Prognostic value of C-reactive protein levels within 6 hours after the onset of acute anterior myocardial infarction with primary PCI

Background Increased levels of inflammatory markers have been documented in various settings of coronary artery disease. The vulnerability of coronary lesions in acute myocardial infarction(AMI) at the time of onset may be related to serum levels of C reactive protein(CRP) on admission, before CRP levels are affected by myocardial damage.Objective This study assessed the predictive value of CRP levels within six hours after the onset of acute anterior myocardial infarction with primary percutaneous coronary intervention(PCI).Methods The plasma CRP of 76 patients with first acute anterior myocardial infarction was measured within 6 hours after onset. They were divided into 2 groups: group 1( n =20) with elevated CRP( ≥0.3mg/dl ) on admission within 6 hours after onset and group 2( n =56) with normal CRP( <0.3mg/dl ) within 6 hours after onset. All patients were treated by primary PCI. The primary combined end points, including death due to cardiac causes, re MI related to the infarction artery(RIA) and repeat intervention of the RIA, and the restenosis rate were assessed in relation to CRP levels within 6 hours after onset. Left ventricular end diastolic volume index(EDVI),end systolic volume index(ESVI),and ejection fraction(EF) on admission and 6 month after the onset were assessed by left ventriculography. Changes in EDVI(ΔEDVI),ESVI(ΔESVI), and EF(ΔEF) were obtained by subtracting respective on admission values from corresponding 6 month follow up values. Results There were no significant differences in baseline characteristics between the two groups. The primary combined end points were significantly more frequent in group 1(20%) than those in group 2( 1.79% , P <0.01 ).In addition, restenosis rates were significantly higher in group 1 than in group 2(41.18% vs 16.07%, P<0.05). Group 1 showed greater increases in left ventricular volume and less improvement in EF compared with group 2(ΔEDVI 6.31 ±2.17 vs 3.29 ±9.46ml/m 2 , ΔESVI 5.92 ±2.31 vs 3.86 ±1.08ml/m 2 , ΔEF 1.92 ±0.47 vs 4.79 ±1.73% , P <0.05 , respectively).Conclusions CRP levels within 6 hours after the onset of AMI might predict adverse outcome after primary PCI and progressive ventricular remodeling within 6 month of AMI.

Impact of Right Ventricular Dysfunction in Morbidity and Mortality in Patients with Inferior Wall Myocardial Infarction Presenting to a Tertiary Care Center of Nepal

Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.

Effects of Compound Danshen Dripping Pills on Ventricular Remodeling and Cardiac Function after Acute Anterior Wall ST-Segment Elevation Myocardial Infarction(CODE-AAMI):Protocol for a Randomized Placebo-Controlled Trial

Background:Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction(AAMI)is an important factor in occurrence of heart failure which additionally results in poor prognosis.Therefore,the treatment of ventricular remodeling needs to be further optimized.Compound Danshen Dripping Pills(CDDP),a traditional Chinese medicine,exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction.Objective:This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale.Methods:This study is a multi-center,randomized,doubleblind,placebo-controlled,parallel-group clinical trial.The total of 268 patients with AAMI after primary percutaneous coronary intervention(pPCI)will be randomly assigned 1:1 to the CDDP group(n=134)and control group(n=134)with a follow-up of 48 weeks.Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction(STEMI),with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI,and the control group treated with a placebo simultaneously.The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(LVEDVI),and left ventricular end-systolic volume index(LVESVI).The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide(NT-proBNP)level,arrhythmias,and cardiovascular events(death,cardiac arrest,or cardiopulmonary resuscitation,rehospitalization due to heart failure or angina pectoris,deterioration of cardiac function,and stroke).Investigators and patients are both blinded to the allocated treatment.Discussion:This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI.Patients in the CDDP group will be compared with those in the control group.If certified to be effective,CDDP treatment in AAMI will probably be advised on a larger scale.(Trial registration No.NCT05000411)

Disappearance of septal q-wave or appearance of abnormal Q-wave in V_5 and V_6 after onset of anterior acute myocardial infarction: electrocardiographic and angiographic correlations

Background The factors influencing the q-wave changes in V5 and V6 during anterior acute myocardial in- farction （AMI） have not been thoroughly described. Methods We studied 70 patients with a first anterior AMI, in whom the electrocardiogram （ECG） showed either disappearance of the normal septal q wave （n = 24） or presence of pathological Q wave in V5 and V6 （n = 46） during follow-up. The ECG and coronary angiography findings were correlated. Results There was no difference between the 2 groups in the culprit site proximal to S1 （46% vs. 36%, P = 0.405）, but the culprit site was more frequently located proximal to DI in the group with abnormal Q wave （21% vs. 67%, P = 0.001）. Patients with disappearance of the septal q wave more often had a large obtuse marginal branch （46 % vs. 22%, P = 0.037） and disappearance of the r wave in V1 （88% vs. 7%, P = 0.001）. Patients with abnormal Q-wave more often had a large LAD （42% vs. 71%）, small r wave or tall or wide R wave in V1 （0 % vs. 89 %, P = 0.001） and abnormal Q waves in the inferior leads （33% vs. 59%, P = 0.044）. Conclusions In patients with first anterior AMI, q wave changes in V5 and V6 correlated with the morphology in V1. Emerging abnormal Q wave in Vs/V6 predicted the culprit lesion in a large LAD proximal to D1, but disappearance of the septal q wave could not predict the culprit lesion proximal to S1.