P610The microvascular obstruction and intramyocardial haemorrhage: impact of different reperfusion strategies in primary myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Vyshlov ◽  
Y A Alekseeva ◽  
V Usov ◽  
V Ryabov
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Prevalence Rates ◽  
Ventricular Ejection Fraction ◽  
Invasive Strategy ◽  
Group 2 ◽  
Group 1

Abstract Background The coronary reperfusion in patients with ST-elevated myocardial infarction (STEMI) is often complicated by reperfusion-ischemic myocardial injury: microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH). Contrast-enhanced cardiac magnetic resonance imaging (MRI) is the best diagnostic method, which allows to assess these phenomena. It is known that in patients with STEMI and primary percutaneous coronary intervention (PCI), the prevalence rates of MVO and IMH are 50–60% and 40–50%, respectively. There is not enough knowledge about the prevalence of these phenomena in patients with pharmaco-invasive strategy. Purpose The aim of the study was to evaluate the prevalence of MVO and IMH in patients with primary STEMI and different reperfusion strategies. Materials and methods This observational cohort study included 47 patients with primary STEMI within the first 12 hours after the onset of disease. Exclusion criteria: pulmonary edema, cardiogenic shock, creatinine clearance <30 mL/min or dialysis, severe comorbidity, acute psychotic disorders, and inability to undergo or contra-indications for MRI. These patients were divided into 2 groups. Patients of group 1 (n=30) were treated with a pharmaco-invasive strategy. Fibrinolysis was performed in all patients in the pre-hospital setting. Patients of group 2 (n=17) were treated by primary PCI. MRI was performed at day 2 post-STEMI in all patients. Late gadolinium enhancement and T2-weighted IMH imaging for microvascular obstruction and IMH were used. Results Patients with primary PCI more often had MVO: 70.5% (n=12) vs. 40% (n=12) in the pharmaco-invasive group (p=0.05). The occurrence of IMH between the groups did not significantly differ: 40% (n=12) in group 1 vs. 64.7% (n=11) in group 2, respectively. The presence of combination of MVO with IMH was observed significantly more often in group of primary PCI: 47% (n=8) vs. 20% (n=6) (p=0.03). The left ventricular ejection fraction was significantly lower in patients with combination of IMH and MVO compared to those without it: 55% (34–66) vs. 62.5% (53–72) (p=0.01). Conclusion MVO and IMH were common findings in patients with primary STEMI and different reperfusion strategies and were present in 40% to 70% of patients. The MVO and combination of MVO with IMH occurred significantly more often in the group of primary PCI. The prevalence rates of IMH in patients with different reperfusion strategies did not significantly differ. ClinicalTrials.gov, identification number is NCT03677466.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

Functional Significance of Collateral Circulation in Patients with Total Coronary Occlusion

1993 ◽  
Vol 1 (4) ◽  
pp. 156-162
Author(s):  
Ha Jong Won ◽  
Cho Seung Yun ◽  
Jang Yang Soo ◽  
Chung Nam Sik ◽  
Shim Won Hewn ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Collateral Circulation ◽  
Coronary Occlusion ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Segmental Wall Motion ◽  
Group 2 ◽  
Group 1

Functional significance of collateral circulation was evaluated in 125 patients with total coronary occlusion. Patients were classified into 2 groups: group 1, patients without myocardial infarction; and group 2, patients with a first transmural myocardial infarction occurring within 3 months of symptom onset. There was a higher prevalence of well-developed collaterals and multivessel disease in patients without myocardial infarction than in those with myocardial infarction. The left ventricular ejection fraction, left ventricular enddiastolic pressure, and segmental wall motion scores were significantly better in group 1 than group 2. Despite total coronary occlusion, 61% of group 1 had a normal resting electrocardiogram; however, 96% of patients who underwent treadmill tests proved positive. The proportions of well-developed collaterals in 3 groups, divided according to the internal between onset of myocardial infarction and angiography (within 1 day of operation, 2 to 14 days, or 15 days to 3 months), were 13%, 54%, and 60%. There were no significant differences in left ventricular ejection fraction, segmental wall motion score, and left ventricular enddiastolic pressure in myocardial infarction patients with poorly developed collaterals and well-developed collaterals. The degree of collateral development is higher in myocardial infarction with right coronary artery occlusion compared with that of left anterior descending artery occlusion, without regarding the dominancy or length. Collateral circulation can prevent myocardial ischemia and present myocardial function in a significant number of patients without infarction; however, it does not provide protection against exercise-induced myocardial ischemia in the majority of patients from group 1. Although well-developed collaterals are not usually present within 1 day after myocardial infarction, they are generally present after 2 weeks. Collateral vessels in patients with myocardial infarction have no beneficial effects on preserving myocardial function.

scholarly journals Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 25 (8) ◽  
pp. 3796
Author(s):  
A. A. Frolov ◽  
K. V. Kuzmichev ◽  
I. G. Pochinka ◽  
E. G. Sharabrin ◽  
A. G. Savenkov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Artery Revascularization ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality.

