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Ernest Spitzer, Susanne Hadorn, Thomas Zanchin, Kyohei Yamaji, Aris Moschovitis, Thomas Pilgrim, Stefan Stortecky, Peter Jüni, Dik Heg, Stephan Windecker, Lorenz Räber
AIMS: Randomised controlled trials (RCTs) represent the most robust source of evidence-based medicine. However, the generalisability of RCTs is limited by the inclusion of selected populations. We sought to assess the external validity of a contemporary trial including patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: Patients presenting to Bern University Hospital during the inclusion period of the COMFORTABLE AMI trial were divided into three groups: RCT participants (41%), eligible not included (17...
October 20, 2016: EuroIntervention
Andreas Baumbach, Dik Heg, Lorenz Räber, Miodrag Ostoijc, Salvatore Brugaletta, Julian W Strange, Thomas W Johnson, Peter Juni, Thomas Engstrøm, Patrick W Serruys, Manel Sabate, Stephan Windecker
AIMS: Selective use of DES only in patients at higher risk of MACE is common practice, particularly in health care systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified. METHODS AND RESULTS: We performed a patient-level pooled analysis of COMFORTABLE-AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length>15mm, vessel size <3mm, and diabetes mellitus...
October 18, 2016: EuroIntervention
Alberto Dominguez-Rodriguez, Pedro Abreu-Gonzalez, Jose M de la Torre-Hernandez, Julia Gonzalez-Gonzalez, Tamara Garcia-Camarero, Luciano Consuegra-Sanchez, Maria Del Mar Garcia-Saiz, Ana Aldea-Perona, Tirso Virgos-Aller, Agueda Azpeitia, Russel J Reiter
The MARIA randomized trial evaluated the efficacy and safety of melatonin for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). This was a prespecified interim analysis. A total of 146 patients presenting with STEMI within 6 hours of chest pain onset were randomized to receive intravenous and intracoronary melatonin (n=73) or placebo (n=73) during primary pecutaneous coronary intervention (PPCI). Primary endpoint was myocardial infarct size as assessed by magnetic resonance imaging (MRI) at 6±2 days...
October 13, 2016: Journal of Pineal Research
Eddie D Brown, James C Blankenship
We propose a mechanism of how stroke may be caused by thrombus aspiration during primary percutaneous coronary intervention (PPCI), and how it may be technique-dependent. Two recent meta-analyses report increased risk of stroke in patients undergoing routine thrombus aspiration during STEMI and the value of this technique has been controversial. The mechanism of stroke has not been fully explained. This case demonstrates 2 mechanisms by which aspiration might cause thrombus embolization. We recommend that if thrombus aspiration is performed during PPCI for STEMI, it should be done selectively and carefully...
October 3, 2016: Catheterization and Cardiovascular Interventions
Daniel A Jones, Rayomand S Khambata, Mervyn Andiapen, Krishnaraj S Rathod, Anthony Mathur, Amrita Ahluwalia
OBJECTIVE: Recent work suggests that intracoronary nitrite reduces myocardial infarct size following primary percutaneous coronary intervention (PPCI) for acute myocardial infarction (AMI), although the exact mechanisms are unclear. We explored the effects of nitrite on reperfusion-induced inflammation, by assessing the levels of specific pro-inflammatory mediators, chemokines and adhesion molecules in plasma and circulating cell subtypes as exploratory end points in the NITRITE-AMI cohort...
September 28, 2016: Heart: Official Journal of the British Cardiac Society
Fei Song, Mengyue Yu, Jingang Yang, Haiyan Xu, Yanyan Zhao, Wei Li, Dewei Wu, Zhifang Wang, Qingsheng Wang, Xiaojin Gao, Yang Wang, Rui Fu, Yi Sun, Runlin Gao, Yuejin Yang
Animal and imaging study evidence favors early reperfusion for acute myocardial infarction. However, in clinical trials, the effect of symptom-onset-to-balloon (S2B) time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) has been inconsistent. Moreover, there are few data regarding the ischemic time in China. A total of 3,877 consecutive patients with STEMI with available S2B time undergoing pPCI from January 2013 to September 2014 at 108 hospitals that participated in the China Acute Myocardial Infarction registry were included and stratified into 3 S2B groups: <6 hours, 6 to 12 hours, >12 hours S2B time was tested in multivariate logistic regression analyses as an independent risk factor of mortality (primary outcome), major adverse cardiovascular and cerebrovascular events (MACCE), and impaired myocardial perfusion (secondary outcomes)...
