血流储备分数指导下分期PCI干预非梗死相关动脉对STEMI患者短期预后的影响

目的:探讨血流储备分数(FFR)指导下分期行经皮冠状动脉(冠脉)介入术(PCI)干预非梗死相关动脉(non-IRA)对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法:将100例拟分期PCI干预non-IRA的STEMI患者随机分为FFR指导下功能性血运重建组(FFR组)和单纯冠脉造影指导下血运重建组(CAG组),各50例。FFR组对狭窄70%～90%的non-IRA行FFR检查,FFR≤0.80为PCI干预的指证;CAG组对狭窄≥70%的non-IRA仅冠脉造影指导下行PCI。比较2组PCI资料和住院期间主要并发症,均术后随访12个月,比较2组术后1个月和12个月时主要不良心血管事件(MACE)的发生率。结果:FFR组和CAG组比较,人均支架植入量[(1.5±0.5)枚∶(2.6±1.0)枚,P≤0.01]和支架植入率[84.2%∶100%,P=0.003]显著降低;2组的PCI时间、造影剂剂量、住院时间、住院费用和住院期间主要并发症均无统计学差异;术后1个月FFR组未增加MACE事件发生率[1例(2%)∶3例(6%),P=0.617];术后12个月FFR组MACE事件[2例(4.08%)∶8例(16.70%),P=0.042]显著降低。结论:对STEMI多支血管病变患者在FFR指导下non-IRA分期功能性血运重建可减少不必要的PCI干预,降低术后12个月的MACE事件发生率。     

直接经皮冠状动脉介入治疗同期干预非梗死相关动脉对ST段抬高型心肌梗死多支血管病变患者预后的影响

目的探讨ST段抬高型心肌梗死(STEMI)多支血管病变直接经皮冠状动脉介入治疗(PCI)成功开通梗死相关血管(IRA)后,同期干预非梗死相关血管(non-IRA)对患者预后的影响。方法选择178例2015年1月至2016年6月于第四军医大学西京医院心血管内科住院治疗的STEMI多支血管病变患者为研究对象,根据non-IRA的干预时机分为一次PCI组(42例)和分期PCI组(136例)。比较两组患者PCI资料和围术期并发症,随访1年,对比两组心功能改善情况和主要不良心血管事件(MACE)发生率。结果与分期PCI组比较,一次PCI组住院时间[(5.5±1.5)d比(9.5±1.5)d,t=3.97,P=0.02]和住院费用[(46 765±20 242)元比(54 884±22 885)元,t=3.88,P=0.04]显著下降;一次PCI组围术期并发症有增加趋势,但差异无统计学意义[6例(14.3%)比13例(9.6%),χ2=0.61,P=0.40];一次PCI组术后1年心功能改善情况优于分期PCI组(左心室射血分数:59.7%±3.4%比55.0%±4.1%,t=3.87,P=0.04),两组MACE发生率的差异无统计学意义[10例(23.8%)比24例(17.6%),χ2=0.79,P=0.38]。结论 STEMI多支血管病变直接PCI同期干预non-IRA显著减少住院时间、住院费用和造影剂用量,更好地改善患者心功能,且未增加围术期并发症和术后发生MACE的风险,在预期成功率较高的情况下可作为STEMI患者直接PCI的一种策略。     

急性前壁心肌梗死患者静脉溶栓后不同时间行经皮冠状动脉介入治疗的对比研究

目的比较急性前壁心肌梗死静脉溶栓后不同时间窗内行经皮冠状动脉介入治疗(PCI)患者的预后情况。方法回顾性分析2016年1月至2019年12月于朝阳市中心医院心血管内科就诊,明确诊断为急性前壁心肌梗死的患者156例。根据治疗方式分为行急诊PCI组(PPCI组,n=78)、溶栓后3~24 h PCI组(TE-PCI组,n=46)与溶栓后48 h行PCI组(TL-PCI组,n=32)。比较患者住院期间和随访1个月心功能和预后情况。结果TL-PCI组患者症状发作到首份心电图时间(S2T)显著长于其余两组(6.9±3.8 vs.4.2±1.9 vs.4.2±1.9,P=0.018)。TL-PCI组和TE-PCI组患者造影提示血管再通(81.3%vs.84.3%vs.15.4%,P<0.001)和心肌染色分级3级比例(88.4%vs.87.0%vs.51.3%,P<0.001)显著高于PPCI组;慢血流/无复流比例(9.4%vs.6.5%vs.21.8%,P=0.043)和术后校正TIMI帧数(21.3±9.2 vs.22.1±9.3 vs.32.7±10.5,P=0.012)显著低于PPCI组。随访1个月,TL-PCI组左室射血分数(LVEF)显著低于TE-PCI组(39.8±9.5 vs.43.2±11.2,P=0.026);TL-PCI组左心室舒张末容积(LVEDV)(124.2±21.3 vs.102.8±15.9,P=0.032)和左心室收缩末容积(LVESV)(74.7±16.2 vs.58.4±11.3,P=0.017)显著高于TE-PCI组。TL-PCI组患者住院期间小出血事件显著高于另外两组(40.6%vs.17.8%vs.12.8%,P=0.004),但大出血无显著差异(P>0.05)。结论溶栓后未及时行PCI的前壁心肌梗死患者强化抗栓后48 h延迟行PCI可改善心肌微灌注,小出血事件虽增加,但未带来大出血事件的增加。     

