scholarly journals Impact of the combined presence of left ventricular systolic and renal dysfunction on the 5-year outcome after ST-elevation myocardial infarction

2015 ◽  
Vol 72 (8) ◽  
pp. 702-709
Author(s):  
Lidija Savic ◽  
Igor Mrdovic ◽  
Milika Asanin ◽  
Sanja Stankovic ◽  
Dragan Matic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Dysfunction ◽  
Independent Predictor ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Prognostic Impact ◽  
Group I ◽  
St Elevation ◽  
Strong Independent Predictor

Background/Aim. The coincidence of left ventricular systolic dysfunction (LVSD) and renal dysfunction (RD) is a strong independent predictor of adverse events in the short-term and mid-term follow-ups of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The aim of this study was primarily to assess the prognostic impact of the LVSD-RD combination on the 5-year all-cause mortality in patients with STEMI treated with pPCI, as well as to assess the prognostic impact of the LVSD-RD combination on the occurrence of major adverse cardiovascular events (MACEs: cardiovascular death, reinfarction, stroke and target vessel revascularization) in these patients. Methods. We analyzed 951 patients divided into 4 groups according to the presence of LVSD (ejection fraction < 40%) and/or baseline RD (creatinine clearance < 60 mL/min): group I (no LVSD, no RD); group II (LVSD, no RD); group III (RD, no LVSD); group IV (LVSD+RD). Results. The 5-year mortality rates were 2.3%, 17.6%, 11.7% and 38.3%, while the 5-year MACE rates were 8.8%, 28.4%, 18.3% and 44.4% in the groups I, II, III and IV, respectively (p < 0.001). The highest percentage of lethal outcomes and MACE was registered in the first year of follow-up in all the groups. The 1-year landmark analysis confirmed that the patients with LVSD-RD combination had the highest percentage of lethal outcomes in the period of 1 to 5 years (p = 0.028). There was a strong trend toward the significance in the occurrence of MACE among the analyzed groups in the period of 1 to 5 years (p = 0.085). In the Cox regression model the LVSD-RD combination was a strong independent predictor of 5-year mortality and the occurrence of MACE: mortality hazard ratio (HR) 4.5 (95%CI 1.9-10.8); MACE HR 2.5 (95%CI 1.4-4.5). Conclusion. The strong negative independent prognostic impact of the LVSD-RD combination persisted in the long-term follow-up of the patients with STEMI treated with pPCI.

P3126Immediate versus delayed revascularization in patients with transient ST-elevation myocardial infarction: 1-year follow-up of the randomized clinical TRANSIENT trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G N Janssens ◽  
N W Van Der Hoeven ◽  
J S Lemkes ◽  
H Everaars ◽  
P Van De Ven ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Target Lesion ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Invasive Group ◽  
St Elevation ◽  
One Year

Abstract Background Up to 24% of acute coronary syndrome patients present with ST-elevation but show complete resolution of ST-elevation and symptoms before revascularization. The current guidelines do not clearly state whether these transient ST-elevation myocardial infarction (TSTEMI) patients should be treated with a ST-elevation myocardial infarction (STEMI)-like or a non-STEMI-like invasive approach. Purpose The aim of the present study is to determine the effect of an immediate versus a delayed invasive strategy on infarct size measured by 4-month cardiac magnetic resonance imaging (CMR) and clinical outcome up to one year. Methods In this multicenter trial, 142 TSTEMI patients were randomized 1:1 to either an immediate or a delayed intervention. CMR was performed at four days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at four months and one year. Results Both in the immediate (0.4 h) and the delayed invasive group (22.7 h) CMR-derived infarct size at four months was very small and left ventricular function was good. In addition, major adverse cardiac events and all-cause mortality at one year were low and not different between both groups (table 1). CMR and clinical outcomes up to one year Outcome Immediate invasive group (n=70) Delayed invasive group (n=72) p-value Myocardial infarct size (% of LV), median (IQR) 0.4 (0.0–3.5) 0.4 (0.0–2.5) 0.79 LVEF (%), mean ± SD 59.9±5.4 59.3±6.5 0.63 LVEF recovery (%), mean ± SD 2.2±5.4 1.7±5.3 0.66 MVO present, No. (%) 0 (0.0) 1 (1.9) 0.50 MACE (death, reinfarction, target lesion revascularization), No. (%) 3 (4.4) 4 (5.7) 1.00 Death from any cause, No. (%) 0 (0.0) 3 (4.3) 0.24 Reinfarction, No. (%) 2 (3.0) 1 (1.4) 0.62 Target lesion revascularization, No. (%) 2 (3.0) 1 (1.4) 0.62 Definite stent thrombosis, No. (%) 1 (1.5) 1 (1.4) 1.00 Abbreviations: IQR, interquartile range; LV, left ventricle; LVEF, left ventricle ejection fraction; MACE, major adverse cardiac events; MVO, microvascular obstruction; NA, not applicable; SD, standard deviation. Conclusions We demonstrated that patients with TSTEMI have limited infarct size and preserved left ventricular function and that an immediate or delayed approach has no effect on clinical outcome up to one year. Therefore, patients with TSTEMI can be treated with both an immediate or a delayed invasive strategy with similar outcome. These findings extend our current knowledge about the optimal timing of coronary intervention in patients with TSTEMI and complement the guidelines. Acknowledgement/Funding AstraZeneca, Biotronik

