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Background: Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time (DBT) of ≤ 90 min for patients undergoing primary percutaneous coronary intervention (PCI). We aimed to investigate the possible impact of further reduction in DBT intervals beyond the 90 min cutoff on short and long-term outcomes among STEMI patients undergoing primary PCI. Methods: We retrospectively studied 889 STEMI patients (median age 61 years, 83% men) who underwent successful primary PCI and had a DBT of ≤ 90 min. Patients were stratified according to DBT into 2 groups: < 60 min and 60–90 min. Patients records were assessed for the occurrence of in-hospital complications, 30-day and 1-year mortality. Results: Patients having DBT < 60 min (n = 608, 68%) were more likely to present earlier, in daytime and weekdays, and had better post-procedural left ventricular ejection fraction and lower 30-day mortality (3% vs. 6%, p = 0.03). Mortality over 1-year was significantly lower among patients having DBT < 60 compared to DBT of 60–90 min (4.6% vs. 9.6%, p = 0.004). In a binary logistic regression model DBT < 60 min was associated with 51% risk reduction for 1-year mortality (OR 0.49, 95% CI 0.25–0.93, p = 0.03). Conclusions: Among STEMI patients undergoing primary PCI within 90 min of admission DBT < 60 min was independently associated with better 1-year mortality. [ABSTRACT FROM AUTHOR]

Cardiac disease is a major cause of morbidity and mortality worldwide. Currently, most researchers focus on identifying risk factors and treatment of cardiac disease. There has been little research on real-time prediction of patient survival in emergency situations with unbalanced data, which is critical to cardiac patient treatment. 2099 records were collected from cardiac patients at the Tel-Aviv Sourasky Medical Center. Using these records, a survival prediction model was built using empirical thresholding logistic regression with unbalanced cardiac patient data. This research (1) provided a simplified, highly efficient and flexible model to predict survival of patients with cardiac disease; (2) revealed important factors that influence survival prediction; and (3) discussed key points related to prediction with unbalanced medical data. The identified risk factors will help doctors concentrate on the most important factors for patient survival. This study provided novel technical and practical insights for patient survival analysis and prediction that traditionally suffers from the common unbalanced data problem. [ABSTRACT FROM AUTHOR]

Background: Recent reports have demonstrated the adverse effects of venous congestion on renal function in patients with heart failure. None of these trials, however, has evaluated the effect of acute myocardial ischemia on the occurrence of acute kidney injury (AKI).Methods: We conducted a retrospective study of 1336 ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) between June 2012 and June 2016. Comprehensive echocardiographic examination was performed within 72 h of hospital admission. Non-invasive evaluation of central venous pressure (CVP) was estimated from measurements of inferior vena cava diameter and its collapsibility. Intermediate-high CVP was defined as ≥ 8 mm/Hg. Patients were stratified according to left ventricular ejection fraction (LVEF) and CVP and assessed for AKI.Results: Intermediate-high CVP was associated with AKI both in patients with LVEF greater than 45% and those with 45% or lower. Patients having LVEF ≤ 45% and intermediate-high CVP had a 10-fold increase in the incidence of AKI compared to patients with LVEF > 45% and normal CVP (39 vs. 4%). In a multivariable logistic regression model, intermediate-high CVP was independently associated with AKI (OR = 2.73, 95% CI 1.54-4.87; p = 0.001). Other variables associated with AKI included LVEF ≤ 45% (OR = 2.37, 95%CI 1.25-4.51; p = 0.008), time to reperfusion, mechanical ventilation and chronic kidney disease.Conclusions: Among STEMI patients undergoing PCI, the utilization of simple echocardiographic measurements (LVEF and CVP) may be useful for early identification of those at high risk for AKI. [ABSTRACT FROM AUTHOR]

