scholarly journals The 9p21 Rs 1333040 polymorphism is associated with coronary microvascular obstruction in ST-segment elevation myocardial infarction treated by primary angioplasty

2017 ◽  
Vol 8 (8) ◽  
pp. 703-707 ◽  
Author(s):  
Francesco Fracassi ◽  
Giampaolo Niccoli ◽  
Vincenzo Vetrugno ◽  
Michele Cauteruccio ◽  
Antonino Buffon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Late Complications ◽  
Nucleotide Polymorphisms ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) leads to higher incidence of both early and late complications. A number of single nucleotide polymorphisms in 9p21 chromosome have been shown to affect angiogenesis in response to ischaemia. In particular, Rs1333040 with its three genotypic vriants C/C, T/C and T/T might influence the occurrence of MVO after pPCI. Methods: We enrolled ST-elevation myocardial infarction (STEMI) patients undergoing pPCI. The Rs1333040 polymorphism was evaluated by polymerase chain reaction-restriction fragment length polymorphism using restriction endonucleases (Bsml). Two expert operators unaware of the patients’ identity performed the angiographic analysis; collaterals were assessed applying Rentrop’s classification. Angiographic MVO was defined as a post-pPCI Thrombolysis In Myocardial Infarction (TIMI)<3 or TIMI 3 with myocardial blush grade 0 or 1, whereas electrocardiographic MVO was defined as ST segment resolution <70% one hour after pPCI. Results: Among our 133 STEMI patients (mean age 63 ± 11 years, men 72%), 35 (26%) and 53 (40%) respectively experienced angiographic or electrocardiographic MVO. Angiographic and electrocardiographic MVO were different among the three variants ( p= 0.03 and p=0.02 respectively). In particular, T/T genotype was associated with a higher incidence of both angiographic and electrocardiographic MVO compared with C/C genotype ( p=0.04 and p=0.03 respectively). Moreover, Rentrop score <2 detection rate differed among the three genotypes ( p=0.03). In particular T/T genotype was associated with a higher incidence of a Rentrop score <2 as compared with C/C genotype ( p= 0.02). Conclusion: Rs1333040 polymorphism genetic variants portend different MVO incidence. In particular, T/T genotype is related to angiographic and electrocardiographic MVO and to worse collaterals towards the culprit artery.

scholarly journals Association between early Q-waves and microvascular injury in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
T Rusak ◽  
LG Gelis ◽  
EA Miadzvedzeva ◽  
NA Shibeko ◽  
IK Haidzel
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Microvascular Injury ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Funding Acknowledgements Type of funding sources: None. Background  Pathological early Q-waves (QW) are associated with adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). It is still not clear how admission Q-waves are related to microvascular injury (microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for STEMI. Aim to determine the association between admission Q-waves and microvascular injury in STEMI patients treated with primary PCI.  Methods  This prospective study included 98 STEMI patients who underwent pPCI within 12 hours and had no contraindication of CMR investigation. Admission 12-lead electrocardiography was evaluated for the presence of pathological QW, defined as a depth of &gt;0,1 mV and a QW duration of &gt; 30 ms. The patients underwent a cardiac magnetic resonance imaging scan at 6 (interquartile range [IQR]: 5-7) days after pPCI to determine infarct characteristics including MVO (late gadolinium enhancement) and IMH (T2* mapping). Results  The 98 first-attack STEMI patients included 87 men and 11 women with a mean age of 55,6 ± 9,7 years in this study. Early QW was observed in 23 (23,5%) patients. These patients were more frequent smokers (p = 0,041), had a significantly more frequent left anterior descending  artery as culprit lesion (p = 0,03), and had higher rates of pre-interventional TIMI flow 0 (p = 0,001). Patients with QW was related to larger infarct size (21% vs. 8% of left ventricular mass, p = 0,002), lower ejection fraction (44% vs. 51%, p = 0,004), and larger MVO (53% vs. 32%, p = 0,001) and IMH (34% vs. 17%, p = 0,003). Q-waves remained associated with both MVO (odds ratio: 5,13, 95% confidence interval: 1,98 to 11,2, p &lt; 0,001) and IMH (odds ratio: 3,66, 95% confidence interval: 1,06 to 7,21, p &lt; 0,001) after adjusting for potential confounders (total ischemia time, ST-segment elevation, pre-interventional TIMI flow 0). Conclusions  Admission Q-waves in the ECG were as independent early markers of microvascular obstruction and intramyocardial haemorrhage  in STEMI patients undergoing pPCI.

