Coronary artery ectasia, an independent predictor of no-reflow after primary PCI for ST-elevation myocardial infarction

2018 ◽  
Vol 265 ◽  
pp. 12-17 ◽  
Author(s):  
H.C.F. Schram ◽  
V.V. Hemradj ◽  
R.S. Hermanides ◽  
E. Kedhi ◽  
J.P. Ottervanger
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Independent Predictor ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Coronary Artery Ectasia ◽  
No Reflow ◽  
St Elevation

Abstract 2833: Low Erythropoietin Serum Levels Are Associated With Angiographic No-reflow After Primary Intervention For Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Giampaolo Niccoli ◽  
Francesca Marzo ◽  
Antonella Paglia ◽  
Eleonora Santucci ◽  
Cristina Spaziani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Serum Levels ◽  
St Elevation Myocardial Infarction ◽  
Consecutive Series ◽  
Primary Pci ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
St Elevation

Background : No-reflow after primary percutaneous coronary intervention (PCI) remains a clinical challenge. Erythropoietin (EPO) has been associated with reduced infarct size due to EPO’s antiapoptotic and nitric oxide enhancing effects. We aimed to assess the association between EPO serum levels measured on admission and angiographic no-reflow in patients undergoing primary PCI. Methods : From a consecutive series of 60 patients presenting with ST elevation myocardial infarction within 12 h of chest pain onset and undergoing successful primary PCI (i.e. residual stenosis < 20%), we included 48 patients (age 61±12 years, male sex 89%), comprising the first 24 with no-reflow and the first 24 without no reflow. Patients with iron deficiency, recent transfusions, liver or lung failure, other haematological disorders or undergoing treatment with EPO were excluded. EPO levels were measured by ELISA before PCI. Clinical, enzymatic, procedural and angiographic data were also collected. No-reflow was defined as a coronary TIMI flow grade ≤ 2 after vessel reopening or as a TIMI flow grade of 3 with a final myocardial blush grade <2. Multivariate predictors of no-reflow were assessed by logistic regression analysis (SPSS 13). Results : Patients with and without no-reflow did not differ significantly in age, sex, cardiovascular risk factors or standard therapy for acute myocardial infarction. Thrombus aspiration was used in 16 patients (32%) whereas abciximab in 31 (63%), and they did not differ between the two groups. Patients with angiographic no-reflow had lower EPO serum levels compared to those having angiographic reflow (4.2 (0.56 –9.5) vs 12.2 (5.7–20.2) mUI/ml, p=0.001). The left anterior descending artery (LAD) was the culprit vessel in 83% of patients having no-reflow as compared to 30% of those having reflow (p<0.0001). At multivariate analysis, including EPO levels, culprit artery and symptoms to balloon time, the independent predictors of no-reflow were LAD as culprit vessel (OR 15, 95% CI 3–75, p=0.001) and low EPO serum levels (OR 0.91, 95% CI 0.84 – 0.99, p=0.048). Conclusion : These data suggest a significant role for EPO in modulating microcirculatory injury after mechanical reperfusion in patients with ST elevation myocardial infarction.

scholarly journals The Relationship Between Hemoglobin Level and No-Reflow Phenomenon in Patients with Myocardial Infraction Undergoing Primary PCI

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ahmad Separham ◽  
Seyedeh Zeinab Seyedi ◽  
Ali Heidari Sarvestani
Keyword(s):  
Myocardial Infarction ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Hemoglobin Level ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
No Reflow ◽  
Timi Flow ◽  
Myocardial Infraction ◽  
St Elevation

