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Silverio A, Bellino M, Scudiero F, Attisano T, Baldi C, Catalano A, Centore M, Cesaro A, Di Maio M, Esposito L, Granata G, Maiellaro F, Muraca I, Musumeci G, Parodi G, Personeni D, Valenti R, Vecchione C, Calabrò P, Galasso G. Intravenous antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention : A report from the INVEST-STEMI group. J Thromb Thrombolysis 2024:10.1007/s11239-024-02970-7. [PMID: 38615155 DOI: 10.1007/s11239-024-02970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/15/2024]
Abstract
The use of intravenous antiplatelet therapy during primary percutaneous coronary intervention (PPCI) is not fully standardized. The aim is to evaluate the effectiveness and safety of periprocedural intravenous administration of cangrelor or tirofiban in a contemporary ST-segment elevation myocardial infarction (STEMI) population undergoing PPCI. This was a multicenter prospective cohort study including consecutive STEMI patients who received cangrelor or tirofiban during PPCI at seven Italian centers. The primary effectiveness measure was the angiographic evidence of thrombolysis in myocardial infarction (TIMI) flow < 3 after PPCI. The primary safety outcome was the in-hospital occurrence of BARC (Bleeding Academic Research Consortium) 2-5 bleedings. The study included 627 patients (median age 63 years, 79% males): 312 received cangrelor, 315 tirofiban. The percentage of history of bleeding, pulmonary edema and cardiogenic shock at admission was comparable between groups. Patients receiving cangrelor had lower ischemia time compared to tirofiban. TIMI flow before PPCI and TIMI thrombus grade were comparable between groups. At propensity score-weighted regression analysis, the risk of TIMI flow < 3 was significantly lower in patients treated with cangrelor compared to tirofiban (adjusted OR: 0.40; 95% CI: 0.30-0.53). The risk of BARC 2-5 bleeding was comparable between groups (adjusted OR:1.35; 95% CI: 0.92-1.98). These results were consistent across multiple prespecified subgroups, including subjects stratified for different total ischemia time, with no statistical interaction. In this real-world multicenter STEMI population, the use of cangrelor was associated with improved myocardial perfusion assessed by coronary angiography after PPCI without increasing clinically-relevant bleedings compared to tirofiban.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy.
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Fernando Scudiero
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Tiziana Attisano
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Cesare Baldi
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Catalano
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giovanni Granata
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | | | - Iacopo Muraca
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Guido Parodi
- Cardiology Unit, Department of Medicine, Lavagna Hospital, Lavagna, Italy
| | - Davide Personeni
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
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Köktürk U, Önalan O, Somuncu MU, Akgül Ö, Uygur B, Püşüroğlu H. Impact of triglyceride-glucose index on intracoronary thrombus burden in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2024; 34:860-867. [PMID: 38336545 DOI: 10.1016/j.numecd.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND AIMS We aimed to investigate the relationship between triglyceride glucose (TyG) index and intracoronary thrombus burden in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS AND RESULTS A total of 468 consecutive patients who were admitted with STEMI and underwent primary PCI were included in the study. TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. According to the angiographic reclassified thrombolysis in myocardial infarction (TIMI) thrombus grade, patients were divided into two groups as small thrombus burden (STB) with TIMI thrombus grade 0-3, and large thrombus burden (LTB) with TIMI thrombus grade 4-5. TyG index was significantly higher in the LTB group than in the STB group (9.11 ± 0.86 vs 8.89 ± 0.62; p = 0.002). In multivariate analysis, TyG index was found to be an independent predictor of LTB in STEMI patients who underwent primary PCI [OR (95 % CI): 1.470 (1.090-1.982), p = 0.012]. The area under the curve (AUC) of TyG index predicting LTB was 0.568 (95 % CI 0.506-0.631; p = 0.023), with the best cut-off value of 8.87. In the classification according to TyG index cut-off value, the frequency of LTB was found to be significantly higher in the high TyG index group than in the low TyG index group (33.6 % vs 21.2 %; p = 0.003). CONCLUSION TyG index, a valid surrogate marker of insulin resistance, is an independent predictor of LTB in STEMI patients who underwent primary PCI and can be used as an indicator of increased intracoronary thrombus burden.
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Affiliation(s)
- Uğur Köktürk
- Department of Cardiology, Karabuk University Training and Research Hospital, Karabuk, Turkey.
| | - Orhan Önalan
- Department of Cardiology, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Mustafa Umut Somuncu
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Özgür Akgül
- Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Begüm Uygur
- Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Püşüroğlu
- Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Peng S, Rempakos A, Mastrodemos OC, Rangan BV, Alexandrou M, Allana S, Al-Ogaili A, Mutlu D, Karacsonyi J, Bergstedt S, Khalid MS, Stanberry L, Brilakis ES. Use of the Indigo CAT RX aspiration system during percutaneous coronary intervention. Catheter Cardiovasc Interv 2024; 103:695-702. [PMID: 38419416 DOI: 10.1002/ccd.30994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The use of the Indigo CAT RX Aspiration System (Penumbra Inc.) during percutaneous coronary intervention has received limited study. METHODS We retrospectively examined the clinical, angiographic, and procedural characteristics, outcomes, and follow-up of patients who underwent mechanical aspiration thrombectomy with the Indigo CAT RX system (Penumbra Inc.) at a large tertiary care hospital between January 2019 and April 2023. RESULTS During the study period, 83 patients (85 lesions) underwent thrombectomy with the Indigo CAT RX. Mean patient age was 64.9 ± 14.48 years and 31.2% were women. The most common presentations were ST-segment elevation myocardial infarction (MI) (66.2%) and non-ST-segment elevation MI (26.5%). A final thrombolysis in MI flow grade of 3 and final myocardial blush grade of 3 were achieved in 76% and 46% of the cases, respectively. Technical success was achieved in 88.9% of the cases that included Indigo CAT RX treatment only, compared with 57.1% of the cases that also included manual aspiration. There were no device-related serious adverse events. At 30-day postprocedure, the incidence of major adverse cardiac events (composite of cardiovascular death, recurrent MI, cardiogenic shock, new or worsening New York Heart Association Class IV heart failure, stroke) was 8.5%: 1.3% stroke (postprocedure, in-hospital), 1.3% MI, 6.1% cardiac death, and 7.5% developed cardiogenic shock. CONCLUSIONS Use of the Indigo CAT RX system is associated with high technical success and acceptable risk of complications, including stroke.
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Affiliation(s)
- Sydney Peng
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman Allana
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Seth Bergstedt
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Muhmmad S Khalid
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Larissa Stanberry
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Toprak K, Toprak İH, Acar O, Ermiş MF. The predictive value of the HALP score for no-reflow phenomenon and short-term mortality in patients with ST-elevation myocardial infarction. Postgrad Med 2024; 136:169-179. [PMID: 38356155 DOI: 10.1080/00325481.2024.2319567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE ST-elevation myocardial infarction (STEMI) is a medical emergency demanding immediate intervention, and primary percutaneous coronary intervention (pPCI) is the standard of care for this condition. While PCI has proven highly effective, a subset of patients experience the devastating no-reflow phenomenon, and some face increased short-term mortality. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a novel biomarker-based tool, has recently surfaced as an innovative predictor of these adverse outcomes. This study aims to investigate the groundbreaking findings that designate a low HALP score as a robust risk factor for no-reflow and short-term mortality in STEMI patients. METHODS 1817 consecutive STEMI patients who underwent pPCI were included in this retrospective study, and the patients were divided into two groups according to whether no-reflow developed or not, and the HALP scores of the groups were compared. In addition, short-term mortality was compared between the study groups according to their HALP score values. The predictive ability of the HALP score for no-reflow was evaluated using a receiver operating characteristic curve. RESULTS No-reflow developed in 198 (10.1%) of the patients included in the study. HALP score value was found to be significantly lower in the no-reflow group (27 ± 13 vs 47 ± 24, p < 0.001). After multivariable adjustment, the HALP score was an independent predictor of no-reflow (OR, 0.923, 95% CI, 0.910-0.935, p < 0.001). Furthermore, the HALP score showed good discrimination for no-reflow (AUC, 0.771, 95% CI, 0.737-0.805, p < 0.001). In addition, HALP score was determined to be an independent predictor for short-term mortality (HR, 0.955, 95% CI, 0.945-0.966, p < 0.001). CONCLUSIONS HALP score can independently predict the development of no-reflow and short-term mortality in STEMI patients undergoing pPCI.
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Affiliation(s)
- Kenan Toprak
- Medicine, Department of Cardiology, Harran University, Sanliurfa, Turkey
| | | | - Osman Acar
- Medicine, Department of Cardiology, Harran University, Sanliurfa, Turkey
| | - Mehmet Fatih Ermiş
- Medicine, Department of Cardiology, Harran University, Sanliurfa, Turkey
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Tretyakov AY, Ermilov OV, Zakharchenko SP, Tretyakova VA, Biryukov GV, Kotova DP. [Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome]. Kardiologiia 2024; 64:60-65. [PMID: 38462805 DOI: 10.18087/cardio.2024.2.n2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 03/12/2024]
Abstract
AIM To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. MATERIAL AND METHODS This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. RESULTS The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. CONCLUSION Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.
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Yarlioglues M, Karacali K, Ilhan BC, Yalcinkaya Oner D. A retrospective study: Association of C-reactive protein and uric acid to albumin ratio with the no-reflow phenomenon in patients with ST elevation myocardial infarction. Int J Cardiol 2024; 397:131621. [PMID: 38036266 DOI: 10.1016/j.ijcard.2023.131621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The no-reflow phenomenon increases mortality and morbidity in patients with ST-segment elevation myocardial infarction (STEMI). Inflammation, endothelial dysfunction, and oxidative stress play important role in its pathophysiology. We aim to evaluate the relationship between the no-reflow phenomenon and C-reactive protein (CRP) and uric acid (UA) to albumin ratio (CUAR), which is a new marker indicating all these pathophysiological mechanisms. METHODS AND RESULTS Study population were divided into two groups as no-reflow and reflow; according to the post-procedural thrombolysis in myocardial infarction flows and myocardial blush grade. A1:4 propensity score matching was performed.CUAR was calculated by using the following formula: log10 (CRP x UA /Albumin). CUAR levels were significantly higher in patients with no-reflow than in those with reflow (P < 0.001). CUAR levels above 1.28 predicted no-reflow with higher sensitivity of 74% and specificity of 71% than all including CRP, UA and albumin (AUC = 0.80 [95%CI: 0.76-0.83], P < 0.001). In multivariate logistic regression analysis, CUAR levels above 1.28 (OR: 4.43 [3.04-6.46], 95% CI; P < 0.001) wereindependently associated with no-reflow phenomenon. CONCLUSION Our results showed that CUAR could be a basic and available marker to predict no-reflow in patients with STEMI who underwent primary percutaneous coronary intervention.
