scholarly journals 658 Impairment of strain reserve extends to remote myocardium in the sub-acute phase of ST-elevation myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Diana ◽  
Laura Manfredonia ◽  
Monica Filice ◽  
Emanuele Ravenna ◽  
Gessica Ingrasciotta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Remote Myocardium ◽  
St Elevation Myocardial Infarction ◽  
Stress Echo ◽  
St Elevation ◽  
Subclinical Dysfunction

Abstract Aims In ST-elevation myocardial infarction (STEMI), subtle tissutal changes in remote myocardium predict long-term left ventricular (LV) remodelling and prognosis, independently of infarct size and microvascular obstruction. Whether there is a subclinical dysfunction of remote myocardium, detectable by longitudinal strain (LS) at echocardiography, and whether it varies in different locations of STEMI and with adenosine (ADO) challenge, is still unknown. Methods and results Fifty-three patients (age 65 ± 12.5 years, 44 male, 20 anterior and 33 non-anterior, P = 0.01) underwent rest/stress echocardiography at 7 ± 2 days after successfully treated STEMI, and at 6-months follow-up. Global LS (GLS), ischaemic and remote LS (iLS and rLS) were analysed in anterior and non-anterior STEMI. Both at rest and at follow-up, GLS was stratified by ejection fraction (EF) into three groups: EF < 40%, 40–49%, and ≥50%. Normal subjects, undergoing ADO stress echo, represented controls. Anterior STEMI showed lower GLS than controls (P < 0.001) and non-anterior STEMI (P < 0.001). ADO increased GLS in controls (P = 0.05), but neither in anterior nor in non-anterior STEMI, GLS changed during ADO stress, although significantly improved at follow-up (P < 0.001 and P = 0.002, respectively). In anterior STEMI, rLS was comparable to iLS at rest, during stress and at follow-up (P = ns), while in non-anterior STEMI rLS was higher than iLS throughout the study (P < 0.001). Patients with EF < 40% and 40–49% had similar values of GLS, iLS, and rLS, which were, both at rest and at follow-up, lower than those of patients with EF ≥ 50% (P < 0.001). Conclusions In the subacute phase, anterior STEMI shows the worst impairment of LS in both ischaemic and remote regions. Strain reserve to ADO is absent in remote myocardium, as well as in ischaemic zone, regardless of MI location. Global, ischaemic and remote LS may improve at follow-up.

Novel biomarker of Cysteine-rich angiogenic inducer 61 (Cyr61) predicts long-term outcome of ST-elevation myocardial infarction

2019 ◽  
Author(s):  
Rui Xiang ◽  
Min Mao ◽  
Ping Tang ◽  
Jun Gu ◽  
Kanghua Ma
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Complications ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Secondary Endpoints ◽  
St Elevation

Abstract Background: Cysteine-rich angiogenic inducer 61 (Cyr61) is a matricellular protein participating in the angiogenesis, inflammation, and fibrotic tissue repair. Previous study has proven its value in diagnosing and risk stratification of ST-elevation myocardial infarction (STEMI). However, there is no study focusing on Cyr61 and the long-term outcome of STEMI. Methods: A total of 426 patients diagnosed with STEMI were enrolled in this study. Blood sample was acquired 24 hours after the admission. The patients were required long-term follow-up after the discharge, when primary endpoint of all-cause death and secondary endpoint of cardiac complications were observed. Cox hazard ratio model and survival analysis were used to compare the risk of patients with higher level and lower level of Cyr61. Results: We conducted an average of (48.4 ± 17.8) months of follow-up, during which a total of 28 deaths happened (6.6%), while 106 episodes of secondary endpoints occurred (24.9%). Patients with higher quartile (Q4) Cyr61 were at higher risk of death [HR 3.404 95%CI (1.574-7.360), P<0.001] when compared with lower three quartiles (Q1-Q3) Cyr61. In terms of secondary endpoints, patients with Q4 Cyr61 were subject to 4.718 [95%CI (3.189-6.978) , P<0.001] times of risk compared with Q1-Q3 Cyr61. Conclusions: For STEMI Patients, those with increased Cyr61 have higher risk of all-cause death and cardiac complications. Therefore, Cyr61 may be a useful tool in predicting the long-term prognosis of STEMI.

