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Introduction@#Red cell distribution width (RDW) is a parameter that is readily available as part of a standard complete blood count (CBC). Studies have shown that an elevated RDW is associated with increased cardiovascular events including acute coronary syndrome (ACS). This cross- sectional retrospective study was conducted to determine the association of RDW in patients with ACS admitted to Bataan General Hospital and Medical Center (BGHMC).@*Methods@#A cross-sectional study was performed in a 500-bed tertiary care hospital in Bataan, Philippines. The clinical medical records of patients with ACS were analyzed retrospectively. A total of 811 patients was admitted as cases of ACS from January 2017 to December 2019. Using Slovin’s formula, the computed sample size was 261 patients. However, only 205 cases were included in the study in accordance to the eligibility criteria. The baseline RDW were recorded from the CBC obtained upon admission of patients with ACS.@*Results@#Based on the data collected from January 2017 to December 2019 from patients admitted to BGHMC, there was no significant association between RDW and in-house morbidity and mortality and classification of ACS.@*Conclusions@#There were no significant association between RDW and in-house morbidity and mortality and classification of ACS. The authors recommend to conduct the study for a longer duration to have more population included and to include other parameters such as cardiac enzymes, electrocardiogram (ECG) changes and presence of co-morbidities.
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Erythrocyte Indices , Acute Coronary Syndrome , Angina, Unstable , ST Elevation Myocardial InfarctionABSTRACT
Resumen Antecedentes: En los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST), el acondicionamiento isquémico puede ayudar a limitar la remodelación ventricular. Objetivos: Investigar el efecto del posacondicionamiento isquémico remoto (PAIR) en la función del ventrículo izquierdo durante la intervención coronaria percutánea primaria (ICPP) en pacientes con IAMCEST. Material y métodos: Estudio de intervención pre y posprueba con un total de 60 pacientes con IAMCEST. Los pacientes fueron divididos en dos grupos: con y sin PAIR. Resultados: En el seguimiento de seis meses se observó una diferencia significativa en la fracción de eyección del ventrículo izquierdo en pacientes con ICPP, la cual fue mayor en el grupo con PAIR en comparación con el grupo sin PAIR: 1.0 (−1.0 a 4.3) versus −1.0 (−4.0 a 1.3), p = 0.033. En la medición de seis meses, el volumen sistólico final del ventrículo izquierdo en los pacientes sin PAIR fue mayor en comparación con el grupo homólogo: 79.3 ± 30.5 mL versus 64.4 ± 21.4 mL, p = 0.032. Conclusiones: PAIR muestra efectos favorables en la función ventricular izquierda y, por lo tanto, en el futuro podría ser una estrategia cardioprotectora potencial contra la lesión por isquemia-reperfusión en pacientes con IAMCEST.
Abstract Background: Ischemic conditioning may help patients with ST-segment elevation myocardial infarction (STEMI) to limit ventricular remodeling. Objectives: To investigate the effect of remote ischemic postconditioning (RIPC) on left ventricular function during primary percutaneous coronary intervention (PPCI) in patients with STEMI. Material and methods: Pre- and post-test intervention study with a total of 60 STEMI patients. Patients were divided in two groups: with and without RIPC. Results: At 6-month follow-up evaluation, a significant difference in left ventricular ejection fraction was observed in patients who underwent PPCI, which was higher in the group with RIPC in comparison with the group without RIPC: 1.0 (−1.0 to 4.3) vs. −1.0 (−4.0 to 1.3), p = 0.033. In addition, at 6-month measurement, left ventricular end-systolic volume in patients without RIPC: was higher in comparison with their counterparts: 79.3 ± 30.5 mL versus 64.4 ± 21.4 mL, p = 0.032. Conclusions: RIPC shows favorable effects on left ventricular function and, therefore, in the future, it could be a potential cardioprotective strategy against ischemia-reperfusion injury in STEMI patients.
