Mortality in Patients With Left Ventricular Ejection Fraction ≤30% After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Background. Apoptosis plays an important role in the myocardial injury after acute myocardial infarction and in the subsequent development of heart failure. Aim. To clarify serum kinetics of apoptotic markers TRAIL and sFas and their relation to left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods. In 101 patients with STEMI treated with pPCI, levels of TRAIL and sFas were measured in series of serum samples obtained during hospitalization and one month after STEMI. LVEF was assessed at admission and at one month. Major adverse cardiovascular events (MACE, i.e., death, re-MI, and hospitalization for heart failure and stroke) were analysed during a two-year followup. Results. Serum level of TRAIL significantly decreased one day after pPCI (50.5pg/mL) compared to admission (56.7pg/mL), subsequently increased on day 2 after pPCI (58.8pg/mL), and reached its highest level at one month (70.3pg/mL). TRAIL levels on days 1 and 2 showed a significant inverse correlation with troponin and a significant positive correlation with LVEF at baseline. Moreover, TRAIL correlated significantly with LVEF one month after STEMI (day 1: r=0.402, p<0.001; day 2: r=0.542, p<0.001). On the contrary, sFas level was significantly lowest at admission (5073pg/mL), increased one day after pPCI (6370pg/mL), and decreased on day 2 (5548pg/mL). Significantly highest sFas level was marked at one month (7024pg/mL). sFas failed to correlate with LVEF at baseline or at one month. Both TRAIL and sFas showed no ability to predict improvement of LVEF one month after STEMI or a 2-year MACE (represented by 3.29%). Conclusion. In STEMI treated with pPCI, TRAIL reaches its lowest serum concentration after reperfusion. Low TRAIL level is associated with worse LVEF in the acute phase of STEMI as well as one month after STEMI. Higher TRAIL level appears to be beneficial and thus TRAIL seems to represent a protective mediator of post-AMI injury.

Download Full-text

Effects of tirofiban and percutaneous coronary intervention in an old patient with acute myocardial infarction and cardiogenic shock

Medicinski pregled ◽

10.2298/mpns1002117c ◽

2010 ◽

Vol 63 (1-2) ◽

pp. 117-122

Author(s):

Tibor Canji ◽

Aleksandra Jovelic ◽

Ilija Srdanovic ◽

Milovan Petrovic ◽

Gordana Panic ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Ejection Fraction ◽

Cardiogenic Shock ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Severe Thrombocytopenia ◽

Ventricular Ejection Fraction ◽

Percutaneous Coronary

A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ST-segment elevation myocardial infarction and cardiogenic shock, 40 minutes after the pain onset. He was pretreated with 300 mg of aspirin, 600 mg of clopidogrel, and was taken to the catheterization laboratory. Door to needle time was 35 minutes. Primary percutaneous coronary intervention with bare-metal stent implantation first in infarct related right coronary artery, with subsequent high-bolus dose (25 fig/kg) tirofiban, and then in suboccluded RCx were done. The procedures were done during the cardio-pulmo-cerebral reanimation because of relapsing ventricular fibrillation, with final TIMI 3 coronary flow established. Subsequently, intraaortic balloon pump was inserted. Echocardiography taken on the second day showed globaly hypokinetic left ventricle, with 10% ejection fraction and competent valves. During the next three weeks of hospital follow-up, there were no major adverse cardiac events, a transient azotemia and fall in hemoglobin concentration without major bleeding, and no episodes of severe thrombocytopenia were recorded. After six months, the patient was without chest pains, 2/3 class according to the New York Heart Association, without major adverse events, and echocardiographic left ventricular ejection fraction increment for 30%.

Download Full-text

LEFT VENTRICULAR EJECTION FRACTION AS A PREDICTOR OF RESTENOSIS AND STENT THROMBOSIS AFTER PERCUTANEOUS CORONARY INTERVENTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)61639-2 ◽

2011 ◽

Vol 57 (14) ◽

pp. E1639

Author(s):

Gabriel Sardi ◽

Rebecca Torguson ◽

Michael A. Gaglia ◽

Gabriel Maluenda ◽

Manuel A. Gonzalez ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Stent Thrombosis ◽

Coronary Intervention ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Percutaneous Coronary

Download Full-text

Early discharge (within 24–72 h) in low-risk AMI patients treated with PCI: feasibility and safety—Hajj study

The Egyptian Heart Journal ◽

10.1186/s43044-020-00095-9 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Sheeren Khaled ◽

Najeeb Jaha ◽

Ghada Shalaby ◽

Azmat Khadija Niazi ◽

Faisal Alhazmi ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Left Ventricular Ejection Fraction ◽

Coronary Intervention ◽

Early Discharge ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Percutaneous Coronary ◽

Discharged Patients

Abstract Background Shortening of the hospital stay in patients admitted with the diagnosis of acute myocardial infarction (AMI) has been observed within the last decades. Our center is the only cardiac center in the region providing tertiary care facility and hence receives all AMI patients deemed suitable for invasive assessment and management and this leads to huge required demand. Our aim is to assess feasibility and safety of the early discharge of selected proportion of AMI patients. Result Out of 557 of patients presented with AMI and treated with percutaneous coronary intervention (PCI), 310 (56%) were discharged early. Men patients and pilgrims were more prevalent among the early discharge group. Early discharged patients had significantly less comorbidities compared to the other group of patients. Moreover, they presented mainly with ST-elevation myocardial infarction (P = 0.04) and treated more with primary percutaneous coronary intervention (PPCI) (P = 0.04). They had favorable coronary anatomy (P = 0.01 and 0.02 for left main and multi-vessel coronary artery disease, respectively), better hospital course, and higher left ventricular ejection fraction compared to non-early discharged patients (P = 0.006 and < 0.001 for pulmonary edema and left ventricular ejection fraction post myocardial infarction). Follow-up of those early discharged patients were promising as majority of them were asymptomatic (95%) and did well post-discharge. Conclusion Our study demonstrated data that support safety of early discharge in a carefully selected group of AMI patients. Early but safe discharge may have a huge impact on increasing bed availability, reducing hospital costs, and improving patient’s satisfaction.

Download Full-text