Impact of primary percutaneous coronary intervention on ST-segment elevation myocardial infarction patients:A comprehensive analysis

BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.

Comprehensive analysis of the impact of primary percutaneous coronary intervention on patients with ST-segment elevation myocardial infarction

This comprehensive analysis by Saeed and Faeq investigates the impact of primary percutaneous coronary intervention(pPCI)on mortality among patients with ST-segment elevation myocardial infarction(STEMI)at the Erbil Cardiac Center.Analyzing data from 96 consecutive STEMI patients,the study identified significant predictors of in-hospital mortality,emphasizing the critical impact of time of hospital arrival post-symptom onset on overall prognosis.Findings indicate that factors such as atypical presentation,cardiogenic shock,chronic kidney disease,and specific coronary complications are associated with higher mortality rates.The study underscores the necessity of prompt medical intervention for improving survival outcomes in STEMI patients,especially in the high-risk subgroup.This research offers valuable insights into optimizing STEMI management and enhancing patient survival rates through effective and timely pPCI.

A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention:Mechanisms,incidence and identification of patients at risk

Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.

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.

Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST- elevation myocardial infarction

Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary pereutaneous coronary intervention （PPCI）. Methods From January 2009 to December 2012, 1268 patients （86.4% male, mean age of 58,4 ± 12.2 years） presented to our hospital for ST-elevation myocardial infarction （STEMI） and underwent PPCI. They were divided into two groups： elderly group defined as age _〉 70 years and non-elderly group defined as age 〈 70 years. Data were collected retrospectively on baseline clinical characteristics, door-to-balloon （D2B） time, angiographic findings, therapeutic modality and hospital course. Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glyeoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strat- egy for these elderly patients are warranted.

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.

Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective： To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction（AMI）. Methods： 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the data from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitalization, and the six-month follow-up results in both groups. Results： Our results showed that the achier ement ratio of arteriopuncture, cannulafion time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min, respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 rain for the transradial group and 27.89 ± 3.95 min（P 〈 0.05） for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 2.2% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days（P 〈 0.05） for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups（P 〉 0.05）. Conclusion： The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.

Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention： a meta-analysis

Background Suboptimal myocardial reperfusion is common in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PPCI）. Furthermore, it results in increased infarct size and mortality rates. We performed a meta-analysis to evaluate the role of aspiration thrombectomy （AT） combined with intracoronary administration of glycoprotein IIb/IIIa inhibitors （GPI） in the improvement of myocardial reperfusion and clinical outcomes. Methods PubMed, Embase, Web of Science, and CENTRAL databases were searched for randomized controlled trials （RCTs） investigating combined AT and intracoronary GPI treatment versus AT alone. Outcomes of interest were thrombolysis in myocardial infarction myocardial perfusion grade （TMPG）, infarct size （IS） assessed by cardiac magnetic resonance imaging, left ventricular ejection fraction （LVEF）, major adverse cardiac events （MACE） at short-term （〈 1 month） and long-term （6-12 months） follow-up, and bleeding complications during the hospital stay. Results Eight trials involving 923 patients were included. Compared with AT alone, combined AT and intracoronary GPI significantly increased TMPG 3 flow （RR： 1.15, 95% CI： 1.04 to 1.26）, reduced IS [mean difference （MD）： -3.46, 95% CI： -5.18 to -1.73], and improved LVEF （MD： 1.44, 95% CI： 0.54 to 2.33）. Furthermore, GPI use decreased the risk of MACE at long-term follow-up （RR： 0.60, 95% CI： 0.37 to 0.98）. There was no significant difference between the two groups in the incidence of minor and major bleeding complications. Conclusions Our findings showed that compared with AT alone, combined AT and intracoronary GPI treatment resulted in improved myocardial reperfusion, better cardiac function, and MACE-free survival benefits at the long-term follow-up for patients with STEMI undergoing PPCI.