急性ST段抬高心肌梗死直接经皮冠状动脉介入后残余ST段抬高与预后的关系

目的探讨急性ST段抬高心肌梗死（STEMI）直接经皮冠脉介入（PCI）后心电图残余ST段抬高总和与预后的关系。方法依据PCI后心电图残余ST段抬高总和（sumSTE）的程度将患者分为A组（sumSTE〈0.1mV）、B组（0.1mV≤sumSTE〈0.3mV）、C组（0.3mV≤sumSTE〈0.7mV）和D组（≥0.7mV）,观察sumSTE与住院期间左室射血分数（LVEF）及6月内总的主要心血管事件（MACE,包括心绞痛、再发心肌梗死、因心血管事件再入院、心衰和死亡等）发生率的关系。结果共有225例患者。男性156例,女性69例,年龄（61.3±12.7）岁。急性前壁梗死118例,非前壁心肌梗死107例。A组LVEF明显高于C组（57.68±6.72%比54.33±8.50%）和D组（57.68±6.72%比51.27±9.20%）。B组LVEF高于C组（57.60±8.40%比54.33±8.50%）和D组（57.60±8.40%比51.27±9.20%）。C组LVEF高于D组（54.33±8.50%比51.27±9.20%）。A、B组两组患者随访MACE发生率差异无统计学意义。但A组MACE发生率低于C组（14.1%比33.3%,χ2=6.164,P=0.012）和D组（14.1%比50.5%,χ2=19.392,P=0.001）。B组、C组两组患者随访MACE发生率差异无统计学意义（26.1%比33.3%,χ2=0.621,P=0.285）。但B组MACE发生率低于D组（26.1%比50.5%,χ2=6.674,P=0.008）。C组MACE发生率显著低于D组（33.3%比50.5%,χ2=3.582,P=0.044）。结论 STEMI患者PCI术后残余ST段抬高与患者住院期间左室EF值、6个月内MACE发生率相关。     

血清鸢尾素水平与急型心肌梗死患者不良心血管预后的相关性

目的:探讨血清鸢尾素水平与ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)治疗后主要心血管不良事件(MACE)发生的相关性。方法:纳入200例接受急诊PCI治疗的STEMI患者,通过ELISA法检测患者PCI术前、术后8 h、16 h、3d、7 d及28 d的血清鸢尾素水平,并根据鸢尾素水平对患者进行分层评估PCI术后1年内MACE发生差异。结果:200例STEMI患者PCI介入前的基线血清鸢尾素水平为(0. 47±0. 23) mg/L。血清鸢尾素水平在PCI术后8 h达到峰值(0. 59±0. 17) mg/L,P=0. 007,而在PCI术后3 d达到最低水平(0. 31±0. 10) mg/L,P<0. 001。STEMI患者的基线血清鸢尾素水平呈偏态分布,中位数为0. 48 mg/L,根据中位数和四分位间距,将STEMI患者分为四组,分别为Q1组(50例,<0. 41 mg/L)、Q2组(50例,0. 42～0. 48 mg/L)、Q3组(50例,0. 49～0. 60 mg/L)和Q4组(50例,>0. 60 mg/L)。其中Q4组患者的心源性死亡率和心力衰竭住院率显著高于其他组患者(均P<0. 05);但再发心肌梗死率、脑卒中发生率、再次血运重建率等,差异无统计学意义(P>0. 05)。总体上,Q4组患者的无MACE生存率显著低于其他组患者(P<0. 001)。多因素Cox回归分析显示:Killip分级3～4级(HR=2. 348,95%CI:1. 240～5. 301,P=0. 021)和血清鸢尾素水平> 0. 60 mg/L(HR=3. 892,95%CI:1. 431～8. 762,P=0. 003)是影响MACE发生的危险因素。结论:STEMI患者血清鸢尾素水平的升高与PCI术后MACE发生风险增加独立相关,血清鸢尾素水平可作为预测STEMI患者发生MACE的有效标志物。     

