scholarly journals The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019

2021 ◽  
Vol 10 (23) ◽  
pp. 5716
Author(s):  
Janusz Sielski ◽  
Karol Kaziród-Wolski ◽  
Karolina Jurys ◽  
Paweł Wałek ◽  
Zbigniew Siudak
Keyword(s):  
Myocardial Infarction ◽  
National Registry ◽  
Timi Flow Grade ◽  
Men And Women ◽  
P2y12 Inhibitors ◽  
Timi Flow ◽  
Invasive Cardiology ◽  
Observational Cohort ◽  
St Elevation ◽  
Related Mortality

Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences.

Abstract 3163: Association of Pre-PCI TIMI flow grade (TFG) with Subsequent Mortality in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael C Nguyen ◽  
Duane S Pinto ◽  
Claudia Hochberg ◽  
Amjad Almahameed ◽  
Yuri Pride ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Real World ◽  
Coronary Intervention ◽  
National Registry ◽  
World Population ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Pre-procedural TIMI flow grade has been associated with mortality (both in-hospital and long-term) in patients (pts) undergoing percutaneous coronary intervention (PCI) following STEMI in randomized trials. This relationship has not been well characterized in a large heterogeneous real world population. Methods: A cohort of 8,133 patients presenting with STEMI in the National Registry of Myocardial Infarction (NRMI) was studied. Analysis of the relationship between pre-PCI TFG and in-hospital mortality was performed. Results: Of the 8133 patients, 6307 (77.5%) had TFG 0/1, 1178 (14.5%) had TFG 2, and 648 (8.0%) had TFG 3. Patients with TFG 0/1 before PCI (primary, rescue or facilitated) had an in-hospital mortality rate of 3.3% compared with TFG 2 of 1.6% and TFG 3 of 1.2% ( P < 0.001). Pre-PCI TFG was associated with significant differences in mortality in all subgroups including age, gender, and location of infarct (see table ). Among pts with TFG 3 post PCI, mortality was still associated with pre-PCI TFG (pre-TFG 0/1 = 2.7%, pre-TFG 2 = 1.5%, TFG 3 = 1.2%, P = 0.002). Conclusion: Pre-PCI TFG is associated with in-hospital mortality in a heterogeneous group of real world patients presenting with STEMI treated with PCI, including those with TFG 3 following PCI.

scholarly journals Identification of predictors of inhospital postreperfusion mode of death in patients with acute ST-elevation myocardial infarction

Medicina ◽  
2010 ◽  
Vol 46 (2) ◽  
pp. 104
Author(s):  
Edvardas Vaicekavičius ◽  
Ramūnas Navickas ◽  
Leonas Survila ◽  
Vytautas Štuikys ◽  
Arnoldas Janavičius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Risk Index ◽  
Control Group ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Timi Risk Score ◽  
Different Characteristics ◽  
Mode Of Death

Objectives. The aim of this study was to identify the predictors of the postreperfusion mode of death using the distinctions in clinical characteristics of patients who died and survived after reperfusion therapy, treated due to ST-elevation myocardial infarction (STEMI). Material and methods. This consecutive study has involved 36 patients: 18 patients who died from progressive heart failure (PHF) (group 1, n=13) or from cardiac rupture (CR) (group 2, n=5) after primary coronary intervention. The control group consisted of 18 randomly selected patients who survived inhospital period (group 3). The initial and postreperfusion heart rate (HR), systolic and diastolic arterial pressures (SAP and DAP), maximal ST elevation (max ST­) and depression (max ST¯), ST score, TIMI flow grade, coronary score (CS), and their perireperfusion changes were assessed for each patient. The complex prognostic predictors – TIMI Risk Score and TIMI Risk Index – were also assessed. The data analysis was performed by standard statistical and machine learning approach methods. Results. The comparison of three patients’ groups according to simple ECG or circulatory characteristics showed that more significant differences were seen in postreperfusion characteristics or their perireperfusion changes. Herewith, the major part of significantly different characteristics (baseline SAP, DAP, and HR, postreperfusion SAP, DAP, ST score, and TIMI flow grade, resolution of ST score) was observed comparing both the groups of dead patients with survivors (control group). The differences in the complex predictors (TIMI Risk Score and TIMI Risk Index) were similar. However, the smallest number of significantly different characteristics was seen comparing both the groups of dead patients. The baseline DAP (P=0.045), postreperfusion SAP (P=0.04) and DAP (P=0.03), and ST score (P=0.0025) were higher in the patients who died from CR. The postreperfusion ST score and SAP were also identified as necessary components in the assessment of informative prognostic sets according to feature selection methods used in data mining field. Conclusion. The postreperfusion ST score, SAP, and DAP could be useful for the prediction of inhospital postreperfusion mode of death in patients with STEMI; evidently more clinical predictors could be useful for the prediction of general occurrence of postreperfusion deaths.

