scholarly journals CARDIOPROTECTION IN PATIENTS WITH ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

2019 ◽  
Vol 8 (3) ◽  
pp. 52-59
Author(s):  
I. E. Vereshchagin ◽  
V. I. Ganyukov ◽  
I. N. Mamchur
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Succinic Acid ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim To evaluate cardioprotective effects of combined intracoronary phosphocreatine and succinic acid administration after primary percutaneous coronary intervention (PCI) in patients with ST elevation acute coronary syndrome who were present within 12 hours of symptom onset.Methods Seven patients with STEMI presenting within 12 hours of onset of symptoms and thrombotic occlusion of the left anterior descending artery were included in the study. Evaluation of efficiency and safety was performed with the recording of major adverse cardiac events, evaluation of the procedure success, and the rate of composite endpoints.Results Six (85.7%) patients after primary PCI showed TIMI grade 3 flow on control coronary angiography. None complications had been reported after intracoronary administration of phosphocreatine and succinic acid. Acquired left ventricular aneurysms were found in two patients in the in-hospital period. One patient was readmitted with acute coronary syndrome without ST-segment elevation. Coronary angiography reported restenosis of the previously implanted stent. No definite increase in the left ventricular ejection fraction had been found in the in-hospital and long-term period.Conclusion There were no evidences on definite increase in myocardial contractility. The obtained results might partially be explained by the median symptom-to-balloon time over 400 minutes.

PREDICTORS OF LONG-TERM ADVERSE PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATION

2019 ◽  
Vol 25 (1) ◽  
pp. 22-27
Author(s):  
S. A Berns ◽  
Valeria A. Zakharova ◽  
E. A Shmidt ◽  
A. A Golikova ◽  
V. S Lynev ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim: Identification of predictors of unfavorable annual prognosis in patients with acute coronary syndrome with ST-segment elevation (STEMI). Material and methods: The study included 69 patients with STEMI who were hospitalized in the period from March 2014 to January 2017 in the hospital named after Zhadkevich. The follow-up period was 12±3 months after the index STEMI Longterm prognosis was established in 62 (89.8%) patients. Results: the fatal outcome was observed in 7 (11.3%) patients. Nonfatal myocardial infarction developed in 10 (16.2%), hospitalization with heart failure decompensation - in 5 (8%), nonfatal acute cerebrovascular accident - in 3 (4.8%) patients. Predictors of adverse prognosis were: age >60 years, level of brain natriuretic peptide (BNP) >29.2 pmol/l, C-reactive protein (CRP) >4.7 mg/l, left ventricular ejection fraction (LVF) 60 years and BNP level >29.2 pmol/l. Conclusion: Adverse factors affecting the long-term outcome of the disease (12±3 months after the STEMI) are: BNP level >29.2 pmol/l, CRP level >4.7 mg/l, LV FV value 60 years.

scholarly journals Predicting the development of adverse events in patients with acute coronary syndrome including genetics in the long-term follow-up

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 77-85
Author(s):  
E. A. Shmidt ◽  
S. A. Berns ◽  
A. V. Ponasenko ◽  
A. V. Klimenkova ◽  
S. A. Tumanova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Long Term Follow Up

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methods This full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.Results During the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.Conclusion Stratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.

scholarly journals Reduced left ventricular ejection fraction in patients with acute coronary syndrome as a risk factor for mortality

2021 ◽  
Vol 10 (1) ◽  
pp. 80
Author(s):  
Parvaiz Kadloor ◽  
Mohammed Hidayathullah ◽  
Abhishek Golla
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: The study aimed to evaluate left ventricular ejection fraction (LVEF) as the risk factor for mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).Methods: This was an observational, single centre study. The patients who were admitted at tertiary care centre in India during the period February 2014 to June 2015 who were diagnosed with ACS were included in the study. The patients were evaluated by dividing into two groups based on LVEF. The patients were followed up to 1 year.Results: Total 100 patients were included in the study. Chest pain was the most prevalent complaint (60%). Seventy patients presented with STEMI (ST-segment elevation myocardial infarction) and 30 with NSTEMI (non-ST-segment elevation myocardial infarction). Seventy five patients had ejection fraction ≥40% and 25 patients had reduced ejection fraction. Reduced LVEF did not show any statistical difference in patients with presentation as STEMI and NSTEMI or need for revascularisation. At year follow up, total 9 patients died. However, reduced LVEF led to statistically higher deaths (p<0.05%).Conclusions: In our study it was observed that patients with ACS complicated by heart failure with reduced ejection fraction have a markedly increased short- and long-term mortality rates compared to ACS patients without heart failure.