血栓抽吸术对急性心肌梗死1年预后的影响

目的：探讨血栓抽吸术对急性ST段抬高心肌梗死患者预后的影响。方法：回顾性分析2013年1月至2015年2月于上海市胸科医院就诊发病时间＜12小时的急性ST段抬高心肌梗死患者257例,所有患者均进行急诊PCI治疗。最终完成1年随访的患者中121例患者进行血栓抽吸术,136例患者进行直接PCI。随访两组患者30天、1年的MACE事件及心功能。结果：两组患者在30天(3.3% vs 5.1%, P=0.548)、1年的MACE事件(5.7% vs 8.8%, P=0.475)发生率上没有显著差异。虽然即刻TIMI 3级血流比例两组同样没有差异(72.7% vs 69.9%, P=0.679),但两组在NYHA III-IV心衰的比例30天随访(15% vs 26.3%, P=0.044)、1年随访(5.0% vs 12.9%, P=0.047)血栓抽吸组均显著降低。结论：血栓抽吸术对心血管主要不良事件无显著影响,但对于降低远期心衰的发作仍具有重要作用。     

远端缺血预处理对急性ST段抬高型心肌梗死患者的保护作用

目的探讨远端缺血预处理(remote ischaemic conditioning,RIC)对急性ST段抬高型心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心肌损伤及预后的影响。方法本研究为一项单中心、前瞻、随机对照研究,采用随机数字表法将2017年1月至2017年12月鄂东医疗集团黄石市中心医院76例行急诊PCI治疗的急性ST段抬高型心肌梗死患者分为RIC组(n=39)和对照组(n=37)。RIC组患者在入院后即接受3次RIC,对照组则不做处理。统计患者术中造影结果、术后肌酸激酶(CK)峰值浓度、ST段回落率及术后3个月随访情况。结果与对照组比较,RIC组术中无血流、慢血流发生较少(7.7%vs. 27%,P0.05),术后肌酸激酶同工酶峰值浓度较低[(24.54±1.06)μmol/L vs.(28.54±1.30)μmol/L,P0.05]、ST段回落更明显(64.82%±1.88%vs. 58.19%±1.53%,P0.05),差异均有统计学意义;术后3个月随访,心脏左心室射血分数更高(51.13%±1.28%vs. 46.92%±1.36%,P0.05)、心肌梗死面积更小[(8.22±0.08)mm~2vs. 8.46±0.08)mm~2),P0.05],差异有统计学意义。结论 RIC能够减少行急诊PCI治疗的ST段抬高型心肌梗死患者的心肌损伤并改善心功能。     

血清总胆红素水平与ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后冠状动脉血流的相关性

目的探讨血清总胆红素(STB)水平与ST段抬高型心肌梗死患者(STEMI)经皮冠状动脉介入治疗(PCI)术后冠状动脉血流的相关性。方法选取成功实施PCI的STEMI患者264例,根据TIMI血流等级将患者分成两组,TIMI 0~2组和TIMI 3组。根据STB水平分成高STB组(>0.9 mg/dl)和低STB组(≤0.9 mg/dl),应用单因素分析和多因素Logistic回归分析探讨PCI术后冠状动脉血流的相关因素。结果 TIMI 0~2组96例患者平均年龄(61.5±9.7)岁,其中男68例,TIMI 3组患者168例,平均年龄(59.3±10.4)岁,其中男132例;TIMI 0~2组STB水平明显高于TIMI 3组(P=0.013);院内心脏不良事件发生率明显高于TIMI 3组(P=0.000 1)。与低STB组相比,高STB水平组无复流现象明显增加(46.0%vs27.5%,P=0.000 9),主要心脏不良事件更加频繁(19.8%vs 8.7%,P=0.005);多因素Logistic回归分析,STB水平(OR=2.15,95%CI 1.87~2.52;P=0.002)仍然是影响PCI术后STEMI患者无复流现象发生的独立危险因素。结论 STB水平可作为STEMI患者PCI术后冠状动脉血流恢复不良的一个可靠而独立的生化标记物。     

