Three-Dimensional Speckle Tracking Echocardiography To Evaluate Left Ventricular Function In Patients With Acute ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention Following Tongxinluo Treatment

Objective: Bying comparing the correlation between three-dimensional speckle tracking echocardiography (3D-STE) and three-dimensional left ventricular ejection fraction (LVEF), to explore the 3D-STE to evaluate the left ventricle of patients with acute ST-segment elevation myocardial infarction (acute STEMI) after percutaneous coronary intervention (PCI) following routine treatment with Tongxinluo drugs. Methods: Altogether, 60 patients with acute STEMI and 30 healthy adults were selected, and the patients were randomly divided into the routine group and the Tongxinluo group, with 30 people in each group. All patients underwent PCI, and routine echocardiography and 3D-STE assessments were performed for each group 72 h after PCI and 12 months after PCI to obtain the following left ventricular related functional parameters: left ventricular end-diastolic diameter (LVEDD), end-ventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular short axis shortening fraction (LVFS), Simpson’s left ventricular ejection fraction (Simpson’s LVEF), three-dimensional left ventricular ejection fraction (3D-LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist angle (LVtw), Torsion (Tor), peak strain dispersion (PSD), and myocardial comprehensive index (MCI). The same parameters were collected in the control group, the results were compared, and the correlation analysis between GCS, GLS, LVtw, Tor, and MCIF, and 3D-LVE was performed. Results: Compared with the control group, the LVFS, LVEF (Simpson), 3D-LVEF, GLS, GCS, LVtw, Tor, and MCI significantly decreased in patients with STEMI after PCI, while the PSD significantly increased ( P <0.05). Compared with the values 72 h after PCI, the LVEDD, LVFS, LVEF (Simpson), 3D-LVEF, GLS, GCS, LVtw, Tor, and MCI significantly increased at 12 m after PCI, while PSD significantly decreased ( P <0.05). No significant difference was observed between the two groups at 72 h after PCI ( P >0.05). At 12 months after PCI, the LVEF, GLS, GCS, LVtw, Tor, and MCI of the Tongxinluo group were higher than those of the routine group. The PSD was significantly lower in the Tongxinluo group ( P <0.05). MCI and 3D-LVEF have the strongest correlation and highest consistency, which can best reflect the changes in the left ventricular function in patients with acute STEMI after PCI. Conclusion: 3D-STE can be used to evaluate the protective effect of Tongxinluo on the left ventricular function in patients with acute STEMI after PCI.

Comparison of Intracoronary Versus Intravneous Tirofiban in Acute STEMI Patients Undergoing Primary PCI

Objective: This study aimed to investigate the effect of intracoronary tirofiban compared to intravenously administered tirofiban in acute ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI).Methods: This study included 180 patients who were admitted with the diagnosis of acute STEMI and undergoing primary PCI. Patients were randomized into an observation group (n = 90) and control group (n = 90). Both groups received typical treatments, such as aspirin and clopidogrel/ticagrelor. During the procedure, the observation and control groups were administered intracoronary (IC) or intravenous (IV) injections of tirofiban, respectively, followed by an intravenous infusion of tirofiban for 24 hours. Changes in thrombolysis in myocardial infarction (TIMI) flow grading, TIMI myocardial perfusion grade 3 (TMP grade 3), thrombus aspiration, brain natriuretic peptide (BNP) levels, creatine kinase peak and inflammatory factor levels, infarct size, resolution of the sum of ST‐segment elevation (Sum‐STR) two hours after the operation, and cardiac functional parameters were investigated before and/or after treatment and 6 months after discharge. The incidence of major adverse cardiovascular events (MACE) and adverse reactions (AEs) such as bleeding were compared between the two groups.Results: There were no statistically significant differences observed in the indices of BNP, creatine kinase peak, cardiac functional parameters, thrombus aspiration, or incidence of bleeding between the two groups before treatment. Following treatment, TIMI flow grading and TMP grade 3 were improved in the observation group that received intracoronary tirofiban compared to the control group (p = 0.022 and p = 0.014, respectively). Additionally, the Sum‐umi two hours after operation in the observation group was better than that in the control group (p = 0.029). The incidence of MACEs in patients given IC tirofiban administration was lower than that in those given IV tirofiban (p = 0.012). Furthermore, levels of glutamic oxaloacetictransaminase (AST), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and myocardial troponin I (TNI) in the observation group was significantly decreased compared to the control group after five days of treatment (p = 0.039, p = 0.040, p = 0.001, and p = 0.041, respectively). Functional heart parameters including CO and LVEF were significantly improved in the observation group 6 months after discharge.Conclusion: This study found that IC administration of tirofiban in patients with STEMI who underwent PPCI improved TIMI, TMP flow and cardiac function including CO and LVEF 6 months after discharge, and reduced CRP, ESR, and TNI. However, the incidence of bleeding between the two groups was comparable. These findings suggest that IC administration should be applied in certain acute STEMI patients.