August 13, 2016: American Journal of Cardiology
Yaniv Levi, Ayyaz Sultan, Mistre Alemayehu, Sabrina Wall, Shahar Lavi
BACKGROUND: Coronary no-reflow during primary percutaneous coronary intervention (PPCI) is a predictor of poorer cardiovascular outcome. Both endothelial dysfunction and no-reflow involves abnormal vascular function and hemostasis. Our aim was to assess the association between endothelial dysfunction and no reflow during primary PCI. METHODS: Thirty consecutive patients with ST elevation myocardial infarction (STEMI) and normal flow during primary PCI were compared to 19 consecutive patients who had no reflow...
September 3, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Yukio Mizuguchi, Hiroki Shibutani, Sho Hashimoto, Takeshi Yamada, Norimasa Taniguchi, Shunsuke Nakajima, Tetsuya Hata, Akihiko Takahashi
AIM: The influence of the time of arrival at the hospital on the door-to-device (DTD) time has been investigated; however, the influence on the onset-to-device (OTD) time is unclear in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to investigate the relationship between the time of arrival at the hospital and the OTD time in STEMI patients. METHODS: We evaluated 377 STEMI patients who underwent primary percutaneous coronary intervention (pPCI) between January 2008 and December 2014...
September 8, 2016: Cardiovascular Therapeutics
K H A J Koolen, K A Mol, B M Rahel, F Eerens, S Aydin, R P T Troquay, L Janssen, W A L Tonino, J G Meeder
OBJECTIVES: To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands. BACKGROUND: Controversy remains about the safety and efficacy of PPCI in off-site PCI centres. METHODS: We retrospectively analysed clinical and procedural data as well as 6‑month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven...
October 2016: Netherlands Heart Journal
Harsh Golwala, Sadip Pant, Ambarish Pandey, Michael P Flaherty, Glenn A Hirsch, Ajay J Kirtane
BACKGROUND: The use of antithrombotic therapy (ATT) (bivalirudin or unfractionated heparin) is a class I recommendation for patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). This survey was conducted to better understand current United States (US) practices in terms of preferences regarding the selection of ATT in STEMI-PPCI, particularly in light of recent clinical trials. METHODS: An electronic survey consisting of 9 focused questions was forwarded to 2676 US interventional cardiologists who were members of the Society for Cardiovascular Angiography and Interventions (SCAI)...
September 2016: Journal of Invasive Cardiology
Jan Kanovsky, Petr Kala, Tomas Novotny, Klara Benesova, Maria Holicka, Jiri Jarkovsky, Lumir Koc, Monika Mikolaskova, Tomas Ondrus, Marek Malik
INTRODUCTION: The right ventricular myocardial infarction (RVMI) has traditionally been mainly related to inferior wall ST elevation myocardial infarction (STEMI). This study assessed the RVMI electrocardiographic (ECG-RVMI) signs in relationship to ECG-based STEMI localization and to the infarct related artery in patients treated with primary percutaneous coronary intervention (pPCI). METHODS: Three hundred consecutive adult patients (107 females) were referred to catheterization laboratory with the acute STEMI diagnosis...
August 5, 2016: Journal of Electrocardiology
Christopher E D Saunderson, Amrit Chowdhary, Richard A Brogan, Phillip D Batin, Christopher P Gale
Mild hypothermia has been shown to improve neurological outcome and reduce mortality following out of hospital cardiac arrest. In animal models the application of hypothermia with induced coronary occlusion has demonstrated a reduction in infarct size. Consequently, hypothermia has been proposed as a treatment, in addition to Primary Percutaneous Coronary Intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). However, there is incomplete understanding of the mechanism and magnitude of the protective effect of hypothermia on the myocardium, and limited outcome data...
November 15, 2016: International Journal of Cardiology
Doo Sun Sim, Myung Ho Jeong, Youngkeun Ahn, Young Jo Kim, Shung Chull Chae, Taek Jong Hong, In Whan Seong, Jei Keon Chae, Chong Jin Kim, Myeong Chan Cho, Seung-Woon Rha, Jang Ho Bae, Ki Bae Seung, Seung Jung Park
BACKGROUND: The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute ST-elevation or Non-ST-elevation Myocardial Infarction 2015 suggested that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). We sought to assess the clinical impact of pharmacoinvasive strategy compared with PPCI in real-world patients with ST-segment-elevation myocardial infarction. METHODS AND RESULTS: We used the Korea Acute Myocardial Infarction Registry to identify ST-segment-elevation myocardial infarction patients receiving either pharmacoinvasive strategy defined as fibrinolysis followed by percutaneous coronary intervention (rescue/urgent or routine elective; n=708) or PPCI (n=8878)...
