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Background: Anaemia is prevalent among cases with acute coronary syndrome (ACS) and has been linked to poor clinical prognosis. Guidelines for cases with ST-segment elevation myocardial infarction (STEMI) recommend timely primary percutaneous coronary intervention (pPCI) as the preferred reperfusion strategy. If timely pPCI cannot be performed, a pharmacoinvasive strategy (PI) is recommended within 12 hours of symptom onset. The aim of this work was to study and assess the impact of hemoglobin level as a predictor of MACE and short-term outcomes in cases treated with Primary PCI vs pharmacoinvasive strategy. Methods: This prospective case-control observational study was conducted on 100 cases that were divided into 2 groups. Group I consisted of 50 anaemic cases & group II consisted of 50 cases that were not anaemic. Both groups were subdivided into A subgroups that underwent revascularization by pPCI and B subgroups that underwent revascularization by pharmacoinvasive strategy. Results: There was no significant difference in LVEF, infarct site and final TIMI flow, the anaemic groups showed statistically significant more total MACE than non-anaemic groups whether revascularized by pPCI or pharmacoinvasive strategy. As expected, anaemic cases tended to have higher bleeding complications especially those undergoing pharmacoinvasive strategy. The anaemic cases also were less likely to be discharged on RAAS and beta blockers. Conclusions: Anaemic cases whether revascularized with pPCI or pharmacoinvasive strategy tend to have higher incidence of MACE and major bleeding with no significant difference in mortality. There was no significant difference between LVEF between the study groups.
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Background: ST-segment elevation myocardial infarction (STEMI) is the most dramatic manifestation of coronary artery disease, acute STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic ST elevation and subsequent release of biomarkers of myocardial necrosis. Reperfusion with thrombolysis or PCI (percutaneous coronary intervention) is the current standard of care for STEMI. Aims and Objectives: The aim of the study was to compare the effectiveness of fibrinolytic therapy and primary PCI which are the available reperfusion strategies for STEMI. Materials and Methods: This prospective and observational study was conducted at a tertiary care hospital in Bangalore. Patients presenting with STEMI to emergency department were treated with either fibrinolysis or PCI as per protocol. Patients in each arm were followed up to know the differences in outcome at discharge and 30-day follow-up. Results: Patients admitted with STEMI had overall in hospital mortality of 17 (7.1%) patients, of which 9 (7.6%) patients were from fibrinolysis group and 8 (6.6%) patients from PCI group with no statistically significant difference (P = 0.760). There was significant incidence (P = 0.001) of reinfarct in fibrinolysis group (9.3%) when compared to PCI group (0%). Conclusion: There was no statistically significant mortality difference at discharge and at 30 day between fibrinolysis and primary PCI in patients with STEMI in our study, this may be attributed to use of rescue PCI in failed fibrinolysis patients and early tricuspid valve repair in many patients after fibrinolysis.
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Aim:This study aimed to compare between the effect ofpharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCIrelated delay (door to ballon) on the mortality and morbidityduring in-hospital stay and after 30-day follow up. Moreover, leftventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University. Patients and Methods:The study was conducted on 300 patients that were dividedinto 2 main groups. Group A consisted of patients had primaryPCI as reperfusion therapy and further divided into threegroups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who undergopharmaco-invasive strategy, PCI within 24 hour afterthrombolysis (76 patients). the second group, coronary angiography was done immediately in cases of failedthrombolysis and for successful thrombolysis; coronaryangiography was performed within 3 –24 hours. Results:During hospital stay, more patients in group A3 died than those of group B orgroup A1, A2 with no statistical significance.In addition, morepatients in group A3 showed heart failure symptoms withstatistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly moreingroupB. Duringfollowupvisits more patients in group A3 complained ofheart failure symptoms with statistical significance than those of group B, A1, A2 patients. Conclusion:Primary PCIwithout door to balloon time delay (≤90 minutes)was encouraged and hadthebest results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCIwhen door to balloon time showed marked delay( <90 minutes)
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Background: Primary PCI (PPCI) is the main reperfusion treatment for ST-segment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI.Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02�.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups.Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups.Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.
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ST-segment elevation myocardial infarction (STEMI) in patients with multivessel disease is a common situation, and suggests poor prognosis. After the reperfusion of infarct-related blood vessels in the primary PCI (PPCI), how to deal with the non-infarct related vessel has been a hot issue. In recent years, more and more evidence suggests that compared with treatment of infarct-related vessels only, revascularization of non-infarct related vessels will result in a better prognosis. But the timing and the choice of non-infarct-related vessel revascularization are still controversial. This article reviews the latest clinical evidence to improve the diagnosis and treatment of STEMI patients with multivessel disease.