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Abstract Background: Patients with higher thrombus burden have higher procedural complications and more long-term adverse cardiac events. Detecting patients with high thrombus burden (HTB) before coronary intervention could help avoid procedural complications. Objective: The research aimed to analyze the R wave peak time (RWPT) on the electrocardiogram to predict thrombus burden before coronary angiography in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: A total of 159 patients with STEMI were included in the study conducted at a tertiary medical center. The thrombolysis in myocardial infarction (TIMI) thrombus scale was applied to assess the thrombus burden. TIMI thrombus grades 0, 1, 2, and 3 were accepted as low; 4 and 5 had HTB. RWPT was measured from the beginning of the QRS complex to the R-peak from the leads pointing to the infarct-related artery. Results: Patients were divided into two groups according to their angiographically defined thrombus burden as low and high. The low thrombus burden group (LTB) comprised fifty-four patients, whereas the HTB group comprised 105 patients. In the LTB group, RWPT was 47.96 ± 9.17 ms, and in the HTB group was 53.58 ± 8.92 ms; it was significantly longer (p < 0.01). Receiver operating characteristic analysis showed that a cut-off value of preprocedural RWPT of > 46.5 ms predicted the occurrence of HTB with a sensitivity and specificity of 87.62% and 51.85%, respectively (AUC 0.682, 95% CI 0.590-0.774, p < 0.001). Conclusion: The present study evaluated the relationship between the RWPT and thrombus burden in STEMI patients. Based on the results, RWPT is an independent predictor of HTB.
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Introducción: la fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano. Su manejo requiere un abordaje holístico para que los resultados sean óptimos, por lo que se considera la epidemia cardiovascular del siglo XXI. Objetivo: establecer las variables ecocardiográficas asociadas al fracaso de la cardioversión en pacientes con diagnóstico clínico de fibrilación auricular y síndrome coronario agudo. Materiales y métodos: se realizó un estudio retrospectivo, analítico, no experimental de casos y controles en pacientes con fibrilación auricular y síndrome coronario agudo, durante el período comprendido entre los años 2017 y 2021. Resultados: la cardioversión eléctrica se observó en 55 pacientes (68,8 %) (OR = 0,24; IC 95 %: 0,08-0,7; p = 0,008). La terapia trombolítica se aplicó en 47 pacientes (58,8 %) (OR = 5,03; IC 95 %: 1,67-15,12; p = 0,0026). En cuanto a parámetros ecocardiográficos, la variable volumen de la aurícula izquierda ≥ 34 ml/sc predominó en 50 pacientes (62,5 %) (OR = 3,5; IC 95 %: 1,22-10,04; p = 0,016); la presión de la aurícula izquierda > 15 mmHg en 23 pacientes (OR = 3,61; IC 95 %: 1,23-10,54; p = 0,015), y el diámetro del ventrículo izquierdo > 57 mm en 20 pacientes (OR = 4,33; IC 95 %: 1,35-13,87; p = 0,009). Conclusiones: el volumen de la aurícula izquierda elevada, la presión de aurícula izquierda, el diámetro del ventrículo izquierdo, la terapia eléctrica y trombolítica, se asocian al fracaso de la cardioversión en pacientes con fibrilación auricular e infarto agudo de miocardio.
Introduction: atrial fibrillation is the most frequent sustained tachyarrhythmia in humans. Its management requires a holistic approach for the results to be optimal; it is considered the cardiovascular epidemics of the 21st century. Objective: to establish echo-cardiographic variables associated with cardioversion failure in patients with clinical diagnosis of atrial fibrillation and acute coronary syndrome. Materials and methods: a retrospective, analytical, non-experimental study of cases and controls was carried out in patients with atrial fibrillation and acute coronary syndrome, during the period between 2017 and 2021. Results: electrical cardioversion was observed in 55 patients (68.8%) (OR = 0.24; CI 95%: 0.08-0.7; p = 0.008). Thrombolytic therapy was applied in 47 patients (58.8%) (OR = 5.03; CI 95%: 1.67-15.12; p = 0.0026). Regarding echocardiographic parameters, the variable left atrial volume ≥ 34 ml/sc predominated in 50 patients (62.5%) (OR = 3.5; CI 95%: 1.22-10.04; p = 0.016); left atrial pressure > 15 mmHg predominated in 23 patients (OR = 3.61; CI 95%: 1.23-10.54; p = 0.015), and left ventricular diameter > 57 mm in 20 patients (OR = 4.33; CI 95%: 1.35-13.87; p = 0.009). Conclusions: elevated left atrial volume, left atrial pressure, and left ventricular diameter, electric and thrombolytic therapy, are all associated to cardioversion failure in patients with atrial fibrillation and acute myocardial infarction.
