Search Results (510)

Previous studies about the COVID-19 pandemic on STEMI patient outcomes have conflicting results. It remains unclear if this may be attributed to regional differences and/or differences during COVID-19 wave periods. Using the American Heart Association Get With The Guidelines–Coronary Artery Disease registry data, we evaluated (1) time metrics related to STEMI system goals and (2) regional variation in STEMI incidence and in-hospital mortality during pandemic wave time periods. The study included all patients 18–100 years old admitted with STEMI (n = 72,516) to 1 of 435 American Heart Association Get With The Guidelines–Coronary Artery Disease hospitals (1 October 2019–31 December 2021). Of these, 70.8% were male and 73.0% non-Hispanic White, with a median age of 63 (IQR 18) years. Compared to pre-pandemic time frames, patients with STEMI had a higher risk profile, delayed time to treatment, were treated with fibrinolytic therapy or primary PCI, and were transferred for primary PCI at similar rates, and had higher adjusted in-hospital mortality (during the second wave in the South and Midwest). Preservation of STEMI systems of care resulted in an overall lower in-hospital mortality rate than predicted, although opportunities exist to improve treatment delays. Regional differences in mortality rates require further study. Full article

Despite the increased mortality due to ST-segment elevation myocardial infarction (STEMI) in South Africa (SA), SA lacks comprehensive data on STEMI clinical outcomes. This study aimed to determine the 30-day and one-year all-cause mortality rates of STEMI patients presenting to our hospital. This was a one-year prospective single-centre study of STEMI patients presenting to the Charlotte Maxeke Johannesburg Hospital in SA between December 2021 and August 2023. We compared the baseline clinical characteristics, reperfusion strategies, and in-hospital, 30-day, and one-year clinical outcomes of survivors and non-survivors. This cohort included 378 STEMI participants. The in-hospital, 30-day, and one-year all-cause mortality rates were 6.6% (n = 25), 10.1% (n = 38), and 17.2% (n = 65), respectively. The pharmacoinvasive strategy was the most used reperfusion therapy (n = 150, 39.7%). On adjusted multivariate Cox regression analysis, a Killip class >2 was the strongest independent predictor of 30-day [HR 5.61, 95% CI 2.83–11.12; p < 0.001] and one-year all-cause mortality [HR 1.72, 95% CI 1.26–2.34; p = 0.001]. Although mortality has increased, our mortality rates were comparable to outcomes from high-income countries but significantly lower than reports from other low- or middle-income countries. Importantly, there were no significant differences in 30-day and one-year survival outcomes between the different reperfusion strategies. Full article

Coronary artery disease (CAD) constitutes a major contributor to morbidity, mortality and healthcare burden worldwide. Recent innovations in imaging modalities, pharmaceuticals and interventional techniques have revolutionized diagnostic and treatment options, necessitating the reevaluation of established drug protocols or the consideration of newer alternatives. The utilization of beta blockers (BBs) in the setting of acute myocardial infarction (AMI), shifting from the pre-reperfusion to the thrombolytic and finally the primary percutaneous coronary intervention (pPCI) era, has become increasingly more selective and contentious. Nonetheless, the extent of myocardial necrosis remains a key predictor of outcomes in this patient population, with large trials establishing the beneficial use of beta blockers. Computed tomography coronary angiography (CTCA) has emerged as a highly effective diagnostic tool for delineating the coronary anatomy and atheromatous plaque characteristics, with the added capability of MESH-3D model generation. Induction and preservation of a low heart rate (HR), regardless of the underlying sequence, is of critical importance for high-quality results. Landiolol is an intravenous beta blocker with an ultra-short duration of action (t1/2 = 4 min) and remarkable β1-receptor specificity (β1/β2 = 255) and pharmacokinetics that support its potential for systematic integration into clinical practice. It has been increasingly recognized for its importance in both acute (primarily studied in STEMI and, to a lesser extent, NSTEMI pPCI) and chronic (mainly studied in elective PCI) CAD settings. Given the limited literature focusing specifically on landiolol, the aim of this narrative review is to examine its pharmacological properties and evaluate its current and future role in enhancing both diagnostic imaging quality and therapeutic outcomes in patients with CAD. Full article

