scholarly journals Comparison of the Effects of Ticagrelor and Clopidogrel on Inflammatory Factors, Vascular Endothelium Functions and Short-Term Prognosis in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention: a Pilot Study

2018 ◽  
Vol 48 (1) ◽  
pp. 385-396 ◽  
Author(s):  
Chang-Zheng Gao ◽  
Qian-Qian Ma ◽  
Jing Wu ◽  
Rui Liu ◽  
Fen Wang ◽  
...  
Keyword(s):  
Vascular Endothelium ◽  
Coronary Intervention ◽  
Control Group ◽  
Vascular Endothelial ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Hs Crp

Background/Aims: Acute ST-segment elevation of myocardial infarction (STEMI) is the most severe type of acute coronary syndrome (ACS). Particular attention has been focused on studying the pathogenesis of STEMI, and how to prevent thrombosis, reduce inflammatory reaction, stabilize plaques and improve vascular endothelial functions to preserve the survived myocardium. This study aimed to compare the anti-inflammatory endothelium-protective effects, clinical prognosis, and relevant bleeding risks of ticagrelor versus clopidogrel in patients with STEMI who underwent urgent percutaneous coronary intervention (PCI) and provide certain experimental evidence and a theoretical basis for the selection of safe and effective drugs and their proper dosage, thereby further guiding clinical medication. Methods: We sequentially enrolled 193 patients (104 males and 89 females) admitted to hospital due to acute STEMI. These patients underwent urgent PCI between December 2013 and May 2015 and met the inclusion criteria. They were assigned (1: 1) into two groups according to different treatments, 97 patients in the ticagrelor group (treatment group), and 96 patients in the clopidogrel group (control group). Levels of hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and endothelial cell-specific molecule 1 (ESM-1) taken at admission and 24 h, 4 days, and 7 days after administration, as well as the correlation between the levels of IL-6, hs-CRP, and ESM-1, were determined in the two groups. At the same time, the effects of treatment with ticagrelor and clopidogrel on the efficacy endpoint events (ischemic and safety) were explored. Results: No statistically significant difference was found in the levels of hs-CRP, IL-6, or ESM-1 at admission between the two groups (P> 0.05); Their levels were significantly elevated 24 h after administration, with statistical differences between two groups (P< 0.05). Furthermore, a downward trend with statistically significant differences was found on Day 4 and Day 7 (P< 0.05); ESM-1 levels increased along with increases of hs-CRP and IL-6 levels, indicating ESM-1 was positively correlated with hs-CRP (r=0.523, P< 0.001) and IL-6 (r=0.431, P< 0.001); and the occurrence rates of ischemic endpoint events at 30 days were lower in the treatment group than in the control group. The occurrence of safety endpoint events was higher than in the control group; however, no statistically significant difference was found (P> 0.05). Conclusions: Compared with clopidogrel, ticagrelor appears to rapidly reduce the prevalence of inflammatory reactions and stabilize the functions of vascular endothelium to improve the stability of atherosclerotic plaque and decrease the occurrence rate of thrombosis as well as ischemic outcome events without any obvious increase in the risk of bleeding in patients with acute STEMI receiving urgent PCI. This renders it a potential drug for clinical practice. At the same time, measurement of ESM-1, a new biological marker for vascular endothelial function disorder, could possibly become a simple, effective, and practical new method for clinical evaluation of risk stratification of patients with acute STEMI at admission.

scholarly journals The effect of heparin after primary percutaneous coronary intervention on short-term clinical outcomes in patients with ST-segment elevation myocardial infarction

2020 ◽  
Vol 9 (11) ◽  
pp. 1636
Author(s):  
Mohammed Rouzbahani ◽  
Mohsen Rezaie ◽  
Nahid Salehi ◽  
Parisa Janjani ◽  
Reza Heidari Moghadam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Control Group ◽  
Short Term ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary

Background: Doing percutaneous coronary intervention (PCI) in the first hours of myocardial infraction (MI) is effective in re-establishment of blood flow. Anticoagulation treatment should be prescribed in patients undergoing PCI to decrease the side effects of ischemia. The aim of this study is to determine the effect of heparin prescription after PCI on short-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Materials: This randomized clinical trial study was conducted at Imam Ali cardiovascular center at Kermanshah university of medical science (KUMS), Iran. Between April 2019 to October 2019, 400 patients with STEMI which candidate to PCI were enrolled. Patients randomly divided in two groups: intervention group (received 5,000 units of heparin after PCI until first 24 hours, every 6 hours) and control group (did not receive heparin). Data were collected using a checklist developed based on the study's aims. Differences between groups were assessed using independent t-tests and chi-square (or Fisher exact tests).Result: Observed that, mean prothrombin time (PT) (13.30±1.60 vs. 12.21±1.15, p<0.001) and partial thromboplastin time (PTT) (35.30±3.08 vs. 34.41±3.01, p=0.003) were significantly higher in intervention group compared to control group. Thrombolysis in myocardial infarction (TIMI) flow grade 0/1 after primary PCI was significantly more frequently in control group (5.5% vs. 1.0%, p=0.034). The mean of ejection fraction (EF) after PCI (47.58±7.12 vs. 45.15±6.98, p<0.001) was significantly higher in intervention group. Intervention group had a statistically significant shorter length of hospital stay (4.71±1.03 vs. 6.12±1.10, p<0.001). There was higher incidence of re-vascularization (0% vs. 3.0%; p=0.013) and re-MI (0% vs. 2.5%; p=0.024) in the control group.Conclusion: Performing primary PCI with receiving heparin led to improve TIMI flow and consequently better EF. Receiving heparin is associated with lower risk of re-MI and re-vascularization.

scholarly journals Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry

2019 ◽  
Vol 9 (8) ◽  
pp. 958-965 ◽  
Author(s):  
Radwan Hakim ◽  
Eric Revue ◽  
Christophe Saint Etienne ◽  
Pierre Marcollet ◽  
Stephan Chassaing ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Rural Areas ◽  
Coronary Intervention ◽  
Inhospital Mortality ◽  
St Segment Elevation ◽  
Transport Delay ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Aims: The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region. Methods and results: Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; P<0.0001). Differences were greatest for transfers under 50 km (13.7% vs. 44.7%; P<0.0001) and for primary transfers (22.4% vs. 49.6%; P<0.0001). The median time from first medical contact to primary percutaneous coronary intervention and from symptom onset to primary percutaneous coronary intervention (total ischaemic time) were significantly higher in the helicopter transport group than in the ground transport group (respectively, 137 vs. 103 minutes; P<0.0001 and 261 vs. 195 minutes; P<0.0001). There was no significant difference in inhospital mortality between the helicopter and ground transport groups (6.9% vs. 6.6%; P=0.88). Conclusions: Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.

scholarly journals Evaluation of a primary care paramedic STEMI bypass guideline

CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 850-856 ◽  
Author(s):  
Jonathan L. Kwong ◽  
Garry Ross ◽  
Linda Turner ◽  
Chris Olynyk ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Arrest ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Care Intervention ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Difference

AbstractObjectiveLimited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline.MethodsWe reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria. Secondary outcomes were the proportion of PCP-transported patients who had an indication for an advanced care intervention (ACI) or who received an ACI when PCPs rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed prehospital outcomes of cardiac arrest patients and calculated the difference in transport intervals between direct PCP bypass and a PCI-centre and predicted transport interval to the closest emergency department (ED).ResultsOf 361 patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There was a significant difference in the distribution of stable and unstable patients between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs). The median difference between direct PCP bypass and a PCI-centre versus transport to the closest ED was 5.53 minutes (IQR=6.71).ConclusionsWe found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass guideline appears feasible.

scholarly journals Associations between macrophage inhibitor factor, anxiety and depression in patients with ST-segment elevation myocardial infarction

2019 ◽  
Vol 26 (3) ◽  
pp. 45-52
Author(s):  
O. V. Petyunina ◽  
M. P. Kopytsya ◽  
О. V. Skrynnik
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Anxiety And Depression ◽  
Control Group ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Anxiety Depression

The aim – to investigate associations between macrophage inhibitory factor (MIF) and anxiety, depression and stress in patients with ST-segment elevation myocardial infarction (STEMI). Materials and methods. 73 patients with STEMI with TIMI-III aged 58.37±10.34 were enrolled in the study. Revascularization tactics distribution was the following: 43 (58.9 %) patients underwent primary percutaneous coronary intervention using bare-metal coronary stent, 30 (41.1 %) – pre-hospital thrombolysis with subsequent percutaneous coronary intervention within12 hours. Echocardiography was done during the period of hospitalization. Serum MIF was studied using the enzyme linked immunoassay method. Anxiety, depression and stress were determined with DASS-21 questionnaire. Results and discussion. When comparing the median values of the MIF level in STEMI patients, a statistically significant increase in the MIF concentration relative to control group (2582.80 [1308.40–4122.20] and 573.75 [397.80–1016.75] ng/ml, p<0.001). It evidences the activation of the formation of MIF after the index event. Positive correlation was determined between the level of MIF, the level of troponin I (r=0.33; р=0.045) and blood leukocytes (r=0.36; р=0.039) that confirms its involvement into inflammation and necrosis processes. The univariant and multivariate analysis revealed the effect of the degree of depression and anxiety growth on the DASS-21 questionnaire (p=0.0138 and p=0.0050, respectively) on the increasing of the MIF. Conclusions. The data obtained confirm the relationship between the MIF and anxiety and depression prior the onset of myocardial infarction, indicating their influence on the processes of inflammation.

