scholarly journals A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score

2022 ◽  
Vol 28 ◽  
pp. 107602962110737
Author(s):  
Ozge Ozcan Abacioglu ◽  
Arafat Yildirim ◽  
Mine Karadeniz ◽  
Serkan Abacioglu ◽  
Nermin Yildiz Koyunsever ◽  
...  
Keyword(s):  
Shear Rate ◽  
Total Protein ◽  
Operating Characteristic ◽  
Youden Index ◽  
Platelet Volume ◽  
Roc Curve Analysis ◽  
St Segment Elevation ◽  
St Segment ◽  
The Mean ◽  
Low Shear

Aim to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. Methods A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. Results The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM ( P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher ( P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. Conclusion The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.

scholarly journals Study of Global Longitudinal Strain and N Terminal Pro BNP as Predictors of Outcome in Acute ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Gehan Magdy ◽  
Salah El-tahhan ◽  
Fatema Al-zahraa Ahmed ◽  
Mahmoud Hasanein
Keyword(s):  
Adverse Outcome ◽  
Global Longitudinal Strain ◽  
P Value ◽  
Roc Curve Analysis ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Mean

Abstract Background Risk stratification of patients presenting with Acute ST-segment elevation myocardial infarction (STEMI) is of greatest importance as it may help to start early therapeutic procedures that could improve the outcome. Our study is designed to assess the prognostic value of N-terminal pro brain natriuretic peptide (NT-proBNP) and global longitudinal strain (GLS) of the left ventricle measured by 2 dimensional speckle tracking echocardiography (STE) in patients presenting with acute STEMI and treated by primary percutaneous coronary interventions (PPCI). Patients and Methods the study prospectively included 100 patients(their age 55.69 ±8.70 years, and 75% were males)presented to our institute (from march 2019 to December 2019) by acute STEMI and treated by PPCI within 12 hour of the onset of chest pain, excluding those with left ventricular ejection fraction ≤40%, left bundle branch block, atrial fibrillation, significant valvular disease, patients with non cardiac causes that interfere with NT-Pro BNP level eg.(renal failure, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia, liver cirrhosis, hyperthyroidism, and on those on chemotherapy). All patients were subjected to peripheral samples of plasma for analysis of NT- proBNP and 2dimentional STE for calculation of the GLS, both were done within 24 hours of admission, and follow up of all patients were done for 6 months to assess outcome. Results The mean GLS for all patients was -10.41 ± 3.59%, and the mean NT- proBNP (2090.1 ± 1375.8) pg/ml. 20 patients (20%) had adverse events during the 6 month follow up including (1(1%) had all cause mortality, 2(2%) had cardiovascular mortality, 6(6%) had reinfarction, 11(11%) had heart failure hospitalization, and according to ROC curve analysis the GLS cut off value of (≤- 8) was able to discriminate patients with adverse outcome (AUC=0.971, p value&lt;0.001,CI=“0.940-1.001”,sensitivity=90%, specificity=91.67%, PPV=78.3%, NPV=96.5%) (figure 1, 2), also according to ROC curve analysis NT-pro BNP cut off value of (&gt;2318pg/ml) was able to discriminate patients with adverse outcome (AUC=0.802,p value&lt;0.001, CI=“0.685-0.920”, sensitivity=89%, specificity=75%, PPV=51.6%, NPV=91.8%) (Figure 3, 4). There was a statistically significant inverse correlation between GLS and NT- ProBNP (r=-0.492*, p value&lt;0.001). In multivariate COX regression analysis for the parameters affecting the outcome, GLS was shown to be the most significant parameter in the prediction of reaching adverse outcome in STEMI patients (p value=0.003, OR “95%C.I”= 0.721 (0.580–0.896). Conclusions our study concluded that both GLS and NT-proBNP are significantly related to adverse outcome with more superiority of the GLS to NT- pro BNP in adverse outcome prediction in patients acute STEMI treated by PPCI.

scholarly journals OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION ARRIVING IN ARMY CARDIAC CENTER LAHORE

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S781-86
Author(s):  
Khurram Shahzad ◽  
Jahanzab Ali ◽  
Ayaz Ahmad ◽  
Ahmad Usman ◽  
Amna Rashdi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Cardiac Center

Objective: To evaluate the feasibility and outcomes of primary percutaneous coronary intervention (PCI) as a mode of treatment in acute ST segment elevation myocardial infarction (STEMI). Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was conducted in Army Cardiac Center Lahore, from Nov 2019 to Feb 2020. Methodology: All patients diagnosed as acute ST-segment elevation myocardial infarction during the study period were offered primary percutaneous coronary intervention among treatment options. Patients who chose primary percutaneous coronary intervention were included in the study. Informed consent was taken. Patient demographics, risk factors, time variables, procedural characteristics and in-hospital adverse events were evaluated. Results: On admission, Out of 50, 30 (60%) of the patients were current smokers, 25 (50%) were hypertensive, 22 (44%) were diabetic, and 1 (2%) had cardiogenic shock. The mean time from symptom onset to hospital arrival was 5 hours and the mean door-to-balloon time was 34 minutes. Culprit coronary artery was the left anterior descending artery (LAD) in 56% cases and multi-vessel disease was present in 38% cases. Primary percutaneous coronary intervention involved balloon dilatation (2%) and stent implantation (98%). The incidence of postprocedural angiographic no-reflow was 0%. All-cause mortality was 1%. Conclusion: This study has shown efficiency, feasibility and safety in performing of primary percutaneous coronary intervention with excellent outcomes in Army Cardiac Center Lahore. In order to further improve its outcomes, our goal should be to decrease reperfusion time which can be achieved by reducing patient delay, increasing public awareness and improving the management of first medical contact.

