scholarly journals Effect of remote ischemic post conditioning on kidney function in STEMI patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Arara ◽  
M Fadil ◽  
Y Karani ◽  
RD Nindrea
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Kidney Function ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Control Group ◽  
P Value ◽  
Baseline Characteristic ◽  
Simple Method ◽  
Percutaneous Coronary

Abstract Funding Acknowledgements Type of funding sources: None. Background Primary percutaneous coronary intervention (PPCI) is a treatment of choice in ST elevation myocardial infarction patients (STEMI). However, this approach could affect the kidney function due to iodinated contrast exposure to the patient. Remote ischemic post conditioning (RIPostC) is a non-invasive and simple method that not only has cardioprotective but also renoprotective effect for kidney function. Purpose The aim of this study was to investigate the effect of RIPostC to kidney function in STEMI patients undergoing PPCI. Methods This study uses pre and post-test only with control group design with experimental research designs. Data was taken at an Indonesian Heart Center from June 2019 until March 2020, there were 66 patients with ST-segment elevation myocardial infarction (STEMI) being performed RIPostC procedure with intermittent ischaemia and reperfusion applied to the arm through five cycles of 5-min inflation and 5-min deflation of an automated cuff device after crossing wire. Creatinine and eGFR were measured pre and 48 hours post PPCI. Kidney function were determined by eGFR post PPCI, ΔeGFR (pre and 48 hours post PPCI), creatinine post PPCI and Δcreatinine (pre and 48 hours post PPCI). Bivariate analysis was performed to determine the effect RIPostC to kidney function using the Chi-square test.  Result A total of 66 patients who underwent the PPCI procedure were divided into two groups RIPostC (n = 33) and without RIPostC (n = 33). The baseline characteristic in both of group was similar. We found that there were no differences of eGFR (70,46 ± 23,06 vs 65,88 ± 23,36, p = 0,424), ΔeGFR (0 [-34,68 - 37,32] vs 0 [-121,53 - 29,70], p value= 0,406), creatinine (1,00 [0,70 - 4,60] vs 1,20 [0,60-4,10], p value= 0,633) and Δcreatinine (0 [-1,20-1,10] vs 0 [-0,50-0,90], p value= 0,390) RIPostC group had a lower CI-AKI incident if we compare with the non RIPostC (15,2% vs 42,4%, p < 0,05). Conclusion Remote ischaemic conditioning does not significantly improve kidney function (eGFR, ΔeGFR, creatinine and Δcreatinine) in patients with STEMI undergoing PPCI The differences of kidney functionVariableRIPostCControlp valueeGFR post PPCI (ml/min/1,73 m2), mean70,46 ± 23,0665,88 ± 23,360,424aΔeGFR(ml/min/1,73 m2), median0 [-34,68 - 37,32]0 [-121,53 - 29,70]0,406bCreatinine post PPCI (mg/dL), median1,00 [0,70 - 4,60]1,20 [0,60-4,10]0,633bΔcreatinine (mg/dL), median0 [-1,20-1,10]0 [-0,50-0,90]0,390ba = Independent sample T testb = mann whitney testAbstract Figure. ΔeGFR and Δcreatinine pre and post PPCI

scholarly journals Effect of remote ischemic post conditioning on incidence of contrast induce acute kidney injury in STEMI patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Arara ◽  
M Fadil ◽  
Y Karani ◽  
RD Nindrea
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Baseline Characteristic ◽  
Chi Square ◽  
Simple Method ◽  
Percutaneous Coronary

Abstract Funding Acknowledgements Type of funding sources: None. Background Primary percutaneous coronary intervention (PPCI) is a treatment of choice in ST elevation myocardial infarction patients (STEMI). However, this approach could increase the risk of contrast induce acute kidney injury (CI-AKI) due to iodinated contrast exposure to the patient. Remote ischemic post conditioning (RIPostC) is a non-invasive and simple method that not only has cardioprotective but also renoprotective effect that could prevent the incidence of CI-AKI.  Purpose The aim of this study was to investigate the effect of RIPostC to CI-AKI incident in STEMI patients undergoing PPCI. Methods This study uses pre and post-test only with control group design with experimental research designs. Data was taken at the Instalasi Pelayanan Jantung Terpadu (IPJT) RSUP Dr. M. Djamil Padang from June 2019 until March 2020, there were 66 patients with ST-segment elevation myocardial infarction (STEMI) being performed RIPostC procedure. with intermittent ischaemia and reperfusion applied to the arm through five cycles of 5-min inflation and 5-min deflation of an automated cuff device after crossing wire. Creatinine and eGFR were measured pre and 48 hours post PPCI. CI-AKI diagnosis based on increase of creatinine level >0,5 mg/dL or 25% from baseline value on 48 hours after PPCI. Bivariate analysis was performed to determine the effect RIPostC to incidence of CI-AKI using the Chi-square test. Result A total of 66 patients who underwent the PPCI procedure were divided into two groups RIPostC (n = 33) and without RIPostC (n = 33). The baseline characteristic in both of group was similar. The RIPostC group had a lower CI-AKI incident if we compare with the non RIPostC (15,2% vs 42,4%, p < 0,05). Conclusion RIPostC effectively reduced incidence of CI-AKI in STEMI patient who underwent the PPCI with statistically significant result. Effect of RIPostC in CI-AKI post PPCIPPCICI-AKI (+)(f/%)CI-AKI (-)(f/%)Total(f/%)OR (95% CI)p valueRIPostC (+)5 (15,2)28 (84,8)33 (100)0,024 (0,07-0,76)0,03*bRIPostC (-)14 (42,4)19 (57,6)33 (100)Total19 (28,8)47 (71,2)66 (100)* significant p if < 0,05b, chi square testAbstract Figure. Effect of RIPostC in CI-AKI post PPCI