Abstract 2833: Low Erythropoietin Serum Levels Are Associated With Angiographic No-reflow After Primary Intervention For Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Giampaolo Niccoli ◽  
Francesca Marzo ◽  
Antonella Paglia ◽  
Eleonora Santucci ◽  
Cristina Spaziani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Serum Levels ◽  
St Elevation Myocardial Infarction ◽  
Consecutive Series ◽  
Primary Pci ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
St Elevation

Background : No-reflow after primary percutaneous coronary intervention (PCI) remains a clinical challenge. Erythropoietin (EPO) has been associated with reduced infarct size due to EPO’s antiapoptotic and nitric oxide enhancing effects. We aimed to assess the association between EPO serum levels measured on admission and angiographic no-reflow in patients undergoing primary PCI. Methods : From a consecutive series of 60 patients presenting with ST elevation myocardial infarction within 12 h of chest pain onset and undergoing successful primary PCI (i.e. residual stenosis < 20%), we included 48 patients (age 61±12 years, male sex 89%), comprising the first 24 with no-reflow and the first 24 without no reflow. Patients with iron deficiency, recent transfusions, liver or lung failure, other haematological disorders or undergoing treatment with EPO were excluded. EPO levels were measured by ELISA before PCI. Clinical, enzymatic, procedural and angiographic data were also collected. No-reflow was defined as a coronary TIMI flow grade ≤ 2 after vessel reopening or as a TIMI flow grade of 3 with a final myocardial blush grade <2. Multivariate predictors of no-reflow were assessed by logistic regression analysis (SPSS 13). Results : Patients with and without no-reflow did not differ significantly in age, sex, cardiovascular risk factors or standard therapy for acute myocardial infarction. Thrombus aspiration was used in 16 patients (32%) whereas abciximab in 31 (63%), and they did not differ between the two groups. Patients with angiographic no-reflow had lower EPO serum levels compared to those having angiographic reflow (4.2 (0.56 –9.5) vs 12.2 (5.7–20.2) mUI/ml, p=0.001). The left anterior descending artery (LAD) was the culprit vessel in 83% of patients having no-reflow as compared to 30% of those having reflow (p<0.0001). At multivariate analysis, including EPO levels, culprit artery and symptoms to balloon time, the independent predictors of no-reflow were LAD as culprit vessel (OR 15, 95% CI 3–75, p=0.001) and low EPO serum levels (OR 0.91, 95% CI 0.84 – 0.99, p=0.048). Conclusion : These data suggest a significant role for EPO in modulating microcirculatory injury after mechanical reperfusion in patients with ST elevation myocardial infarction.

scholarly journals Determinants and prognostic value of cardiac magnetic resonance imaging-derived infarct characteristics in non-ST-elevation myocardial infarction

2019 ◽  
Vol 21 (1) ◽  
pp. 67-76 ◽  
Author(s):  
Hans-Josef Feistritzer ◽  
Michael Nanos ◽  
Ingo Eitel ◽  
Alexander Jobs ◽  
Suzanne de Waha-Thiele ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Prognostic Value ◽  
St Elevation Myocardial Infarction ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Lv Ejection Fraction ◽  
Cmr Imaging

Abstract Aims The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI. Methods and results Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6–4.9) years. Median IS was 7.2% (IQR 2.2–13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3–84.9). Age (P ≤ 0.003), heart rate (P ≤ 0.02), the number of diseased coronary arteries (P ≤ 0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P &lt; 0.001) were independent predictors of IS and MSI. The primary endpoint occurred in 64 (22.5%) patients. CMR-derived infarct characteristics had no additional prognostic value beyond LV ejection fraction in multivariable analysis. Conclusion In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction. Clinicaltrials.gov NCT03516578.

scholarly journals TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

2021 ◽  
Vol 3 (1) ◽  
pp. 61-66
Author(s):  
Rikesh Tamrakar ◽  
Rajib Rajbhandari ◽  
Sanjay Singh KC
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcome ◽  
Percutaneous Intervention ◽  
St Elevation Myocardial Infarction ◽  
Significant Implication ◽  
Primary Pci ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Primary Percutaneous Intervention