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Affiliation(s)
- Mikail Yarlioglues
- Ankara Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Kadir Karacali
- Ankara Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Bilal Canberk Ilhan
- Ankara Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Coşkun G, Ozde C, Kayapinar O, Aktore G, Ekşi E, Afşin H, Sayın AE. The Relationship of Coronary Thrombus Burden and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Score in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2024; 30:10760296241237232. [PMID: 38644774 PMCID: PMC11036931 DOI: 10.1177/10760296241237232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND The anticoagulation and risk factors in atrial fibrillation (ATRIA) score is associated with adverse cardiovascular events. However, its relationship with coronary thrombus burden is unclear. Therefore, we aimed to investigate the relationship between the ATRIA score and thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). MATERIALS AND METHODS The study was designed as a prospective cross-sectional observational study. Our study included 319 patients who were prospectively admitted with STEMI between January 2021 and April 2022. Patients were divided into 2 groups with low thrombus burden (LTB) (grade <3) and high thrombus burden (HTB) (grade ≥3). ATRIA score was calculated and recorded for all patients. ATRIA scores of both groups were compared. RESULTS In our study, 58.9% (n = 188) of patients in the LTB group and 41% (n = 131) of patients in the HTB group. The ATRIA risk score (p < .001) was significantly higher in the HTB group. In multivariate logistic regression analysis, ATRIA score, glomerular filtration rate, hypertensıon, abciximab usage, and no-reflow were found to be independent predictors of HTB in STEMI patients undergoing primary PCI. In receiver operating characteristic analysis, ATRIA score >4 had a sensitivity of 66.2% and specificity of 95.2%, and ATRIA score >8 sensitivity of 98% and specificity of 100% predicted HTB. CONCLUSION In this study, we found that thrombus burden may be associated with ATRIA risk score in patients presenting with STEMI.
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Affiliation(s)
| | - Cem Ozde
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
| | | | | | - Ensar Ekşi
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
| | - Hamdi Afşin
- Düzce Üniversitesi Tip Fakültesi, Duzce, Turkey
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Zhang Z, Sheng Z, Che W, An S, Sun D, Zhai Z, Zhao X, Yang Y, Meng Z, Ye Z, Xie E, Li P, Yu C, Gao Y, Xiao Z, Wu Y, Dong F, Ren J, Zheng J. Design and rationale of the ATTRACTIVE trial: a randomised trial of intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion in ST-segment elevation myocardial infarction patients with high thrombus burden. BMJ Open 2023; 13:e076476. [PMID: 37949622 PMCID: PMC10649700 DOI: 10.1136/bmjopen-2023-076476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION ST-segment elevation myocardial infarction (STEMI) with high thrombus burden is associated with a poor prognosis. Manual aspiration thrombectomy reduces coronary vessel distal embolisation, improves microvascular perfusion and reduces cardiovascular deaths, but it promotes more strokes and transient ischaemic attacks in the subgroup with high thrombus burden. Intrathrombus thrombolysis (ie, the local delivery of thrombolytics into the coronary thrombus) is a recently proposed treatment approach that theoretically reduces thrombus volume and the risk of microvascular dysfunction. However, the safety and efficacy of intrathrombus thrombolysis lack sufficient clinical evidence. METHODS AND ANALYSIS The intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion trial is a multicentre, prospective, open-label, randomised controlled trial with the blinded assessment of outcomes. A total of 2500 STEMI patients with high thrombus burden who undergo primary percutaneous coronary intervention will be randomised 1:1 to intrathrombus thrombolysis with a pierced balloon or upfront routine manual aspiration thrombectomy. The primary outcome will be the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, heart failure readmission, stent thrombosis and target-vessel revascularisation up to 180 days. ETHICS AND DISSEMINATION The trial was approved by Ethics Committees of China-Japan Friendship Hospital (2022-KY-013) and all other participating study centres. The results of this trial will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05554588.
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Affiliation(s)
- Zhen Zhang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhaoxue Sheng
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Wuqiang Che
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Shuoyan An
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Di Sun
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhengqin Zhai
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xuecheng Zhao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yaliu Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen Meng
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zixiang Ye
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Enmin Xie
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peizhao Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Changan Yu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhu Xiao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanfen Wu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Fen Dong
- Department of Clinical Research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jingyi Ren
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Jingang Zheng
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
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Dai C, Yang Z, Liu M, Zhou Y, Lu D, Chang S, Li C, Lu H, Chen Z, Qian J, Ge J. Prognostic value and clinical usefulness of PIANO score in patients undergoing primary percutaneous coronary intervention. Int J Cardiol 2023; 390:131258. [PMID: 37574024 DOI: 10.1016/j.ijcard.2023.131258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/29/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND In our previous study, the PIANO score was constructed to predict the occurrence of no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PCI). In the current analysis, we sought to evaluate the prognostic value and clinical usefulness of the PIANO score in this population. METHODS Patients with acute myocardial infarction (AMI) undergoing primary PCI were consecutively enrolled and followed up in this register. The endpoint of interest was all-cause mortality at 2 years after the procedure. The clinical benefits of thrombus aspiration (TA) during primary PCI in certain subgroups were also evaluated as exploratory analyses. RESULTS A total of 2100 patients were identified, and 54.3% had high (≥8) PIANO score. After 2-year follow-up, patients with high PIANO score had higher risk of all-cause mortality after adjustment for propensity score (6.7% vs. 3.1%, adjusted hazard ratio = 2.11 [1.21-3.68], p = 0.008), especially in the first month (adjusted hazard ratio = 2.33 [1.17-4.65], p = 0.017). Restricted cubic spline analysis indicated the linear association between the PIANO score and 2-year all-cause mortality (nonlinear p = 0.556). Further analysis demonstrated that TA did not reduce all-cause mortality in the overall patients, as well as in those with visible thrombus, high thrombus burden, or occlusive lesions. However, the PIANO score defined "high-risk" (PIANO score ≥ 8) patients could benefit from it. CONCLUSIONS The PIANO score had potential prognostic value in patients with AMI undergoing primary PCI. It might also be helpful for identifying patients who would benefit from TA. These observations require further confirmation in future studies.
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Affiliation(s)
- Chunfeng Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zheng Yang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Muyin Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - You Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Danbo Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
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10
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Kaplangoray M, Toprak K, Aslan R, Deveci E, Gunes A, Ardahanli İ. High CRP-albumin ratio is associated high thrombus burden in patients with newly diagnosed STEMI. Medicine (Baltimore) 2023; 102:e35363. [PMID: 37832116 PMCID: PMC10578711 DOI: 10.1097/md.0000000000035363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023] Open
Abstract
In patients undergoing primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI), an increased intracoronary thrombus burden is a strong predictive factor for adverse cardiovascular events. The C-reactive protein (CRP)-serum albumin (SA) ratio (CAR), used as an inflammatory marker, is closely associated with thrombogenicity. In this study, we investigated the relationship between coronary thrombus burden and CAR in patients undergoing pPCI due to newly diagnosed STEMI. A total of 216 patients who underwent pPCI due to STEMI were retrospectively included for the study. Angiographic thrombus burden was assessed according to thrombolysis in myocardial infarction (TIMI) grading, and those with grade 1, 2, 3 were classified as low thrombus burden (n = 120) and those with grade 4, 5 were classified as high thrombus burden (HTB) (n = 96). CAR was calculated as the ratio of CRP to SA. The average age of the patients was 60 ± 9.8, and the male ratio was 61.1. Compared to the LTB group, the HTB group had higher CAR, age, SYNTAX score, baseline cTnT, peak cTnT, CRP, glucose, WBC, and NLR while the LVEF and SA levels were lower (P < .05). Spearman's correlation analysis revealed a significant correlation between thrombus burden and CAR. The multivariable logistic regression analysis revealed that CAR (odds ratio: 10.206; 95% confidence interval: 2.987-34.872, P < .001) was a independent risk factor for HTB. According to the receiver operating characteristic (ROC) analysis, when the cutoff value for CAR was taken as ≥1.105 CAR could predict HTB with a sensitivity of 70.8% and specificity of 67.7%. Our data indicate that CAR an independent risk factor for thrombus burden.
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Affiliation(s)
| | - Kenan Toprak
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ramazan Aslan
- Department of Cardiology, Bilecik Şeyh Edebali University, Bilecik, Turkey
| | - Edhem Deveci
- Department of Cardiology, University of Health Sciences Mehmet Akif İnan Research and Training Hospital, Sanliurfa, Turkey
| | - Ahmet Gunes
- Department of Cardiology, University of Health Sciences Mehmet Akif İnan Research and Training Hospital, Sanliurfa, Turkey
| | - İsa Ardahanli
- Department of Cardiology, Bilecik Şeyh Edebali University, Bilecik, Turkey
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11
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Cioffi GM, Zhi Y, Madanchi M, Seiler T, Stutz L, Gjergjizi V, Romero JP, Attinger-Toller A, Bossard M, Cuculi F. Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus burden: Insights from a prospective cohort study. BMC Cardiovasc Disord 2023; 23:506. [PMID: 37828421 PMCID: PMC10571234 DOI: 10.1186/s12872-023-03540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. METHODS From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. RESULTS Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. CONCLUSIONS Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.
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Affiliation(s)
- Giacomo Maria Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, McMaster University, Ontario, Hamilton, Canada
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Leah Stutz
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jean-Paul Romero
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
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12
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Yoneda S, Asaumi Y, Murai K, Iwai T, Matama H, Sawada K, Miura H, Honda S, Fujino M, Takagi K, Otsuka F, Kataoka Y, Nishimura K, Noguchi T. Feasibility of rotational atherectomy in patients with acute coronary syndrome: favorable in-hospital outcomes and clinical importance of complexed coronary atherosclerosis. Heart Vessels 2023; 38:1193-1204. [PMID: 37202532 DOI: 10.1007/s00380-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
The feasibility of rotational atherectomy (RA) during percutaneous coronary intervention (PCI) in patients who present with acute coronary syndrome (ACS) remains fully unsettled. We retrospectively evaluated 198 consecutive patients who underwent RA during PCI from 2009 to 2020. All patients underwent intracoronary imaging (intravascular ultrasound 96.5%, optical coherence tomography 9.1%, both 5.6%) during PCI. Patients who underwent RA during PCI were divided into two groups: ACS (n = 49; unstable angina pectoris, n = 27; non-ST-elevation myocardial infarction, n = 18, and ST-elevation myocardial infarction, n = 4) and chronic coronary syndrome (CCS) (n = 149). The RA procedural success rate was comparable between in the ACS and CCS groups (93.9 vs. 89.9%, P = 0.41). No significant differences were observed in procedural complications and in-hospital death between the groups. The incidence of major adverse cardiovascular event (MACE) after 2 years was significantly higher in ACS group compared with CCS group (38.7 vs. 17.4%, log-rank P = 0.002). Multivariable Cox regression analysis identified SYNTAX score or CABG SYNTAX score > 22 (hazard ratio (HR) 2.66, 95% confidence interval (CI) 1.40-5.06, P = 0.002) and mechanical circulatory support during the procedure (HR 2.61, 95% CI 1.21-5.59, P = 0.013) as predictors of MACE at 2 years, but not ACS on index admission (HR 1.58, 95% CI 0.84-2.99, P = 0.151). RA procedure is feasible as a bail-out strategy for ACS lesions. However, more complexed coronary atherosclerosis and mechanical circulatory support during RA procedure, but no ACS lesions were associated with worse mid-term clinical outcomes.
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Affiliation(s)
- Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventative Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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13
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Bayramoğlu A, Hidayet Ş. Association between pan-immune-inflammation value and no-reflow in patients with ST elevation myocardial infarction undergoing percutaneous coronary intervention. Scand J Clin Lab Invest 2023; 83:384-389. [PMID: 37498164 DOI: 10.1080/00365513.2023.2241131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
Noreflow is a condition associated with a poor prognosis in ST segment elevation myocardial infarction patients. It has been shown that many inflammatory markers and index such as procalcitonin, C-reactive protein, neutrophil to lymphocyte ratio, systemic immune inflammatory index (SII), are associated with noreflow. We used a brand-new index pan-immune-inflammation value (PIV) to retrospectively evaluate the relationship between PIV and noreflow. A total of 1212 patients were included for analysis. Noreflow was observed in 145 patients. In multivariate analysis, PIV (odds ratio (OR): 1.025; [1.002-1.115], p < 0.001), baseline ejection fraction (OR: 0.963; [0.934-0.993], p = 0.015), stent length (OR: 1.032; [1.010-1.054], p = 0.004), age (OR: 1.034; [1.014-1.053], p = 0.001) and pain to PCI time (OR: 1.003 [1.002-1.005], p < 0.001) were observed to be the independent predictors of noreflow. ROC curve analysis showed that the best cut off value of PIV for predicting noreflow was ≥889 with 77.2% sensitivity and 77.5% specificity (AUC, 0.828; 95% CI [0.806-0.849]). A ROC curve comparison analysis was performed to compare PIV and SII. The predictive power of PIV was higher than SII (differences between areas: 0.154; p < 0.001). According to our findings, an increase in PIV is an independent predictor of noreflow in patients with STEMI.