Recurrence of angina after ST-segment elevation myocardial infarction: the role of coronary microvascular obstruction

2019 ◽  
pp. 204887261988066
Author(s):  
Rocco A Montone ◽  
Vincenzo Vetrugno ◽  
Giovanni Santacroce ◽  
Marco Giuseppe Del Buono ◽  
Maria Chiara Meucci ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: The recurrence of angina after percutaneous coronary intervention affects 20–35% of patients with stable coronary artery disease; however, few data are available in the setting of ST-segment elevation myocardial infarction. We evaluated the relation between coronary microvascular obstruction and the recurrence of angina at follow-up. Methods: We prospectively enrolled patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Microvascular obstruction was defined as thrombolysis in myocardial infarction flow less than 3 or 3 with myocardial blush grade less than 2. The primary endpoint was the recurrence of angina at follow-up. Moreover, angina status was evaluated by the Seattle angina questionnaire summary score (SAQSS). Therapy at follow-up and the occurrence of major adverse cardiovascular events were also collected. Results: We enrolled 200 patients. Microvascular obstruction occurred in 52 (26%) of them. Follow-up (mean time 25.17±9.28 months) was performed in all patients. Recurrent angina occurred in 31 (15.5%) patients, with a higher prevalence in patients with microvascular obstruction compared with patients without microvascular obstruction (13 (25.0%) vs. 18 (12.2%), P=0.008). Accordingly, SAQSS was lower and the need for two or more anti-anginal drugs was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. At multiple linear regression analysis a history of previous acute coronary syndrome and the occurrence of microvascular obstruction were the only independent predictors of a worse SAQSS. Finally, the occurrence of major adverse cardiovascular events was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. Conclusions: The recurrence of angina in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention is an important clinical issue. The occurrence of microvascular obstruction portends a worse angina status and is associated with the use of more anti-anginal drugs.

scholarly journals Acute Serious Thrombocytopenia Associated with Intracoronary Tirofiban Use for Primary Angioplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mustafa Yurtdaş ◽  
Yalin Tolga Yaylali ◽  
Nesim Aladağ ◽  
Mahmut Özdemir ◽  
Memiş Hilmi Atay
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Successful Management ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Tirofiban, a specific glycoprotein IIb/IIIa inhibitor, may cause extensive thrombocytopenia with an incidence of 0.2% to 0.5%. We report the case of a 50-year-old man who developed thrombocytopenia after tirofiban use (both intracoronary and peripheral) over hours and the successful management of this complication after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

Implications of ventricular arrhythmia “bursts” with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: A biosignature of direct myocellular injury “downstream of downstream”

2014 ◽  
Vol 4 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Mohamed Majidi ◽  
Andrzej S Kosinski ◽  
Sana M Al-Khatib ◽  
Lilian Smolders ◽  
Ecaterina Cristea ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Arrhythmia ◽  
Cellular Response ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Electrocardiogram Ecg

Aims: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia “bursts” (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR). Methods and results: Anterior STEMI patients with final TIMI 3 flow had protocol-blinded analyses of simultaneous MBG, continuous 12-lead electrocardiogram (ECG) STR, Holter VABs, and day 5–14 SPECT imaging infarct size (IS) assessments. Over 20 million cardiac cycles from >4500 h of continuous ECG monitoring in subjects with STR were obtained. IS and clinical outcomes were examined in patients stratified by MBG and VABs. VABs occurred in 51% (79/154) of subjects. Microcirculation (MBG 2/3) was restored in 75% (115/154) of subjects, of whom 53% (61/115) had VABs. No VABs were observed in subjects without microvascular flow (MBG of 0). Of 115 patients with TIMI 3 flow, STR, and MBG 2/3, those with VABs had significantly larger IS (median: 23.0% vs 6.0%, p=0.001). Multivariable analysis identified reperfusion VABs as a factor significantly associated with larger IS ( p=0.015). Conclusions: Despite restoration of normal epicardial flow, open microcirculation, and STR, concomitant VABs are associated with larger myocardial IS, possibly reflecting myocellular injury in reperfusion settings. Combining angiographic and ECG parameters of epicardial, microvascular, and cellular response to STEMI intervention provides a more predictive “biosignature” of optimal reperfusion than do single surrogate markers.

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