血栓抽吸导管在急性ST段抬高型心肌梗死患者择期PCI术中的应用价值

目的 观察急性ST段抬高型心肌梗死患者恢复期择期经皮冠状动脉介入(PCI)治疗中抽吸导管的使用对无复流现象和患者预后的影响.方法 2009年11月-2011年8月因急性ST段抬高型心肌梗死入院,择期行PCI术的患者58例.随机分为先抽吸组(TA组)与常规PCI组(SP组),比较两组介入治疗后无复流或慢血流的发生率,术后3个月左室射血分数(LVEF)改变和严重心脏不良事件(MACE)发生率.结果 TA组无复流的发生率明显低于SP组(0 vs 13.33%,P=0.045).TA组TIMI血流3级率显著高于SP组(92.86% vs 53.33%,P=0.001).术后3个月左室射血分数TA组高于SP组[(55.42±0.30)% vs (51.78±0.23)%,P＜0.01)].TA组和SP组均未发生MACE事件,但TA组再发心绞痛者明显低于SP组(3.57% vs 23.33% P=0.029).结论 急性ST段抬高型心肌梗死患者恢复期介入治疗中应用血栓抽吸导管能够减少无复流和慢血流的发生,并可能改善患者心功能.     

急性ST段抬高型心肌梗死急诊经皮冠状动脉支架术后支架内再狭窄相关因素分析

目的:分析急性ST段抬高型心肌梗死急诊冠状动脉支架(PCI)术后支架内再狭窄相关危险因素。方法:入选我院2005年至2014年,急性ST段抬高型心肌梗死行急诊PCI病例,并因再发症状于我院复查冠状动脉造影的患者333例,男性270例(81. 1%),女性63例(18. 9%)。根据支架内狭窄是否≥50%,分为再狭窄组及无再狭窄组。记录患者的一般情况和手术情况,分析相关危险因素。结果:平均复查时间25. 04个月(中位数12个月),复查造影支架内再狭窄组132例及无再狭窄组组201例。再狭窄组年龄小于无再狭窄组组[(56. 08±10. 10) vs.(58. 40±10. 42)岁,t=-2. 032,P=0. 043];再狭窄组LDL-C高于无再狭窄组组[(3. 17±0. 81) vs.(2. 95±0. 82) mmol/L,t=2. 404,P=0. 017];应用球囊后扩张比例再狭窄组低于无再狭窄组组(13. 6%vs. 45. 3%,χ~2=36. 319,P0. 001)。多因素Logistic回归分析显示:年龄(OR=0. 962,95%CI:0. 934～0. 991,P=0. 010)、CK-MB(OR=0. 998,95%CI:0. 996～1. 000,P=0. 033)及使用球囊后扩张(OR=0. 139,95%CI:0. 068～0. 284,P0. 001)减少支架内再狭窄的发生,糖尿病病史(OR=1. 902,95%CI:1. 036～3. 492,P0. 038)增加支架内再狭窄的危险。结论:急性ST段抬高型心肌梗死患者,急诊PCI术中行球囊后扩张术支架内再狭窄率较低,且明显降低支架内再狭窄风险。同时糖尿病病史显著增加支架内再狭窄危险。     

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation

We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited.A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable).After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE (P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis (P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis.In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.     

Temporal Trends in the Clinical Acuity of Patients with ST-Segment Elevation Myocardial Infarction

Background

Despite advances in ST-segment elevation myocardial infarction (STEMI) systems of care over the last decade, studies have shown no improvement in risk-adjusted mortality. It has been hypothesized that the population presenting to the catheterization laboratory has become sicker over time, in ways not accurately captured by current mortality models. The objective of this study was to examine changes in the clinical characteristics and in-hospital case fatality rate of the STEMI population treated with early percutaneous coronary intervention (PCI).

rt-PA治疗急性ST段抬高心肌梗死的疗效

目的：探讨急性ST段抬高心肌梗死（STEMI）患者应用瑞替普酶（rt-PA）静脉内溶栓的临床效果。方法：94例STEMI患者给予rt-PA静脉内溶栓,分析其溶栓再通率、再灌注心律失常情况、不良反应发生率和急性期病死率。结果：应用rt-PA静脉内溶栓的患者再通率88．3％;牙龈出血、恶心、呕吐等并发症发生率9．5％,无严重的出血并发症（如脑出血、消化道大出血等）;室性早搏等再灌注心律失常发生率73．4％。结论：应用rt-PA静脉内溶栓治疗AMI,再通率较高,出血并发症少。     

