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Background: Emergency percutaneous coronary intervention (PCI) is a common treatment for ST-elevated myocardial infarction (STEMI) patients. However, the coronary slow flow/no reflow phenomenon (CSF/NRP) can occur as a complication during or after the procedure. Identifying predictors of CSF/NRP after emergency PCI in STEMI patients can help clinicians anticipate and prevent this complication. In this study, we aimed to investigate clinical, laboratory, and procedural factors that may contribute to the development of CSF/NRP in STEMI patients undergoing PCI. Results: A total of 460 patients were included in this study, with a mean (± SD) age of 60 ± 12.5 years. The incidence of CSF/NRP was 30.2% (n = 139) among the study population. The univariate analysis showed that older age, lower left ventricular ejection fraction (LVEF), initial thrombolysis in myocardial infarction (TIMI)flow grade 0–2, increased creatinine level, lower estimated glomerular filtration rate (eGFR), diffuse target lesion length, and longer length of stent were significantly associated with the occurrence of CSF/NRP (p < 0.05). However, in the multivariate logistic regression model, only eGFR (OR = 0.98, 95% CI: 0.96–0.99, p = 0.005), diffuse target lesion length (OR = 2.15, 95% CI: 1.20–3.83, p = 0.009) and LVEF (OR = 0.96, 95% CI: 0.94–0.98, p = 0.004) remained significant predictors of CSF/NRP. Conclusions: The present study demonstrated that diffuse lesion length, lower LVEF, and lower eGFR can be considered as independent predictors of CSF/NRP in STEMI patients. [ABSTRACT FROM AUTHOR]

Abstract Background Emergency percutaneous coronary intervention (PCI) is a common treatment for ST-elevated myocardial infarction (STEMI) patients. However, the coronary slow flow/no reflow phenomenon (CSF/NRP) can occur as a complication during or after the procedure. Identifying predictors of CSF/NRP after emergency PCI in STEMI patients can help clinicians anticipate and prevent this complication. In this study, we aimed to investigate clinical, laboratory, and procedural factors that may contribute to the development of CSF/NRP in STEMI patients undergoing PCI. Results A total of 460 patients were included in this study, with a mean (± SD) age of 60 ± 12.5 years. The incidence of CSF/NRP was 30.2% (n = 139) among the study population. The univariate analysis showed that older age, lower left ventricular ejection fraction (LVEF), initial thrombolysis in myocardial infarction (TIMI)flow grade 0–2, increased creatinine level, lower estimated glomerular filtration rate (eGFR), diffuse target lesion length, and longer length of stent were significantly associated with the occurrence of CSF/NRP (p

The incidence and mortality of ST-elevated myocardial infarction are increasing year by year, causing a huge economic burden to patients' families due to its severe clinical symptoms, high mortality, and poor prognosis. Percutaneous coronary intervention is the best treatment strategy for reducing myocardial infarction area, prolonging survival, and improving prognosis. To further improve the clinical effect of percutaneous coronary intervention in the treatment of ST-elevated myocardial infarction, this study explored the application value of nicorandil in the procedure. Oral nicorandil tablets were found to improve the cardiac function and myocardial microcirculation of patients with ST-elevated myocardial infarction, enhance their nutritional status, and reduce the risk of malnutrition. In the 6-month prognostic follow-up, nicorandil tablets provided more effective prognostic myocardial protection for patients. Therefore, we recommend the use of nicorandil tablets for adjuvant therapy during primary percutaneous coronary intervention in the future. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) usually develops after preceding infection, but cardiac surgery can also occasionally cause GBS. Currently, cardiac catheterizations have already become common therapeutic options for heart diseases, but there have been no reports of GBS occurrence after that. Herein, we present a rare case in which GBS occurred following catheterization. An 85-year-old-man with sudden onset chest pain was rushed to our hospital and diagnosed with ST-elevated myocardial infarction. He underwent emergent percutaneous coronary intervention (PCI) to left anterior descending artery, but he still had exertional chest pain. Echocardiography revealed severe aortic stenosis (AS) and our heart team considered AS was the cause of symptom and decided to perform and transcatheter aortic valve implantation (TAVI), 11 days after the PCI. However, 5 days after the TAVI procedure, he presented with symmetrical muscular weakness of extremities. Cranial magnetic resonance imaging showed no significant lesion. Based on several signs including albuminocytologic dissociation in cerebrospinal fluid examination, demyelinating polyneuropathy in nerve conduction study, positive anti-ganglioside antibody, and the lack of preceding infection, he was diagnosed with GBS triggered by cardiac catheterizations. We administered high-dose intravenous immunoglobulin therapy and his motor strength gradually improved, finally discharged with full motor strength after 7 months rehabilitation. • Cardiac surgery has been already reported as a non-infectious risk factor of Guillain-Barré syndrome (GBS) in previous literatures, and cardiac catheterization such as percutaneous coronary intervention and transcatheter aortic valve implantation, which were relatively less invasive procedure, may be a potential risk factor for GBS occurrence as well. • If a patient complains of progressive, symmetrical neurological symptoms after cardiac catheterization, GBS should be considered as the possible cause, and nerve conduction study and cerebrospinal fluid examination may be helpful for the diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background New-onset atrial fibrillation (NOAF) complicating with ST-elevated myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) is associated with worse prognosis. The systemic inflammatory response index (SIRI), serves as a novel inflammatory indicator, is found to be predictive of adverse outcomes. The aim of this study is to explore the association between NOAF and SIRI. Methods A retrospective data included 616 STEMI participants treated with PCI in our cardiology department had been analyzed in present investigation, of which being divided into a NOAF or sinus rhythm (SR) group based on the presence or absence of atrial fibrillation. The predictive role of SIRI for in detecting NOAF had been evaluated by the logistic regression analyses and receiver operating characteristic (ROC) curve. Additionally, long-term all-cause mortality between both groups was compared using the Kaplan–Meier test. Results NOAF during hospitalization developed in 7.6% of PCI-treated individuals. After multivariate regression analyses, SIRI remains to be an independently predictor of NOAF (odds ratio 1.782, 95% confidence interval 1.675–1.906, P = 0.001). In the ROC curve analysis, SIRI with a cut-off value of 4.86 was calculated to predict NOAF, with 4.86, with a sensitivity of 80.85% and a specificity of 75.57%, respectively (area under the curve (AUC) = 0.826, P < 0.001). Furthermore, pairwise compassion of ROC curves displayed the superiority of SIRI in the prediction of NOAF in comparison with that of neutrophil/lymphocyte or monocyte/lymphocyte (P < 0.05). In addition, the participants in NOAF group had a significantly higher incidence of all-cause death compared to those in SR group after a median of 40-month follow-up (22.0% vs 5.8%, log-rank P < 0.001). Conclusion SIRI can independently predict NOAF in patients with STEMI after PCI, with being positively correlated to worsened outcomes.

