scholarly journals Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction

2021 ◽  
Author(s):  
Goutam Datta ◽  
Sandipan Sarkar
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Vasodilator Therapy ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
Flow Group ◽  
One Year

  Background: Mechanical revascularization of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI).No flow occurs in ∼8.8-10% of cases of primary percutaneous coronary intervention(PCI) in STEMI patients. Our aim was to study     actual incidence and outcome of no flow patients. Methods: Five hundred and eighty primary PCI patients were studied over a period of two years i.e. January 2016 to December 2017. Drug eluting stents were used in all cases. Majority of our patients(>90%) came  6 hours  after onset of chest pain. There were many patients where there was  no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have studied primary outcome(mortality) of no flow in those patients.                                                                                                                 Results: There were 44 cases of  no flow in our series(7.75%). Left anterior descending artery(LAD )was involved in eighteen patients. Right coronary artery(RCA) was culprit in twenty four cases. Only two cases were seen in LCX territory. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group. Conclusion: Refractory no flow during primary PCI in STEMI is associated with high mortality and morbidity. There is no established strategy to solve this phenomenon.    

Pitavastatin Combined with Ezetimibe Treatment was an Effective Approach to Non-IRA Lesion of ST-segment Elevation Myocardial Infarc-tion Patients with Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 21 ◽  
Author(s):  
Bo Zhao ◽  
Guang Ping Li ◽  
Jian Jun Peng ◽  
Li Hui Ren ◽  
Li Cheng Lei ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Gensini Score ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
One Year

Objective: ST-segment elevation myocardial infarction (STEMI) patients with the multivessel disease have distinctive plaque characteristics in non-IRA lesions. Intensive statin therapy was a potential approach to treat STEMI patients with the non-IRA disease. However, there is still poor evidence about the therapeutic effect. In this study, we have evaluated the detailed therapeutic effect of statin plus ezetimibe intensive therapy. Method: For STEMI patients with non-IRA disease undergoing primary percutaneous coronary intervention (PCI), 183 control STEMI patients without non-IRA disease undergoing primary PCI, and 200 STEMI patients with non-IRA disease undergoing primary PCI were introduced into this study. 200 STEMI patients with non-IRA disease undergoing primary PCI were divided into Normal group, Intensive group, Normal & Combined group, and Intensive & Combined group. The baseline information for each participant was recorded. Meanwhile, the physiological and biochemical indicators of each member with different treatments were collected after one-year follow-up. Result: For STEMI patients with non-IRA disease undergoing primary PCI, no differences could be detected in multiple indexes such as OCT examination results, age, stroke, etc. However, diabetes mellitus, smoking, and coronary Gensini score were different between different groups (P<0.05). After one year follow-up, cholesterol, low-density lipoprotein, coronary Gensini score, thin-cap fibroatheroma, length of non-infarcted arterial lesions, non-infarct artery lesion range, myocardial infarction again, and revascularization again were significantly different between different groups (P<0.05). Conclusion: The results mentioned above suggested that pitavastatin combined with ezetimibe was an effective approach to STEMI patients with non-IRA disease undergoing primary PCI. The results obtained in this study have provided a novel way for the treatment of STEMI patients with non-IRA disease undergoing primary PCI.

scholarly journals Intracoronary Thrombolysis in no Flow after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

2020 ◽  
Vol 3 (13) ◽  
pp. 01-05
Author(s):  
Goutam Datta
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Vasodilator Therapy ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Intracoronary Thrombolysis ◽  
Flow Group

Introduction: Mechanical revascularization of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI).No-reflow occurs in ∼8.8-10% of cases of primary percutaneous coronary intervention(PCI) in STEMI patients. Intracoronary tenectaplase was used when there was huge thrombus causing no flow in coronary artery following primary PCI in STEMI patients. Methods: Five hundred and eighty primary PCI patients were studied over a period of two years i.e. January 2016 to December 2017. Drug eluting stents were used in all cases. Majority of our patients (>90%) came 6 hours after onset of chest pain. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have given 20 mg of tenectaplase through microcatheter in those cases. Results: There were 44 cases of no flow in our series (7.75%). TIMI 3 Flow was reestablished in thirty two patients after intracoronary tenectaplase (72%). Amongst twelve failure cases LAD involvement was most common eight cases. RCA was involved in four patients. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group. Both were statistically significant. Conclusion: Refractory no reflow during primary PCI in STEMI is associated with high mortality and morbidity. There is no established strategy to solve this phenomenon. Intracoronary thrombolysis is an option to salvage these patients.

scholarly journals Prolonged Hyperglycemia and Renal Failure after Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 9 (2) ◽  
pp. 92-99
Author(s):  
Elena Izkhakov ◽  
Zach Rozenbaum ◽  
Gilad Margolis ◽  
Shafik Khoury ◽  
Gad Keren ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Kidney Injury ◽  
Fold Increase ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Hba1c Levels

