scholarly journals Microbiota Thrombus Colonization May Influence Athero-ThrombosIs in Hyperglycemic Patients With ST Segment Elevation Myocardial Infarction (STEMI). MARIANELLA Study

2020 ◽  
Author(s):  
Celestino Sardu ◽  
Maria Consiglia Trotta ◽  
Biagio Santella ◽  
Nunzia D' Onofrio ◽  
Michelangela Barbieri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Segment Elevation Myocardial Infarction ◽  
Blood Glucose Levels ◽  
Coronary Thrombus ◽  
St Segment

Abstract Objectives. We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI).Background. Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications. Methods. We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (>140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina.Results. In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp and Alistipesspp. between patients with hyperglycemia (n=56) and those with normal glucose levels (n=90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p<0.01), thrombus dimensions (p<0.01), TMAO, CDL40 (p<0.01) and vWF (p<0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up.Conclusions. Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi.

scholarly journals A Nomogram Based on Apelin-12 for the Prediction of Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention among Patients with ST-Segment Elevation Myocardial Infarction

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Enfa Zhao ◽  
Hang Xie ◽  
Yushun Zhang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Objective. This study aimed to establish a clinical prognostic nomogram for predicting major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention (PCI) among patients with ST-segment elevation myocardial infarction (STEMI). Methods. Information on 464 patients with STEMI who performed PCI procedures was included. After removing patients with incomplete clinical information, a total of 460 patients followed for 2.5 years were randomly divided into evaluation (n = 324) and validation (n = 136) cohorts. A multivariate Cox proportional hazards regression model was used to identify the significant factors associated with MACEs in the evaluation cohort, and then they were incorporated into the nomogram. The performance of the nomogram was evaluated by the discrimination, calibration, and clinical usefulness. Results. Apelin-12 change rate, apelin-12 level, age, pathological Q wave, myocardial infarction history, anterior wall myocardial infarction, Killip’s classification > I, uric acid, total cholesterol, cTnI, and the left atrial diameter were independently associated with MACEs (all P<0.05). After incorporating these 11 factors, the nomogram achieved good concordance indexes of 0.758 (95%CI = 0.707–0.809) and 0.763 (95%CI = 0.689–0.837) in predicting MACEs in the evaluation and validation cohorts, respectively, and had well-fitted calibration curves. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions. We established and validated a novel nomogram that can provide individual prediction of MACEs for patients with STEMI after PCI procedures in a Chinese population. This practical prognostic nomogram may help clinicians in decision making and enable a more accurate risk assessment.

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 Admission Glucose Levels and the Risk of Acute Kidney Injury in Nondiabetic ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2015 ◽  
Vol 5 (3) ◽  
pp. 191-198 ◽  
Author(s):  
Yacov Shacham ◽  
Amir Gal-Oz ◽  
Eran Leshem-Rubinow ◽  
Yaron Arbel ◽  
Gad Keren ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Admission Glucose

Background: Hyperglycemia upon admission is associated with an increased risk for acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, the relation of this association to the absence of diabetes mellitus (DM) is less studied. We evaluated the effect of acute hyperglycemia levels on the risk of AKI among STEMI patients without DM who were all treated with primary PCI. Methods: We retrospectively studied 1,065 nondiabetic STEMI patients undergoing primary PCI. Patients were stratified according to admission glucose levels into normal (<140 mg/dl), mild (140-200 mg/dl), and severe (>200 mg/dl) hyperglycemia groups. Medical records were reviewed for the occurrence of AKI. Results: The mean age was 61 ± 13 years and 81% were males. Hyperglycemia upon hospital admission was present in 402 of 1,065 patients (38%). Patients with severe admission hyperglycemia had a significantly higher rate of AKI compared to patients with no or mild hyperglycemia (20 vs. 7 and 8%, respectively; p = 0.001) and had a significantly greater serum creatinine change throughout hospitalization (0.17 vs. 0.09 and 0.07 mg/dl, respectively; p = 0.04). In multivariate logistic regression, severe hyperglycemia emerged as an independent predictor of AKI (OR = 2.46, 95% CI 1.16-5.28; p = 0.018). Conclusion: Severe admission hyperglycemia is an independent risk factor for the development of AKI among nondiabetic STEMI patients undergoing primary PCI.

scholarly journals The Significance of Dynamics of ST Segment Changes When Assessing the Effectiveness of Mechanical Reperfusion of the Myocardium in Hyperglycaemic Patients with Acute Myocardial Infarction with Persistent ST-Segment Elevation

2020 ◽  
pp. 1-6
Author(s):  
Marek Andres ◽  
Maciej Małecki ◽  
Ewa Konduracka ◽  
Jacek Legutko ◽  
Janusz Andres ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Coronary Intervention ◽  
Glucose Metabolism Disorders ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
St Segment ◽  
Significant Difference ◽  
St Elevation