scholarly journals INFARCT HEALING DURING LONG-TERM FOLLOW-UP AFTER ST-ELEVATION MYOCARDIAL INFARCTION

2018 ◽  
Vol 71 (11) ◽  
pp. A1652
Author(s):  
Christina Tiller ◽  
Hans-Josef Feistritzer ◽  
Gert Klug ◽  
Sebastian Reinstadler ◽  
Martin Reindl ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Long Term Follow Up ◽  
Infarct Healing ◽  
St Elevation

scholarly journals Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction

Heart ◽  
2018 ◽  
Vol 104 (17) ◽  
pp. 1432-1438 ◽  
Author(s):  
Joëlle Elias ◽  
Ivo M van Dongen ◽  
Truls Råmunddal ◽  
Peep Laanmets ◽  
Erlend Eriksen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Randomised Trial ◽  
Left Ventricular ◽  
Total Occlusion ◽  
St Elevation ◽  
One Year

BackgroundDuring primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.MethodsThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.ResultsThe median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).ConclusionsIn this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registrationEXPLORE trial number NTR1108 www.trialregister.nl.

P3126Immediate versus delayed revascularization in patients with transient ST-elevation myocardial infarction: 1-year follow-up of the randomized clinical TRANSIENT trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G N Janssens ◽  
N W Van Der Hoeven ◽  
J S Lemkes ◽  
H Everaars ◽  
P Van De Ven ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Target Lesion ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Invasive Group ◽  
St Elevation ◽  
One Year

Abstract Background Up to 24% of acute coronary syndrome patients present with ST-elevation but show complete resolution of ST-elevation and symptoms before revascularization. The current guidelines do not clearly state whether these transient ST-elevation myocardial infarction (TSTEMI) patients should be treated with a ST-elevation myocardial infarction (STEMI)-like or a non-STEMI-like invasive approach. Purpose The aim of the present study is to determine the effect of an immediate versus a delayed invasive strategy on infarct size measured by 4-month cardiac magnetic resonance imaging (CMR) and clinical outcome up to one year. Methods In this multicenter trial, 142 TSTEMI patients were randomized 1:1 to either an immediate or a delayed intervention. CMR was performed at four days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at four months and one year. Results Both in the immediate (0.4 h) and the delayed invasive group (22.7 h) CMR-derived infarct size at four months was very small and left ventricular function was good. In addition, major adverse cardiac events and all-cause mortality at one year were low and not different between both groups (table 1). CMR and clinical outcomes up to one year Outcome Immediate invasive group (n=70) Delayed invasive group (n=72) p-value Myocardial infarct size (% of LV), median (IQR) 0.4 (0.0–3.5) 0.4 (0.0–2.5) 0.79 LVEF (%), mean ± SD 59.9±5.4 59.3±6.5 0.63 LVEF recovery (%), mean ± SD 2.2±5.4 1.7±5.3 0.66 MVO present, No. (%) 0 (0.0) 1 (1.9) 0.50 MACE (death, reinfarction, target lesion revascularization), No. (%) 3 (4.4) 4 (5.7) 1.00 Death from any cause, No. (%) 0 (0.0) 3 (4.3) 0.24 Reinfarction, No. (%) 2 (3.0) 1 (1.4) 0.62 Target lesion revascularization, No. (%) 2 (3.0) 1 (1.4) 0.62 Definite stent thrombosis, No. (%) 1 (1.5) 1 (1.4) 1.00 Abbreviations: IQR, interquartile range; LV, left ventricle; LVEF, left ventricle ejection fraction; MACE, major adverse cardiac events; MVO, microvascular obstruction; NA, not applicable; SD, standard deviation. Conclusions We demonstrated that patients with TSTEMI have limited infarct size and preserved left ventricular function and that an immediate or delayed approach has no effect on clinical outcome up to one year. Therefore, patients with TSTEMI can be treated with both an immediate or a delayed invasive strategy with similar outcome. These findings extend our current knowledge about the optimal timing of coronary intervention in patients with TSTEMI and complement the guidelines. Acknowledgement/Funding AstraZeneca, Biotronik

