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.

Thrombosis and major bleeding risk after primary percutaneous coronary intervention among patients with multi-vessels coronary artery disease (Preprint)

2021 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Chen Liu ◽  
Peng Zhou ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Major Bleeding ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Primary Pci ◽  
Percutaneous Coronary

BACKGROUND The risk of thrombotic events (TEs), including myocardial infarction (MI) and ST, is lower in patients with acute coronary syndrome who receive dual antiplatelet therapy (DAPT) with aspirin or who have undergone primary percutaneous coronary intervention (PCI) OBJECTIVE Background and Aims The present study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multi-vessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI). METHODS TEs were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) 3 or 5 bleeding. The derivation and validation cohorts comprised 2976 patients who underwent primary PCI between January 2010 and June 2017. RESULTS At a median follow-up of 3.07 years (1122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.820 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n=755) was associated with a higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death, compared to low risk (n=1275) (p=0.0022, 0.019, 0.012, respectively). High bleeding risk (n=1675) was associated with a higher incidence of bleeding, MACEs, cardiac death, compared to low risk (n=355) (p<0.0001). CONCLUSIONS Conclusion Simple risk scores can be useful in predicting the risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

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 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 Isolated right ventricular myocardial infarction: a case report

2020 ◽  
Author(s):  
Adeogo Akinwale Olusan ◽  
Paul Francis Brennan ◽  
Paul Weir Johnston
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Ventricular ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Right Ventricular Myocardial Infarction ◽  
Percutaneous Coronary

Abstract Background Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway. Case summary A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. Discussion This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.

Sign in / Sign up

Export Citation Format

Share Document