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Rotational atherectomy (RA) in ST-segment elevation myocardial infarction (STEMI) is uncommon and its use in a thrombotic lesion is labelled a contraindication by its manufacturer due to the concern for further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting no-reflow (NR). However, thrombus burden varies significantly in the STEMI setting and can be classified according to the thrombolysis in myocardial infarction (TIMI) thrombus grade (TG). This case demonstrates the successful off-label use of RA-assisted primary percutaneous coronary intervention to facilitate treatment of a heavily calcified ostial right coronary artery lesion with low thrombotic burden (TIMI TG 0) in an octogenarian STEMI patient. Atherectomy drug cocktails, intracoronary vasodilators, short burr runs and avoidance of rotating the burr at slower than minimum approved rotational speed contribute to atherectomy success and decrease the chances of NR.

Patient undergoing PCI can have distal embolization and microvascular obstruction despite normalization of epicardial blood flow. Aspiration thrombectomy has been studied previously to reduce infarct size, but prior methods of aspiration thrombectomy were associated with increased risk of stroke and is currently recommended as a bailout strategy. Penumbra CAT RX has been recently approved for aspiration thrombectomy, we evaluated the catheter's use in an academic cardiac catheterization lab. Patients undergoing cardiac catherization at an academic medical center who had deployment of the Penumbra CAT RX from 2017 through 2020 were included in the case series. TIMI flow pre and post procedure were determined by individual operator. Endpoints included 30-day cardiovascular death and post-procedural stroke. The Penumbra CAT RX catheter was used in a total of 34 patients, with 71% STEMI, 23% NSTEMI , 3% UA, and 3% new onset heart failure. TIMI 3 flow was achieved in 88% of cases. There were no cases of 30-day cardiovascular death or post procedural stroke. Aspiration thrombectomy continues to have clinical benefit in modern cardiac catherization laboratories with use in select cases. The Penumbra CAT RX appears to be safe and highly effective at thrombus removal in the acute setting without increased stroke risk as seen with manual aspiration thrombectomy.

Background Cardiac rupture (CR) is a catastrophic complication of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) reduces the incidence of CR. This study aimed to investigate the clinical risk factors and characteristics of CR after pPCI. Methods This was a retrospective, case-control, multicenter study. We enrolled 2444 consecutive patients with ST-elevation myocardial infarction (STEMI) who had undergone pPCI between 2009 and 2015; 33 patients experienced CR (1.35%): 19 were assigned as early CR (≤72 h) and 14 as late CR (>72 h). The 132 controls were randomly selected from the 2411 STEMI patients without CR, by matching institutions at a 1:4 ratio. Results : Multivariate logistic regression revealed that female sex, acute hyperglycemia, thrombocytopenia (platelets 1, and post-PCI TIMI 1 and thrombocytopenia were strongly associated with late CR. Early CR occurred more frequently between 12:00 and 21:00 h, whereas the peak incidence of late CR was bimodal between 6:00–12:00 and 21:00–24:00 h. Conclusions In STEMI patients after pPCI, acute hyperglycemia and thrombocytopenia are new risk factors for early and late CR, respectively. Clinical risk factors and time of occurrence of early and late CR may differ in the PCI era.

Background : Among various mechanical support devices, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the last resort for acute myocardial infarction (AMI) patients complicated with refractory cardiogenic shock or cardiac arrest. The purpose of this study was to investigate the V-A ECMO-related complications in AMI patients who underwent percutaneous coronary intervention (PCI), and to find the association between complications and in-hospital death in that population. Methods : We retrospectively included 101 AMI patients who received V-A ECMO and underwent PCI to the culprit lesion, and divided them into the survivor group (n=43) and the in-hospital death group (n=58). We compared the clinical characteristics and outcomes including complications between the 2 groups, and performed multivariate logistic regression analysis to find factors associated with in-hospital death and major bleeding. Results : The incidence of major bleeding including V-A ECMO site bleeding and intracranial hemorrhage was higher in the in-hospital death group (34.5%) than in the survivor group (7%) (p=0.001). Multivariate logistic regression analysis revealed that final thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (OR 4.453, 95% CI1.427-13.894, p=0.010) and major bleeding (OR 4.986, 95% CI1.277-19.466, p=0.021) were significantly associated with in-hospital death. Out-of-hospital cardiac arrest (OHCA) was significantly associated with major bleeding (OR 3.881, 95% CI 1.358-11.089, p=0.011). Conclusions : In AMI patients who received V-A ECMO and underwent PCI, final TIMI flow grade ≤2 and major bleeding were associated with in-hospital death. OHCA was closely associated with major bleeding.

Objectives: To investigate the application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy. Methods: Two hundred patients with acute ST-segment elevation myocardial infarction (STEMI) complicated with diabetes who underwent percutaneous coronary intervention (PCI) and found to have high thrombus burden in coronary artery admitted to our hospital from September 2018 to September 2020 were selected as subjects, and were divided into two groups according to the randomization method: the intravenous tirofiban bolus group and the intracoronary tirofiban bolus group, with 100 cases in each group. The levels of LVEF, LVESD and LVEDD were detected immediately after admission and 15 days after therapy, and the enzyme-linked immunosorbent assay was utilized to detect the levels of CK-MB, MMP-9 and hs-CRP. Furthermore, the levels of BNP, TNI, CR and UREA of the patients were analyzed, and the levels of ESR and FIB were detected with an automatic blood rheology analyzer to analyze the TIMI classification and the incidence of MACE in the two groups. Results: Significant differences were seen between the two groups in the levels of various indicators after therapy. Fifteen days after therapy, the levels of LVEF and LVEDD were higher and the level of LVESD was lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p0.05); Similarly, 3d after therapy, the levels of TNI, Cr and Urea, as well as ESR, FIB and hs-CRP were lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p