scholarly journals Prediction of left ventricular remodeling following ST elevation myocardial infarction: role of myocardial deformation parameters

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
AI Scarlatescu ◽  
S Onciul ◽  
A Pascal ◽  
I Petre ◽  
D Zamfir ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Mechanical Dispersion ◽  
Significant Difference ◽  
Lv Remodeling ◽  
Adverse Remodeling ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF - I agree that this information can be anonymised and then used for statistical purposes only Background Left ventricular (LV) remodeling after ST elevation myocardial infarction (STEMI) plays an important role in predicting the outcome of this patient group. It is also useful in assessing the benefit of revascularization. Its identification is also of clinical importance in order to set up preventive strategies for patients with adverse remodeling Purpose To find an echocardiographic predictor of LV adverse remodeling following STEMI. Materials and methods In this prospective study we included 52 consecutive patients, aged between 35-70,  with STEMI treated by primary PCI. We performed conventional 2D transthoracic echocardiography for patients. In addition to conventional parameters we also measured LV global longitudinal strain (GLS) and LV mechanical dispersion using 2D speckle tracking imaging. For morphological and functional analysis of LV we used 3D echocardiography (volumes, LVEF). LV remodeling (LVR) was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) at 6 months follow up. Results We found significant differences in time (baseline and 6 month follow up) between LVEF (43,08 vs 47,91, p = 0.034), LVEDV (105,95 vs 113,21, p = 0.000), LV GLS (-12.61 vs - 14,58, p = 0.01), and mechanical dispersion (61,68 vs 56,11, p = 0.00) in all patients. LV remodeling at 6 months (15% increase in LVEDV) was observed in 30 % of the included patients. At 6 months after STEMI we observed a significant difference between the two groups (remodeling vs no remodeling) regarding 3D LVEF (42.28 %vs 50.30%,p = 0.009), LVEDV (131 ml vs 109 ml, p = 0.05), GLS (-11.15 vs -16.02, p = 0.00) and LV mechanical dispersion (69.02 vs 50.54, p = 0.00). Patients with LV remodeling at 6 months after STEMI had lower LVEF, worse LV GLS and higher LV mechanical dispersion at baseline. Using ROC curve analysis we identified two cut off values, one of -11.55 for baseline LV GLS (Sb 78%, Sp 81%, AUC 0.852, CI 95%, p = 0.00) and another one of 63.7 for LV baseline mechanical dispersion (Sb 71,4%, Sp 66 %, AUC 0.762, p 0.005) to discriminate between patients with or without LV adverse remodeling at 6 months. Using linear regression analysis, we demonstrated that GLS (p = 0.00) and LV mechanical dispersion (p = 0.016) are able to predict LV remodeling in time. We also found a negative correlation between peak CK-MB levels at baseline LVEF at 6 months. Regression analysis showed that CK-MB levels at baseline could predict LVEF at 6 months (p = 0.008) Conclusion Baseline LV mechanical dispersion and LV GLS can predict LV adverse remodeling at 6 months after STEMI. These parameters could be used at baseline in order to predict worse outcome in STEMI patients. Further larger scale studies are needed to validate these findings.

scholarly journals Rivaroxaban versus Vitamin K Antagonists (Warfarin) based on the triple therapy for left ventricular thrombus after ST-Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Zhongfan Zhang ◽  
Qian Zhang ◽  
Ming Qu ◽  
Miao Yu ◽  
Zhenya Jiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Triple Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
St Elevation Myocardial Infarction ◽  
Ventricular Thrombus ◽  
St Elevation