Correlation between body mass index and in-hospital mortality in patients with ST-segment elevation myocardial infarction in Erbil city- Iraq

Background: Although High body mass index is associated with many cardiovascular diseases including coronary artery disease. Its effect on in-hospital death in patients with acute ST-segment elevation myocardial infarction (STEMI) is still a subject of controversy. Objective: To determine the correlation between body mass index (BMI) and in-hospital mortality in those patients. Patients and Methods: In this cross-sectional study, 180 adult patients with acute STEMI were enrolled and their BMI was measured. The participants were classified according to BMI into three groups as normal, overweight, and obese. A correlation between in-hospital mortality due to STEMI and BMI was evaluated. Results: Of the total participants, 62 (34.4%) were normally weighted, 61(33.8%) were over-weighted, and 57(31.6%) were obese. There was a significant difference (p= <0.001) between the groups concerning troponin I, hs-CRP, GRACE score, and the probability of in-hospital death. There were 16 (8.8%) in-hospital deaths during the study distributed as follows; 1(1.6%) in the normal-weight group, 5(8.1%) in the overweight group, and 10 (17.5%) in the obese group. In-hospital death showed a significant difference (p=0.04) between the study groups. In addition, a significant positive correlation(r=0.9) was found between BMI and in-hospital death. Conclusion: A robust positive correlation was detected between BMI and in-hospital mortality due to acute STEMI. When BMI increases, the number of deaths also increases exponentially. Keywords: Body mass index, ST-segment elevation myocardial infarction, mortality

Comparison between preoperative loading dose with Ticagrelor and Clopidogrel on myocardial perfusion during intervention in patients with STsegment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Aim and Objectives The aim of this study is to compare between clopidogrel and ticagrelor loading doses 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. They were divided into 2 groups where the1st group 85 patients received clopidogrel loading dose (600mg) and the 2nd group 85 patients received ticagrelor loading dose (180mg). Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation (71.8% in the clopidogrel group and 50.6% in ticagrelor group). In the clopidogrel 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 ticagrelor group there was 2 patients with TIMI I flow and MBG I, s with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. There was no statistical significance between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion Ticagrelor loading before primary PCI resulted in improved TIMI flow, MBG but did not decrease incidence of in-hospital MACE.

Study of Global Longitudinal Strain and N Terminal Pro BNP as Predictors of Outcome in Acute ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions

Background Risk stratification of patients presenting with Acute ST-segment elevation myocardial infarction (STEMI) is of greatest importance as it may help to start early therapeutic procedures that could improve the outcome. Our study is designed to assess the prognostic value of N-terminal pro brain natriuretic peptide (NT-proBNP) and global longitudinal strain (GLS) of the left ventricle measured by 2 dimensional speckle tracking echocardiography (STE) in patients presenting with acute STEMI and treated by primary percutaneous coronary interventions (PPCI). Patients and Methods the study prospectively included 100 patients(their age 55.69 ±8.70 years, and 75% were males)presented to our institute (from march 2019 to December 2019) by acute STEMI and treated by PPCI within 12 hour of the onset of chest pain, excluding those with left ventricular ejection fraction ≤40%, left bundle branch block, atrial fibrillation, significant valvular disease, patients with non cardiac causes that interfere with NT-Pro BNP level eg.(renal failure, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia, liver cirrhosis, hyperthyroidism, and on those on chemotherapy). All patients were subjected to peripheral samples of plasma for analysis of NT- proBNP and 2dimentional STE for calculation of the GLS, both were done within 24 hours of admission, and follow up of all patients were done for 6 months to assess outcome. Results The mean GLS for all patients was -10.41 ± 3.59%, and the mean NT- proBNP (2090.1 ± 1375.8) pg/ml. 20 patients (20%) had adverse events during the 6 month follow up including (1(1%) had all cause mortality, 2(2%) had cardiovascular mortality, 6(6%) had reinfarction, 11(11%) had heart failure hospitalization, and according to ROC curve analysis the GLS cut off value of (≤- 8) was able to discriminate patients with adverse outcome (AUC=0.971, p value&lt;0.001,CI=“0.940-1.001”,sensitivity=90%, specificity=91.67%, PPV=78.3%, NPV=96.5%) (figure 1, 2), also according to ROC curve analysis NT-pro BNP cut off value of (&gt;2318pg/ml) was able to discriminate patients with adverse outcome (AUC=0.802,p value&lt;0.001, CI=“0.685-0.920”, sensitivity=89%, specificity=75%, PPV=51.6%, NPV=91.8%) (Figure 3, 4). There was a statistically significant inverse correlation between GLS and NT- ProBNP (r=-0.492*, p value&lt;0.001). In multivariate COX regression analysis for the parameters affecting the outcome, GLS was shown to be the most significant parameter in the prediction of reaching adverse outcome in STEMI patients (p value=0.003, OR “95%C.I”= 0.721 (0.580–0.896). Conclusions our study concluded that both GLS and NT-proBNP are significantly related to adverse outcome with more superiority of the GLS to NT- pro BNP in adverse outcome prediction in patients acute STEMI treated by PPCI.