Background: The objectives of this study were to assess the relation of blood groups and the rate of successful angioplasty in patients with ST-elevated myocardial infarction (STEMI) and also to investigate long-term adverse outcomes follow-up. Materials and Methods: In this study, 500 eligible patients with definitive diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were followed up for 3 years. The patient's angiography images were examined and thrombolysis in myocardial infarction (TIMI) flow rate and coronary artery patency rate were evaluated in different ABO blood groups. All patients were followed up after 3 years based on major adverse cardiovascular events. Results: There was no significant difference in coronary artery patency rate between the patients of the different blood types with respect to TIMI flow before (P = 0.19) and after revascularization (P = 0.69). The incidence of atrial fibrillation (AF) in blood Group A was the highest. Death in the blood Groups AB and O was significantly higher than the other groups. No significant differences were seen in different blood groups in the frequency of mortality (P = 0.13), myocardial infarction (P = 0.46), heart failure (P = 0.83), re-hospitalization, angiography (P = 0.90), PCI (P = 0.94), coronary artery bypass graft (P = 0.26), implantable cardioverter defibrillator (ICD) implantation (P = 0.26), and mitral regurgitation (P = 0.88). Conclusion: The incidence of AF in blood Group A and inhospital mortality in blood Groups AB and O were the highest. The blood group may be considered in assessment of clinical risk in STEMI patients. [ABSTRACT FROM AUTHOR]

Background: New-onset atrial fibrillation (NOAF) complicating with ST-elevated myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) is associated with worse prognosis. The systemic inflammatory response index (SIRI), serves as a novel inflammatory indicator, is found to be predictive of adverse outcomes. The aim of this study is to explore the association between NOAF and SIRI. Methods: A retrospective data included 616 STEMI participants treated with PCI in our cardiology department had been analyzed in present investigation, of which being divided into a NOAF or sinus rhythm (SR) group based on the presence or absence of atrial fibrillation. The predictive role of SIRI for in detecting NOAF had been evaluated by the logistic regression analyses and receiver operating characteristic (ROC) curve. Additionally, long-term all-cause mortality between both groups was compared using the Kaplan–Meier test. Results: NOAF during hospitalization developed in 7.6% of PCI-treated individuals. After multivariate regression analyses, SIRI remains to be an independently predictor of NOAF (odds ratio 1.782, 95% confidence interval 1.675–1.906, P = 0.001). In the ROC curve analysis, SIRI with a cut-off value of 4.86 was calculated to predict NOAF, with 4.86, with a sensitivity of 80.85% and a specificity of 75.57%, respectively (area under the curve (AUC) = 0.826, P < 0.001). Furthermore, pairwise compassion of ROC curves displayed the superiority of SIRI in the prediction of NOAF in comparison with that of neutrophil/lymphocyte or monocyte/lymphocyte (P < 0.05). In addition, the participants in NOAF group had a significantly higher incidence of all-cause death compared to those in SR group after a median of 40-month follow-up (22.0% vs 5.8%, log-rank P < 0.001). Conclusion: SIRI can independently predict NOAF in patients with STEMI after PCI, with being positively correlated to worsened outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Symptom-to-balloon time (SBT) represents the total ischemic time in ST-elevated myocardial infarction (STEMI) and is associated with poor long-term outcomes. The study aimed to explore the association between SBT and in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods This retrospective, multicenter, observational study included patients admitted to the Hebei General Hospital, Baoding No. 1 Central Hospital, and Cangzhou Central Hospital from January 2016 to December 2018. The outcome was all-cause mortality during the hospital stay. Logistic regression models were established to explore the association between SBT and all-cause mortality during the hospital stay. Results This study included 1169 patients: 876 males of 59.6 ± 11.4 years of age, and 293 females 66.3 ± 13.3 years of age. A first analysis showed EF had an interaction with SBT (P = 0.01). In patients with EF ≥ 50%, SBT was not an independent risk factor for postoperative all-cause mortality in the hospital (all P > 0.05). In patients with EF