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Affiliation(s)
| | - Şıho Hidayet
- Department of Cardiology, Inonu University, Malatya, Turkey
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14
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Kwon W, Choi KH, Yang JH, Chung YJ, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Gwon HC. Efficacy of thrombus aspiration in cardiogenic shock complicating acute myocardial infarction and high thrombus burden. Rev Esp Cardiol (Engl Ed) 2023; 76:719-728. [PMID: 36746233 DOI: 10.1016/j.rec.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Current guidelines do not recommend routine thrombus aspiration in acute myocardial infarction (AMI) because no benefits were observed in previous randomized trials. However, there are limited data in cardiogenic shock (CS) complicating AMI. METHODS We included 575 patients with AMI complicated by CS. The participants were stratified into the TA and no-TA groups based on use of TA. The primary outcome was a composite of 6-month all-cause death or heart failure rehospitalization. The efficacy of TA was additionally assessed based on thrombus burden (grade I-IV vs V). RESULTS No significant difference was found in in-hospital death (28.9% vs 33.5%; P=.28), or 6-month death, or heart failure rehospitalization (32.4% vs 39.4%; HRadj: 0.80; 95%CI, 0.59-1.09; P=.16) between the TA and no-TA groups. However, in 368 patients with a higher thrombus burden (grade V), the TA group had a significantly lower risk of 6-month all-cause death or heart failure rehospitalization than the no-TA group (33.4% vs 46.3%; HRadj: 0.59; 95%CI, 0.41-0.85; P=.004), with significant interaction between thrombus burden and use of TA for primary outcome (adjusted Pint=.03). CONCLUSIONS Routine use of TA did not reduce short- and mid-term adverse clinical outcomes in patients with AMI complicated by CS. However, in select patients with a high thrombus burden, the use of TA might be associated with improved clinical outcomes. The study was registered at ClinicalTrials.gov (Identifier: NCT02985008).
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Affiliation(s)
- Woochan Kwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yu Jin Chung
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Agrawal RS, Yusuf J, Mahajan B, Mehta V, Mandal S, Mukhopadhyay S. Effect of prasugrel versus ticagrelor on coronary microcirculation in patients undergoing pharmacoinvasive strategy - acute and short-term results. Coron Artery Dis 2023; 34:381-388. [PMID: 37471285 DOI: 10.1097/mca.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Both ticagrelor and prasugrel are class I recommendations for treatment of ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) [ 1 ]. But clinical outcomes with the two drugs are conflicting which might be due to differential effects on coronary microcirculation. No study to date had compared the effects of prasugrel or ticagrelor on coronary microcirculation in patients undergoing pharmacoinvasive PCI (pPCI). AIM AND OBJECTIVE To compare the effects of prasugrel and ticagrelor on coronary microcirculation in STEMI patients undergoing pPCI as assessed by Myocardial Blush Grade (MBG). The secondary aim was to assess flow in the infarct-related artery by corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC) and whether a differential effect if detected on coronary microcirculation translated in improvement in left ventricular ejection fraction assessed at 6 months. MATERIAL AND METHODS A total of 240 patients with STEMI were evaluated in this open-label randomized control trial who initially underwent thrombolysis and later PCI (from 24 to 48 h) post-successful thrombolysis. The study subjects were randomized to receive either ticagrelor ( n = 120) or prasugrel ( n = 120) in 1 : 1 ratio 2 h prior to elective PCI. Patients underwent PCI according to standard protocol and post-procedure cTFC and MBG were compared. Patients were also followed up for 6 months to compare ejection fractions in both groups. We also assessed the effect of the two drugs on bleeding complications during hospitalization and over 6-month follow-up period. RESULTS There were no significant differences between the two groups with respect to baseline characteristics. Prasugrel administration resulted in higher MBG Grade 3 (50.86% vs 33.89%, P = 0.012) and lower cTFC (17.14 ± 4.08 vs 19.3 ± 4.06, P < 0.01). Improvement in ejection fraction was significantly higher with prasugrel compared to ticagrelor (10.29% ± 15.2 vs 4.66% ± 13.5, P = 0.003). Bleeding events at 6 months follow-up according to TIMI classification were similar in both the groups (11.86% vs 6.9%, P = 0.39). CONCLUSION Prasugrel produces greater improvement in coronary microcirculation than Ticagrelor resulting in improved myocardial salvage in patients of STEMI undergoing pPCI.
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Affiliation(s)
| | | | - Bhawna Mahajan
- Department of Biochemistry, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | | | - Sunil Mandal
- Department of Cardiology
- Department of Biochemistry, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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16
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Zhou L, Hu X, Zhang H, Lu H, Lin Y, Wang W, Yu B, Liang W, Zhou Y, Li G, Dong H. Effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction. J Int Med Res 2023; 51:3000605231182547. [PMID: 37377087 DOI: 10.1177/03000605231182547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Evidence of therapy for dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is limited. This study was performed to compare the effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation. METHODS This retrospective study enrolled 597 consecutive patients with STEMI who underwent pPCI in 3 centers from June 2016 to December 2019. Dysfunctional coronary circulation was defined by the thrombolysis in myocardial infarction (TIMI) grade and the TIMI myocardial perfusion grade (TMPG). Logistic regression analysis was used to evaluate the impact of different statin types on dysfunctional coronary circulation. RESULTS The incidence of TIMI no/slow reflow did not differ between the two groups, but the incidence of TMPG no/slow reflow was significantly lower in the atorvastatin than rosuvastatin group (44.58% vs. 57.69%, respectively). After multivariate adjustment, the odds ratio with 95% confidence interval of rosuvastatin was 1.72 (1.17-2.52) for after pretreatment TMPG no/slow reflow and 1.73 (1.16-2.58) for after stenting TMPG no/slow reflow. Atorvastatin and rosuvastatin showed no significant differences in clinical outcomes during hospitalization. CONCLUSIONS Compared with rosuvastatin, atorvastatin was associated with better coronary microcirculatory perfusion in patients with STEMI who underwent pPCI.
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Affiliation(s)
- Langping Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haotian Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haoyu Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yan Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Shantou University Medical College, Shantou, China
| | - Weimian Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wensheng Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Nyingchi People's Hospital, Nyingchi, China
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Osinalde EP, Bastante T, Cecconi A, Muñiz ÁM, García-Guimaraes M, Rivero F, Rojas-González A, Olivera MJ, Salamanca J, de Isla LP, De Agustín JA, Caballero P, Torres RA, Jiménez-Borreguero LJ, Alfonso F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy: the MATURE prospective study (MSCT to Assess ThrombUs REsolution). Coron Artery Dis 2023; 34:167-176. [PMID: 36762665 DOI: 10.1097/mca.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. METHODS We systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa ( K ) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. RESULTS Thirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good ( K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. CONCLUSIONS Although CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.
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Affiliation(s)
- Eduardo Pozo Osinalde
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Álvaro Montes Muñiz
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Marcos García-Guimaraes
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Hospital del Mar - Parc de Salut Mar, Barcelona
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Antonio Rojas-González
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | | | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rio Aguilar Torres
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
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Aono-Setoguchi H, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with intensive care unit delirium in patients with acute myocardial infarction. Heart Vessels 2023; 38:478-487. [PMID: 36399179 DOI: 10.1007/s00380-022-02200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
Some patients admitted to intensive care units (ICU) would develop delirium, which is associated with poor prognosis. The purpose of this retrospective study was to identify factors associated with ICU delirium in patients with acute myocardial infarction (AMI). We included 753 AMI and divided those into the ICU-delirium group (n = 110) and the non-ICU-delirium group (n = 643) according to the presence of ICU delirium. The ICU delirium was evaluated by confusion assessment method for the intensive care unit. Patient characteristics and clinical outcomes were compared between the 2 groups, and factors associated with ICU delirium were sought by multivariate analysis. The prevalence of female sex was significantly higher in the ICU-delirium group (43.6%) than in the non-ICU-delirium group (20.2%) (p < 0.001). The incidence of in-hospital death was significantly higher in the ICU-delirium group (17.3%) than in the non-ICU-delirium group (0.5%) (p < 0.001). The multivariate logistic regression analysis revealed that age [every 10 years increase: odds ratio (OR) 1.439, 95% confidence interval (CI) 1.127-1.837, p = 0.004], female sex (OR 2.237, 95%CI 1.300-3.849, p = 0.004), triple vessel disease (OR 2.317, 95%CI 1.365-3.932, p = 0.002), body mass index < 18.5 kg/m2 (OR 2.910, 95%CI 1.410-6.008, p = 0.004), use of mechanical support (OR 2.812, 95%CI 1.500-5.270, p = 0.001), respiratory failure (OR 5.342, 95%CI 3.080-9.265, p < 0.001), and use of continuous renal replacement therapy (OR 5.901, 95%CI 2.520-13.819, p < 0.001) were significantly associated with ICU delirium. In conclusion, ICU delirium was associated with in-hospital death. Older age, female sex, triple vessel disease, leanness, use of mechanical support, respiratory failure, and continuous renal replacement therapy were significantly associated with the occurrence of ICU delirium.
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Affiliation(s)
- Hitomi Aono-Setoguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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19
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Yusuf J, Pandey PK, Mehta V, Mukhopadhyay S. R wave peak time and no reflow following primary percutaneous coronary intervention: Immediate and short-term outcomes. J Electrocardiol 2023; 79:66-74. [PMID: 36963284 DOI: 10.1016/j.jelectrocard.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND No reflow (NR) remains an important constraint in management of ST elevation myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Most ECG parameters validated till date including ST resolution are postprocedural. R wave peak time (RWPT) is a dynamic parameter and reflects conduction delay in ischaemic myocardium in selected leads supplied by infarct related artery (IRA). The present study was undertaken to see whether preprocedural RWPT per se or RWPT following primary PCI can predict persistence of NR along with immediate and short-term clinical outcome. METHODS 200 patients were enrolled after exclusion. Clinical, Biochemical, ECG parameters including RPWT and angiographic parameters (pre- and post-procedure) were recorded. ECG papers was analysed using digital image processing software (http://imagej.nih.gov/ij/). All patients were followed up for 6 months. RESULTS NR was observed in 35% of the patients. Age, Diabetes, symptom to balloon time, higher thrombus burden, peak CPK-MB level (pre and post procedure) were significantly higher in NR group. On ECG analysis, baseline RWPT, QRS duration and pathological Q wave were significantly higher in NR group. On multivariate analysis, age (OR 1.10 CI 1.00-1.21 P = 0.04), thrombus grade ≥ 3 in IRA (OR 12.38 CI 2.08-73.58 P = 0.006), symptom to balloon time (OR 2.18 CI 1.6-3.0 P < 0.001) and baseline RWPT on ECG [OR 1.86 CI 1.24-2.78, P = 0.003] were found to be independent predictors of NR. Increase in RWPT following primary PCI was found to both highly sensitive and specific for diagnosing persistence of NR after primary PCI. Follow up at the end of 6 months has shown that patients with increased RWPT following primary PCI had worse short-term cardiovascular outcomes compared to those with decreased RWPT following primary PCI. CONCLUSION Baseline RWPT is a significant predictor of NR in patients of STEMI undergoing primary PCI. A persistently increased RWPT following primary PCI is also a highly sensitive and specific ECG marker of persistence of NR which is associated with adverse short-term clinical outcome.