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Abstract Background To offer proper medical care to patients with ST-segment Elevation Acute Myocardial Infarction (STEMI) in low- and middle-income settings (LMIS) is challenging. However, it is not known if performance indicators have changed back after the epidemiological recovery. Objective to describe performance measures (PM) in patients with STEMI during and after the COVID-19 pandemic. Methods Observational study of patients with STEMI, from an LMIS, with analysis of PM suggested in the 2017 AHA-ACC Performance Measures for Adults with STEMI. COVID-19 period was determined from January 2020 to October 2021, and from November 2021 to February 2022 as the post-COVID-19 period. Baseline characteristics, treatments and selected PM were compared using the χ2 test or Mann-Whitney U test. All tests were two-sided, and statistical significance was considered as p-value <0.05. Coronary interventionism-related PM were not reported. Results Administration of thrombolysis decreased (71.2% vs 51.6% (p: 0.001)), while the delay time for its administration (Median (Interquartile Range)) increased considerably (30 min (16-60) to 45 min (35- 60) (p: 0.003)). Aspirin at admission was administered in each period at 92.9% vs 94.2% (p: 0.62); and at discharge to 97.8% vs 98.9% (p: 0.48). Beta-blockers, P2Y12 inhibitors, statins, and angiotensin-converting enzyme inhibitors in patients with heart failure were administered to 67.1% vs 85.1% (p: 0.01), 96.4% vs 84% (p: 0.001), 96.2 % vs 95.7% (p: 1), and 81.2% vs 94.3% (p: 0.14), respectively. Conclusion Despite this being a current period of epidemiological recovery, the COVID-19 pandemic continues to negatively impact the care of patients with STEMI.
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Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records. Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ?30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents. Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.
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Introducción: los síndromes coronarios agudos representan la forma aguda de la cardiopatía isquémica. Esta constituye, en Cuba, la primera causa de muerte en los últimos años. La provincia de Matanzas muestra un comportamiento similar. Objetivo: evaluar las tendencias de morbilidad y letalidad de los pacientes con síndrome coronario agudo en un período de cinco años. Materiales y métodos: se realizó un estudio descriptivo retrospectivo de corte transversal, con 734 pacientes ingresados con síndrome coronario agudo en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2016 y diciembre de 2020. Se caracterizaron los pacientes según variables clínicas. Los datos se extrajeron de las historias clínicas. Se aplicó el test Chi cuadrado. Resultados: hubo una disminución progresiva y continua del total de pacientes con síndrome coronario agudo en los cinco años estudiados. Sobresalió el sexo masculino, con un 53,67 % (p < 0,02). El grupo etario más afectado fue el de 60 a 69 años. El síndrome coronario agudo sin elevación del segmento ST prevaleció en cuatro de los años analizados. Preponderó la instauración del tratamiento trombolítico en el 78,75 % de los pacientes con síndrome coronario agudo con elevación del ST. El total de fallecidos decreció en el período estudiado. Se demostró la importancia de la aplicación de la trombolisis. Conclusiones: en el quinquenio estudiado, disminuyó gradualmente el total de pacientes con diagnóstico de síndrome coronario agudo, y la letalidad por esta causa, en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas.
