A Comparative Study of Risk Factors and Prognosis in Young and Elderly Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of young patients with acute STEMI.Methods:Patients initially diagnosed with STEMI in the 920"Hospital of Joint Logistic Support Force of PLA from January 1,2018 to December 31,2022 were retrospectively enrolled in this study.A total of 235 STEMI patients aged≤45 years old and 532 STEMI patients aged≥65 years old were screened.The baseline characteristics,laboratory indicators,clinical characteristics,coronary angiography,SYNTAX score and major adverse cardiovascular events(MACE)during 1-year follow-up were analyzed and compared.Results:A total of 767 STEMI patients were enrolled,including 235 in the young group and 532 in the elderly group.Among the STEM patients in the young group,224 cases were male,and smoking and drinking were common.Compared with the elderly group,the young group had shorter hospital stays and more family history of ischemic heart disease(IHD).The level of low-density lipoprotein in the young group was higher than that in the old group,while the level of high-density lipoprotein in the young group was lower than that in the old group.The level of high uric acid and homocysteine in the young group was significantly higher than that in the old group.The main cause of STEMI in the young group was fatigue,and the most common symptom was angina pectoris.Coronary angiography showed that single vessel disease was more common in the young group than in the elderly group,and the lesion in the young group was the left anterior descending artery.The SYNTAX score was significantly lower in the young group than in the elderly group according to the anatomical characteristics of coronary artery disease.In the forest plot,diabetes mellitus and a family history of IHD showed a trend of major adverse cardiovascular events(MACE)in both groups.Conclusion:Males,smokers,alcohol drinkers and family history of ischemic heart disease are more common in young patients.Common risk factors include fatigue,hyperuricemia,hyperlipidemia and so on.In addition,age itself is an independent risk factor.Management of diabetes,hyperuricemia,and homocysteine levels is essential to reduce the incidence of cardiovascular events in young patients.By controlling these factors,the incidence of young patients with acute STEMI can be effectively prevented and the corresponding prevention and treatment basis can be provided.

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient:A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction

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 CMRFT 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.

Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction： a multicenter random- ized clinical trial

Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.

Culprit vessel only versus ＂one-week＂ staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

Objective To explore the impact of a ＂one-week＂ staged muhivessel percutaneous coronary intervention （PCI） versus culprit-only PCI on deaths and major adverse cardiac events （MACE）. Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction （STEMI） within 12 h before undergoing PCI between July 26, 2008 and Septem- ber 25, 201 l. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a ＂one-week＂ staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause （i.e., cardiac and noncardiac） and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the ＂one-week＂ staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 （16.7%） vs. 13 （6.5%）, P = 0.004] and MACE [82 （33.3%） vs. 40 （19.9%）, P = 0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 （17.5%） vs. 20 （10.0%）, P = 0.023], coronary-artery bypass grafting [CABG; 20 （8.1%） vs. 6 （3.0%）, P = 0.021], and PCI [31 （12.6%） vs. 12 （6.0%）, P - 0.018]. Patients undergoing culprit-only PCI compared to ＂one-week＂ PCI had the same number of stent thrombosis events [7 （2.8%） vs. 3 （1.5%）, P - 0.522]. Conclusions Compared to a culprit-only PCI treatment approach, ＂one-week＂ staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCL

Effects of nicorandil on myocardial infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention:study design and protocol for the randomized controlled trial

Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.

Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

AIM: To evaluate the impact of thrombus aspiration(TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction(STEMI) registry.METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.RESULTS: A total of 456 patients were analyzable and categorized in TA group(156 patients; 34.2%) and non-TA(NTA) group(300 patients; 65.8%). Patientstreated with TA had less prevalence of multivessel disease(39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow 【 3(P 【 0.001) than NTA group. There was a higher rate of direct stenting(58.7% vs 45.5%, P = 0.009), with shorter(24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents(3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P 【 0.001) in the TA group as compared to NTA group. The number of implanted stents(1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION: In an “all-comers” STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).

The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction： results from the Korean Acute Myocardial Infarction National Registry with Registries

Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction （STEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.

N-terminal pro-B-type natriuretic peptide as prognostic marker for patients of non ST-segment elevation myocardial infarction

In this work, we analyzed only the patients of the NSTEMI (non ST-segment elevation myocardial infarction) who arrived at the hospital within 12 h after symptoms started. Using NSTEMI follow-up data within, the characteristics of the clinical data, the risk factor, and the blood tested in the hospital visit were analyzed for MACE (major adverse cardiac events) patients. MACE includes cardiac death, MI (myocardial infarction), Re-PCI, and CABG (coronary artery bypass graft). As a result, from the NSTEMI patients which can be followed up for over 12 m, NT-ProBNP (p=0.014) and age (p=0.045) are found to be the independent risk factors related to MACE. Accordingly, they can be useful for the diagnosis and prognosis for NSTEMI patients as a biomarker.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.