Cardiac magnetic resonance (CMR) imaging provides valuable prognostic information in patients with ST-elevation myocardial infarction (STEMI). The peri-infarct zone (PIZ) is a potential marker for post-infarction risk stratification. The aim of this study was to assess the prognostic impact of PIZ in a large multicenter STEMI-trial.The study population consisted of 704 consecutive patients undergoing CMR within 10 days after STEMI to assess established parameters of myocardial injury and additionally the extent of PIZ. The primary clinical endpoint was major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure within 1 year after infarction.The median heterogeneous PIZ-volume in the overall population was 14 ml (interquartile range [IQR] 7 to 24 ml). Male sex, infarct size, and left ventricular ejection fraction were identified as independent predictors of larger PIZ alterations. Patients with MACE had a significantly larger PIZ volume compared to patients without adverse events (21 ml [IQR 12 to 35 ml] versus 14 ml [IQR 7 to 23 ml]; p = 0.001). In stepwise multivariable Cox regression analysis, PIZ median (14 ml) emerged as an independent predictor of MACE (hazard ratio [HR] 2.84; 95% confidence interval [CI] 1.34 to 6.00; p = 0.006) in addition to the Thrombolysis In Myocardial Infarction (TIMI) risk score (HR 1.53; 95% CI 1.19 to 1.53; p 0.001). Addition of PIZ to a CMR risk model comprising LVEF, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.46 (0.19-0.73, p 0.001).In this currently largest prospective, multicenter CMR study assessing PIZ, the extent of PIZ emerged as an independent predictor of MACE and a potential novel marker for optimized risk stratification in STEMI patients. ClinicalTrials.gov: NCT00712101.

Background In the acute management of ST-elevation myocardial infarction (STEMI), glycoprotein IIb/IIIa inhibitors (GPIs) bolus not followed by intravenous infusion is potentially advantageous given their fast onset and offset of action, but clinical evidence in a contemporary setting is limited. Methods We collected data from consecutive STEMI patients admitted to the cardiac catheterization laboratory of the Fondazione Policlinico Universitario A. Gemelli from October 2017 to September 2019. Results Out of 423 consecutive STEMI patients, 297 met the inclusion and exclusion criteria and were included in the study. Of them, 107/297 (36%) received an intracoronary GPI bolus-only during primary percutaneous coronary intervention (PPCI) not followed by intravenous infusion and 190/297 (64%) received standard antithrombotic therapy. Of the 107 GPI-treated, 22/107 (21%) had P2Y12 inhibitor pre-treatment (adjunctive strategy) and 85/107 (79%) did not (bridging strategy). During hospital staying, there was no difference in the primary safety endpoint of TIMI major+minor bleeding (p=0.283), TIMI major (p=0.267) or TIMI minor (p=0.685) bleeding between groups. No stroke event occurred in the GPI group. Despite patients receiving GPI having a significantly higher intraprocedural ischemic burden, no significant differences were found in the efficacy outcomes between groups. Consistent findings were observed for patients receiving GPIs bolus before (bridging strategy) or after (adjunctive strategy) P2Y12 inhibitors, compared to those receiving standard therapy. Multivariate logistic regression analyses did not find any independent predictors significantly associated to the primary and secondary composite endpoints. Conclusions In a contemporary real-world population of STEMI patients undergoing PPCI, the use of intracoronary GPIs bolus-only in selected patients at high ischemic risk is safe and could represent a useful antithrombotic strategy both in those pre-treated and in those naive to P2Y12 inhibitors.

Background: Fractional flow reserve (FFR) is a gold standard to assess the impact of stenosis on the blood flow. The FFR method enhances diagnostic accuracy, lessens the need for stenting, and reduces costs. However, FFR is used in less than 10% of percutaneous coronary intervention (PCI) procedures because it needs pressure wires to measure the distal and proximal pressures and adenosine to create hyperemic conditions. Pressure-wire-based FFR measurement is, therefore, expensive and invasive. Objective: This study aims to introduce a new approach on the basis of 3D coronary angiography and the Thrombolysis in Myocardial Infarction (TIMI) frame count for fast computation of FFR in patients with coronary artery disease. Material and Methods: In this simulation study, we herein introduce Non-Invasive Flow Ratio drawing upon CFD to measure FFR based on coronary angiography images with less run time. In this study, 3D geometry was created based on coronary angiography images. The mean volumetric flow rate was calculated using the TIMI frame count. FFR calculated based on CFD was compared with pressure-wire-based FFR and NiFR was calculated in 85 patients. Results: The NiFR (r = 0.738, P< 0.001) exhibited a strong correlation with pressure-wire-based FFR. The result indicated that FFR was higher than 0.8 in the arteries with non-signif­icant stenosis and lower than 0.8 in the arter­ies with significant stenosis. Conclusion: The computational simulation of FFR and hemodynamic parameters such as pressure drop is a safe, efficient, and cost-effective method to evaluate the severity of coronary stenosis.