Introduction: acute coronary syndromes represent the acute form of ischemic heart disease. In Cuba, it is the first cause of death in recent years. The province of Matanzas shows similar behavior. Objective: to evaluate morbidity and lethality tendencies of the patients with acute coronary syndrome in a period of five years. Materials and methods: a descriptive, retrospective, cross-sectional study was carried out with 734 patients admitted with acute coronary syndrome in the Emergency Intensive Care Unit of the Clinical Surgical University Hospital Comandante Faustino Perez, of Matanzas, between January 2016 and December 2020. The patients were characterized according to clinical variables. The data were extracted from clinical records. The Chi-square test was applied. Results: there was a progressive and continuous decrease of the total of patients with acute coronary syndrome in the studied five years. Male gender stood up with 53.67% (p < 0, 02). The most affected age group was the 60-69 years one. The acute coronary syndrome without ST segment elevation prevailed in four of the analyzed years. The establishment of the thrombolytic treatment prevailed in 78.75% of the patients with ST segment elevated acute coronary syndrome. The total of deaths decreased in the studied period. The importance of thrombolysis application was demonstrated. Conclusions: the total of patients with diagnosis of acute coronary syndrome and lethality due to this cause gradually decreased in the studied five-year period in the Emergency Intensive Care Unit of the Clinical Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas.
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Abstract Purpose To investigate the association between serum bilirubin levels and in-hospital Major Adverse Cardiac Events (MACE) in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI). Methods A total of 418 patients with STEMI who underwent primary PCI were enrolled from October 1st, 2021 to October 31st 2022. The average age of enrolled participants was 59.23 years, and 328 patients (78.50%) were male patients. Patients were divided into MACE (patients with angina pectoris after infarction, recurrent myocardial infarction, acute heart failure, cardiogenic shock, malignant arrhythmias, or death after primary PCI) (n = 98) and non-MACE (n = 320) groups. Univariate and multivariate logistic regression analyses were performed to estimate the association between different bilirubin levels including Total Bilirubin (TB), Direct Bilirubin (DB), Indirect Bilirubin (IDB), and risk of in-hospital MACE. The area under the Receiver Operating Characteristic (ROC) curve was used to determine the accuracy of bilirubin levels in predicting in-hospital MACE. Results The incidence of MACE in STEMI patients increased from the lowest to the highest bilirubin tertiles. Multivariate logistic regression analysis showed that increased total bilirubin level was an independent predictor of in-hospital MACE in patients with STEMI (p for trend = 0.02). Compared to the first TB group, the ORs for risk of MACE were 1.58 (95% CI 0.77‒3.26) and 2.28 (95% CI 1.13‒4.59) in the second and third TB groups, respectively. The ROC curve analysis showed that the areas under the curve for TB, DB and IDB in predicting in-hospital MACE were 0.642 (95% CI 0.578‒0.705, p < 0.001), 0.676 (95% CI 0.614‒0.738, p < 0.001), and 0.619 (95% CI 0.554‒0.683, p < 0.001), respectively. Conclusions The current study showed that elevated TB, DB, and IDB levels are independent predictors of in-hospital MACE in patients with STEMI after primary PCI, and that DB has a better predictive value than TB and IDB.
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Introducción: El patrón de supradesnivel del segmento ST en aVR en el síndrome coronario agudo se asocia con un aumento de la mortalidad. Objetivo: Evaluar la relación entre el patrón de supradesnivel del segmento ST en aVR y las complicaciones cardiovasculares no letales. Método: Estudio observacional de corte transversal, con componente analítico de todos los pacientes ingresados con síndrome coronario agudo sin elevación del segmento ST, en el Hospital Universitario Manuel Fajardo de la Habana entre los años 2016 y 2020. Resultados: Predominó el sexo femenino en el primer grupo, con una mediana de 78 años. Hubo incidencia de cardiopatía isquémica (75 por ciento y 56,4 por ciento) e hipertensión arterial (78,8 por ciento y 85,8 por ciento ). Se determinó una relación estadística significativa entre el patrón con elevación del segmento ST en aVR y las complicaciones cardiovasculares con un riesgo relativo de 5,769 veces. Conclusiones: El patrón de supradesnivel del segmento ST en un síndrome coronario agudo sin elevación del segmento ST predice complicaciones intrahospitalarias cardiovasculares no letales(AU)