Background: There are limited data regarding the effect of long-standing hyperglycemia on the occurrence of acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods: We retrospectively studied 723 STEMI patients undergoing primary PCI. Patients were stratified into two groups according to glycated hemoglobin (HbA1c) levels as a marker of prolonged hyperglycemia: those with HbA1c < 7% and those with HbA1c ≥7%. Medical records were reviewed for the occurrence of AKI. Results: HbA1c levels ≥7% were found in 225/723 (31%) of patients. The occurrence of AKI was significantly higher among patients with HbA1c levels ≥7% (32/225, 14%) compared to patients with HbA1c levels < 7% (32/498, 6%; p = 0.001). Patients with chronic kidney disease (CKD) and HbA1c ≥7% had an eight-fold increase in the incidence of AKI compared to patients with HbA1c < 7% and no CKD (32 vs. 4%). In a multivariable regression model, HbA1c ≥7% was independently associated with AKI (OR 1.92, 95% CI 1.09–3.36, p = 0.02). Conclusion: HbA1c ≥7% was associated with a higher likelihood of AKI in STEMI patients treated with primary PCI.

The effects of percutaneous coronary intervention on mortality in elderly patients with non-ST-segment elevation myocardial infarction undergoing coronary angiography

2020 ◽  
Vol 65 (3) ◽  
pp. 81-88
Author(s):  
Pınar D Gündoğmuş ◽  
Emrah B Ölçü ◽  
Ahmet Öz ◽  
İbrahim H Tanboğa ◽  
Ahmet L Orhan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
One Year

Introduction Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. Methods Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. Results Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. Conclusion The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.

scholarly journals Preliminary Report on the Safety and Efficacy of Staged versus Complete Revascularization in Patients with Multivessel Disease at the Time of Primary Percutaneous Coronary Intervention

2016 ◽  
Vol 26 (03) ◽  
pp. 143-147 ◽  
Author(s):  
Ahmed Rashed ◽  
Wael El-kilany ◽  
Mohamed El-Haddad ◽  
Islam Elgendy ◽  
Marwan Saad
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Type A ◽  
Coronary Intervention ◽  
Multivessel Disease ◽  
Fluoroscopy Time ◽  
Complete Revascularization ◽  
Primary Pci ◽  
Safety And Efficacy ◽  
St Segment Elevation ◽  
Percutaneous Coronary

This study aims to determine the safety and efficacy of complete versus staged-percutaneous coronary intervention (PCI) of nonculprit lesions at the time of primary PCI in patients with multivessel disease. Recent trials had suggested that revascularization of nonculprit lesions at the time of primary PCI is associated with better outcomes, however; the optimum timing and overall safety of this approach is not well known. An observational prospective study was conducted, including 50 patients who presented with ST-segment elevation myocardial infarction and found to have at least an additional nonculprit significant (> 70%) type A or B lesion. According to the operator's discretion, patients either underwent complete revascularization of nonculprit significant lesions during primary PCI procedure or within 60 days of primary PCI (staged-PCI). Safety outcomes evaluated were contrast-induced nephropathy (CIN), the amount of contrast used, and fluoroscopy time. Efficacy outcome assessed was major adverse events (MACE) at 1 year. The fluoroscopy time and amount of contrast used were increased in complete revascularization group (35.3 ± 9.6 vs. 26.3 ± 6.7 minutes, p < 0.001, and 219.5 ± 35.1 vs. 187.5 ± 45.5 mL, p = 0.01, respectively); while incidence of CIN remained similar (p = 0.73). The incidence of MACE at 1 year was similar in both groups (23% in the complete revascularization group vs. 25% in the staged-PCI group, p = 0.43). Complete revascularization and staged-PCI of nonculprit type A or B lesions at the time of primary PCI were associated with similar long-term outcomes and safety profile. Larger studies are needed to further validate these results.

Abstract 379: The Prognostic Value of Eosinophil to Leukocyte Ratio in Patients Presenting With ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Takao Konishi ◽  
Naohiro Funayama ◽  
Tadashi Yamamoto ◽  
Daisuke Hotta
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Infarct Size ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Elevated neutrophil to leukocyte ratio in patients with ST-segment elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. However, whether decreased eosinophil ratio after primary percutaneous coronary intervention (PCI) reflects larger infarct size has not been fully investigated. This study examined the relationship between eosinophil ratio and creatinine kinase-MB (CK-MB) elevation after primary PCI in patients presenting with STEMI. Methods and Results: We analyzed the data of 321 consecutive patients who underwent primary PCI for ST-elevation myocardial infarction between January 2009 and August 2015. Total and each type of leukocyte counts 24 hours after admission were measured. The eosinophil/leukocyte ratio (ER) was calculated as the ratio of eosinophil to leukocyte count. The primary end point was major adverse cardiac event (MACE) and the follow-up period was 180 days. The mean ER and max CK-MB was 0.44±0.65 % and 217.3±224.4 IU/l, respectively. ER obtained 24 hours after admission was inversely correlated with CK-MB concentration (r=-0.37, r2=0.14, P<0.001). MACE within 180 days occurred in 68 patients (21%) including death (9%), myocardial infarction (MI) (1%) and target lesion or vessel revascularization (10%). Patients who had MACE within 180 days had lower ER (0.20±0.51 vs 0.49±0.66, P<0.001) at 24 hours after admission. Conclusions: The decreased ER after primary PCI in patients presenting with STEMI was associated with increased CK-MB concentration, which might indicate larger infarct size, therefore, poor prognosis.

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