P3683Monocyte to high-density lipoprotein ratio as a predictor of mortality and MACEs among STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis (original) (raw)
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Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 2017
The predictive significance of ST-segment elevation (STE) in lead V4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4 R in patients with anterior STEMI. A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4 R STE (Group 1), early but not late V4 R STE (Group 2) and late V4 R STE (Group 3). In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < ...
The American Journal of Cardiology, 2008
Accurate risk stratification has an important role in the management of patients with acute coronary syndromes. Even in patients with ST-elevation acute myocardial infarction (STEMI), for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making. We aimed to compare the prognostic value of 4 risk scores used to evaluate patients with STEMI. We conducted a prospective registry of all patients treated with primary percutaneous coronary intervention for STEMI from January 2001 to June 2006. Excluded were patients with cardiogenic shock. A total of 855 consecutive patients were included in the analysis (age 60.5 ؎ 13 years, 19% women, 28% with diabetes, and 48% with anterior wall myocardial infarction). For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) risk scores were calculated using specific clinical variables and angiographic characteristics. Thirty-day and 1-year clinical outcomes were assessed. The predictive accuracy of the 4 risk scores was evaluated using the area under the curve or C statistic method. The CADILLAC, TIMI, and PAMI risk scores all had relatively high predictive accuracy for 30-day and 1-year mortality (C statistic range 0.72 to 0.82), with slight superiority of the CADILLAC score. These 3 risk scores also performed well for prediction of reinfarction at 30 days (C statistic range 0.6 to 0.7). The GRACE score did not perform as well and had low predictive accuracy for mortality (C statistic 0.47). In conclusion, risk stratification of patients with STEMI undergoing primary percutaneous coronary intervention using the CADILLAC, TIMI, or PAMI risk scores provide important prognostic information and enables accurate identification of high-risk patients.
The Egyptian Journal of Hospital Medicine, 2018
Background: Early improvement of perfusion after acute MI will improve left ventricle function and decrease the infarction area, thus decreasing mortality. Methodology: 52 patients presented with acute ST segment elevation MI Who underwent primary PCI within 24 hours of presentation. All patients were subjected to full history taking, physical examination, serial ECG, cardiac enzymes, calculation of relative importance index (RII) by dividing culprit segment diameter by left anterior descending , circumflex and right coronary arteries at their proximal segments and myocardial perfusion image to detect infarction size. Results: There is significant correlation between RII and left ventricular dysfunction (p: 0.028). Significant correlation between RII and mortality are present. Conclusion: RII is significantly correlated with adverse clinical outcome in patients with acute STEMI.
The American Journal of Cardiology, 2004
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Clinical and Applied Thrombosis/Hemostasis, 2014
Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore 9, n ¼ 819), Q2 (9 < SXscore < 16, n ¼ 715), Q3 (16 SXscore < 20, n ¼ 710), and Q4 (SXscore 20, n ¼ 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip 2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion (P < .001), multivessel disease (P < .001), chronic total occlusion (P < .001), and proximal lesion localization (P < .001). At longterm follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P ¼ .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.
2015
Background: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the preferred therapy for STEMI if it is done within 120 min from the first medical contact, by an experienced team in a high-volume center. The aim of this study was to assess the clinical characteristics and predictors of in-hospital mortality of patients with STEMI treated by percutaneous coronary interventions (PCIs). Methods: We analyzed data from 15,076 STEMI patients enrolled in the RO-STEMI registry (RO-manian ST-Elevation Myocardial Infarction registry). Patients were divided into 2 groups: PCI (11.669; 77%) and conservative treated (3.407; 23%). PCI group includes both pPCI treated patients (84.3%), and patients undergoing rescue PCI (6.4%) and late PCI (9.3%). Results: The mean age of STEMI patients was 62.7+/-12.7 years. 70% were males. Patients treated by PCI were younger (61.4+/-12.2 versus 67....
Kardiologia Polska, 2014
Background: Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis. Aim: To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI). Methods: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplasty and 60 min after pPCI. ∑STR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(-), and those with STR(+). Patients were also analysed according to the infarct-related artery. Results: GS-pPCI was significantly higher in patients with STR(-) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r =-0.287, p = 0.002). In subgroup analysis, patients in the STR(-) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(-) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03-1.12, p = 0.001 and OR 3.28, 95% CI 1.11-9.72, p = 0.03, respectively). Conclusions: GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI.
Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction
Journal of cardiovascular medicine (Hagerstown, Md.), 2012
Long-term prognosis of ST segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (pPCI) remains relatively poorly investigated in unselected patients. This study analyzed 8-year follow-up of STEMI patients enrolled in the Florence Acute Myocardial Infarction Registry, a population-based, observational study performed in Italy in 2000-2001. The prognostic effect of pPCI adjusted for clinical and demographic characteristics on a composite end-point of new myocardial infraction, urgent revascularization or death, and on all-cause mortality separately, was assessed in multivariable Cox analysis, calculating hazard ratios and 95% confidence intervals. This analysis is concerned with 875 STEMI patients (mean age 70.6 ± 12.9 years), treated with pPCI (459) or conservatively (416). After 8 years, 59% of patients had experienced the composite end-point and 49% had died. The multivariable analysis showed a significantly better prognosis in pat...
2021
Background : The risk of adverse cardiovascular events remains substantial and may vary significantly among STEMI patients. Echocardiography is the recommended diagnostic tool in predicting outcomes. This study purposed to assess the prognostic role of the combination of LAVI/a’ ratio and E/e’ in STEMI patients who received percutaneous coronary intervention (PCI). Objectives : This study aims to investigated the role of LAVI/a‘ And E/e’as predictors of major cardiac event in St-Elevation acute myocardial infraction who underwent Percutaneous coronary intervention Methods : We conducted a retrospective cohort study in Saiful Anwar General Hospital from 2019 to 2020. All STEMI patients who received PCI were registered. Echocardiography examination was conducted within 24-48 hours after admission. The measurements included LVEF, E/A, E/e’, LAVI/a’, and LV diastolic function according to ASE/EACVI guidelines. All of the patients were given standard medical treatment. Patients who did n...
International Journal of Cardiology, 2012
Identification of high-risk patients with ST-segment elevation acute myocardial infarction (STEMI) is of the utmost importance for adequate patient stratification and evaluation of additive treatments. However, there is no consensus on the optimal definition of high-risk patients. We therefore compared 5 scoring systems in the assessment of the risk of 30-day mortality in 3214 patients with STEMI treated with primary percutaneous coronary intervention (PCI). Clinical scores showed a large variability in risk stratifying patients. Identification of high-risk patients ranged from 15% (PAMI score ≥ 9) to 66% (McNamara definition). McNamara, Antoniucci and Brodie definitions had the best sensitivity (0.87-0.88 and 95% confidence intervals (CI) ranging from 0.82-0.93) while PAMI ≥ 9 had the best specificity (0.87 with 95% CI of 0.86-0.88), while its sensitivity was quite low (0.42). In a sample size simulation of a trial aimed at demonstrating a 33% difference in 30-day mortality between two hypothetical treatments, the number of STEMI patients needed to be screened varied from 4712 for the Brodie definition to 9038 for the PAMI ≥ 9 score. There is a large variability in risk stratification, sensitivity, specificity and predictive values among different scoring systems. These considerations should be taken into account when designing randomised trials.