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(A) Kaplan-Meier event rate for mortality up to 30 days after admission. (B) Kaplan-Meier event rate for mortality up to 1 year after admission. (C) Kaplan-Meier event rate for mortality up to 5 years after admission. LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery.
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Background
ST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention...
Context in source publication
Context 1
... data on death are obtained from the Swedish National Population Registry, follow-up data on our primary outcome were obtained for virtually all patients as in previously published research from the SWEDE- HEART registry. 8-10 Unadjusted mortality was the highest among LAD patients for all time periods, including the primary endpoint of 1-year mortality (4.8%, 7.1%, 5.4% for RCA, LAD and LCx, respectively, p<0.001; figure 2). Unadjusted Cox regression analyses showed that LAD had significantly higher unadjusted risk of death compared with RCA for all time periods (HR 1.64 (95% CI 1.44 to 1.88), 1.52 (95% CI 1.37 to 1.69) and 1.25 (95% CI 1.16 to 1.34) for 30-day, 1-year and 5-year mortality, respectively), while LCx had no significant increase in mortality for any time period compared with RCA (table 3). ...
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Purpose:
Interventional coronary procedures are an important source of radiation. This study sought to evaluate the effect of the renewal of the radiologic system on patient exposure during diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCIs).
Methods:
DCA and PCIs were obtained from three centres, which renewed t...
Citations
... STEMI and MVD patients experienced more MACEs and higher mortality than STEMI patients with single-vessel lesions. 29,30 MVD is an essential factor in the poor prognosis of these patients and can significantly increase recurrence of myocardial infarction and short-term mortality after PCI. 6,31 The COMPLETE trial demonstrated that, on a background of optimal medical therapy, compared with a culprit lesion-only revascularization strategy, a complete revascularization strategy can significantly reduce the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. ...
Objective
Approximately 50% of ST-segment elevation myocardial infarction (STEMI) patients have multivessel coronary artery disease (MVD). The management strategy for these patients remains controversial. This study aimed to develop predictive models and nomogram of outcomes in STEMI patients with MVD for better identification and classification.
Methods
The least absolute shrinkage and selection operator (LASSO) method was used to select the features most significantly associated with the outcomes. A Cox regression model was built using the selected variables. One nomogram was computed from each model, and individual risk scores were obtained by applying the nomograms to the cohort. After regrouping patients based on nomogram risk scores into low- and high-risk groups, we used the Kaplan–Meier method to perform survival analysis.
Results
The C-index of the major adverse cardiovascular event (MACE)-free survival model was 0·68 (95% CI 0·62–0·74) and 0·65 [0·62–0·68]) at internal validation, and that of the overall survival model was 0·75 (95% CI 0·66–0·84) and (0·73 [0·65–0·81]). The predictions of both models correlated with the observed outcomes. Low-risk patients had significantly lower probabilities of 1-year or 3-year MACEs (4% versus 11%, P= 0.003; 7% versus 15%, P=0.01, respectively) and 1-year or 3-year all-cause death (1% versus 3%, P=0.048; 2% versus 7%, respectively, P=0.001) than high-risk patients.
Conclusion
Our nomograms can be used to predict STEMI and MVD outcomes in a simple and practical way for patients who undergo primary PCI for culprit vessels and staged PCI for non-culprit vessels.
... Previous studies have proven that ventricular arrhythmia was significantly associated with in-hospital and thirty-day mortality rates [20]. Moreover, mortality from hospital discharge to one month was strongly affected by the three-vessel disease, chronic kidney disease, left anterior descending artery, cardiogenic shock, especially those are on positive inotropes and admitted to ICU on mechanical ventilation, intubated patients, patients who present to hospital with ventricular tachycardia/ventricular fibrillation or a ventricular arrhythmia that happened in Cath-lab and no-reflow less than class 2, respectively affect mortality. ...
BACKGROUND Myocardial infarction, particularly ST-segment elevation myocardial infarction (STEMI), is a key global mortality cause. Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center. Multiple factors were identified influencing in-hospital mortality. Significantly, time from symptom onset to hospital arrival emerged as a decisive factor. Consequently, our study hypothesis is: "Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."