Background: Symptom-to-balloon time (SBT) represents the total ischemic time in ST-elevated myocardial infarction (STEMI) and is associated with poor long-term outcomes. The study aimed to explore the association between SBT and in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute STEMI.Methods: This retrospective, multicenter, observational study included patients admitted to the Hebei General Hospital, Baoding No. 1 Central Hospital, and Cangzhou Central Hospital from January 2016 to December 2018. The outcome was all-cause mortality during the hospital stay. Logistic regression models were established to explore the association between SBT and all-cause mortality during the hospital stay.Results: This study included 1169 patients: 876 males of 59.6 ± 11.4 years of age, and 293 females 66.3 ± 13.3 years of age. A first analysis showed EF had an interaction with SBT (P = 0.01). In patients with EF ≥ 50%, SBT was not an independent risk factor for postoperative all-cause mortality in the hospital (all P > 0.05). In patients with EF < 50%, SBT was an independent risk factor for postoperative all-cause mortality in the hospital [model 3: 1.51 (1.17, 1.54), P for trend = 0.01].Conclusions: SBT was independently associated with all-cause mortality in the hospital after PCI in patients with acute STEMI and EF < 50%. Specifically, the risk of in-hospital mortality for those with SBT ≥ 361 min is increased by 51% compared with those with SBT ≤ 120 min. [ABSTRACT FROM AUTHOR]

Background and Objective: Acute myocardial infarction is the leading cause of mortality and morbidity across the world. Acute myocardial infarction with ST-segment elevation has been considered a common cardiac emergency and has considerable morbidity and mortality. The role of uric acid (UA) in the mortality rate of ST-segment elevation myocardial infarction (STEMI) was examined in the present study. Materials and Methods: In this prospective study, 107 patients diagnosed with STEMI aged 18 years and older in the coronary care unit at Azadi Teaching Hospital, Duhok, Iraq from April 20, 2017 to December 20, 2017 were followed up for 1 month to determine the 30-day mortality in relation to serum UA level. Results: The mean age of patients was 55.27±13.59 years. The inferior type of STEMI was the most prevalent one among the patients (45.1%). Serum UA was not significantly different in both the groups (P > 0.05). Conclusion: The study did not show UA as a risk factor for mortality in patients with STEMI.

Abstract Background Currently, how to accurately determine the patient prognosis after a percutaneous coronary intervention (PCI) remains unclear and may vary among populations, hospitals, and datasets. The aim of this study was to establish a prediction model of in-hospital mortality risk after primary PCI in patients with acute ST-elevated myocardial infarction (STEMI). Methods This was a multicenter, observational study of patients with acute STEMI who underwent primary PCI. The outcome was in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method was used to select the features that were the most significantly associated with the outcome. A regression model was built using the selected variables to select the significant predictors of mortality. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results Totally, 1169 and 316 patients were enrolled in the training and validation sets, respectively. Fourteen predictors were identified by the LASSO analysis: sex, Killip classification, left main coronary artery disease (LMCAD), grading of thrombus, TIMI classification, slow flow, application of IABP, administration of β-blocker, ACEI/ARB, symptom-to-door time (SDT), symptom-to-balloon time (SBT), syntax score, left ventricular ejection fraction (LVEF), and CK-MB peak. The mortality risk prediction nomogram achieved good discrimination for in-hospital mortality (training set: C-statistic = 0.987; model calibration: P = 0.722; validation set: C-statistic = 0.984, model calibration: P = 0.669). Area under the curve (AUC) values for the training and validation sets are 0.987 (95% CI: 0.981–0.994, P = 0.003) and 0.990 (95% CI: 0.987–0.998, P = 0.007), respectively. DCA shows that the nomogram can achieve good net benefit. Conclusions A novel nomogram was developed and is a simple and accurate tool for predicting the risk of in-hospital mortality in patients with acute STEMI who underwent primary PCI.

Low body mass index (BMI) is a predictor of adverse events in patients with ST-elevated myocardial infarction (STEMI) in Western countries. Because the average BMI of Asians is significantly lower than that of the Western population, the appropriate cut-off BMI value and its role in long-term mortality are unclear in Asian patients. Between January 2006 and December 2017, 1215 patients who underwent percutaneous coronary intervention (PCI) for acute STEMI and were alive at discharge (mean age, 67.7 years; male, 75.4%) were evaluated. The cut-off BMI value, which could predict all-cause mortality within 10 years, was detected using a survival classification and regression tree (CART) model. The causes of death according to the BMI value were evaluated in each group. Based on the CART model, the patients were divided into three groups (BMI < 18 kg/m2: 54 patients, 18 kg/m2 ≤ BMI ≤ 20 kg/m2: 109 patients, and BMI > 20 kg/m2: 1052 patients). The BMI decreased with age; with an increased BMI, patients with dyslipidemia, diabetes mellitus, and smoking habit increased. During the study period (median, 4.9 years), 194 patients (26.8%) died (cardiac death, 59 patients; non-cardiac death, 135 patients). All-cause mortality was more frequent as the BMI decreased (BMI < 18 kg/m2; 72.8%, 18 kg/m2 ≤ BMI ≤ 20 kg/m2; 40.5%, and BMI > 20 kg/m2; 22.8%; log-rank p < 0.001). Non-cardiac deaths were more frequent than cardiac deaths in all groups, and the dominance of non-cardiac death was highest in the lowest BMI group. Cut-off BMI values of 18 kg/m2 and 20 kg/m2 can predict long-term mortality after PCI in Asian STEMI survivors, whose cut-off value is lower than that in the Western populations. The main causes of death in this cohort differed according to the BMI values. [ABSTRACT FROM AUTHOR]

Abstract Background De Winter syndrome accounts for approximately 2% of all patients with acute anterior myocardial infarction admitted to the emergency department, and is characterized by severe stenosis of the left anterior descending coronary artery (LAD). The ECG changes are not recognized by ECG software, and poor understanding of the syndrome among physicians may lead to misdiagnosis, delayed reperfusion, and mortality. Case presentation A 51-year-old male patient presented with a newly developed ECG pattern suggestive of de Winter Syndrome. Coronary angiography revealed anterior myocardial infarction. Based on the ECG and clinical manifestations, the patient was diagnosed with de Winter syndrome and underwent timely percutaneous coronary intervention to revascularize the left anterior descending artery (LAD). The patient showed good outcomes and no complications at 4 months after the operation. Conclusions This case highlights the importance of being aware of the possibility of de Winter syndrome in patients with symptoms of myocardial infarction but atypical ECG in order to conduct early revascularization and treatments.

