Time for a new paradigm shift from STE/non-STEMI to ACO/non-ACOMI?

Introduction

Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and cause a substantial amount of false catheterization laboratory activations.

Purpose

We sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy.

Methods

A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 hours and angiographic appearance.

Results

In non-STEMI group, 282 patients were re-classified as having ACO. This subgroup had a higher ACO frequency and myocardial damage compared to NSTEMI group. More importantly, in-hospital and long-term mortality rates was similar to STEMI patients. The ECG reviewers prospectively classified 35.6% of ECGs as STEMI and 35.5% of ECGs as ACOMI; 25.6% being shared in the both definitions. Both unweighted and weighted diagnostic accuracy of STEMI/non-STEMI and ACOMI/non-ACOMI approaches for ACO and long-term mortality were presented in Table 1. The diagnostic accuracy of the ACOMI/non-ACOMI approach was superior to the STEMI/non-STEMI approach in three out of four comparisons. We also sought to compare ECG subtypes according to early (ECG-to-PCI time<120 min) and late (ECG-to-PCI time over 120 min) coronary intervention (Figure 1).

Conclusions

We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI.

Figure 1

Funding Acknowledgement

Type of funding source: None

The association of acute-to-chronic glycemic ratio with no-reflow in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Introduction

In the present study, we investigate the association of acute-to-chronic (A/C) glycemic ratio with no-reflow (NR) development in ST elevation myocardial infarction (STEMI) patients following primary percutaneous coronary intervention (PCI).

Material and methods

This retrospective study included 905 consecutive STEMI patients who were treated with primary PCI. The A/C glycemic ratio was determined as admission blood glucose (ABG) divided by the estimated average glucose (eAG). We evaluated two primary models (full model and reduced model).The primary outcome was the presence of NR.

Results

The incidence of NR was 22.7% (206 cases) in the present study. We divided the study population into three tertiles (T1, T2, and T3) based on the ABG/eAG ratio. There was a stepwise increase of the frequency of NR development from the T1 to T3 group (36 patients [12%] vs. 70 patients [23%] vs. 100 patients [33%]; respectively [p <0.001, for each group comparison]). In a full model, the ABG/eAG ratio (OR; 2.274, 95% CI; 1.587–3.26, p<0.001) was associated with NR. After the performance of a step-down backward variable selection method, the thrombus grade, the ABG/eAG ratio, the infarct-related artery diameter, and age remained in the reduced model. The ABG/eAG ratio (contributing 25.3% of the explainable outcome in the model) was one of the strong predictors of NR in the reduced model.

Conclusion

To the best of our knowledge, this might be the first study showing a significant relationship between the ABG/eAG ratios with NR in STEMI patients after primary PCI.

Figure 1

Funding Acknowledgement

Type of funding source: None

Relationship between pulmonary edema development and left atrium mechanical functions in patients with left ventricular hypertrophy

Background

Since there is no proven treatment to reduce mortality in heart failure with preserved ejection fraction patients, to identify the predictors of decompensation are important in these patients.

Purpose

In this study, we aimed to evaluate the left atrium (LA) mechanical functions in patients with left ventricular hypertrophy (LVH) presenting with dyspnea and to investigate the predictors of pulmonary edema (PE).

Methods

This study was designed as a single-center cross-sectional study. Patients with LVH who presented to the emergency department with dyspnea were divided into two groups as PE (n=30) and non-PE (n=100). Mechanical functions of the LA were evaluated by speckle-tracking echocardiography. As a statistical method, diagnostic modelling was performed to demonstrate the relationship between demographic and echocardiographic features with the diagnosis of the patient (with or without PE). First, a basal model was created consisting of age, gender, body mass index (BMI), left ventricular mass index (LVMI), creatinine (Model 0). Then, different models were created by adding reservoir strain (S) (Model 1), conduit S, pump S, reservoir strain rate (SR), conduit SR and pump SR to the basal model, respectively. It was analyzed how each model made changes in performance criteria compared to the basal model.

Results

When the relationship between left atrial strain parameters and PE were analyzed, LA reservoir S (OR: 1.74 (1.14–2.64); p: 0.003) and LA pump SR (OR: 1.69 (1.07–2.64); p: 0.023) had found to be significantly associated with the development of PE. Another parameter associated with PE was admission creatinine value (OR: 1.52 (1.08–2.15), p-value: 0.016). In our study, LVMI is not a predictor for PE but, when the interaction of LA reservoir S and LVMI was considered, it is observed that decreased LA reservoir S is associated with more PE, especially in individuals with higher LVMI.

Conclusion

In this study, we found that the LA reservoir S is significantly associated with the development of PE in patients with LVH, especially in individuals with higher LVMI.

Interaction of reservoir S and LVMI

Funding Acknowledgement

Type of funding source: None