scholarly journals The Clinical Prediction Factors for Non-Culprit Lesion Progression in Patients with Acute ST Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
jian wang ◽  
Cheng-ying Yan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background To investigate the relationship between the clinical features and progression of non-culprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods A total of 480 patients (57.1 ± 9.2 y) with STEMI who underwent PPCI between January 2016 and December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as a treatment for culprit lesions. Clinical and angiographic follow-up were performed for 12 months. All patients were divided into a non-culprit lesions (NCL) progression group (205 cases) and a control group (275 cases) based on angiographic follow-up outcomes at 12 months. The clinical and angiographic features were analyzed. Results Body mass index (BMI), serum creatinine (Scr), fasting blood glucose (FBG), glycated serum albumin, glycated hemoglobin and homocysteine levels in the NCL progression group were significantly higher than those in the control group (P < 0.05). A logistic regression analysis showed that FBG (odds ratio = 1.274, 95% confidence interval: 1.077–1.505, P = 0.005) and Scr (odds ratio = 1.020, 95% confidence interval: 1.002–1.038, P = 0.027) were independent predictors of NCL progression. A partial correlation analysis showed that FBG was positively correlated with NCL progression (r = 0.231, P = 0.001). A receiver operating characteristic curve showed that the boundary point of FBG to predict NCL progression was 5.715 mmol/L, and the sensitivity was 74.4% and the specificity was 46.4%. Conclusions FBG is a valuable predictor for NCL progression in patients with STEMI after PPCI.

scholarly journals New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block

2020 ◽  
Vol 9 (14) ◽  
Author(s):  
Andrea Di Marco ◽  
Marcos Rodriguez ◽  
Juan Cinca ◽  
Antoni Bayes‐Genis ◽  
Jose T. Ortiz‐Perez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Left Bundle Branch Block ◽  
Primary Percutaneous Coronary Intervention ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Control Group ◽  
Bundle Branch Block ◽  
Percutaneous Coronary

Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction ( AMI ) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI ); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI ). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm ( BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS , in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS , ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules ( P <0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention , the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI , leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.

scholarly journals THE CORRELATION BETWEEN TROPONIN I LEVEL WITH CORRECTED THROMBOLYSIS IN MYOCARDIAL INFARCTION FRAME COUNT IN PATIENTS WHOSE UNDERWENT PRIMARY PERCUTANEOUS CORONARY INTERVENTION: A SINGLE CENTER STUDY

2020 ◽  
pp. 63-66
Author(s):  
MASRUL SYAFRI ◽  
ERYATI DARWIN ◽  
ETI YERIZEL ◽  
HARDISMAN
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Retrospective Analysis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Flow ◽  
Troponin I ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Baseline Characteristic ◽  
Percutaneous Coronary

Objective: There were studies reported about the correlation between troponin I with scale of myocardial infarction (MI) area. However, the effect of revascularization into the coronary flow has not been reported. We aim to determine the correlation between high sensitivity troponin I and the successfulness of revascularization primary percutaneous coronary intervention (PPCI) in ST-elevation MI (STEMI) patients. The successfulness of revascularization was assessed by calculating Corrected thrombolysis in MI frame count (CTFC). Methods: This is a retrospective analysis including all consecutive patients undergoing PPCI over 1-year period from December 2018 to 2019 at the Integrated Heart Service Installation Dr. M. Djamil Padang Hospital, West Sumatra. Exclusion criteria included patients with incomplete medical record data, incomplete coronary angiography data, prior MI, and prior PCI and coronary artery bypass graft. Patients were put into two groups with normal (CTFC <30) and high (CTFC ≥30) to define the baseline characteristics. Results: A retrospective analysis was performed of patients undergoing primary PCI. Ninety-six patients underwent PPCI between December 2018 and 2019 were enrolled. For the baseline characteristic, patient was divided into two groups with normal CTFC (<30) and high (CTFC ≥30). There was negative weak correlation between troponin I level and CTFC with Spearman’s correlation value was 0.371 and correlation coefficient −0.092. Conclusion: Troponin I level at first presentation before revascularization did not have a significant correlation with coronary flow result after revascularization in STEMI patients.

scholarly journals The clinical prediction factors of nonculprit lesions progression in patients with acute ST elevation myocardial infarction after primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian wang ◽  
Xue-Jie WANG
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Objective :To investigate the relationship between the clinical features and progression of nonculprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods: A total of 192 patients (57.1 ± 9.2 years) with STEMI who underwent PPCI from January 2016 to December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions.Clinical and angiographic follow-up were performed in 12 months. All patients were divided into Nonculprit lesions(NCL) progression group ( 82 cases) and the control group (110 cases) according to angiographic follow-up outcome in 12 months. The clinical and angiographic features were analyzed.Results: Levels of body mass index（BMI）,serum creatinine（Scr）,fasting blood glucose（FBG）,glycated serum albumin（GSA）,glycated hemoglobin(GHb) and homocysteine (Hcy) in NCL progression group were significantly higher than those in the control group( P < 0. 05,respectively).Logistic regression showed that FBG( odds ratio = 1. 274,95% confidence interval: 1. 077-1. 505,P = 0. 005) and Scr ( odds ratio =1. 020,95% confidence interval:1. 002-1. 038,P=0. 027) were independent predictors of NCL progression.Partial correlation analysis showed that FBG was positively correlated with NCL progression( r = 0. 231,P = 0. 001) .Receiver operating characteristic(ROC) curve showed that the boundary point of FBG to predict NCL progression was 5. 715 mmol /L, the sensitivity was 74. 4% and the specificity was 46. 4%.Conclusion: FBG is an valuable predictor for NCL progression in patients with STEMI after PPCI.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

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