Safety of Early and Late Discharge in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 104 (8) ◽  
pp. 1339-1346
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Early Discharge ◽  
Asian Countries ◽  
Killip Class ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Coronary Care ◽  
Group 2 ◽  
Group 1

Background: Primary percutaneous coronary intervention (PPCI) is now a standard treatment procedure for ST elevation myocardial infraction (STEMI) patients. Because of the many STEMI patients, there is a space constraint in coronary care unit, especially in Southeast Asian countries. Therefore, we practitioners should be evaluating if the patients could be safely discharged earlier. The current European Society of Cardiology STEMI 2017 guideline recommended early discharge in stable patients; however, the data are limited, especially in the Asian countries. Objective: To determine the rate of 30-day, 1-year mortality, and readmission of STEMI patients that underwent PPCI and were discharged early within three days of admission, compared with the late discharge of more than three days after admission. Materials and Methods: The present study was a retrospective cohort study at King Chulalongkorn Memorial Hospital. The authors collected consecutive cases of STEMI patients that underwent PPCI and were discharged between January 1999 and December 2015.The patients were divided into two groups as group 1 with early discharge within three days of admission and group 2 with late discharge more than three days of admission. The follow up on the mortality and readmission rates were collected at 30-day and 1-year after discharge. Results: Out of 1,242 STEMI patients, 691 patients (55.6%) were classified in group 1 and 551 patients (44.4%) were in group 2. The 30-day mortality was 0.4% in group 1 compared with 1.3% in group 2 (HR 2.93, p=0.12) and 1-year mortality was 3.9% in group 1 compared with 8.0% in group 2 (HR 2.09, p=0.003). There was no difference in 30-day readmission between both groups at 1.3% versus 2.5% (OR 1.98, p=0.113), but there was a difference in 1-year readmission between the two groups at 4.5% versus 10.6% (OR 2.51, p<0.001). In multivariate analysis, the predictive factors for early discharged STEMI patients were male (adjusted OR 1.78, p=0.007), Killip classification 1, 2, and 3 (adjusted OR 5.85, p=0.001), EF greater than 40% (adjusted OR 2.51, p=0.001), and TIMI flow after PPCI 3 (adjusted OR 1.48, p=0.016). Conclusion: Early discharge in STEMI patients within three days after PPCI is safe in terms of mortality and readmission compared to late discharge, especially in STEMI patients with Killip class I. Early discharge can provide more space for coronary care. Keywords: STEMI; PPCI; Early discharge; Late discharge; Mortality; Readmission; Killip class

SOLELY INFARC-RELATED ARTERY VERSUS STAGED PERCUTANEOUS CORONARY INTERVENTION IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS WITH MULTIVESSEL CORONARY DISEASE

2014 ◽  
pp. 56-62
Author(s):  
Anh Tuan Ho ◽  
Van Dien Nguyen ◽  
Anh Tien Hoang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Today, there are different interventional approaches for patients undergoing ST elevation myocardial infarction (STEMI) with multiple vessel diseases. Objectives: to compare the mid-term results of two strategies of myocardial revascularization used for the management of patients with STEMI with multiple vessel diseases. Material and methods: we analyzed retrogradely 64 profiles of patients diagnosed STEMI with multiple vessel diseases on coronary angiography and underwent angioplasty in Cardiovascular department from 5/2013 – 1/2014. The patients had been divided into 2 groups: group 1 (percutaneous coronary intervention (PCI) of the sole Infarct-related artery followed by medical therapy, n=33) and group 2 (staged PCI in STEMI patients with multiple vessel diseases, n=31). Results: group 2 had comparable combined end-points (death + Myocardial infarction + revascularization) rate but higher rate of detection of significantly stenosed non-culprit vessels than those of group 1. Conclusion: for the STEMI patients with multiple vessel diseases admitted to Hue University hospital, staged PCI was better than PCI of the sole infarct-related artery in term of omitting less patients who were appropriate for revascularization (these patients had no indication for coronary artery bypass graft). However, these two approaches had no statistical difference regarding to major adverse cardiac events. Key words: Acute myocardial infarction, Multivessel disease, Primary percutaneous coronary intervention

Abstract 4471: Long-Term Follow-Up After Deferral of Percutaneous Coronary Intervention (PCI) in Patients With Moderate Coronary Lesions and Borderline Fractional Flow Reserve Measurements

