The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI

Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public health issue. Despite advances in therapy, patients remain at risk for death, repeat myocardial infarction (MI) shock and heart failure (HF). Novel markers that predict those at risk are needed. We studied 903 STEMI patients in The Assessment of Pexelizumab in Acute Myocardial Infarction trial (which enrolled STEMI patients presenting < 6 hrs of symptom onset who were to undergo primary PCI) in a case-control design (cases selected based on the trial’s primary composite outcome - death, shock or HF - and matched on age, gender and infarct location to controls). NT-proBNP (pg/ml) was measured at randomization and 24 hrs. Outcomes (individually and the composite) of death, shock, and HF at 90 days were examined by quartiles of NT-proBNP. A CART model was used to categorize adjusted risk. NT-proBNP was higher in patients who had events. Patients with higher NT-proBNP levels at baseline (median symptom onset to randomization 2.7 hrs) and 24 hrs had more events (composite p<0.001; death p<0.0001; HF p<0.0001; shock p=0.05) - See figure . Using the CART model (adjusted for age, gender and infarct location), baseline Killip class and NT-proBNP could further subcategorize patients into 90 day mortality categories 4%, 10%, 30%, and 53%. In fact, only 4 patients (1%) with a 24 hour NT-proBNP <999 pg/ml had any event in the next 90 days. Although the overall prognosis in STEMI patients undergoing primary PCI is good, NT-proBNP performed early and at 24 hrs provides important prognostic information for predicting negative outcomes i.e. shock, heart failure and death. Figure. Kaplan-Meier curve for the primary composite outcome stratified by baseline NT-proBNP (a), or 24 hour NT-proBNP (b).

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Impact of Late Ventricular Arrhythmias on Cardiac Mortality in Patients with Acute Myocardial Infarction

Journal of Interventional Cardiology ◽

10.1155/2019/5345178 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Takuma Takada ◽

Koki Shishido ◽

Takahiro Hayashi ◽

Shohei Yokota ◽

Hirokazu Miyashita ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ventricular Arrhythmias ◽

Coronary Intervention ◽

Primary Pci ◽

Cardiac Mortality ◽

Killip Class ◽

Percutaneous Coronary ◽

The Relationship ◽

Lower Ejection Fraction

Objectives. This study investigated the relationship between the timing of ventricular tachycardia or ventricular fibrillation (VT or VF) and prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Background. It is unknown whether the timing of VT/VF occurrence affects the prognosis of patients with AMI. Methods. From January 2004 to December 2014, 1004 patients with AMI underwent primary PCI. Of these patients, 888 did not have VT/VF (non-VT/VF group) and 116 had sustained VT/VF during prehospitalization or hospitalization. Patients with VT/VF were divided into two groups: early VT/VF (VT/VF occurrence before and within 2 days of admission, 92 patients) and late VT/VF (VT/VF occurrence >2 days after admission; 24 patients) groups. Results. The frequency of VT/VF occurrence was high between the day of admission and the 2nd day and between days 6 and 10 of hospitalization. The late VT/VF group had a significantly longer onset-to-balloon time, lower ejection fraction, poorer renal function, and higher creatine phosphokinase (CK)-MB level on admission (p< 0.001). They also had a lower 30-day cardiac survival rate than the early VT/VF and non-VT/VF groups (42% vs. 76% vs. 96%, p < 0.001). Moreover, independent predictors of in-hospital cardiac mortality among patients with AMI who had sustained VT/VF were higher peak CK-MB [Odds ratio (OR: 1.001, 95%confidence interval (CI): 1.000-1.002, p= 0.03)], higher Killip class (OR: 1.484, 95%CI 1.017-2.165, p= 0.04), and late VT/VF (OR: 3.436, 95%CI 1.115-10.59, p= 0.03). Conclusions. The timing of VT/VF occurrences had a bimodal peak. Although late VT/VF occurrence after primary PCI was less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis.

