Effect of New Method of Intracoronary Adenosine Injection during Primary Percutaneous Coronary Intervention on Microvascular Reperfusion Injury - Clinical Outcome and 1-Year Follow-Up

Background: Recent animal studies have suggested that mitral valve (MV) leaflet remodeling can occur even without significant tethering force and that the postinfarct biological reaction would contribute to the histopathologic changes of the leaflet. We serially evaluated the MV remodeling in patients with anterior and inferior acute myocardial infarction (MI), by using 2- and 3-dimensional transthoracic echocardiography. Additional histopathologic examinations were performed to assess the leaflet pathology. Methods: Sixty consecutive first-onset acute MI (anterior MI, n=30; inferior MI, n=30) patients who underwent successful primary percutaneous coronary intervention were examined (1) before primary percutaneous coronary intervention, (2) at 6-month follow-up, and (3) at follow-up 1 year or later after onset. MV complex geometry including MV leaflet area and thickness was analyzed using dedicated software. Additional histopathologic study compared 18 valves harvested during surgery for ischemic mitral regurgitation (MR). Results: MV area and thickness incrementally increased during the follow-up period. MV leaflet area significantly increased (anterior MI: 5.59 [5.28–5.98] to 6.54 [6.20–7.26] cm 2 /m 2 , P <0.001; inferior MI: 5.60 [4.76–6.08] to 6.32 [5.90–6.90] cm 2 /m 2 , P <0.001), and leaflet thickness also increased (anterior MI: 1.09 [0.92–1.24] to 1.45 [1.28–1.60] mm/m 2 , P <0.001; inferior MI: 1.15 [1.03–1.25] to 1.44 [1.27–1.59] mm/m 2 , P <0.001); data represent onset versus ≥1 year. Larger annuls, larger tenting, and a reduced leaflet area/annular ratio with smaller coaptation index were observed in patients with persistent ischemic MR compared with those without significant ischemic MR. Histopathologic examinations revealed that MV thickness was significantly greater in chronic ischemic MR compared with acute ischemic MR (1432.6±490.5 versus 628.7±278.7 μm; P =0.001), with increased smooth muscle cells and fibrotic materials. Conclusions: MV leaflet remodeling progressed both in area and thickness after MI. This is the first clinical study to record the longitudinal course of MV leaflet remodeling by serial echocardiography.

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Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619886312 ◽

2020 ◽

pp. 204887261988631

Author(s):

Lars Nepper-Christensen ◽

Jacob Lønborg ◽

Dan Eik Høfsten ◽

Golnaz Sadjadieh ◽

Mikkel Malby Schoos ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcome ◽

Primary Percutaneous Coronary Intervention ◽

Symptom Onset ◽

Coronary Intervention ◽

Adverse Clinical Outcome ◽

St Segment Elevation ◽

St Segment ◽

Increased Risk ◽

Percutaneous Coronary

Background: Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention 12 or more hours after symptom onset are non-existent. We evaluated the association between primary percutaneous coronary intervention performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort. Methods: All STEMI patients treated with primary percutaneous coronary intervention in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the percutaneous coronary intervention. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from nationwide Danish registries. Results: We included 6674 patients: 6108 (92%) were treated less than 12 hours and 566 (8%) were treated 12 or more hours after symptom onset. During a median follow-up period of 3.8 (interquartile range 2.3–5.6) years, 30-day, one-year and long-term cumulative rates of the combined endpoint were 11%, 17% and 25% in patients treated 12 or fewer hours and 21%, 29% and 37% in patients treated more than 12 hours ( P<0.001 for all) after symptom onset. Late presentation was independently associated with an increased risk of an adverse clinical outcome (hazard ratio 1.42, 95% confidence interval 1.22–1.66; P<0.001). Conclusions: Increasing duration from symptom onset to primary percutaneous coronary intervention was associated with an increased risk of an adverse clinical outcome in patients with STEMI, especially when the delay exceeded 12 hours.

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Relationship between White Blood Count to Mean Platelet Volume Ratio and Clinical Outcomes and Severity of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention

Cardiovascular Therapeutics ◽

10.1155/2020/9625181 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Altekin Refik Emre ◽

Kilinc Ali Yasar ◽

Yanikoglu Atakan ◽

Cicekcibasi Orhan ◽

Kucuk Murathan

Keyword(s):

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Mean Platelet Volume ◽

Cardiac Death ◽

Volume Ratio ◽

Coronary Intervention ◽

White Blood Count ◽

Platelet Volume ◽

Percutaneous Coronary

Background. The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). Method. Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. Results. In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR<1286) and 269 patients in the high WMR group (WMR≥1286). RSS (p=0.01) value of the high WMR group was higher than that of the low WMR group. The rates of in-hospital MACE (p=0.001), cardiac death (p<0.001), decompansated heart failure (0.007), and ventricular tachycardia/fibrillation (p=0.003) were higher in the high WMR group than in the low WMR group. The follow-up MACEs (p=0.043), cardiac death (p=0.026), and reinfarction (p=0.031) ratio were higher in the high WMR group. In ROC analysis, cut-off values of in-hospital and follow-up MACEs were >1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p=0.006). A moderate correlation was observed between WMR and RSS (r: 456, p=0.002). Conclusion. A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI.

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