OBJECTIVES Our primary objective was to describe the risk of major adverse cardiac events (MACE) at 1, 6, and 12 months after a negative coronary computed tomography angiogram (cCTA), electrocardiogram (ECG) stress test, stress echocardiography, and myocardial perfusion scintigraphy (MPS) in low- to intermediate-risk patients. METHODS Initially, 952 articles were identified for screening, 81 met criteria for full-text review, and once risk of bias was assessed, 33 articles were included in this meta-analysis. We utilized a random-effects model to assess pooled MACE event proportion for patients undergoing evaluation of acute coronary syndrome (ACS) when risk stratified to a low- to intermediate-risk category after undergoing standard testing. Heterogeneity analysis was performed using Cochrane's Q-test and I2 statistic. RESULTS Twenty-one studies evaluated follow-up at 1 month with cCTA having a 0.09% (95% confidence interval [CI] = 0.03% to 0.26%) pooled MACE compared to 0.23% (95% CI = 0.01% to 5.8%) of the exercise stress testing (p = 1). MPS and cCTA had an overall event rate of 0.15% (95% CI = 0.06% to 0.41%) at 6 months (I2 = 0%). At 12 months, a subgroup analysis found a pooled cCTA MACE of 0.16% (95% CI = 0.04% to 0.65%) compared to 1.68% (95% CI = 0.01% to 2.6%) for stress echocardiography with low within-group heterogeneity (I2 = 0%). Subgroup analysis of cCTA with no disease versus nonobstructive disease (

Objectives The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery. Methods One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12–18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1–9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated. Results RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84–0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89–0.98], p=0.014), TnT (OR: 0.84 [0.68–0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10–6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88–0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41–24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59–24.89], p Conclusions Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.

Background Although not common, coronary artery aneurysms (CAAs) can develop to over 8 mm in diameter to become giant CAAs. In the context of systemic lupus erythematosus (SLE), autoantibody- and immune complex-mediated atherosclerosis is believed to be the most prevalent cause of aneurysm. Case presentation We report the case of a 53-year-old female SLE patient who presented to our hospital with radiating chest pain. Coronary angiography revealed a giant aneurysm in the middle segment of the left anterior descending artery (LAD) and distal subtotal occlusion in the left circumflex artery (LCX). Laboratory testing also identified risk factors such as an abnormal pulmonary enzyme profile, dyslipidemia, and nephritis parameters.To prevent thromboembolism, anticoagulation and antiplatelet therapy were administered. In addition, one stent was implanted at the distal end of the LCX and repeated coronary angiography verified restoration of TIMI grade III flow.The patient was discharged with resolved chest pain. During 6 months of follow-up, the patient is in good health. Conclusions Our case study, together with 16 recent comparable reports, emphasizes the need for coronary aneurysm screening in SLE patients. It is necessary that thromboembolism, anticoagulation and antiplatelet therapy were administered for CAA.

Slow flow (SF) that develops after percutaneous coronary intervention (PCI) is significantly associated with poor prognosis in Non-ST elevation myocardial infarction (Non-STEMI) patients. Increased Selvester QRS score and Frontal QRS-T angle [f(QRS-T)] are related to adverse cardiovascular outcomes. We aimed to investigate the predictive role of the Selvester QRS score and f(QRS-T) for the development of post-PCI SF in patients with Non-STEMI.In a retrospective study, 210 patients with Non-STEMI were divided into two groups as SF (29) and Non-SF (181) according to their TIMI coronary flow grade. For all patients the Selvester QRS score and f(QRS-T) were calculated from automatic electrocardiography (ECG) reports. The mean age of the study population was 63 (55-75) years and 102 (68.6%) of patients were male. The Selvester QRS score and f(QRS-T) were higher in the SF group than in the Non-SF group [(5[3-8], 3[2-5]); (67° [42°-88°], 39° [24°-59°]), respectively, all p 0.01]. In a logistic regression analysis, the Selvester QRS score (OR = 4,862; 95% (CI) = 1,131-20,904, p =0.03) and f(QRS-T) (OR = 5,489; 95% (CI)= 11,433-21,034, p =0.01) were found independent predictors of post-PCI SF in Non-STEMI patients. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of the Selvester QRS score [86% sensitivity; 44% specificity; cut off 2; (AUC, 0.693)] and f(QRS-T) [62% sensitivity; 73% specificity; cut off 58°; (AUC, 0.778)].The Selvester QRS score and f(QRS-T), both easy-to-calculate ECG parameters, are predictors of post-PCI SF in Non-STEMI patients.

The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA2DS2-VASc score is used to predict the risk of thromboembolic events in patients with nonvalvular atrial fibrillation. We aimed to evaluate the predictive role of the CHA2DS2-VASc score in the estimation of intracoronary thrombus burden in patients with acute myocardial infarction (AMI) who underwent SVG-PCI. We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0–3) and high thrombus burden (HTB; TIMI 4 and 5). The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA2DS2-VASc scores (p 3 (OR: 3.876, 95% CI: 1.705–8.808, p = 0.001) were significantly associated with HTB. The ability of the CHA2DS2-VASc score to predict HTB burden was evaluated by receiver-operating characteristics analysis curve analysis. The optimum cut-off value of the CHA2DS2-VASc score for predicting HTB was 3 (with a sensitivity of 67.9% and a specificity of 69.3%) according to the Youden index. The CHA2DS2-VASc score can be used as an easy practical tool to predict HTB in AMI patients undergoing SVG-PCI.