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Affiliation(s)
- Jamal Yusuf
- Department of Cardiology, D.M. Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India
| | - Purneshwar Kumar Pandey
- Department of Cardiology, D.M. Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India
| | - Vimal Mehta
- Department of Cardiology, D.M. Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, D.M. Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India.
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Kulick N, Friede KA, Stouffer GA. Safety and efficacy of intracoronary thrombolytic agents during primary percutaneous coronary intervention for STEMI. Expert Rev Cardiovasc Ther 2023; 21:165-175. [PMID: 36825458 DOI: 10.1080/14779072.2023.2184353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Large thrombus burden in patients with ST elevation myocardial infarction (STEMI) is associated with higher rates of distal embolization, no-reflow phenomenon, abrupt closure, stent thrombosis, major adverse cardiovascular events (MACE), and mortality. Intracoronary (IC) thrombolytic agents are theoretically attractive as an adjunct to primary percutaneous coronary intervention (PPCI) as they activate endogenous fibrinolysis which results in degradation of the cross-linked fibrin matrix in coronary thrombus. AREAS COVERED We reviewed published studies reporting on intraprocedural anti-thrombus strategies used during PPCI including randomized controlled trials and observational studies. EXPERT OPINION Published studies are limited by small sample size and heterogeneity due to variation in indication, inclusion criteria, thrombolytic agent, dose, delivery mechanisms, antiplatelet and anticoagulant regimen, timing in regard to reperfusion, PCI techniques, and endpoints. Despite these limitations, data are consistent that IC administration of thrombolytic agents at low doses is associated with low rates of bleeding and vascular complications. While there is currently no compelling data demonstrating a benefit to the routine use of IC thrombolytic therapy in patients with STEMI, there is suggestive data that IC thrombolysis may have benefit in selected patients.
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Affiliation(s)
- Natasha Kulick
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Kevin A Friede
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - George A Stouffer
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
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21
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Mathews SJ, Parikh SA, Wu W, Metzger DC, Chambers JW, Ghali MG, Sumners MJ, Kolski BC, Pinto DS, Dohad S. Sustained Mechanical Aspiration Thrombectomy for High Thrombus Burden Coronary Vessel Occlusion: The Multicenter CHEETAH Study. Circ Cardiovasc Interv 2023; 16:e012433. [PMID: 36802804 PMCID: PMC9944712 DOI: 10.1161/circinterventions.122.012433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Poor myocardial reperfusion due to distal embolization and microvascular obstruction after percutaneous coronary intervention is associated with increased risk of morbidity and mortality. Prior trials have not shown a clear benefit of routine manual aspiration thrombectomy. Sustained mechanical aspiration may mitigate this risk and improve outcomes. The objective of this study is to evaluate sustained mechanical aspiration thrombectomy before percutaneous coronary intervention in high thrombus burden acute coronary syndrome patients. METHODS This prospective study evaluated the Indigo CAT RX Aspiration System (Penumbra Inc, Alameda CA) for sustained mechanical aspiration thrombectomy before percutaneous coronary intervention at 25 hospitals across the USA. Adults presenting within 12 hours of symptom onset with high thrombus burden and target lesion(s) located in a native coronary artery were eligible. The primary end point was a composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York Heart Association class IV heart failure within 30 days. Secondary end points included Thrombolysis in Myocardial Infarction thrombus grade, Thrombolysis in Myocardial Infarction flow, myocardial blush grade, stroke, and device-related serious adverse events. RESULTS From August 2019 through December 2020, a total of 400 patients were enrolled (mean age 60.4 years, 76.25% male). The primary composite end point rate was 3.60% (14/389 [95% CI, 2.0-6.0%]). Rate of stroke within 30 days was 0.77%. Final rates of Thrombolysis in Myocardial Infarction thrombus grade 0, Thrombolysis in Myocardial Infarction flow 3, and myocardial blush grade 3 were 99.50%, 97.50%, and 99.75%, respectively. No device-related serious adverse events occurred. CONCLUSIONS Sustained mechanical aspiration before percutaneous coronary intervention in high thrombus burden acute coronary syndrome patients was safe and was associated with high rates of thrombus removal, flow restoration, and normal myocardial perfusion on final angiography.
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Affiliation(s)
- S. Jay Mathews
- Bradenton Cardiology Center, Manatee Memorial Hospital, FL (S.J.M.)
| | - Sahil A. Parikh
- Columbia University Irving Medical Center, New York, NY (S.A.P.)
| | - Willis Wu
- North Carolina Heart and Vascular Research, Raleigh (W.W.)
| | | | | | | | | | | | - Duane S. Pinto
- Beth Israel Deaconess Medical Center, Boston, MA (D.S.P.)
| | - Suhail Dohad
- Cedars-Sinai Medical Center, Los Angeles, CA (S.D.)
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22
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Beska B, Ratcovich H, Bagnall A, Burrell A, Edwards R, Egred M, Jordan R, Khan A, Mills GB, Morrison E, Raharjo DE, Singh F, Wilkinson C, Zaman A, Kunadian V. Angiographic and Procedural Characteristics in Frail Older Patients with Non-ST Elevation Acute Coronary Syndrome. Interv Cardiol 2023; 18:e04. [PMID: 37614703 PMCID: PMC10442670 DOI: 10.15420/icr.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/10/2022] [Indexed: 08/25/2023] Open
Abstract
Background Angiographic and procedural characteristics stratified by frailty status are not known in older patients with non-ST elevation acute coronary syndrome (NSTEACS). We evaluated angiographic and procedural characteristics in older adults with NSTEACS by frailty category, as well as associations of baseline and residual SYNTAX scores with long-term outcomes. Methods In this study, 271 NSTEACS patients aged ≥75 years underwent coronary angiography. Frailty was assessed using the Fried criteria. Angiographic analysis was performed using QAngio® XA Medis in a core laboratory. Major adverse cardiovascular events (MACE) consisted of all-cause mortality, MI, stroke or transient ischaemic attack, repeat unplanned revascularisation and significant bleeding. Results Mean (±SD) patient age was 80.5 ± 4.9 years. Compared with robust patients, patients with frailty had more severe culprit lesion calcification (OR 5.40; 95% CI [1.75-16.8]; p=0.03). In addition, patients with frailty had a smaller mean improvement in culprit lesion stenosis after percutaneous coronary intervention (50.6%; 95% CI [45.7-55.6]) than robust patients (58.6%; 95% CI [53.5-63.7]; p=0.042). There was no association between frailty phenotype and completeness of revascularisation (OR 0.83; 95% CI [0.36-1.93]; p=0.67). A high baseline SYNTAX score (≥33) was associated with adjusted (age and sex) 5-year MACE (HR 1.40; 95% CI [1.08-1.81]; p=0.01), as was a high residual SYNTAX score (≥8; adjusted HR 1.22; 95% CI [1.00-1.49]; p=0.047). Conclusion Frail adults presenting with NSTEACS have more severe culprit lesion calcification. Frail adults were just as likely as robust patients to receive complete revascularisation. Baseline and residual SYNTAX score were associated with MACE at 5 years.
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Affiliation(s)
- Benjamin Beska
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Hanna Ratcovich
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Department of Cardiology, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | - Alan Bagnall
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Amy Burrell
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Mohaned Egred
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | | | - Amina Khan
- Leeds Teaching Hospitals NHS TrustLeeds, UK
| | - Greg B Mills
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | - Emma Morrison
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
| | | | - Fateh Singh
- Sandwell and West Birmingham Hospitals NHS TrustBirmingham, UK
| | - Chris Wilkinson
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle UniversityNewcastle, UK
| | - Azfar Zaman
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle UniversityNewcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
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23
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Dolu AK, Karayiğit O, Ozkan C, Çelik MC, Kalçık M. Relationship between intracoronary thrombus burden and systemic immune-inflammation index in patients with ST-segment elevation myocardial infarction. Acta Cardiol 2023; 78:72-79. [PMID: 35105281 DOI: 10.1080/00015385.2022.2035082] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM This study aimed to evaluate the relationship between intracoronary thrombus burden and systemic immune-inflammation index (SII) and to compare the predictive capacity of SII together with the neutrophil-lymphocyte ratio (NLR), and the platelet-lymphocyte ratio (PLR) in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). PATIENT & METHODS A total of 425 patients were included in the study. The clinical, laboratory, and demographic characteristics of the patients were recorded. The thrombus classification "Thrombolysis in myocardial infarction (TIMI)" was used to assess the intracoronary thrombus burden. According to the TIMI thrombus classification, 229 (54%) patients with low thrombus burden (grade 0-3) and 196 (46%) patients with high thrombus burden (grade 4 and 5) were compared. SII was calculated as platelet × neutrophil/lymphocyte counts. RESULTS High NLR (OR: 1.068, 95% CI:1.023-1.404; p = 0.031), PLR(OR: 1.012, 95% CI:1.002-1.018; p = 0.043), SII(OR: 1.325, 95% CI: 1.156-1.879; p = 0.015) and low left ventricle ejection fraction (LVEF) (OR: 0.957, 95% CI:0.924-0.990; p = 0.012) were found to be independent predictors of high thrombus burden. SII values above 812 predicted a high thrombus burden with a sensitivity of 82% and specificity of 73% (AUC: 0.836; 95% CI:0.795-0.877; p < 0.001). This predictiveness of SII was stronger as compared to NLR (0.836 vs. 0.818, p = 0.043) and PLR (0.836 vs. 0.780, p < 0.001). CONCLUSION SII is an independent predictor of high thrombus burden in patients with STEMI. In addition, SII is superior to NLR and PLR in this regard.
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Affiliation(s)
- Abdullah Kadir Dolu
- Department of Cardiology, Izmir Katip Çelebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Orhan Karayiğit
- Department of Cardiology, Yozgat City Hospital, Yozgat, Turkey
| | - Can Ozkan
- Department of Cardiology, Muş State Hospital, Muş, Turkey
| | - Muhammet Cihat Çelik
- Department of Cardiology, Hitit University Erol Olçok Education and Research Hospital, Corum, Turkey
| | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Corum, Turkey
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Kaplangoray M, Toprak K, Cekici Y, Yildirim A, Abacioglu OO. Relationship between blood viscosity and thrombus burden in ST-segment elevation myocardial infarction. Clin Hemorheol Microcirc 2023; 85:31-40. [PMID: 37522201 DOI: 10.3233/ch-231756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND İncreased whole blood viscosity (WBV) is associated with increased infarct area, impaired microvascular circulation and mortality in patients with ST-elevation myocardial infarction (STEMI). OBJECTIVES We aimed to analyze the association between the WBV and thrombus burden (TB) in STEMI patients. METHODS This cross-sectional study included 167 STEMI patients who received primary percutaneous coronary intervention. WBV values were assessed using hematocrit and total protein values, and low shear rate(LSR) and high shear rate(HSR) were calculated. Angiographic TB was assessed according to the definition of the Thrombolysis in Myocardial Infarction (TIMI) study group. The cases were dichotomized into low TB (grade 1-3) (n = 87) and high TB (grade 4-5) (n = 80) groups. RESULTS The mean HSR and LSR values of the high TB group were significantly increased compared to the low TB group (p < 0.001, for each). In ROC analysis,for prediction of TB, a cut-off value of 3.83 WBV for HSR had a 71% sensitivity and a 60.7% specificity, and a cut-off value of 21 WBV for LSR had a 70% sensitivity and 59.9% specificity (p < 0.001,for each). Multivariate regression analysis showed that both HSR (OR = 2.408;p=0.020) and LSR (OR = 1.055;p=0.021) were independent predictors for high TB. CONCLUSION İncreased WBV was an independent predictor for the presence of high TB in patients with STEMI.