... Previous studies have proven that ventricular arrhythmia was significantly associated with in-hospital and thirty-day mortality rates [20]. Moreover, mortality from hospital discharge to one month was strongly affected by the three-vessel disease, chronic kidney disease, left anterior descending artery, cardiogenic shock, especially those are on positive inotropes and admitted to ICU on mechanical ventilation, intubated patients, patients who present to hospital with ventricular tachycardia/ventricular fibrillation or a ventricular arrhythmia that happened in Cath-lab and no-reflow less than class 2, respectively affect mortality. ...
BACKGROUND
Myocardial infarction, particularly ST-segment elevation myocardial infarction (STEMI), is a key global mortality cause. Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center. Multiple factors were identified influencing in-hospital mortality. Significantly, time from symptom onset to hospital arrival emerged as a decisive factor. Consequently, our study hypothesis is: "Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."
AIM
To determine the key factors influencing mortality rates in STEMI patients.
METHODS
We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PPCI) at the Erbil Cardiac Center. Their clinical histories were compiled, and coronary evaluations were performed via angiography on admission. Data included comorbid conditions, onset of cardiogenic shock, complications during PPCI, and more. Post-discharge, one-month follow-up assessments were completed. Statistical significance was set at P < 0.05.
RESULTS
Our results unearthed several significant findings. The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2% and 2.3% respectively. On the investigation of independent predictors of in-hospital mortality, we identified atypical presentation, onset of cardiogenic shock, presence of chronic kidney disease, Thrombolysis In Myocardial Infarction grades 0/1/2, triple vessel disease, ventricular tachycardia/ventricular fibrillation, coronary dissection, and the no-reflow phenomenon. Specifically, the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer (6.92 ± 3.86 h) compared to those who survived (3.61 ± 1.67 h), P < 0.001. These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.
CONCLUSION
Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients, highlighting the critical need for prompt intervention.
... Багато досліджень присвячено вивченню можливості прогнозування клінічних наслідків шляхом детального аналізу змін на ЕКГ [5,6], ЕХО-кардіоскопії [7] та біохімічних маркерів [8][9][10]. Існують публікації, в яких вивчався вплив інфаркт-залежної судини на віддалені наслідки інфаркту та виявлено більш важкі наслідки при ураженні лівої коронарної артерії [11,12]. Однак вплив локалізації інфаркт-залежного сегмента на клінічні наслідки вивчений мало. ...
Cardiovascular diseases are the main cause of mortality and disability factors. Prediction of the possible consequences of treatment, based on data on the features of anatomical localization of lesions, will obviously be able to improve the quality of treatment and reduce the level of disability. Optimization of interventional treatment methods depending on the coronary vasculature anatomical features, the development of collateral blood flow is aimed at the implementation of a personalized approach to the medical care.The aim of the work was to optimize interventional treatment of patients with acute coronary syndrome by studying the features of segmental formation of coronary arteries. The study analyzed the data of 121 patients with acute coronary syndrome who underwent coronary angiography with radial access and stenting of the infarct-related artery. Determination of coronary artery segments was performed according to the numbering method proposed by the American Heart Association. The severity of coronary artery disease was determined according to the Gensini scale. 88.43% of the patients included in the study had multivessel coronary disease. A relation was established between the lesion of segment 10 (r=0.312, p<0.001), segment 11 (r=0.211, p=0.015) and segment 14 (r=0.228, p=0.008) with the occurrence of MI recurrences. In case of diagonal artery lesions (D2), recurrences of MI occurred in 40.0% of patients, in the circumflex artery: 14 segment – 25.0%, and 11segment – 14.29%. In the remaining cases, the proportion of MI recurrences was significantly lower (from 2.67 to 8.86%). Analysis of the segmental localization of the infarct-related area of the coronary artery shows that there are certain "typical" areas of lesions in right and left coronary arteries - the middle section of the right coronary artery and the proximal section of the anterior interventricular branch of the