scholarly journals Effect of primary PCI on the recovery of atrioventricular block in inferior STEMI patients with late presentation (>12 hours): insights from a single center 10-year experience

2020 ◽  
Vol 68 (5) ◽  
pp. 1011-1014 ◽  
Author(s):  
Xiaojuan Fan ◽  
Prabindra Maharjan ◽  
Ping Liu ◽  
Ling Bai
Keyword(s):  
Median Time ◽  
Atrioventricular Block ◽  
Symptom Onset ◽  
Strong Association ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Atrioventricular Conduction ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
St Elevation

There is no definite reperfusion time for inferior ST-elevation myocardial infarction (STEMI) patients presenting later than 12 hours after symptom onset and complicated by newly-developed atrioventricular block (AVB). It is not clear whether the percutaneous coronary intervention (PCI) could facilitate the recovery of AVB in this patient group. We conducted a retrospective study including 52 consecutive inferior STEMI patients with presenting time >12 hours and new onset second or third-degree AVB on admission. All of them underwent PCI. The clinical characteristics, time to PCI and time to AVB improvement after symptom onset were studied. There were 42 males and the mean age was 61±10 years. Median presenting time from symptom onset was 36 hours (ranging 13–192 hours). Median time to PCI was 6.0 days (ranging 1–15 days) and median time of AVB improvement from symptom onset was 5.0 days (ranging 1–15 days). 24 patients got improvement of atrioventricular conduction before PCI procedure (defined as preoperative group) while 28 patients got improvement of atrioventricular conduction after PCI procedure (defined as postoperative group). In the postoperative group, there was a strong association between time to PCI and time to AVB improvement (R2=0.752, p=0.000). No adverse PCI procedure-related complications or death occurred and all the patients got complete AVB recovery at discharge. Early PCI is safe and should be recommended as the priority strategy for late presenting inferior STEMI patients when complicated by AVB. Successful reperfusion of the infarct-related artery is helpful to facilitate AVB recovery in this situation.

scholarly journals In the transition from fibrinolysis to primary PCI, the HERO trials help refine STEMI ECG interpretation and Q wave analysis potentially alters future management

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 26-33
Author(s):  
Cheuk-Kit Wong ◽  
Harvey D White
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Q Wave

Electrocardiogram sub-studies from the Hirulog Early Reperfusion/Occlusion 1 and 2 trials, which tested bivalirudin as an adjunctive anticoagulant to fibrinolysis in ST-elevation myocardial infarction, have contributed to the literature. The concept of using the presence of infarct lead Q waves to determine reperfusion benefit has subsequently been explored in multiple primary percutaneous coronary intervention studies. The angiographic findings before percutaneous coronary intervention combine with the baseline electrocardiogram to accurately diagnose ST-elevation myocardial infarction and evaluate its potential territory. This review discusses the relative merits of the presence of infarct lead Q waves versus time duration from symptom onset using observational data from cohorts of patients from multiple clinical trials. The presence of infarct lead Q waves at presentation has been repeatedly shown to be superior to time duration from symptom onset in determining prognosis, despite that continuous variable (time duration) statistically should be more powerful than dichotomous variable (Q wave). If quantitative or semi-quantitative measurement of Q waves correlates well with irreversible myocardial injury in vivo (a research goal of many cardiac magnetic resonance imaging studies), Q waves measurements by mirroring ST-elevation myocardial infarction evolution better than the current metric of time duration of symptoms will impact future ST-elevation myocardial infarction reperfusion management. Newer methodology will more quickly capture and transmit electrocardiogram information including infarct lead Q waves potentially before first medical contact, and help differentiate new evolving Q waves of the ongoing ST-elevation myocardial infarction from old changes. Q waves as the new metric in ST-elevation myocardial infarction reperfusion should be tested in upcoming trials.

scholarly journals Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: What We Know and What Lies Ahead

2021 ◽  
Author(s):  
Enrico Fabris ◽  
Serge Korjian ◽  
Barry Coller ◽  
Jurriën M. ten Berg ◽  
Christopher B Granger ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Early Period ◽  
Antiplatelet Agents ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Hospital Treatment ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
St Elevation

Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with ST-elevation myocardial infarction (STEMI). In order to decrease the duration of ischemia, continuous efforts have been made to improve pre-hospital treatment and to target the early period after symptom onset, when the platelet content of the fresh coronary thrombus is maximal and the thrombi are dynamic, and thus more susceptible to powerful antiplatelet agents. There have been substantial advances in antiplatelet therapy in the last three decades with several classes of oral and intravenous antiplatelet agents with different therapeutic targets, pharmacokinetics, and pharmacodynamic properties. New parenteral drugs achieve immediate inhibition of platelet aggregation and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors. Moreover, potential future management of STEMI could directly involve select patients in the process with self-administered antiplatelet agents designed to achieve rapid reperfusion. However the potential anti-ischemic benefits of potent antiplatelet agents will need to be balanced against their risk of increased bleeding. This manuscript presents a comprehensive and updated review of pre-hospital antiplatelet therapy among STEMI patients undergoing primary percutaneous intervention and explores new therapies under development.

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