ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Abstract

Introduction: Spontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes. Aim: To investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling. Material and methods: Of 155 STEMI patients with patent IRA, 19 (12.3%) patients with TIMI-2 (T2 Res) and 85 (54.8%) with TIMI-3 (T3 Res) had further STE resolution following PCI, 20 (12.9%) with TIMI-3 did not require PCI (T3 noPCI) and 31 (20.0%) with TIMI-2/3 had reSTE of ≥ 1 mm following PCI as compared with pre-PCI recordings (T23 reSTE). LV ejection fraction (LVEF, %) and LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI, ml/m 2) were measured by echocardiography 2 days and 6 months following PCI. Results: In 6-month observation the improvement of LVEF in T3 Res (by 3.9 ±5.1%) and in T3 noPCI (by 5.7 ±6.1%) patients was higher as compared with T23 reSTE (0.2 ±7.0%, p < 0.05 versus both). LVEDVI increased in T23 reSTE patients by 6.6 ±12.6 ml/m 2 , but decreased in T3 Res by 3.8 ±9.7 ml/m 2 and in T3 noPCI by 2.4 ±6.2 ml/m 2 (for both p < 0.05 vs. T23 reSTE). LVESVI increased in T23 reSTE patients (by 3.8 ±10.8 ml/m 2), did not change in T2 Res (by 0.1 ±9.0 ml/m 2), but decreased in T3 Res (by 4.2 ±7.2 ml/m 2 , p < 0.05 vs. T23 reSTE) and in T3 noPCI patients (by 4.7 ±7.7 ml/m 2 , p < 0.05 vs. T23 reSTE). ReSTE was an independent predictor of LVEF, LVEDVI and LVESVI changes (p < 0.001 for all). Conclusions: ReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.

Worse long-term prognosis in myocardial infarction occurring at weekends or public holidays with insight into myocardial infarction with nonobstructive coronary arteries

“…Interestingly, in this study also a higher prevalence of undetermined IRA and diagnosis of MINOCA was documented during WD. Difficulties in determination of IRA are often associated with its spontaneous recanalization without leaving visible residual stenosis, which is a proven favorable prognostic factor [17,19]. Although MINOCA was less often diagnosed in NWD, it was not associated with higher long-term mortality.…”

“…Moreover patients with MINOCA were analyzed for the presence of insignificant stenosis in epicardial arteries and were divided into two groups with i) normal coronary arteries or minimal intracoronary irregularities with stenosis of less than 30% or with ii) mild to moderate lesions of at least 30% and less than 50% [16]. Epicardial blood flow was evaluated by means of the Thrombolysis In Myocardial Infarction (TIMI) scale in all patients [17]. TIMI 2 or 3 epicardial blood flow without flow limiting dissection not covered by stent was recognized as the optimal PCI result, whereas TIMI 0 or 1 flow was the equivalent of incomplete epicardial reperfusion [17][18][19].…”

“…Epicardial blood flow was evaluated by means of the Thrombolysis In Myocardial Infarction (TIMI) scale in all patients [17]. TIMI 2 or 3 epicardial blood flow without flow limiting dissection not covered by stent was recognized as the optimal PCI result, whereas TIMI 0 or 1 flow was the equivalent of incomplete epicardial reperfusion [17][18][19]. According to the commonly accepted the American Heart Association (AHA)/ACC/SCAI clinical competence statement, operators performing <50 PCI/year, 50-100 PCI/year or >100 PCI/year were defined as low-, intermediate-or high-volume, respectively [20,21].…”

Screening diagnosis of dementia in patients following heart failure decompensation is associated with a higher relative wall thickness

“…The two-dimensional transthoracic echocardiography was performed at rest in a left decubitus position in accordance with the American Society of Echocardiography and European Association of Echocardiography recommendations (16) by a trained physician between the second and fourth day of hospitalization using a Vivid S5 ultrasound (GE, Solingen, Germany) equipped with multi-frequency harmonic transducer 3Sc-RS (1.3-4.0 MHz). The size of the heart cavities and their function, as well as heart valves function have been assessed (17). A relative wall thickness (RWT) in this study was expressed as a ratio of doubled posterior wall diameter and LV end-diastolic diameter.…”

Cardiac Magnetic Resonance Shows Improved Outcomes in Patients with an ST-Segment Elevation Myocardial Infarction and a High Thrombus Burden Treated with Adjuvant Aspiration Thrombectomy

“…Restoration of the infarct-related artery (IRA) patency, at least theoretically, enables coronary microcirculation salvage and prevents myocardial necrosis. However, modern imaging methods have revealed a discrepancy between epicardial vessel patency and microcirculation perfusion in at least one third of STEMI patients treated with PCI [ 5 , 6 ].…”