scholarly journals Long-term echocardiography results in patients with ST-segment elevation myocardial infarction after pharmaco-invasive reperfusion therapy, depending on the choice of thrombolytic drug

2020 ◽  
Vol 1 (2) ◽  
pp. 46-53
Author(s):  
A. V. Khripun ◽  
A. A. Кastanayan ◽  
M. V. Malevannyy ◽  
Ya. V. Kulikovskikh
Keyword(s):  
Systolic Function ◽  
Reperfusion Therapy ◽  
Invasive Treatment ◽  
Open Label ◽  
St Segment Elevation ◽  
Thrombolytic Drug ◽  
St Segment ◽  
Lv Systolic Function

Objectives: to analyze the results of echocardiography 1 year after STEMI in patients undergoing pharmaco-invasive reperfusion using various thrombolytic drugs.Materials and Methods: 240 patients with STEMI after pharmaco-invasive reperfusion were included in an open-label prospective cohort study. Depending on the thrombolytic agent used, the patients were divided into 4 groups: in the 1st (n = 73) — lysis was performed with alteplase; in the 2nd (n = 40) — tenecteplase; in the 3rd (n = 95) — forteplase; in the 4th (n = 32) — streptokinase. Depending on the fibrin-specificity of the thrombolytic, all patients were presented with 2 groups: the group of fibrin-specific thrombolytics (FST, n = 208) and the group of fibrin-nonspecific streptokinase (FNST, n = 32). Echocardiography was assessed 1 year after reperfusion.Results: after 1 year, there was a slight violation of the global LV systolic function, while the EF between the groups did not differ (p = 0.420). A higher EF was recorded in the FST group compared with FNST (49.8 ± 7.4 % versus 47.4 ± 6.8 %; p = 0.048). After 1 year, violations and local LV contractility persisted in each of the four groups (p = 0.161). At the same time, lower WMSI were recorded in the FST group compared to FNST (1.19 [1.06; 1.38] versus 1.25 [1.175; 1.5]; p = 0.029). In the FST group, significantly lower iEDV were recorded (p = 0.048), and iESV (p = 0.022) and LA size (p = 0.007) compared with FNST. In dynamics, 1 year after reperfusion in the FST group, there was a significant increase in EF by 5.5 % (p = 0.000) and a decrease in LV WMSI by 5 % (p = 0.000) compared with the FNST group.Conclusions: pharmaco-invasive treatment of STEMI with the use of thrombolytic drugs after 1 year of follow-up is characterized by comparable echocardiography parameters. After 1 year of follow-up, patients undergoing pharmaco-invasive treatment with fibrin-specific drugs had significantly higher EF, as well as lower WMSI, iEDV, iESV, and LA size compared to fibrin-nonspecific streptokinase.

Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p<0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p<0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p<0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

scholarly journals Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

2019 ◽  
Vol 20 (1) ◽  
pp. 105-115 ◽  
Author(s):  
Christel Bruggmann ◽  
Juan F. Iglesias ◽  
Marianne Gex-Fabry ◽  
Rachel Fesselet ◽  
Pierre Vogt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
St Segment Elevation ◽  
Follow Up Study ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Timoteo ◽  
L Moura Branco ◽  
A Galrinho ◽  
T Mano ◽  
P Rio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Global Longitudinal Strain ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Elevation Acute Myocardial Infarction

Abstract Background Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. Methods A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization. Results In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank <0,001). For MACE, the performance of all methods is suboptimal, with an AUC <0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event. Conclusions LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis

2017 ◽  
Vol 89 (4) ◽  
pp. 29-34 ◽  
Author(s):  
V I Ganyukov ◽  
R S Tarasov ◽  
Yu N Neverova ◽  
N A Kochergin ◽  
O L Barbarash ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Coronary Atherosclerosis ◽  
Long Term Results ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.

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