Background: The coexistence of coronary heart disease and consequently, acute myocardial infarction with persistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolism disorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disabling the function of microcirculation, which in turn may affect the outcome of coronary intervention. The aim of this study was to evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segment elevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycaemia treated with a percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment of reperfusion effectiveness. Methods: The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and was divided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higher glucose levels on admission (Glc ≥ 7.8 mmol/L, n = 46), a group with lower glucose levels on admission (Glc < 7.8 mmol/L, n = 46) and into groups based on the concentration of HbA1c: a group with a lower HbA1c level (<6.5% (48 mmol/mol), n=71) and a group with a higher level (≥6.5%, n=21). Results: On admission, there were no significant differences in terms of clinical characteristics between the groups of patients with normoglycemia and reactive hyperglycaemia. After PCI, the patients with normoglycemia had significantly higher (p = 0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed in an indicator of sum STR (resolution of ST-elevation). A degree of resolution of ST elevation in ECG was significantly (p = 0.021) dependent on the level of blood glucose – higher the blood glucose level, weaker the resolution. The patients with glucose levels ≥7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48 hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization between individuals from the group with lower and higher blood glucose levels on admission (p = 0.028). A 4-month follow-up revealed no significant difference in the incidence of major adverse cardiovascular events (MACE) in the study groups (p = 0.063). A 4-year follow-up of patients with higher levels of blood glucose on admission showed a higher incidence of MACE (p = 0.01). The patients with HbA1c ≥ 6.5% were older (p = 0.004), had a greater BMI > 30kg/m2 (p=0.019) and the lower ejection fraction of the left ventricle (p = 0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.

Systemic Immune Inflammation Index: A Novel Predictor of Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction

Angiology ◽  
2021 ◽  
pp. 000331972110077
Author(s):  
Saban Kelesoglu ◽  
Yucel Yilmaz ◽  
Deniz Elcık ◽  
Zeki Çetınkaya ◽  
Mehmet Tugrul Inanc ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Immune Inflammation

We investigated whether the systemic immune inflammation index (SII) on admission is an independent risk factor that predicts the development of contrast-induced nephropathy (CIN) in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). A total of 429 patients with NSTEMI were enrolled in the study. Contrast-induced nephropathy was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hour after the procedure. Patients were divided into 2 groups: with and without CIN. Demographics, clinical risk factors, angiographic and laboratory parameters, CIN incidence, and SII score were compared between the 2 groups. Non-ST segment elevation myocardial infarction patients, who developed CIN, had higher glucose levels ( P = .009), neutrophil counts ( P < .001), platelet counts ( P < .001), neutrophil-lymphocyte ratios ( P < .001), high sensitivity C-reactive protein levels ( P = .009), and SII levels ( P < .001) than those who did not develop CIN. The receiver operating characteristic curve analysis showed that at a cutoff of 933.2, the value of SII exhibited 77.6% sensitivity and 69.2% specificity for detecting CIN. Our study showed that the SII levels on admission were independently associated with CIN development after PCI in patients with NSTEMI.

scholarly journals NT-proBNP and Major Adverse Cardiovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Primary Percutaneous Coronary Intervention: A Prospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zuoan Qin ◽  
Yaoyao Du ◽  
Quan Zhou ◽  
Xuelin Lu ◽  
Li Luo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Inflection Point ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Peak Value

Background. The prognostic significance of the amino-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) has not been fully elucidated. Major adverse cardiovascular events (MACEs) are clinically viable indicators for the accurate, rapid, and safe evaluation of patients with STEMI. This study was designed to investigate the relationship between NT-proBNP levels and the occurrence of short-term MACEs in patients with STEMI who underwent emergency PCI. Methods. This prospective cohort study included 405 patients with STEMI aged 20–90 years who underwent emergency PCI at the First People’s Hospital of Changde City from April 6, 2017, to May 31, 2019. Stent thrombosis, reinfarction, congestive heart failure, unstable angina, and cardiac death were considered as MACEs in this study. The target-independent and -dependent variables were NT-proBNP at baseline and MACE, respectively. Results. There were 28.25% of MACEs. Age, number of implanted stents, Killip class, infarction-related artery, applied intra-aortic balloon pump (IABP), creatine kinase (CK) peak value, CK-MB peak value, TnI peak value, and ST-segment resolution were independently associated with MACE ( P < 0.05 ). In a multivariate model, after adjusting all potential covariates, Log2 NT-proBNP levels remained significantly associated with MACE, with an inflection point of 11.66. The effect sizes and confidence intervals of the left and right sides of the inflection point were 1.07 and 0.84–1.36 ( P = 0.5730 ) and 3.47 and 2.06–5.85 ( P < 0.0001 ), respectively. Conclusions. In patients with STEMI who underwent PCI, Log2 NT-proBNP was positively correlated with MACE within 1 month when the Log2 NT-proBNP was >11.66 (NT-proBNP >3.236 pg/mL).

Impact of the admitting ward on care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry

2021 ◽  
Author(s):  
Saadiq M Moledina ◽  
Ahmad Shoaib ◽  
Louise Y Sun ◽  
Phyo K Myint ◽  
Rafail A Kotronias ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Invasive Coronary Angiography ◽  
Coronary Intervention ◽  
National Registry ◽  
Care Quality ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
To Receive

Abstract Background Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). Methods & Results We analysed data from 337,155 NSTEMI admissions between 2010–2017 in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70y vs 75y, P &lt; 0.001), and less likely to be female (33% vs 40%, P &lt; 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18–1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16–1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs 81%, P &lt; 0.001) and dual antiplatelet therapy (DAPT) (91% vs 88%, P &lt; 0.001) on discharge, undergo invasive coronary angiography (78% vs 59%, P &lt; 0.001) and receive revascularisation in the form of PCI (52% vs 36%, P &lt; 0.001). Following multivariable logistic regression, the odds of in-hospital all-cause mortality (OR: 0.75, 95% CI: 0.70–0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78–0.91) were lower in patients admitted to a cardiac ward. Conclusion Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.

Sign in / Sign up

Export Citation Format

Share Document