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.

Effects of primary PCI and facilitated PCI on myocardial viability and ventricular systolic synchrony in acute myocardial infarction patients

Objective To evaluate short time effects of primary percutaneous coronary intervention (pPCI) and rtPA thrombolysis+PCI (rtPA+PCI) on myocardial viability and ventricular systolic synchrony in AMI patients.Methods Eighty seven patients with first AMI were divided into two groups: group A ( n =42), pPCI group, the patients underwent PCI within 6h after onset of AMI; group B ( n =45), rtPA+PCI group, the patients underwent PCI after thrombolysis within 6h after onset of AMI; Myocardial viability was measured by 99m Tc MIBI SPECT. While, the parameters of cardiac function LVEF and ventricular systolic synchrony LVPS were measured by 99m Tc gated cardiac blood pool image on the first and the fourth weekend. Results (1) The peak CK MB was significantly lower in group A than that in group B( P <0.01 ). (2) Myocardial infarction area (MIA) was decreased and radioactivity counts in MIA was significantly increased in group A and B on the 4th weekend compared with that on the first weekend ( P <0.01 ), but there were no significant difference between group A and group B. (3) LVEF, LVPS were no significant difference between group A and group B.Conclusions (1)pPCI in acute myocardial infartion can limit infarct area, maintain ventricular systolic synchrony and improve ventricular function; (2) but, in those hospitals that there were no any condition for PCI, they should transfer the patients to central hospital for PCI after thrombolysis at the first time. It is beneficial to improve myocardial viability and ventricular systolic synchrony of AMI patients in short time.

Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction

ABSTRACT It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention （PCI） early after acute ST- segment elevation myocardial infarction （STEMI）.

Randomized trial of primary PCI with or without routine manual thrombectomy

Background During primary percutaneous coronary intervention （PCI）, manual thrombectomy may reduce distal embolization and thus improve microvascular peffusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results.

Door-to-balloon time and mortality among patients undergoing primary PCI

Background Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-bal- loon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention （PCI）. Door-to-balloon time has become a performance measure and is the focus of regional and national quality-im- provement initiatives. However, it is not known whether national improvements in door-to-balloon times have been accompanied by a decline in mortality.

Impact of Smoking Status on Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction Either Treated by Pharmaco-Invasive Strategy or Primary Percutaneous Coronary Intervention

Introduction: Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems. Smoking may increase the thrombus burden in patients with acute coronary syndrome. The “smoker’s paradox” has been described for more than 25 years. Its existence and its effect on patients’ outcome post-myocardial infarction are debatable. Methods: Our prospective observational study was conducted from-August 2018 to August 2019 on STEMI patients with the duration from onset of symptoms to first medical contact were 12 hours or less. We included 199 patients in our study. Patients are divided into 4 groups Group 1 (Smokers treated by PPCI) Group 2 (Non-smokers treated by PPCI) Group 3 (Smoker treated by pharmaco-invasive strategy) Group 4 (Non- smoker treated by pharmaco-invasive strategy) TIMI flow before and after PCI, duration of hospital stay and all caeses of MACE were assessed in each patient. Results: Smokers are younger than non-smokers and have fewer co-mor- bidities. Patients treated by primary PCI and pharmaco-invasive strategy either smokers ornon-smokers showed no significant difference in angiographic data and outcome except that smokers treated by pharmaco-invasive strategy had a lower incidence of TIMI flow III at diagnostic angiography before PCI with P value (0.047). Conclusion: There is no actual smokers paradox. A pharmaco-invasive strategy is a good option when a PPCI is not available. Finally, early transfer of smokers treated with a pharmaco-invasive strategy to a PCI capable hospital for early intervention may be recommended.

Effects of post-dilation on coronary blood flow and MACE events following primary percutaneous coronary intervention in patients with STEMI

Objective:This retrospective cohort study aimed to evaluate the effect of post-dilation on coronary blood flow and MACE events during hospitalization and 1 year follow-up following primary PCI in patients with ST-segment.Methods:419 eligible patients who underwent PPCI due to STEMI between January 2015 and October 2019 were enrolled.The CTFC,final QCA,and the incidence of no-reflow/slow-flow during different procedure moments were assayed.Study end points was to compare two groups of patients with clinical characteristics,compared two groups of patients with the incidence of no-reflow and slow-flow,and the incidence of MACE during hospitalization and 1-year follow-up.Results:The incidence of final no-reflow/slow-flow in the post-dilation group was not significantly higher than that in the non-post-dilation group(24.3%vs.19.4%;p=0.238).There was no significant statistical difference in MACE events during hospitalization,but for the 1-year follow-up,the incidence of Target vessel revascularization and Target lesion revascularization in the post-dilation group was lower than that in the non-post-dilation group.A multivariable logistic regression model revealed that age(OR=1.078,95%CI=1.038-1.120;P<0.001),history of diabetes(OR=3.009,95%CI=1.183-7.654;P=0.021),post-dilation(OR=0.192,95%CI=0.067-0.549;P=0.002)were independently correlated with long-term follow-up of MACE.Conclusion:Post-dilation does not increase poor prognosis during hospitalization,and reduces the incidence of TVR and TLR events during long-term follow-up.

Comparison of benefit and safety between different loading dose of clopidogrel on elderly patients undergoing primary percutaneous cronary intervention for ST-segment elevation myocardial infarction

Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST- segment elevation myocardial infarction （STEMI） who undergo primary percutaneous cronary intervention （PCI）, there is still concern about its benefit and safety on elderly population. Methods Data of 172 consecutive elderly patients （~〉75 years） with STEMI who underwent primary PCI at Guangdong Provincial Cardiovascular Institute from January 2008 to December 2011 were retrospectively collected. Patients were divided into 600-mg loading clopidogrel group and 300-mg clopidogrel group accoring to the loading dose of clopidogrel before primary percunaeous coronary intervention（PCI）. Enzymatic myocardial infarction size estimated by peak creatine kinase-myocardial band （CK-MB） and patency of the infarct-related artery （IRA） were compared. Thirty-day major adverse cardiac events （MACEs）, which consist of death, nonfatal myocardial infarction （MI）, nonfatal stroke, target vessel revascularization （TVR） or stent thrombosis （ST） were compared to assess the efficacy of different loading dose. Bleeding information was compared as well to assess the safety of different pretreatment stragety before primary PCI. Results 96 patients were adminstered with 600-mg loading clopidogrel before primary PCI while 76 were administered with 300-mg. Patency of the IRA was significantly higher in patients administered with 600-mg loading clopidogrel therapy as compared with those who received 300-mg loading clopidogrel （94.8% vs. 85.5%, P = 0.038）. 600-mg loading dose of clopidogrel was associated with lower incidence of 30-day MACEs compared with 300-mg loading dose of clopidogrel （8.3% vs. 19.7%, P = 0.029） while did not increase the risk of TIMI major （3.1% vs. 3.9%, P = 0.770） and minor bleeding （10.4% vs. 6.6%, P = 0.376）. Conclusion 600-mg loading clopidogrel improves final patency of the IRA and clinical outcome as compared with 300-mg loading clopidogrel without increasing bleeding hazard.