Infarct-Related Coronary Artery Patency and Medication Use Prior to ST-Segment Elevation Myocardial Infarction

Robinson, C.; Martin, Justin L.; Zhang, Lily; Canham, Russell M.; Abdullah, Shuaib; Cigarroa, Joaquin E.; Hillis, L. David; Murphy, Sabina A.; McGuire, Darren K.; Lemos, James A. de; Keeley, Ellen C.

doi:10.1016/j.amjcard.2005.07.103

Cited by 10 publications

(11 citation statements)

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“…Moreover, treating all patients with primary PCI has been beneficial in that we can safely reperfuse the vast majority of patients with STEMI, particularly those with prolonged symptom onset to presentation times and those with contraindications to thrombolytic therapy (common findings seen in our patient population) 24, 25 . However, we acknowledge that while in‐hospital clinical outcomes may be influenced by the initial reperfusion treatment strategy for STEMI, long‐term outcomes are also influenced by other important factors not addressed by the present study (such as differences in lipid profiles, inflammatory responses to plaque rupture, intrinsic fibrinolytic activity, risk factor modification, compliance with medications, and access to medical care) 26–28 …”

Section: Discussionmentioning

confidence: 83%

“…24,25 However, we acknowledge that while inhospital clinical outcomes may be influenced by the initial reperfusion treatment strategy for STEMI, longterm outcomes are also influenced by other important factors not addressed by the present study (such as differences in lipid profiles, inflammatory responses to plaque rupture, intrinsic fibrinolytic activity, risk factor modification, compliance with medications, and access to medical care). [26][27][28] Our study has several limitations. First, since it is a small, retrospective analysis, our study may be underpowered to show a difference in mortality between white and non-white patients.…”

Section: Discussionmentioning

confidence: 99%

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Racial Disparity in Clinical Outcomes Following Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Influence of Process of Care

Jacobi

Parikh

McGuire

et al. 2007

J Interven Cardiology

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Previous studies have shown that compared with white patients, non-white patients with ST elevation myocardial infarction (STEMI) have worse clinical outcomes. Differences in co-morbidities, extent and severity of coronary artery disease, health insurance, and socioeconomic status have been identified as possible reasons for this disparity. However, an alternative explanation for such observed disparities in outcomes could be differences in process of care. For example, in most of these studies, non-white patients were less likely to receive reperfusion therapy, and if treated, were more likely to receive thrombolysis than to undergo primary percutaneous coronary intervention (PCI). We hypothesized that if all patients were treated similarly with primary PCI, there would be no difference in clinical outcomes. We analyzed the demographic, angiographic, in-hospital clinical outcomes, and long-term mortality rates of a racially diverse group of patients presenting to the same hospital with STEMI, all of whom were treated with primary PCI. Our data demonstrate that compared with white patients, non-white patients with STEMI who undergo primary PCI have similar in-hospital clinical outcomes and one-year mortality. This suggests that the previously observed differences in mortality rates may be, at least in part, attributable to differences in the process of care, and not solely to differences in patient factors or differential therapeutic effects.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Racial Disparity in Clinical Outcomes Following Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Influence of Process of Care

Jacobi

Parikh

McGuire

et al. 2007

J Interven Cardiology

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“…In 27% of all patients, we found that a TIMI flow grade of 3 during initial angiography represented SR. In the literature, there are reports asserting that improved IRA patency rates are observed in patients taking antithrombotic medications (25, 27). Specifically, improved IRA patency rates of 21% were reported in patients taking thienopyridine if the medication was administered early in the emergency department (25).…”

Section: Discussionmentioning

confidence: 99%

Novel predictors of infarct-related artery patency for ST-segment elevation myocardial infarction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio

Acet¹,

Ertaş²,

Akıl³

et al. 2015

Anatol J Cardiol

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Objective:The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and uric acid (UA) are inflammatory markers in cardiovascular disease. However, there are not enough data on infarct-related artery (IRA) patency in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of NLR, PLR, and UA with IRA patency before percutaneous coronary intervention (PCI) in STEMI.Methods:The study was designed as a retrospective study. Three hundred and twenty-four consecutive patients with STEMI were divided into two groups according to pre-PCI Thrombolysis in Myocardial Infarction flow grade (TIMI). Patients with a TIMI flow grade of into the spontaneous reperfusion (SR) group, while patients with TIMI flow grade of 0, 1 and 2 were placed into the non-SR group. The x2 and independent-samples t-test, Mann-Whitney U test, multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used for the statistical analysis.Results:PLR, NLR, and UA values in the SR group were lower than in the non-SR group (p<0.004, p<0.001, p<0.001, respectively). In the multivariate analysis, serum UA level and PLR were found to be independent predictors of pre-PCI IRA patency. In the ROC curve analysis, PLR >190, UA>5.75 mg/dL, and NLR>4.2 predicted non-SR. The sensitivity and specificity of the association between low IRA TIMI flow grade and PLR were 88% and 84%, 72% and 66% for UA, and 74% and 44% for NLR, respectively.Conclusion:We determined that PLR and UA are novel predictors of IRA patency before PCI. We suggest that PLR and UA may be used in risk-stratifying STEMI.

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“…In studies assessing the prognostic value of initial cTnI and hs-CRP in STEMI, elevated levels were associated with adverse prognosis and lower rate of recanalization after fibrinolysis or PCI (balloon angioplasty or uncoated stent), 4,6,20,21 but negative correlations also coexisted. 7,10 There are no published data on the value of initial cTnI and hs-CRP level for predicting clinical outcomes after primary DES implantation in STEMI.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Jeong

Lee

et al. 2008

Clinical Cardiology

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Background: Several cardiac biomarkers have been shown to have predictive values for the development of cardiovascular disease and clinical outcome after events, and are now broadly used by clinicians. Little is known about the utility of these biomarker values on admission in ST-elevation myocardial infarction (STEMI) cases of primary drug-eluting stent (DES) implantation and intense medical therapy. Hypothesis: Because little is known about the utility of these biomarkers on admission in ST-elevation myocardial infarction (STEMI) in cases primary drug-eluting stent (DES) implantation and intense medical therapy, we evaluated clinical outcomes. Methods: We enrolled 207 consecutive STEMI patients treated with primary stenting (mean age, 57.3±12.0 y). We evaluated the association between B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), highsensitivity C-reactive protein (hs-CRP) on admission, and death, reinfarction, and new or worsening congestive heart failure (CHF) through 1 y. Results: In backward-elimination models including all biomarkers, only the cTnI level was retained as a predictor of 1-y CHF (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.001-1.034, p = 0.039). There were no predictors in terms of 1-y death, reinfarction, and composite endpoint. When we applied a simple score system, in which patients were categorized on the basis of the number of elevated biomarkers, the 1-y risks of death (p = 0.600), reinfarction (p = 0.185), and composite endpoint (p = 0.620) did not increase in proportion to the number of elevated biomarkers on admission. One-y CHF only tended to increase according to the number of elevated biomarkers (p = 0.067). Conclusions:The use of cardiac biomarkers on admission, in each or in combination, had only a minimal impact for the prediction of long-term cardiovascular events after primary stenting in STEMI patients.

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Infarct-Related Coronary Artery Patency and Medication Use Prior to ST-Segment Elevation Myocardial Infarction

Cited by 10 publications

References 11 publications

Racial Disparity in Clinical Outcomes Following Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Influence of Process of Care

Racial Disparity in Clinical Outcomes Following Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Influence of Process of Care

Novel predictors of infarct-related artery patency for ST-segment elevation myocardial infarction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

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