Background: Since the advent of primary percutaneous coronary intervention (PCI), studies have reported a declining incidence of left ventricular thrombus (LVT) following ST-elevation myocardial infarction (STEMI). We investigated the incidence and outcomes of early (pre-discharge) LVT in the contemporary era of PCI practice in a large cohort of STEMI patients. Methods: We retrospectively studied 2071 consecutive STEMI patients who underwent successful primary PCI. Screening echocardiography was performed within 24-48 h of admission. Patients with anterior STEMI were treated with intravenous heparin for 24-48 h until a first echocardiography test was performed. Patients with reduced ejection fraction (EF) ≤40% had a repeat test before hospital discharge (days 5-7). Heparin was continued in case of significant left ventricular dysfunction (EF < 35%) or apical akinesis or dyskinesis, until a second test ruled out LVT. Results: LVT was diagnosed before hospital discharge in 31/2071 patients (1.5%), 28 of whom (90%) had anterior STEMI. Only 2/31 patients with LVT (6.5%) developed embolic events before discharge and 1/31 (3.2%) had an episode of upper gastrointestinal bleeding that required blood transfusion. There was no significant difference between the two groups regarding in-hospital STEMI-related complications, short- and long-term mortality. All LVTs resolved in subsequent echocardiograms within 6 months of discharge. Conclusions: We report a low incidence of early LVT following STEMI. Further studies are needed to assess the efficacy and safety of a limited in-hospital anticoagulation protocol in STEMI patients with reduced EF. [ABSTRACT FROM AUTHOR]

Objective: Increased transmitral flow velocity ( E) to the early mitral annulus velocity ( e′) ratio ( E/ e′), signifying increased cardiac filling pressure, was previously found to be associated with deterioration of renal function in patients with congestive heart failure. No study, however, included patients with acute myocardial ischemia. We hypothesized that elevated E/ e′ ratio would be associated with an increased risk of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Study design and methods: We conducted a retrospective study of 804 consecutive STEMI patients between June 2012 and December 2015 who underwent primary PCI and had a comprehensive echocardiographic examination performed within 72 h of hospital admission. Patients were stratified according to E/ e′ ratio above and ≤15, and assessed for AKI using the KDIGO criteria, defined as either a serum creatinine rise >0.3 mg/dl, or an increase in serum creatinine ≥1.5 times baseline. Results: Patients with E/ e′ ratio >15 had lower left ventricular (LV) ejection fraction, higher systolic pulmonary artery pressures, as well as right atrial pressures, and demonstrated worse in-hospital outcomes. Patients with E/ e′ ratio >15 had more AKI complicating STEMI (27 vs. 7 %; p < 0.001). In multivariate logistic regression model, E/ e′ ratio >15 was independently associated with AKI (OR = 1.87, 95 % CI 0.99-3.52; p = 0.05). Other variables associated with AKI included diabetes, LV ejection fraction, and glomerular filtration rate. Conclusions: Among STEMI patients undergoing primary PCI, the early E/ e′ ratio >15 was associated with increased risk for AKI. [ABSTRACT FROM AUTHOR]

Background: Elevated periprocedural high sensitive C-reactive protein (hs-CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in non-myocardial infarction (MI) patients undergoing percutaneous coronary intervention (PCI), however, no information to date is present regarding its predicting role for AKI in MI patients. We evaluated whether admission serum hs-CRP levels may predict risk of AKI among ST elevation MI (STEMI) patients undergoing primary PCI. Methods: Five hundred and sixty-two patients that were admitted with STEMI and treated with primary PCI were included in the study. Serum hs-CRP levels were determined from blood samples taken prior to PCI. Patients' medical records were reviewed for occurrence of AKI, in-hospital complications and 30 days mortality. Results: Mean age was 62 ± 16 and 455 (80 %) were males. Patients were divided into two groups, according to their admission hs-CRP values: group 1: hs-CRP ≤9 mg/l ( n = 394) and group 2: hs-CRP >9 mg/l ( n = 168). Patients with hs-CRP >9 mg/l had significantly higher rate of AKI following PCI (17 vs. 6 %; p < 0.001), more in-hospital complications and higher30 -day mortality rate (11 vs. 1 %; p = 0.02). In a multivariable logistic regression model admission hs-CRP level >9 mg/l was an independent predictor for AKI (OR 2.7, 95 % CI: 1.39-5.29; p = 0.001) and a strong trend for 30 day mortality (OR 4.27, 95 % CI: 0.875-21.10; p = 0.07). Conclusion: Admission serum hs-CRP level >9 mg/l is an independent predictor for AKI following primary PCI in STEMI patients. [ABSTRACT FROM AUTHOR]