Background: No-reflow is considered a major percutaneous coronary intervention complication, especially in primary PCI. A variety of medications have been studied for no-reflow treatment, including intracoronary nitrates, verapamil, adenosine, glycoprotein IIb/IIIa inhibitors, and epinephrine. Glycoprotein IIb/IIIa inhibitors and epinephrine are the two most promising agents for the treatment of no-reflow. Aim of work: evaluating epinephrine and glycoprotein IIb/IIIa inhibitors efficacy in treating no-reflow through local distal intracoronary injection in comparison to traditional intracoronary administration in the guiding catheter. Subjects and methods: 30 patients undergoing PCI complicated by no-reflow phenomenon. Patients were randomized to either group I where they were treated by local distal intracoronary injection of GP IIb/IIIa inhibitor and epinephrine or to group II where they received the same medications via the traditional intracoronary injection. Primary outcomes were TIMI flow, corrected TIMI frame count and TMPG, and major adverse cardiac events within 48 hours was the secondary outcome. Results: Group I had significantly superior angiographic outcomes than group II. As regards TIMI II-III flow, 86.7% of patients achieved it in versus 53.3% in group II, CTFC was 8.2versus 9.9, and in group I, 80% of patients achieved TMPG II-III, compared to 46.7 % in group II. MACE was insignificantly different between both groups. Diabetes mellitus was found to be the only predictor to be negatively associated with TIMI flow. Conclusion: Distal coronary artery local injection of a combination of GP IIb/IIIa inhibitors and epinephrine achieved superior angiographic outcomes in the treatment of refractory no-reflow in comparison with traditional intracoronary administration of the same medications.

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p

Objectives The purpose of this study was to test whether the success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) increased with pre-procedural coronary computed tomography angiography (CTA). Background Coronary CTA provides valuable information before and during CTO-PCI. However, there are no randomized data that explore whether coronary CTA increases its success rate. Methods In this multicenter, randomized trial, a total of 400 patients with CTO were randomized to receive PCI with pre-procedural coronary CTA (coronary CTA–guided group; n = 200) or without coronary CTA (angiography-guided group; n = 200) between January 2014 and September 2019. The primary endpoint was the successful recanalization rate, a final TIMI (Thrombolysis In Myocardial Infarction) grade ≥2, and ≤30% residual stenosis on the final angiogram. Results A total of 10 operators performed PCI. Successful recanalization was achieved in 187 patients (93.5%) in the coronary CTA–guided group and in 168 patients (84.0%) in the angiography-guided group (absolute difference, 9.5% [95% confidence interval: 3.4% to 15.6%]; p = 0.003). When comparing the success rates according to the Multicenter CTO Registry of Japan score (J-CTO), the coronary CTA guidance was favored over the angiography-guidance in the subset of J-CTO ≥2 versus in the subset of J-CTO Conclusions Pre-procedural coronary CTA-guidance for CTO resulted in higher success rates with numerically fewer immediate periprocedural complications such as coronary perforations or periprocedural myocardial infarction than angiography guidance. Higher success rates were more prominently observed in patients with CTO who had a high J-CTO score than those who did not. (Role of CT Scan for the Successful Recanalization of Chronic Total Occlusion; a Randomized Comparison Between 3D CT-guided PCI vs. Conventional Treatment [CT-CTO Trial]; NCT02037698 )

Background Significance of total ischemic time (TIT) in the context of ST-segment elevation myocardial infarction (STEMI) is still controversial. Therefore, in this study, we have evaluate the association of TIT with immediate outcomes in STEMI patients in whom recommended door to balloon (DTB) time of less than 90 min was achieved. Results A total of 5730 patients were included in this study, out of which 80.9% were male and median age was 55 [61–48] years. The median DTB was observed to be 60 [75–45] min and onset of chest pain to emergency room (ER) arrival time was 180 [300–120] min. Prolonged TIT was associated with poor pre-procedure thrombolysis in myocardial infarction (TIMI) flow grade (p = 0.022), number of diseased vessels (p = 0.002), use of intra-aortic balloon pump (p = 0.003), and in-hospital mortality (p = 0.002). Mortality rate was 4.5%, 5.7%, and 7.8% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Thirty days’ risk of mortality on TIMI score was 4.97 ± 7.09%, 5.01 ± 6.99%, and 7.12 ± 8.64% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Conclusions Prolonged total ischemic was associated with higher in-hospital mortality. Therefore, TIT can also be considered in the matrix of focus, along with DTB time and other clinical determinants to improve the survival from STEMI.

Background: Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear. Methods and Results: This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100–425] vs. 390 [302–477], P

OBJECTIVE: In this study, we aimed to determine whether admission hemoglobin versus post-percutaneous coronary intervention (PCI) hemoglobin level at 24 hours is a predictor of in-hospital mortality for patients with ST elevation myocardial infarction (STEMI) without evidence of clinical hemorrhage who underwent primary PCI. METHODS: In this study, we included 1,444 consecutive patients with STEMI who underwent primary PCI at a tertiary heart hospital. The primary outcome of the study was the in-hospital all-cause mortality. We used the penalized maximum likelihood estimation (PMLE) logistic regression method to examine the relationship between primary outcome and candidate predictors. RESULTS: In total, 172 (11.9%) patients died during the in-hospital course. According to a PMLE logistic regression analysis, age, KILLIP class ≥2, pre-PCI thrombolysis in myocardial infarction (TIMI) flow

