Coronary flow improvement following unsuccessful primary percutaneous coronary intervention in ST-elevation myocardial infarction with diffuse ectatic coronary artery

Fujii, Toshiharu; Sakai, Katsuaki; Kimura, Manabu; Ohno, Yohei; Nakazawa, Gaku; Shinozaki, Norihiko; Matsukage, Takashi; Yoshimachi, Fuminobu; Ikari, Yuji

doi:10.1177/2048872616633850

Cited by 12 publications

(6 citation statements)

References 39 publications

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“…16 However, these findings were limited by the unadjusted statistical analysis, the relatively small sample size, the paucity of adverse events, and the short-term follow-up time. Fujii et al 26 documented a crude value of lower mortality in CAE patients compared to no CAE at 1 year after STEMI. However, the propensity-matched analysis between groups did not detect any statistically significant difference, confirming the hypothesis that these findings could be the result of different baseline characteristics between the two populations.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of patients with ST‐elevation myocardial infarction and angiographic evidence of coronary artery ectasia

Baldi

Silverio

Esposito

et al. 2021

Cathet Cardio Intervent

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Objectives: The aim of this study was to describe the prevalence of coronary artery ectasia (CAE) in patients with ST-elevation myocardial infarction (STEMI) and to compare the long-term outcome of subjects with and without CAE undergoing emergent coronary angiography. Background:The prognostic impact of CAE in STEMI patients has been poorly investigated.Methods: This retrospective, single-center, study included consecutive patients with STEMI undergoing emergent coronary angiography from January 2012 to December 2017.The primary endpoint was the assessment of recurrent myocardial infarction (MI) in patients with versus those without CAE at the longest available follow-up. The propensity score weighting technique was employed to account for potential selection bias between groups.Results: From 1,674 patients with STEMI, 154 (9.2%) had an angiographic evidence of CAE; 380 patients were included in the no CAE group. CAE patients were more often males and smokers, and showed a lower prevalence of diabetes than no CAE patients. After percutaneous coronary intervention, the corrected thrombolysis in MI frame count (p < .001) and the myocardial blush grade (p < .001) were significantly lower in CAE than in no CAE patients.The mean follow-up was 1,218.3 ± 574.8 days. The adjusted risk for the primary outcome resulted significantly higher in patients with CAE compared to those without (adjusted HR: 1.84; p = .017). No differences in terms of all-cause and cardiac death were found between groups.Conclusions: In this study, STEMI patients with CAE had a distinct clinical and angiographic profile, and showed a significantly higher risk of recurrent MI than those without CAE.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of patients with ST‐elevation myocardial infarction and angiographic evidence of coronary artery ectasia

Baldi

Silverio

Esposito

et al. 2021

Cathet Cardio Intervent

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“…e results revealed that the implementation of percutaneous coronary intervention after drug thrombolysis can effectively reduce the blood flow patency time, thereby restoring myocardial blood perfusion and effectively protecting cardiac function. Compared with group A, the pre-proBNP content in groups B and C was significantly lower at 1 week, 2 weeks, and 3 weeks after treatment and significantly lower in group C than in group B (P < 0.05); the study found that atrial fibrillation, arrhythmia, pulmonary hypertension, asthma, pneumonia, and other diseases could cause abnormal increase of pre-proBNP [23], that is, the decrease of proBNP content could reflect that the patient's cardiac function was improved to a certain extent.…”

Section: Discussionmentioning

confidence: 67%

Evaluation of Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction with Hypertension by Dynamic Electrocardiogram Feature Data

