MVO) is a specific cardiac magnetic resonance (CMR) imaging feature in patients with acute myocardial infarction. The purpose of this study was to elucidate the predictive value of MVO in left ventricular adverse remodeling after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 167 patients with STEMI undergoing primary PCI in the Chinese PLA General Hospital from 2016 to 2020 were enrolled in this prospective cohort study, the average age of study patients was 57±10 years old, with 151 males (90.4%) and 16 females (9.6%). The patients were divided into the MVO group (n=81) and non-MVO group (n=86) according to the presence or absence of MVO on CMR imaging, respectively. The primary endpoint of the study was the occurrence of left ventricular adverse remodeling, which was defined as an increase in left ventricular end diastolic volume (LVEDV) by >20% at 6 months after primary PCI compared with the baseline. Patients who completed follow-up were diagnosed as left ventricular adverse remodeling or no left ventricular adverse remodeling according to CMR. The baseline data, perioperative data, and related data of end points were compared between the MVO group and non-MVO group. Finally, the predictive value of MVO in left ventricular adverse remodeling was calculated by receiver operating characteristic curve analysis. Results: In the baseline data, preoperative thrombolysis in myocardial infarction (TIMI) flow (χ2=13.74, P=0.003) and postoperative TIMI flow (χ2=14.87, P=0.001) were both obviously decreased in the MVO group. After 6 months of follow-up, the incidence of left ventricular adverse remodeling in the MVO group was significantly higher than that in the non-MVO group [37.0%(27/73) vs. 18.9%(14/74), χ2=5.96, P=0.015]. The left ventricular end systolic volume at 6 months post infarction in the MVO group was significantly larger than that in the non-MVO group [(94±32) vs. (68±20) ml, t=-5.98, P<0.001], as well as the LVEDV [(169±38) vs. (143±29) ml, t=-4.74, P<0.001]. Receiver operating characteristic curve showed that the area under the curve of MVO size for predicting left ventricular adverse remodeling was 0.637. Conclusion: The risk of left ventricular adverse remodeling is significantly increased in patients with MVO after primary PCI for acute STEMI.

Prognostic value of arterial lactate index in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: a prospective cohort study.

Aim: Limited knowledge exists on the pathophysiological cascade beyond serum lactate's association with myocardial injury. Method: Assessed the prognostic value of lactate index on periprocedural variables and its impact on 30-day major adverse cardiovascular events (MACE)in 300 prospective ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Results: Significant correlations were observed between admission lactate and Killip class, periprocedural time intervals, postprocedure thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG;p<0.01). Lactate levels correlated with diminished ST-deviation resolution, cardiac enzymes (CK-MB, troponin;p<0.001; 0.004), and lower ejection fraction (p<0.001). This relationship impacted 30-day MACE (p<0.001). Conclusion: Hyperlactatemia in STEMI patients undergoing pPCI is associated with worse Killip class, unsatisfactory TIMI flow, MBG, larger infarct size and higher 30-day MACE. Serum lactate aids risk stratification in pPCI for STEMI patients.

Effect of preinitiated glucose-insulin-potassium strategy for patients with undergoing planned percutaneous coronary intervention: a systematic review and meta-analysis

ObjectivesWhether the glucose-insulin-potassium (GIK) should be used as an adjuvant therapy for ischaemic myocardial disease remains controversial nowadays reperfusion era. This meta-analysis aimed to assess the effects of preinitiated GIK...

The Coronary Reperfusion Effect and Safety of Prehospital P2Y12 Inhibitor in Primary-PCI STEMI Patients: A Systematic Review and Meta-Analysis

