P1696Clinical value of QRS spatial dispersion in non-ST elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I M Ibrahim ◽  
A Frere ◽  
M M Alcekelly

Abstract Background More than 40% of patients with non-ST Elevation Myocardial Infarction (NSTEMI) have multi-vessel disease with the rate of in-hospital emergent bypass surgery ranging from 11–13%. So, rapid scoring is critical for optimum management even before P2Y12 loading. Purpose We aimed to determine the role of QRS dispersion at emergency department, as a simple and rapid sign, in predicting coronary anatomy complexity and in-hospital outcome. Methods 192 (126 males, age 57.4±6.8 years) patients with NSTEMI and QRS duration <120 ms who underwent coronary angiography were included. QRS dispersion was automatically measured. Results Using Spearman's rank correlation, SYNTAX score was found to be positively correlated with admission HR (r 0.54, p value <0.001), maximum HsTnT level (r 0.523, p value <0.001), age (r 0.262, p value 0.015), male gender (r 0.286, p value 0.005), QRS dispersion (r 0.248, p value 0.015), QTc dispersion (r 0.289, p value 0.01), and Grace score (r 0.247, p value 0.015). ROC curve analyses for prediction of SYNTAX score >33 were done for variables with significant correlation. By multivariate logistic regression, male gender (OR 5.042, 95% CI 1.633 –15.567, p value 0.005), admission HR >80 bpm (OR 1.088, 95% CI 1.024 –1.157, p value 0.017) and QRS dispersion >20ms (OR 1.020, 95% CI 1.003 –1.037, p value 0.02) were independent predictors of SYNTAX score >33 (table). Patients with QRS dispersion >20 ms had in-hospital higher Killip class (P<0.001), recurrent ischemia (P 0.003), serious ventricular arrhythmias (P 0.01) and higher GRACE score (P<0.001). Binary logistic regression for prediction of SYNTAX score >33 Variables Univariate analysis Multivariate analysis OR (95% CI) P value OR (95% CI) P value Age >61 (years) 1.337 (1.019–4.392) 0.015 0.953 (0.878–1.033) 0.242 Male gender 4.851 (2.014–5.301) 0.001 5.042 (1.633–15.567) 0.005 HR >80 (bpm) 3.945 (1.706–6.953) 0.002 1.088 (1.024–1.157) 0.017 QRS dispersion >20 (ms) 2.911 (0.617–13.738) 0.013 1.020 (1.003–1.037) 0.02 QTc dispersion >53 (ms) 6.101 (1.926–19.323) 0.002 2.378 (1.890–2.561) 0.043 Maximum HsTnT >1105 (ng/L) 3.837 (0.236–8.965) 0.004 2.785 (2.501–3.012) 0.034 Grace Score >112 (points) 7.122 (0.632–12.216) <0.001 2.912 (2.703–3.309) 0.030 Conclusion In NSTEMI, QRS dispersion was positively correlated with SYNTAX score and a cut-off value of 20 ms independently predicted SYNTAX score >33. Regarding in-hospital outcome, QRS dispersion >20 ms was associated with in-hospital higher Killip class, recurrent ischemia, serious ventricular arrhythmias and higher GRACE score

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sunil Upadhaya ◽  
Seetharamprasad Madala ◽  
Kanchan Tiwari

Introduction: About one-fourth of patient with acute coronary syndrome present with transient ST-elevation myocardial infarction (STEMI). No specific recommendations exist in current guidelines regarding the timing of intervention for such patients due to lack of high-quality randomized trials. Methods: The Cochrane library and PubMed databases were searched for relevant studies. Two authors independently screened and included studies that were randomized controlled trials or observational studies comparing early with delayed invasive strategies in transient STEMI. Efficacy outcomes included target vessel revascularization, reinfarction and recurrent ischemia rates. Primary safety outcome was major bleeding. Random-effects model was used for pooled calculation of odds ratio (OR). Results: Out of all studies found, only 4 studies were included in our analysis (295 patients in early intervention group and 307 patients in delayed intervention group). Delayed intervention was associated with significant increase in all-cause mortality (OR: 2.81 [1.39-5.68], I 2 = 0%, p value = 0.004) (Figure 1). We did not find any significant difference in reinfarction rate (OR: 0.75 [0.12-4.66], I 2 = 0%, p value = 0.75), target vessel revascularization rate (OR: 0.66 [0.11-4.14] I 2 = 0%, p value = 0.66) and recurrent ischemia rate (OR 1.52[0.40-5.84], I 2 = 18 %, p value = 0.54). In addition, major bleeding rate was also similar in both groups (OR 0.68 [0.25-2.25], I 2 = 12%, p value = 0.60). Conclusions: This low to moderate-quality evidence suggests that early invasive strategy might reduce the mortality rate in transient STEMI. There is need of well-designed large randomized studies to gather further evidence regarding the best management of transient STEMI.