心电图在急性心肌梗死超急性期诊断中的应用

目的：探讨心电图诊断急性心肌梗死（心梗）超急性期的临床价值。方法选择2013年1月至2015年1月经我院确诊的90例急性心梗超急性期患者,根据发病时间将其随机分为 A、B、C 三组,分别有患者55例、18例和17例,发病时间分别为≤2 h、2～6 h 及6～8 h。对三组患者行24 h 心电监测,详细记录各组心电图 Q 波、ST 段和 T 波的变化情况,并统计分析阳性改变率。结果经24 h 心电监测发现,所有患者的心电图阳性改变主要是 Q 波、ST 段及 T 波的改变。其中,ST 段及 T 波的改变诊断急性心梗超急性期的敏感性和特异性、阳性预测值与阴性预测值均高于 Q 波改变。三组的心电图阳性改变发生率依次为81．82％、38．89％和17．65％,A 组均显著高于 B、C 组（P ＜0．05）。A 组患者中,ST 段抬高型心梗者的心电图诊断阳性率显著高于非 ST 段抬高型心梗者（34．09％ vs．18．18％,P ＜0．05）。结论对急性心梗超急性期患者,尤其是发病2 h 内的患者进行24 h 心电监护,对准确判断病情和及时施治非常关键。T 波宽大、高耸及 ST 段抬高可作为急性心梗超急性期的特征性心电图表现,为临床诊断和治疗提供参考依据。     

血浆和肽素对ST段抬高型急性心肌梗死患者住院期间发生主要不良心脏事件的评估价值

目的：探讨血浆和肽素水平对ST段抬高型急性心肌梗死（STEAMI）患者住院期间主要不良心脏事件（MACE）的临床评估价值。
　　方法：2012-06至2014-06采用酶联免疫吸附法（ELISA）测定80例STEAMI（STEAMI组）患者及80例稳定性冠心病（对照组）患者血浆和肽素水平,观察STEAMI患者住院期间MACE发生情况。
　　结果：STEAMI组患者血浆和肽素水平为（523.26±142.69）pg/ml,对照组血浆和肽素水平为（345.25±89.36）pg/ml,差异有统计学意义（P<0.05）。STEAMI组院内发生MACE者共有28例（35.00％）,与（未发生）非MACE者相比,MACE者血浆和肽素、血心肌肌钙蛋白I（cTnI）、肌酸激酶MB同工酶（CK-MB）、左心室射血分数（LVEF）水平显著升高,差异有统计学意义（P<0.05）。经Logistic多因素分析显示,血浆和肽素、心肌肌钙蛋白I、左心室射血分数是STEAMI住院期间发生MACE的独立危险因素。经接受者操作特性曲线下面积显示,血浆和肽素水平对STEAMI住院期间发生MACE的接受者操作特性曲线下面积、阳性预测值、阴性预测值、灵敏性及特异性显著高于心肌肌钙蛋白I、肌酸激酶MB同工酶浓度,差异有统计学意义（P<0.05）。
　　结论：血浆和肽素能有效预测STEAMI患者住院期间MACE的发生,对STEAMI患者预后判断具有一定的预测价值。     

Acute ST-segment elevation myocardial infarction: A rare initial presentation of previously undiagnosed essential thrombocythemia

Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by hemorrhagic and thrombotic complications. We describe a rare case of ST-segment elevation myocardial infarction (STEMI) in a patient with previously undiagnosed ET, confirmed by gene mutation. A 68-year-old man presented with severe acute chest pain and was diagnosed with STEMI. Primary coronary angiography showed severe stenosis with thrombus in the proximal left anterior descending coronary artery. Percutaneous aspiration thrombectomy was performed with no residual stenosis. The patient was discharged on antiplatelet agents, aspirin, and clopidogrel. Further investigations for intracoronary thrombus with no underlying atherosclerotic disease revealed positive Janus kinase 2 (JAK2) V617F gene mutation, and this was consistent with a diagnosis of ET with elevated platelet count. This case describes a rare initial presentation of previously undiagnosed ET with acute STEMI and highlights the potential importance of secondary workup for non-atherosclerotic causes of STEMI with isolated intracoronary thrombus otherwise normal coronary vasculature with no focal atherosclerosis.     

Reactive protein,plasminogen activator inhibitor type-1 （PAI-1） levels,PAI-1 promoter 4G/5G polymorphism and acute myocardial infarction

Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI）. Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI （80.12ng/ml VS.73.01ng/ml, P 〈0.01）, while CRP levels were not significantly different between patient with STEMI and NSTEMI （3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05）. PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels     

Left circumflex artery-related myocardial infarction: Does ST elevation matter? Results from the Euro Heart Survey PCI registry

Background/objectives

Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction.

Methods and results

Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n = 1100, 54.7%) were compared to those with LCX-related NSTEMI (n = 910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P < 0.001) or had been resuscitated (8.5 versus 2.7%, P < 0.0001). TIMI 0–1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P < 0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P = 0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08–2.72, P < 0.05).

Conclusions

Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI.