scholarly journals Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Protocol for a Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Younes Nozari ◽  
Babak Geraiely ◽  
Kian Alipasandi ◽  
Arash Jalali ◽  
Negar Omidi ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Cross Sectional Study ◽  
Primary Pci ◽  
Cardiac Events ◽  
Cross Sectional ◽  
Time To Treatment ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary

BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI) experience major adverse cardiac events (MACEs) following primary percutaneous coronary intervention (PCI). Although the relationship between time to treatment (eg, door-to-balloon time, symptom onset-to-balloon time, and symptom onset-to-door time) and 1-month all-cause mortality was assessed previously, its relationship with in-hospital MACEs and the effect of some clinical characteristics on this relationship were not considered. Furthermore, previous studies that were conducted in developed countries with a different quality of care cannot be applied in Iran, as Iran is a developing country and the studies were not performed according to the 24/7 primary PCI service registry. OBJECTIVE The objective of this study protocol is to determine the relationship between time to treatment and in-hospital MACEs. METHODS This cross-sectional study will take place at the Tehran Heart Center (THC), which is affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. Data related to patients with STEMI, who underwent primary PCI between March 2015 and March 2019, that have been prospectively recorded in the THC’s 24/7 primary PCI service registry will be analyzed. The study outcome is the occurrence of in-hospital MACEs. Data analysis will be conducted using SPSS for Windows, version 16.0 (SPSS Inc). We will perform chi-square tests, independent-samples t tests, or the Mann-Whitney U test, as well as univariate and multivariate binary logistic regression with a significance level of less than .05 and 95% CI for odds ratios. RESULTS From March 2015 to September 2017, 1586 patients were included in the THC service registry, consecutively. We will conduct a retrospective analysis of this registry on patient entries between March 2015 and March 2019 and data will be analyzed and published by the end of 2019. CONCLUSIONS To our knowledge, this is the first observational study based on the 24/7 primary PCI service registry in Iran. The findings of this study may reveal current problems regarding time to treatment in STEMI management in the THC. Results from this study may help determine appropriate preventive strategies that need to be applied in order to reduce time-to-treatment delays and improve patients’ outcomes following primary PCI in the setting of STEMI at the THC and similar clinical centers. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/13161

scholarly journals The Clinical Short-term Outcome of Atorvastatin and Trimetazidine Combination Treatment in Patients with Non-ST Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

2016 ◽  
Vol 8 ◽  
Author(s):  
Jiangyou Wang ◽  
Han Chen ◽  
Dan Song ◽  
Jian Peng ◽  
Xi Su
Keyword(s):  
Cardiac Function ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Short Term ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

<p><strong>Background and Objectives: </strong>To investigate the effects of atorvastatin (ATV) and trimetazidine (TMZ) combination treatment in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention. <strong></strong></p><p><strong>Subjects and Methods: </strong>A total of 92 patients with NSTE-ACS were randomly divided into the pretreatment with ATV group (80mg 12h before PCI, with a further 20mg every day to 30th days after PCI, n=44) or the pretreatment with ATV (as the ATV group) and TMZ (60mg 30min before PCI, with a further 20mg tid to 30th days after PCI, n=48). Echocardiography was executed and plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) levels were measured just prior to the PCI and 30th days after PCI. The main end point was a 30-day incidence of major adverse cardiac events.</p><p><strong>Result: </strong>Major adverse cardiac events occurred in 9.1% of patients in the ATV group and 4.2% of those in the ATV+TMZ group (P=0.189). NT-pro-BNP of the two groups were decreased 30th days after PCI, however, NT-pro-BNP in the ATV+TMZ group were significantly lower than those in the ATV group (P&lt;0.05). Cardiac function in NSTE-ACS patients, as reflected by the increased LVEF, FS as well as decreased LVEDd (P&lt;0.05) in all groups at 30 days after intervention, but cardiac function parameters were more obviously improved in the group administered with ATV+TMZ (p&lt;0.05).</p><p><strong>Conclusion: </strong>Short-term pretreatment with the combination of ATV and TMZ administration prior to PCI can prominently decrease NT-pro-BNP and improve cardiac function compared to a single administration of the ATV. </p>

scholarly journals Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Cross-Sectional Study (Preprint)

2020 ◽  
Author(s):  
Younes Nozari ◽  
Babak Geraiely ◽  
Kian Alipasandi ◽  
Seyedeh Hamideh Mortazavi ◽  
Negar Omidi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Time To Treatment ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Door To Balloon

BACKGROUND Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to &lt;90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI. OBJECTIVE We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI. METHODS In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time &lt;90 and ≥90 minutes, and symptom-to-balloon time &lt;180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, <i>t</i> test, and univariate and multivariate logistic regression analyses, and with a significance level of &lt;.05 and 95% CIs for odds ratios (ORs). RESULTS Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; <i>P</i>=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; <i>P</i>=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, <i>P</i>=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; <i>P</i>=.04). CONCLUSIONS A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs. INTERNATIONAL REGISTERED REPORT RR2-10.2196/13161

scholarly journals Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Cross-Sectional Study

10.2196/20352 ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. e20352
Author(s):  
Younes Nozari ◽  
Babak Geraiely ◽  
Kian Alipasandi ◽  
Seyedeh Hamideh Mortazavi ◽  
Negar Omidi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Time To Treatment ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Door To Balloon

Background Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to <90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI. Objective We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI. Methods In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time <90 and ≥90 minutes, and symptom-to-balloon time <180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, t test, and univariate and multivariate logistic regression analyses, and with a significance level of <.05 and 95% CIs for odds ratios (ORs). Results Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; P=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; P=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, P=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; P=.04). Conclusions A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs. International Registered Report Identifier (IRRID) RR2-10.2196/13161

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