The Significance of Apolipoprotein-A in the Long-Term Death of Patients with STEMI

Objective. To analyze apolipoprotein-A for its predictive value for long-term death in individuals suffering from acute ST-segment elevation myocardial infarction following percutaneous coronary intervention. Methods. We selected patients suffering from acute ST-segment elevation myocardial infarction who underwent emergency PCI at the Affiliated Hospital of Putian University from January 2017 to August 2019. The patients were divided into a high-Apo-A group and low-Apo-A group, and we observed all-cause deaths of patients in the 2 groups within 2 years. Results. The ROC curve analysis indicated the best critical value for predicting 2-year mortality as 0.8150 (area under the curve was 0.626, sensitivity 75.1%, and specificity 51.9%). There was no statistical difference among the two groups in gender, age, lesion vessel, and comorbidities. The two groups had statistically significant differences in apolipoprotein-B/A, high-density lipoprotein, apolipoprotein-A, and hypersensitivity C-reactive protein. Correlation analysis showed a significant negative correlation between apolipoprotein-A and hypersensitive C-reactive protein. The results of the 24-month analysis indicated the incidence of all-cause mortality as higher in the low-Apo-A group, and Kaplan–Meier survival analysis showed the same trend. Conclusion. Apolipoprotein-A can predict the potential for long-term mortality among individuals having acute ST-segment elevation myocardial infarction.

Qrs-Complex Fragmentations and Right Ventricular Infarction in the Presence of Inferior Infarction with Triple-Vessels Disease; Bad Initials but a Good Outcome

Rationale: The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated right ventricular infarction with inferior infarction maybe carry a risk impact and serious complications. Patient concerns: A 64-year-old married, farmer, heavy smoker, Egyptian male patient presented with acute severe chest pain and inferior with right ventricular ST-segment elevation myocardial infarction and fragmentation of the QRS complex. Diagnosis: QRS-complex fragmentations and right ventricular infarction in the presence of inferior infarction with the triple-vessels disease. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute inferior with right ventricular ST-segment elevation myocardial infarction and QRS-complex fragmentations to streptokinase. Lessons: Despite the presence of inferior and right ventricular ST-segment elevation myocardial infarction with QRS-complex fragmentations, but there is no correlation with the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase and fibrinolytic. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications.

Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry

Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (−) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan–Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.

Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction

Background: At present, the mechanism of reciprocal ST-segment depression(RSTD) is still not clear.Methods: The electrocardiogram and angiography of 85 STEMI patients were retrospectively analyzed to summarize the characteristics of ST segment changes and explore the mechanism of RSTD.Results: A total of 85 patients were included, of which 75 were patients with RSTD (10 patients with anterior myocardial infarction had no RSTD), all 45 patients with inferior myocardial infarction had limb leads RSTD, and 37 of them had anterior lead ST segment depression.Thirty patients with anterior myocardial infarction were accompanied by mild ST segment changes in the limb leads. According to the characteristics of RSTD, it is speculated that the mechanism of RSTD is that the action potential of infarct area decreased , which could not offset the action potential in non-infarct area.Conclusion: the mechanism of RSTD in acute myocardial infarction maybe that the negative electrode action potential of the lead was weakened or disappeared, and the positive electrode action potential could not be completely offset, resulting in ST segment depression.

Optimal Revascularization Strategy for Patients With ST-segment Elevation Myocardial Infarction and Multivessel Disease: A Pairwise and Network Meta-Analysis

Background: The relative benefit of immediate complete revascularization, staged complete revascularization, and culprit-only percutaneous coronary intervention (PCI) remains unclear in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. The aim of this study was to compare the clinical outcomes of the 3 PCI strategies in this population.Methods: We followed a pre-specified protocol (PROSPERO number: CRD42020183801). A comprehensive search of the electronic databases including PubMed, EMBASE and Cochrane Library from inception through February 21, 2020 was conducted. Randomized trials evaluating the comparative efficacy and safety of at least 2 of the 3 PCI strategies were identified. The primary endpoint was the composite of cardiovascular mortality or myocardial infarction (MI) during the longest follow-up. Pairwise and network meta-analyses were performed with random-effects model.Results: Eleven trials including 6,942 patients were analyzed. Pairwise meta-analysis noted that immediate complete revascularization and staged complete revascularization were respectively associated with a 52 and 27% reduction in the risk of cardiovascular death or MI (relative risk [RR] 0.48, 95% confidence interval [CI] 0.32–0.73, I2 = 0%; and RR 0.73, 95% CI 0.61–0.88, I2 = 0%, respectively), compared with culprit-only PCI. The risk of cardiovascular death or MI was not statistically different in staged and immediate complete revascularization groups (RR 0.88, 95% CI 0.45–1.72, I2 = 0%). Network meta-analysis obtained almost similar results compared with pairwise meta-analysis, and immediate complete revascularization had a 77% probability of being the best strategy for reducing cardiovascular death or MI among the 3 PCI strategies.Conclusion: The current evidence suggests that both immediate and staged complete revascularization were associated with a reduction of cardiovascular death or MI compared with culprit-only PCI. Further trials are warranted to directly compare immediate vs. staged complete revascularization in this population.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42020183801].

Evaluation of Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction with Hypertension by Dynamic Electrocardiogram Feature Data

This work was to study the application value of dynamic electrocardiogram (ECG) feature data in evaluating the curative effect of percutaneous coronary intervention in acute ST-segment elevation myocardial infarction with hypertension, so as to facilitate the early diagnosis and treatment of the disease. In this study, 90 patients with acute ST-segment elevation myocardial infarction accompanied by hypertension were selected as the study subjects and randomly divided into group A (oral aspirin antiplatelet therapy), group B (thrombolytic drug streptokinase (SK) therapy), and group C (percutaneous coronary intervention), with 30 cases in each group. In addition, a P-wave detection algorithm was introduced for automatic detection and analysis of electrocardiograms, and the efficacy of patients was assessed by Holter feature data based on the P-wave detection algorithm. The results showed that the diagnostic error rate, sensitivity, and predictive accuracy of the P-wave detection algorithm for ST-segment elevation myocardial infarction caused by acute occlusion of left main coronary artery (LMCA) were 0.24%, 95.41%, and 92.33%, respectively; the diagnostic error rate, sensitivity, and predictive accuracy for non-LMCA (nLMCA) ST-segment elevation myocardial infarction were 0.28%, 95.32%, and 96.07%, respectively; the proportion of patients with symptom to blood flow patency time <3 h in group C (55.3%) was significantly higher than that in groups A and B (22.1% and 22.6%) ( P < 0.05). Compared with group A, the content of B-type natriuretic peptide (pre-proBNP) at 1 week, 2 weeks, and 3 weeks after treatment in groups B and C was significantly lower and group C was significantly lower than group B ( P < 0.05). In summary, the P-wave detection algorithm has a high application value in the diagnosis and early prediction of acute ST-segment elevation myocardial infarction. Percutaneous coronary intervention in the treatment of acute ST-segment elevation myocardial infarction with hypertension can shorten the opening time of infarction blood flow, so as to effectively protect the heart function of patients.