Abstract 2833: Low Erythropoietin Serum Levels Are Associated With Angiographic No-reflow After Primary Intervention For Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Giampaolo Niccoli ◽  
Francesca Marzo ◽  
Antonella Paglia ◽  
Eleonora Santucci ◽  
Cristina Spaziani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Serum Levels ◽  
St Elevation Myocardial Infarction ◽  
Consecutive Series ◽  
Primary Pci ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
St Elevation

Background : No-reflow after primary percutaneous coronary intervention (PCI) remains a clinical challenge. Erythropoietin (EPO) has been associated with reduced infarct size due to EPO’s antiapoptotic and nitric oxide enhancing effects. We aimed to assess the association between EPO serum levels measured on admission and angiographic no-reflow in patients undergoing primary PCI. Methods : From a consecutive series of 60 patients presenting with ST elevation myocardial infarction within 12 h of chest pain onset and undergoing successful primary PCI (i.e. residual stenosis < 20%), we included 48 patients (age 61±12 years, male sex 89%), comprising the first 24 with no-reflow and the first 24 without no reflow. Patients with iron deficiency, recent transfusions, liver or lung failure, other haematological disorders or undergoing treatment with EPO were excluded. EPO levels were measured by ELISA before PCI. Clinical, enzymatic, procedural and angiographic data were also collected. No-reflow was defined as a coronary TIMI flow grade ≤ 2 after vessel reopening or as a TIMI flow grade of 3 with a final myocardial blush grade <2. Multivariate predictors of no-reflow were assessed by logistic regression analysis (SPSS 13). Results : Patients with and without no-reflow did not differ significantly in age, sex, cardiovascular risk factors or standard therapy for acute myocardial infarction. Thrombus aspiration was used in 16 patients (32%) whereas abciximab in 31 (63%), and they did not differ between the two groups. Patients with angiographic no-reflow had lower EPO serum levels compared to those having angiographic reflow (4.2 (0.56 –9.5) vs 12.2 (5.7–20.2) mUI/ml, p=0.001). The left anterior descending artery (LAD) was the culprit vessel in 83% of patients having no-reflow as compared to 30% of those having reflow (p<0.0001). At multivariate analysis, including EPO levels, culprit artery and symptoms to balloon time, the independent predictors of no-reflow were LAD as culprit vessel (OR 15, 95% CI 3–75, p=0.001) and low EPO serum levels (OR 0.91, 95% CI 0.84 – 0.99, p=0.048). Conclusion : These data suggest a significant role for EPO in modulating microcirculatory injury after mechanical reperfusion in patients with ST elevation myocardial infarction.

scholarly journals The Relationship Between Hemoglobin Level and No-Reflow Phenomenon in Patients with Myocardial Infraction Undergoing Primary PCI

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ahmad Separham ◽  
Seyedeh Zeinab Seyedi ◽  
Ali Heidari Sarvestani
Keyword(s):  
Myocardial Infarction ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Hemoglobin Level ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
No Reflow ◽  
Timi Flow ◽  
Myocardial Infraction ◽  
St Elevation

Background: Anemia is a predictor of no reflow with high rate morbidity and mortality particularly in patients with heart failure. Objectives: The aim of this study was to investigate the relation between hemoglobin level and no-reflowing in patients with ‎myocardial infraction undergoing primary PCI. Methods: In this retrospective cross sectional study, all patients with ST elevation myocardial infarction (STEMI) undergoing coronary angiography from 2016 till 2018 were included. According to post procedural TIMI flow, the patients were divided into two groups: patients with TIMI flow III and those with TIMI flow less than III. ‎ Patients’ demographic and laboratory data such as hemoglobin, hematocrit, platelets count, white blood cells, serum creatinine level and troponin were collected. To compare the ‎quantitative variables chi square test and to compare qualitative variables t-test were applied by SPSS software version 19. Results: In this study 1200 patients with acute ST elevation myocardial infarction (STEMI) treated with primary PCI were included. The mean Hemoglobin level in normal TIMI group and low TIMI group were 14.15 ± 1.49 and ‎‎13.66 ± 1.69, respectively ‎ (P < 0.001). Our results also showed a significant lower RBC count (P < 0.001), lower HCT level (P < 0 .001) and lower RDW (P < 0.001) in those patients with lower TIMI flow.‎ Based on the multivariate regression analysis lower hemoglobin has a significant association with lower TIMI flow and no-reflow (OR = 0.747, CI = 0.618 - 0.888, P < 0.001)‎ Conclusions: Our study showed that in patients with STEMI undergoing primary PCI, hemoglobin level had a significant association with post procedural low TIMI flow and no-reflow. Our results emphasize the need for randomized control trials to evaluate the importance of pre-simultaneous blood transfusion in patients with anemia undergoing PPCI.