Background: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. Methods: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14–22 months), including major adverse cardiac events (MACEs). Kaplan–Meier and Cox regression analyses were performed. Results: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, p = 0.04). Male sex (OR 0.30; 95% CI: 0.14–0.65; p < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45–1.85; p < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, p < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181–0.557; p < 0.0001). Conclusions: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women. Full article

Background/aim: We aimed to analyze eight-year mortality in patients with ST-elevation myocardial infarction (STEMI) complicated by the development of in-hospital heart failure with preserved ejection fraction (HFpEF). Method: We analyzed 3260 STEMI patients treated with primary PCI (pPCI). Reduced EF was defined as value <50% and preserved EF as value ≥50%. Patients were divided in three groups: without HF, with HFpEF, and with HF with reduced EF (HFrEF). Patients with cardiogenic shock at admission were excluded. Results: In-hospital HF was registered in 759 (23.2%) patients. Among the patients with in-hospital HF, 80 (10.5%) patients had HFpEF. Patients with HFpEF had significantly higher 8-year mortality compared with patients without HF (11.2% vs. 3.5%, respectively, p < 0.001), but significantly lower mortality compared with patients with HFrEF: 11.2% vs. 25.1%, respectively, p < 0.001. In the Cox regression model, HFpEF and HFrEF were independent predictors for 8-year mortality-HFpEF: HR1.85 (95%CI 1.26–4.25); HFrEF: 4.89 (95%CI 3.19–6.42). Conclusion: Development of in-hospital HFpEF in STEMI patients was an independent predictor for long-term mortality. The negative prognostic impact of HFpEF was weaker when compared to the impact of in-hospital HFrEF. Full article

Coronary no-reflow (CNR) is the failure of blood to reperfuse ischemic myocardial tissue after restoration of the vasculature. CNR poses a significant clinical challenge in the treatment of patients with ST-segment elevation myocardial infarction (STEMI), as it increases mortality and the risk of major adverse cardiac events (MACEs). Myocardial ischemia with subsequent reperfusion results in severe damage to the cardiac microcirculation. The pathophysiological causes of CNR include cardiomyocyte vulnerability, capillary and endothelial damage, leukocyte activation, reactive oxygen species (ROS) production, and changes in microRNA profiles and related gene expression. The impact of percutaneous coronary intervention (PCI) on the occurrence of CNR cannot be overlooked, as it can provoke distal atherothrombotic embolization. Current standards of pharmacological therapy for CNR are confined to intracoronary vasodilators and antiplatelet agents. As our understanding of the pathogenesis of the CNR phenomenon improves, opportunities emerge for developing novel therapeutic strategies. The following literature review provides an overview of the pathophysiology of the no-reflow phenomenon (based on animal and preclinical studies), contemporary treatment trends, and current therapeutic approaches. Full article

We introduce a novel technique for the sonification/auditory representation of a 12-lead electrocardiogram (ECG), the standard diagnostic method for the detection of ST elevation myocardial infarction (STEMI). Our approach to ST elevation sonification conveys the detailed variation of the ST segment to enable differentiated, correct interpretation and severity without consulting a visual display. We present a variety of novel sonification designs and discuss their benefits and limitations. As part of an emergency training program, a cohort of 44 medical students (5th academic year) participated in a classification study in which the diagnostic accuracy of the participants was determined with regard to audibly presented ECG sequences of different STEMI severity levels. Regarding the classification of sonified ECG sequences, the discrimination of isoelectricity (IE, the healthy class) from all other (STEMI) classes combined yielded a perfect classification of all 660 classification instances (sensitivity = specificity = 1). With respect to the individual classification of all five classes (IE, inferior/anterior, and moderate/severe STEMI), an overall accuracy of 0.82 (0.79, 0.85) and an intraclass coefficient of $\kappa =0.77$ were estimated. Full article

