scholarly journals VENTRICULAR ARRHYTHMIA BURSTS FOLLOWING PRIMARY PCI FOR ACUTE MYOCARDIAL INFARCTION: CORRELATIONS WITH CMRI OF MICROVASCULAR OBSTRUCTION AND FINAL INFARCT SIZE

2013 ◽  
Vol 61 (10) ◽  
pp. E150
Author(s):  
Kirian van der Weg ◽  
Sebastiaan C.A.M. Bekkers ◽  
Jan Tijssen ◽  
Cindy Green ◽  
Mitchell Krucoff ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Arrhythmia ◽  
Infarct Size ◽  
Microvascular Obstruction ◽  
Primary Pci ◽  
Final Infarct Size

Abstract 2667: Aspiration Coronary Thrombectomy for Acute Myocardial Infarction Improves Myocardial Salvage Index. Single Center Randomized Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michal Ciszewski ◽  
Jerzy Pregowski ◽  
Anna Teresinska ◽  
Maciej Karcz ◽  
Witold Ruzyllo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Perfusion Imaging ◽  
Randomized Study ◽  
Myocardial Salvage ◽  
Aspiration Thrombectomy ◽  
Acute Stemi ◽  
Final Infarct Size ◽  
Myocardium At Risk

Primary percutaneus intervention (pPCI) is a recommended treatment strategy for acute myocardial infarction with ST segment elevation (STEMI). Adjunctive thrombectomy may add clinical benefits. The aim of our study was to compare the efficacy of aspiration thrombectomy versus standard pPCI for STEMI. The primary endpoint was salvage index assessed by sestamibi SPECT perfusion imaging. Single centre randomized study on aspiration thrombectomy in acute STEMI. 135 patients (88 males, mean age 64,3±12,4 yrs) with first acute STEMI were enrolled between Nov 2004 and Dec 2007. Inclusion criteria were: first anterior or inferior STEMI within 12 hours from pain onset with culprit lesion in left anterior descending (LAD) or right coronary artery (RCA) and TIMI flow ≤ 2. Patients were randomly assigned to thrombectomy with Rescue or Diver device followed by stent implantation (65) vs. standard pPCI with stenting (70 pts). 5 patients initially randomised to thrombectomy were finally treated with standard pPCI. Two SPECT examinations were performed: before and 5– 8 days after reperfusion therapy. Five patients died 3–7 days after the procedure, and in 3 pts second SPECT could not be performed because of patients’ severe condition. Thus two SPECT examinations were performed in 127 patients (63 treated with thrombectomy and 64 in control group). These 127 subject were the basis of the intention to treat analyses. There were 41 pts with anterior STEMI and 86 pts with inferior STEMI. Both treatment groups were similar regarding baseline demographic and clinical variables. Based on the SPECT perfusion imaging results, the final infarct size was assessed and myocardial salvage index (proportion of the myocardium at risk salvaged by reperfusion) was calculated. Baseline myocardium at risk area was 35,0%±2,8% in thrombectomy group vs 35,8%±10,9% in control patients. (p=NS). Myocardial salvage index was larger in patients treated with aspiration thrombectomy (0,33±0,27 vs. 0,20 ± 0,21 p = 0,004). Moreover, final infarct size was significantly smaller in patients treated with thrombectomy: 23,9% ± 13,1 % vs.28,3 % ±9,6% p = 0,005. Our results show that coronary thrombectomy is beneficial as an adjunctive therapy to pPCI in STEMI.

