Thrombosis and major bleeding risk after primary percutaneous coronary intervention among patients with multi-vessels coronary artery disease (Preprint)

2021 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Chen Liu ◽  
Peng Zhou ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Major Bleeding ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Primary Pci ◽  
Percutaneous Coronary

BACKGROUND The risk of thrombotic events (TEs), including myocardial infarction (MI) and ST, is lower in patients with acute coronary syndrome who receive dual antiplatelet therapy (DAPT) with aspirin or who have undergone primary percutaneous coronary intervention (PCI) OBJECTIVE Background and Aims The present study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multi-vessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI). METHODS TEs were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) 3 or 5 bleeding. The derivation and validation cohorts comprised 2976 patients who underwent primary PCI between January 2010 and June 2017. RESULTS At a median follow-up of 3.07 years (1122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.820 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n=755) was associated with a higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death, compared to low risk (n=1275) (p=0.0022, 0.019, 0.012, respectively). High bleeding risk (n=1675) was associated with a higher incidence of bleeding, MACEs, cardiac death, compared to low risk (n=355) (p<0.0001). CONCLUSIONS Conclusion Simple risk scores can be useful in predicting the risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

scholarly journals C-Reactive Protein to Albumin Ratio Versus Coronary Artery Ectasia as Predictors of No-reflow After Primary Percutaneous Coronary Intervention for Patients Presenting with ST Segment Elevation Myocardial Infarction

2020 ◽  
pp. 85-96
Author(s):  
Mohamed Shousha ◽  
Yasser Elbarbary ◽  
Mohamed Khalfallah ◽  
Samia Sharaf Eldin
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Coronary Artery Ectasia ◽  
Albumin Ratio ◽  
No Reflow ◽  
Percutaneous Coronary

Aims: to assess and compare the significance of C-reactive protein Albumin ratio (CAR) versus coronary artery ectasia (CAE) as predictors of no-reflow phenomenon. Methods: This study was conducted on 90 ST segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (PPCI) within 24 hours of presentation at cardiovascular medicine department Tanta university hospitals in Gharbia Governorate, Egypt. This is a prospective study and data collection was done within 12 months started from June 2018. Patients were divided into two groups according to the post primary PCI thrombolysis in myocardial infarction (TIMI) flow score. Group I (Case group), patients with no-reflow phenomenon TIMI 0-1 flow post primary PCI. Group II (Control group) with TIMI flow ≥ 2 after primary PCI. They                   were subjected to full clinical examination, laboratory investigation including CRP and serum albumin, 12 leads surface ECG, echocardiography and primary percutaneous coronary intervention (PCI). Results: There was significant statistical difference between both groups as regard age <) 60 years, 96.7% vs 20%, P < 0.001), gender (male, 93.3% vs 63.3%, P = 0.002), ischemia time ) < 6 hours, 100% vs 33.3%, P > 0.001), CRP level (64 ± 32.6 mg/L vs 26.27 ± 21.5 mg/L, P > 0.001), serum albumin (3.22 ± 0.23 g/dL vs 3.55 ± 0.20 g/dL, P > 0.001), CRP albumin ratio (CAR) (0.0204 ± 0.011 vs 0.0076 ± 0.0064, P > 0.001), coronary artery ectasia (30% vs 6.7%, P = 0.003), thrombus grade score )≥ 4, 100% vs 10%, P > 0.001). However, there was no significant  statistical difference between both groups as regard smoking, dyslipidemia and revascularization method. Conclusion: Compared to CAE, CAR is more significant and more reliable to predict no reflow in acute STEMI patients managed by primary PCI within 24 hours of presentation.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (&gt;50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF&lt;40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF&lt;40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p&lt;0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p&lt;0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p&lt;0.001) and median age (61 vs. 59 vs. 64 years, p&lt;0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p&lt;0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p&lt;0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p&lt;0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (&lt;40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Isolated right ventricular myocardial infarction: a case report

2020 ◽  
Author(s):  
Adeogo Akinwale Olusan ◽  
Paul Francis Brennan ◽  
Paul Weir Johnston
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Ventricular ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Right Ventricular Myocardial Infarction ◽  
Percutaneous Coronary

Abstract Background Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway. Case summary A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. Discussion This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.

scholarly journals Clinical Profile and Outcomes of Patients Undergoing Primary Percutaneous Coronary Intervention in Employee Scheme Insurance Beneficiaries in India

2020 ◽  
Vol 7 (46) ◽  
pp. 2685-2689
Author(s):  
Lachikarathman Devegowda ◽  
Satvic Cholenahally Manjunath ◽  
Anindya Sundar Trivedi ◽  
Ramesh D ◽  
Shanmugam Krishnan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiogenic Shock ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Clinical Profile ◽  
Major Adverse Cardiovascular Events ◽  
Primary Pci ◽  
Ischemic Time ◽  
Percutaneous Coronary

