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Background: There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference., Objectives: Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission., Design: Retrospective SETTING: Tertiary percutaneous coronary intervention center., Patients and Methods: Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals., Main Outcome Measures: Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women., Results: Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime ( P =.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV ( P =.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime ( P =.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night ( P =.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality., Conclusions: While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes., Limitations: More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI., Conflict of Interest: None.

The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.

Background/aim: The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI)., Materials and Methods: ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies., Results: A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988)., Conclusion: Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.

Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) have been reported in patients with coronary artery disease (CAD). In this study, we sought to evaluate the association between TRI and the extent and severity of CAD evaluated by SYNTAX score (SS) and Gensini score in patients with ST elevation myocardial infarction (STEMI)., Methods: A total of 290 patients with STEMI were included in the study. GRS and TRI were calculated on admission using specified variables. The extent and severity of CAD were evaluated using the SS and Gensini scores. The patients were divided into low (TRI ⩽19), intermediate (TRI 19-30), and high (TRI ⩾30) risk groups. A Pearson correlation analysis was used for the relationship between TRI, GRS, Gensini score and SS., Results: There were significant differences in the mean age (p < 0.001), admission heart rate (p < 0.001), admission systolic blood pressure (p = 0.009), SS (p < 0.001), GRS (p < 0.001) and in-hospital major adverse cardiac events (MACE) in all patients between the low, intermediate and high TRI risk groups. There was a positive significant correlation between TRI and SS (r = 0.24, p < 0.001), Gensini score (r = 0.18, p = 0.002), GRS (r = 0.74, p = 0.001) and in-hospital MACE (r = 0.29, p < 0.001)., Conclusion: TRI is significantly related to SS and Gensini score in predicting the extent and severity of CAD in patients with STEMI., (© The Author(s), 2015.)

The aim of the study was to evaluate the utility of the preprocedural platelet-lymphocyte ratio (PLR) for predicting no reflow in patients undergoing primary percutaneous intervention (PCI) for the treatment of ST-segment elevation myocardial infarction. The thrombolysis in myocardial infarction (TIMI) flow grades of 287 patients treated with primary PCI were assessed retrospectively. Patients were divided into 3 tertiles based upon preprocedural PLR. Pre- and postprocedural TIMI flow grades were evaluated. No reflow developed in 6, 14, and 43 patients in the lower, middle, and higher tertiles, respectively (P < .001). After multivariate analysis, PLR remained a significant predictor of no reflow together with neutrophil-lymphocyte ratio (NLR). A cutoff value of 160 for PLR and 5.9 for NLR predicted no reflow with sensitivities and specificities of 75% and 71% and 74% and 70%, respectively. In conclusion, high preprocedural PLR and NLR levels are significant and independent predictors of no reflow in patients undergoing primary PCI., (© The Author(s) 2014.)

Introduction: Previous studies have reported a relationship between serum bilirubin levels and coronary artery disease (CAD). However, data are rare up to now regarding the relation of bilirubin levels with infarct-related artery (IRA) patency in the setting of ST-segment elevation myocardial infarction (STEMI). Moreover, previous studies reported that increased bilirubin was related to impaired post-intervention coronary flow. To our knowledge, the association between serum total bilirubin (TB) levels and pre-primary percutaneous coronary intervention (PCI) with patency of IRA flow in STEMI patients has not been investigated. Aim: To evaluate the association of TB with pre-primary PCI, coronary flow and in-hospital major adverse cardiac events (MACE) in patients with STEMI. Material and methods: A total of 360 consecutive patients with STEMI (mean age = 61.4 ±13.7 years) admitted within 12 h from the time of symptom onset were enrolled. Patients were divided into 2 groups based on the serum TB levels. We defined normal flow as pre-PCI TIMI 3 flow, while impaired flow was defined as pre-PCI TIMI ≤ 2 flow. Results: Pre-PCI impaired flow was higher in the TB group than pre-PCI normal flow (p < 0.001). In-hospital mortality and MACE were significantly higher in the high TB group (p = 0.002, p < 0.001 respectively). In the receiver operating characteristic curve analysis, TB > 0.825 mg/dl predicted impaired IRA flow before p-PCI with a sensitivity of 79% and specificity of 71%. Conclusions: The TB is an inexpensive and readily available marker for STEMI patients undergoing PCI. It can be used for risk stratification in this patient population. [ABSTRACT FROM AUTHOR]