scholarly journals TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

2021 ◽  
Vol 3 (1) ◽  
pp. 61-66
Author(s):  
Rikesh Tamrakar ◽  
Rajib Rajbhandari ◽  
Sanjay Singh KC
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcome ◽  
Percutaneous Intervention ◽  
St Elevation Myocardial Infarction ◽  
Significant Implication ◽  
Primary Pci ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Primary Percutaneous Intervention

Background: Timely reperfusion, preferably by primary percutaneous intervention (PCI) has been the guiding-principle for the treatment of patients with acute ST-elevation myocardial infarction (STEMI). TIMI flow grade of the culprit lesion after the procedure have shown to have significant implication in clinical outcome. Objective: We aimed to study the relation of TIMI flow grade with the in-hospital outcome and complication among patients of STEMI.Methods: All consecutive acute STEMI patients undergoing primary PCI during the study period (January 2020 to June 2020) were analyzed for correlation between TIMI flow grade and clinical outcome during the hospital stay. Prior approval was taken from institutional review board. The study design was retrospective observational study.Result: Total of 51(55%) patients had achieved the TIMI 3 flow after the primary PCI. Number of patients achieving TIMI flow of 2,1 and 0 after the procedure were 34(37%),6(6.5%) and 2(2%). Incidence of traditional risk factors like dyslipidemia, diabetes, hypertension was higher in TIMI flow <2 . TIMI flow <2 was also associated with more adverse events namely cardiogenic shock, arrythmias, in-hospital mortality and overall major adverse cardiovascular events.Conclusion: Patients with dyslipidemia had poor TIMI flow grade during primary PCI. Similarly, patients having hypertension, diabetes mellitus and late presentation showed tendency for TIMI flow <2 . Also, the poor TIMI flow grade after primary PCI had unfavorable the clinical outcomes like increased complications and mortality. Keywords: Primary percutaneous intervention (PCI), ST elevation MI (STEMI), TIMI flow grade

scholarly journals Determinants and prognostic value of cardiac magnetic resonance imaging-derived infarct characteristics in non-ST-elevation myocardial infarction

2019 ◽  
Vol 21 (1) ◽  
pp. 67-76 ◽  
Author(s):  
Hans-Josef Feistritzer ◽  
Michael Nanos ◽  
Ingo Eitel ◽  
Alexander Jobs ◽  
Suzanne de Waha-Thiele ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Prognostic Value ◽  
St Elevation Myocardial Infarction ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Lv Ejection Fraction ◽  
Cmr Imaging

Abstract Aims The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI. Methods and results Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6–4.9) years. Median IS was 7.2% (IQR 2.2–13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3–84.9). Age (P ≤ 0.003), heart rate (P ≤ 0.02), the number of diseased coronary arteries (P ≤ 0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P &lt; 0.001) were independent predictors of IS and MSI. The primary endpoint occurred in 64 (22.5%) patients. CMR-derived infarct characteristics had no additional prognostic value beyond LV ejection fraction in multivariable analysis. Conclusion In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction. Clinicaltrials.gov NCT03516578.

