Thrombectomy in Acute Myocardial Infarction

2009 ◽  
Vol 4 (1) ◽  
pp. 86 ◽  
Author(s):  
On Topaz ◽  
Allyne Topaz ◽  
Pritam R Polkampally ◽  
◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mechanical Thrombectomy ◽  
Tissue Perfusion ◽  
Coronary Intervention ◽  
Direct Result ◽  
St Segment Elevation ◽  
Direct Stenting ◽  
Increased Risk ◽  
Thrombus Removal ◽  
Antegrade Flow

Percutaneous coronary intervention (PCI) is the preferred management strategy for ST-segment-elevation myocardial infarction (STEMI) patients. However, a significant number of revascularisations result insuboptimal restoration of epicardial antegrade flow and inadequate myocardial tissue perfusion. This is mainly attributed to the underlying thrombus burden within the infarct-related vessel. Interventions for thrombotic lesions are clearly associated with an increased risk of acute and long-term complications. Thrombus remains a predictor of ischaemic complications, immediate and late stent thrombosis, increased in-hospital complications, death at six months and recurrent MI. Two types of thrombus removal device are available for utilisation in the setting of acute MI (AMI): aspiration-based catheters and mechanical thrombectomy. Administration of either systemic or selective adjunct pharmacotherapy can be useful in conjunction with application of all thrombus removal devices. Recent studies have demonstrated that thrombus aspiration is applicable and safe in a large majority of patients with STEMI, resulting in better reperfusion and clinical outcomes than standard PCI. However, it is unclear whether these findings are a direct result of a reduction in thrombus burden, facilitation of direct stenting or a combination of the two. The heavier the underlying thrombus burden, the higher the yield of mechanical thrombectomy over aspiration catheter. The role of thrombectomy as a useful adjunct therapy aimed specifically at direct contact and clearance of AMI-related thrombus continues to evolve.

scholarly journals Association Between Smoking Status and Outcomes in ST-Segment Elevation and Non-ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Ching-Hui Sia ◽  
Junsuk Ko ◽  
Huili Zheng ◽  
Andrew Ho ◽  
David Foo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Smoking Status ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Beneficial Effects ◽  
St Segment ◽  
Increased Risk ◽  
Percutaneous Coronary

Abstract Smoking is one of the leading risk factors for cardiovascular diseases, including ischemic heart disease and hypertension. However, in acute myocardial infarction (AMI) patients, smoking has been associated with better clinical outcomes, a phenomenon termed the “smoker’s paradox.” Given the known detrimental effects of smoking on the cardiovascular system, it has been proposed that the beneficial effects of smoking on outcomes is due to age differences between smokers and non-smokers and is therefore a smoker’s pseudoparadox. The aim of this study was to evaluate the association between smoking status and clinical outcomes in ST-segment elevation (STEMI) and non-STEMI (NSTEMI) patients treated by percutaneous coronary intervention (PCI), using a national multi-ethnic Asian registry. In unadjusted analyses, current smokers had better clinical outcomes following STEMI and NSTEMI. However, after adjusting for age, the protective effect of smoking was lost, confirming a smoker’s pseudoparadox. Interestingly, although current smokers had increased risk for recurrent MI within 1 year after PCI in both STEMI and NSTEMI patients, there was no increase in mortality. In summary, we confirm the existence of a smoker’s pseudoparadox in a multi-ethnic Asian cohort of STEMI and NSTEMI patients and report increased risk of recurrent MI, but not mortality, in smokers.

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

Cardiology ◽  
2018 ◽  
Vol 140 (4) ◽  
pp. 227-236 ◽  
Author(s):  
Fabien Huet ◽  
Mariama Akodad ◽  
Nils Kuster ◽  
Hélène Kovacsik ◽  
Florence Leclercq ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Vascular Occlusion ◽  
Coronary Intervention ◽  
Resonance Imaging ◽  
St Segment Elevation ◽  
St Segment ◽  
Increased Risk ◽  
Second Peak

Introduction: Micro-vascular occlusion (MVO) in a myocardial infarction (MI) is associated with an increased risk of heart failure and mortality. Hs-T-troponin has a double peak kinetic after MI. The aim was to determine if this kinetic was correlated to MVO evaluated by cardiac magnetic resonance imaging (MRI) after MI. Methods: This is a monocentric retrospective study. Inclusion criteria were hospitalization for MI, Thrombolysis In Myocardial Infarction flow 0 at coronary angiography, reperfusion within 12 h from the onset of chest pain, cardiac MRI within the first month, and a 5-days’ biological follow-up with at least hs-T-Troponin and C-reactive protein (CRP). Statistics were performed using the R software. Results: Ninety-eight patients were included. Fifty-three patients (54.1%) had MVO at MRI. The existence of MVO was associated with a trend of more kissing procedure during primary percutaneous coronary intervention (p = 0.06), a significantly more frequent second peak of troponin (p = 0.048), a significantly higher CRP level (p < 0.0001) and a longer time to balloon (p = 0.01). The association of CRP level above 40 mg/L at day 2 and the observation of a second peak of troponin were associated to 95% of MVO in ST-segment elevation MI patients. By contrast, in the absence of these 2 criteria, MVO was absent in 78% of the cases. This score was associated with a higher rate of hospitalisation at 2 years. Conclusion: A biological score integrating hs-TNT second peak and CRP might help to predict MVO and predict outcomes after reperfused MI in our population.

scholarly journals Association between smoking status and outcomes in myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ching-Hui Sia ◽  
Junsuk Ko ◽  
Huili Zheng ◽  
Andrew Fu-Wah Ho ◽  
David Foo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Smoking Status ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Asian Cohort

AbstractSmoking is one of the leading risk factors for cardiovascular diseases, including ischemic heart disease and hypertension. However, in acute myocardial infarction (AMI) patients, smoking has been associated with better clinical outcomes, a phenomenon termed the “smoker’s paradox.” Given the known detrimental effects of smoking on the cardiovascular system, it has been proposed that the beneficial effect of smoking on outcomes is due to age differences between smokers and non-smokers and is therefore a smoker’s pseudoparadox. The aim of this study was to evaluate the association between smoking status and clinical outcomes in ST-segment elevation (STEMI) and non-STEMI (NSTEMI) patients treated by percutaneous coronary intervention (PCI), using a national multi-ethnic Asian registry. In unadjusted analyses, current smokers had better clinical outcomes following STEMI and NSTEMI. However, after adjusting for age, the protective effect of smoking was lost, confirming a smoker’s pseudoparadox. Interestingly, although current smokers had increased risk for recurrent MI within 1 year after PCI in both STEMI and NSTEMI patients, there was no increase in mortality. In summary, we confirm the existence of a smoker’s pseudoparadox in a multi-ethnic Asian cohort of STEMI and NSTEMI patients and report increased risk of recurrent MI, but not mortality, in smokers.

scholarly journals 777 Prehospital ECG in patients with acute myocardial infarction during the COVID-19 pandemic

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Attilio Leone ◽  
Marisa Avvedimento ◽  
Domenico Angellotti ◽  
Fiorenzo Simonetti ◽  
Cristina Iapicca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Control Period ◽  
Coronary Intervention ◽  
Risk Difference ◽  
Myocardial Salvage ◽  
Delayed Presentation ◽  
Campania Region ◽  
St Segment Elevation ◽  
Increased Risk ◽  
Q Wave

