scholarly journals Intracoronary Adenosine versus Intravenous Adenosine during Primary PCI for ST-Elevation Myocardial Infarction: Which One Offers Better Outcomes in terms of Microvascular Obstruction?

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Gemina Doolub ◽  
Erica Dall'Armellina
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Study Drug ◽  
Treated Group ◽  
St Elevation Myocardial Infarction ◽  
High Dose ◽  
Primary Pci ◽  
Intracoronary Administration ◽  
Significant Difference ◽  
St Elevation

Aims. Previous studies have suggested that intravenous administration of adenosine improves myocardial reperfusion and reduces infarct size in ST-elevation myocardial infarction (STEMI) patients. Intracoronary administration of adenosine has shown conflicting results. Methods. In this retrospective, single-centre, blinded clinical study, we assessed whether selective intracoronary administration of adenosine distal to the occlusion site immediately before initial balloon inflation reduces microvascular obstruction (MVO) as assessed with cardiac magnetic resonance imaging (MRI). Using contrast-enhanced sequences, microvascular obstruction (MVO) was calculated. We found 81 patients presenting with STEMI within 12 h from symptom onset who were eligible for the study. In 80/81 (100%) patients receiving the study drug, MRI was performed on Day 1 after primary angioplasty. Results. The prevalence of MVO was reduced in the patients treated with intracoronary adenosine, (45%) compared to 85% of patients who were administered intravenous adenosine (). We found that the size of MVO in patients receiving intracoronary adenosine was significantly reduced compared to 0.91 g in the intravenous-treated group (). There was no statistically significant difference in TIMI flow and clinical outcomes after primary PCI. Conclusion. We found significant evidence that selective high-dose intracoronary administration of adenosine distal to the occlusion site of the culprit lesion in STEMI patients results in a decrease in microvascular obstruction.

Abstract 15151: The Prevalence of Covid-19 on the Door to Balloon Time in Patients With St-elevation Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
yuki matsubara ◽  
Takeshi Yamada ◽  
Soichiro Washimi ◽  
Akihiko Takahashi ◽  
Tetsuya Hata ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Mortality Rate ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Time Duration ◽  
Significant Difference ◽  
St Elevation ◽  
Door To Balloon ◽  
The Impact

Background: Patients with ST-elevation myocardial infarction (STEMI) should undergo primary PCI (percutaneous coronary intervention) as a standard of care. However, with the increase in the prevalence of COVID-19, all patients with suspected STEMI should be treated as possible COVID-19 cases. Therefore, more time may be needed to establish an acute MI diagnosis and to perform a COVID-19 status assessment. There has been a paucity of data regarding its influence on the primary PCI procedure. Objective: We sought to evaluate the impact of the prevalence of COVID-19 on the door-to-balloon time and clinical outcome in patient with STEMI. Method: Between January 2019 and May 2020, 157 patients with STEMI underwent primary PCI in 3 Japanese PCI centers. Mean age of patients was 70.4±12.9 years, and 71.6% were male. Right distal radial artery access was used in 110 patients (94.8%). We divided these patients into two groups: a group before the COVID -19 outbreak and another group during the pandemic, and were retrospectively analyzed. The following patients’ baseline characteristics were obtained: door-to-balloon time, duration in the emergency department, finding of CT scan if conducted, peak CK, 30-day mortality rate. Results: We evaluated patients with STEMI who underwent PCI between January 2019 and January 2020 (before the pandemic) and between February 2020 and May 2020 (during the pandemic). The number of patients was 119 before pandemic and 37 during pandemic. Mean door-to-balloon time was 35.8 ± 24.5 min before the pandemic and 41.2 ± 20.8 min after the outbreak (p<0.05). Induration at the emergency department was 22.6 ± 18.6 min before the pandemic and 21.3 ± 13.3 min after the outbreak (p=0.329). CT evaluation was performed before PCI was conducted in 41 patients (34.5%) and 14 patients (37.8%) (p=0.699). The peak CPK was 1956.2 ±2141.9 U/L and 2801.1 ± 2982.5 U/L (P=0.006). There was no significant difference in a 30-day mortality rate (5% vs 0%; P=0.699). Of the 37 patients after the outbreak, no patient underwent PCR examination for COVID-19 virus. Conclusion: The COVID-19 pandemic changed the diagnostic procedure in the emergency department and affected door-to-balloon time in patients with STEMI.

scholarly journals Relationship Between Delta Troponin I Levels And In-Hospital Cardiovascular Endpoints In Acute ST Elevation Myocardial Infarction

2019 ◽  
Vol 100 (5) ◽  
Author(s):  
Aydin Ercan ◽  
Osken Altug ◽  
Yaylaci Selcuk ◽  
Sahinkus Salih ◽  
İbrahim Kocayiğit ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Troponin I ◽  
St Elevation Myocardial Infarction ◽  
Mechanical Complication ◽  
Primary Pci ◽  
Randomized Controlled Studies ◽  
Rate Of Increase ◽  
Significant Difference ◽  
St Elevation

Objectives. In this study, we investigated the relationship between the rate of increase in troponinI levels and in-hospital cardiovascular endpoints (outcomes) in patients with ST-elevation myocardial infarction (STEMI). Methods. Eighty-four patients with acute STEMI who received thrombolytic treatment or who underwent primary percutaneous coronary intervention (PCI) were enrolled. After admission to hospital, delta troponinI levels, which were determinedby serial measurements after 2, 4, and 6h of admission, and in-hospital major cardiovascular events were evaluated. Results. There were 35(41.7%) patients in the thrombolytic group and 49(58.3%) patients in the primary PCI group. As major cardiovascular endpoints, death from cardiovascular events was seen in 7(8.3%) patients, stroke/transient ischemic attack in 2(2.4%), recurrent ischemia in 5(6%), arrhythmia in 8(9.5%), and urgent revascularization was performed in 5(6%) cases. In patients with arrhythmia, ventricular fibrillation was seen in 3(3.6%) patients, atrial fibrillation in 3(3.6%), and ventricular tachycardia in 2(2.4%) patients. The ventricular septal defect was observed only in 1(1.2%) patient as a mechanical complication, and the patient underwent urgent surgery. The analysis of all patients and sub-groups of thrombolytic and primary PCI patients revealed no statistically significant difference between delta troponinI levels at time intervals of (02), (04), and (06)h and in-hospital major cardiovascular endpoints (p0.05). Conclusion. The analysis of delta troponinI levels is not a predicting factor of in-hospital endpoints (outcomes) in patients with STEMI treated by thrombolytic therapy or primary PCI. Randomized controlled studies with a larger study population are needed on this subject.

Risk factors of coronary microvascular obstruction (Preprint)

2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Neutrophil Percentage ◽  
Percutaneous Coronary ◽  
St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

scholarly journals 27 Use of rotational atherectomy in primary pci for st-elevation myocardial infarction- a single centre 10-year experience

Heart ◽  
2017 ◽  
Vol 103 (Suppl 5) ◽  
pp. A22.2-A23
Author(s):  
MM Mahmood ◽  
MA Qureshi ◽  
R Morley ◽  
D Austin ◽  
J Carter ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Rotational Atherectomy ◽  
Primary Pci ◽  
Single Centre ◽  
St Elevation

Direct Stenting Versus Stenting After Pre-dilation in Primary PCI for ST-Elevation Myocardial Infarction

2019 ◽  
Vol 28 ◽  
pp. S394
Author(s):  
V. Vijayarajan ◽  
A. Ekmejian ◽  
R. Cohen ◽  
S. Eather ◽  
A. Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Direct Stenting ◽  
St Elevation
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