Background: Anemia is a predictor of no reflow with high rate morbidity and mortality particularly in patients with heart failure. Objectives: The aim of this study was to investigate the relation between hemoglobin level and no-reflowing in patients with ‎myocardial infraction undergoing primary PCI. Methods: In this retrospective cross sectional study, all patients with ST elevation myocardial infarction (STEMI) undergoing coronary angiography from 2016 till 2018 were included. According to post procedural TIMI flow, the patients were divided into two groups: patients with TIMI flow III and those with TIMI flow less than III. ‎ Patients’ demographic and laboratory data such as hemoglobin, hematocrit, platelets count, white blood cells, serum creatinine level and troponin were collected. To compare the ‎quantitative variables chi square test and to compare qualitative variables t-test were applied by SPSS software version 19. Results: In this study 1200 patients with acute ST elevation myocardial infarction (STEMI) treated with primary PCI were included. The mean Hemoglobin level in normal TIMI group and low TIMI group were 14.15 ± 1.49 and ‎‎13.66 ± 1.69, respectively ‎ (P < 0.001). Our results also showed a significant lower RBC count (P < 0.001), lower HCT level (P < 0 .001) and lower RDW (P < 0.001) in those patients with lower TIMI flow.‎ Based on the multivariate regression analysis lower hemoglobin has a significant association with lower TIMI flow and no-reflow (OR = 0.747, CI = 0.618 - 0.888, P < 0.001)‎ Conclusions: Our study showed that in patients with STEMI undergoing primary PCI, hemoglobin level had a significant association with post procedural low TIMI flow and no-reflow. Our results emphasize the need for randomized control trials to evaluate the importance of pre-simultaneous blood transfusion in patients with anemia undergoing PPCI.

scholarly journals Clinical outcome of patients with ST-elevation myocardial infarction and angiographic evidence of coronary artery ectasia

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Silverio ◽  
L Esposito ◽  
G Fierro ◽  
M Di Maio ◽  
F Di Feo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
St Elevation Myocardial Infarction ◽  
Coronary Artery Ectasia ◽  
Comparable Rate ◽  
Long Term Outcome ◽  
Angiographic Evidence ◽  
St Elevation

Abstract Background Coronary artery ectasia (CAE) is a relatively frequent finding in patient with ST-elevation myocardial infarction (STEMI) who undergo emergent coronary angiography. However, the long-term outcome of STEMI patients with CAE as compared to Non-CAE has been poorly investigated. Purpose To compare the baseline features and outcome of patients with and without CAE in the clinical setting of STEMI. Methods All patients with STEMI who underwent emergent coronary angiography from January 2012 to December 2017 at our Institution were retrospectively enrolled. Baseline demographic, clinical, instrumental, angiographic and percutaneous coronary intervention (PCI) findings were collected for patients with and without CAE. The study outcome measures were recurrent myocardial infarction (MI) and all-cause death. The propensity score weighting (PSW) technique was used to take into account for potential selection bias in treatment assignment between CAE and Non-CAE groups. Results The study included 534 patients with STEMI (mean age 62.9±12.0 years), 154 were CAE and 380 Non-CAE. The two groups were significantly different in terms of sex (90.9% in CAE vs 72,6% in Non-CAE, p&lt;0.001), diabetes (11.7% vs. 25.8%; p=0.009) and smoking status (72.1% vs. 62.4%; p=0.042). The right coronary artery was more commonly treated in CAE patients (41.6% vs. 30.8%, p=0.023) and, as expected, the stent diameter (p&lt;0.001) and the TIMI frame count (p&lt;0.001) were significantly higher in CAE group. The myocardial blush grade was higher in Non-CAE (p&lt;0.001). The Kaplan-Meyer analysis showed a comparable rate of all-cause death among the two groups (3.4/100 person/years in CAE vs. 3.5 per 100 person/years in Non-CAE, Log-Rank = 0.86). The survival free from recurrent MI was lower, although not statistically significant, in CAE vs. Non-CAE patients (3.1/100 person/years vs. 4.8/100 person/years; Log-Rank = 0.068). After PSW, an optimal balance was obtained as demonstrated by a standardized mean difference &lt;0.1 for all the variables included in the model. The adjusted Cox regression analysis showed a significantly higher risk of recurrent MI in CAE vs. Non-CAE groups (HR = 1.93; p=0.009). No difference in the risk of all-cause death was observed (HR = 0.83, p=0.501). Conclusions Patient with STEMI and angiographic evidence of CAE have a different clinical profile compared to Non-CAE. In this analysis focused on STEMI patients, CAE was associated with a higher risk of recurrent MI at long-term follow-up. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document