Abstract Background: Left ventricular thrombus(LVT) can lead to serious complications, and mostly formed after ST-Elevation myocardial infarction(STEMI). The Off-label use of new oral anticoagulants(NOACs) in the triple therapy of LVT after STEMI has increased in the past few years. As one of the most widely used NOACs, the data of safety and efficacy of rivaroxaban in LVT after STEMI is limited and warrants continued exploring.Methods: We conducted a retrospective cohort study involving STEMI patients underwent primary percutaneous coronary intervention (PCI). Among patients who developed LVT after STEMI, we evaluated the efficacy and safety of rivaroxaban plus DAPT therapy associated with thrombus resolution and clinical adverse events, compared with triple therapy with VKA. Results: In 1,335 patients with STEMI, a total of 77 (5.7%) developed LVT over the follow up period (median 25.0 months). Of the patients diagnosed with LVT, 31 patients were started on triple therapy with VKA, 33 patients on triple therapy with rivaroxaban. There was a consistent similarity in LVT resolution with rivaroxaban application compared to VKA application during the follow-up period[HR:1.57(95%CI 0.89-2.77), p=0.096; Adjusted HR:1.70(95%CI 0.90-3.22), p=0.104]. When the analysis focused on LVT resolution at different time points during the follow-up period, triple therapy with rivaroxaban showed quicker resolution than with VKA(6months:p=0.049; 12months:p=0.044; 18months:p=0.045). Meanwhile, similar risks of ISTH bleeding were recorded in both groups, with no difference between the two groups(Rivaroxaban 6.1% vs VKA 9.7% , p=0.444). Fewer net adverse clinical events(NACE) were observed in the rivaroxaban group compared with the VKA group[Rivaroxaban 24.2% vs VKA 58.1%; HR:0.31(95%CI 0.14-0.68), p=0.003; Adjusted HR: 0.23(95%CI 0.09-0.57), p=0.001].Conclusions: This observational study suggests triple therapy with rivaroxaban has similar and quicker LVT resolution in patients with LVT after STEMI, compared with triple therapy with VKA, and perhaps was accompanied with a better clinical benefit. Larger sample sizes and randomized controlled trials are needed to confirm this observation.

scholarly journals Non-ST elevation myocardial infarction in patients with previous CABG: what is the best treatment option?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Oliveira ◽  
C Machado ◽  
C Almeida ◽  
M Fatima Loureiro ◽  
D Martins ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Bypass Graft ◽  
Previous History ◽  
St Elevation Myocardial Infarction ◽  
Prognostic Impact ◽  
Invasive Strategy ◽  
St Elevation

Abstract Background Current European Society of Cardiology guidelines recommend an invasive strategy (IS) for the treatment of non-ST elevation myocardial infarction (NSTEMI) patients, but the clinical trials that support this recommendations included only a few patients with previous coronary artery bypass graft (CABG). Purpose To characterize NSTEMI patients with previous CABG who underwent medical and invasive management and to evaluate the prognostic impact of the type of strategy used. Methods Retrospective analysis of a cohort of patients from a multicenter national registry diagnosed with NSTEMI with a previous history of CABG between 2010 and 2021. Patient's baseline demographics, medical history and in-hospital management data was collected. Outcomes of in-hospital and six months follow-up all-cause mortality were accessed. Results A total of 890 patients were included in the analysis. Of these, 470 were medically managed (MM) – this group included 249 patients (53.1%) who underwent coronary angiography but did not perform any further revascularization. The remaining 420 underwent an invasive strategy (IS) and performed additional revascularization, mainly percutaneous (only 1 patient submitted to reCABG). Mean age was similar (MM 72±10 vs IS 71±10 years, p=0.147) and most patients were male (MM 81.5% vs IS 83.8%, p=0.362). MM patients had more chronic kidney disease (16.7% vs 9.9%, p=0.003), peripheral artery disease (20.5% vs 15.0%, p=0.003) and heart failure (20.5% vs 11.9%, p&lt;0.001). Main presenting symptom was chest pain in both groups, however it was more frequent in the IS group (89.4% vs 94.5%, p=0.006) and dyspnea in the MM patients (6.3% vs 3.1%). Mean left ventricle ejection fraction was similar between groups (MM 49±12% vs IS 50±11%, p=0.290). Although the GRACE risk score was available for only 124 patients, high risk patients (GRACE score &gt;140) were equally distributed among the two groups (55.9% vs 48.2%, p=0.395). An IS was associated with significant lower in-hospital mortality (4.5% vs 1.7%, OR 0.37, 95% CI 0.15–0.87, p=0.018). At six months follow-up an IS was also associated with lower mortality (6.6% vs 2.4%, HR 0.18, 95% CI 0.06–0.52, p=0.002), even after adjusting for the baseline differences (HR 0.41, 95% CI 0.20–0.85, p=0.016). Conclusions In this cohort of patients with NSTEMI and previous CABG, an IS was linked to better outcomes during hospitalization and during six months follow-up. Randomized clinical trials are needed to address this issue. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Prognostic impact of left ventricular mass change in patients with ST-elevation myocardial infarction

