Abstract P178: Echocardiographic Correlates of Persistent Q-Waves in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mikhail Kirnus ◽  
Adeyemi Iyanoye ◽  
Elizabeth Hubbard ◽  
Mikhail Torosoff
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Wall Motion ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Wall Motion Abnormalities

Background Historic data suggests 65-70% prevalence of Q-waves and concurrent wall motion abnormalities in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics. We investigated prevalence of post-MI Q-waves and correlation between Q-waves and left ventricular wall motion abnormalities in STEMI patients treated with primary percutaneous coronary intervention (PCI). Study Design A retrospective study cohort included 145 patients (24% females, 57+/-13 years old) without prior Q-wave MI who underwent successful primary PCI for STEMI at a single academic tertiary center. New York State Angioplasty Registry endpoints were utilized. Echocardiograms and ECGs (median 53 days post STEMI) were reviewed for presence or absence of segmental wall motion abnormalities (WMAs) and Q-waves. ANOVA and chi-square analyses were performed. Results Prevalence of post PCI Q-waves in STEMI patients was 69%, similar to historic 64% in TIMI 14 trial patients (p=0.258). Timing of PCI was not a significant predictor of Q-waves, but there was a trend towards higher pre- and post-PCI creatine kinase and troponin levels in patients with Q-waves. Patients with history of hypertension were less likely to develop Q-waves (62% vs. 77%, p=0.048), while age, gender, history of CHF, COPD, diabetes, renal failure, smoking, and admission hemodynamic status were not predictive of post-PCI Q-waves. WMAs were present in 38% of patients with Q-waves vs. 9% in the rest of the cohort (p=0.0003). Q-waves were equally likely to develop regardless of location of ST elevations at presentation; however, WMAs were more likely in patients with Q-waves in leads II-III-AVF (p=0.008) and V1-2-3 (p<0.0001), V4-5-6 (p=0.008), but not I-AVL (p=0.07). Positive predictive value for WMAs in patients with Q waves was 38%, while negative predictive value for lack of WMAs in patients without Q waves was 91%. Conclusions Prevalence of Q waves, reflective of myocardial damage, in STEMI patients treated with primary coronary intervention is similar to such observed in thrombolysis trials. Positive predictive value of Q-waves for WMAs is low. In CAD patients without Q-waves segmental WMAs are unlikely.

P6529Safety of emergency pretreatment regimen for contrast allergy before percutaneous coronary intervention for ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Jha ◽  
A Berger ◽  
J Blankenship
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Medical Center ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prior History ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Contrast Allergy

Abstract Background Primary percutaneous coronary intervention (PPCI) is the best treatment for ST-elevation myocardial infarction (STEMI). However, patients with prior contrast reactions may not receive PCI due to concern over a recurrent contrast reaction. Purpose To determine the clinical efficacy of emergency pretreatment regimens for contrast allergy in STEMI patients undergoing PPCI. Methods We retrospectively identified all individuals with a history of contrast allergy who presented with STEMI, were pretreated for contrast allergy, and underwent PPCI at our medical center between January 2005 to May 2018. Emergency pretreatment regimen included a combination of intravenous (IV) steroid, IV famotidine and IV diphenhydramine administered immediately before PCI. Laboratory records, inpatient notes, and discharge summaries were reviewed to confirm the severity of the original contrast allergy and identify any allergic breakthrough reaction after pretreatment with an emergency regimen. Reactions were characterized as mild, moderate, severe, or of unknown severity. Results During the study period 15,712 individuals underwent PCI, of which 176 patients presented with STEMI, had confirmed contrast allergy, and were pretreated before undergoing PCI. No patient with a history of contrast allergy underwent PPCI without pre-treatment. Mean age was 64 years, with 52% males, and all individuals were white. The majority had hypertension (77%), 67% had dyslipidemia, 29% had diabetes mellitus, and 20% patients had a prior history of MI. Intravenous steroids used in the emergency regimen included methylprednisone (n=100), hydrocortisone (n=70), and dexamethasone (n=6). The original allergic response to ICM was mild in 59% patients, moderate in 15%, severe in 20% and of unknown severity in 13% patients. Of the 176 patients only 10 (5.6%) developed a breakthrough reaction. Most of which were mild; none was fatal. Median length of hospital stays was three days and nine patients (10.8%) passed away within 30 days of hospital admission. Conclusions Patients with prior contrast allergy presenting with STEMI can safely undergo PPCI after emergency pretreatment. Breakthrough reactions are infrequent and mild.

scholarly journals How to Manage a Patient with Haemophilia and ACS Requiring PCI: A Battle between Bleeding and Thrombosis

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 352
Author(s):  
Konstantinos C. Theodoropoulos ◽  
Sofia Vakalopoulou ◽  
Maria Oikonomou ◽  
George Stavropoulos ◽  
Antonios Ziakas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Management Plan ◽  
Clotting Factor ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation

We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.

The Predictive Value of PRECISE-DAPT Score for In-Hospital Mortality in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Angiology ◽  
2018 ◽  
Vol 70 (5) ◽  
pp. 440-447 ◽  
Author(s):  
Veysel Ozan Tanik ◽  
Tufan Cinar ◽  
Emre Arugaslan ◽  
Yavuz Karabag ◽  
Mert Ilker Hayiroglu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Primary Percutaneous Coronary Intervention ◽  
Predictive Value ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Bleeding Complications ◽  
Percutaneous Coronary ◽  
St Elevation

The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy (PRECISE-DAPT) score predicts the bleeding risk in patients treated with dual antiplatelet treatment after primary percutaneous coronary intervention (pPCI). This study aimed to determine the predictive value of the admission PRECISE-DAPT score for in-hospital mortality in patients with ST elevation myocardial infarction (STEMI) treated with pPCI. Of the 1418 patients enrolled, the study population was divided into 2 groups: PRECISE-DAPT score ≥25 and PRECISE-DAPT score <25. The primary goal was to determine the incidence of in-hospital all-cause mortality. In-hospital mortality was significantly higher in patients whose PRECISE-DAPT score ≥25 compared with the patients whose PRECISE-DAPT score <25 (9.4 vs 0.9%; P < .001, respectively). Both univariate and multivariate Cox proportional hazard analyses showed that the PRECISE-DAPT score is independently associated with in-hospital mortality (hazards ratio [HR]: 1.043, 95% confidence interval [CI]: 1.003-1.084; P = .035; and HR: 1.026, 95% CI: 1.004-1.048; P = .021, respectively). A pairwise comparison of receiver operating characteristic curves showed that the predictive value of the PRECISE-DAPT score with regard to in-hospital mortality was noninferior compared with the Thrombolysis in Myocardial Infarction risk score. The PRECISE-DAPT score may be a significant independent predictor of in-hospital mortality in patients with STEMI treated with pPCI.

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