Direct or Direct-Like Stenting in Acute Stemi with High-Grade Thrombus: A Clinical Case Series

We consider herewith acute ST-elevation myocardial infarction cases having high grade thrombus who underwent direct stenting or direct like stenting of the culprit vessel in those a drug-eluting stent was not crossable directly or distal landing zone was not visible directly after successful guidewire navigation in distal true lumen. All the 4 patients had presented with acute STEMI and high-grade thrombus on angiography. All of them were treated with percutaneous coronary intervention incorporating either direct stenting or direct like stenting. All had a very good angiographic outcome with TIMI 3 flow and MBG >/= 2. In most patients with acute STEMI and high-grade thrombus, direct or direct-like stenting is possible, it simplifies the procedure with almost nil on table complications. Twee table abstract Direct and direct-like stenting in patients with high grade thrombus with STEMI is possible in most of the patients. It resulted in TIMI 3 flow and MBG 2 in all our patients. None of them had no-reflow phenomenon. Lay Abstract In any case of ST-elevation MI, time is one of the most important aspects. In this process, it is important to minimize the damage to the heart muscle. Therefore, we need to open the culprit artery in a timely and urgent fashion to restore the blood flow to the heart muscle as quickly as possible. During this restoration of the blood flow, we need to minimize the distal embolization of the clot which may be detrimental to the heart muscle. Here, we describe the cases where we have done stenting directly without touching the clot and that resulted in minimal embolization and better outcomes.

Relationship between Admission Electrolyte Level and Short-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

Objective. The objective of this study is to analyze the relationship between the electrolyte level of patients with acute ST-segment elevation myocardial infarction (STEMI) and short-term prognosis after percutaneous coronary intervention (PCI). Methods. The clinical data of 142 patients with acute STEMI who underwent PCI in our hospital from September 2018 to September 2019 were retrospectively analyzed. According to the level of serum sodium, potassium, and chloride in patients admitted to the hospital, they were divided into the normal electrolyte group (n = 78), the mild decline group (n = 46), and the severe decline group (n = 16). Univariate and logistic regression multivariate analysis of the relationship between patient electrolyte levels and general clinical data is performed. Statistical analysis of patients’ adverse events within 90 days was performed. The Kaplan–Meier survival curve analyzed the relationship between the survival period and electrolyte levels in patients with acute STEMI without major acute cardiovascular events (MACE) within 90 days. Results. The levels of creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), myocardial infarction area, and Gensini score in patients with mild decline were significantly higher than those in the normal group, left ventricle ejection fractions (LVEF) value was significantly lower than the normal group, and patients with severe decline were significantly higher in creatine kinase (CK) level than the normal group ( P < 0.05 ). The levels of CK-MB, CK, cTnI, and myocardial infarction area of the patients in the severe decline group were significantly higher than those in the mild decline group, and the LVEF values were significantly lower than those in the mild decline group ( P < 0.05 ). The levels of CK-MB, CK, cTnI, the area of myocardial infarction, and Gensini score in patients with acute STEMI have an independent effect on their electrolyte levels. The patients in the mild decline group and severe decline group had significantly higher rates of cardiogenic shock, heart failure, ventricular aneurysm formation, ventricular septal perforation, or death within 90 days after PCI. The median without MACE survival time of patients with mildly and severely reduced electrolyte levels was significantly lower than that of patients with normal electrolyte levels. Conclusion. Patients with acute STEMI are prone to electrolyte disturbances, and their CK-MB, CK, and cTnI levels; myocardial infarction area; and Gensini score have independent effects on electrolyte levels. Patients with electrolyte disturbances are prone to poor prognosis after PCI, and their survival period without MACE at 90 days is significantly lower than that of normal patients.