P878Prevalence and prognosis of patients with myocardial infarction with nonobstructive coronary arteries: a nationwide registry based study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Janosi ◽  
T Ferenci ◽  
P Andreka
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Population Level ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
Artery Disease ◽  
Long Term Prognosis

Abstract Background There are conflicting data about the proportion and prognosis of patients (pts) with acute myocardial infarction (AMI) with nonobstructive coronary arteries (MINOCA). Purpose To define the incidence and prognosis of MINOCA pts in different types of AMI. Methods The Hungarian Myocardial Infarction Registry (HUMIR) is a nationwide, mandatory database in which the clinical and demographic informations of patients with AMI are recorded. Between January 1, 2014 and June 30, 2018, a total of 45,223 AMI (ST-elevation myocardial infarction (STEMI) n=22,469) pts were registered. After excluding pts with previous AMI, PCI, CABG, and congestive heart failure, 2003 MINOCA pts were found (MINOCA group), while 43,220 AMI pts had obstructive coronary artery disease (MI-CAD group). Results The proportion of pts with MINOCA disease was 4.4% among the total pts with AMI. The prevalence was higher in the non ST-elevation myocardial infarction (NSTEMI) group (n=1546, 6.8%) than in the STEMI (n=457, 2.0%) group. The pts with MINOCA disease were slightly younger compared to the pts with MI-CAD (mean age 64.0±14.4 vs. 65.5±12.2 years respectively). The proportion of women was higher in the MINOCA group than in the MI-CAD group (55.7% vs. 36.5%). At discharge, pts with MINOCA disease were less likely to be prescribed certain drugs compared to the pts with MI-CAD. These include aspirin (85.4% vs. 95.6%), RAAS blockers (83.8% vs. 90.4%), statins (86.2% vs. 94.7%), β-blockers (86.8% vs. 89.8%) for the MINOCA and MI-CAD groups respetively. At the 1-year follow-up, the incidence of new AMI events was 1.6% in the MINOCA group compared with 5.0% in the MI-CAD group (HR=2.79). All-cause mortality was higher among the pts with MI-CAD compared to the pts with MINOCA disease. In the MINOCA group, among the pts with NSTEMI, men and women had similar outcomes at 30 days, but men had somewhat higher mortality at one and two years. In contrast, in the STEMI group, women had higher mortality compared to men at all time points during the study (Table 1). Mortality among MINOCA and MI-CAD pts Mortality MINOCA (n=2003) MI-CAD (n=43,220) MINOCA – STEMI MINOCA – NSTEMI Men (n=218) Women (n=239) Men (n=669) Womenr (n=877) 30-day 5.9% [4.9–7.0] 8.4% [8.1–8.7] 8.7% [4.9–12.4] 13.4% [9–17.6] 4.3% [2.8–5.9] 4.4% [3.1–5.8] 1-year 12.5% [11.0–14.0] 15.6% [15.3–16.0] 12.1% [7.6–16.4] 20.3% [15–25.2] 12.2% [9.6–14.7] 10.8% [8.7–12.8] 2-year 16.7% [14.9–18.5] 19.9% [19.5–20.3] 18.2% [12.4–23.6] 23.6% [17.8–29] 16.9% [13.8–20] 14.3% [11.7–16.7] 95% confidence interval in brackets. Conclusion The population-level incidence of MINOCA disease was 4.4% in AMI; the incidence was higher in the NSTEMI group compared to the STEMI group (6.8% vs. 2.0%). Despite the benign anatomy, the long-term prognosis is poor, especially in women after STEMI: 1 out of 4 pts died at the two-year follow up. Acknowledgement/Funding None

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