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stanley Chia ◽  
O. Christopher Raffel ◽  
Faisal Merchant ◽  
Frans J Wackers ◽  
Fred Senatore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Troponin T ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Primary Pci ◽  
Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

scholarly journals Effect of primary percutaneous coronary intervention on ventricular repolarization through evaluation of QT dispersion in patient with acute myocardial infarction

2018 ◽  
Vol 5 (2) ◽  
pp. 506
Author(s):  
Behzad Babapour ◽  
Bita Shahbazzadegan ◽  
Bahareh Khademi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ventricular Arrhythmia ◽  
Primary Percutaneous Coronary Intervention ◽  
Qt Dispersion ◽  
Coronary Intervention ◽  
Ventricular Repolarization ◽  
Primary Pci ◽  
Percutaneous Coronary

Background: Cardiovascular disease is the most common cause of death around the world. QT dispersion is one of the parameters that used for evaluation of ventricular arrhythmia. Primary PCI increases probability of coronary artery and reperfusion of the ventricular arrhythmia. The aim of this study was to determine effect of primary percutaneous coronary intervention (PCI) on ventricular repolarization through evaluation of QT dispersion in patient with acute myocardial infarction. Methods: In this pre-post test study, 77 patients with acute ST with elevated myocardial infarction under primary PCI were investigated. The ECG and ST dispersion before PCI and 24 hours after PCI were determined and then the amount of QTd was calculated. The repeated measurement ANOVA was used to compare QTd of pre- PCI treatment and QTd in 24 hours after PCI. Data analysis was performed using statistical software SPSS ver.17. Results: From 77 participants, 60 were male and 17 were female. 43 (55.8%) had a MI position in ANT, PRE, and EXT, 33 (42.9%) had in the INF, and only one person (1.3%) had a MI position in LAT. The results showed that mean QT dispersion in ECG, 24h after primary PCI, for most of measured variables was deceased compare to before primary PCI, but the difference was not significant. Conclusions: The amount of QTd 24 hours after PCI decreased but its decline was not significant. With regards to lack of convenience data, more researches are recommended in this field. 

PlA polymorphism of the glycoprotein IIIa and efficacy of reperfusion therapy in patients with acute myocardial infarction

2004 ◽  
Vol 91 (01) ◽  
pp. 141-145 ◽  
Author(s):  
Olga Gorchakova ◽  
Werner Koch ◽  
Julinda Mehilli ◽  
Nicolas von Beckerath ◽  
Markus Schwaiger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Reperfusion Therapy ◽  
Primary Treatment ◽  
Platelet Glycoprotein ◽  
Myocardial Salvage ◽  
Genotype Distribution ◽  
Final Infarct Size ◽  
Glycoprotein Iiia

SummaryThe PlA polymorphism of the platelet glycoprotein IIIa gene is associated with altered platelet function and response to antiplatelet drugs. We sought to assess whether the PlA polymorphism influences myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction. We analyzed 292 patients enrolled in 2 randomized trials that compared stenting plus abciximab with thrombolysis (alteplase alone or alteplase plus abciximab) in acute myocardial infarction. Patients were genotyped for the PlA polymorphism using polymerase chain reaction with fluorogenic probes. Technetium-99m sestamibi was injected before and 1-2 weeks after reperfusion treatment. The scintigrams enabled the calculation of the initial perfusion defect, final infarct size, and the proportion of initial defect salvaged by reperfusion (salvage index). Clinical follow-up was done up to 18 months after primary treatment. The genotype distribution was as follows: PlA2/A2 in 3.4%, PlA1/A2 in 24.7% and PlA1/A1 in 71.9% of patients. There were no significant differences between PlA2 allele carriers and PlA1/A1 patients in salvage index (0.46±0.50 vs. 0.41±0.43, respectively, P=0.48), final infarct size (16.8±20.8% vs. 18.4±19.1% of left ventricle, respectively, P=0.46) as well as 18-month mortality (8.5% vs.7.1%, respectively, P=0.69). The lack of relationship between PlA2 allele and myocardial salvage was observed for both reperfusion strategies, stenting and thrombolysis. Thus, these findings show that the functional PlA polymorphism of platelet glycoprotein IIIa has no influence on the degree of myocardial salvage achieved by reperfusion therapies in patients with acute myocardial infarction.

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