Effects of Loading-Dose Statins Combined with PCSK9 Inhibitor Pre-Treatment before Primary Percutaneous Coronary Intervention on the Short-Term Prognosis in Patients with ST-Segment Elevation Myocardial Infarction

Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with ST-segment elevation myocardial infarction(STEMI).Method:Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the study.The enrolled patients had no history of oral statins or antiplatelet therapy.The patients were divided into a combined treatment group(loading dose of statins combined with PCSK9 inhibitors,35 patients)and a routine treatment group(loading dose of statins only,30 patients).The primary endpoints were thrombolysis in myocardial infarction(TIMI)blood flow grading,corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grading(TMPG),immediately after and 30 days after the operation.The secondary endpoint was a composite endpoint of cardiovascular death,nonfatal myocardial infarction,and target vessel revascularization 30 days after the operation.Results:The combined treatment group had significantly lower CTFC(14.09±8.42 vs 26±12.42,P=0.04)and better TMPG(2.74±0.61 vs 2.5±0.73,P=0.04)than the routine treatment group immediately after the operation.Similarly,the combined treatment group had a significantly lower CTFC(16.29±7.39 vs 26.23±11.53,P=0.04)and significantly better TMPG(2.94±0.24 vs 2.76±0.43,P=0.01)than the routine treatment group 1 month after the operation.Conclusion:Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with STEMI.However,the treatment did not significantly decrease the incidence of cardiovascular death,nonfatal myocardial infarction,or target vessel revascularization.

Effects of intermittent cold-exposure on culprit plaque morphology in ST-segment elevation myocardial infarction patients: a retrospective study based on optical coherence tomography

Objective:Present study aimed to explore the effects of intermittent cold-exposure(ICE)on culprit plaque morphology in patients with ST-segment elevation myocardial infarction(STEMI)in frigid zone.Methods:Totally 848 STEMI patients with plaque rupture(N=637)or plaque erosion(N=211)were enrolled consecutively according to optical coherence tomography imaging.Data on the changes of outdoor air temperature corresponding to 24 solar terms were collected.Patients were divided into different groups according to 24 solar terms and the number of days with indoor central heating.Imaging data were measured and analyzed qualitatively and quantitatively.Statistical analysis was conducted to elucidate the possible association of the STEMI patients of different groups with plaque morphology of culprit vessel with alterations of ambient temperature.Results:The incidence of both plaque rupture and plaque erosion presented trough in summer.The incidence of plaque rupture reached a peak value in early winter when outdoor air temperature dropped below 0℃and declined with supply of central heating.Persistent cold exposure in early winter was positively and significantly associated with plaque rupture.The incidence of plaque erosion presented a peak in severe winter with outdoor air temperature dropping below-20℃and steady supply of central heating.ICE in severe winter was positively and significantly associated with plaque with intact intima,especially in aged male or current smoking patients.The positive correlation of cold exposure with lipid size in culprit plaque in winter weakened with central heating.Conclusion:ICE resulted from switching staying in between outdoor cold environment and indoor warm temperature with central heating in severe winter changed culprit plaque morphology in STEMI.Plaque rupture decreased whereas plaque erosion increased impacted by ICE.The effect of ICE on the transformation of plaque morphology might be explained by reduced lipid deposition.

Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention： an updated meta- analysis

Background The clinical efficacy and safety of adjunctive thrombus aspiration （TA） in patients with ST-segment elevation myocardial infarction （STEMI） during percutaneous coronary intervention （PCI） remain controversial. Methods Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration （TA） with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events （MACE）, recurrent infarction （RI）, target vessel revascularization （TVR）, stent thrombosis （ST）, perfusion surrogate markers and stroke. Results TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm [relative risk （RR）： 1.05, 95% confidence intervals （CI）： 1.02-1.09, P = 0.004] and （RR： 1.68, 95% CI： 1.40-2.00, P 〈 0.001）, respectively. There were no significant differences in all-cause mortal- ity, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration （RR： 0.60, 95% CI： 0.38-0.96, P = 0.03）, but there was no significant difference in RI incidence over the me- diumor long-term follow-up periods （RR： 1.00, 95% CI： 0.77-1.29, P = 0.98）, and （RR： 0.96, 95% CI： 0.81-1.15, P = 0.69）, respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI （RR： 1.60, 95% CI： 1.08-2.38, P = 0.02） and （RR： 1.43, 95% CI： 1.03-1.98, P = 0.03）, respectively; this was not observed between the two arms during the short-term follow-up period （RR： 1.47, 95% CI： 0.97-2.21, P = 0.07）. Conclusions Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.

Timely reperfusion for ST-segment elevation myocardial infarction:Effect of direct transfer to primary angioplasty on time delays and clinical outcomes

Primary percutaneous coronary intervention(PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction(STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them,prehospital diagnosis and direct transfer to the cath lab,by-passing the emergency department of hospitals,has emerged as anattractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.

Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.

ST-segment elevation myocardial infarction in Kawasaki disease:A case report and review of literature

BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.