Medicine ◽  
2018 ◽  
Vol 97 (4) ◽  
pp. e9748 ◽  
Author(s):  
Jin-Sun Park ◽  
Jeoung-Sook Shin ◽  
You-Hong Lee ◽  
Kyoung-Woo Seo ◽  
Byoung-Joo Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Mass ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Mass Change ◽  
Prognostic Impact ◽  
Ventricular Mass ◽  
St Elevation

Serum neprilysin levels are associated with myocardial stunning after ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Legallois ◽  
C Macquaire ◽  
A Hodzic ◽  
S Allouche ◽  
I El Kouakhi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Limit Of Detection ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Stunned Myocardium ◽  
Ventricular Ejection Fraction ◽  
St Elevation

Abstract Background/Introduction Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome. Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF). Purpose We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion. Methods Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and at follow-up (7 months). We compared 3 groups: a group with a low-level of plasma neprilysin (&lt;125 pg/mL, i.e. the lower limit of detection of the assay, 38 patients) and the two other groups were defined as being below or above the median value of the remaining samples (15 patients each). Results Median age was 58.5±12.8 years and 56 (82.4%) were men. Median LVEF was 45.0±8.5%. Baseline characteristics were comparable among groups. At baseline there was a non-significant trend towards lower end-diastolic volume (p=0.07) but significantly lower LVEF in the high neprilysin group (46.4±8.3%, 47.1±8.1% and 39.1±6.9%, p&lt;0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p=0.022 for relative change in LVEF and 6.6±7.3%, 3.6±9.0% and 11.3±8.4%, p=0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0±8.9%, 50.6±9.7% and 50.4±9.9%, p=0.55). Conclusion(s) Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up. Funding Acknowledgement Type of funding source: None

Left atrial strain is associated with left ventricular remodeling in patients with ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Legallois ◽  
A Hodzic ◽  
P Milliez ◽  
A Manrique ◽  
E Saloux ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Atrial ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Volume Increase ◽  
St Elevation

Abstract Background/Introduction Left ventricular remodeling (LVR) remains common and is associated with outcomes in patients with ST-elevation myocardial infarction (STEMI). Left atrial (LA) volume has been described as a predictor of outcomes in the latter population. Purpose To investigate the association between LA mechanical function using speckle tracking imaging and LVR at follow-up in STEMI patients. Methods Baseline 3D transthoracic echocardiograms were performed in 121 STEMI patients. LA global longitudinal strain was reported separately for the reservoir (LASr), conduit (LAScd), and contraction (LASct) phases. Follow-up echocardiograms were performed at 6 months. Results Mean age was 58.3±12.5 years and 98 (81%) were men. Baseline left ventricular ejection fraction (LVEF) was 46.8% [41.0, 52.9] and significantly improved to 52.1% [45.8, 57.0] at follow-up, (p&lt;0.001). A lower LASct was associated with a significant dilation of left ventricle at follow-up (%end-diastolic volume increase: −1.9% [−11.0, 15.2] in the two higher LASct tertiles group vs. 19.2% [5.0, 34.3] in the lower LASct tertile group, p=0.001). A higher %end-systolic volume increase at follow-up was associated with lower LASct as well: 12.6% [−16.2, 39.8] in the lower LASct group vs. −6.8% [−23.6, 14.4] in the two higher LASct tertiles group (p=0.004). Regarding LVEF, a low LVEF at follow-up was associated with the worst tertile of all LA strains (LASr, p=0.002; LAScd, p=0.01 and LASct, p=0.01). Conclusion(s) The three components of baseline LA strain were associated with LVEF at follow-up in patients with STEMI. Some of these components were also significantly associated with lower LVEF at baseline or predictive of a significant increase in left ventricular volumes during follow-up, indicating LVR. Funding Acknowledgement Type of funding source: None

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