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Tullio Palmerini Stefano De Servi Alessandro Politi Alessandro Martinoni Giuseppe Musumeci Federica Ettori Emanuela Piccaluga Diego Sangiorgi Giulia Lauria Alessandra Repetto Battistina Castiglioni Franco Fabbiocchi Marco Onofri Nicoletta De Cesare Maurizio D'Urbano Fabrizio Poletti Giuseppe Sangiorgi Roberto Zanini Corrado Lettieri Guido Belli Salvatore Pirelli Silvio Klugmann Lombardima Study Group 《The American journal of cardiology》2010,105(5):605-610
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Wilson Mathias Jeane M. Tsutsui Bruno G. Tavares Agostina M. Fava Miguel O.D. Aguiar Bruno C. Borges Mucio T. Oliveira Alexandre Soeiro Jose C. Nicolau Henrique B. Ribeiro Hsu Po Chiang João C.N. Sbano Abdulrahman Morad Andrew Goldsweig Carlos E. Rochitte Bernardo B.C. Lopes José A.F. Ramirez Roberto Kalil Filho Thomas R. Porter 《Journal of the American College of Cardiology》2019,73(22):2832-2842
BackgroundPreclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI).ObjectivesThis study tested the clinical effectiveness of sonothrombolysis in patients with STEMI.MethodsPatients with their first STEMI were prospectively randomized to either diagnostic ultrasound–guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared.ResultsST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045).ConclusionsSonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330). 相似文献
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S Pedersen R Mogelvang M Bjerre J Frystyk A Flyvbjerg S Galatius TB Sørensen A Iversen A Hvelplund JS Jensen 《Cardiology》2012,123(1):31-38
Background: Osteoprotegerin (OPG) is a glycoprotein with a regulatory role in immune, skeletal and vascular systems. Data suggest that high circulating OPG levels are associated with an increased risk of cardiovascular disease. We analyzed the association between OPG and long-term outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods: We included 716 consecutive STEMI patients admitted to a single high-volume invasive heart center from September 2006 to December 2008. Endpoints were all-cause mortality, repeat myocardial infarction, admission due to heart failure and combinations thereof. Median follow-up lasted 27 months (interquartile range: 22-33). Results: OPG levels exhibited a non-Gaussian distribution and were therefore divided into quartiles. High levels of OPG were significantly associated with a worse outcome. After adjustment for conventional risk factors (e.g. C-reactive protein, estimated glomerular filtration rate, symptom-to-balloon time and troponin I) using Cox regression, OPG remained a significantly independent predictor of death (HR per increase in OPG quartile: 1.28; CI: 1.03-1.59; p = 0.03), repeat myocardial infarction (HR: 1.30; CI: 1.00-1.68; p = 0.05) and admission with heart failure (HR: 1.50; CI: 1.18-1.90; p = 0.001). Conclusion: This study shows that OPG independently predicts long-term outcome in STEMI patients treated with pPCI. Eventually, this knowledge could improve risk stratification and overall outcome. 相似文献
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目的探讨急性非ST段抬高性心肌梗死急诊冠状动脉介入治疗的有效性及合理性.方法回顾性总结我院及中日友好医院对急性非ST段抬高性心肌梗死12例进行急诊冠状动脉介入治疗.结果12例病人中完全性闭塞7例,次全闭塞5例,其中三支病变3例.10例接受了PCI及支架术,共治疗病变25处,成功植入支架23枚.再灌注心律失常2例.术后心功能均有不同程度的改善.1例保守治疗;急诊外科搭桥1例.结论急性非ST段抬高性心肌梗死病人及早行冠状动脉造影检查,能尽早对病变血管作出正确的判断,对预后及治疗选择均有重要意义,早期对高危病人行介入治疗有利于改善病人预后. 相似文献
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《JACC: Cardiovascular Interventions》2022,15(3):251-263
ObjectivesThis study sought to assess the association between postprocedural anticoagulation (PPAC) use and several clinical outcomes.BackgroundPPAC after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) may prevent recurrent ischemic events but may increase the risk of bleeding. No consensus has been reached on PPAC use.MethodsUsing data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome registry, conducted between 2014 and 2019, we stratified all STEMI patients who underwent pPCI according to the use of PPAC or not. Inverse probability of treatment weighting and a Cox proportional hazards model with hospital as random effect were used to analyze differences in in-hospital clinical outcomes: the primary efficacy endpoint was mortality and the primary safety endpoint was major bleeding.ResultsOf 34,826 evaluable patients, 26,272 (75.4%) were treated with PPAC and were on average younger, more stable at admission with lower bleeding risk score, more likely to have comorbidities and multivessel disease, and more often treated within 12 hours of symptom onset than those without PPAC. After inverse probability of treatment weighting adjustment for baseline differences, PPAC was associated with significantly reduced risk of in-hospital mortality (0.9% vs 1.8%; HR: 0.62; 95% CI: 0.43-0.89; P < 0.001) and a nonsignificant difference in risk of in-hospital major bleeding (2.5% vs 2.2%; HR: 1.05; 95% CI: 0.83-1.32; P = 0.14).ConclusionsPPAC in STEMI patients after pPCI was associated with reduced mortality without increasing major bleeding complications. Dedicated randomized trials with contemporary STEMI management are needed to confirm these findings. 相似文献