scholarly journals Mortality predictors after percutaneous coronary intervention – a prospective single-center registry study

2020 ◽  
Vol 30 (3) ◽  
pp. 413-422
Author(s):  
László Hadadi ◽  
Paul Calburean ◽  
Paul Grebenisan ◽  
Victor Vacariu ◽  
Reka-Katalin Drincal ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiovascular Mortality ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary

Objectives – To evaluate the predictors of three-year cardiovascular mortality after percutaneous coronary intervention (PCI) in a Romanian tertiary cardiovascular center. Methods – Consecutive patients treated by PCI in the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures were included prospectively in a local PCI Registry. Demographic, clinical, and procedural parameters of the patients enrolled in the year 2016 were statistically analyzed as possible predictors of three-year cardiovascular mortality post-PCI. Results – 1079 patients were included: 254 (23.5%) with ST-segment elevation acute myocardial infarction (STEMI), 278 (25.8%) with non-ST segment elevation acute coronary syndrome (NSTEACS) and 547 (50.7%) with chronic coronary syndrome (CCS). Three-year cardiovascular mortality was 20.1%, 10.8% and 5.7% after PCI for STEMI, NSTEACS and CCS, respectively. Cox proportional hazards regression evidenced as independent predictors of long-term mortality after PCI: low left ventricular ejection fraction (LVEF), renal dysfunction, presentation with cardiogenic shock or with cardiac arrest in the case of acute coronary syndromes, and the history of signifi cant valvular heart disease and low LVEF in the case of CCS (all p ≤0.01). Conclusions – Simple clinical variables but no procedural factors were the main predictors of 3-year cardiovascular mortality after PCI in this all-comers population.

scholarly journals Characteristics and 1-year prognosis of non-obstructive acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
JM Viegas ◽  
AV Goncalves ◽  
I Cardoso ◽  
SA Rosa ◽  
AT Timoteo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Disease ◽  
Tertiary Care ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Tertiary Care Centre ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Among patients admitted at catheterization laboratory with suspicion of acute coronary syndrome (ACS) a minority have no obstructive epicardial coronary disease (MINOCA).  The characteristics and outcomes of this subgroup remains unclear. Purpose The aim of the present study is to characterize MINOCA patients and assess the 1-year prognosis regarding total mortality. Methods A standardized registry was prospectively performed for all ACS patients admitted in a single tertiary care centre during a ten-year period. Patients were divided according to have at least one obstructive coronary artery (G1), defined by a stenosis above 50%, or not (G2) and baseline characteristics were compared between the two groups. All-cause mortality at 30 days and at 1 year were also compared using univariate Cox analysis. Results From 3765 ACS patients admitted during the study period, 461 (12.2%) were included in G2. G2 patients were older (62.6 ± 13.1 vs 66.2 ± 13.7; p &lt; 0.001) and more frequently women (26.3% vs 44.2%; p &lt; 0.001). Smoking was more frequent in G1 (40.0% vs 21.9%; p &lt; 0.001) but the prevalence of hypertension was higher in G2 (55.2% vs 64.2%; p &lt; 0.001). There were no differences regarding dyslipidaemia and diabetes. End-stage chronic kidney disease was higher in G2 (2.4% vs 4.1%; p = 0.025). Regarding the clinical evolution during hospitalization, G2 presented more frequently with Killip-Kimball class ≥II (13.9% vs 19.3%; p = 0.001), but at release there was no difference in the proportion of patients with left ventricular ejection fraction ≤50% (34.8% vs 32.1%; p = 0.286).  ACS with ST-segment elevation was more common in G1 (58.8% vs 52.1%; p = 0.006), but no differences were found regarding left and right bundle branch block patterns at presentation. In-hospital and 30-day mortality was not significantly different between groups (5.9% vs 7.4%; p = 0.205). However, at 1-year follow-up, G2 had a worse outcome regarding total mortality (HR (95%CI); 1.473 (1.103-1.969); p = 0.008, figure 1). Conclusion MINOCA patients seem not to be a low-risk group of ACS patients, since in this study they had a higher 1-year mortality than ACS patients with obstructive coronary disease. This higher mortality only became apparent after 30 days from the ACS. A systematic diagnostic work-up for further implementation of the most appropriate treatment should be crucial for getting better outcomes with this group of patients. Abstract Figure.