Risk factors of acute myocardial infarction following primary percutaneous coronary intervention among elderly patients

Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention （PCI） with the routine use of drug-eluting stents is safe and effective, however, the patients older than 75 years undergoing PCI are at increased risk for major adverse cardiac events, so that the patients are usually excluded from this trial. The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary PCI. Methods We analyzed the outcome after stenting in 136 patients older than 60 years in our coronary care unit with acute STEMI, and the patients were further classified in 2 age groups： patients≥75 years and 〈75 years. Results Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than those of the younger, the procedural success had no difference between two groups. The main adverse clinical events （MACE） for the old group was a little higher comparing with the younger in 12-month following up. Conclusions Our study suggest that drug-eluting stent implantation in elderly patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time form symptom onset to PCI and improve final TIMI flow strategy may decrease MACE among old patients following PCI（J Geriatr Cardio12009; 6：67-70）.

Development of Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy for Patients with ST-Elevation Myocardial Infarction and Assessment of Its Use in Egypt

Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.

Dual-phase contrast-enhancement multislice computed tomography imaging for the assessment of elderly patients with acute myocardial infarction after primary percutaneous coronary intervention

Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography(MSCT)was implicated in porcine model.There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction(STEMI),especially after primary percutaneous coronary intervention(PCI).In elderly patients with STEMI,the safety issues remain unknown.Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients(≥60 years old)with STEMI within one week after primary PCI.The presence,location and enhancement pattern on MSCT were evaluated.MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase(CK)release.Serum creatinine level was recorded before and after MSCT scan.Results MSCT scans were successfully performed in all the patients.Early myocardial perfusion defect(early defect,ED)was detected in all of the 11 patients(100%)in the early phase of the contrast bolus(subendocardial ED in 10 patients and transmural in 1 patient).Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium(46±17 HU vs 104±17 HU;P<0.01).Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients(100%).On delayed phase of MSCT scan,different enhancement patterns were observed:isolated subendocardial late enhancement(LE)in 6 patients,subendocardial residual perfusion defect(RD)and subepicardial LE in 1 patient,subendocardial RD in 4 patients.Infarct volume assessed by MSCT correlated well with area under the curve CK release(R=0.72,P<0.01).Serum creatinine level after MSCT scan showed no difference with that before MSCT scan.Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI.Variable abnormal myocardial enhancement patterns were seen on dual phase MSCT in these patients with STEMI after primary PCI.Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion.

Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:An Updated Systematic Review and Meta-analysis

Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.

Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention:A case report

BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and metaanalysis

BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction:A review of clinical evidence and guidelines

Acute ST segment elevation myocardial infarction(STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention(PPCI),however this does not always restore normal myocardial perfusion,mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure,especially in patients with a high thrombus burden. However,a large body of evidence from recent major randomized controlled trials(notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI.

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease

BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease(SVD).AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease(MVD).METHODS The retrospective cohort of patients were divided into two groups:SVD and MVD group.The study population consisted of both male and female young(≤45 years)patients presented with ST-elevation myocardial infarction(STEMI)at the National Institute of Cardiovascular Disease,Karachi,Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018.Pre and postprocedure management of the patients was as per the guidelines and institutional protocols.RESULTS A total of 571 patients with STEMI,≤45 years were stratified into two groups by the number of vessels involved,342(59.9%)with SVD and 229(40.1%)with MVD.The average age of these patients was 39.04±4.86 years.A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group(25.1%vs 38%,P<0.01;11.7%vs 27.5%,P<0.001)respectively.While,smoking was more prevalent among the SVD group as compare to MVD group(36.3%vs 28.4%,P=0.05).The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group(48.8%vs 39.2%,P=0.021).Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98%vs 96.5%of the patients is SVD vs MVD group.CONCLUSION The MVD comprised of around 40%of the young patients presented with STEMI.Also,this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases,therefore,preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

The Relationship Between Mean Platelet Volume and In-Hospital Mortality in Geriatric Patients with ST Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention

Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.