scholarly journals The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

2021 ◽  
Vol 10 (2) ◽  
pp. 278
Author(s):  
Sherif Ayad ◽  
Rafik Shenouda ◽  
Michael Henein
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Coronary Intervention ◽  
Control Group ◽  
St Segment Elevation ◽  
Clinical Procedures ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

scholarly journals Effect of early Trimetazidine on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

2021 ◽  
Author(s):  
GENG QIAN ◽  
Ying Zhang ◽  
Xin A ◽  
Xiaosi Jiang ◽  
Zichao Jiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Control Group ◽  
Primary Pci ◽  
Double Blind ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Infarction Size ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Purpose: Trimetazidine, a metabolic agent with anti-ischemic effects, was reported to reduce reperfusion injury in animal models. In this randomized double-blind placebo-controlled trial, we investigated the effects of trimetazidine on reducing infarction size in patients undergoing revascularization for ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI randomly received trimetazidine (n=87) or placebo (n= 86) in a double-blind manner before primary percutaneous coronary intervention (PCI), and study treatment was maintained for 12 months after the procedure. The primary endpoint was infarction size measured by cardiac magnetic resonance (CMR) after primary PCI. Results: The clinical characteristics of patients (90% male, mean age 57±12 years) in both groups were well-matched on the baseline. Compared with patients in control group, the percentage and weight of infarction size of patients in trimetazidine group were both significantly lower (22.1±11.8% [n =74] vs. 26.9±11.9% [n=74], p=0.010; 28±18g [n =74] vs. 35±19g [n=74], p=0.022), the myocardial microvascular obstruction (MVO) rate measured by CMR was lower in trimetazidine group (29.7% [22/7] vs. 52.7% [39/74], p=0.007), while myocardial salvage index (MSI) was significantly higher in trimetazidine group (48±20% vs. 39±27%, p=0.008). The incidence of readmission due to aggravated heart failure in trimetazidine group was lower than that in the control group without significance (8.0% vs 14.0%, p=0.234). Conclusions: Our study provides suggests that trimetazidine initiated prior to primary PCI, improves myocardial infarct size, MVO and MSI, possibly by reducing reperfusion injury.

scholarly journals The Evaluation of Plasma and Leukocytic IL-37 Expression in Early Inflammation in Patients with Acute ST-Segment Elevation Myocardial Infarction after PCI

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Xin Wang ◽  
Xiangna Cai ◽  
Lan Chen ◽  
Duanmin Xu ◽  
Jilin Li
Keyword(s):  
Myocardial Infarction ◽  
Healthy Volunteers ◽  
Venous Blood ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Hs Crp

Objective. Acute ST-segment elevation myocardial infarction (ASTEMI) is accompanied by increased expression of inflammation and decreased expression of anti-inflammation. IL-37 was found to be involved in the atherosclerosis-related diseases and increased in acute coronary syndrome. However, the level of IL-37 in blood plasma and leukocytes from patients with ASTEMI after percutaneous coronary intervention (PCI) has not been explored.Methods. We collected peripheral venous blood from consented patients at 12 h, 24 h, and 48 h after PCI and healthy volunteers. Plasma IL-37, IL-18, IL-18-binding protein (BP), and high sensitive C reaction protein (hs-CRP) were quantified by ELISA and leukocytic IL-37 and ICAM-1 by immunoblotting.Results. Plasma IL-37, IL-18, and IL-18 BP expression decreased compared to those in healthy volunteers while hs-CRP level was high. Both leukocytic IL-37 and ICAM-1 were highest expressed at 12 h point but significantly decreased at 48 h point.Conclusion. These findings suggest L-37 does not play an important role in the systematic inflammatory response but may be involved in leukocytic inflammation in ASTEMI after PCI.

scholarly journals Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden

2022 ◽  
Vol 11 (1) ◽  
pp. 262
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Aspiration Thrombectomy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

Comparison of the clinical characteristics of myocardial infarction with and without ST-segment elevation in Hungary. National Registry of Myocardial Infarction

2014 ◽  
Vol 155 (21) ◽  
pp. 828-832
Author(s):  
Tamás Breuer ◽  
András Jánosi ◽  
Krisztina Szüts ◽  
Péter Andréka ◽  
Péter Ofner
Keyword(s):  
Myocardial Infarction ◽  
Clinical Characteristics ◽  
Coronary Intervention ◽  
National Registry ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Patient Groups

Introduction: Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary. Aim: To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database. Method: Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis. Results: Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction. Conclusions: The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups. Orv. Hetil., 2014, 155(21), 828–832.

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