A higher SYNTAX score (SS) is strongly associated with poor prognosis in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). However, the predictive value of culprit-lesion SYNTAX score (cul-SS) and SS has not been compared although the culprit-lesion-only primary percutaneous coronary intervention (PCI) strategy showed improved long-term survival recently. This study compared the predictive utility of cul-SS and SS for in-hospital mortality among the patients with CS-STEMI from during 2010-2019. Of the 215 patients, 79 (37%) died. SS ≥22, cul-SS ≥11, final thrombolysis in myocardial infarction (TIMI) flow ≤2, and no-reflow phenomenon were associated with in-hospital mortality. In patients with multi-vessel disease, the nonsurvivors with cul-SS ≥11 had a higher mortality rate than the survivors (75.0% vs. 44.9%, p = 0.001), whereas the SS ≥22 showed no significant difference. The cul-SS ≥11 revealed only an independent factor in the multivariate analysis (OR 2.6, p = 0.010). the AUC of cul-SS ≥11 for in-hospital mortality was modest (0.617 p < 0.05), which might be augmented up to 0.745 (p < 0.001) by the combination with TIMI flow ≤2, no-reflow phenomenon, and blood total CO2 content

OBJECTIVE In recent years, epicardial fat tissue (EFT) has been found to be strongly associated with the development of atrial fibrillation (AF). It was also reported to be a predictor of cardiac arrhythmias in different clinical situations. However, in the current literature, the role of EFT thickness in the development of AF in patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been studied. In this study, we aimed to investigate the relationship between EFT thickness and the development of new-onset AF in patients with NSTEMI during in-hospital follow-up. METHODS We enrolled 493 consecutive patients who were diagnosed NSTEMI in this study. During in-hospital follow-up, 68 patients developed AF, and the remaining 425 patients were determined as the control group. The thrombolysis in myocardial infarction (TIMI) risk score for NSTEMI was calculated. All clinical, echocardiographic, and laboratory parameters were compared between the 2 groups. RESULTS EFT thickness was higher in the AF group than in the controls (p

Background Deferred stenting, despite being successful in early studies, showed no benefit in recent trials. However, these trials were testing routine deferral; not in patients with heavy thrombus burden. Results This is a prospective, Randomized Clinical Trial that included 150 patients who presented with STEMI, patients were allocated into three equal groups after the coronary angiography ± primary intervention and before stenting of the culprit lesion; group (A) included 50 patients with early deferral of stenting, group (B) included 50 patients with late deferral and group (C) included 50 patients with immediate stenting. No-reflow was significantly higher in group C, while Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group A and B than group C; p = 0.019 and p p = 0.029). Conclusions Stent deferral was proved to be better than immediate stenting after recanalization of IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and restoration of myocardial function in a subset of STEMI patients presenting with large thrombus burden. While, no significant difference was found between both deferral times in final TIMI flow, or clinical outcomes.

Purpose: In this study, we aimed to investigate the relationship between high triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio and coronary slow-flow phenomenon (CSFP) in patients undergoing elective coronary angiography for suspected coronary artery disease. Methods: This prospective study included a total of 84 CSFP patients and 83 controls with normal coronary flow, as evidenced by coronary angiography. The Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) was used to measure the coronary blood flow velocity. The lipid profiles were analyzed and TG/HDL-C ratio were calculated dividing absolute TG levels by absolute HDL-C levels in peripheral blood. Results: The median TG/HDL-C ratio was higher in the CSFP group than the control group (3.4 [2.6 to 4.9] vs. 2.3 [1.8 to 3], respectively; p

Aims In this secondary analysis of the VOYAGER trial, rivaroxaban 2.5 mg twice/day plus aspirin 100 mg/day was assessed in older adults. Advanced age is associated with elevated bleeding risk and unfavourable net benefit for dual antiplatelet therapy in chronic coronary artery disease. The risk–benefit of low-dose rivaroxaban in patients ≥75 years with peripheral artery disease (PAD) after lower extremity revascularization (LER) has not been described. Methods and results The primary endpoint was a composite of acute limb ischaemia, major amputation, myocardial infarction, ischaemic stroke, or cardiovascular death. The principal safety outcome was thrombolysis in myocardial infarction (TIMI) major bleeding analysed by the pre-specified age cut-off of 75 years. Of 6564 patients randomized, 1330 (20%) were >75 years. Absolute 3-year Kaplan–Meier cumulative incidence rates for primary efficacy (23.4% vs. 19.0%) and safety (3.5% vs. 1.5%) endpoints were higher in elderly vs. non-elderly patients. Efficacy of rivaroxaban (P-interaction 0.83) and safety (P-interaction 0.38) was consistent irrespective of age. The combination of intracranial and fatal bleeding was not increased in patients >75 years (2 rivaroxaban vs. 8 placebo). Overall, benefits (absolute risk reduction 3.8%, number needed to treat 26 for the primary endpoint) exceeded risks (absolute risk increase 0.81%, number needed to harm 123 for TIMI major bleeding). Conclusion Patients ≥75 years with PAD are at both heightened ischaemic and bleeding risk after LER. No excess harm with respect to major, intracranial or fatal bleeding was seen in older patients yet numerically greater absolute benefits were observed. This suggests that low-dose rivaroxaban combined with aspirin should be considered in PAD after LER regardless of age.