P1697Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in Non-ST-Elevation Myocardial Infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-J Feistritzer ◽  
I Eitel ◽  
A Jobs ◽  
S De Waha-Thiele ◽  
R Meyer-Saraei ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Cardiac Magnetic Resonance ◽  
Prognostic Value ◽  
St Elevation Myocardial Infarction ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Cmr Imaging

Abstract Background The prognostic significance of cardiac magnetic resonance (CMR) derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. Purpose To investigate determinants and the long-term prognostic impact of CMR imaging derived infarct characteristics in patients with NSTEMI. Methods Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) were assessed using CMR imaging in 311 consecutive NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centers. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The clinical endpoint was defined as major adverse cardiac events (MACE) during a median follow-up of 4.4 (IQR 3.6–4.9) years. Results Median IS was 7.0% (IQR 2.3–13.5) of LV myocardial mass (%LV) and MSI was 65.2 (IQR 36.7–82.9). Age (p=0.003), heart rate (p=0.002) and TIMI flow grade before PCI (p<0.001) were independent predictors of IS. Independent predictors of the MSI were age (p=0.001), heart rate (p=0.01), the number of diseased coronary arteries (p=0.001) and the TIMI flow grade before PCI (p<0.001). MACE occurred in 75 (24.1%) patients. CMR-derived infarct characteristics had no additional prognostic value over and above LV ejection fraction in multivariable analysis. Conclusions In this prospective, multicenter NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics above and beyond traditional risk markers.

scholarly journals Predictors of No-Reflow Phenomenon in ST-Elevation Myocardial Infarction in Patients undergoing Primary Percutaneous Coronary Intervention

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H S Abdelaziz ◽  
M E Zahran ◽  
K S Othman ◽  
S S Wafa
Keyword(s):  
Myocardial Infarction ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Primary Pci ◽  
University Hospitals ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
Study Population

Abstract Background Functional single ventricle (FSV) is a spectrum of severe congenital heart disease, with multiple anatomic variations but similar surgical treatment strategies. FSV patients are living longer into adulthood compared to two or three decades ago, and they are more frequently undergoing imaging to assist in clinical and surgical management. Objective To assess the relation between admission eGFR, HDL, Monocytes, CRP & albumin levels in patients presenting with acute STEMI and angiographic no-reflow after primary PCI. Material and Methods From October 2018 to February 2019, 60 patients with STEMI who underwent primary PCI in Ain-Shams University hospitals. All patients subjected to history, clinical examination, ECG pre and post pPCI, pre-pPCI eGFR, monocytes, HDL, CRP and albumin, echocardiography. Patients were divided into two groups based on post-pPCI Thrombolysis in Myocardial Infarction (TIMI) flow grade. No reflow was defined as TIMI flow grades ≤ 2, and normal reflow was defined as TIMI 3 flow grade. All the laboratory parameters were measured on admission before pPCI. Results The study population was divided into 2 groups: reflow (n = 31) and no-reflow (NR) (n = 29) groups. CRP over albumin ration “CAR” (7.9 [4.41-16.18] vs 1.74 [1.54-2.35] (P &lt;.001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. However, eGFR and Monocytes over HDL ratio “MHR” didn’t show any statistical differences between the two groups. Conclusion No-reflow can be predicted by systemic inflammation markers including monocytes, CRP, albumin and HDL. CAR has the highest positive predictive value for no-reflow.

Acute myocardial infarction

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Current Therapy ◽  
Primary Pci ◽  
St Elevation

Diagnosis and current therapy of ST elevation myocardial infarction are presented. Recent recommendations by the ACC/AHA and the ESC on primary PCI and fibrinolysis have been summarized and tabulated.

Plasma apelin-12 levels may predict in-hospital major adverse cardiac events in ST-elevation myocardial infarction and the relationship between apelin-12 and the neutrophil/lymphocyte ratio in patients undergoing primary coronary intervention

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 206-213 ◽  
Author(s):  
Mustafa Topuz ◽  
Fahrettin Oz ◽  
Oguz Akkus ◽  
Omer Sen ◽  
Ayse Nur Topuz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Syntax Score ◽  
Normal Flow ◽  
No Reflow ◽  
Timi Flow ◽  
St Elevation ◽  
Flow Group ◽  
Plasma Apelin

Objective: We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Material and Methods: The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. Results: Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). Conclusion: We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.

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