scholarly journals Intensive Statin Therapy in NSTE-ACS Patients Undergoing PCI: Clinical and Biochemical Effects

2015 ◽  
Vol 42 (6) ◽  
pp. 528-536 ◽  
Author(s):  
Mohamed Shehata ◽  
George Fayez ◽  
Ahmed Nassar
Keyword(s):  
Acute Coronary Syndrome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
Hs Crp ◽  
Group B

Early initiation of statin therapy in acute coronary syndrome patients has a favorable prognostic impact because of its anti-inflammatory and antithrombotic properties. In this study, we explored the effect of atorvastatin-loading, followed by intensive atorvastatin therapy, on clinical and biochemical outcomes in non-ST-segment-elevation acute coronary syndrome patients who were scheduled for percutaneous coronary intervention. We prospectively enrolled 140 patients (mean age, 56 ± 9 years, 68% men). Once eligible, patients were randomly assigned to receive either a moderate 20-mg daily dose of atorvastatin (Group A) or a 160-mg loading dose followed by an intensified 80-mg daily dose (Group B). High-sensitivity C-reactive protein (hs-CRP) levels were recorded before and after intervention. Evaluation after 6 months included hs-CRP levels, left ventricular systolic function, and major adverse cardiac events. We found no significant difference between the 2 groups in regard to the interventional data. However, blood sampling after coronary intervention, and again 6 months later, revealed a significant decline in mean hs-CRP level among Group B patients (P &lt;0.001). Moreover, patients in Group B manifested a higher left ventricular ejection fraction than did patients in Group A (P &lt;0.05). After 6 months, we found no significant difference between groups in the incidence of major adverse cardiac events. We conclude that intensive atorvastatin therapy in non-ST-segment-elevation acute coronary syndrome patients is associated with lower hs-CRP levels and with higher left ventricular ejection fraction after 6 months, with no significant impact on adverse cardiac events.

scholarly journals Clinical and angiographic predictors in primary percutaneous intervention

2020 ◽  
Vol 30 (2) ◽  
pp. 230-235
Author(s):  
Pavel Platon ◽  
Carmen Ginghina
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
European Society Of Cardiology

Percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction with ST segment elevation (STEMI) is the standard treatment according to the current European Society of Cardiology Guidelines. Certain aspects of therapy remain under debate, as periodic changes in the guidelines are enabled by new and thorough research. Objectives – We aimed to evaluate clinical and angiographic prognostic factors in patients presenting with acute STEMI treated with primary PCI. Methods – Demographical, clinical and procedural parameters were retrospectively analysed for 303 consecutive STEMI patients successfully treated with primary PCI. Short-term and long-term outcomes were evaluated. Results – Mean follow-up period was 18 ± 12 months. The studied endpoints were mortality, major adverse cardiac events (MACEs) and left ventricular ejection fraction (LVEF). At admission TIMI fl ow 0 or 1 was found in 233 (76.9%) of patients and was associated with increased mortality and MACE. Of the studied population, 232 (76.6%) patients had MBG 0 and 52 (17.2%) of patients had MBG 1. In these subgroups of patients mortality was higher than in those with MBG of 2 or 3 (p < 0.05). An increase in TIMI fl ow and MBG score of at least 2 points after successful reperfusion was correlated with decreased mortality and improvement in the LVEF (p < 0.05). 46 (15.2%) of patients presented with atrial fibrillation while 277 (91.4 %) of patients presented with hypertension at admission. These clinical characteristics were associated with negative survival in STEMI patients (p < 0.05). Conclusion – TIMI fl ow grade and MBG were strong predictors for mortality and cardiovascular events in STEMI patients undergoing primary coronary artery angioplasty. Atrial fibrillation and presence of hypertension predict survival in STEMI patients treated with primary PCI.

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