Introduction: The pattern of ST-segment elevation in aVR in acute coronary syndrome is associated with increased mortality. Objective: To evaluate the relationship between the pattern of ST-segment elevation in aVR and nonlethal cardiovascular complications. Methods: Observational cross-sectional study, with analytical component of all patients admitted with non-ST-segment elevation acute coronary syndrome at the Manuel Fajardo University Hospital of Havana between 2016 and 2020. Results: Female gender predominated in the first group, with an average age of 78 years. There was incidence of ischemic heart disease (75 percent and 56.4 percent) and arterial hypertension (78.8 percent and 85.8 percent). A significant statistical relationship was determined between the pattern with ST-segment elevation in aVR and cardiovascular complications with a relative risk of 5.769 times. Conclusions: ST-segment suprathreshold pattern in non-ST-segment elevation acute coronary syndrome predicts non-lethal in-hospital cardiovascular complications(AU)
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Humans , Male , Female , Middle Aged , Aged , Electrocardiography/methods , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , Non-ST Elevated Myocardial Infarction/epidemiology , Heart Disease Risk Factors , Cross-Sectional Studies , Myocardial Ischemia/complications , Coronary Care Units , Observational StudyABSTRACT
Objective To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n =98 ), the MVO group had significantly reduced LV global RS (t= -4.30, P < 0.001), global CS (t= 4.99, P < 0.001), and global LS ( t= 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t= -3.38, P = 0.001; t= 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t= 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR= 4.10, 95%CI: 2.05 - 8.19, P<0.001) and its size [OR=1.38, 95%CI: 1.10-1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 - 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.
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Humans , Middle Aged , Aged , ST Elevation Myocardial Infarction/complications , Contrast Media , Retrospective Studies , Gadolinium , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Percutaneous Coronary InterventionABSTRACT
Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.
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Objective:To explore the prognostic predictive value of deep neural network (DNN) assisted myocardial contrast echocardiography (MCE) quantitative analysis of ST-elevated myocardial infarction (STEMI) patients after successful percutaneous coronary intervention(PCI).Methods:A retrospective analysis was performed in 97 STEMI patients with thrombolysis in myocardial infarction-3 flow in infarct vessel after primary PCI in Renmin Hospital of Wuhan University from June to November 2021. MCE was performed within 48 h after PCI. Patients were followed up to 120 days. The adverse events were defined as cardiac death, hospitalization for congestive heart failure, reinfarction, stroke and recurrent angina. The framework consisted of the U-net and hierarchical convolutional LSTMs. The plateau myocardial contrast intensity (A), micro-bubble rate constant (β), and microvascular blood flow (MBF) for all myocardial segments were obtained by the framework, and then underwent variability analysis. Patients were divided into low MBF group and high MBF group based on MBF values, the baseline characteristics and adverse events were compared between the two groups. Other variables included biomarkers, ventricular wall motion analysis, MCE qualitative analysis, and left ventricular ejection fraction. The relationship between various variables and prognosis was investigated using Cox regression analysis. The ROC curve was plotted to evaluate the diagnostic efficacy of the models, and the diagnostic efficacy of the models was compared using the integrated discrimination improvement index (IDI).Results:The time-cost for processing all 3 810 frames from 97 patients was 377 s. 92.89% and 7.11% of the frames were evaluated by an experienced echocardiographer as "good segmentation" and "correction needed". The correlation coefficients of A, β, and MBF ranged from 0.97 to 0.99 for intra-observer and inter-observer variability. During follow-up, 20 patients met the adverse events. Multivariate Cox regression analysis showed that for each increase of 1 IU/s in MBF of the infarct-related artery territory, the risk of adverse events decreased by 6% ( HR 0.94, 95% CI =0.91-0.98). There was a 4.5-fold increased risk of adverse events in the low MBF group ( HR 5.50, 95% CI=1.55-19.49). After incorporating DNN-assisted MCE quantitative analysis into qualitative analysis, the IDI for prognostic prediction was 15% (AUC 0.86, sensitivity 0.78, specificity 0.73). Conclusions:MBF of the area supplied by infarct-related artery after STEMI-PCI is an independent protective factor for short-term prognosis. The DNN-assisted MCE quantitative analysis is an objective, efficient, and reproducible method to evaluate microvascular perfusion. Assessment of culprit-MBF after PCI in STEMI patients adds independent short-term prognostic information over qualitative analysis.It has the potential to be a valuable tool for risk stratification and clinical follow-up.