Abstract Aims Primary percutaneous coronary intervention (PCI) represents the preferred revascularization strategy among patients with acute ST-segment elevation myocardial infarction (STEMI). A decline in the rates of primary PCI has been observed globally during the outbreak of coronavirus disease-19 (COVID-19). Fear of exposure to in-hospital infection has been hypothesized as the main mechanism of this phenomenon, also contributing to a delayed presentation of patients with STEMI. However, a formal assessment of initial electrocardiograms (ECGs) among STEMI patients during the COVID-19 pandemic is still lacking. We therefore compared pre-hospital ECGs of STEMI patients hospitalized in Italy after the first reported case of COVID-19 on 21 February 2020 with data from the same period in 2019 to identifying potential changes between the two periods. Methods and results Prehospital ECGs were obtained from the STEMI care network in the Campania region. Deidentified ECGs were analysed by two expert reviewers who were blinded to date of recording. Pathological Q-waves were defined as a Q-wave with a duration ≥40 ms and/or depth ≥25% of the R-wave in the same lead or the presence of a Q-wave equivalent. These criteria have been shown to be associated with final infarct size at cardiac magnetic resonance. For all conventional STEMI, the timing of STEMI onset was estimated with the Anderson-Wilkins (AW) acuteness score, ranging from 1 (least acute) to 4 (most acute). From 21 February 2020 to 16 April 2020, a total of 3239 pre-hospital ECGs were recorded by the emergency medical system and 167 (5.15%) were classified as STEMI. During the same period in 2019, 3505 pre-hospital ECGs were recorded, and 196 (5.59%) were classified as STEMI. There was no difference between the two study periods in terms of age, gender, type, and location of STEMI (Table 1). Pathological Q-waves were present in 54.5% of ECGs recorded during the COVID-19 period compared with 22.1% of ECGs recorded in the same period in 2019 (risk difference 32.3, 95% confidence intervals [CI]: 21.2–43.5 percentage points). There was also an increase in the mean number of Q-waves during the COVID-19 compared with the control period (1.4 vs. 0.9; P &lt; 0.001). These findings remained similar when QS- and qR complexes were analysed separately. Consistently, the AW score was significantly lower during the COVID-19 period (2.4 vs. 2.8; P &lt; 0.001). Conclusions Prehospital ECGs of STEMI patients during the COVID-19 pandemic presented more frequently with signs of late ischemia compared with the equivalent period in 2019. Approximately, one out of two patients had already pathological Q-waves in the initial ECG. The AW acuteness score is superior to patient history (historical timing) in predicting myocardial salvage and mortality after reperfusion in STEMI patients, thus explaining the higher mortality rate and the increased risk of infarct-related complications observed during the COVID-19 pandemic.

scholarly journals Effects of chronic beta-blocker treatment on admission haemodynamics in STEMI patients treated with primary angioplasty

2018 ◽  
Vol 9 (5) ◽  
pp. 462-468 ◽  
Author(s):  
Vincent Roolvink ◽  
Veemal V Hemradj ◽  
Jan Paul Ottervanger ◽  
Arnoud WJ van ’t Hof ◽  
Jan-Henk E Dambrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Primary Percutaneous Coronary Intervention ◽  
Beta Blocker ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Increased Risk ◽  
Percutaneous Coronary

Background: The association between chronic beta-blocker treatment and haemodynamics at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention is not well studied. We investigated the impact of chronic beta-blocker treatment on the risk of cardiogenic shock and pre-shock at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Methods and results: A total of 4907 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention were included in the study. A total of 1148 patients (23.3%) were on chronic beta-blocker treatment. Cardiogenic shock was observed in 264 patients (5.3%). Pre-shock was defined as a shock index (the ratio of heart rate and systolic blood pressure) of 0.7 or greater, and was observed in 1022 patients (20.8%). The risk of cardiogenic shock in patients with chronic beta-blocker treatment was not increased (adjusted hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.65–1.46, P=0.90). Chronic beta-blocker treatment was also not associated with an increased risk of pre-shock (adjusted HR 0.86, 95% CI 0.68–1.07, P=0.19). Also after propensity score matched analysis, there was no increased risk of cardiogenic shock or pre-shock in patients with chronic beta-blocker treatment (respectively HR 0.97, 95% CI 0.61–1.51, P=0.88 and HR 0.82, 95% CI 0.65–1.06, P=0.12). Conclusion: In ST-segment elevation myocardial infarction, chronic beta-blocker treatment is not associated with an increased risk of cardiogenic shock or pre-shock.

Sign in / Sign up

Export Citation Format

Share Document