September 2016: Circulation. Cardiovascular Interventions
N S Vos, G Amoroso, M J Grundeken, A J J Ijsselmuiden, R J M van Geuns, R Spaargaren, J G P Tijssen, K T Koch
AIM: The aim of this study was to achieve useful insights into pre-hospital management and procedural performance for ST-elevation myocardial infarction (STEMI) in the Netherlands by extrapolating patient characteristics, and procedural and clinical outcomes of the Dutch patient cohort from the APPOSITION-III trial. METHODS: This is a retrospective analysis from the APPOSITION-III trial with respect to the geographical borders of STEMI management. The APPOSITION-III trial was a European registry for the use of the STENTYS self-expandable stent in STEMI patients undergoing primary percutaneous coronary intervention (PPCI)...
August 31, 2016: Netherlands Heart Journal
Hesham K Abdelaziz, Wael Elkilany, Said Khalid, Sameh Sabet, Marwan Saad
OBJECTIVE: The aim of this study was to compare the role of intracoronary (IC) verapamil versus sodium nitroprusside (SNP) in the prevention of microvascular obstruction (MVO) during a primary percutaneous coronary intervention (pPCI). BACKGROUND: A head-to-head comparison between verapamil and SNP in the prevention of MVO lacks evidence. PATIENTS AND METHODS: Sixty patients with ST-segment elevation myocardial infarction were randomized to receive IC verapamil (n=30) versus SNP (n=30) during pPCI...
August 23, 2016: Coronary Artery Disease
Michal Kacprzak, Marzenna Zielinska
: Inflammation plays an important role on every stage of atherosclerosis. Myeloperoxidase (MPO), a leukocyte-derived enzyme that participates in the innate immunity, probably is involved in many stages of atherothrombosis. According to the recent studies, MPO is related with unfavorable outcome in patients with chest pain and acute coronary syndromes. Its role in prediction of outcomes after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of the study was to assess if elevated MPO level is a predictor of long-term adverse cardiac events in patients with STEMI treated with primary percutaneous coronary intervention (pPCI)...
November 15, 2016: International Journal of Cardiology
Dawod Sharif, Wisam Matanis, Amal Sharif-Rasslan, Uri Rosenschein
BACKGROUND: Myocardial stunning is responsible for partially reversible left ventricular (LV) systolic dysfunction after successful primary percutaneous coronary intervention (PPCI) in patients with acute ST-elevation myocardial infarction (STEMI). AIM: To test the hypothesis that early coronary blood flow (CBF) to LV systolic function ratios, as an equivalent to LV stunning index (SI), predict recovery of LV systolic function after PPCI in patients with acute STEMI...
August 20, 2016: Echocardiography
Kuljit Singh, Benjamin Hibbert, Balwinder Singh, Kristin Carson, Manuja Premaratne, Michel Le May, Aun-Yeong Chong, Margaret Arstall, Derek So
AIMS: Admission hyperglycaemia (AH) has been associated with worse outcomes in acute myocardial infarction (AMI). In the current review, we evaluated the impact of primary angioplasty (pPCI) on mortality in AMI patients with AH. Our second aim was to evaluate if AH is a marker of baseline risk or an independent predictor of mortality. METHODS AND RESULTS: A comprehensive search of four major databases was performed. We included original research studies reporting data on mortality in AMI patients with AH (mean plasma glucose >156 mg/dL/8...
October 2015: European Heart Journal. Cardiovascular Pharmacotherapy
L Huang, Y W Liu, T Li, X M Hu, D W Duan, P Wu, W J Peng, Y H Lang
OBJECTIVE: To evaluate the effect of extracorporeal membrane oxygenation (ECMO) combined with primary percutaneous coronary intervention (PPCI) on cardiac arrest in patients with acute myocardial infarction (AMI). METHODS: We retrospectively analyzed the clinical data from twenty cardiac arrest patients due to AMI from January 2010 to January 2015, who received both ECMO and PPCI after failed conventional cardiopulmonary resuscitation (CCPR) procedure in our center...
July 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
Adil Bata, Ata Ur Rehman Quraishi, Michael Love, Lawrence Title, Hussein Beydoun, Tony Lee, Najaf Nadeem, Bakhtiar Kidwai, Catherine Kells, Helen Curran
BACKGROUND: To determine whether pre-activation of the cardiac catheterization lab by Emergency Health Services (EHS) with a single call system in the field was associated with reduced time to reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: Consecutive STEMI patients identified by EHS and subsequently taken to the Queen Elizabeth II Health Sciences Center (QEIIHSC) for PPCI between February 1, 2011 and January 30, 2013 were examined...
November 1, 2016: International Journal of Cardiology
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