left coronary artery. We also consider the obtained data to be important for predicting the risk of myocardial infarction recurrence, which turned out to be greater with occlusion of the 10th, 11th, and 14th segments of the coronary artery. In patients over 63 years of age, attention should be paid to the fourth segment of the right coronary artery, since occlusion of this section occurs more often in this age group. Atherosclerotic injury to the proximal part of the right coronary artery usually is not accompanied by prodromal syndrome of myocardial infarction in the form of unstable angina pectoris.The number of implanted stents did not reliably affect mortality and long-term survival. Correlations of lesions of certain segments of coronary vessels with previous manifestations of unstable angina pectoris and recurrent course, age and gender differences, presence of comorbidity, especially with arterial hypertension and diabetes have been established. Structural and functional changes in the myocardium were found to be the most severe in pathology of the left main stem. The relation between the lesion of the left main stem and the deterioration in the left ventricle ejection fraction (r=-0.244, p=0.005), the development of the left ventricle aneurysm (r=0.211, p=0.015) was established in 16.67% (in other segments - from 0 to 5.55%), rhythm disorders such as atrial fibrillation (r=0.304, p<0.001) in 25.00% (in other segments – from 2.17 to 9.52%), were more often accompanied by acute heart failure (Killip3-4) in 17.67% (in other segments - from 0 to 7.50%).
... This has important implications for treatment, as patients with in-hospital HF after ACS are more likely to be medically managed and have longer delays to percutaneous or surgical revascularization [4]. While HF is more commonly seen with left sided MIs (i.e. after occlusion of the left anterior descending artery, LAD, or the circumflex artery, CX) [5], HF due to right ventricular (RV) MI has several unique hemodynamic and electrocardiographic features that need to be considered by treating physicians. was only identified in 3% of patients, whereas left ventricular (LV) failure was the dominant cause of shock (79% of patients) [7]. ...
... However, looking at the culprit vessel, infarction in the LAD or CX territory generally carry a higher risk of HF and mortality in both short (30 days) and long-term follow-up (5 years) compared to RCA infarctions, possibly owing to the higher risk for permanent LV dysfunction and the better potential of the RV to recover [5,15]. ...
Purpose of Review
Heart failure (HF) after right ventricular myocardial infarction (RVMI) is common and complicates its clinical course. This review aims to provide a current overview on the characteristic features of RV failure with focus on acute management.
Recent Findings
While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients.
Summary
HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
... Our prior approach to induce LAD infarction in Yucatan micropigs were not successful owing to interactable ventricular fibrillation and cardiac arrest. Information on the increased mortality rate in LAD occlusion, presenting <30% ejection fraction [26], led us to choose LCX occlusion for MI induction for improving the post-MI survival rate. Also, our focus was to induce an infarction with moderate severity with >40% ejection fraction. ...
Background:
Despite the recent advancements in the cardiac regenerative technologies, the lack of an ideal translationally relevant experimental model simulating the clinical setting of acute myocardial infarction (MI) hurdles the success of cardiac regenerative strategies.
Methods:
We developed a modified minimally invasive acute MI model in Yucatan miniswine by catheter-driven controlled occlusion of LCX branches for regenerative cardiology. Using a balloon catheter in three pigs, the angiography guided occlusion of LCX for 10-15 minutes resulted in MI induction which was confirmed by the pathological ECG changes compared to the baseline control.
Results:
Ejection fraction was considerably decreased post-procedure compared to the baseline. Importantly, the highly sensitive MI biomarker Troponin I was significantly increased in post-MI and follow-up groups along with LDH and CCK than the baseline control. The postmortem infarct zone tissue displayed the classical features of MI including ECM disorganization, hypertrophy, inflammation, and angiogenesis confirming the MI at the tissue level.
Conclusions:
The present model possesses the advantage of minimal mortality, simulating the pathological features of clinical MI and the suitability for injectable regenerative therapies suggesting the translational significance in regenerative cardiology.
... The majority of these potential lethal culprit lesions is located in the proximal coronary arteries [2]. Due to its critical location, coronary artery disease (CAD) in the left anterior descending artery (LAD) leads to the most dangerous ischemic events [3]. ...
Background
Aim of this study was to investigate immune cells and subsets in different stages of human coronary artery disease with a novel multiplex immunohistochemistry (mIHC) technique.
Methods
Human left anterior descending coronary artery specimens were analyzed: eccentric intimal thickening (N = 11), pathological intimal thickening (N = 10), fibroatheroma (N = 9), and fibrous plaque (N = 9). Eccentric intimal thickening was considered normal, and pathological intimal thickening, fibroatheroma, and fibrous plaque were considered diseased coronary arteries. Two mIHC panels, consisting of six and five primary antibodies, autofluoresence, and DAPI, were used to detect adaptive and innate immune cells. Via semi-automated analysis, (sub)types of immune cells in whole plaques and specific plaque regions were quantified.
Results
Increased numbers of CD3⁺ T cells (P < 0.001), CD20⁺ B cells (P = 0.013), CD68⁺ macrophages (P = 0.003), CD15⁺ neutrophils (P = 0.017), and CD31⁺ endothelial cells (P = 0.024) were identified in intimas of diseased coronary arteries compared to normal. Subset analyses of T cells and macrophages showed that diseased coronary arteries contained an abundance of CD3⁺CD8⁻ non-cytotoxic T cells and CD68⁺CD206⁻ non-M2-like macrophages. Proportions of CD3⁺CD45RO⁺ memory T cells were similar to normal coronary arteries. Among pathological intimal thickening, fibroatheroma, and fibrous plaque, all immune cell numbers and subsets were similar.
Conclusions
The type of immune response does not differ substantially between different stages of plaque development and may provide context for mechanistic research into immune cell function in atherosclerosis. We provide the first comprehensive map of immune cell subtypes across plaque types in coronary arteries demonstrating the potential of mIHC for vascular research.
... In patients with STEMI, the anterior localization of the infarction is often associated with greater myocardial dysfunction, heart failure and increased mortality, mostly due to the larger myocardial territory supplied by the left anterior descending artery (LAD) [13][14][15][16][17][18]. ...
... These findings might be related to the higher myocardial mass perfused by the LAD compared to other myocardial regions [23]. Usually, infarcts caused by LAD occlusion are associated with a larger left ventricular damage and an increased risk of heart failure and death [17], this may be due to the larger infarct size rather than the mere infarct localization. In a recent patients level pooled analysis of ten randomized trials, a strong association between infarct size and all-cause mortality was demonstrated regardless of the infarct location, although the anterior infarct location was a strong determinant of increased infarct size [18]. ...
Large thrombus burden (LTB) during ST-segment elevation myocardial infarction (STEMI) could translate into worse clinical outcomes. The impact of a LTB in terms of long-term clinical outcomes on different myocardial infarct territories has not yet been fully evaluated. From April 2002 to December 2004, consecutive patients with STEMI undergoing percutaneous coronary intervention with drug eluting stent were evaluated. The study sample was stratified in two groups: anterior STEMI and non-anterior STEMI. LTB was considered as a thrombus larger than or equal to 2-vessel diameters, and small thrombus burden less than 2-vessel diameters. Major adverse cardiac events (MACE) were evaluated at 10-year and survival data were collected up to 15-year. A total of 812 patients were evaluated, 6 patients were excluded due to inadequate angiographic images, 410 (50.9%) had an anterior STEMI and 396 (49.1%) a non-anterior STEMI. Patients with LTB had higher rates of 10-year mortality (aHR 2.27, 95%CI 1.42–3.63; p = 0.001) and 10-year MACE (aHR 1.46, 95%CI 1.03–2.08; p = 0.033) in anterior STEMI, but not in non-anterior STEMI (aHR 0.78, 95%CI 0.49–1.24; p = 0.298; aHR 0.71, 95%CI 0.50–1.02; p = 0.062). LTB was associated with increased 30-day mortality (aHR 5.60, 95%CI 2.49–12.61; p < 0.001) and 30-day MACE (aHR 2.72, 95%CI 1.45–5.08; p = 0.002) in anterior STEMI, but not in non-anterior STEMI (aHR 0.39, 95%CI 0.15–1.06; p = 0.066; aHR 0.67, 95%CI 0.31–1.46; p = 0.316). Beyond 30-day, LTB had no impact on mortality and MACE in both groups. In anterior STEMI, LTB is associated with worse long-term clinical outcomes, this effect was driven by early events.
... 22 A recent registry study demonstrated that both LAD and LCX infarctions were significantly associated with higher event rates of stroke within 1 year after AMI compared with RCA infarction (1.5%, 1.7%, and 1.2%, respectively). 23 The higher relative risk of stroke in patients with LAD (and LCX) infarction could be explained by the anatomical myocardial supply, because LAD supplies the apex of the heart where apical dyskinesia may lead to increased risk for mural thrombi. 24 In contrast, the incidences of stroke in the present study were significantly lower in patients with LAD infarction compared to LCX, RCA infarctions (0.4%, 1.6%, and 1.5%, respectively). ...
Background:
Previous studies have reported that acute myocardial infarction (AMI) related to left anterior descending (LAD) lesion is associated with worse outcomes than left circumflex artery (LCX) or right coronary artery (RCA) lesions. However, it is unknown whether those relationships are still present in the contemporary era of primary percutaneous coronary intervention (PCI), using newer generation drug-eluting stents and potent antiplatelet agents.Methods and Results:This study is a sub-analysis of the Japan AMI Registry (JAMIR), a multicenter, prospective registry enrolling 3,411 AMI patients between December 2015 and May 2017. Among them, 2,780 patients undergoing primary PCI for only a culprit vessel were included and stratified based on infarction-related artery type (LAD, LCX, and RCA). The primary outcome was 1-year cardiovascular death. The overall incidence of cardiovascular death was 3.4%. Patients with LAD infarction had highest incidence of cardiovascular death compared to patients with LCX and RCA infarction (4.8%, 1.3%, and 2.4%, respectively); however, landmark analysis showed that culprit vessel had no significant effect on cardiovascular death if a patient survived 30 days after primary PCI. LAD lesion infarction was an independent risk factor for cardiovascular death in adjusted Cox regression analysis.
Conclusions:
The present sub-analysis of the JAMIR demonstrated that LAD infarction is still associated with worse outcomes, especially during the first 30 days, even in the contemporary era of PCI.
... Similarly, this has been our finding as well. [29][30][31] Several limitations of this study should be acknowledged. Firstly, the study comprised only a small group of participants, therefore obtained findings may not be an actual representation of the entire population. ...
Background: Compared to older counterparts, a significant distinction has been found related to risk factors, clinical presentation, and prognosis of ST-segment elevation myocardial infarction (STEMI) in younger patients. To date, a lack of studies has been looked, specifically at-risk factors and angiographic profile of STEMI among younger patients; with this in mind, we conducted the present study.Methods: This hospital-based, cross-sectional, open-label study was carried out at Deccan College of Medical Sciences between April 2018 and December 2019. Patients under 40 years with the presentation of STEMI were included. All patients were subjected to electrocardiography, 2D echocardiography, and coronary angiogram. Baseline demographics, risk factors, and procedural characteristics were recorded.Results: Of 51 young STEMI patients, 41 (80.4%) were male and 10 (19.6%) were female. The most common risk factors associated with the development of STEMI in young patients were smoking (58.8%), followed by diabetes (45.1%), and dyslipidaemia (45.1%). Anterior wall MI was the most frequent presentation (84.3%). The left anterior descending artery was the most frequently (62.8%) involved vessel, followed by left circumflex artery (9.8%), and right coronary artery (5.9%).Conclusions: Insights gained from the study can aid in identifying clinical characteristics of STEMI in young patients, which may be beneficial to achieve appropriate and timely management. Further, the young population should be educated as to control modifiable risk factors and smoking cessation to prevent coronary artery disease since they belong to the highly productive group in the community.