Background: The objectives of this study were to assess the relation of blood groups and the rate of successful angioplasty in patients with ST-elevated myocardial infarction (STEMI) and also to investigate long-term adverse outcomes follow-up. Materials and Methods: In this study, 500 eligible patients with definitive diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were followed up for 3 years. The patient's angiography images were examined and thrombolysis in myocardial infarction (TIMI) flow rate and coronary artery patency rate were evaluated in different ABO blood groups. All patients were followed up after 3 years based on major adverse cardiovascular events. Results: There was no significant difference in coronary artery patency rate between the patients of the different blood types with respect to TIMI flow before (P = 0.19) and after revascularization (P = 0.69). The incidence of atrial fibrillation (AF) in blood Group A was the highest. Death in the blood Groups AB and O was significantly higher than the other groups. No significant differences were seen in different blood groups in the frequency of mortality (P = 0.13), myocardial infarction (P = 0.46), heart failure (P = 0.83), re-hospitalization, angiography (P = 0.90), PCI (P = 0.94), coronary artery bypass graft (P = 0.26), implantable cardioverter defibrillator (ICD) implantation (P = 0.26), and mitral regurgitation (P = 0.88). Conclusion: The incidence of AF in blood Group A and inhospital mortality in blood Groups AB and O were the highest. The blood group may be considered in assessment of clinical risk in STEMI patients.

Objective: It is crucial to determine the high-risk group in ST-elevated myocardial infarction (STEMI). Left ventricle ejection fraction (LVEF) and left atrial volume index (LAVI) are the well-established parameters for risk prediction. However, major adverse cardiovascular events (MACEs) may be predicted less than actual when LVEF or LAVI are in the normal range. It was investigated LAVI to LVEF ratio (LAVI/LVEFr) for more accurate MACE prediction. Methods: Patients with STEMI were included in the study. LAVI and LVEF were obtained at admission. The LAVI/LVEFr was calculated as LAVI dividing by LVEF. The composite primary endpoint of the study was all-cause mortality and new-onset heart failure for 8 years follow-up. Results: A total of 176 patients were divided into two groups according to the presence of MACE. MACE (+) group consisted of 70 (39.7%) patients who were older and more likely to be male. While LVEF (P < 0.001) was lower, LAVI (P < 0.001) and LAVI/LVEFr (P < 0.001) were higher in MACE (+) group. Age (P = 0.003), serum creatinine (P < 0.001), and LAVI/LVEFr (P < 0.001) were independent predictors of MACE. Conclusion: Combined usage of LAVI and LVEF (LAVI/LVEFr), increased age, and serum creatinine level were the independent predictors of MACE during 8 years of follow-up in STEMI patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Acute myocardial infarction is the leading cause of mortality and morbidity across the world. Acute myocardial infarction with ST-segment elevation has been considered a common cardiac emergency and has considerable morbidity and mortality. The role of uric acid (UA) in the mortality rate of ST-segment elevation myocardial infarction (STEMI) was examined in the present study. Materials and Methods: In this prospective study, 107 patients diagnosed with STEMI aged 18 years and older in the coronary care unit at Azadi Teaching Hospital, Duhok, Iraq from April 20, 2017 to December 20, 2017 were followed up for 1 month to determine the 30-day mortality in relation to serum UA level. Results: The mean age of patients was 55.27±13.59 years. The inferior type of STEMI was the most prevalent one among the patients (45.1%). Serum UA was not significantly different in both the groups (P > 0.05). Conclusion: The study did not show UA as a risk factor for mortality in patients with STEMI. [ABSTRACT FROM AUTHOR]

Aim. To identify genetic markers of risk for ST-elevated myocardial infarction (STEMI).Material and methods. The study included 210 patients (119 men, 91 women) with STEMI, hospitalized from December 21, 2016 to June 16, 2017 The average age of men was 55,5±9,5 years, women — 57,5±9,1 years. The diagnosis of STEMI was verified according to the criteria of the European Society of Cardiology (2015, 2017). During hospitalization, patients underwent clinical and instrumental examination, stipulated by medical care standards and clinical guidelines We also conducted a genetic study of single nucleotide polymorphisms (SNPs), which showed their association with the risk of coronary artery disease (CAD) and acute myocardial infarction (AMI) according to the GWAS: rs2820315 of the LMOD1 gene (Leiomodin 1, mapped on chromosome 1), rs9349379 of the PHACTR1 gene (regulator 1 of actin and phosphotase, localized on chromosome 6p241), rs867186 of the PROCR gene (Protein C receptor, located on chromosome 20q11.22), rsi1799883 of the FABP2 gene (Fatty acid-binding protein 2, located on chromosome 4q26). Statistical data analysis was performed using the SPSS 170.5 software package and authorial odds ratio (OR) calculator.Results. Carriage of the CC genotype of rs2820315 polymorphism of the LMOD gene is associated with an increased risk of STEMI by 1,87 times (95% CI 1,2862,722, p=0,016). Carriers of the CT genotype of rs2820315 polymorphism have a reduced risk of STEMI (OR 0,633; 95% CI 0,436-0,918, p=0,016).Conclusion. In order to identify risk groups for STEMI development, the study of the rs2820315 polymorphism of the LMOD gene is recommended. This will define the high-risk group for STEMI for developing of personalized programs for primary and secondary prevention of cardiovascular events in practical health care, which will contribute to reducing of STEMI mortality.

Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

Aim. To study the effect of the 48-week atorvastatin therapy on the mechanisms of arrhythmogenesis, determined during daily ECG monitoring, in patients with ST-elevated myocardial infarction (STEMI).Material and methods. The study included 104 people. Patients were randomized into two groups: a high-dose statin therapy group who took 80 mg of atorvastatin per day, and a comparison group who received atorvastatin 20 mg/day for 48 weeks. Upon admission and every 12 weeks, the total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol and triglycerides were determined. At the 7-9th day, 24th and 48th weeks of STEMI the daily ECG monitoring on 12 leads using the Holter Analysis-Astrocard complex (Meditek CJSC, Russia) with an assessment of the circadian dynamics of the heart rate, late ventricular potentials, duration, variability and dispersion of the QT interval, temporal and spectral parameters of heart rate variability, heart rate turbulence and the frequency of ventricular arrhythmias. Various cardiovascular events in the postinfarction period were taken as the end points.Results. Depending on the achievement/non-achievement of the LDL-С target level in the treatment process, two groups were identified: highly effective lipidlowering therapy “HET” — 51 people and relatively effective lipid-lowering therapy “RET” — 49 patients. In the HET group, QT dispersion regression was obtained from the 24th week of treatment; in the RET group, the dynamics of QTe disp, sdQTe, sdQTa values was not found. A positive transformation of all parameters characterizing the post-depolarization activity was revealed only in the HET group: a decrease in QRSf and HFLA, an RMS increase. Significant differences were obtained in the most of the parameters of both temporal and spectral analysis of HRV in the HET group. Clinically significant rhythm and conduction disturbances were more frequently recorded in patients of the RET group.Conclusion. Achieving the target LDL values in atorvastatin therapy in patients with STEMI is associated with the electrophysiological stability of the myocardium and the clinical well-being of patients in the post-infarction period.

OBJECTIVE: Compared with intravenous injection, to probe into the effect of coronary arterial injection of tirofiban on microvascular occlusion in patients with ST-elevated myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI). METHODS:Totally 378 STEMI patients undergoing PCI admitted into the First Hospital of Qinhuangdao City from Dec. 2017 to Nov. 2019 were selected and divided into intravenous administration group and coronary arterial administration group via random number table, with 189 cases in each group. The coronary arterial administration group was given tirofiban through suction tube after surgery, with a dosage of 10 μg / kg, followed by continuous intravenous administration at a maintenance dose of 0. 15 μg / ( kg·min) for 24-48 h. The intravenous administration group was first received intravenous tirofiban at a dose of 10 μg / kg, followed by continuous intravenous administration at a maintenance dose of 0. 15 μg / ( kg·min) for 24-48 h. The baseline clinical indicators, cardiac magnetic resonance before treatment and at 6 months after treatment were collected and compared between two groups; the incidence of major adverse cardiac events ( MACE) was compared between two groups after 1 year of treatment. Multivariate logistic regression analysis was used to evaluate the factors associated with the occurrence of MACE. RESULTS: After PCI, compared with intravenous administration group, the left ventricular ejection fraction(LVEF) of patients in the coronary arterial administration group was significantly increased(t = 3. 351, P= 0. 001), and the incidence of microvascular occlusion was significantly decreased(χ 2 = 15. 377, P<0. 001); after 1-year follow-up, the left ventricular end-diastolic volume index( t = 4. 591, P<0. 001), left ventricular end-systolic volume index(t = 8. 622, P < 0. 001) and infarct size ( t = 10. 664, P < 0. 001) of patients in the coronary arterial administration group were significantly decreased, and the LVEF was significantly increased( t = 4. 366, P<0. 001), with statistically significant differences. Coronary artery injection of tirofiban was an independent protective factor against MACE in STEMI patients at 1 year after PCI ( OR = 0. 423, 95% CI = 0. 190-0. 943, P = 0. 036 ). CONCLUSIONS: Compared with intravenous injection of tirofiban, coronary artery injection of tirofiban can significantly improve the incidence of MVO and remodeling of left ventricle in patients with STEMI within 6 months after PCI, and reduce the incidence of MACE events at 1 year after surgery. [ABSTRACT FROM AUTHOR]