scholarly journals Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes

2020 ◽  
Vol 9 (10) ◽  
pp. 3377
Author(s):  
Jacek Piegza ◽  
Lech Poloński ◽  
Aneta Desperak ◽  
Andrzej Wester ◽  
Marianna Janion ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Invasive Treatment ◽  
Old Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndromes ◽  
Group 2 ◽  
Group 1

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients.

scholarly journals TWO-DIMENSIONAL ECHOCARDIOGRAPHIC CHARACTERISTICS IN PRE-ADOLESCENT ATHLETES

2016 ◽  
Vol 3 (3) ◽  
pp. 138-141
Author(s):  
O. Onikiienko
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Myocardial Remodeling ◽  
Two Dimensional ◽  
Ventricular Ejection Fraction ◽  
Cardiac Adaptation ◽  
Group 3 ◽  
Group 2 ◽  
Sports Activities ◽  
Group 1

Data of echocardiographic characteristics of 59 children 10-11 years old, involved in football is presented in article. Depending on the duration of sports activities the children were divided into 3 groups: group 1 - children who play football up to 3 years (24 children), Group 2 - children who play football from 3 to 5 years (23 children), Group 3 - training duration over 5 years (12 children). It was found that the linear sizes of the heart were not significantly different in the groups studied, which may indicate that myocardial remodeling as cardiac adaptation to sporting loads takes more time. It was revealed that more trained children (group 3) have significantly higher left ventricular ejection fraction compared with group 1 (p = 0.05) and Group 2 (p = 0.0051). Keywords: athletes, children, echocardiography РезюмеО. ОникиенкоДвумерные эхокардиографические характеристики препубертатных спортсменов В статье приведены результаты ультразвукового обследования 59 детей 10-11 лет, занимающихся футболом. В зависимости от длительности занятий спортом дети были разделены на 3 группы: группа 1 – дети со стажем до 3 лет (24 ребенка), группа 2  - стаж занятий от 3 до 5 лет (23 ребенка), группа 3 – стаж занятий более 5 лет (12 детей). Установлено, что линейные размеры сердца достоверно не отличались в группах обследованных, что может свидетельствовать о более длительном процессе ремоделирования миокарда как адаптации сердца к спортивным нагрузкам. Выявлено, что у более тренированных детей (группа 3) достоверно выше фракция выброса левого желудочка по сравнению с группой 1 (p = 0.05) и с группой 2 (p = 0.0051). Ключевые слова: спортсмены, дети, эхокардиография   РезюмеО. ОнікієнкоДвовимірні ехокардіографічні характеристики препубертатних спортсменівУ статті наведено результати ультразвукового обстеження 59 дітей 10-11 років, які займаються футболом. Залежно від тривалості занять спортом діти були розділені на 3 групи: група 1 - діти зі стажем до 3 років (24 дитини), група 2 - стаж занять від 3 до 5 років (23 дитини), група 3 - стаж занять більше 5 років (12 дітей). Встановлено, що лінійні розміри серця достовірно не відрізнялися в групах обстежених, що може свідчити про більшу тривалість ремоделювання міокарда як адаптації серця до спортивних навантажень. Виявлено, що у більш тренованих дітей (група 3) достовірно вища фракція викиду лівого шлуночка в порівнянні з групою 1 (p = 0.05) і з групою 2 (p = 0.0051). Ключові слова: спортсмени, діти, ехокардіографія

scholarly journals Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

2018 ◽  
Vol 3 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Tiberiu Nyulas ◽  
Mirabela Morariu ◽  
Nora Rat ◽  
Emese Marton ◽  
Victoria Ancuta Rus ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Epicardial Adipose Tissue ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background: Epicardial adipose tissue (EAT) has been recently identified as a major player in the development of the atherosclerotic process. This study aimed to investigate the role of EAT as a marker associated with a higher vulnerability of atheromatous coronary plaques in patients with acute myocardial infarction (AMI) as compared to patients with stable angina. Material and methods: This analysis enrolled a total of 89 patients, 47 with stable angina (SA) and 42 with AMI, who underwent echocardiographic investigations and epicardial fat measurement in 2D-parasternal long axis view. The study lot was divided as follows: Group 1 included patients with prior AMI, and Group 2 included patients with SA. Results: There were no significant differences between the two groups regarding cardiovascular risk factors, excepting smoking status, which was recorded more frequently in Group 1 as compared to Group 2 (36.17% vs. 11.63%, p = 0.02). The mean epicardial fat diameter was 9.12 ± 2.28 mm (95% CI: 8.45–9.79 mm) in Group 1 and 6.30 ± 2.03 mm (95% CI: 5.675–6.93 mm) in Group 2, the difference being highly significant statistically (p <0.0001). The mean value of left ventricular ejection fraction was significantly lower in patients with AMI (Group 1 – 47.60% ± 7.96 vs. Group 2 – 51.23% ± 9.05, p = 0.04). EAT thickness values showed a weak but significant positive correlation with the level of total cholesterol (r = −0.22, p = 0.03) and with the value of end-systolic left ventricle diameter (r = 0.33, = 0.001). Conclusions: The increased thickness of EAT was associated with other serum- or image-based biomarkers of disease severity, such as the left ventricular ejection fraction, end-systolic diameter of the left ventricle, and total cholesterol. Our results indicate that EAT is significantly higher in patients with acute coronary syndrome, proving that EAT could serve as a marker of vulnerability in cardiovascular diseases.

Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 15-19
Author(s):  
A. N. Kostomarov ◽  
M. A. Simonenko ◽  
M. A. Fedorova ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Death Rate ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

scholarly journals The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction

2019 ◽  
Author(s):  
Shuning Zhang ◽  
Xin Deng ◽  
Wenlong Yang ◽  
Liping Xia ◽  
Kang Yao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Ventricular Ejection Fraction ◽  
Timi Grade ◽  
Short And Long Term ◽  
The Impact

Abstract Background: To detect the impact of loss of main diagonal branch (D) flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).Methods: Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI)at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.Results: A total of 392 patients (mean age of 63.9years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n=69) and no loss (TIMI grade2-3, n=323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p=0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p<0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.Conclusion: Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.

scholarly journals UTILITY OF SHOCK INDEX FOR PREDICTION OF CARDIOGENIC SHOCK DEVELOPED DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

2020 ◽  
pp. 1-3
Author(s):  
Sourav Bansal ◽  
Dinesh Gautam ◽  
Shashi Mohan Sharma ◽  
Shekhar Kunal
Keyword(s):  
Heart Rate ◽  
Cardiogenic Shock ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Morbidity ◽  
Primary Pci ◽  
Shock Index ◽  
Ventricular Ejection Fraction ◽  
Group 2

Introduction: Cardiogenic shock (CS) is a distinct clinical entity with a high morbidity and mortality. CS after primary PCI usually portends a bad prognosis and needs prompt recognition. Shock Index (SI) serves as one of the valuable non-invasive marker for development of CS. Methods: This was a single centre prospective observational study wherein patients with ST elevated myocardial infarction (STEMI) were enrolled. In all these patients, prior to performing the coronary angiogram, shock index (SI) was calculated as heart rate (HR) divided by SBP on admission. Primary outcome was the occurrence of CS during the period of hospitalisation post primary PCI. Study population was divided into two groups: Group 1: patients with ACS without CS and Group 2: patients with ACS with CS. Results: A total of 240 patients were included in the study of whom 19 (7.9%) developed CS. Patients with CS (Group 2) had a significantly higher frequency of anterior wall MI, prior history of stroke, heart rate and a lower left ventricular ejection fraction. Multivariate logistic regression analysis revealed pre-procedure SBP, pre-procedure HR, Killip class, serum creatinine and Shock Index to be the independent predictors of developing CS post primary PCI. ROC curve showed that SI (AUC: 0.8113 ; P=0.004) had a better predictive ability as compared to pre-procedural heart rate (AUC: 0.7111; P=0.01) and pre-procedural SBP (AUC: 0.7582; P=0.001) for prediction of CS post primary PCI. Conclusion: SI is a promising tool to detect presence of shock post primary PCI in STEMI patients.

scholarly journals Association between C-Reactive Protein Velocity and Left Ventricular Function in Patients with ST-Elevated Myocardial Infarction

2022 ◽  
Vol 11 (2) ◽  
pp. 401
Author(s):  
Ariel Banai ◽  
Dana Levit ◽  
Samuel Morgan ◽  
Itamar Loewenstein ◽  
Ilan Merdler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
C Reactive Protein ◽  
Ventricular Ejection Fraction ◽  
Reactive Protein ◽  
Wide Range ◽  
Echocardiographic Parameters

C-reactive protein velocity (CRPv), defined as the change in wide-range CRP concentration divided by time, is an inflammatory biomarker associated with increased morbidity and mortality in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (PCI). However, data regarding CRPv association with echocardiographic parameters assessing left ventricular systolic and diastolic function is lacking. Echocardiographic parameters and CRPv values were analyzed using a cohort of 1059 patients admitted with STEMI and treated with primary PCI. Patients were stratified into tertiles according to their CRPv. A receiver operating characteristic (ROC) curve was used to evaluate CRPv optimal cut-off values for the prediction of severe systolic and diastolic dysfunction. Patients with high CRPv tertiles had lower left ventricular ejection fraction (LVEF) (49% vs. 46% vs. 41%, respectively; p < 0.001). CRPv was found to independently predict LVEF ≤ 35% (HR 1.3 CI 95% 1.21–1.4; p < 0.001) and grade III diastolic dysfunction (HR 1.16 CI 95% 11.02–1.31; p = 0.02). CRPv exhibited a better diagnostic profile for severe systolic dysfunction as compared to CRP (area under the curve 0.734 ± 0.02 vs. 0.608 ± 0.02). In conclusion, For STEMI patients treated with primary PCI, CRPv is a marker of both systolic and diastolic dysfunction. Further larger studies are needed to support this finding.

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