Purpose: Acute kidney injury (AKI) is associated with adverse outcomes after acute ST elevation myocardial infarction (STEMI). The recently proposed AKI network (AKIN) suggested modifications to the consensus classification system for AKI known as the risk, injury, failure, loss, end-stage (RIFLE) criteria. The aim of the current study was to compare the incidence and mortality (early and late) of AKI diagnosed by RIFLE and AKIN criteria in the STEMI patients undergoing primary percutaneous intervention (PCI). Methods: We retrospectively studied 1,033 consecutive STEMI patients undergoing primary PCI. Recruited patients were admitted between January 2008 and November 2012 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of RIFLE and AKIN criteria for the diagnosis, classification, and prediction of mortality. Results: The AKIN criteria allowed the identification of more patients as having AKI (9.6 vs. 3.9 %, p < 0.001) and classified more patients with stage 1 (risk in RIFLE) (7.6 vs. 1.9 %, p < 0.001) compared with the RIFLE criteria. Mortality was higher in AKI population defined by either RIFLE (46.3 vs. 6.8 %, OR 11.9, 95 % CI 6.15-23.1; p < 0.001) or AKIN (29 vs. 6.1 %; OR 6.3, 95 % CI 3.8-10.4; p < 0.001) criteria. In a multivariable logistic regression model, AKI defined with both RIFLE and AKIN was an independent predictor of both 30-day and up to 5-year all-cause mortality. However, there was no significant statistical difference in the risk provided by these two scoring systems. Conclusions: AKIN criteria are more sensitive in defining AKI compared with the RIFLE criteria in STEMI. However, no difference exists in the mortality risk provided by these two scoring systems. [ABSTRACT FROM AUTHOR]

Objective: Conflicting data exists regarding the frequency and significance of acute kidney injury (AKI) in ST segment elevation MI (STEMI) patients. The acute kidney injury network (AKIN) classification has been shown to predict mortality in various critically ill patients; however, limited information is available regarding its use and its clinical relevance among STEMI patients. Study design and methods: We retrospectively studied 1,033 STEMI patients undergoing primary percutaneous intervention (PCI). AKI was identified on the basis of the changes in serum creatinine during hospitalization according to the AKIN criteria. Patients were assessed for in-hospital adverse outcomes as well as all-cause mortality up to 5 years. Results: Overall, 100 patients (9.6 %) developed AKI: 79 patients (79 %) had stage 1, 14 patients (14 %) developed stage 2, and 7 patients (7 %) developed stage 3 AKI. Patients with AKI had more complications during hospitalization, with higher 30 days (11 vs 1 %; p < 0.001) and 5-year all-cause mortality (29 vs 6 %; p < 0.001) compared to those without AKI. The adjusted risk of death increased proportionally to AKI severity. Compared to patients with no AKI, the adjusted hazard ratio for all-cause mortality was 6.68 (95 % confidence interval: 2.1-21.6, p = 0.002) in patients with AKI. Age, hypertension, chronic kidney injury and low left ventricular ejection fraction were independent predictors of developing AKI. Conclusion: In STEMI patients undergoing primary PCI, AKI assessed by AKIN criteria is a frequent complication, associated with an increased risk of both short- and long-term mortality. [ABSTRACT FROM AUTHOR]

The original version of this article unfortunately contained a mistake. The name of the author Keren-Lee Rozenfeld was rendered wrongly. The correct name is shown above. [ABSTRACT FROM AUTHOR]