Two-Year Clinical Outcomes According to Pre-PCI TIMI Flow Grade and Reperfusion Timing in Non-STEMI After Newer-Generation Drug-Eluting Stents Implantation

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Yong Hoon Kim ◽  
Ae-Young Her ◽  
Myung Ho Jeong ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Treatment Strategies ◽  
Drug Eluting Stents ◽  
Cardiac Events ◽  
Timi Flow Grade ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Timi Flow ◽  
Drug Eluting

The 2-year clinical outcomes according to pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow grade and reperfusion timing were investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who received newer-generation drug-eluting stents. A total of 7506 NSTEMI patients were divided into 2 groups: early (PCI ≤ 24 hours: n = 6398; pre-PCI TIMI 0/1 [n = 2729], pre-PCI TIMI 2/3 [n = 3669]) and delayed (PCI > 24 hours: n = 1108; pre-PCI TIMI 0/1 [n = 428], pre-PCI TIMI 2/3 [n = 680]) invasive groups. Major adverse cardiac events were defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. All-cause death ( P = 0.005 and 0.009, respectively) and cardiac death ( P = .003 and 0.046, respectively) were significantly higher in pre-PCI TIMI 0/1 patients than in pre-PCI TIMI 2/3 patients both in the early and delayed invasive groups. In pre-PCI TIMI 0/1 patients, all-cause death rate was significantly higher in the delayed group ( P = .023). In pre-PCI TIMI 2/3 patients, the clinical end point was similar between the 2 groups. An early invasive strategy is preferred to a delayed invasive strategy in reducing all-cause death in patients with pre-PCI TIMI 0/1. However, in patients with pre-PCI TIMI 2/3, both treatment strategies are acceptable.

Impact of Pre-percutaneous Coronary Intervention Thrombolysis in Myocardial Infarction Flow Grade in Patients With ST-segment Elevation Myocardial Infarction and Prediabetes or Diabetes After Successful Newer-generation Drug-eluting Stent Implantation

2020 ◽  
Author(s):  
Yong Hoon Kim ◽  
Ae-Young Her ◽  
Myung Ho Jeong ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Repeat Revascularization ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Drug Eluting

Abstract Background: Studies comparing long-term clinical outcomes between prediabetes and diabetes based on pre-percutaneous coronary intervention (PCI) Thrombolysis in Myocardial Infarction (TIMI) flow grade in patients with ST-segment elevation myocardial infarction (STEMI) after successful PCI with newer-generation drug-eluting stents are limited. We compared 2-year clinical outcomes of these two groups. Methods: Overall, 6448 STEMI patients were divided into two groups: pre-PCI TIMI 0/1 group (n = 4854) and pre-PCI TIMI 2/3 group (n = 1594). Subsequently, these two groups were further divided into patients with normoglycemia, prediabetes, and type 2 diabetes mellitus (T2DM). The major endpoint was the occurrence of major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. Results: After adjustment, in the pre-PCI TIMI 0/1 group, the cumulative incidence of all-cause death was higher in both prediabetes (adjusted hazard ratio [aHR]: 1.633, p = 0.045) and T2DM (aHR: 2.064, p = 0.002) groups than in the normoglycemia group. In the pre-PCI TIMI 2/3 group, the cumulative incidence of any repeat revascularization was higher in both prediabetes (aHR: 2.511, p = 0.039) and T2DM (aHR: 3.156, p = 0.009) groups than in the normoglycemia group. However, in each group (pre-PCI TIMI 0/1 or 2/3), the cumulative incidences of MACEs and all other clinical outcomes were not significantly different between the prediabetes and T2DM groups. Conclusions: In this retrospective registry study, prediabetes showed worse clinical outcomes similar to those of T2DM regardless of the pre-PCI TIMI flow grade. However, further studies are warranted to confirm these results.

Acute Myocardial Infarction – The Role of Drug-eluting Stents in Treatment Strategies

2011 ◽  
Vol 7 (2) ◽  
pp. 113 ◽  
Author(s):  
Ronald K Binder ◽  
Ahmed A Khattab ◽  
◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Segment Elevation ◽  
Drug Eluting

Although primary percutaneous coronary intervention (PCI) has become the cornerstone in the treatment of ST-segment elevation acute myocardial infarction (AMI), systemic fribrinolysis may still be considered for patients in areas where PCI is not accessible. The downside of initial plain balloon angioplasty, mainly coronary artery dissection and vessel re-occlusion, was effectively solved by the application of coronary stents. The incidence of target vessel failure, witnessed after bare metal stent (BMS) implantation, was dramatically reduced by the introduction of drug-eluting stents (DES), which significantly and effectively alleviate restenosis in the overall population. A minute incidence of late and very late DES thrombosis led to some safety concerns, which were soon rebutted, particularly by the development of newer generation DES. DES have consequently outplayed BMS among almost all anatomical and clinical subgroups of coronary artery disease patients. However, AMI remains one of the last contested territories. Today there is a growing body of evidence to support the use of DES as a safe and effective treatment of AMI.

scholarly journals Prediabetes versus type 2 diabetes mellitus based on pre-percutaneous coronary intervention thrombolysis in myocardial infarction flow grade in patients with ST-segment elevation myocardial infarction after successful newer-generation drug-eluting stent implantation

2021 ◽  
Vol 18 (1) ◽  
pp. 147916412199150
Author(s):  
Yong Hoon Kim ◽  
Ae-Young Her ◽  
Myung Ho Jeong ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Repeat Revascularization ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary

Background: We compared the 2-year clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) according to the pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow grade in patients with ST-segment elevation myocardial infarction. Methods: Overall, 6448 STEMI patients were divided into two groups: pre-PCI TIMI 0/1 group ( n = 4854) and pre-PCI TIMI 2/3 group ( n = 1594). They were further divided into patients with normoglycemia, prediabetes, and T2DM. The major endpoint was major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. Results: In the pre-PCI TIMI 0/1 group, all-cause death rate was higher in both prediabetes (adjusted hazard ratio [aHR]: 1.633, p = 0.045) and T2DM (aHR: 2.064, p = 0.002) groups than in the normoglycemia group. In the pre-PCI TIMI 2/3 group, any repeat revascularization rate was also higher in both prediabetes (aHR: 2.511, p = 0.039) and T2DM (aHR: 3.156, p = 0.009) than normoglycemia. In each group (pre-PCI TIMI 0/1 or 2/3), the MACEs and all other clinical outcomes rates were similar between the prediabetes and T2DM groups. Conclusions: Prediabetes showed comparable worse clinical outcomes to those of T2DM regardless of the pre-PCI TIMI flow grade.

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