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Takafumi Yamane ◽  
Koichi Tamita ◽  
Noriomi Kimura ◽  
Shunsuke Funakoshi ◽  
Kite Kim ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Coronary Lesions ◽  
Group 2 ◽  
Group 1

Background: Many studies have demonstrated that deferral of percutaneous coronary intervention (PCI) on the basis of a myocardial fractional flow reserve (FFR) ≥0.75 is associated with a very low coronary event rate. However, some groups have empirically chosen the cut-off value of 0.80 rather than 0.75 for decision to defer PCI and the FFR measurement between 0.75 and 0.80 has been established as a grey zone. The aim of this study was to evaluate the long-term clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80. Methods: The study included 125 anigiographically moderate coronary lesions (>50% diameter stenosis by visual assessment) in 125 patients but in whom the PCI was deferred on the basis of an FFR ≥ 0.75. The FFR was calculated as the ratio of mean distal pressure divided by the proximal pressure during hyperemia. Patients were divided into two groups according to the result of FFR: ≥ 0.80 (n=99, group 1) and between 0.75 and 0.79 (n=26, group 2). We evaluated the long-term major adverse cardiovascular events (MACE) related and unrelated to the FFR-evaluated lesion. Results: During a follow-up period of 82 ± 29 months (mean ± SD), The Kaplan-Meier event-free survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0148). The incidence of MACE unrelated FFR-evaluated lesion in group 1 was equivalent to that in group 2 (p=0.96). Conclusions: In patients with moderate coronary lesions and borderline FFR measurements, deferral of PCI was associated with a higher rate of MACE related to the FFR-evaluated lesion. FFR cut-off point of 0.80 instead of 0.75 may be more appropriate for deferring PCI.

scholarly journals Current perspectives on location of monitoring and length of stay following PPCI for ST elevation myocardial infarction

2019 ◽  
Vol 8 (6) ◽  
pp. 562-570 ◽  
Author(s):  
Musa A Sharkawi ◽  
Sean McMahon ◽  
Dania Al Jabri ◽  
Paul D Thompson
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Critical Care ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Early Discharge ◽  
Percutaneous Coronary ◽  
St Elevation

Importance: There is marked variability in location of care and hospital length of stay after primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI). Observations: We performed a literature review on non-critical care monitoring and early discharge following primary percutaneous coronary intervention and describe a framework for implementation in the real world. The medical literature was searched from 1 January 1988 to 31 April 2019 using PubMed and Cochrane Central Register of Controlled Trials. Randomized clinical trials, observational studies and guideline statements were included. Available data suggest that carefully selected low-risk STEMI patients identified using Zwolle or CADILLAC risk stratification scores after primary percutaneous coronary intervention may be considered for discharge after 48 hours of hospital care. There was no increase in major adverse cardiac events, medication non-compliance or hospital readmission with this treatment strategy. There are limited data on non-critical monitoring of uncomplicated STEMI patients; however, given the low adverse events rate, this strategy is likely to be safe in selected patients and may facilitate reduced length of stay and reduce resource utilization. Conclusions and relevance: Available evidence supports the safety of early discharge after 48 hours of care and omission of critical care monitoring in carefully selected patients following primary percutaneous coronary intervention. Early risk stratification and structured discharge planning are imperative. Adoption of this treatment strategy could reduce hospital costs, resource utilization and enhance patient satisfaction without affecting outcomes.

Ticagrelor pretreatment in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Graca Santos ◽  
R Ribeiro Carvalho ◽  
S Fernandes ◽  
F Montenegro Sa ◽  
C Ruivo ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Catheterization Laboratory ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Safety Endpoint ◽  
St Elevation ◽  
Group 2 ◽  
One Year ◽  
Primary Safety Endpoint

