scholarly journals GW28-e1171 The effect of Intra-coronary Bivalirudin injection during primary PCI on coronary blood flow and clinical events in patients with acute ST segment elevation myocardial infarction: A Pilot Study

2017 ◽  
Vol 70 (16) ◽  
pp. C105
Author(s):  
Zhenyang Liang ◽  
Xuedong Zhao ◽  
Haiwei Liu ◽  
Kai Xu ◽  
Meili Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Pilot Study ◽  
Coronary Blood Flow ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Clinical Events ◽  
St Segment

P957Survival benefits of routine glycoprotein IIb/IIIa inhibitors during primary PCI in ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Karathanos ◽  
Y F Lin ◽  
L Dannenberg ◽  
C Parco ◽  
V Schulze ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Repeat Revascularization ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Randomised Controlled

Abstract Background Cardiovascular guidelines recommend adjunct glycoprotein IIb/IIIa inhibitors (GPI) only in selected patients with acute ST-segment elevation myocardial infarction (STEMI). Purpose This study aimed to evaluate routine GPI use in STEMI treated with primary PCI. Methods Online databases were systematically searched for randomised controlled trials (RCTs) of routine GPI vs. control therapy in STEMI. Data from retrieved studies were abstracted and evaluated in a comprehensive meta-analysis using Mantel-Haenszel estimates of risk ratios (RR) as summary statistics. Results After systematic review, twenty-one RCTs with 8,585 patients were included: ten trials randomized tirofiban (T), nine abciximab (A), one eptifibatide (E), one trial used A+T; only one trial used DAPT with prasugrel/ ticagrelor. Routine GPI were associated with a significant reduction in all-cause mortality at 30 days (2.4% (GPI) vs. 3.2%; risk ratio (RR) 0.72; p=0.01) and 6 months (3.7% vs. 4.8%; RR 0.76; p=0.02), and a reduction in recurrent MI (1.1% vs. 2.1%; RR 0.55; p=0.0006), repeat revascularization (2.5% vs. 4.1%; RR 0.63; p=0.0001), TIMI flow <3 after PCI (5.4% vs. 8.2%; RR 0.61; p<0.0001) and ischemic stroke (RR 0.42; p=0.04). Major (4.7% vs. 3.4%; RR 1.35; p=0.005) and minor bleedings (7.2% vs. 5.1%; RR 1.39; p=0.006) but not intracranial bleedings (0.1% vs. 0%; RR 2.7; p=0.37) were significantly increased under routine GPI. Conclusions Routine GPI administration during primary PCI in STEMI resulted in mortality reduction, driven by reductions in recurrent ischemic events – however predominantly in trials pre-prasugrel/ticagrelor. Trials in contemporary STEMI management are needed to confirm these findings.

A macrophage migration inhibitory factor as a predictor of reperfusion myocardial injury in patients with st-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Vishnevskaya ◽  
T.Y.E Storozhenko ◽  
M.P Kopytsya
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Macrophage Migration Inhibitory Factor ◽  
Myocardial Injury ◽  
Macrophage Migration ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
No Reflow Phenomenon

Abstract Introduction Major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) are still common despite the modern treatment approaches. It may be caused by the “no-reflow” phenomenon. One of the promising biomarkers for the coronary “no-reflow” phenomenon prediction is proinflammatory cytokine macrophage migration inhibitory factor (MIF). Purpose To estimate the role of MIF in the prediction of early reperfusion myocardial injury in patients with STEMI. Methods The study involved 341 STEMI patients (78.6% male and 21.4% female) with an average age of 59.08±9.65 years. Control group of 12 healthy volunteers included. All patients were made to undergo a baseline investigation. In addition, the level of MIF determined twice during the first 12 hours of STEMI, before the percutaneous coronary intervention (PCI) and after the procedure. Coronary blood flow evaluated using TIMI flow grade and myocardial blush grade (MBG). All patients had epicardial blood flow TIMI 3. The criteria for “no-reflow” diagnosis were myocardial perfusion at MBG 0 or MBG 1 level with complete recovery of epicardial blood flow or ST-segment resolution (rST) of less than 70% from baseline within 2 hours after PCI. All patients were divided into two groups according to MBG and rST after PCI more and less than 70%: 147 patients in the first group with MBG stage 0–1, 182 patients with MBG stage 2–3 Results 64% of STEMI patients had elevated MIF levels above the highest value in healthy controls (2778±217 ng/ml; 225±6,7 ng/ml; p=0,0003). The level of MIF biomarker, determined before PCI was significantly higher in the group of patients with MBG 0–1 in comparison to MBG 2–3. (4708±471 ng/ml vs 2914±347ng/ml; p=0,004). Using the multivariate regression analysis, the dependencies of the biomarker MIF on the parameters of the reperfusion myocardial injuries were obtained. MIF measured before revascularization as well as the patient's gender, was an independent predictor of MBG 0–1 and rST less than 70% (coefficients Beta 0,1; odd ratio 1,1; 95%confidential interval (CI) 1,0–1,2; p=0,037 and coefficient Beta 2,9; odd ratio 17.7; 95% CI 0,96–32; p=0,05, respectively). Conclusions The study revealed that MIF predicts reperfusion myocardial injury in patients with STEMI. Future investigations of the MIF biological effects are the perspective direction in the field of modern cardiology. Funding Acknowledgement Type of funding source: None

Abstract 12762: Clinical Characteristics and Determinants of Non-Eligibility for Reperfusion in Patients With ST Segment Elevation Myocardial Infarction: Insights From the NCDR®

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tarun W Dasari ◽  
Steve Hamilton ◽  
Anita Y Chen ◽  
Tracy Y Wang ◽  
James A de Lemos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Characteristics ◽  
Major Contributor ◽  
Primary Pci ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation

Background: There is little recent data describing the characteristics and outcomes of STEMI patients who do not undergo urgent reperfusion. Methods: Using the ACTION Registry®-GWTG™ database, we examined 232,208 STEMI patients presenting January 2007 through December 2013 at 793 U.S. centers. The cohort was divided into those who underwent reperfusion (n=194,916; 84%), had documented contraindication to reperfusion (n=31,518; 13.5%) and were eligible but not reperfused (n=5,774; 2.5%). Clinical characteristics and in-hospital outcomes were compared between these groups. Results: Compared with those reperfused, patients not reperfused were older, more often female and had higher rates of hypertension, diabetes, MI, stroke and atrial fibrillation. LBBB and CHF were more common in the non-reperfused groups upon presentation. The major documented contraindications to reperfusion were unsuitable anatomy for primary PCI (31%), symptoms onset > 12 hours (9%), patient/family refusal/DNR status (6%), resolved chest pain (6%) and ST elevation (5%) presentation to non-PCI centers (4%). Three-vessel disease and in-hospital CABG were more common in non-reperfused patients with and without contraindication compared with those receiving reperfusion (39 & 37% vs. 26%, p<0.001) and (17 & 17% vs. 3%, p<0.001 respectively). In-hospital outcomes are summarized in the table. Conclusion: Most STEMI patients who were not reperfused had a documented contraindication. Unsuitable anatomy for PCI was the major contributor to ineligibility. In hospital mortality, death/MI and cardiogenic shock were higher in the non-reperfused groups.

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