Influence of the Timing of Percutaneous Coronary Intervention on Clinical Outcomes in Non-ST-Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: We have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI). SUBJECTS AND METHODS: A total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months. RESULTS: Third month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9+/-6.0% vs. 54.1+/-8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065). CONCLUSION: The early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy.

NT-proBNP levels and QT changes in acute ischemic stroke

Background: In literature, electrocardiographic (ECG) changes and the increase in the levels of the natriuretic peptide are shown to occur in patients having acute ischemic stroke. We aimed to investigate the association between ECG alterations and NT pro B-type natriuretic peptide (NT-proBNP) values in patients having acute ischemic stroke with no known cardiac pathology. Methods: The patients who admitted to the emergency service with acute ischemic stroke were enrolled in the study. Their ECGs were recorded and serum samples were obtained as soon as they arrived into the emergency service. The plasma NT-proBNP levels were measured by electrochemiluminescence method. Maximum QT interval, QT dispersion (QTd), corrected QT and corrected QTd (cQT and cQTd) was calculated, for each ECG. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). Results: A total of 50 consecutive patients were evaluated. QT intervals for 4 patients (8%) and cQT intervals for 29 patients (58%) were above 440 ms and 11 patients (22%) had QTd values above 50ms and 17 (34%) had cQTd values above 50 ms. The NTproBNP levels had a negative correlation with the GCS (p=0.001, r= -0.461) and a positive correlation with the NIHSS, cQT, QTd and cQTd (p=0.001, r=0.444, p=0.000, r=0.494, p=0.016, r=0.338 p=0.011, r=0.355, respectively). Conclusions: The NT-proBNP levels in the ischemic stroke patients with no known cardiac pathology were markedly increased, and this increase was found to be associated with the GCS, NIHSS, cQT, QTd and the cQTd interval.