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
DUYGU Inan ◽  
DUYGU Genc ◽  
BARIS Simsek ◽  
OZAN Tanik ◽  
EVLIYA Akdeniz ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Inotroduction . CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation. Method This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE Results MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value &lt;0.0001), creatinine level on admission (OR and 95% CI, 1.54 [1.10-2.16]; p value: 0.0024), peak CK-MB level (OR and 95% GA, 1.63 [0.98-2.70]; p value: 0.0001) and presence of no-reflow (OR and 95% CI, 2.45 [1.25-4.80]; p value: 0.0085) were indendified as other independent predictors of MACE. Conclusion CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others. Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p &lt; 0.0001 Hemoglobin (g/dL) ( 12 to 15) 0.96 (0.54-1.70) p = 0.4066 Creatinine ( mg/dL) (0.74 to 1.0) 1.54 (1.10-2.16) p = 0.0024 Peak CK-MB (IU/L) (40.8 to 165.1) 1.63 (0.98-2.70) p = 0.0001 No-reflow (yes) 2.45 (1.25-4.80) p = 0.0085 Independent predictors of MACE in STEMI patients according to penalized proportional odds logistic regression analysis Abstract Figure. Partial impact plots of predictors


2019 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Yuli Astuti ◽  
Budi Yuli Setianto ◽  
Nahar Taufiq

Background: Acute myocardial infarction (AMI) is the leading cause of death in the world. AMI is classified into ST-elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Diagnosis and prediction of severity of atherosclerotic in NSTEMI is a challenge. Despite the risk stratification, 14-20% of patients that undergo coronary angiography have normal or non significant coronary artery disease. The role of platelet and the extent of atherotrombosis in patients with NSTEMI are interesting field of research. Mean platelet volume (MPV) reflects platelet size and reactivity. It can be used as a diagnostic marker and may have predictive value. This study aims to prove the role of MPV as a predictor of the degree of atherosclerotic based on Syntax score in patients with NSTEMI undergoing coronary angiography.Methods: This is a cross sectional study enrolled 86 subjects with NSTEMI. Blood samples were taken at the time of admission to the hospital. An MPV was measured by automated machine. Subsequent coronary angiography was performed using standardized method. Syntax score was determined to reflect the atherosclerotic severity. Statistical analysis was used to assess whether an MPV as a predictor of atherosclerotic severity based on Syntax score.Results: The chi-square analysis showed that high MPV could not be used as a predictor of the atherosclerotic severity based on Syntax score in NSTEMI patients (p value =0.5, prevalence ratio 1.15 (95% CI: 0.755-1.753). From multivariate analysis, only smoking factor had an independent relationship with Syntax score (p value =0.047; Odds ratio 2.531(95% CI: 1.012-6.328).Conclusions: High MPV cannot be used as a predictor of atherosclerotic severity based on Syntax score in NSTEMI patients.


2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Pessoa Amorim ◽  
D Santos-Ferreira ◽  
A Azul Freitas ◽  
H Santos ◽  
A Belo ◽  
...  

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI &gt;25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine &gt;2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (&gt;3 cardiovascular drugs), admission haemoglobin &lt;10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI&gt;0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p&lt;0.001). Delayed angiography (&gt;72h) was more common among NSTEMI frail patients (p&lt;0.001), and radial access was less commonly used overall (p&lt;0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p&lt;0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p&lt;0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p&lt;0.05), their 1-year prognostic benefit remained unaffected (Wald test p&gt;0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p&lt;0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
K Eletriby ◽  
A Desoky ◽  
N Shawky ◽  
A Farag