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RANDOMIZED COMPARISON OF PREHOSPITAL INITIATED FACILITATED PCI VERSUS PRIMARY PCI IN ACUTE MYOCARDIAL INFARCTION WITH < 3 H AFTER SYMPTOM ONSET

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)60965-5 ◽

2010 ◽

Vol 55 (10) ◽

pp. A103.E964

Author(s):

Holger Thiele ◽

Ingo Eitel ◽

Claudia Meinberg ◽

Gerd Plock ◽

Wolfgang Strauß ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Symptom Onset ◽

Primary Pci ◽

Facilitated Pci

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Treatment delay in STEMI is associated with heart failure and mortality. National data from the Norwegian myocardial infarction register

European Heart Journal ◽

10.1093/ehjci/ehaa946.1350 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.K Halle ◽

R.E.S Govatsmark ◽

K.H Bonaa

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Time Delay ◽

Symptom Onset ◽

Missing Values ◽

Outcome Variable ◽

P Value ◽

Primary Pci ◽

Increased Risk

Abstract Background European guidelines in ST-segment elevation acute myocardial infarction (STEMI) recommends a primary PCI (P-PCI) strategy if wire crossing of the occluded artery can be performed within 120 min of ECG diagnosis. A large proportion of the Norwegian population lives in remote geographical areas where P-PCI may not be performed expeditiously. Time delay from first medical contact to primary PCI is expected to be related to outcomes like heart failure and mortality. Norwegian hospitals are by law required to register clinical data for all patients treated for acute myocardial infarction in the Norwegian Myocardial Infarction. The register includes >90% of eligible patients. Purpose The aim of the study was to investigate the association of time from first medical contact (FMC) to P-PCI with heart failure (EF <50%) and mortality. Methods The study includes all patients registered during 2015–2018 in the Norwegian Myocardial Infarction Registry with STEMI who were <85 years of age and had <12 hours from symptom onset to FMC. For patients with missing values, FMC was calculated as time of prehospital ECG minus 10 minutes. The primary outcome variable was heart failure (defined as ejection fraction <50% during hospitalization) or all-cause mortality within 1 year after hospitalization. We calculated ORs (95% CI) adjusted for age, gender, and history of myocardial infarction, hypertension, diabetes, and heart failure. Results During 2015–2018 a total of 6398 STEMI patients <85 years of age were registered in the Norwegian Myocardial Infarction Registry with less than 12 hours from symptom onset to FMC. Time delay from FMC to P-PCI were <90 minutes, 90–119 minutes, and >120 minutes in 40%, 25%, and 35% of the patients, respectively. Compared to patients with P-PCI within 90 minutes after FMC, the multivariable adjusted OR (95% CI; p-value) for heart failure or 1 year mortality was 1.05 (1.02–1.08; p<0.01) for patients with P-PCI within 90–119 minutes after FMC, and 1.05 (1.02–1.08; p<0.001) for patients with P-PCI >120 minutes after FMC. The corresponding ORs for 1 year mortality were 1.01 (0.99–1.02) and 1.03 (1.02–1.04), respectively, and the corresponding ORs for EF<50% were 1.07 (1.04–1.11) and 1.07 (1.04–1.11). Conclusion In Norway, only 40% of STEMI patients undergo P-PCI within 90 minutes after FMC, and 35% of patients undergoes P-PCI >120 minutes after FMC. Time delays of more than 90 minutes after FMC are associated with increased risk of heart failure and mortality. A fibrinolysis strategy may be preferred over P-PCI for a substantial proportion of STEMI patients. Funding Acknowledgement Type of funding source: None

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The relationship of markers of systemic inflammatory response and myocardial necrosis in patients with acute myocardial infarction complicated by ventricular arrhythmia

Problems of Uninterrupted Medical Training and Science ◽

10.31071/promedosvity2017.04.024 ◽

2017 ◽

Vol 27 (4) ◽

pp. 24-29

Author(s):

I. M. Fushtey ◽

◽

Mohamed Fedi ◽

E.V. Sid’ ◽

◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Inflammatory Response ◽

Ventricular Arrhythmia ◽

Myocardial Necrosis ◽

Systemic Inflammatory Response ◽

Relationship Of ◽

The Relationship

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Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

Current Pharmaceutical Design ◽

10.2174/1381612824666171227211623 ◽

2018 ◽

Vol 24 (4) ◽

pp. 414-426 ◽

Cited By ~ 3

Author(s):

Patrick Proctor ◽

Massoud A. Leesar ◽

Arka Chatterjee

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Coronary Intervention ◽

Evidence Base ◽

Primary Pci ◽

Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

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