Background: We intended in this study to evaluate the impact of the different techniques of unprotected left main coronary artery (ULMCA) stenting on the clinical outcomes. Methods: The study included 65 patients with ACS and left main disease subjected to UPLMCA intervention [46 males (70.8%) with median(Q1-Q3) age of 63(53-70) years old] in an observational prospective cohort study. Data were collected through reviewing patient’s medical records and angiographic procedures. Angiographic assessment included evaluation of Syntax II score, EURO II score, and TIMI flow grading. The primary outcome was the major adverse cardiac and cerebral events (MACCE) at 1 year while the secondary outcomes included the development of acute kidney injury (AKI), one year mortality, and need for CABG post PCI. Results: One-year MACCE was 46.2 % when the angle between LAD and LCX was>70o compared to 81.5% when it was less than 70o (P=0.008). The wide angle was also associated with 0% 1-year mortality compared to 18.5% for narrow angle, a difference which is statistically significant (P=0.03). The 1-year MACCE was 35.7% compared to 74.4% when it was not used (P=0.013). When POT was used, the 1-year MACCE was 47.6% compared to 75% when it was not used (P=0.041). None of the other studied parameters including those related to procedure technique was significantly affecting the outcome in our study. Conclusion: We concluded that the non-use of FKI nor POT together with the lower angulation between LAD and LCX could predict worse clinical outcome at one-year in unprotected left main PCI.

A proper analysis for the connection between baseline characteristics and the incidence of death and death-plus-myocardial (re)infarction at 30 days was done by [1]. The most important baseline features associated with death in analysis were age, heart rate, systolic blood pressure, ST-segment depression, signs of pump failure, and elevated levels of biomarkers. A risk estimation score was developed from this analysis [1].Over the last 10 years, multiple methods of risk stratification for ACS patients have been developed. Different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission. Even among patients with ST-elevation myocardial infarction (STEMI), for whom initial therapeutic options are well defined, patient risk characteristics impact short and long term medical decision making [2].The TIMI risk score [3] is validated predictor of short term mortality.so we aimed to Correlate between TIMI score and in hospital outcomes in Acute Coronary Syndrome patients and concluded that the higher the TIMI score the higher adverse in hospital clinical cardiovascular outcomes.

Professor Eugene Braunwald, often referred to as the ‘Father of Modern Cardiology’, has contributed significantly to medicine and cardiology. He is best known for the acclaimed textbook Braunwald’s Heart Disease and for being the founding chairman of the Thrombolysis in Myocardial Infarction (TIMI) Study Group. Our primary aim is to highlight his experiences and the guidance that he has to offer to future generations of medical trainees and professionals. An interview with Prof. Braunwald provided the authors with an insight into his journey in medicine. A range of questions were posed pertaining to his struggles and accomplishments in cardiology, his perspectives on the future of cardiology and research, as well as his advice to current and future medical professionals. 1 Positive role models are an inspiration to all, regardless of the stage in their career. With hard work, unwavering dedication and a strong desire to make a positive difference to patients and the field, the opportunities are endless. Whether it is clinical or bench research, advances in clinical cardiology and research usually go hand-in-hand. Although primary and secondary prevention of cardiovascular disease remain of critical importance, it is now time to focus on primordial prevention to step back and reduce the development of the risk factors for the future development of cardiovascular disease in the first place. There have been significant advances in cardiology over the past two-thirds of the century during which Prof. Braunwald trained and then led the field. However, there is still much work to be done. Mentors and medical institutions alike must work towards a common goal of ‘igniting the fire’ within the new generation of clinicians and investigators who will then propel this important specialty to ever greater heights.

Resumo Fundamentos: Os escores GRACE, TIMI e HEART foram validados para avaliar desfechos clínicos desfavoráveis no contexto da suspeita de síndrome coronária aguda sem elevação do segmento ST (SCASSST). No entanto, a associação entre os escores clínicos e a complexidade angiográfica ainda não está bem estabelecida. Objetivos: Descrever as características clínicas de pacientes com SCASSST admitidos em internação hospitalar para estratificação invasiva, a fim de avaliar a associação entre os escores clínicos (TIMI, GRACE e HEART) e a complexidade angiográfica, através do escore SYNTAX. Métodos: Estudo observacional incluindo pacientes com diagnóstico de SCA e admitidos no Instituto Dante Pazzanese de Cardiologia entre os meses de julho de 2018 e fevereiro de 2019. A associação entre os escores foi avaliada por correlações bivariadas e a sua acurácia pela área sob a curva (ASC) ROC. A significância estatística foi estabelecida em 5% (p < 0,05). Resultados: Um total de 138 pacientes foram diagnosticados com SCASSST. As medianas do GRACE, TIMI e HEART foram de 97, 3 e 5, respectivamente. A mediana do SYNTAX foi de 8. Foram observadas correlações positivas do SYNTAX com o HEART (ρ = 0,29; p < 0,01) e o GRACE (ρ = 0,18; p < 0,03). Em contrapartida, a correlação com o TIMI não atingiu significância estatística (ρ = 0,15; p = 0,08). O HEART foi o escore com a maior ASC para predizer SYNTAX > 32 [HEART = 0,81] (IC 95% 0,7-0,91). HEART > 4 apresentou sensibilidade de 100%, com especificidade de 50%, e GRACE > 139 sensibilidade de 55% e especificidade de 97% para SYNTAX alto. Conclusão: Os escores clínicos de risco apresentam associação modesta ao escore SYNTAX. O uso combinado do HEART e do GRACE, entretanto, oferece acurácia favorável para a detecção de complexidade angiográfica. Abstract Background: GRACE, TIMI and HEART scores have been previously validated to predict serious untoward events among patients with non-ST elevation acute coronary syndrome (Non-ST ACS). However, the ability of these scores to discriminate the angiographic complexity of coronary artery disease has not been clearly established. Objectives: We sought to evaluate the correlation between clinical scores (TIMI, GRACE and HEART) and the anatomical complexity assessed by SYNTAX score, among non-ST ACS patients undergoing cinecoronariography. Methods: Transversal cohort encompassing patients with diagnosis of Non-ST ACS referred to invasive stratification in our single center, between July 2018 and February 2019. Association between the scores was established by the Pearson's linear correlation test while the accuracy of the clinical scores versus SYNTAX score was determined with the ROC curve. Results: A total of 138 patients were enrolled. Median GRACE, TIMI and HEART scores were 97, 3 and 5, respectively, whereas the median SYNTAX was 8. There was a positive correlation between the SYNTAX and the HEART (ρ =0.29; p 4 presented 100% sensitivity, with 50% specificity; and GRACE> 139 showed 55% sensitivity and 97% specificity for high SYNTAX. Conclusion: The clinical scores presented a positive, although modest, association with the SYNTAX score. The combined use of HEART and GRACE offers good accuracy for detecting angiographic complexity.