Acute neutrophil responses following myocardial infarction (MI) play a central role in remodeling, contributing to both repair and potential maladaptive responses. Although prior studies have investigated circulating immune cell indices at a single time point during hospitalization for MI, limited data exist on acute intra-individual changes in circulating immune profiles during evolving MI. We analyzed clinical measurements, such as the count and proportion of immune cell components in a serial complete blood count, with differential tests conducted for patients hospitalized with ST-elevation MI (STEMI) in various hospitals in the Northwestern Medicine system from 1 January 2002 to 1 August 2024. Patients with STEMI diagnosis, troponin peaks ≥ 5 ng/mL, and cell count and proportion data prior to the troponin peak and within 24 h after the troponin peak were included. Primary analyses investigated the associations between the troponin peak and peri-STEMI changes in immune cell subsets. Multivariable-adjusted Cox models were used to investigate associations between these peri-STEMI immune cell changes and mortality at 1 year and 3 years. Among the 694 STEMI patients meeting the inclusion criteria, a higher troponin peak was associated with a modest peri-MI increase in neutrophil proportion. Higher adjusted peri-STEMI increases in neutrophil count and proportion were strongly associated with mortality at one and three years [hazard ratio (HR) = 1.31 (95% confidence interval (CI) 1.15–1.49) and HR = 1.27 (95% CI 1.14–1.45) per 1000 cells/μL absolute neutrophil increase, respectively]. Individuals with higher STEMI-related neutrophil increases had higher mortality at one year and three years, independent of the extent of troponin elevation. Full article

Background: Patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who undergo complete revascularization (CR) have a more favorable prognosis than those who receive incomplete revascularization (IR), as evidenced by recent randomized controlled trials. Despite the absence of a survival benefit associated with CR in these trials, positive outcomes were ascribed to combined endpoints, such as repeat revascularization, myocardial infarction, or ischemia-driven rehospitalization. In light of the significant burden that rehospitalization from STEMI imposes on healthcare systems, we examined the long-term effects of CR on ischemia-driven rehospitalization and cardiovascular (CV) mortality in STEMI patients with MVD. Methods: In our retrospective study, we included patients with STEMI and MVD who underwent successful primary percutaneous coronary intervention (PCI) at the University Medical Centre Ljubljana between 1 January 2009, and 11 April 2011. The combined endpoint was ischemia-driven rehospitalization and CV mortality, with a minimum follow-up period of six years. Results: We included 235 participants who underwent CR (N = 70) or IR (N = 165) at index hospitalization, with a median follow-up time of 7 years (interquartile range 6.0–8.2). The primary endpoint was significantly higher in the IR group than in the CR group (47.3% vs. 32.9%, log-rank p = 0.025), driven by CV mortality (23.6% vs. 12.9%, log-rank p = 0.047), as there was no difference in ischemia-driven rehospitalization rate (log-rank p = 0.206). Ischemia-driven rehospitalization did not influence CV mortality in the CR group (p = 0.49), while it significantly impacted CV mortality in the IR group (p = 0.03). After adjusting for confounders, there were no differences in CV mortality between CR and IR groups (p = 0.622). Predictors of the combined endpoint included age (p = 0.014), diabetes (p = 0.006), chronic kidney disease (CKD) (p = 0.001), cardiogenic shock at presentation (p = 0.003), chronic total occlusion (CTO) (p = 0.046), and ischemia-driven rehospitalization (p = 0.0001). Significant risk factors for the combined endpoint were cardiogenic shock at presentation (p < 0.001), stage 4 kidney failure (p = 0.001), age over 70 years (p = 0.004), female gender (p = 0.008), and residual SYNTAX I score > 5.5 (p = 0.017). Conclusions: Patients with STEMI and MVD who underwent CR had a lower combined endpoint of ischemia-driven rehospitalizations and CV mortality than IR patients, but after adjustments for confounders, the true determinants of the combined endpoint and risk factors for the combined endpoint were independent of the revascularization method. Full article