Background: Timely reperfusion, preferably by primary percutaneous intervention (PCI) has been the guiding-principle for the treatment of patients with acute ST-elevation myocardial infarction (STEMI). TIMI flow grade of the culprit lesion after the procedure have shown to have significant implication in clinical outcome. Objective: We aimed to study the relation of TIMI flow grade with the in-hospital outcome and complication among patients of STEMI.Methods: All consecutive acute STEMI patients undergoing primary PCI during the study period (January 2020 to June 2020) were analyzed for correlation between TIMI flow grade and clinical outcome during the hospital stay. Prior approval was taken from institutional review board. The study design was retrospective observational study.Result: Total of 51(55%) patients had achieved the TIMI 3 flow after the primary PCI. Number of patients achieving TIMI flow of 2,1 and 0 after the procedure were 34(37%),6(6.5%) and 2(2%). Incidence of traditional risk factors like dyslipidemia, diabetes, hypertension was higher in TIMI flow <2 . TIMI flow <2 was also associated with more adverse events namely cardiogenic shock, arrythmias, in-hospital mortality and overall major adverse cardiovascular events.Conclusion: Patients with dyslipidemia had poor TIMI flow grade during primary PCI. Similarly, patients having hypertension, diabetes mellitus and late presentation showed tendency for TIMI flow <2 . Also, the poor TIMI flow grade after primary PCI had unfavorable the clinical outcomes like increased complications and mortality. Keywords: Primary percutaneous intervention (PCI), ST elevation MI (STEMI), TIMI flow grade

P1697Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in Non-ST-Elevation Myocardial Infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-J Feistritzer ◽  
I Eitel ◽  
A Jobs ◽  
S De Waha-Thiele ◽  
R Meyer-Saraei ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Cardiac Magnetic Resonance ◽  
Prognostic Value ◽  
St Elevation Myocardial Infarction ◽  
Timi Flow Grade ◽  
Timi Flow ◽  
St Elevation ◽  
Cmr Imaging

Abstract Background The prognostic significance of cardiac magnetic resonance (CMR) derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. Purpose To investigate determinants and the long-term prognostic impact of CMR imaging derived infarct characteristics in patients with NSTEMI. Methods Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) were assessed using CMR imaging in 311 consecutive NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centers. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The clinical endpoint was defined as major adverse cardiac events (MACE) during a median follow-up of 4.4 (IQR 3.6–4.9) years. Results Median IS was 7.0% (IQR 2.3–13.5) of LV myocardial mass (%LV) and MSI was 65.2 (IQR 36.7–82.9). Age (p=0.003), heart rate (p=0.002) and TIMI flow grade before PCI (p<0.001) were independent predictors of IS. Independent predictors of the MSI were age (p=0.001), heart rate (p=0.01), the number of diseased coronary arteries (p=0.001) and the TIMI flow grade before PCI (p<0.001). MACE occurred in 75 (24.1%) patients. CMR-derived infarct characteristics had no additional prognostic value over and above LV ejection fraction in multivariable analysis. Conclusions In this prospective, multicenter NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics above and beyond traditional risk markers.

scholarly journals Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ana Lopez-de-Andres ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernández-Barrera ◽  
Jose M. de Miguel-Yanes ◽  
Romana Albaladejo-Vicente ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Sex Differences ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Discharge ◽  
St Elevation Myocardial Infarction ◽  
Men And Women ◽  
St Elevation

Abstract Background To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences. Methods Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM. Results MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI. Conclusions T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

Effect of high dose statin preloading on TIMI flow in patients presenting with ST-Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
K Eletriby ◽  
A Desoky ◽  
N Shawky ◽  
A Farag
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Coronary Intervention ◽  
Control Group ◽  
P Value ◽  
Primary Pci ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Aim and objectives The aim of this study was to assess the impact of high intensity statins used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received high intensity statins (40-80mg of atorvastatin or 20-40mg of rosuvastatin) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy, and high intensity statins after going back to the coronary care unit after primary PCI. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded and ST-segment resolution was measured. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation. In the control group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the cases group there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction measured by M-mode had values of Mean+-SD of 45.91 ± 5.49 in cases group vs 43.01 ± 8.80 in control group which was statistically significant with a P value of 0.011. There was not a statistically significant difference between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion High intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution and ejection fraction as measured by M-mode but did not decrease incidence of in-hospital MACE.

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