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《JACC: Cardiovascular Interventions》2014,7(9):981-987
ObjectivesThis study sought to determine the contemporary clinical characteristics and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and previous coronary artery bypass graft (CABG), including those with a saphenous vein graft culprit lesion.BackgroundThe outcome of STEMI patients with previous CABG is reported to be inferior to those without previous CABG, but limited data is available from the primary percutaneous coronary intervention era.MethodsData was extracted from a large, regional STEMI system’s prospective database, which contained 3,542 unique STEMI episodes from March 4, 2003 through April 22, 2012.ResultsPrevious CABG was present in 249 patients (7%). Despite higher comorbidity, patients with versus those without previous CABG had similar in-hospital (4.8% vs. 5.2%; p = 0.82) and 1-year (10.8% vs. 9.1%; p = 0.36) mortality, but 5-year (24.9% vs. 14.2%; p < 0.001) mortality was higher. Patients with previous CABG have similar door-to-balloon times. The culprit vessel was the saphenous vein graft in 84 patients (34%), a native vessel in 104 (42%), with no clear culprit in 59 (24%). The left internal mammary artery graft was not a culprit in any patient. Mortality at 30 days (8.3% vs. 3.9% vs. 1.7%, p = 0.19) and 1 year (14.3% vs. 9.0% vs. 6.8%; p = 0.35) was higher (but not statistically) with a saphenous vein graft culprit and was equivalent at 5 years (25.0% vs. 26.0% vs. 20.3%; p = 0.71).ConclusionsPatients with previous CABG treated in a regional STEMI system have similar outcomes as patients without previous CABG, although 5-year mortality is higher. The most common culprit location was a native vessel (42%). Outcomes have improved significantly compared with historical reports. 相似文献
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Ajar Kochar Hussein R. Al-Khalidi Steen M. Hansen Jay S. Shavadia Mayme L. Roettig Christopher B. Fordyce Shannon Doerfler Bernard J. Gersh Timothy D. Henry Peter B. Berger James G. Jollis Christopher B. Granger 《JACC: Cardiovascular Interventions》2018,11(18):1824-1833
Objectives
This study sought to examine whether quality improvement initiatives across multiple ST-segment elevation myocardial infarction (STEMI) systems translated to faster first medical contact (FMC)-to-device times for patients presenting with cardiogenic shock (CS).Background
There are limited data describing contemporary rates of achieving guideline-directed FMC-to-device times for STEMI patients with CS.Methods
From 2012 to 2014, the American Heart Association Mission: Lifeline STEMI Systems Accelerator project established a protocol-guided approach to STEMI reperfusion systems in 484 U.S. hospitals. The study was stratified by CS versus no CS at presentation and performed Cochrane-Armitage tests to evaluate trends of achieving FMC-to-device time targets. A multivariable logistic regression model assessed the association between achieving guideline-directed FMC-to-device times and mortality.Results
Among 23,785 STEMI patients, 1,993 (8.4%) experienced CS at presentation. For direct presenters, patients with CS were less likely to achieve the 90-min FMC-to-device time compared with no-CS patients (37% vs. 54%; p < 0.001). For transferred patients, CS patients were even less likely to reach the 120-min FMC-to-device time compared with no-CS patients (34% vs. 47%; p < 0.0001). The Accelerator intervention did not result in improvements in the FMC-to-device times for direct-presenting CS patients (p for trend = 0.53), although there was an improvement for transferred patients (p for trend = 0.04). Direct-presenting patients arriving within 90 min had lower mortality rates compared with patients who reached after 90 min (20.49% vs. 39.12%; p < 0.001).Conclusions
Fewer than 40% of STEMI patients presenting with CS achieved guideline-directed FMC-to-device targets; delays in reperfusion for direct-presenting patients were associated with higher mortality. 相似文献10.
