1 Incidence and prevalence of MINOCA (myocardial infarction with non-obstructive coronary arteries) in STEMI patients: experience from Irish tertiary care centre

Kumar, Jagdesh; Kumar, R; Armstrong, Richard; Murphy, Ryan; Daly, Conor

doi:10.1136/heartjnl-2021-ics.1

Cited by 4 publications

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“…These studies should aim to establish clear guidelines and protocols to standardize the use of these strategies, thereby reducing variability and improving patient outcomes. Additionally, further should explore the mechanisms underlying the observed benefits of provocative strategies to better understand their role in enhancing reperfusion and reducing ischemic injury (8).…”

Section: Discussionmentioning

confidence: 99%

“…The integration of provocative strategies into primary PCI seeks to address limitations inherent in conventional approaches, particularly in complex or high-risk cases. Techniques such as thrombus aspiration, intracoronary vasodilators, embolic protection devices, and distal protection devices have shown potential in reducing distal embolization and improving microvascular perfusion (8). These adjunctive methods aim to optimize the mechanical and pharmacological aspects of reperfusion, thus enhancing myocardial recovery and reducing the incidence of adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Provocative Strategies for Primary PCI in STEMI: Time to Rethink Guidelines

Akhtar,

Adil,

Akhtar

et al. 2024

JHRR

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Background: The primary percutaneous coronary intervention (PCI) is now the reference treatment for ST-segment elevation myocardial infarction (STEMI). Findings from randomized controlled trials suggest that PCI is superior to thrombolytic therapy in preventing death and recurrent myocardial infarction. However, longer delays for PCI implementation and variability in outcomes among different operators and centers may affect its efficacy. The European guidelines recommend fibrinolytic therapy if PCI cannot be performed within 120 minutes of the first medical contact. Objective: The main objective of the study was to evaluate the efficacy of adjunctive provocative strategies in primary PCI for STEMI and their impact on procedural success and clinical outcomes. Methods: This retrospective observational study was conducted at Luqman International Hospital, Mingora Swat, from December 2022 to June 2023. Data were collected from 230 STEMI patients, including demographic information, clinical characteristics, procedural details, and outcomes. The primary outcome measure was the occurrence of major adverse cardiac events (MACE) within 30 days and one year after primary PCI. Secondary outcomes included procedural success rate, myocardial blush grade, and left ventricular ejection fraction (LVEF) during follow-up assessments. Statistical analyses were performed using SPSS version 25, with continuous variables expressed as means and standard deviations and categorical variables as frequencies and percentages. Comparisons between groups were conducted using chi-square tests for categorical variables and Student’s t-tests or Mann-Whitney U tests for continuous variables, with a p-value of less than 0.05 considered statistically significant. Results: Of the 230 patients, 120 (52%) received conventional strategies, while 110 (48%) received adjunctive provocative strategies. The provocative strategy group had higher rates of successful reperfusion (95.5% vs. 83.3%), improved myocardial blush grades (mean ± SD: 3.2 ± 0.6 vs. 2.7 ± 0.8), and lower rates of the no-reflow phenomenon (9.1% vs. 20.8%). At 30 days post-PCI, the incidence of MACE was lower in the provocative strategy group (9.1% vs. 12.5%). At one year, the provocative strategy group continued to show lower MACE rates (16.4% vs. 20.8%). Conclusion: Adjunctive provocative strategies in primary PCI for STEMI show promise in enhancing reperfusion efficacy and preserving myocardial function. While trends towards improved procedural success and short-term outcomes were observed, larger prospective studies are needed to validate these findings. The exploration of provocative strategies represents an important avenue for advancing STEMI management and improving patient outcomes in interventional cardiology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Provocative Strategies for Primary PCI in STEMI: Time to Rethink Guidelines

Akhtar,

Adil,

Akhtar

et al. 2024

JHRR

View full text Add to dashboard Cite

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“…Recent studies have found a prevalence of MINOCA of 2% to 11% in AMI patients [ 2 , 3 , 4 , 5 , 6 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…MINOCA was first described by Gross and Steinberg in 1939 [ 1 ]. Recent studies have found a prevalence of MINOCA of 2–11% in AMI patients [ 2 , 3 , 4 , 5 , 6 ]. However, prevalence varied widely across the studies.…”

Section: Introductionmentioning

confidence: 99%

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

Oliveira

Correia²,

Nicz³

et al. 2022

JCM

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA.

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Angiography-based coronary microvascular assessment with and without intracoronary pressure measurements: a systematic review

Kest,

Ágoston,

Szabó

et al. 2023

Clin Res Cardiol

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Background In recent years, several indices have been proposed for quantifying coronary microvascular resistance. We intended to conduct a comprehensive review that systematically evaluates indices of microvascular resistance derived from angiography. Objective The objective of this study was to identify and analyze angiography-derived indices of microvascular resistance that have been validated against an invasive reference method. We aimed to compare their limits of agreement with their reference methods and explore their advantages and inherent limitations. Methods and results We searched PubMed from inception until 2022 for studies on different techniques for quantifying microvascular resistance. Seven studies met the inclusion criteria. Five studies included techniques that applied calculations based solely on invasive angiography, and were validated against invasively measured thermodilution-derived index of microvascular resistance. The remaining two studies combined angiography with invasively measured intracoronary pressure data, and were validated against invasive Doppler measurements. We converted the ± 1.96 standard deviation limits of agreement with the reference method from the seven studies into percentages relative to the cut-off value of the reference method. The lower limits of agreement for angiography-based methods ranged from − 122 to − 60%, while the upper limits ranged from 74 to 135%. The range of the limits of agreement was considerably lower for the two combined angiography- and pressure-based methods, standing at − 52 to 60% and − 25 to 27%. Conclusion Our findings suggest that combined angiography- and pressure-based methods provide a more reliable assessment of microvascular resistance compared to methods relying solely on angiography. Graphical Abstract Central illustration. Comparative assessment of image-based methods quantifying microvascular resistance with and without intracoronary pressure measurements. Angiography-based methods rely on angiography alone to calculate the microvascular resistance by utilizing angiographic frame counting to extrapolate coronary flow (Q) and subsequently deriving distal coronary pressure using fluid dynamic equations. Combined angiography- and pressure-based methods utilize invasive intracoronary pressure gradients measured during rest and maximal vasodilation to determine coronary flow in their calculation of microvascular resistance. The combined methods showed more acceptable levels of agreement with their reference methods compared to angiography-based methods alone.

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1 Incidence and prevalence of MINOCA (myocardial infarction with non-obstructive coronary arteries) in STEMI patients: experience from Irish tertiary care centre

Abstract: Study Limitations This study has some limitations, it is a retrospective analysis and data from a single Irish primary PCI centre. Furthermore, majority of patients with STEMI and

Cited by 4 publications

References 0 publications

Provocative Strategies for Primary PCI in STEMI: Time to Rethink Guidelines

Provocative Strategies for Primary PCI in STEMI: Time to Rethink Guidelines

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

Angiography-based coronary microvascular assessment with and without intracoronary pressure measurements: a systematic review

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