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Affiliation(s)
- Mustafa Kaplangoray
- Department of Cardiology, University of Health Sciences, Mehmet Akif İnan Research and Training Hospital, Sanlíurfa, Turkey
| | - Kenan Toprak
- Republic of Turkey Ministry of Health Siverek State Hospital, Cardiology Department, Sanlíurfa, Turkey
| | - Yusuf Cekici
- Department of Cardiology, Bilecik Şeyh Edebali University, Faculty of Medicine, Bilecik, Turkey
| | - Arafat Yildirim
- Department of Cardiology, University of Health Sciences, Adana, Health Practice and Research Center, Adana, Turkey
| | - Ozge Ozcan Abacioglu
- Department of Cardiology, University of Health Sciences, Adana, Health Practice and Research Center, Adana, Turkey
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25
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Muacevic A, Adler JR. Intra-Aortic Balloon Pump During Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With High Thrombus Burden and Cardiogenic Shock. Cureus 2023; 15:e34188. [PMID: 36843698 PMCID: PMC9951549 DOI: 10.7759/cureus.34188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) with high-grade thrombus is a high-risk intervention associated with poor clinical outcomes. Circulatory support with an intra-aortic balloon pump (IABP) during PCI may potentially improve coronary hemodynamics and clinical outcomes in such patients. As existing data on this situation are sparse, we did an observational study to determine short-term outcomes of PCI with IABP support in STEMI patients with high thrombus burden. OBJECTIVES To determine whether IABP has a potential role in improving outcomes in patients with STEMI with high thrombus burden who are undergoing PCI. METHODS AND RESULTS Thirty consecutive patients of STEMI with high thrombus burden undergoing PCI with IABP assistance were included. Ninety-three percent of patients had a cardiogenic shock. Clinical and angiographic outcomes assessed include a change in left ventricular ejection fraction (LVEF), 30-day mortality, and assessment of TIMI (thrombolysis in myocardial infarction) flow, TIMI frame count, and TIMI myocardial perfusion grade in the culprit vessel. IABP was initiated before coronary angiography in 36.6% (n=11), between angiography and PCI in 30% (n=9), and after PCI in 33.3% (n=10) of patients. During the 30-day follow-up period, 50% (n=15) of patients died. 86.6% (n=13) of survivors had pre-PCI IABP initiation compared to only 46.6% (n=7) among those who died (p=0.020). With pre-PCI IABP initiation (n=20), 30-day mortality was 35% (n=7) compared to 80% (n=8) with post-PCI IABP initiation (n=10) (p=0.020). CONCLUSION IABP initiation before PCI in STEMI complicated by cardiogenic shock and high angiographic thrombus burden can decrease mortality without any effect on angiographic parameters.
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Damonte JI, Fernández AD, Agatiello CR, Seropian IM. Dual Role of Guide Extension Catheters for the Management of High Thrombus Burden in STEMI: Case Report and Mini Review. Cardiovasc Revasc Med 2022; 45:74-77. [PMID: 35909034 DOI: 10.1016/j.carrev.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Abstract
High thrombus burden in ST segment elevation myocardial infarction (STEMI) patients increases the risk of adverse events. In this report, we review current strategies for high thrombus burden and present a case report with the combination of two different techniques: aspiration through a guide extension catheter followed by local intracoronary thrombolysis with 'marinade' technique.
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Affiliation(s)
- Juan I Damonte
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro D Fernández
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carla R Agatiello
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio M Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Nepper-Christensen L, Kelbæk H, Ahtarovski KA, Høfsten DE, Holmvang L, Pedersen F, Tilsted HH, Aarøe J, Jensen SE, Raungaard B, Terkelsen CJ, Køber L, Engstrøm T, Lønborg J. Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER. Eur Heart J Acute Cardiovasc Care 2022; 11:742-748. [PMID: 36006808 DOI: 10.1093/ehjacc/zuac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
AIMS Stent implantation during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) occasionally results in flow disturbances and distal embolization, which may cause adverse clinical outcomes. Deferred stent implantation seems to reduce the impairment on myocardial function, although the mechanisms have not been clarified. We sought to evaluate whether deferred stenting could reduce flow disturbance in patients treated with primary PCI. METHODS AND RESULTS Patients with STEMI included in the DANAMI-3-DEFER trial were randomized to deferred versus immediate stent implantation. The primary and secondary outcomes of this substudy were the incidences of slow/no reflow and distal embolization. A total of 1205 patients were included. Deferred stenting (n = 594) resulted in lower incidences of distal embolization [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46-0.98, P = 0.040] and slow/no reflow (OR 0.60, 95%CI 0.37-0.97, P = 0.039). In high-risk subgroups, the protective effect was greatest in patients >65 years of age (slow/no reflow: OR 0.36, 95% CI 0.17-0.72, P = 0.004 and distal embolization: OR 0.34, 95% CI 0.18-0.63, P = 0.001), in patients presenting with occluded culprit artery at admission (slow/no reflow: OR 0.33, 95% CI 0.16-0.65, P = 0.001 and distal embolization: OR 0.54, 95% CI 0.31-0.96, P = 0.036) and in patients with thrombus grade >3 (slow/no reflow: OR 0.37, 95% CI 0.20-0.67, P = 0.001 and distal embolization: OR 0.39, 95% CI 0.24-0.64, P < 0.001) with a significant P for interaction for all. CONCLUSION Deferred stent implantation reduces the incidences of slow/no reflow and distal embolization, especially in older patients and in those with total coronary occlusion or high level of thrombus burden.
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Affiliation(s)
- Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Kiril A Ahtarovski
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 AalborgDenmark
| | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 AalborgDenmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 AalborgDenmark
| | - Christian J Terkelsen
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
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Kiris T, Avci E, Ekin T, Akgün DE, Tiryaki M, Yidirim A, Hazir K, Murat B, Yeni M, Altindag R, Gül S, Arik B, Güzel T, Murat S, Oz A, Karabacak M, Aktas Z, Yildirim T, Kilicaslan B, Ergene AO. Comparison of long-term outcome of patients with ST-segment elevation myocardial infarction between pre-COVID-19 and COVID-19 era. Eur J Clin Invest 2022; 52:e13834. [PMID: 35851657 PMCID: PMC9349930 DOI: 10.1111/eci.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
AIMS To compare major cardiovascular and cerebrovascular events (MACCE) rates between patients in the pre-COVID-19 era and COVID-19 era, and to assess the impact of the presence of COVID-19 (+) on long-term MACCE in ST-segment elevation myocardial infarction (STEMI) in Turkey. METHODS Using the TURSER study (TURKISH ST-segment elevation myocardial infarction registry) data, the current study included 1748 STEMI patients from 15 centres in Turkey. Patients were stratified into COVID-19 era (March 11st-May 15st, 2020; n = 723) or pre-COVID-19 era (March 11st-May 15st, 2019; n = 1025) cohorts. Long-term MACCE rates were compared between groups. In addition, the effect of COVID-19 positivity on long-term outcomes was evaluated. The primary outcome was the occurrence of MACCE at long-term follow-up, and the secondary outcome was hospitalization with heart failure. RESULTS The MACCE and hospitalization with heart failure rates between pre-COVID-19 era and COVID-19 era were 23% versus 22% (p = .841), and 12% versus 8% (p = .002), respectively. In the COVID-19 era, the rates of MACCE and hospitalization with heart failure COVID-19-positive versus COVID-19-negative patients were 40% versus 20%, (p < .001), and 43% versus 11% (p < .001), respectively. CONCLUSION There was no difference between the pre-COVID-19 era and the COVID-19 era in terms of MACCE in STEMI patients in Turkey. In the COVID-19 era, STEMI patients positive for COVID-19 had a higher rate of MACCE and heart failure hospitalization at the long-term follow-up.
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Affiliation(s)
- Tuncay Kiris
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Eyüp Avci
- Department of Cardiology, Balikesir University Medical School, Balikesir, Turkey
| | - Tuba Ekin
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - Didar Elif Akgün
- Department of Cardiology, Balikesir University Medical School, Balikesir, Turkey
| | - Mücahit Tiryaki
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Arafat Yidirim
- Department of Cardiology, Ministry Of Health Adana City Training & Research Hospital, Adana, Turkey
| | - Kutluhan Hazir
- Department of Cardiology, Izmir University Of Health Sciences Tepecik Training And Research Hospital, Izmir, Turkey
| | - Bektaş Murat
- Department of Cardiology, Ministry Of Health Eskisehir City Hospital, Eskisehir, Turkey
| | - Mehtap Yeni
- Department of Cardiology, Ministry Of Health Isparta City Hospital, Isparta, Turkey
| | - Rojhad Altindag
- Department of Cardiology, Training and Research Hospital, Health Sciences University Diyarbakır Gazi Yasargil, Diyarbakır, Turkey
| | - Sefa Gül
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Baran Arik
- Dicle University Medical School, Dicle University, Diyarbakır, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Selda Murat
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ahmet Oz
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Karabacak
- Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Zihni Aktas
- Department of Cardiology, BalikesirAtaturk City Hospital, Balikesir, Turkey
| | - Tarik Yildirim
- Department of Cardiology, Balikesir University Medical School, Balikesir, Turkey
| | - Baris Kilicaslan
- Department of Cardiology, Izmir University Of Health Sciences Tepecik Training And Research Hospital, Izmir, Turkey
| | - Asim Oktay Ergene
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
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Singh R, Singla SK, Singla A, Manchanda S, Kaur M. Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study. Int J Appl Basic Med Res 2022; 12:260-264. [PMID: 36726658 PMCID: PMC9886142 DOI: 10.4103/ijabmr.ijabmr_407_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden. Aim Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI. Materials and Methods and Results This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%. Conclusions Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects.
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Affiliation(s)
- Rakendra Singh
- Department of Medicine, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India
| | - Sanjeev Kumar Singla
- Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India
| | - Ankush Singla
- Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India
| | - Surbhi Manchanda
- Department of Medicine, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India
| | - Manjot Kaur
- Department of Radiology, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India
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Aktürk İF, Yıldız C, Karabulut D, Oflar E, Şahin A, Ertuğrul AS, Koyuncu A, Polat V, Karahan A, Koşar F, Alp İB, Keskin K, Çağlar FNT. Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience. Acta Cardiol 2022; 77:720-728. [PMID: 34427169 DOI: 10.1080/00015385.2021.1967614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. METHODS A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. RESULTS During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). CONCLUSION Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.