Background/Objectives: Despite the contemporary management of ST segment elevation myocardial infarction (STEMI) patients, in-hospital mortality rates remain considerable. Therefore, the assessment of in-hospital mortality risk of patients with STEMI has a major role in terms of disease course. R2CHADS2, R2CHA2DS2-VASc, and R2CHA2DS2-VA scores are potential candidate for the prediction of in-hospital mortality in STEMI patients. This study aims to determine the association between R2CHADS2, R2CHA2DS2-VASc, and R2CHA2DS2-VA scores and in-hospital mortality in patients with STEMI who have undergone primary percutaneous coronary intervention (p-PCI). Methods: A total of 857 consecutive patients diagnosed with STEMI who were admitted to our hospital and treated with p-PCI were included in our study. Results: The mean age of the study population was 58 ± 11 years and the population was predominantly male (78.5%). Patients in the in-hospital mortality group tended to be older compared to those who survived (65 ± 12 and 57 ± 11 years, respectively, p < 0.001), while gender showed no significant difference. Multivariable regression models showed that left ventricular ejection fraction, eGFR, R2CHADS2 (OR 2.21, 95% CI 1.38–3.54, p = 0.001), R2CHA2DS2-VASc (OR 1.91, 95% CI 1.30–2.80, p = 0.001), and R2CHA2DS2-VA (OR 1.97, 95% CI 1.345–2.910, p = 0.001) scores were independent predictors of in-hospital mortality. Conclusions: The R2CHADS2, R2CHA2DS2-VASc, and R2CHA2DS2-VA scores demonstrate strong predictive ability for in-hospital mortality in STEMI patients, and their non-negligible advantages support their implementation in clinical practice. Full article

Background and Objectives: and Objectives: Admission hyperglycemia (AH) is common in acute ST-elevation myocardial infarction (STEMI) and linked to poor prognosis. The stress hyperglycemia ratio (SHR) reflects relative hyperglycemia and may more accurately predict outcomes. This study examined AH, SHR, and in-hospital stent thrombosis (ST) in STEMI patients undergoing primary percutaneous coronary intervention (p-PCI). Material and Methods: Retrospective analysis included 1034 patients. AH was defined as glucose ≥ 11.1 mmol/L at admission. SHR was calculated as admission glucose divided by estimated average glucose derived from hemoglobin A1c (HbA1c). The primary outcome was in-hospital stent thrombosis. Patients were grouped by the occurrence of in-hospital ST. Univariable, multivariable, and LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression identified predictors of ST. Results: In-hospital ST occurred in 1.5% of patients. ST patients had higher Killip class, heart rate, white blood cell, platelet counts, creatinine, AH, and SHR. SHR was an independent predictor of ST (OR 3.15, 95% CI 1.88–5.27, p < 0.001), whereas AH was not (p = 0.182). Neutrophil count, correlated with WBC, was also a significant risk factor. ROC analysis showed SHR ≥ 1.26 as an optimal cutoff predicting ST. Conclusions: SHR is a strong independent predictor of in-hospital ST after STEMI, superior to AH. Monitoring and managing stress-induced hyperglycemia play a crucial role in the setting of STEMI. Further studies are needed. Full article

Background: Coronary artery disease (CAD) is a leading global cause of mortality. The role of calcium (Ca), a key metabolic and structural element, in atherosclerosis and inflammation remains unclear. Ca influences immune cell function and is a component of atherosclerotic plaques. Hair analysis reflects long-term mineral exposure and may serve as a non-invasive biomarker. Objectives: This pilot study aimed to investigate the association between hair Ca levels and acute coronary syndrome (ACS), and to evaluate correlations with the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and selected CAD risk factors. Methods: Ca levels were measured in hair samples from patients undergoing coronary angiography for suspected myocardial infarction. Associations with ACS diagnosis, Syntax score, SII, SIRI, and CVD risk factors were analyzed. Results: Serum calcium levels were not significantly associated with the presence of acute coronary syndrome (ACS) (p = 0.392) or with its clinical subtypes, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) (p = 0.225). Diagnosis of ACS was linked to higher SII (p = 0.028) but not SIRI (p = 0.779). Ca levels correlated negatively with Syntax score (R = −0.19, p = 0.035) and SII (R = −0.22, p = 0.021) and positively with HDL-C (R = 0.18, p = 0.046). Conclusions: Hair calcium content may reflect subclinical inflammation and CAD severity. Although no direct link to ACS was observed, the associations with SII, HDL-C, and Syntax score suggest a potential diagnostic role which should be further explored in larger, well-controlled studies. Full article