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p<0.0001). Pearson correlation analysis in AMI patients, a slightly positive correlation between BMI and aPTT was observed (r=0.19, p<0.001) and also between PT and aPTT (r=0.66, p<0.001). Conclusion: There was a slightly positive correlation found between BMI and aPTT which indicated that the weight and height of the patients do not affect the plasma PT and aPTT levels on anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Background: Currently, how to accurately determine the patient prognosis after a percutaneous coronary intervention (PCI) remains unclear and may vary among populations, hospitals, and datasets. The aim of this study was to establish a prediction model of in-hospital mortality risk after primary PCI in patients with acute ST-elevated myocardial infarction (STEMI).Methods: This was a multicenter, observational study of patients with acute STEMI who underwent primary PCI. The outcome was in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method was used to select the features that were the most significantly associated with the outcome. A regression model was built using the selected variables to select the significant predictors of mortality. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram.Results: Totally, 1169 and 316 patients were enrolled in the training and validation sets, respectively. Fourteen predictors were identified by the LASSO analysis: sex, Killip classification, left main coronary artery disease (LMCAD), grading of thrombus, TIMI classification, slow flow, application of IABP, administration of β-blocker, ACEI/ARB, symptom-to-door time (SDT), symptom-to-balloon time (SBT), syntax score, left ventricular ejection fraction (LVEF), and CK-MB peak. The mortality risk prediction nomogram achieved good discrimination for in-hospital mortality (training set: C-statistic = 0.987; model calibration: P = 0.722; validation set: C-statistic = 0.984, model calibration: P = 0.669). Area under the curve (AUC) values for the training and validation sets are 0.987 (95% CI: 0.981-0.994, P = 0.003) and 0.990 (95% CI: 0.987-0.998, P = 0.007), respectively. DCA shows that the nomogram can achieve good net benefit.Conclusions: A novel nomogram was developed and is a simple and accurate tool for predicting the risk of in-hospital mortality in patients with acute STEMI who underwent primary PCI. [ABSTRACT FROM AUTHOR]

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Background: De Winter syndrome accounts for approximately 2% of all patients with acute anterior myocardial infarction admitted to the emergency department, and is characterized by severe stenosis of the left anterior descending coronary artery (LAD). The ECG changes are not recognized by ECG software, and poor understanding of the syndrome among physicians may lead to misdiagnosis, delayed reperfusion, and mortality.Case Presentation: A 51-year-old male patient presented with a newly developed ECG pattern suggestive of de Winter Syndrome. Coronary angiography revealed anterior myocardial infarction. Based on the ECG and clinical manifestations, the patient was diagnosed with de Winter syndrome and underwent timely percutaneous coronary intervention to revascularize the left anterior descending artery (LAD). The patient showed good outcomes and no complications at 4 months after the operation.Conclusions: This case highlights the importance of being aware of the possibility of de Winter syndrome in patients with symptoms of myocardial infarction but atypical ECG in order to conduct early revascularization and treatments. [ABSTRACT FROM AUTHOR]

Background: India has a growing trend of acute myocardial infarction (AMI) due to shifting lifestyle. Objective: To study the profile of patients died due to AMI and to find its risk correlates. Methods: A study was conducted on consecutive AMI cases admitted in the teaching hospital at Port Blair from April 2011 to March 2016. During inpatients management, outcomes were followed up from admission till discharge or expiry. Results: Of the total 491 cases, majority (75.99%) had ST-elevated myocardial infarction (STEMI); mean age of 73 deaths was 58.01 ± 13.60, mortality probability among females was less; in the age group 41–50 years the case fatality rate was the lowest (7.58%). Mean age of survival was 56.75 ± 10.47; great majorities were males across all age groups in cases and deaths; highest number of cases were in the age group 51–60 (34.21%); reportedly 83.10% had some physical activities; 6.52% were vegetarian; 34.22% were smokers; 10.39% had family history of AMI, majority (59.06%) were from white collar profession (teacher, clerical, etc.); 52.95% were diabetics; and 47.45% were hypertensives. Lifestyle-related risk factors, physical activity, and vegetarian diet were not protective; family history and addiction to smoking were significantly associated with AMI deaths. Thrombolytic intervention helped the survival of 73.68%, and the odds ratio of survival showed benefit. Conclusions: Acute STEMI had male and middle-age predominance with a common risk factor of family history, smoking, diabetes, and hypertension.

Background and Objective: Acute coronary syndrome (ACS) is an umbrella term representing a common end result, acute myocardial ischemia: Including ST-segment elevation myocardial infarction (STEMI), non-ST-STEMI (NSTEMI), and unstable angina (UA). The present study was undertaken to observe and compare the clinical profile of ACS in male and female young adults. Materials and Methods: The present cross-sectional study was conducted at cardiac ward and cardiac intensive care unit, Little Flower Hospital and Research Centre, Angamaly. 50 male and female participants admitted with ACS were recruited for the study after obtaining written informed consent by purposive sampling. Data were analyzed using SPSS 20.0. The statistical test used is regression analysis and Student’s t-test. Results: Female’s age group is significantly different than males. Body mass index (BMI) is not significantly different in males and female participants. NSTEMI and UA incidence are significantly higher in females (P < 0.001). While significantly higher incidence rate of STEMI ACS was observed in males (P < 0.001). 48.65% of male patients had dyslipidemia (DLP), while only 38.46% of female patients had DLP. The incidence rate of DLP was significantly (P = 0.0067) higher in male patients. Significantly greater number of male patients presented symptoms of chest pain, while female patients presented with symptoms of chest pain or chest discomfort. The symptoms chest discomfort was significantly lower in male patients. While 7.69% of female patients presented with chest heaviness or abdominal pain, these symptoms were not observed among male patients. A symptom of sweating was prominently observed in male patients, while symptoms of retrosternal pain and tiredness were exclusive to male patients. A symptom of vomiting was equally reported by both male and female patients. Furthermore, the observation of multiple symptoms was significantly (P < 0.01) higher among male patients. As the r2 value is positive, the correlation between the parameters, although very low its positive. Female’s age group is significantly different than males. BMI is not significantly different in males and female participants. Both systolic and diastolic pressures were not significantly different in the participants. High-density lipoproteins, fasting blood sugar, low-density lipoproteins cholesterol is slightly higher in females; however, it is not statistically significant. Triglycerides and troponin I were lower in females than males. However, it is not statistically significant. Blood urea and serum creatinine were slightly lower in females than males; however, it is not statistically significant. No difference in uric acid levels was observed. Serum glutamic oxaloacetic transaminase and serum glutamic-pyruvic transaminase enzyme levels are lower in females when compared with males; however, it is not statistically significant. Sodium levels are slightly lower in females, and potassium levels are slightly higher in females when compared with males; however, it is not statistically significant. Conclusion: The present study indicates NSTEMI and UA incidence was higher in females, and STEMI incidence was higher in males. We recommend further detailed multicenter study in this area with higher sample size to confirm the results and implement preventive measures for the benefit of the society in general.