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Affiliation(s)
- İbrahim Faruk Aktürk
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Cennet Yıldız
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Dilay Karabulut
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Ersan Oflar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Alparslan Şahin
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Abdulcelil Sait Ertuğrul
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Atilla Koyuncu
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Veli Polat
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Aysun Karahan
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Feridun Koşar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - İlayda Bostancı Alp
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Fatma Nihan Turhan Çağlar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
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Watanabe T, Akasaka T, Kobara S, Yamamoto K. Successful visible thrombus aspiration in ST-segment elevation myocardial infarction: associated factors and the clinical impact. Coron Artery Dis 2022; 33:479-484. [PMID: 35811556 DOI: 10.1097/mca.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thrombus aspiration (TA) has been considered a procedure for controlling distal emboli and improving microvascular perfusion. However, current guidelines classify routine TA as class III recommendation, and it has been reported that the efficacy of TA is limited because of the relatively high incidence of failure in retrieval of thrombotic material. The aim of this study was to explore patient characteristics and procedural factors associated with successful TA in ST-elevation myocardial infarction (STEMI) and to assess the clinical impact of successful TA. METHODS This single-center retrospective study enrolled 158 STEMI patients who underwent TA as initial recanalization. Factors associated with successful TA, which was defined as retrieving any visible material by aspiration catheter, were explored, and angiographical and short-term outcomes were assessed. RESULTS In 146 cases (92.4%), the aspiration catheter reached the culprit lesion. Successful TA was achieved in 72 cases (45.6%). The single angiographical characteristic of successful TA was a higher Thrombolysis in Myocardial Infarction grade before TA. Among the procedural characteristics, the rate of successful TA was higher with a 7-French aspiration catheter compared with the rate with a 6-French catheter (57.1% vs. 29.9%, P = 0.01). Thrombolysis in Myocardial Infarction grade 3 flow was more frequent in patients with successful TA immediately after TA (36.1% vs. 16.3%, P = 0.006) and at final angiography (91.7% vs 79.1%, P = 0.04) compared with the grade in patients without successful TA, respectively. CONCLUSIONS The use of a larger aspiration catheter may be effective in retrieving visible thrombus material, and successful TA led to better angiographical results.
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Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
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Faysal Şaylık, Tufan Çınar, Murat Selçuk, İbrahim Halil Tanboğa. The predictive value of triglyceride-glucose index for in-hospital and one-year mortality in elderly non-diabetic patients with ST-segment elevation myocardial infarction. J Geriatr Cardiol 2022; 19. [PMID: 36339471 DOI: 10.11909/j.issn.1671-5411.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index, a reliable marker of insulin resistance, was associated with cardiovascular morbidity and mortality. This study aimed to evaluate the predictive value of TyG index for mortality in elderly non-diabetic patients with ST-segment elevation myocardial infarction (STEMI). METHODS In total, 430 non-diabetic patients aged over 65 years with STEMI were consecutively included. The TyG index was calculated by using the following formula: TyG index = ln (fasting triglyceride × fasting glucose/2). The 5-item modified frailty index score was utilized to determine comorbidities. Patients were divided into three groups based on TyG index tertiles. RESULTS Patients included into high TyG index tertile were male and had higher body mass index, glucose, triglyceride, low-density lipoprotein cholesterol, 5-item modified frailty index and GRACE risk score; and had low systolic blood pressure, estimated glomerular filtration rate and left ventricular ejection fraction. A one-unit increase in TyG index was associated with 3.03 extra cases per 1000 person-day for in-hospital mortality and 0.29 extra cases per 1000 person-day for long-term mortality. There was a non-linear relationship between TyG index and the risk of mortality with an increased risk above 8.5 for TyG index. Kaplan-Meier survival curves revealed that patients in high TyG index tertile had higher in-hospital and long-term mortality rates than those in low TyG index tertile. CONCLUSIONS This was the first study to demonstrate that the TyG index could predict in-hospital and long-term mortality in elderly non-diabetic STEMI patients.
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Külahçıoğlu Ş, Kültürsay B, Çeneli D, Bıyıklı K, Danışman N, Karaçam M, Tuncer ŞB, Demirci K, Eminoğlu H, Korun O, Karagöz A, Kaymaz C. Obesity Paradox in Coronary Thrombus Burden of Patients with Acute Coronary Syndrome. Metab Syndr Relat Disord 2022; 20:489-496. [PMID: 36037015 DOI: 10.1089/met.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Although obesity is a risk factor for ACS, decreased mortality has been shown in overweight individuals. This study aims to determine the association of body fat parameters such as body fat percentage (BFP), relative fat mass (RFM), and coronary thrombus burden with angiographic thrombotic grade in a series of patients presenting with ACS. Methods: Three hundred ninety patients who underwent percutaneous coronary intervention were enrolled in the study. BFP was calculated using the U.S. Navy formula. RFM index was calculated using gender, height, and waist circumference regardless of weight. Body mass index (BMI) is calculated as the weight in kilograms divided by the square of body length in meters (kg/m2). Two experienced interventional cardiologists reviewed coronary angiograms according to the TIMI thrombus scale. Patients were divided into groups according to thrombus classification and clinical status. Results: RFM, which is an anthropometric measurement parameter for obesity, was inversely related to thrombus burden in patients with ACS. There were no significant differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups according to demographic, clinical characteristics, and coronary risk factors. Likewise, RFM, BFP, and BMI were comparable between the two groups. BFP and RFM were lower in patients with thrombus present STEMI group compared with no thrombus group. Thrombus presence was also compared in the NSTEMI group, and BMI, BFP, and RFM were lower in patients with thrombus present NSTEMI group. Conclusions: Our analysis demonstrated that RFM was better than BFP and BMI for predicting thrombus presence in patients with ACS.
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Affiliation(s)
- Şeyhmus Külahçıoğlu
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Doğancan Çeneli
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kadir Bıyıklı
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Neşri Danışman
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Murat Karaçam
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Şeref Berk Tuncer
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Koray Demirci
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Halit Eminoğlu
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Okan Korun
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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Çakmak Karaaslan Ö, Çöteli C, Özilhan MO, Akdi A, Başyiğit F, Selçuk H, Selçuk MT, Maden O. The predictive value of MAPH score for determining thrombus burden in patients with non-ST segment elevation myocardial infarction. Egypt Heart J 2022; 74:60. [PMID: 35969290 PMCID: PMC9378801 DOI: 10.1186/s43044-022-00299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/08/2022] [Indexed: 08/30/2023] Open
Abstract
Background A high thrombus burden has been connected with poor clinical events in patients with non-ST segment elevation myocardial infarction (NSTEMI). In patients with STEMI, a high MAPH score has been associated with a large thrombus burden. However, the predictive value of the MAPH score in determining the thrombus burden in patients with NSTEMI is unclear. The present report aimed to evaluate the prognostic role of the MAPH score in the estimating coronary thrombus burden in NSTEMI patients. The study patients were split into two groups according to their thrombus grade. The low shear rate (LSR) and high shear rate (HSR) were estimated by haematocrit levels and serum total protein levels. The MAPH score was calculated by adding mean platelet volume (MPV) levels and age, in addition to total protein and haematocrit.
Results The patients with a high thrombus burden (HTB) had a higher LSR, higher HSR and higher MAPH score compared to patients with low thrombus burden. MAPH score was found to be an independent predictors of HTB in Model 1 (OR: 1.124, 95% CI: 1.011–1.536; p = 0.039) and Model 2 (OR: 1.236; 95% CI: 1.002–1.525; p = 0.047). The cut-off value of the MAPH score for predicting HTB was 2 based on the Youden index. Conclusions The MAPH score, which calculated by adding MPV levels and age, in addition to total protein and haematocrit, is a novel, easily accessible score. The MAPH score at both LSR and HSR was an independent predictor of HTB.
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Köktürk U, Somuncu MU, Uygur B, Akgül Ö, Püşüroğlu H. Prognostic significance of thrombus burden on short- and long-term clinical outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2022. [PMID: 35942618 DOI: 10.1097/MCA.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Large thrombus burden (LTB) observed during ST-segment elevation myocardial infarction (STEMI) may end up with worse clinical outcomes. The relationship between LTB and long-term mortality and major adverse cardiac events (MACE) in STEMI patients undergoing percutaneous coronary intervention (PCI) is unclear. In this study, we aimed to investigate the relationship of LTB with short- and long-term mortality and MACE in STEMI patients undergoing PCI. METHODS Thrombus burden (TB) was evaluated in STEMI patients who underwent PCI between December 2010 and April 2012. After infarct-related arterial flow was restored, TB was reclassified. LTB was defined as thrombus with the largest dimension of at least two vessel diameters. Patients were evaluated for 1-month, 1-year, and 10-year follow-ups in terms of MACE and mortality. RESULTS Four hundred ninety-nine patients with clinical information and TB classification were analyzed. Three hundred sixty-six patients (73.3%) were in the small TB (STB) group, and 133 patients (26.7%) were in the LTB group. No-reflow (10.6% vs. 5.2%; P = 0.033) and stent thrombosis (7.5% vs. 3.3%; P = 0.042) were observed at a higher rate in the LTB group compared with the STB group. Thirty-day mortality (9.8% vs. 3.8%; P = 0.009) and MACE (16.5% vs. 9.6%; P = 0.030) were higher in the LTB group than in the STB group. Although 10-year MACE (56.4% vs. 46.2%; P = 0.044) was observed higher in the LTB group, no significant difference was observed between the two groups in terms of 10-year mortality (35.3% vs. 32.8%; P = 0.589). LTB was found to be an independent predictor for 10-year MACE (OR, 1.62; 95% CI, 1.01-2.61; P = 0.045). CONCLUSION LTB was associated with short- and long-term clinical events in STEMI patients undergoing PCI, but the mortality effect disappeared at the end of 1 year. Nevertheless, hospitalizations due to heart failure became significant in 10-year follow-up.
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He Y, Wang R, Liu J, Li F, Li J, Li C, Zhou J, Zhao Z, Yang W, Mou F, Wang J, Kan J, Li X, Li Y, Zheng M, Chen S, Gao C, Tao L. A Randomized Comparison of the Healing Response Between the Firehawk Stent and the Xience Stent in Patients With ST-Segment Elevation Myocardial Infarction at 6 Months of Follow-Up (TARGET STEMI OCT China Trial): An Optical Coherence Tomography Study. Front Cardiovasc Med 2022; 9:895167. [PMID: 35722108 PMCID: PMC9198262 DOI: 10.3389/fcvm.2022.895167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background The healing response of the Firehawk stent in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Aim We compared the vascular healing of a biodegradable polymer sirolimus-eluting stent (Firehawk) vs. a durable polymer everolimus-eluting stent (Xience) at 6 months after percutaneous coronary intervention (PCI) in patients with STEMI. Methods In this prospective, multicenter, randomized, non-inferiority study, patients within 12 h of STEMI onset were randomized in a ratio of 1:1 to receive Firehawk or Xience stents. Optical coherence tomography (OCT) follow-up was performed 6 months after the index procedure and assessed frame by frame. The primary endpoint was the neointimal thickness (NIT) at 6 months evaluated by OCT. The safety endpoint was target lesion failure (TLF) at 12 months. Results The Firehawk stent was non-inferior to the Xience stent in terms of the neointimal thickness (73.03 ± 33.30 μm vs. 78.96 ± 33.29 μm; absolute difference: −5.94 [one-sided 95% lower confidence bound: −23.09]; Pnon−inferiority < 0.001). No significant difference was observed between the Firehawk and Xience groups regarding the percentage of uncovered struts (0.55 [0.08, 1.32]% vs. 0.40 [0.21, 1.19]%, P = 0.804), the percentage of malapposed struts (0.17 [0.00, 1.52]% vs. 0.17 [0.00, 0.69]%, P = 0.662), and the healing score (1.56 [0.23, 5.74] vs. 2.12 [0.91, 3.81], P = 0.647). At 12 months, one patient in the Firehawk group experienced a clinically indicated target lesion revascularization. No other TLF events occurred in both groups. Independent risk factors of the NIT included body mass index, hyperlipidemia, B2/C lesions, thrombus G3–G5, thrombus aspiration, and postdilation pressure. Conclusion In patients with STEMI, Firehawk was non-inferior to Xience in vascular healing at 6 months. Both stents exhibited nearly complete strut coverage, moderate neointimal formation, and minimal strut malapposition. Clinical Trial Number NCT04150016.
