scholarly journals Relationship between the ST-Segment Resolution and Microvascular Dysfunction in Patients Who Underwent Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Byung Gyu Kim ◽  
Sung Woo Cho ◽  
Jeong-Ha Ha ◽  
Hyo Seung Ahn ◽  
Hye Young Lee ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Microvascular Dysfunction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Objectives. Incomplete ST-segment elevation resolution (STR) occasionally occurs despite successful revascularization of epicardial coronary artery after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the relationship between the degree of STR and the severity of microvascular dysfunction. Methods. A total of 73 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful PPCI were evaluated. Serial 12-lead electrocardiography was performed at baseline and at 90 minutes after PPCI. Microvascular dysfunction was assessed by index of microvascular resistance (IMR) immediately after PPCI. Results. Patients were classified into 2 groups: 50 patients with complete STR (STR ≥50%) and 23 patients with incomplete STR (STR <50%). The incomplete STR group had a higher IMR value and lower left ventricular ejection fraction (LVEF), compared with the complete STR group. The degree of STR was significantly correlated with IMR (r = −0.416, P=0.002) and LVEF (r = 0.300, P=0.011). These correlations were only observed in patients with left anterior descending artery (LAD) infarction but not observed in patients with non-LAD infarction. A cutoff IMR value was 27.3 for predicting incomplete STR after PPCI. Conclusion. Incomplete STR after PPCI in patients with STEMI reflects the presence of microvascular and left ventricular dysfunction, especially in patients with LAD infarction.

scholarly journals Mortality predictors after percutaneous coronary intervention – a prospective single-center registry study

2020 ◽  
Vol 30 (3) ◽  
pp. 413-422
Author(s):  
László Hadadi ◽  
Paul Calburean ◽  
Paul Grebenisan ◽  
Victor Vacariu ◽  
Reka-Katalin Drincal ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiovascular Mortality ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary

Objectives – To evaluate the predictors of three-year cardiovascular mortality after percutaneous coronary intervention (PCI) in a Romanian tertiary cardiovascular center. Methods – Consecutive patients treated by PCI in the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures were included prospectively in a local PCI Registry. Demographic, clinical, and procedural parameters of the patients enrolled in the year 2016 were statistically analyzed as possible predictors of three-year cardiovascular mortality post-PCI. Results – 1079 patients were included: 254 (23.5%) with ST-segment elevation acute myocardial infarction (STEMI), 278 (25.8%) with non-ST segment elevation acute coronary syndrome (NSTEACS) and 547 (50.7%) with chronic coronary syndrome (CCS). Three-year cardiovascular mortality was 20.1%, 10.8% and 5.7% after PCI for STEMI, NSTEACS and CCS, respectively. Cox proportional hazards regression evidenced as independent predictors of long-term mortality after PCI: low left ventricular ejection fraction (LVEF), renal dysfunction, presentation with cardiogenic shock or with cardiac arrest in the case of acute coronary syndromes, and the history of signifi cant valvular heart disease and low LVEF in the case of CCS (all p ≤0.01). Conclusions – Simple clinical variables but no procedural factors were the main predictors of 3-year cardiovascular mortality after PCI in this all-comers population.

Left ventricular myocardial work in the culprit vessel territory and impact on left ventricular remodelling in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

2020 ◽  
Author(s):  
Rodolfo P Lustosa ◽  
Federico Fortuni ◽  
Pieter van der Bijl ◽  
Laurien Goedemans ◽  
Mohammed El Mahdiui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Work Index ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Aims Adverse left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Global and regional LV myocardial work (LVMW) derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings could provide information for prediction of LV remodelling after STEMI. The aim of the study was to assess the predictive value of global and regional LVMW for LV remodelling before discharge in patients with STEMI. Methods and results Three-hundred and fifty STEMI patients treated with primary percutaneous coronary intervention (PCI) were included [265 men (76%), mean age: 61 ± 10 years]. Clinical variables, conventional echocardiographic parameters, global and regional measures of myocardial work index (MWI), and myocardial work efficiency were recorded before discharge. The primary endpoint was early LV remodelling defined as increase in LV end-diastolic volume (LVEDV) ≥20% at 3 months after STEMI. Eighty-seven patients (25%) showed early LV remodelling. The global and regional LVMW in the culprit territory were significantly lower in patients with early LV remodelling. Peak troponin I (OR 1.109, 95% CI 1.046–1.177; P = 0.001), LVEDV (OR 0.972, 95% CI 0.959–0.984; P &lt; 0.001) and regional MWI in the culprit vessel territory (OR 0.602, 95% CI 0.383–0.945; P = 0.027) were independently associated with early LV remodelling. Conclusion In STEMI patients treated with primary PCI and optimal medical therapy, the regional cardiac work index in the culprit vessel territory before discharge is independently associated with early adverse LV remodelling.

scholarly journals Early intravenous beta-blockers in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A patient-pooled meta-analysis of randomized clinical trials

2019 ◽  
Vol 9 (5) ◽  
pp. 469-477 ◽  
Author(s):  
Niels PG Hoedemaker ◽  
Vincent Roolvink ◽  
Robbert J de Winter ◽  
Niels van Royen ◽  
Valentin Fuster ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: Conflicting evidence is available on the efficacy and safety of early intravenous beta-blockers before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. We performed a patient-pooled meta-analysis of trials comparing early intravenous beta-blockers with placebo or routine care in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Aim: The aim of this study was to evaluate the clinical and safety outcomes of intravenous beta-blockers in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: Four randomized trials with a total of 1150 patients were included. The main outcome was one-year death or myocardial infarction. Secondary outcomes included biomarker-based infarct size, left ventricular ejection fraction during follow-up, ventricular tachycardia, and a composite safety outcome (cardiogenic shock, symptomatic bradycardia, or hypotension) during hospitalization. Results: One-year death or myocardial infarction was similar among beta-blocker (4.2%) and control patients (4.4%) (hazard ratio: 0.96 (95% confidence interval: 0.53–1.75, p=0.90, I2=0%). No difference was observed in biomarker-based infarct size. One-month left ventricular ejection fraction was similar, but left ventricular ejection fraction at six months was significantly higher in patients treated with early intravenous beta-blockade (52.8% versus 50.0% in the control group, p=0.03). No difference was observed in the composite safety outcome or ventricular tachycardia during hospitalization. Conclusion: In ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, the administration of early intravenous beta-blockers was safe. However, there was no difference in the main outcome of one-year death or myocardial infarction with early intravenous beta-blockers. A larger clinical trial is warranted to confirm the definitive efficacy of early intravenous beta-blockers.

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