Background The role of stent post dilatation (SPD) during primary percutaneous intervention (PPCI) is controversial. Currently there are no clear guidelines or consensus regarding when to perform SPD and it is left to the operator decision. Purpose The aim of this study was to evaluate the procedural and long terms outcomes of SPD during PPCI. Methods We collected retrospectively data of 614 STEMI patients who presented to two tertiary centers during one year period. All patients underwent PPCI. We excluded patients with cardiogenic shock, prior CABG, severe LM disease. Patients were divided into two groups according to SPD procedure. Group 1: who had SPD included 424 patients (69.1%). Group 2: no SPD included 190 patients (30.9%). Both groups were well matched with regard to demographic data and lesion characteristics. Procedural outcomes and clinical outcomes at one year were collected. Results SPD patients had significantly higher incidence of no reflow during the procedure (33.7% in group 1 vs. 21.6% in group 2, P=0.026), but the final TIMI flow was similar between two groups. Also, there was no significant difference between two groups regarding other procedural outcomes as dissection, perforation, or cardiac death. After one year follow up SPD patients had significantly higher incidence of reinfarction (5.6% of group 1 vs. 1.5% in group 2, P=0.03) and significantly more target vessel revascularization (TVR) (16.7% in group 1 vs. 4.7% in group 2 P<0.001). There was no significant difference between the two groups regarding the incidence cerebrovascular stroke (CVS), heart failure or cardiac death. Conclusion Our study shows that SPD during PPCI is associated with an increased risk of procedural no reflow and increased risk of reinfarction as well as need for TVR after 1 year follow up. Finally, SPD did not improve clinical outcomes after 1 year follow up. Nonetheless, large-scale randomized trials are required to establish the role of SPD during PPCI. Funding Acknowledgement Type of funding sources: None.
Background Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricle dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not evaluate RV diastolic dysfunction. Purpose In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI. Methods Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Presence of a pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (e', a' and E/e' ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. Results The average age of the study population was 51.58±10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary oedema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 hours. Patients who developed MACE had high filling pressures, as all of them had E/e' >6. E' velocity ≤6 cm/s was associated with increased MACE as 25% of patients with e' velocity ≤6 cm/s had MACE compared with 2.3% of patients with e' velocity >6 cm/s with a P value of 0.015. Conclusions Because tricuspid inflow velocities by PW doppler varies with respiration, volume status and other conditions, tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/e' and e' has a prognostic value in patients with Inferior STEMI and RV infarction. Funding Acknowledgement Type of funding sources: None.
Background Elderly patients presenting with acute coronary syndrome (ACS) are at a higher risk for morbidity, complications and early mortality than younger patients. Elderly are frequently underrepresented in clinical trials. Methods A descriptive multi-center study including 760 patients admitted with ACS in order to determine the most frequently encountered cardiovascular risk factors, as well as the in-hospital complications among this age group. Results Of the 760 patients, 42.1% were males with a mean age of 85 years. Non-ST-elevation ACS was encountered in 496 patients (65.3%; NSTEMI 50% and unstable angina 15.3%) while STEMI was encountered in 264 patients (34.7%). Regarding risk factors, 61.1% of patients were hypertensive, 60% were diabetics, 44.7% were smokers, 28.9% had dyslipidemia, 16.8% had a family history of coronary artery disease, and 20% had chronic renal impairment at presentation. 252 patients (33.2%) underwent primary PCI, 440 patients (57.9%) underwent elective PCI, 36 patients (4.7%) underwent coronary artery bypass graft (CABG) surgery while 32 patients (4.2%) were maintained on conservative medical therapy and no patients received fibrinolytic therapy. In-hospital mortality was only 3.7% (28 patients), cerebrovascular stroke occurred in 16 patients (2.1%) and recurrent infarction occurred only in 8 patients (1.1%). Conclusions In patients over 80 years presenting with ACS, female sex, hypertension and diabetes were the most frequently encountered cardiovascular risk factors, with more frequent presentation of NSTEMI than STEMI and in-hospital mortality of 3.7%. Funding Acknowledgement Type of funding sources: None.
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