Background/Objectives: Cangrelor, an intravenous P2Y12 inhibitor, is increasingly used during percutaneous coronary intervention (PCI) for rapid and reversible platelet inhibition in patients unable to take oral antiplatelet agents, particularly in emergencies such as ST-elevation myocardial infarction (STEMI), cardiac arrest, or cardiogenic shock. This single-centre study evaluates cangrelor and outcomes in a non-surgical centre. Methods: Between June 2017 and December 2021, all the patients for whom cangrelor was used at a district general hospital (DGH) in the UK were included in this study. Data collection included baseline characteristics, admission, procedural details, and patient outcomes. The primary outcome was a composite of all-cause mortality, bleeding, and cardiovascular events, including myocardial infarction, stent thrombosis, and stroke, within 48 h. Secondary outcomes included predictors of the composite outcome at 48 h. Results: During the study period, cangrelor was administered peri-procedurally to 93 patients. Males comprised 85% of the patients; the mean age was 65.5 ± 10.6 years. A total of 1 patient (1.1%) had a cardiovascular event within 48 h of cangrelor administration, whereas all-cause mortality occurred in 17 patients (18%) within 48 h. No major bleeding events were noted at 48 h following cangrelor administration. Regression analysis did not find predictors of composite outcomes at 48 h. Conclusions: Cangrelor offers a potential alternative to oral P2Y12 inhibitors in specific high-risk scenarios. Further research is needed to validate its role in broader populations. Full article

Background: Residual risk after acute coronary syndromes (ACSs) continues to affect prognosis. We investigated the impact of female sex, non-ST-segment–elevation myocardial infarction (NSTEMI), diabetes mellitus (DM), and chronic kidney disease (CKD) on coronary atherosclerosis extent, culprit stenosis location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was additionally evaluated. Methods: We enrolled 1404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit stenoses were analyzed using angiography. Biohumoral data was assessed at admission and at 1 month and 12 months after discharge. Patients were compared based on sex, NSTEMI, DM, and CKD presence. Results: NSTEMI patients had a higher number of total coronary stenoses (3.5 vs. 3.3, p = 0.013) and non-culprit stenoses (2.3 vs. 1.6, p = 0.0001). Non-culprit percent stenosis was significantly greater in NSTEMI as compared to STEMI patients (57.9% vs. 47.1%, p = 0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p = 0.0001). CKD patients showed a higher prevalence of left main disease (3.4% vs. 1.5%, p = 0.038). Female patients had higher LDL-cholesterol values at 1 month and 12 months. NSTEMI, DM, and creatinine level were independent predictors of MACE. NSTEMI patients had an increased risk of non-fatal RCE. Conclusions: NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE in the first 5 years after an ACS. Full article

Background/Objectives: Obesity is increasingly common among patients with acute ST-segment elevation myocardial infarction (STEMI), potentially influencing both clinical evaluation and outcomes. Traditional echocardiographic metrics may be suboptimal for prognosis estimation in this population. Left ventricular myocardial work (LVMW) represents an emerging, load-adjusted marker of myocardial performance. This study aimed to assess the prognostic relevance of LVMW in obese STEMI patients. Methods: A total of 143 patients presenting with STEMI were prospectively enrolled and categorized based on their obesity status (body mass index ≥30 kg/m²). LVMW parameters were measured using echocardiography within 72 ± 24 h of hospital admission. The patients were monitored for major adverse cardiovascular events (MACE), defined as cardiovascular death, malignant ventricular arrhythmias, or unplanned hospitalizations due to heart failure or acute coronary syndrome. Results: During a median follow-up of 13 months (interquartile range: 6–28 months), MACE occurred in 30 patients (21%). Among obese individuals, left ventricular global work efficiency (LVGWE) emerged as the most robust predictor of adverse events, with an area under the receiver operating characteristic curve of 0.736 (95% confidence interval [CI]: 0.559–0.914; p = 0.009). A threshold value of 79% for LVGWE was identified as optimal for predicting MACE. Kaplan–Meier analysis revealed significantly lower event rates in obese patients with LVGWE ≥79% (log-rank p = 0.006). In univariate Cox regression analysis, LVGWE <79% was associated with a markedly elevated risk of MACE in obese patients (hazard ratio [HR] = 5.59; 95% CI: 1.33–23.50; p = 0.019), and remained a significant predictor in the overall cohort (HR = 2.73; 95% CI: 1.26–5.90; p = 0.010). Conclusions: LVGWE demonstrates strong prognostic utility in STEMI, particularly among obese patients. The incorporation of myocardial work indices into routine evaluation may enhance risk stratification and guide management in this high-risk subgroup. Full article