Abstract Aim and objectives The aim of this study was to assess the impact of high intensity statins used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received high intensity statins (40-80mg of atorvastatin or 20-40mg of rosuvastatin) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy, and high intensity statins after going back to the coronary care unit after primary PCI. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded and ST-segment resolution was measured. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation. In the control group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the cases group there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction measured by M-mode had values of Mean+-SD of 45.91 ± 5.49 in cases group vs 43.01 ± 8.80 in control group which was statistically significant with a P value of 0.011. There was not a statistically significant difference between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion High intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution and ejection fraction as measured by M-mode but did not decrease incidence of in-hospital MACE.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3630-3630
Author(s):  
Murtadha K. Al-Khabori ◽  
Said Al Busaifi ◽  
Al Ghaliya Al Omairi ◽  
Moez Hassan ◽  
Humoud Al Dhuhli ◽  
...  

Abstract Introduction and Objectives: Iron overload in patients with Thalassemia Major (TM) leads to various complications including liver fibrosis. The independent impact of gender on this risk has been previously investigated but not yet confirmed. We, therefore, planned to assess the independent impact of gender in patients with TM on the risk of liver fibrosis. Methods: We included 96 patients with TM followed and transfused in one academic tertiary hospital. Patients underwent assessment of liver fibrosis using ultrasound elastography (FibroScan device) with a cut off value of 7.8 kPa. The mean ferritin in the 5 years prior to elastography assessment was used to represent iron overload. Association was tested using Chi-squared and the independent impact of gender was confirmed in the multivariable logistic regression with a model that included mean ferritin and gender. Results: The median age of the 96 included patients was 26 years (Interquartile range [IQR]: 22-30). Males constituted 45% of patients and 33% of patients were splenectomised. The median alanine transaminase, aspartate transaminase, albumin and total bilirubin were 30 U/L (IQR: 18-64), 30 U/L (IQR: 18-46), 46 g/L (IQR: 44-48) and 21 µmol/L (IQR: 14-32) respectively. The median ferritin and liver iron concentration assessed by MRI T2* were 1293 µg/L (IQR: 753-2715) and 6.7 mg/gdw (IQR: 3.5-16.1) respectively. Thirty seven percent of patients had positive serology for HCV while 1% of patients had positive serology for HBV. The proportion of patients with fibrosis as assessed by elastography was 59%. The proportion of male patients with fibrosis was 70% compared to 51% in female patients with a trend towards statistical significance (odds ratio [OR] of 2.2 with a p value of 0.094). In the multivariable logistic regression model, both gender (OR of 3.0, P value of 0.0188) and ferritin (OR of 1.0004, p value of 0.0036) were statistically significant independent predictors of liver fibrosis. Conclusion: Male gender increases the risk of liver fibrosis independent from iron overload. Our study confirms the previously suspected but unproven association. Follow up and therapy may be tailored to include gender as a decision factor. Larger studies are needed to further confirm these results. Disclosures No relevant conflicts of interest to declare.


2018 ◽  
Vol 27 (5) ◽  
pp. 459-465 ◽  
Author(s):  
Erdal Aktürk ◽  
Lütfü Aşkın ◽  
Hakan Taşolar ◽  
Serdar Türkmen ◽  
Hakan Kaya

Objective: We evaluated the relationship between various risk scores (SYNTAX score [SS], SYNTAX score-II [SS-II], thrombolysis in myocardial infarction [TIMI] risk scores, and Global Registry of Acute Coronary Events [GRACE] risk scores) and major adverse cardiovascular events (MACE) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients, and points were added according to the predefined algorithm, taking into account the other 6 clinical variables being monitored (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral artery disease). Patients were classified into tertile 1 (SS < 22), tertile 2 (SS 23–32), and tertile 3 (SS > 32). Results: The group with high SS-II for PCI values in the risk scores were observed from tertile 1 to tertile 3 (from 25.0 ± 7.7 to 31.6 ± 9.4, p < 0.001, respectively). The SS-II score in patients with PCI was an independent predictor of MACE, in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis (OR 1.082, 95% CI 1.036–1.131, p < 0.001). The overall MACE, in-hospital mortality, and nonfatal myocardial infarction rates were significantly higher in the high SS-II for PCI group (p < 0.001). Conclusion: TIMI and GRACE risk scores were able to predict MACE. In addition to these, SS-II was also able to predict in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis.


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