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Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.
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Background: Aim of the study was to evaluate the primary procedural success of Multivessel Percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction at the same sitting. Methods: Total 23 (13.4%) patients were enrolled in this very preliminary study, among the total 171 patients who had primary PCI at our center from Jan 2010 to February 2015. Among them, Male: 20 and Female: 3. Total 52 stents were deployed in 46 territories. Mean age were for both male and female were 54 yrs. Associated coronary artery disease risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, positive family history for coronary artery disease and Smoking. Results: Among the study group; 17(74%) were Dyslipidemic, 11(47.8%) were hypertensive; 8(34.8%) patients were Diabetic, positive family history 4(17.4%) and 9(39%) were all male smoker. Female patients were more obese (BMI: M 26: F 27). Common diagnosis at admission based on ECG evidence was; Inferior wall myocardial infarction: 12 (52.2%), Anterior wall myocardial infarction 9(39.1%) and lateral 2(8.7%). Common stented territory was left anterior descending artery 9(39.1%), right coronary artery 7(30.4%), and left circumflex artery 7(30.4%). Stent used: Bare metal stent 3 (5.7%), DES: 49 (94.2%). Among the different drug eluting stents, Everolimus 26 (52%), Sirolimus 8(15.4%) and Zotarolimus 9(17.3%), Paclitaxel 2 (3.8%), Biolimus 2 (3.8%), Genous 2 (3.8%). Conclusion: In the current prospective non randomized study, we found that the multivessel primary PCI for ST elevation myocardial infarction with non-culprit vessel are suitable for PCI at the same sitting with better in-hospital and 1 yr survival outcome.
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Objective: Aim of our study was to evaluate the safety and survival outcome of Primary PCI (pPCI) in patients with Acute Myocardial infarction in our hospital setting. Methods: Total 30 (Female 5; Male 25) patients were enrolled in this study who were brought in to our hospital with STEMI. Average age was, Male 56, Female 52. Primary PCI was performed after transferring patient from Emergency Department (ED) to Cardiac Catheterization laboratory. Cardiovascular risk factors among the studied population were Dyslipidemia, Diabetes Mellitus, Hypertension, Smoking and Family History. Results: Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (Sirolimus-eluting stent or Paclitaxel stent) were performed in total 13 LAD lesion and 15 RCA lesion and 2 LCX lesion. BMS used were 66.7%, Sirolimus 20% and Paclitaxel-eluting stent 13.3%. Total 2 patients expired but due to hemorrhagic CVA and refractory heart failure. At presentation, ECG evidenced diagnosis were Acute Anterior Wall MI : 12 (40%), Inferior MI: 16 (53%), Infero-Posterior MI: 2 (6.7%). Our study showed that Primary PCI increases the higher survival outcome 28 (93.3%) out of 30 patients with acute MI. Conclusion: Our present study revealed that revascularization by Primary PCI showed safety and better percentage of In-hospital and 30-days survival outcome in patients with Acute myocardial infarction in our hospital setting.
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Objective To study mortality of acute myocardial infarction caused by acute left main coronary artery occlusion.The objectives of this analysis were to determine the effect of primary PCI and the impact of cardiogenic shock on acute myocardial infarction caused by acute left main coronary artery occlusion.Methods From 1999 to 2005,of 752 consecutive patients with acute myocardial infarction,16 patients had acute left main coronary artery occlusion with TIMI flow≤2.All patients were given primary PCI.Results Of these 16 patients,9(56.25%)died in hospital,and 7(43.75%)discharged.In the survival group reperfusion was successful in 100% of patients,as opposed to 44.44% in the mortality group(P=0.019).Cardiogenic shock was overt in 12(75.00%)patients,42.86% of the survival group and 100% of the mortality group(P=0.020).Shock patients had higher in-hospital mortality than stable patients(75 % vs 0%,odds=4.0,95%CI 1.50~10.66,P=0.019).Conclusion Patients presenting with AMI caused by acute left main coronary artery occlusion and cardiogenic shock have poor survival regardless of primary PCI.Nevertheless,primary PCI is a feasible and effective procedure,and it may save lives in this clinical setting.
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0.05, all statistically insignificant. Conclusions: Primary PCI was equally effective for the treatment of one vessel and multivessel AMI patients.