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Objective:To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction (STEMI) patients with left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI).Methods:One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group (LVR group, 34 cases) and non left ventricular remodeling group (NLVR group, 92 cases) according to whether there was left ventricular remodeling 3 months after surgery. General data were collected. Routine echocardiography and noninvasive myocardial work imaging were performed before, 1 week, 1 month, and 3 months after surgery, the differences in the above parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI, and a predictive model was obtained. The diagnostic value of the model was judged by ROC curve.Results:①General information comparison: There were statistically significant differences between the two groups in BMI, systolic blood pressure, diastolic blood pressure, average number of stents implanted, and history of hyperlipidemia (all P<0.05), but there was no significant difference in other data (all P>0.05). There was no statistically significant difference in two-dimensional transthoracic echocardiography (2D-TTE) parameters and non-invasive myocardial work (MW) parameters between the two groups before and 1 week after operation (both P>0.05). ②2D-TTE parameter comparison: LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group, and LVEF and E/A were significantly lower than those in the NLVR group (all P<0.05); There were no significant differences in other indexes between the two groups by conventional echocardiography at 3 months after PCI(all P>0.05). ③Comparisons of noninvasive myocardial work parameters: GLS, GWE, GWI, GCW at 1 month and 3 months after PCI in the LVR group were significantly lower than those in the NLVR group, and GWW were significantly higher than those in the NLVR group ( P<0.001). ④Correlation analysis: GLS, GWE, GCW, GWI and LVEDV were negatively correlated at 1 month after operation ( r=-0.42, -0.38, -0.50, -0.53, all P<0.001), GWW was positively correlated with LVEDV ( r=0.45, P<0.001). ⑤Logistic regression analysis: GLS<17%, GCW<1 900 mmHg%, GWW>105 mmHg%, and GWE<90 mmHg% at 1 month after PCI were independent predictors for LVR in STEMI patients after PCI (all P<0.05). The predictive model was Logit (P)=0.692GLS+ 0.804GCW+ 0.972GWW+ 0.880GWE. The AUC of this model was 0.886, 95% CI=0.845-0.926, which was significantly higher than single index, the sensitivity was 0.86, and the specificity was 0.79. Conclusions:GLS, GWE, GWI, GCW are positively correlated with LVR, while GWW is negatively correlated with left ventricular remodeling. Noninvasive myocardial work parameters are independent risk factors for left ventricular remodeling in patients with STEMI after PCI surgery. This technique can be used to evaluate LVR and has great clinical application value.
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Objective:To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI.Results:In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade Ⅲ, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95% CI) was 0.702-0.923], 0.725 (95% CI was 0.666-0.812) and 0.882 (95% CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. Conclusions:The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.
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Objective:To explore the application and effect of scenario simulation teaching in ST-segment elevation myocardial infarction (STEMI) course for emergency training of "5+3" professional master.Methods:A randomized controlled trial was conducted among 48 "5+3" professional masters who would rotate in the emergency department, to compare the test results of the total and three scenes between scenario simulation teaching group ( n=24) and traditional teaching group ( n=24). The STEMI teaching was carried out through simulating the emergency room, standardized patients and first-aid simulators in the simulation teaching group, and the traditional teaching group was taught by conventional classroom teaching. After the class, "Theoretical Examination" and "Questionnaire Survey" were used to evaluate the teaching effect. The former was further divided into "first diagnosis and differential diagnosis of chest pain", "fast identification and processing of STEMI" and "rescue of cardiac arrest" for inter-group and intra-group evaluation. SPSS 20.0 was used to conduct t-test. Results:In the theoretical examination, the scenario simulation teaching group was superior to the traditional teaching group in the test of emergency processing for STEMI course [(82.38±2.41) vs . (68.00±1.95), t=4.64, P<0.001]. In the sub-analysis of scenario simulation teaching group, students in the role-play group had significantly higher scores than others in the non-role-play group [(90.50±3.04) vs . (79.67±2.79), t=2.09, P=0.049]. Scenario simulation teaching group was also superior to traditional teaching group in the "Questionnaire Survey". Conclusion:In the training and teaching of STEMI emergency processing, scenario simulation teaching group proves to be superior to traditional teaching, which deserves further promotion.
