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 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 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 Circulating miR-660-5p is associated with no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
Jian-Wei zhang ◽  
Cheng-Ping Hu ◽  
Ying-Xin Zhao ◽  
Ling-Jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Characteristic Curve ◽  
Linear Regression Analysis ◽  
Coronary Intervention ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple linear regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

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.

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