scholarly journals The Influence of the Duration of Acute Coronary Syndrome on the Outcomes of Endovascular Treatment

2021 ◽  
pp. 43-48
Author(s):  
Sergii V. Salo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Efficiency ◽  
Clinical Course ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Infarct Zone ◽  
Coronary Syndrome

Multicenter studies have proven the high effectiveness of percutaneous coronary intervention (PCI) in terms of restoring patency of the infarct-related artery (IRA) and improving the prognosis in acute myocardial infarction (AMI). The mechanism of improvement of clinical result after PCI procedure appears to be multifactorial. The aim. To investigate the effect of IRA stenting on the clinical course, prognosis and contractility of the heart in patients with different duration of acute myocardial infarction and its influence on the short-term and long-term effects after intervention. The main determinant for the favorable clinical course and improvement of the prognosis is early (within the first hours of the disease) restoration of antegrade blood flow by IRA stenting. Thus, it is possible to signifi-cantly improve the blood supply to the peri-infarct zone and limit the area of necrosis and maintain heart rate. Materials and methods. The analyzed group included 684 patients with AMI who were endovascularly treated at the Department of Emergency Endovascular Heart Surgery of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 1, 2017 to January 1, 2021. Coronary artery stenting was performed in all the patients. STEMI occurred in 495 (72.4%) patients, and non-STEMI in 189 (27.6%) patients. The mean age of the subjects was 61.8 ± 12.1 years. There were 289 women (42.3%) and 395 men (57.7%). Distribu-tion of the patients depending on the initial Killip class was as follows: 13 (1.9%) had class I, 199 (29.1%) had class II, and 472 (69.0%) had class III myocardial infarction. Atrial fibrillation occurred in 72 (10.5%) patients. Echocardiographic parameters were as follows: left ventricular (LV) end-systolic index 54.1 ± 12.8 ml/m2, LV ejection fraction 0.53 ± 0.05, left atrial diameter 39.5 ± 3.8 mm, systolic pulmonary artery pressure 44.8 ± 7.8 mmHg. In this study, clinical condition and functional capacity of the heart muscle in patients with AMI depending on the condition of the stent segment and the timing of endovascular procedures after the onset of the disease were first inves-tigated in the long term. Conclusions. High efficiency and safety of PCI have been proven, which makes it possible to recommend this pro-cedure for wide application. It has been proven that PCI using matrix and modular stents, as well as statins can reduce the frequency of in-stent stenosis and improve the clinical course of the disease in the long term. It has been proven that stenting in patients with AMI is most effective in the earliest stages of the disease with preservation of LV contractility with possibly complete myocardial revascularization, which contributes to the preservation of viable myocardium in the peri-infarct zone, improvement of myocardial contractility and prevention of myocardium remodeling.

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

Impact of early changes in left ventricular filling pattern on long-term outcome after acute myocardial infarction

2003 ◽  
Vol 89 (2-3) ◽  
pp. 207-215 ◽  
Author(s):  
Jacob E. Møller ◽  
Steen H. Poulsen ◽  
Eva Søndergaard ◽  
James B. Seward ◽  
Christopher P. Appleton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Filling ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Filling Pattern ◽  
Ventricular Filling

Depression in Acute Coronary Syndrome

2003 ◽  
Vol 93 (3_suppl) ◽  
pp. 1105-1108 ◽  
Author(s):  
Damir Kozmar ◽  
Katija Čatipović-Veselica ◽  
Andrea Galić ◽  
Jasna Habek
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ventricular Fibrillation ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Control Group ◽  
Coronary Syndrome ◽  
Mean Differences ◽  
And Control

This study examined the prevalence of depression based on scores of 200 patients with acute coronary syndrome on the Emotion Profile Index of Plutchik and its relationship with the type of acute coronary syndrome and the severity of ischemic heart disease. Patients with acute coronary syndrome scored higher on depression than the control group. There was no difference in scores on Depression by type of acute coronary syndrome and no significant mean differences on Depression for patients with and without left ventricular failure. Patients with acute myocardial infarction and ventricular fibrillation scored lower on Depression than other patients with acute myocardial infarction and control group. This study supports the view that patients with acute myocardial infarction and ventricular fibrillation and lower scores on Depression have good prognosis during hospitalization and maybe for the long term.

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