Objectives: To evaluate the association between time to treatment and to check the effect of various risk factors such as diabetes mellitus, hypertension (HTN), smoking, family history of coronary artery disease (CAD) and obesity on infarct size (IS), transmurality and ST-segment resolution (STR) with DE-MRI (delayed enhancement magnetic resonance imaging) on 3-month follow-up in patients treated for ST-elevated myocardial infarction (STEMI), with primary percutaneous coronary intervention (PPCI). Background: Early PPCI decreases IS and transmurality but increases STR. Materials and Methods: Fifty consecutive patients with STEMI treated with reperfusion therapy in the form of PPCI and underwent cardiac MRI at 3-month interval follow-up. The primary endpoint is final IS and transmurality as assessed by DE-MRI at 3-month follow-up. Results: IS and transmurality increase and STR decreases with increase in duration to percutaneous coronary intervention from the onset of symptoms. Similarly, the effect of various confounding factors such as diabetes mellitus, HTN, smoking, family history of CAD and obesity on IS, transmurality and STR was assessed which did not affect immediate prognosis during treatment. Conclusion: Primary angioplasty is the treatment modality of choice in the case of STEMI when available. Time to treatment directly influences STR, final IS and transmurality, that is, the earlier the intervention done, more will be STR and lesser will be final IS and transmurality. There is no significant effect of confounding variables such as cardiac risk factors except family history of CAD on immediate prognosis during treatment.

Objective: To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI)., Materials and Methods: We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the one-week CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC)., Results: Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) ( P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) ( P = 0.727)., Conclusion: Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2023 The Korean Society of Radiology.)

Background: No study has investigated the prognostic importance of the combined use of QRS distortion and fragmented QRS (fQRS) for risk stratification in acute ST segment elevation myocardial infarction (STEMI).Objective: To determine the prognostic value of the combined use of QRS distortion and fQRS in patients with acute STEMI undergoing primary percutaneous coronary intervention (pPCI).Methods: A total of 454 patients with first STEMI who underwent pPCI were included in this study. Patients were categorized into three groups according to the presence of QRS distortion and fQRS on admission electrocardiography. Group I was defined as fQRS (-) and QRS distortion (-), group 2 was defined as fQRS (+) and QRS distortion (-), or fQRS (-) and QRS distortion (+), and group 3 was defined as both fQRS (+) and QRS distortion (+).Results: Patients in group III had a significantly higher in-hospital mortality rate compared with patients in groups I and II. These patients also had lower left ventricular ejection fraction and ST resolution ratios, higher maximum troponin, and higher frequency of three-vessel disease. Multivariate analysis indicated that group III (OR: 8.84, 95% CI: 2.73-28.62, p<0.001) was an independent predictors of in-hospital mortality.Conclusion: The combined use of QRS distortion and fQRS provides additional prognostic value compared with the presence of QRS distortion or fQRS alone for early risk stratification in patients with STEMI treated with pPCI. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.Methods: We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA.Results: We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines.Conclusions: Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further.Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. [ABSTRACT FROM AUTHOR]

Background: India has a growing trend of acute myocardial infarction (AMI) due to shifting lifestyle. Objective: To study the profile of patients died due to AMI and to find its risk correlates. Methods: A study was conducted on consecutive AMI cases admitted in the teaching hospital at Port Blair from April 2011 to March 2016. During inpatients management, outcomes were followed up from admission till discharge or expiry. Results: Of the total 491 cases, majority (75.99%) had ST-elevated myocardial infarction (STEMI); mean age of 73 deaths was 58.01 ± 13.60, mortality probability among females was less; in the age group 41-50 years the case fatality rate was the lowest (7.58%). Mean age of survival was 56.75 ± 10.47; great majorities were males across all age groups in cases and deaths; highest number of cases were in the age group 51-60 (34.21%); reportedly 83.10% had some physical activities; 6.52% were vegetarian; 34.22% were smokers; 10.39% had family history of AMI, majority (59.06%) were from white collar profession (teacher, clerical, etc.); 52.95% were diabetics; and 47.45% were hypertensives. Lifestyle-related risk factors, physical activity, and vegetarian diet were not protective; family history and addiction to smoking were significantly associated with AMI deaths. Thrombolytic intervention helped the survival of 73.68%, and the odds ratio of survival showed benefit. Conclusions: Acute STEMI had male and middle-age predominance with a common risk factor of family history, smoking, diabetes, and hypertension. [ABSTRACT FROM AUTHOR]

Lipoprotein(a) [Lp(a)], which is genetically determined, has been reported as an independent risk factor for atherosclerotic vascular disease. However, the prognostic value of Lp(a) for secondary vascular events in patients after coronary artery disease has not been fully elucidated. This 3-year observational study included a total of 176 patients with ST-elevated myocardial infarction (STEMI), whose Lp(a) levels were measured within 24 h after primary percutaneous coronary intervention. We divided enrolled patients into two groups according to Lp(a) level and investigated the association between Lp(a) and the incidence of major adverse cardiac and cerebrovascular events (MACCE). A Kaplan-Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of MACCE than those with lower Lp(a) levels (log-rank P = 0.034). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the occurrence of MACCE after adjusting for other classical risk factors of atherosclerotic vascular diseases (hazard ratio 1.030, 95 % confidence interval: 1.011-1.048, P = 0.002). In receiver-operating curve analysis, the cutoff value to maximize the predictive power of Lp(a) was 19.0 mg/dl (area under the curve = 0.674, sensitivity 69.2 %, specificity 62.0 %). Evaluation of Lp(a) in addition to the established coronary risk factors improved their predictive value for the occurrence of MACCE. In conclusion, Lp(a) levels at admission independently predict secondary vascular events in patients with STEMI. Lp(a) might provide useful information for the development of secondary prevention strategies in patients with myocardial infarction. [ABSTRACT FROM AUTHOR]