Despite improvements in the survival rate of acute myocardial infarction (AMI), out-of-hospital cardiac arrest (OHCA) due to AMI is still a devastating condition. Thrombolysis in myocardial infarction (TIMI) grade is used to classify coronary reperfusion after percutaneous coronary intervention (PCI), but it remains unclear whether TIMI grade after emergent PCI is associated with short-term mortality in patients with AMI who have suffered OHCA. We analyzed data collected from 2012 to 2017 and recorded in the Yamagata AMI registry, which is a multicenter surveillance conducted in all institutions in Yamagata prefecture. Among 3332 patients with AMI, 254 had suffered OHCA. There were 564 deaths during the 30 days after the onset of AMI. The survival rate was lower in patients who had suffered OHCA than in those who had not (40% vs. 87%; P

Background Distal embolism is a frequent complication in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) due to thrombotic lesions. Distal embolism causes no reflow phenomenon, which leads to worse patient prognosis after AMI. There is no established treatment to prevent distal embolism in PCI for thrombotic lesions The aim of this study is to investigate the usefulness of long inflation balloon angioplasty (LIBA) with perfusion balloon in PCI for AMI due to thrombotic lesions. Methods and results This is a case series study. We investigated 10 cases treated with LIBA for cases with massive thrombus remaining after thrombus aspiration therapy in primary PCI for acute myocardial infarction. We investigated the success rate of the procedure, residual stenosis rate, TIMI flow grade, TIMI frame count, and myocardial blush score in 10 cases of primary PCI with LIBA at our hospital. In all 10 cases, distal embolism was not observed by angiogram after LIBA. In 9 cases, residual stenosis was improved to less than 25% and the procedure was completed without a stent. Before PCI, all cases had TIMI flow grade 0, but in all 10 cases, TIMI flow grade 3 was obtained after PCI. The mean TIMI frame count was 19.6 ± 2.50 for RCA lesions and 27.5 ± 1.5 for LAD lesions. Regarding myocardial blush score, grade 3 was obtained in 8 cases and grade 2 was obtained in 2 cases. Conclusion LIBA using a perfusion balloon is a useful technique in thrombus lesion to prevent distal embolism.

Background We aimed to investigate the relationship between baseline clinical characteristics and postprocedural myocardial perfusion as determined by dynamic computed tomography myocardial perfusion imaging (CT-MPI). Methods We retrospectively included consecutive symptomatic post percutaneous coronary intervention (PCI) patients, who underwent dynamic CT-MPI + coronary CT angiography (CCTA) and who were revealed to have patent stents on previously revascularized lesions. Myocardial blood flow (MBF) was measured for stented territories and reference territories. Various baseline clinical and angiographic parameters were tested for the association with reduced MBF of stented territories. Results A total of 81 patients with 96 stented vessels were included in the analysis. The mean effective doses of radiation for the whole integrated CT protocol (calcium score + dynamic CT-MPI + CCTA) was 4.89±1.14 (2.58-6.93) mSv. Overall, 49 stented vessels had reduced MBF (75.3±17.2 mL/100 mL/min) within related territories, whereas 47 stented vessels had normal MBF (138.6±20.5 mL/100 mL/min). Peak levels of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and glucose were significantly higher, while preprocedural thrombolysis in myocardial infarction (TIMI) flow grade was lower in participants with reduced MBF of stented territories. Acute myocardial infarction (AMI) also predominantly presented in participants with decreased MBF after revascularization. According to multivariate analysis, peak hs-cTnI level was the strongest predictor [adjusted hazard ratio (HR): 4.548, P=0.003] for decreased myocardial perfusion, followed by TIMI flow grade, AMI, stenotic extent, and NT-pro-BNP. Conclusions The baseline hs-cTnI peak level was the strongest predictor for decreased myocardial perfusion after revascularization, followed by AMI, stenotic extent, and NT-pro-BNP.