BACKGROUND We wanted to assess the clinical profile and in-hospital outcomes of Primary Percutaneous Coronary Intervention (PPCI) for ST-segment Elevation Myocardial Infarction (STEMI) in India in ESI (Employee Scheme Insurance) beneficiaries. METHODS From January 2017 to July 2018, 122 consecutive acute STEMI patients undergoing PPCI under ESI scheme were included in the study. Patients’ clinical profile, detailed procedural characteristics, time variables along with in-hospital major adverse cardiovascular events (MACE) were also assessed. RESULTS 122 patients underwent primary PCI during the study period. In the study, mean age was 55.23 (27 - 85) years; 94 (77.04 %) were males; 53 (43.44 %) were hypertensives; 38 (31.14 %) were smokers; and 44 (36.06 %) were diabetics. Ten (8.19 %) patients were in cardiogenic shock (CS). Anterior myocardial infarction was present in 70 (57.37 %) patients. The median chest-pain-onset to hospitalarrival-time was 270 (70 - 720), door-to-balloon time was 55 (20 - 180) and total ischemic time was 325 (105 - 780) minutes. In-hospital adverse events occurred in 14 (11.4 %) patients [death 8 (6.55 %), major bleeding 2 (1.63 %), urgent CABG 3 (2.45 %) and stroke 1 (0.81 %)]. Seven patients with cardiogenic shock died. CONCLUSIONS The mean age of our cohort was 55.23 years. In our study, majority of patients were males (77.05 %), hypertension was associated with 43.44 %, and diabetes was associated with 36.06 % of patients. Procedural success was achieved in 95.89 %. The overall in-hospital mortality was 6.55 % and 70 % in the cardiogenic shock subset. KEYWORDS Primary PCI, STEMI, ESI, PCI

scholarly journals Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

2021 ◽  
Author(s):  
Pria MD Nippak ◽  
Jodie Pritchard ◽  
Robin Horodyski ◽  
Candace J Ikeda-Douglas ◽  
Winston W Isaac
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

scholarly journals Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

2021 ◽  
Author(s):  
Pria MD Nippak ◽  
Jodie Pritchard ◽  
Robin Horodyski ◽  
Candace J Ikeda-Douglas ◽  
Winston W Isaac
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

P3123Enoxaparin versus unfractionated heparin in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Graca Santos ◽  
R Ribeiro Carvalho ◽  
F Montenegro ◽  
C Ruivo ◽  
J Correia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Major Bleeding ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Group A ◽  
St Elevation ◽  
Group B

Abstract Background The use of intravenous enoxaparin (LBWH) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) was upgraded in the latest European Guidelines to a class IIa recommendation. Purpose The authors aim to compare safety and prognostic impact of LMWH versus unfractionated heparin (UFH) use in STEMI patients undergoing primary PCI. Methods Retrospective study of 3875 STEMI patients who underwent pPCI between October 2010 and September 2017 and were included in a national multicenter registry. Group A consisted of patients managed only with LMWH, and Group B patients were treated with UFH regardless of eventual LMWH associated exposure. The groups were compared according to their demographic, clinical and laboratory characteristics. The primary endpoint (PE) results from a composite which included: procedural failure (pPCI failure or bailout use of GPIIb/IIIa inhibitors), in-hospital mortality, re-infarction or major bleeding (according to the registry criteria). The secondary endpoint (SE) included: in-hospital major bleeding, need for red blood cell transfusion, or haemoglobin drop ≥2g/dL. A 1:1 propensity score (PS) analysis was performed according to demographic variables, medical history and previous medication, physical examination, electrocardiogram characteristics and left ventricular function, matching 1558 of the 3875 patients for later comparison between groups. Results Overall, Group A included 1083 (27.9%) and Group B 2792 (72.1%) patients. The mean age was 63±14 years, and 33.5% of the cohort were female. Despite the baseline characteristics heterogeneity between groups, this phenomenon was not observed after PS matching. The PE was more frequent in Group A, without reaching statistical relevance (15.6% vs 13.3%, p=0.07). The SE was superior in Group A (34.4 vs 29.4%, p=0.01). According to the PS matching analysis, there were no differences beetween groups in terms of the PE (13.9% vs 12.0%, p=0.28), while the SE kept more frequent among Group A (34.9% vs 28.5%, p=0.02) [Figure]. Propensity score: group comparison Conclusion In this study based on a national multicentric registry of STEMI patients, the use of LMWH was not associated with better in-hospital prognosis in terms of major cardiovascular events and was related with higher rates of bleeding related events in the scenario of pPCI, compared to UFH. According to these results, further studies are required to support the widespread use of LMWH in this clinical scenario.

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