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.

The prognostic role of N-terminal prohormone brain natriuretic peptide and TIMI risk score in patients with ST segment elevation myocardial infarction

Background ST segment elevation myocardial infarction （STEMI） remains a major cause of death world-wide. The thrombolysis in myocardial infarction （TIMI） risk score is a risk assessment tool to detect high risk STEMI patients. NT-proBNP has been used to assess the severity of heart failure. However, the predictive power of TIMI risk score is not high enough to identify all high-risk patients, and whether NT-proBNP adds power to the TIMI risk score for predicting in-hospital mortality is unclear. Methods 664 STEMI patients were included and divided into 3 groups according to TIMI risk score ≤3 （n=211）, 4-6 （n=281）, and ≥7 （n=172）. The relation-ships between TIM! risk score and events were evaluated. The modified TIMI risk score was constructed through multivariate logistic regression analysis. Results The proportion of in-hospital death （0.5% vs. 3.2% vs. 10.5%, P〈0.001） and major adverse clinical events （MACEs） （14.2% vs. 22.8% vs. 40.1%, P〈0.001） increased as higher TIMI risk score was. ROC curve showed that the AUC of NT-proBNP for predicting in-hospital death was 0.792, with optimal cut-off being 3500pg/mL. Multivariate logistic regression analysis revealed that TIMI risk score （OR=1.26, 95% CI 1.05-1.50, P=0.012） and NT-proBNP〉3500pg/mL （OR=7.30, 95% CI 2.56-20.83, P〈0.001） were independently associated with in-hospital death. Adding NT-proBNP to TIMI risk score produced higher predictive value （AUC： 0.871 vs. 0.804, P=0.040）. Conclusion NT-proBNP is associated with in-hospital death in STEMI patients and has an additive prognostic value to TIMI risk score.

Red cell distribution width and KAMIR score predict in-hospital mortality of patients with ST segment elevation myocardial infarction

Background The incremental predictive value of red cell distribution width （RDW） on Korea Acute Myocardial Infarction Registry （KAMIR） score in patients with ST segment elevation myocardial infarction （STE- MI） has not been assessed. This study was to investigate whether RDW had additional prognostic value on KA- MIR score for predicting in-hospital death of STEMI patients. Methods Seven hundred and seven STEMI patients were included in this study. The predictive value was evaluated using the receiver operating characteristic （ROC）. Multivariate logistic regression was used to determine risk predictors. Results Thirty four patients died while in hospital, who were older than those who survived, and had more proportion of Killip class/〉 2 and no in -hospital PCI. Blood glucose, serum creatinine, white blood cell count, RDW and KAMIR score were signifi- cantly higher in the Death group, among whom systolic blood pressure, hemoglobin and LVEF were lower. ROC curve analysis showed RDW could predict in-hospital death, with the optimal cut-off values being 14.1% （AUC=0.707, 95%CI, 0.618-0.796, P〈0.001）. When compared with the KAMIR score alone, the addition of RDW was associated with significant improvements in predicting in-hospital （AUC ： 0.865 vs. 0.839, P=0.039）. Conclusion RDW might provide additional information over the KAMIR score in STEMI patients.

Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).