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Objective:To construct acute ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) by using lipoprotein-associated phospholipase A2 (Lp-PLA2) and D-dimer to fibrinogen ratio (D/F) and other indicators postoperative patient prognosis nomogram model and evaluation of its predictive value.Methods:A total of 291 acute STEMI patients admitted to the BenQ Hospital Affiliated to Nanjing Medical University from January 2017 to January 2020 were retrospectively selected, including but not limited to Lp-PLA2 and D/F, were collected. Receiver operating characteristic (ROC) curve and multivariate Logistic regression were used to analyze the risk factors of death within 90 d after PCI in STEMI patients, and Kaplan-Meier survival curves were drawn to compare the survival of patients in different Lp-PLA2 and D/F groups. The R language software was used to build nomogram model and decision curve.Results:The AUCs of LpPLA2 and D/F for predicting the risk of death from cardiac causes at 90 s after PCI in patients with acute STEMI were 0.896 (95% CI 0.850 to 0.932) and 0.884 (95% CI 0.837 to 0.922), respectively. The values were 59.50 μg/L and 0.46 respectively ( P<0.05); the mortality rates of acute STEMI patients in LpPLA2>59.50 μg/L and D/F>0.46 groups after PCI were higher than those in LpPLA2≤59.50 μg/L group and D/F≤0.46 group ( P<0.05); age (>66 years), left ventricular ejection fraction (LVEF) (≤45%), LpPLA2 (>59.50 μg/L), D/F (>0.46), N-terminal brain natriuretic peptide precursor (>1.55 μg/L) and fasting blood glucose (>7.00 mmol/L) were the risk of death from cardiac causes at 90 d after PCI in patients with acute STEMI ( P<0.05); when the risk thresholds were >0.24, the nomogram model could provide significant additional net clinical benefit. Conclusions:Lp-PLA2 and D/F are closely related to the prognosis of patients with acute STEMI after PCI, and the nomogram model constructed in combination with other clinical indicators can effectively predict the risk of death within 90 d after PCI.
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Although bivalirudin has been recently made available for purchase in China, large-scale analyses on the safety profile of bivalirudin among Chinese patients is lacking. Thus, this study aimed to compare the safety profile of bivalirudin and heparin as anticoagulants in Chinese ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). A total of 1063 STEMI patients undergoing PCI and receiving bivalirudin (n=424, bivalirudin group) or heparin (n=639, heparin group) as anticoagulants were retrospectively enrolled. The net adverse clinical events (NACEs) within 30 days after PCI were recorded, including major adverse cardiac and cerebral events (MACCEs) and bleeding events (bleeding academic research consortium (BARC) grades 2-5 (BARC 2-5)). The incidences of NACEs (10.1 vs 15.6%) (P=0.010), BARC 2-5 bleeding events (5.2 vs 10.3%) (P=0.003), and BARC grades 3-5 (BARC 3-5) bleeding events (2.1 vs 5.5%) (P=0.007) were lower in the bivalirudin group compared to the heparin group, whereas general MACCEs incidence (8.9 vs 6.4%) (P=0.131) and each category of MACCEs (all P>0.05) did not differ between two groups. Furthermore, the multivariate logistic analyses showed that bivalirudin (vs heparin) was independently correlated with lower risk of NACEs (OR=0.508, P=0.002), BARC 2-5 bleeding events (OR=0.403, P=0.001), and BARC 3-5 bleeding events (OR=0.452, P=0.042); other independent risk factors for NACEs, MACCEs, or BARC bleeding events included history of diabetes mellitus, emergency operation, multiple lesional vessels, stent length >33.0 mm, and higher CRUSADE score (all P<0.05). Thus, bivalirudin presented a better safety profile than heparin among Chinese STEMI patients undergoing PCI.
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Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI
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ABSTRACT Objective: ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. Methods: Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients' age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. Results: The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). Conclusion: High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.
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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.