scholarly journals FAILED PREHOSPITAL FIBRINOLYSIS IN PATIENT WITH PERCUTANEOUS CORONARY INTERVENTION IN ST-ELEVATION MYOCARDIAL INFARCTION

2018 ◽  
Keyword(s):  
Myocardial Infarction ◽  
Hemorrhagic Stroke ◽  
Lifestyle Modification ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
High Risk Factors ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Reperfusion Strategy

On the example of the clinical case of newly diagnosed ST-elevation myocardial infarction combination of different reperfution strategies and their benefit was discussed. Recommendations on lifestyle modification and medicament treatment tactics are described. From one hand, in spite of side-effects of treatment as an increased risk of stroke and hemorrhagic stroke, prehospital FL is associated with a decreased risk of cardiogenic shock and its effectiveness depends on the time from symptom onset to reperfusion. From other hand, despite the fact that PPCI is the recommended default reperfusion strategy, its effectiveness depends also on time limits and absence of the majority of PPCI-facilated hospitals worldwide. Combination of prehospital single-bolus FL following after 3–24h early routine angiography and PCIcan improve post-STEMI survival and help to avoid hyperreactivity and thrombin-induced platelet activation after FL, which can be a key to success in effective treatment and rehabilitationafter STEMI in patients without high risk factors of potential bleeding or stroke.

scholarly journals High triglyceride–glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Erfei Luo ◽  
Dong Wang ◽  
Gaoliang Yan ◽  
Yong Qiao ◽  
Bo Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Insulin resistance (IR) is considered a pivotal risk factor for cardiometabolic diseases, and the triglyceride–glucose index (TyG index) has emerged as a reliable surrogate marker of IR. Although several recent studies have shown the association of the TyG index with vascular disease, no studies have further investigated the role of the TyG index in acute ST-elevation myocardial infarction (STEMI). The objective of the present study was to evaluate the potential role of the TyG index as a predictor of prognosis in STEMI patients after percutaneous coronary intervention (PCI). Methods The study included 1092 STEMI patients who underwent PCI. The patients were divided into 4 quartiles according to TyG index levels. Clinical characteristics, fasting plasma glucose (FPG), triglycerides (TGs), other biochemical parameters, and the incidence of major adverse cardiovascular and cerebral events (MACCEs) during the follow-up period were recorded. The TyG index was calculated using the following formula: ln[fasting TGs (mg/dL) × FPG (mg/dL)/2]. Results The incidence of MACCEs and all-cause mortality within 30 days, 6 months and 1 year after PCI were higher among STEMI patients with TyG index levels in the highest quartile. The TyG index was significantly associated with an increased risk of MACCEs in STEMI patients within 1 year after PCI, independent of confounding factors, with a value of 1.529 (95% CI 1.001–2.061; P = 0.003) for those in the highest quartile. The area under the curve (AUC) of the TyG index predicting the occurrence of MACCEs in STEMI patients after PCI was 0.685 (95% CI 0.610–0.761; P = 0.001). The results also revealed that Killip class > 1, anaemia, albumin, uric acid, number of stents and left ventricular ejection fraction (LVEF) were independent predictors of MACCEs in STEMI patients after PCI (all P < 0.05). Conclusions This study indicated an association between higher TyG index levels and increased risk of MACCEs in STEMI patients for the first time, and the TyG index might be a valid predictor of clinical outcomes in STEMI patients undergoing PCI. Trial Registration ChiCTR1900024577.

scholarly journals Glycoprotein IIb/IIIa Inhibitors Use and Outcome after Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
J. P. Howard ◽  
D. A. Jones ◽  
S. Gallagher ◽  
K. Rathod ◽  
S. Antoniou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Aims. We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.Methods and Results. This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P=0.136) or MACE (P=0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P=0.021).Conclusion. Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.

scholarly journals Timing of Nonculprit Percutaneous Coronary Intervention after ST-Elevation Myocardial Infarction

Cardiology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Joshua H. Arnold ◽  
Tamir Bental ◽  
Gabriel Greenberg ◽  
Hana Vaknin-Assa ◽  
Ran Kornowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cox Regression ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Time Interval ◽  
Complete Revascularization ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

<b><i>Introduction:</i></b> Complete revascularization of ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) has recently shown to reduce risk of adverse cardiovascular events, including cardiovascular death. Optimal timing of revascularization of nonculprit lesions remains controversial. We aimed to measure cardiac outcomes related to duration between primary percutaneous coronary intervention (pPCI) of the culprit lesion and staged PCI (sPCI) of nonculprit lesions. <b><i>Methods:</i></b> From a prospectively collected consecutive registry of 3,002 patients treated for STEMI by pPCI, 1,555 patients with MVD requiring sPCI were identified. Patients were placed into quartiles of duration to sPCI: 0–7 days (Q1), 7–22 days (Q2), 22–42 days (Q3), &#x3e;42 days (Q4), excluding those who had complete revascularization at the index event. Major adverse cardiac events (MACEs) included all-cause mortality, myocardial infarction, target vessel revascularization, and coronary artery bypass surgery. Cox regression and propensity score matching were performed correcting for confounding factors. <b><i>Results:</i></b> The average age at presentation was 65.7 ± 11.5 years. 333 were female (21.4%). Mean time between pPCI and sPCI was 28.3 days (±24.8). Rates of MACE were Q1 - 16.5%, Q2 - 21.2%, Q3 - 25.8%, and Q4 - 30.1% (log-rank &#x3c;0.001). Following regression analysis, sPCI remained an independent risk factor for MACE (hazard ratio [HR] = 1.226 [95% confidence interval {CI}: 1.129–1.331, <i>p</i> &#x3c; 0.001]). There was no association between the time interval up to sPCI with all-cause death (HR = 1.022 [95% CI: 0.925–1.129, <i>p</i> = 0.671]). <b><i>Conclusions:</i></b> Patients with MVD are at increased risk of experiencing MACE after revascularization of nonculprit vessels with increasing time delay between pPCI and sPCI.

Fibrinolytic treatment of ST-elevation myocardial infarction

2014 ◽  
Vol 34 (01) ◽  
pp. 47-53 ◽  
Author(s):  
K. Huber ◽  
S. Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Fibrinolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Invasive Treatment ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Reperfusion Strategy

SummaryPrimary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI), as long as it can be delivered within 90-120 minutes from patient’s first medical contact, and is the leading reperfusion strategy in most European countries. However, as PPCI cannot be offered in a timely manner to all patients, fibrinolytic therapy (FT) is the recommended choice in patients with an anticipated delay to PPCI of >90-120 minutes, presenting early after symptom onset and without contra-indications. FT should preferably be started in the pre-hospital setting. Following FT, all patients should be transferred to a PCI-center for rescue PCI or routine coronary angiography with PCI as indicated. Such a pharmaco-invasive strategy, combining FT with invasive treatment, has recently been shown to be non-inferior to PPCI in patients living in areas with long transfer delays to PCI (>60 minutes).In this overview, we will briefly present the evidence for the benefit of FT in STEMI, and discuss the role of FT in the current era of PPCI as well as the optimal treatment following pharmacologic reperfusion.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

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