Abstract Introduction Dual antiplatelet therapy is recommended in non-ST elevation acute coronary syndrome (NSTACS), regardless of the treatment strategy (invasive vs. conservative). Although prasugrel pretreatment is not recommended due to safety concerns, the timing of ticagrelor administration is still debated. Aim To investigate the clinical effects of ticagrelor pretreatment in NSTACS patients (pts) undergoing percutaneous coronary intervention. Methods Retrospective multicentre study of 5213 NSTACS pts who underwent percutaneous coronary intervention (PCI) up to 72 hours following hospital admission, between January 2013 and December 2018. Patients with prior chronic exposure to oral antithrombotics (except acetylsalicylic acid), not acutely managed with ticagrelor, and those with missing data were excluded. A total of 415 pts were included for analysis, 256 (61.6%) received ticagrelor pretreatment (Group 1) and 159 (38.3%) were treated with ticagrelor only in the catheterization laboratory (Group 2). The primary safety endpoint was a composite of in-hospital major bleeding, need for red blood cell transfusion or haemoglobin drop ≥2g/dL and the secondary endpoint of periprocedural events was a composite of PCI failure, bailout use of GPIIb/IIIa inhibitors and in-hospital re-infarction. Multivariate analysis was performed to determine the correlates of ticagrelor pretreatment and each of the endpoints. One-year follow up was achieved in 103 pts (24.8%). Results Overall, mean age was 62±11 years and 20.7% were female. Crude event rates did not differ regarding primary endpoint (16.5 vs 11.5%; p=0.17), while secondary endpoint was more frequent among group 2 (2.1% vs 7.1%; p=0.01). Multivariate analysis showed no association between the timing of ticagrelor administration and the primary safety endpoint, while periprocedural events were less frequent in pretreated pts (Figure 1A). At the Kaplan-Meier analysis, one-year cumulative event-free (all-cause death, stroke or re-infarction) rates did not differ (Figure 1B). Conclusion In this cohort of NSTACS pts undergoing PCI in the first 72 hours after hospital admission, ticagrelor pretreatment was associated with less periprocedural events with no compromise regarding safety, compared to treatment in the catheterization laboratory. Additional data is still needed to clarify these findings. Funding Acknowledgement Type of funding source: None

scholarly journals Features of energy and adipokine metabolism in patients with acute myocardial infarction and type 2 diabetes after percutaneous coronary intervention

2021 ◽  
Vol 25 (4) ◽  
pp. 599-604
Author(s):  
M. Yu. Koteliukh
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
Group 2 ◽  
Group 1

Annotation. The study of energy and adipokine metabolism indicators for the development and course of acute myocardial infarction (AMI) with comorbidity remains relevant. The aim of the study was to determine the content of energy and adipokine metabolism in patients with myocardial infarction and ST-segment elevation depending on the presence and absence of type 2 diabetes mellitus (DM) after percutaneous coronary intervention (PCI). The study involved examination of 60 patients with AMI (Group 1) and 74 patients with AMI and type 2 diabetes (Group 2). Each group was divided into 2 subgroups according to coronary artery (CA) stenting. The control group included 20 healthy individuals. Adropin, irisin, fatty acid binding protein 4 (FABP 4), C1q / TNF-associated protein 3 (CTRP 3) were determined by enzyme-linked immunosorbent assay. All patients underwent coronary angiography. Statistical processing of the results of the study was carried out using the software package “IBM SPPS Statistics 27.0”. There was a decrease in the content of adropin, irisin and CTRP 3 and an increase in the concentration of FABP 4 on day 1 in Groups 1 and 2 compared with the control group (p˂0.05). In Groups 1 and 2 on day 14 there was an increase in the concentration of adropin by 23.87% and 41.43%, irisin by 56.59% and 11.11%, CTRP3 by 11.59% and 20.01% compared to day 1 (p<0.05). The level of FABP 4 in Groups 1 and 2 decreased by 19.69% and 26.61% compared to day 1 (p <0.05). In Group 1, an inverse correlation was found between Syntax Score (SS) and adropin (r= -0.432, p=0.01), irisin (r= -0.478, p<0.01), CTRP 3 (r= - 0.473, p<0.01) and a positive correlation between SS and FABP 4 (r= 0.436, p<0.05). In Group 2, there was an inverse relationship between SS and adropin (r= -0.452, p<0.05), irisin (r= -0.458, p<0.05), CTRP 3 (r= -0.437, p<0.05) and the direct relationship between SS and FABP 4 (FABP 4 (r= 0.418, p<0.05). Thus, the peculiarities of the content of energy and adipokine metabolism indicators in patients with AMI with existing and absent type 2 diabetes before and after primary CA stenting were studied.

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