Background The concept of early administration of P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is widely accepted, but whether prehospital administration results in greater coronary reperfusion remains unclear. Our study aims to analyze the benefit and safety of prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor administration. Method Three databases (PubMed, EMBASE, and Cochrane Library) were searched from database inception to June 2023. We included all types of studies except for conference publications, abstract presentations, reviews, and case reports. The primary outcomes were pre-PCI TIMI flow grade 2–3 (TIMI = Thrombolysis in Myocardial Infarction) and major bleeding. The secondary outcomes included post-PCI TIMI flow grade 2–3, major adverse cardiac events (MACE), recurrent myocardial infarction (MI), and short-term (30-day) mortality. Result Eight individual studies with a total of 10823 patients were included in our meta-analysis. Compared with in-hospital P2Y12 inhibitor, prehospital P2Y12 inhibitor were associated with significantly higher rates of pre-PCI TIMI flow grade 2–3 (OR 1.32, 95% CI: 1.09–1.61, p = 0.005) and post-PCI TIMI flow grade 2–3 (OR 1.43, 95% CI: 1.04–1.97, p = 0.03), and a significantly lower risk of recurrent MI (OR 0.69, 95% CI: 0.49–0.96, p = 0.03). There were no significant difference in the risk of major bleeding (OR 1.00, 95% CI: 0.75–1.32, p = 0.98), MACE (OR 0.94, 95% CI: 0.70–1.25, p = 0.65), or short-term mortality (OR 0.87, 95% CI: 0.50–1.51, p = 0.61). Conclusion Prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor is associated with a significantly higher rate of pre-PCI and post-PCI TIMI flow grade 2–3, a reduced risk of recurrent MI, and no increase in major bleeding in STEMI patients undergoing primary PCI.

Angiographic Predictors of Viability During Intervention for a ST Elevation Myocardial Infarction.

This study aimed to identify angiographic features that would predict myocardial viability after coronary intervention for ST elevation myocardial infarction (STEMI). This retrospective study included patients who attended Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 with a STEMI. A total of 72 patients (61 male; mean age = 54.9 ± 12.7 years) were included in the study; 11 patients had evidence of non-viability on echocardiography. There were 13 patients with viable myocardium and 3 with non-viable myocardium who had a myocardial blush grade (MBG) of 2 or lower. Similarly, 10 patients with viability and 1 with non-viable myocardium had thrombolysis in myocardial infarction (TIMI) flow of 2 or lower in the infarct related artery (IRA). However, none of these were statistically significant. The TIMI flow in the IRA at the end of the procedure correlated with the MBG. There were no clear angiographic features during primary angioplasty that could predict myocardial viability.

Comparison of Intracoronary Tirofiban And Intravenous Tirofiban for Major Adverse Cardiac Events and Cerebrovascular Accident

Major Adverse Cardiovascular Events (MACE) and and Cerebrovascular Accidents (CVA) have become primary areas of interest due to the ongoing focal research in cardiovascular diseases. Objective: To assess the frequency of major adverse cardiac events and cerebrovascular accidents for intracoronary tirofiban and intravenous tirofiban. Methods: It was a comparative study conducted at the Punjab Institute of Cardiology, Lahore from March 2019 to March 2020. A total of 250 patients of both genders, aged between 20 to 65 years were enrolled in this study who had STEMI and have high thrombus burden or TIMI flow grade &lt; 3 during primary PCI. They were divided into two groups namely intracoronary tirofiban group and intravenous tirofiban. The impact of intracoronary tirofiban versus intravenous tirofiban outcomes were assessed. Results: Statistically insignificant difference in MACE (myocardial infarction, cerebrovascular accident &amp; revascularization) between intracoronary &amp; intravenous tirofiban groups was noted. The frequency distribution for cerebrovascular accidents (CVA) showed that haemorrhage was found similar in both groups. Ischemic stroke, in patients of the intracoronary tirofiban group compared with intravenous tirofiban group, was 1 (0.8%) vs 3 (2.4%) with p-value 0.348 respectively. Reversible ischemic neurological deficit (RIND) was found in 3 (2.4%) in the intracoronary and 4 (3.2%) in the intravenous group. Transient ischemic attack (TIA) found in the intracoronary was 8(6.4%) whereas in the intravenous group was 9 (7.2%). Conclusions: The results of our study make us conclude that tirofiban when given intracoronary or intravenous does not show any significant difference for major adverse cardiac events and cerebrovascular accidents.