scholarly journals Value of a new multiparametric score for prediction of microvascular obstruction lesions in ST-segment elevation myocardial infarction revascularized by percutaneous coronary intervention

2010 ◽  
Vol 103 (10) ◽  
pp. 512-521 ◽  
Author(s):  
Nicolas Amabile ◽  
Alexis Jacquier ◽  
Jean Gaudart ◽  
Anthony Sarran ◽  
Anes Shuaib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Recurrence of angina after ST-segment elevation myocardial infarction: the role of coronary microvascular obstruction

2019 ◽  
pp. 204887261988066
Author(s):  
Rocco A Montone ◽  
Vincenzo Vetrugno ◽  
Giovanni Santacroce ◽  
Marco Giuseppe Del Buono ◽  
Maria Chiara Meucci ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: The recurrence of angina after percutaneous coronary intervention affects 20–35% of patients with stable coronary artery disease; however, few data are available in the setting of ST-segment elevation myocardial infarction. We evaluated the relation between coronary microvascular obstruction and the recurrence of angina at follow-up. Methods: We prospectively enrolled patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Microvascular obstruction was defined as thrombolysis in myocardial infarction flow less than 3 or 3 with myocardial blush grade less than 2. The primary endpoint was the recurrence of angina at follow-up. Moreover, angina status was evaluated by the Seattle angina questionnaire summary score (SAQSS). Therapy at follow-up and the occurrence of major adverse cardiovascular events were also collected. Results: We enrolled 200 patients. Microvascular obstruction occurred in 52 (26%) of them. Follow-up (mean time 25.17±9.28 months) was performed in all patients. Recurrent angina occurred in 31 (15.5%) patients, with a higher prevalence in patients with microvascular obstruction compared with patients without microvascular obstruction (13 (25.0%) vs. 18 (12.2%), P=0.008). Accordingly, SAQSS was lower and the need for two or more anti-anginal drugs was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. At multiple linear regression analysis a history of previous acute coronary syndrome and the occurrence of microvascular obstruction were the only independent predictors of a worse SAQSS. Finally, the occurrence of major adverse cardiovascular events was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. Conclusions: The recurrence of angina in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention is an important clinical issue. The occurrence of microvascular obstruction portends a worse angina status and is associated with the use of more anti-anginal drugs.

scholarly journals Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Björn Redfors ◽  
Reza Mohebi ◽  
Gennaro Giustino ◽  
Shmuel Chen ◽  
Harry P. Selker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Magnetic Resonance ◽  
Infarct Size ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment–elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment–elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2–4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45–90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130–269] and 46 [28–83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3–12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4–3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7–6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, −1.2 to 1.9] for intermediate versus short DBT and −0.1% [95% CI, −1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3–1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, −0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment–elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

scholarly journals Predictive Value of Fasting Blood Glucose for Microvascular Obstruction in Nondiabetic Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Han Wu ◽  
Ran Li ◽  
Kun Wang ◽  
Dan Mu ◽  
Jian-Zhou Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Microvascular Obstruction ◽  
Fasting Blood Glucose ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background. The relationship between fasting blood glucose (FBG) and microvascular obstruction (MVO) after primary percutaneous coronary intervention (PCI) remains unclear in nondiabetic patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to determine the predictive value of FBG in MVO in nondiabetic STEMI patients. Methods. A total of 108 nondiabetic STEMI patients undergoing primary PCI were enrolled in this study. The patients were classified into either the MVO group or non-MVO group based on cardiac magnetic resonance imaging (CMR). Results. FBG in the MVO group was higher than in the non-MVO group. Univariate analysis showed that FBG, peak high-sensitive troponin T (TnT), pre-PCI thrombolysis in myocardial infarction (pre-PCI TIMI) flow, left ventricular ejection fraction (LVEF), infarction size, left ventricular end-diastolic diameter (LVEDd), left ventricular end-diastolic volume (LVEDV), and global longitudinal strain (GLS) were likely predictive factors of MVO. After adjustment for other parameters, FBG, peak TnT, LVEF, and LVEDV remained independent predictors for MVO. Conclusion. FBG was independently associated with MVO in nondiabetic STEMI patients.

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