Wang

Zhao

2022

Scientific Programming

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This work was to study the application value of dynamic electrocardiogram (ECG) feature data in evaluating the curative effect of percutaneous coronary intervention in acute ST-segment elevation myocardial infarction with hypertension, so as to facilitate the early diagnosis and treatment of the disease. In this study, 90 patients with acute ST-segment elevation myocardial infarction accompanied by hypertension were selected as the study subjects and randomly divided into group A (oral aspirin antiplatelet therapy), group B (thrombolytic drug streptokinase (SK) therapy), and group C (percutaneous coronary intervention), with 30 cases in each group. In addition, a P-wave detection algorithm was introduced for automatic detection and analysis of electrocardiograms, and the efficacy of patients was assessed by Holter feature data based on the P-wave detection algorithm. The results showed that the diagnostic error rate, sensitivity, and predictive accuracy of the P-wave detection algorithm for ST-segment elevation myocardial infarction caused by acute occlusion of left main coronary artery (LMCA) were 0.24%, 95.41%, and 92.33%, respectively; the diagnostic error rate, sensitivity, and predictive accuracy for non-LMCA (nLMCA) ST-segment elevation myocardial infarction were 0.28%, 95.32%, and 96.07%, respectively; the proportion of patients with symptom to blood flow patency time <3 h in group C (55.3%) was significantly higher than that in groups A and B (22.1% and 22.6%) ( P < 0.05). Compared with group A, the content of B-type natriuretic peptide (pre-proBNP) at 1 week, 2 weeks, and 3 weeks after treatment in groups B and C was significantly lower and group C was significantly lower than group B ( P < 0.05). In summary, the P-wave detection algorithm has a high application value in the diagnosis and early prediction of acute ST-segment elevation myocardial infarction. Percutaneous coronary intervention in the treatment of acute ST-segment elevation myocardial infarction with hypertension can shorten the opening time of infarction blood flow, so as to effectively protect the heart function of patients.

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“…In only 50% of the patients with diffuse ectatic coronary arteries a TIMI grade 3 flow is achieved immediately after primary PCI for STEMI. 7 Many of these patients however show a normalisation of the epicardial coronary flow during the chronic phase and the mortality is much lower than expected on the basis of the high prevalence of a TIMI grade 2 or less flow. It is speculated that the intracoronary thrombus in these patients may have a different composition since it is formed due to flow sluggishness in ectacic coronary arteries.…”

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confidence: 94%

Update on ST elevation Myocardial infarction

Vrints¹

2017

European Heart Journal: Acute Cardiovascular Care

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During the last two decades the management of ST elevation myocardial infarction (STEMI) has evolved considerably throughout Europe through the organisation of regional STEMI networks and the increasing use of primary percutaneous coronary intervention (PCI) as preferred reperfusion strategy. Inclusion of out of hospital emergency physicians and other prehospital healthcare professionals is of uttermost importance in order to keep the delay between first medical contact and the first balloon dilatation as short as possible. Involvement of prehospital emergency teams resulted in the French RESCUe registry over a period of 5 years in a progressive reduction of the delay between first medical contact and the first balloon dilatation and also in progressive increase of primary PCI. 1 The delay between onset of symptoms and calling the emergency medical system (patient delay) affects significantly the treatment delay before initiation of reperfusion therapy. The implementation of a national primary PCI strategy in Denmark apparently resulted in an increased public awareness on the symptoms of a heart attack as a mild reduction of the patient delay was observed over a 7-year period. 2 Patient delay remains however substantial and is most problematic in the elderly, diabetics, female patients and when symptoms arise during the night.A significant number of patients with ST-elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). The indication and timing of coronary intervention on non-culprit lesions is still a matter of debate. A post-hoc analysis of the AIDA STEMI trial shows that PCI of the culprit lesion alone had no negative effect on reperfusion success and myocardial salvage in patients with MVD as compared to STEMI patients with single vessel disease. 3 However, the presence of MVD is an independent risk factor associated with a threefold increase of major adverse cardiac events during long term followup. This study indicates that immediate multivessel PCI is not necessary in order to improve myocardial reperfusion but that a staged revascularisation of non-culprit lesions may be good strategy to improve the long-term outcome of STEMI patients with MVD.At present, there is no consensus on the optimal revascularisation of MVD in STEMI patients presenting with cardiogenic shock. In a post-hoc analysis of the randomized IABP-SHOCK II trial that investigated the effect of intraaortic balloon pump on the outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock, MVD was present in 75% of the patients 4 . In contrast with ESC STEMI guidelines that recommend to consider immediate PCI of all significant non-infarct related lesions 5 , two thirds of the MVD patients were treated with primary PCI of the culprit artery only and staged PCI procedures or coronary bypass surgery were only rarely performed. Immediate multivessel PCI that was performed in only 37% of the patients, was not associated with any benefit on long-term mortality, immediate TIMI 3 patency or o...

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Coronary flow improvement following unsuccessful primary percutaneous coronary intervention in ST-elevation myocardial infarction with diffuse ectatic coronary artery

Cited by 12 publications

References 39 publications

Clinical outcome of patients with ST‐elevation myocardial infarction and angiographic evidence of coronary artery ectasia

Clinical outcome of patients with ST‐elevation myocardial infarction and angiographic evidence of coronary artery ectasia

Evaluation of Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction with Hypertension by Dynamic Electrocardiogram Feature Data

Update on ST elevation Myocardial infarction

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