Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial

2017 ◽  
Vol 8 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Enrico Fabris ◽  
Arnoud van ’t Hof ◽  
Christian W Hamm ◽  
Frédéric Lapostolle ◽  
Jens F Lassen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation

Background: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. Methods: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Results: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19–0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02–0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19–0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85–0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44–0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99–1.51; p=0.06). Conclusions: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients’ delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

scholarly journals Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

2019 ◽  
Vol 17 (1) ◽  
pp. 147916411988398 ◽  
Author(s):  
Mohamed Khalfallah ◽  
Randa Abdelmageed ◽  
Ehab Elgendy ◽  
Yasser Mostafa Hafez
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. Methods: The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. Results: Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. Conclusion: Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

Efficacy of Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction and Impaired Glucose Tolerance or Diabetes Mellitus

Kardiologiia ◽  
2014 ◽  
Vol 11_2014 ◽  
pp. 4-10
Author(s):  
Yu.A. Belenkova Belenkova ◽  
V.N. Karetnikova Karetnikova ◽  
A.O. Dyachenko Dyachenko ◽  
O.P. Blagoveschenskaya Blagoveschenskaya ◽  
T.S. Molodtsova Molodtsova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
St Elevation

scholarly journals The Clinical Prediction Factors for Non-Culprit Lesion Progression in Patients with Acute ST Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
jian wang ◽  
Cheng-ying Yan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background To investigate the relationship between the clinical features and progression of non-culprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods A total of 480 patients (57.1 ± 9.2 y) with STEMI who underwent PPCI between January 2016 and December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as a treatment for culprit lesions. Clinical and angiographic follow-up were performed for 12 months. All patients were divided into a non-culprit lesions (NCL) progression group (205 cases) and a control group (275 cases) based on angiographic follow-up outcomes at 12 months. The clinical and angiographic features were analyzed. Results Body mass index (BMI), serum creatinine (Scr), fasting blood glucose (FBG), glycated serum albumin, glycated hemoglobin and homocysteine levels in the NCL progression group were significantly higher than those in the control group (P < 0.05). A logistic regression analysis showed that FBG (odds ratio = 1.274, 95% confidence interval: 1.077–1.505, P = 0.005) and Scr (odds ratio = 1.020, 95% confidence interval: 1.002–1.038, P = 0.027) were independent predictors of NCL progression. A partial correlation analysis showed that FBG was positively correlated with NCL progression (r = 0.231, P = 0.001). A receiver operating characteristic curve showed that the boundary point of FBG to predict NCL progression was 5.715 mmol/L, and the sensitivity was 74.4% and the specificity was 46.4%. Conclusions FBG is a valuable predictor for NCL progression in patients with STEMI after PPCI.

scholarly journals Predictors of contrast-induced nephropathy in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Mohamed Abdel-Ghany ◽  
Ghada Morsy ◽  
Yehia Taha Kishk
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Old Age ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Contrast-induced nephropathy (CIN) is a serious complication with primary percutaneous coronary intervention (PPCI). We aimed to study the different predictors of CIN and determine the cutoff point of contrast volume (CV)/creatinine clearance (CrCl) and the applicability of CHA2DS2-VASC score in the prediction of CIN after PPCI in ST-elevation myocardial infarction (STEMI) patients. Four hundred patients presented with STEMI and eligible for primary PCI were included in the study. Patients with GFR < 30 ml/min were excluded from the study. Results Fifty-four (13.5%) patients who developed CIN who were older (64.20 ± 13.16 vs. 55.80 ± 10.58) had a higher prevalence of diabetes mellitus (DM), hypertension (HTN), and female gender than those without CIN. They also had a higher Killip class and lower hemoglobin (HB) level (P < 0.05) compared to those with no CIN. The incidence of no CIN was (85.8%) in the low-risk Mehran score group and 14.2% in the moderate-risk group, and all patients of high and very high score group developed CIN (P<0.001). Multiple logistic regression showed that old age (OR= 1.06, 95% CI= 1.02–1.11, P< 0.001), female sex (OR= 3.1, 95% CI= 2.65–6.99, P= 0.02), high Mehran score (OR=2.48, 95% CI= 1.98–6.24, P= 0.01), CV/CrCl > 2.8 (odds ratio=1.45, 95% CI= 1.22–2.01, P= 0.03), and CHA2DS2-VASC score > 2 (odds ratio=1.90, 95% CI= 1.76–2.11, P= 0.04) were predictors of CIN. Conclusions Old age, female sex, high Mehran score, CHADS2-VASC score > 2, CV/CrCl > 2.8 were predictors of CIN in STEMI patients who underwent PPCI.

scholarly journals The clinical prediction factors of nonculprit lesions progression in patients with acute ST elevation myocardial infarction after primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian wang ◽  
Xue-Jie WANG
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Objective :To investigate the relationship between the clinical features and progression of nonculprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods: A total of 192 patients (57.1 ± 9.2 years) with STEMI who underwent PPCI from January 2016 to December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions.Clinical and angiographic follow-up were performed in 12 months. All patients were divided into Nonculprit lesions(NCL) progression group ( 82 cases) and the control group (110 cases) according to angiographic follow-up outcome in 12 months. The clinical and angiographic features were analyzed.Results: Levels of body mass index（BMI）,serum creatinine（Scr）,fasting blood glucose（FBG）,glycated serum albumin（GSA）,glycated hemoglobin(GHb) and homocysteine (Hcy) in NCL progression group were significantly higher than those in the control group( P < 0. 05,respectively).Logistic regression showed that FBG( odds ratio = 1. 274,95% confidence interval: 1. 077-1. 505,P = 0. 005) and Scr ( odds ratio =1. 020,95% confidence interval:1. 002-1. 038,P=0. 027) were independent predictors of NCL progression.Partial correlation analysis showed that FBG was positively correlated with NCL progression( r = 0. 231,P = 0. 001) .Receiver operating characteristic(ROC) curve showed that the boundary point of FBG to predict NCL progression was 5. 715 mmol /L, the sensitivity was 74. 4% and the specificity was 46. 4%.Conclusion: FBG is an valuable predictor for NCL progression in patients with STEMI after PPCI.

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