Joo Myung Lee Tae-Min Rhee Joo-Yong Hahn Hyun Kuk Kim Jonghanne Park Doyeon Hwang Ki Hong Choi Jihoon Kim Taek Kyu Park Jeong Hoon Yang Young Bin Song Jin-Ho Choi Seung-Hyuk Choi Bon-Kwon Koo Young Jo Kim Shung Chull Chae Myeong Chan Cho Chong Jin Kim Myung Ho Jeong 《Journal of the American College of Cardiology》2018,71(8):844-856
Background
Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock.Objectives
This study investigated the prognostic impact of multivessel PCI in patients with STEMI multivessel disease presenting with cardiogenic shock, using the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction-National Institutes of Health) registry.Methods
Among 13,104 consecutive patients enrolled in the KAMIR-NIH registry, we selected patients with STEMI with multivessel disease presenting with cardiogenic shock and who underwent primary PCI. Primary outcome was 1-year all-cause death, and secondary outcomes included patient-oriented composite outcome (a composite of all-cause death, any myocardial infarction, and any repeat revascularization) and its individual components.Results
A total of 659 patients were treated by multivessel PCI (n = 260) or IRA-only PCI (n = 399) strategy. The risk of all-cause death and non-IRA repeat revascularization was significantly lower in the multivessel PCI group than in the IRA-only PCI group (21.3% vs. 31.7%; hazard ratio: 0.59; 95% confidence interval: 0.43 to 0.82; p = 0.001; and 6.7% vs. 8.2%; hazard ratio: 0.39; 95% confidence interval: 0.17 to 0.90; p = 0.028, respectively). Results were consistent after multivariable regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. In a multivariable model, multivessel PCI was independently associated with reduced risk of 1-year all-cause death and patient-oriented composite outcome.Conclusions
Of patients with STEMI and multivessel disease with cardiogenic shock, multivessel PCI was associated with a significantly lower risk of all-cause death and non-IRA repeat revascularization. Our data suggest that multivessel PCI for complete revascularization is a reasonable strategy to improve outcomes in patients with STEMI with cardiogenic shock. 相似文献11.
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Abdulla A. Damluji Karen Bandeen-Roche Carol Berkower Cynthia M. Boyd Mohammed S. Al-Damluji Mauricio G. Cohen Daniel E. Forman Rahul Chaudhary Gary Gerstenblith Jeremy D. Walston Jon R. Resar Mauro Moscucci 《Journal of the American College of Cardiology》2019,73(15):1890-1900
Background
Older adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.Objectives
The purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mortality.Methods
We used a large publicly available all-payer inpatient health care database sponsored by the Agency for Healthcare Research and Quality between 1999 and 2013. The primary outcome was in-hospital mortality. The influence of PCI on in-hospital mortality was assessed by quintiles of propensity score (PS).Results
Of the 317,728 encounters with STEMI and shock in the United States, 111,901 (35%) were adults age ≥75 years. Of these, 53% were women and 83% were Caucasians. The median number of chronic conditions was 8 (interquartile range: 6 to 10). The diagnosis of STEMI and cardiogenic shock in older patients decreased significantly over time (proportion of older adults with STEMI and shock: 1999: 42% vs. 2013: 29%). Concomitantly, the rate of PCI utilization in older adults increased (1999: 27% vs. 2013: 56%, p < 0.001), with declining in-hospital mortality rates (1999: 64% vs. 2013: 46%; p < 0.001). Utilizing PS matching methods, PCI was associated with a lower risk of in-hospital mortality across quintiles of propensity score (Mantel-Haenszel odds ratio: 0.48; 95% confidence interval [CI]: 0.45 to 0.51). This reduction in hospital mortality risk was seen across the 4 different U.S. census bureau regions (adjusted odds ratio: Northeast: 0.41; 95% CI: 0.36 to 0.47; Midwest: 0.49; 95% CI: 0.42 to 0.57; South: 0.51; 95% CI: 0.46 to 0.56; West: 0.46; 95% CI: 0.41 to 0.53).Conclusions
This large and contemporary analysis shows that utilization of PCI in older adults with STEMI and cardiogenic shock is increasing and paralleled by a substantial reduction in mortality. Although clinical judgment is critical, older adults should not be excluded from early revascularization based on age in the absence of absolute contraindications. 相似文献17.
目的:研究急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)中血栓抽吸对各项心肌灌注和临床指标的影响。方法:108例冠状动脉造影证实血栓负荷重的急性STEMI患者,随机分为血栓抽吸+PCI组(n=53)及传统PCI组(n=55),比较两组术后心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正TIMI帧数、TIMI心肌灌注分级、ST段抬高回落百分比、血浆肌酸激酶MB同工酶、肌钙蛋白I峰值及术后30天主要心脏不良事件发生率的差别。结果:血栓抽吸+PCI组TIMI血流分级、校正TIMI帧数、TIMI心肌灌注分级、ST段抬高回落百分比均明显优于传统PCI组(P<0.05或0.01),且血浆肌酸激酶MB同工酶、肌钙蛋白I峰值显著低于传统PCI组(P<0.05),差异均有统计学意义。结论:STEMI直接PCI中应用血栓抽吸可以改善血流及心肌灌注情况、降低心肌标志物峰值。 相似文献
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Ming Gao Waiou Zhao Zhiguo Zhang Ling Qin Weihua Zhang Yang Zheng 《The American journal of the medical sciences》2018,355(6):544-552
Background
There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients.Methods
The study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years.Results
The all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non–high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients.Conclusions
STEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non–high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients. 相似文献19.