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Affiliation(s)
- Yuan He
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
- Department of Cardiology, Radboud University, Nijmegen, Netherlands
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Jianzheng Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jingyu Zhou
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zhijing Zhao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wangwei Yang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Fangjun Mou
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jing Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ming Zheng
- Shanghai MicroPort Medical (Group), Shanghai, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
- Department of Cardiology, Radboud University, Nijmegen, Netherlands
- Department of Cardiology, National University of Ireland, Galway, Ireland
- *Correspondence: Chao Gao
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
- Ling Tao
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Hu X, Yang X, Li X, Li G, Zhou Y, Dong H. Elevated uric acid is related to the no-/slow-reflow phenomenon in STEMI undergoing primary PCI. Eur J Clin Invest 2022; 52:e13719. [PMID: 34800289 DOI: 10.1111/eci.13719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND No-/slow-reflow phenomenon (NRP) is a severe complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study aimed to explore the relationship between elevated serum uric acid (SUA) and NRP in patients with STEMI undergoing pPCI, focusing on inflammation and angiographic findings. METHODS A total of 610 patients who received pPCI for STEMI were retrospectively enrolled. Patients were divided into a hyperuricaemia group and a non-hyperuricaemia group according to SUA levels. Clinical information and angiographic indicators were compared between the two groups. Thrombolysis in myocardial infarction (TIMI) flow and TIMI myocardial perfusion grade (TMPG) <3 after stent implantation were defined as TIMI-NRP and TMPG-NRP, respectively. A logistic model was used to analyse the relationship between hyperuricaemia and NRP. RESULTS The hyperuricaemia group had a higher incidence of TIMI-NRP (24.9% vs 14.0%, p < .001) and TMPG-NRP (33.0% vs 24.9%, p = .03), higher levels of C-reactive protein (7.2 vs 4.1 mg/L, p < .001) and worse left ventricular ejection fraction (51.5% vs 54.0%, p = .002) than the non-hyperuricaemia group. As for angiographic findings, there was no significant difference between the two groups in terms of lesion characteristics measured by quantitative coronary angiography. After multivariable adjustment, elevated SUA was significantly associated with TIMI-NRP (odds ratio: 1.94, 95% confidence interval: 1.24-3.01, p = .003). Subgroup analysis showed that the effect of hyperuricaemia in TIMI-NRP was more pronounced in patients with delayed perfusion as well as in patients with diabetes mellitus. CONCLUSIONS Elevated SUA is associated with severe inflammation and has higher incidence of TIMI-NRP in patients with STEMI undergoing pPCI, especially in those with delayed perfusion or diabetes mellitus.
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Affiliation(s)
- Xiangming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai, China
| | - Xida Li
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Huang YX, Cao Y, Chen Y, Qiu YG, Zheng JY, Liu YM, He JC, Zhao L, Li TC. AngioJet rheolytic thrombectomy in patients with thrombolysis in myocardial infarction thrombus grade 5: an observational study. Sci Rep 2022; 12:5462. [PMID: 35361855 PMCID: PMC8971501 DOI: 10.1038/s41598-022-09507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/24/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness and safety of AngioJet rheolytic thrombectomy among patients with high thrombus burden. Routine manual thrombus aspiration in patients with ST-segment elevation myocardial infarction (STEMI) does not improve clinical outcomes and was associated with an increased rate of stroke. However, the safety of mechanical thrombus aspiration is still unknown. This was a retrospective, single-center study involving 621 patients with Thrombolysis In Myocardial Infarction thrombus grade 5. The primary outcome was the composite of major adverse cardiovascular events (MACE) within 12 months. The safety outcome was stroke within 1-year. Propensity matching score was calculated due to the significant baseline differences between the AngioJet rhelytic thrombectomy group and the routine treatment group. AngioJet rheolytic thrombectomy was performed in 117 patients. After propensity-score matching, there was no significant difference both in the incidence of MACE (11.1% vs 17.9%, hazard ratio, 1.641; 95% confidence interval [CI] 0.822 to 3.277, p = 0.161) and the incidences of stroke (1.7% vs 2.6%, hazard ratio 1.522; 95% confidence interval [CI] 0.254 to 9.107, p = 0.646) between two groups at 1-year follow-up. In patients with Thrombolysis In Myocardial Infarction thrombus grade 5, AngioJet rheolytic thrombectomy did not improve clinical outcomes at 1 year. However, AngioJet rheolytic thrombectomy did not increase the risk of stroke in patients with high thrombus burden.
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Affiliation(s)
- Yi-Xiong Huang
- Medical School of Chinese People's Liberation, Army General Hospital, 28 Fuxing Road, Haidian District, Peking, 100853, People's Republic of China
| | - Yi Cao
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Yu Chen
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Yi-Gang Qiu
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Jian-Yong Zheng
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Ying-Ming Liu
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Jiang-Chun He
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Li Zhao
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China
| | - Tian-Chang Li
- Department of Cardiology, Sixth Medical Center of Chinese People's Liberation, Army General Hospital, 6 Fucheng Road, Haidian District, Peking, 100048, People's Republic of China.
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Zeren G, Avci İİ, Sungur MA, Şimşek B, Sungur A, Yılmaz MF, Can F, Gurkan U, Karabay CY. Association of ectatic non-infarct-related artery with 1-month stent thrombosis in patients with ST elevation myocardial infarction. Postgrad Med J 2022; 98:660-665. [PMID: 37062981 DOI: 10.1136/postgradmedj-2021-141483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ectatic infarct-related artery (IRA) has been shown to be associated with higher thrombus burden, no-reflow, stent thrombosis (ST) and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). The effect of ectatic non-IRA on ST without ectatic IRA is not known. We aimed to assess the effect of ectatic non-IRA presence on ST within 1 month after primary percutaneous intervention (pPCI) in patients with STEMI. METHODS A total of 1541 patients with a diagnosis of STEMI and underwent pPCI between 2015 and 2020 were retrospectively included in the study. Patients with and without 1 month ST were compared. Penalised logistic regression method was used to assess the association between ST and candidate predictors due to the risk of overfitting. RESULTS Median age of the study group was 56.5 (48.7 to 67.2) years. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, ectatic non-IRA presence and use of tirofiban were significantly higher in the ST group (18.2±9.9 vs 15.1±9.9, p=0.03; 25% vs 7.2%, p<0.001; 54.2% vs 30.5%, p<0.001; respectively). Significantly higher thrombus aspiration (14.3% vs 6.7%, p=0.03) and lower stent implantation (67.7% vs 84%, p<0.001) rates were observed in ectatic IRA group compared with ectatic non-IRA group. In multivariable analysis, ectatic non-IRA presence was independently associated with 1-month ST (OR 4.01, 95% CI 1.86 to 8.63, p=0.01). CONCLUSION Ectatic non-IRA presence without ectatic IRA in patients with STEMI increases the risk of ST within the first month of pPCI.
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Affiliation(s)
- Gönül Zeren
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - İlhan İlker Avci
- Department of Cardiology, İstanbul Dr Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Istanbul, Turkey
| | - Mustafa Azmi Sungur
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Barış Şimşek
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aylin Sungur
- Department of Cardiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Fatih Yılmaz
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Can
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Gurkan
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Zhao S, Huang R, Liu F, Li Y, Gong Y, Xing J, Zhang H. Study on Correlation between Type 2 Diabetes and No-Reflow after PCI. Disease Markers 2022; 2022:1-7. [PMID: 35340412 PMCID: PMC8947868 DOI: 10.1155/2022/7319277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022]
Abstract
Diabetes, a serious chronic disease globally, is often complicated with cardiovascular diseases for which percutaneous coronary intervention (PCI) is the mainstay. The no-reflow rate of diabetic patients after PCI is 2-4 times higher than that of nondiabetic patients, yet the specific mechanism is still unclear. This study was designed to investigate the correlation between the duration of diabetes, preoperative blood glucose level, coronary angiographic blood flow, coronary artery stenosis level, and no-reflow after PCI. A total of 131 patients with type 2 diabetes who underwent PCI in our hospital from 2019 to 2020 were divided into control group and observation group. The disease duration, preoperative blood glucose level, coronary angiographic blood flow, and coronary artery stenosis level of the two groups were calculated. There were differences in the duration of diabetes between the two groups; the blood glucose level of the control group was about 3.8%, which was lower than 5.8% of the observation group; the thrombolysis in myocardial infarction (TIMI) value of the control group was
, which was lower than
of the observation group; The degree of coronary stenosis in the control was
, which was lower than
in the observation group. Binary logistic stepwise regression analysis was performed on these indicators and no-reflow after PCI to explore the correlation between these indicators and no-reflow after PCI in diabetic patients. The study found that the diabetes duration, higher preoperative blood glucose level, coronary angiography blood flow, and coronary artery were positively associated with no-reflow after PCI.
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Wang Y, Kang L, Chien CW, Xu J, You P, Xing S, Tung TH. Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:831143. [PMID: 35360030 PMCID: PMC8964144 DOI: 10.3389/fcvm.2022.831143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives This study aimed to investigate the differences in the characteristics, management, and clinical outcomes of patients with and that of those without coronavirus disease 2019 (COVID-19) infection who had ST-segment elevation myocardial infarction (STEMI). Methods Databases including Web of Science, PubMed, Cochrane Library, and Embase were searched up to July 2021. Observational studies that reported on the characteristics, management, or clinical outcomes and those published as full-text articles were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included studies. Results A total of 27,742 patients from 13 studies were included in this meta-analysis. Significant delay in symptom onset to first medical contact (SO-to-FMC) time (mean difference = 23.42 min; 95% CI: 5.85–40.99 min; p = 0.009) and door-to-balloon (D2B) time (mean difference = 12.27 min; 95% CI: 5.77–18.78 min; p = 0.0002) was observed in COVID-19 patients. Compared to COVID-19 negative patients, those who are positive patients had significantly higher levels of C-reactive protein, D-dimer, and thrombus grade (p < 0.05) and showed more frequent use of thrombus aspiration and glycoprotein IIbIIIa (Gp2b3a) inhibitor (p < 0.05). COVID-19 positive patients also had higher rates of in-hospital mortality (OR = 5.98, 95% CI: 4.78–7.48, p < 0.0001), cardiogenic shock (OR = 2.75, 95% CI: 2.02–3.76, p < 0.0001), and stent thrombosis (OR = 5.65, 95% CI: 2.41–13.23, p < 0.0001). They were also more likely to be admitted to the intensive care unit (ICU) (OR = 4.26, 95% CI: 2.51–7.22, p < 0.0001) and had a longer length of stay (mean difference = 4.63 days; 95% CI: 2.56–6.69 days; p < 0.0001). Conclusions This study revealed that COVID-19 infection had an impact on the time of initial medical intervention for patients with STEMI after symptom onset and showed that COVID-19 patients with STEMI were more likely to have thrombosis and had poorer outcomes.
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Affiliation(s)
- Yanjiao Wang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Linlin Kang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Jiawen Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Peng You
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Sizhong Xing
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Sizhong Xing
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- *Correspondence: Tao-Hsin Tung
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Özbiçer S, Yüksel G, Urgun ÖD, Neşelioğlu S, Erel Ö. Thiols and disulfide levels are correlated with TIMI thrombus grade in non-ST elevation myocardial infarction patients. Biomark Med 2022; 16:233-240. [PMID: 35176898 DOI: 10.2217/bmm-2021-0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated the relationship between thrombolysis in myocardial infarction (TIMI) thrombus grade and thiol/disulfide levels. Materials & methods: 182 non-ST elevation myocardial infarction (NSTEMI) patients were divided into two groups; TIMI grade 0 patients who do not have any visible thrombus in their culprit vessels, and TIMI thrombus grade 1-5 patients. Results: Native and total thiol levels and disulfide to thiol ratio were higher in the low thrombus group. In addition, thrombus grade was positively correlated with disulfide to native and total thiol ratio and negatively with native and total thiol levels in NSTEMI patients. Conclusion: We can assert that thiol levels tend to decrease, and the disulfide to thiol ratio increase with increasing thrombus burden in NSTEMI patients.
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Affiliation(s)
- Süleyman Özbiçer
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Gülhan Yüksel
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Örsan D Urgun
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Salim Neşelioğlu
- Department of Clinical Biochemistry, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
| | - Özcan Erel
- Department of Clinical Biochemistry, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
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Ma M, Wang L, Diao KY, Liang SC, Zhu Y, Wang H, Wang M, Zhang L, Yang ZG, He Y. A randomized controlled clinical trial of prolonged balloon inflation during stent deployment strategy in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a pilot study. BMC Cardiovasc Disord 2022; 22:30. [PMID: 35120436 PMCID: PMC8815170 DOI: 10.1186/s12872-022-02477-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023] Open
Abstract
Background Primary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for ST-segment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains common and is associated with adverse outcomes. Aims This study aimed to evaluate whether prolonged balloon inflation in stent deployment would lessen the occurrence of the no-reflow phenomenon in PPCI compared with conventional rapid inflation/deflation strategy. Methods Patients were randomly assigned to either the prolonged balloon inflation in stent deployment group (PBSG) or conventional deployment strategy group (CDSG) in a 1:1 ratio. A subset of patients was included in the cardiac magnetic resonance (CMR) assessment. Results Thrombolysis in MI (TIMI) flow grade 3 was found in 96.7% and 63.3% of the patients of the PBSG and CDSG, respectively (P = 0.005). The results of the PBSG and CDSG are respectively shown as follows: 0% versus 30% no-reflow or slow flow (P = 0.002); 90% versus 66.7% ST-segment resolution ≥ 50% (P = 0.028); 35.6 ± 14.5 frames versus 49.18 ± 25.2 frames on corrected TIMI frame count (P = 0.014); and 60% versus 20% myocardial blush grade 3 (P = 0.001). At 1 month, the major cardiovascular adverse event (cardiovascular mortality) rate was 3.3% in both groups; at 1 year, the rate was 3.3% and 6.7% for the PBSG and CDSG, respectively (P = 1.00). In the CMR subset of cases, the presence of microvascular obstruction (MVO) was detected in 6.7% and 50% of the patients in the PBSG and CDSG, respectively (P = 0.023). Conclusion In our pilot trial, prolonged balloon inflation during stent deployment strategy in PPCI reduces the occurrence of the no-reflow phenomenon in patients with STEMI and improved the myocardial microcirculation perfusion (ClinicalTrials.gov number: NCT03199014; registered: 26/June/2017).
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Affiliation(s)
- Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.,Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Ling Wang
- Department of Cardiology, Mian Yang People's Hospital, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China
| | - Shi-Chu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Mian Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Li Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXueXiang, Chengdu, 610041, China.
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Dai C, Liu M, Zhou Y, Lu D, Li C, Chang S, Chen Z, Qian J, Ge J. A score system to predict no-reflow in primary percutaneous coronary intervention: The PIANO Score. Eur J Clin Invest 2022; 52:e13686. [PMID: 34596236 DOI: 10.1111/eci.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Angiographic no-reflow is associated with poor outcomes in patients with ST-segment elevation myocardial infarction (STEMI). We sought to develop and validate a score system to predict angiographic no-reflow in primary percutaneous coronary intervention (PCI). METHODS ST-segment elevation myocardial infarction patients undergoing primary PCI were consecutively enrolled and were randomly divided into the training and validation set. Angiographic no-reflow was defined as thrombolysis in myocardial infarction (TIMI) flow grade 0 to 2 after PCI. In the training set, independent predictors were identified by logistic regression analysis, and a score system (PredIction of Angiographic NO-reflow, the PIANO score) was constructed based on the β-coefficient of each variable. The established model was evaluated for discrimination and calibration. RESULTS Angiographic no-reflow occurred in 362 (17.8%) of 2036 patients. Age ≥70 years, absence of pre-infarction angina, total ischaemic time ≥4 h, left anterior descending as culprit artery, pre-PCI TIMI flow grade ≤1 and pre-PCI TIMI thrombus score ≥4 were independent predictors of angiographic no-reflow. The PIANO score ranged from 0 to 14 points, yielding a concordance index of 0.857 (95% confidence interval: 0.833 to 0.880), with good calibration. In the high-risk (≥8 points) group, the probability of angiographic no-reflow phenomenon was 38.7%, while it was only 4.8% in the low-risk (<8 points) group. The score system performed well in the validation set. CONCLUSIONS We establish and validate a score system based on six clinical variables to predict angiographic no-reflow in STEMI patients undergoing primary PCI, which may help choose the optimal individual treatment strategy.
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Affiliation(s)
- Chunfeng Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Muyin Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - You Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Danbo Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Yildiz BS, Cetin N, Gunduz R, Bilge A, Ozgur S, Orman MN. Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit? Angiology 2022; 73:565-578. [PMID: 35104154 DOI: 10.1177/00033197211053404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We assessed the effect of thrombus aspiration (TA) during percutaneous coronary intervention (PCI) on in-hospital and 3-year mortality in consecutive non-ST segment elevation myocardial infarction (n = 189) and unstable angina pectoris (n = 148) patients (n = 337) between 2011 and 2016. In total, 153 patients (45.4%) underwent TA. The number of patients with postoperative thrombolysis in terms of myocardial infarction grade 3 blood flow (P < .001) and myocardial blush grade 3 (P < .001) were significantly higher in all TA groups. At 6-, 12- and 24-month post-PCI, the mean left ventricular ejection fraction was significantly higher in the all TA groups versus the stand alone PCI group (P < .001). Thrombus aspiration was associated with a significant improvement both in epicardial flow, myocardial perfusion and left ventricular ejection fraction. Thrombus aspiration during PCI in all acute coronary syndrome (except ST segment elevation) patients was associated with better survival compared with stand alone PCI group at 3-year follow-up (P = .019).
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Affiliation(s)
- Bekir S Yildiz
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Nurullah Cetin
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ramazan Gunduz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Adnan Bilge
- Department of Emergency Medicine, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet N Orman
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
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Özkan U, Gürdoğan M, Öztürk C, Demir M, Akkuş ÖF, Yılmaz E, Altay S. Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome. Medicina (B Aires) 2022; 58:143. [PMID: 35208466 PMCID: PMC8875451 DOI: 10.3390/medicina58020143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives: Excessive coronary thrombus burden is known to cause an increase in mortality and major adverse cardiac events (MACEs) in NSTE-ACS (non-ST acute coronary syndrome) patients. We investigated the association between the systemic immune-inflammation index (SII) and coronary thrombus burden in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography and percutaneous coronary intervention (PCI). Materials and Methods: A total of 389 patients with the diagnosis of NSTEMI participated in our study. Coronary thrombus burden was classified in the TIMI (thrombolysis in myocardial infarction) thrombus grade scale and patients were divided into two groups: a TIMI thrombus grade 0–1 group (n = 209, 157 males) and a TIMI thrombus grade 2–6 group (n = 180, 118 males). Demographics, angiographic lesion images, coronary thrombus burden, clinical risk factors, laboratory parameters, and SII score were compared between the two groups. Results: The high thrombus burden patient group had a higher neutrophil count, WBC count, platelet count, and systemic immune-inflammation index (SII) (p < 0.001). The receiver operating characteristic (ROC) curve analysis showed that at a cutoff of 1103, the value of SII manifested 74.4% sensitivity and 74.6% specificity for detecting a high coronary thrombus burden. Conclusions: Our study showed that the SII levels at hospital admission were independently associated with high coronary thrombus with NSTEMI.
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Noma S, Miyachi H, Fukuizumi I, Matsuda J, Sangen H, Kubota Y, Imori Y, Saiki Y, Hosokawa Y, Tara S, Tokita Y, Akutsu K, Shimizu W, Yamamoto T, Takano H. Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden. J Clin Med 2022; 11:jcm11010262. [PMID: 35012003 PMCID: PMC8745791 DOI: 10.3390/jcm11010262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. METHODS We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). RESULTS Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). CONCLUSIONS Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.
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Affiliation(s)
- Satsuki Noma
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Hideki Miyachi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
- Correspondence: hidep-@nms.ac.jp; Tel.: +81-3-3822-2131
| | - Isamu Fukuizumi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoichi Imori
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yoshiyuki Saiki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Yukichi Tokita
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Koichi Akutsu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (S.N.); (I.F.); (J.M.); (H.S.); (Y.I.); (Y.S.); (Y.H.); (S.T.); (Y.T.); (K.A.); (W.S.); (T.Y.)
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (Y.K.); (H.T.)
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Scarparo P, Improta R, Wilschut J, Kardys I, Den Dekker WK, Daemen J, Zijlstra F, Van Mieghem NM, Diletti R. Very long-term clinical outcomes after direct stenting in patient presenting with ST-segment elevation myocardial infarction. Cardiovascular Revascularization Medicine 2022; 41:144-150. [DOI: 10.1016/j.carrev.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/03/2023]
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Alıcı G, Barman HA, Atıcı A, Tuğrul S, Genç Ö, Şahin İ. The Impact of Lesion Complexity and the CHA 2DS 2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction. Int J Clin Pract 2022; 2022:8066780. [PMID: 35685511 PMCID: PMC9159176 DOI: 10.1155/2022/8066780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). OBJECTIVE The present study aimed to determine the impact of lesion complexity and the CHA2DS2-VASc score on SR in patients with STEMI. METHODS A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. RESULTS The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA2DS2-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA2DS2-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001). CONCLUSION Our study demonstrated that lesion complexity and the CHA2DS2-VASc score are independently associated with spontaneous reperfusion.
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Affiliation(s)
- Gökhan Alıcı
- Okmeydani Training and Research Hospital, Department of Cardiology, Darulaceze Street No:25, Okmeydanı 34384, İstanbul, Turkey
| | - Hasan Ali Barman
- İstanbul University–Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
| | - Adem Atıcı
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, İstanbul 34722, Turkey
| | - Sevil Tuğrul
- Bağcılar Training and Research Hospital, Department of Cardiology, Bağcılar Center, Mimar Sinan Street, Bağcılar, İstanbul 34100, Turkey
| | - Ömer Genç
- Ağrı Training and Research Hospital, Department of Cardiology, Ağrı Center, Ağrı 04200, Turkey
| | - İrfan Şahin
- Bağcılar Training and Research Hospital, Department of Cardiology, Bağcılar Center, Mimar Sinan Street, Bağcılar, İstanbul 34100, Turkey
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Rodi Tosu A, Çinar T, Kalyoncuoğlu M, Biter Hİ, Çakal S, Çakal B, Selçuk M, Belen E, Mustafa Can M. Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with non-ST-elevation myocardial infarction. J Cardiovasc Thorac Res 2022; 14:214-219. [PMID: 36699552 PMCID: PMC9871161 DOI: 10.34172/jcvtr.2022.30549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/13/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction: The focus of this research was to explore the link between CRP (C-reactive protein) /albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P=0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was>1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.
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Affiliation(s)
- Aydın Rodi Tosu
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tufan Çinar
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey,Corresponding Author: Tufan Çınar,
| | - Muhsin Kalyoncuoğlu
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Halil İbrahim Biter
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sinem Çakal
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Beytullah Çakal
- Department of Cardiology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdal Belen
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Mustafa Can
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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