scholarly journals Doppler ultrasound for diagnosis of soft tissue sarcoma: efficacy of ultrasound-based screening score

2015 ◽  
Vol 49 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Satoshi Nagano ◽  
Yuhei Yahiro ◽  
Masahiro Yokouchi ◽  
Takao Setoguchi ◽  
Yasuhiro Ishidou ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Ultrasound Imaging ◽  
Operating Characteristic ◽  
Soft Part ◽  
Imaging Modality ◽  
Screening Method ◽  
Area Under The Curve ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
The Mean

Abstract Background. The utility of ultrasound imaging in the screening of soft-part tumours (SPTs) has been reported. We classified SPTs according to their blood flow pattern on Doppler ultrasound and re-evaluated the efficacy of this imaging modality as a screening method. Additionally, we combined Doppler ultrasound with several values to improve the diagnostic efficacy and to establish a new diagnostic tool. Patients and methods. This study included 189 cases of pathologically confirmed SPTs (122 cases of benign disease including SPTs and tumour-like lesions and 67 cases of malignant SPTs). Ultrasound imaging included evaluation of vascularity by colour Doppler. We established a scoring system to more effectively differentiate malignant from benign SPTs (ultrasound-based sarcoma screening [USS] score). Results. The mean scores in the benign and malignant groups were 1.47 ± 0.93 and 3.42 ± 1.30, respectively. Patients with malignant masses showed significantly higher USS scores than did those with benign masses (p < 1 × 10-10). The area under the curve was 0.88 by receiver operating characteristic (ROC) analysis. Based on the cut-off value (3 points) calculated by ROC curve analysis, the sensitivity and specificity for a diagnosis of malignant SPT was 85.1% and 86.9%, respectively. Conclusions. Assessment of vascularity by Doppler ultrasound alone is insufficient for differentiation between benign and malignant SPTs. Preoperative diagnosis of most SPTs is possible by combining our USS score with characteristic clinical and magnetic resonance imaging findings.

scholarly journals Identification of familial hypercholesterolemia in acute coronary syndrome patients: are we missing the mark?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
P Garcia Bras ◽  
G Portugal ◽  
A Castelo ◽  
V Ferreira ◽  
J Reis ◽  
...  
Keyword(s):  
Family History ◽  
Familial Hypercholesterolemia ◽  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
St Segment Elevation ◽  
St Segment ◽  
All Cause Mortality ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with familial hypercholesterolemia (FH) have considerable elevation in levels of low-density lipoprotein (LDL) cholesterol and a higher risk of premature coronary artery disease (CAD) and acute coronary syndromes (ACS). However, even in a hospital setting with a high volume of ACS P, the diagnosis of FH frequently goes undetected. The aim of this study was to evaluate the application of the Dutch Lipid Clinic Network (DLCN) Criteria in P admitted for ACS and analyse ACS recurrence, hospitalization and mortality in a 30-day follow-up. Methods Retrospective evaluation of P with ACS admitted to a tertiary center from 2005 to 2019. Data from the digital files including family history and laboratory tests was analysed and P were followed up for 30 days for hospitalization, recurrent ACS, all cause mortality and cardiovascular (CV) death. Evaluation of tendinous xanthomata, arcus cornealis and genetic analysis was not undertaken. Results 3811 P were evaluated, mean age 63 ± 13 years, 28% female gender, 1497 P (39%) with active or previous smoking habits, 847 P (22%) with diabetes mellitus, 419 P (11%) with family history of coronary disease, 1340 P (35%) with premature CAD, 53 P (1.4%) with premature cerebral or peripheral vascular disease and 522 (14%) with previous ACS. The mean LDL cholesterol level was 125 ± 43 mg/dL, the mean high-density lipoprotein (HDL) cholesterol level was 40 ± 16 mg/dL and the mean triglyceride level was 132 ± 89 mg/dL. The diagnosis at hospital admission was unstable angina (UA) in 189 P (5%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1024 P (27%) and ST-segment elevation MI (STEMI) in 2598 P (68%). The hospital mortality rate was 4.3% (163P). Applying the DLCN criteria, 3089 P (81%) had a score of &lt;3 ("unlikely FH"), 675 P (17.7%) a score of 3 to 5 ("possible FH"), 41 P (1.1%) a score of 6 to 8 ("probable FH") and 1 P (0.03%) a score of &gt;8 ("definite FH"). Stratifying according to ACS type: among UA, 31 P (16%) had "possible FH" and 4 P (2.1%) had "probable FH". Among NSTEMI, 145 P (14.2%) had "possible FH", 9 P (0.9%) "probable FH" and 1 P (0.03%) had "definite FH". Finally, among STEMI P, 497 P (19.1%) had "possible FH" and 28 P (1.1%) had "probable FH". In a 30-day follow-up, there was an all cause mortality of 2% (78 P) and a CV death of 1.3% (49P), while the all cause hospitalization rate was 3.5% (134P) and the admission rate for recurrent ACS was 1.7% (65P). The DLCN criteria score was significantly correlated with CV death (OR 1.25, CI 95% 1.04-1.50, p = 0.020) and admission for recurrent ACS (OR 1.19, CI 95% 1.04-1.36, p = 0.04). Conclusion Application of the DLCN criteria in P admitted for ACS revealed 675 P (17.7%) with "possible FH" and 41 P (1.1%) with "probable FH" as well as show significant correlation with CV death and recurrent ACS. Routine assessment of these criteria can be an accessible tool to stratify likelihood of FH and proceed accordingly to genetic testing.

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