Left ventricular free wall rupture is not a rare complication of ST-elevated myocardial infarction, and causes fatal results. This complication is often diagnosed on the basis of hemodynamic collapse and transthoracic echocardiography. We describe a case of posterolateral free wall rupture that could not be diagnosed using transthoracic echocardiography but was diagnosed using left ventriculography, mainly in the left anterior oblique view. We were unsuccessful in preventing patient fatality because of late diagnosis. Therefore, we must keep in mind the limitation of each diagnostic modality. < Learning objective: A posterior wall rupture sometimes shows no pericardial effusion on transthoracic echocardiography. Left ventriculography may be a useful modality as a last resort to detect posterior wall rupture. In this situation, the right anterior oblique view may not demonstrate the contrast extravasation of a posterior wall rupture, and the left anterior oblique view may be useful in detecting it.> [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between time to treatment and to check the effect of various risk factors such as diabetes mellitus, hypertension (HTN), smoking, family history of coronary artery disease (CAD) and obesity on infarct size (IS), transmurality and ST-segment resolution (STR) with DE-MRI (delayed enhancement magnetic resonance imaging) on 3-month follow-up in patients treated for ST-elevated myocardial infarction (STEMI), with primary percutaneous coronary intervention (PPCI). Background: Early PPCI decreases IS and transmurality but increases STR. Materials and Methods: Fifty consecutive patients with STEMI treated with reperfusion therapy in the form of PPCI and underwent cardiac MRI at 3-month interval follow-up. The primary endpoint is final IS and transmurality as assessed by DE-MRI at 3-month follow-up. Results: IS and transmurality increase and STR decreases with increase in duration to percutaneous coronary intervention from the onset of symptoms. Similarly, the effect of various confounding factors such as diabetes mellitus, HTN, smoking, family history of CAD and obesity on IS, transmurality and STR was assessed which did not affect immediate prognosis during treatment. Conclusion: Primary angioplasty is the treatment modality of choice in the case of STEMI when available. Time to treatment directly influences STR, final IS and transmurality, that is, the earlier the intervention done, more will be STR and lesser will be final IS and transmurality. There is no significant effect of confounding variables such as cardiac risk factors except family history of CAD on immediate prognosis during treatment. [ABSTRACT FROM AUTHOR]

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore ≥22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 ± 0.42 vs 1.02 ± 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI. [ABSTRACT FROM PUBLISHER]

The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ≥3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI. [ABSTRACT FROM PUBLISHER]

Abstract: With the advent of thrombolytics, guidelines for ST-elevated myocardial infarction (STEMI) recognition were presented in terms of an ST segment exceeding a particular level (1 or 2 mm) in 2 contiguous leads. However, more than half of prehospital electrocardiograms that exceed these ST criteria are from patients not having an acute myocardial infarction. In contrast, expert physicians (EXMD) maintain a high specificity (>95%) for the recognition of STEMI. Likewise, in terms of increasing sensitivity, it has been found that the EXMD will classify STEMI at lower levels than specified in the guideline. Thus, the EXMD uses additional electrocardiogram features to identify patients for appropriate intervention. Given that STEMI can be defined in terms of a pattern that is recognized by the EXMD as well as a clinical classification that can be evaluated in terms of clinical outcomes, the development and validation of a computer algorithm for STEMI need to include both the art of understanding how the human is detecting STEMI as well as the science required to develop quantified criteria based on clinical outcomes. Evidence is presented that demonstrates that reciprocal depression is a strong indicator of STEMI versus other causes of ST elevation. [Copyright &y& Elsevier]

Objective: To detect residual platelet aggregation following the switch from generic (GC) to brand clopidogrel (BC) in male patients after ST-elevated myocardial infarction (STEMI). Methods: The study was designed as an open-label, prospective cohort trial. Thirty-three male STEMI patients were enrolled. All patients received dual antiplatelet therapy with aspirin (100 mg/daily) and one of six GC at a daily dose of 75 mg. After 2 weeks, all patients were switched to BC. Adrenaline- and adenosine diphosphate (ADP)-induced platelet aggregation was assessed twice: on day 14 (before the switch) and on day 21 (after 1 week of BC therapy). Results: Adrenaline-induced platelet aggregation did not differ among clopidogrel formulations. In contrast, residual 5 µM ADP-induced platelet aggregation after BC differs from GC by 14% (28.0 ± 2.5 vs. 23.9 ± 2.1%; p = 0.03). When 20 µM ADP was used as agonist, the difference was smaller (36.2 ± 2.9 vs. 34.6 ± 2.8%) but still significant (p = 0.04) favoring BC. Conclusions: After 2 weeks of therapy, switching from GC to BC was associated with a mild but significant reduction in ADP-induced platelet aggregation in male post-STEMI patients. The observed differences between GC and BC should be confirmed in a larger randomized study, but may represent a risk in underdeveloped countries, where GC therapy is mandatory for post-MI inpatients. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]