Diagnostic criteria for anterior STEMI differ between the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC). A greater degree of ST-segment elevation is required to meet ERC criteria compared to ESC criteria. This may potentially lead to discrepancies in management between emergency teams and cardiologists, subsequent delay in reperfusion therapy and worse prognosis.We performed an observational study in patients with anterior STEMI routinely treated with primary PCI and assessed whether differing electrocardiographic diagnostic criteria could impact treatment and short-term prognosis. All patients in the study had anterior STEMI confirmed by electrocardiographic ESC criteria and subsequent coronary angiography. Patients were divided into two groups. Those who did not meet ERC criteria in the index ECG were assigned to the "non-ERC" group and were compared with those who met them - the "ERC" group.Out of 60 patients with anterior STEMI based on ESC criteria (mean age 66.9 ± 13.6 years, 70% males), 26 patients (44%) did not meet ERC criteria ("non-ERC" group) for STEMI. There were no significant differences in age, gender distribution or clinical characteristics between "ERC" and "non-ERC" patients. Total-Ischemic-Time, Patient-Delay, and System-Delay times were significantly longer in "non-ERC" group (433.1 ± 389.9 min vs. 264.2 ± 229.6 min, p = 0.03; 290.8 ± 337.6 min vs. 129.5 ± 144.9 min; p0.05 and 158.8 ± 158 vs 134.6 ± 191 min, p0.02 respectively). There were no differences in In-Hospital-Delay, procedure duration, and success rate of PCI. Proximal LAD occlusion (64.7%) and TIMI = 0 flow (73.5%) tended to be more frequently observed in "ERC" than in the "non-ERC" group (53.8% and 65.4%, respectively). Hospitalization time and LVEF (44.4 ± 8.7 vs 42.8 ± 9.5%, p = 0.53) were similar between groups.Differences in electrocardiographic criteria for anterior STEMI leave a significant proportion of patients undiagnosed. Patients with STEMI who failed to meet less strict ERC criteria had more distal LAD disease with better TIMI flow but received reperfusion therapy later. Thus, character of the disease may compensate for treatment delay but this needs to be further evaluated. Finally, lowering the cut-off point with stricter criteria compromises specificity and is expected to increase the false positive rate, however there were no false positives in this study as all patients were angiographically confirmed to have acute coronary obstruction.

Background There is a paucity of data regarding the best treatment for spontaneous coronary artery dissection (SCAD). Purpose To compare the prognostic impact of conservative versus invasive treatment in patients with SCAD. Methods We systematically searched the literature for studies evaluating the comparative efficacy and safety of invasive revascularization versus medical therapy for the treatment of SCAD from 1990 to 2019. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results 24 observational studies with 1720 patients were included. After 28±14 months, a conservative approach reduced target vessel revascularization rate compared with invasive treatment (OR=0.50; 95% CI 0.28–0.90; P=0.02). No difference was found regarding all-cause mortality (OR=0.81; 95% CI 0.31–2.08; P=0.66), cardiovascular mortality (OR=0.89; 95% CI 0.15–5.40; P=0.89), myocardial infarction (OR=0.95; 95% CI 0.50–1.81; P=0.87), heart failure (OR 0.96; 95% CI 0.41–2.22; P=0.92) and SCAD recurrence (OR=0.94; 95% CI 0.52–1.72; P=0.85). The meta-regression analysis suggested that male gender, diabetes mellitus, smoking habit, prior coronary artery disease, left main coronary artery involvement and lower ejection fraction at admission are related with higher overall mortality, whereas SCAD recurrence was higher among patients with fibromuscular dysplasia. Conclusion A conservative approach provides similar clinical outcomes and lower target vessel revascularization rates compared to an invasive strategy in the setting of SCAD; therefore, when feasible, it should be preferred in this scenario. Forest plots on the study outcomes Funding Acknowledgement Type of funding source: None

Background: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital. Methods: A retrospective chart review study in a rural hospital was conducted for subjects that received left heart catheterizations, exercise stress tests, or chemical stress tests for a diagnosis of UA/NSTEMI. A total of 399 subjects who underwent left heart catheterization and/or stress testing were recruited for this study. A total of 153 subjects who were transferred out to a larger facility, transitioned to comfort care, refused intervention, or passed away were excluded from the study. The 246 remaining subjects were classified into two groups, those with TIMI 0–2 compared with those having TIMI ≥ 3. A null hypothesis was postulated that there was no significant difference between the two groups with regard to prevalence of either positive stress test or evidence of obstructive coronary disease following coronary angiography. T-test and Wilcoxon rank-sum analysis were performed through SPSS statistical analysis. Results: Formal statistical analysis using T-test as well as Wilcoxon rank-sum test comparing the two groups showed p = 0.34 for T-test and p = 0.60 for Wilcoxon rank-sum test. This is consistent with the postulated null hypothesis: that there is no significant difference between the two surgery groups with respect to the mean/median TIMI score. Conclusion: There was no statistical difference between high and low TIMI score in the intervention of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in a rural hospital.

The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Nonpatent flow was defined as TIMI grade 0 (no-reflow), 1, and 2 flows, and normal flow was defined as TIMI 3 flow. There was a significant positive correlation between CAR and SYNTAX score ( r = 0.312, P < .001) and a negative correlation between CAR and TIMI grade flow ( r = −0.210, P < .001). At a cutoff level of 0.693, the CAR predicted TIMI no-reflow with a sensitivity of 65.4% and a specificity of 65.5% (area under the curve: 0.670, 95% CI: 0.62-0.71, P < .001). Multivariate logistic regression analyses showed that CAR was an independent predictor of IRA patency (0.003 [0.001-0.029]; P < .001). A higher CAR is a significant and independent predictor of IRA patency in patients with STEMI.

Intervention in calcified coronaries remains a particular challenge as it is tough to crack the calcium with semi-compliant balloon dilatation. Coronary calcium is cracked with the non-compliant balloon, cutting balloon, scoring balloon, and rota ablation. Intravascular lithotripsy (IVL) has emerged now as a new modality to crack the coronary calcium and bring successful outcomes in coronary angioplasty. We present a case series of two cases where we cracked multi-vessel high dense coronary calcium with IVL and stented the coronary segments with drug-eluting stents to bring good angiographic results and Thrombolysis in Myocardial Infarction (TIMI) III flow.

Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI. We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009. 72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality. These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.

In 1984, the National Heart, Lung, and Blood Institute (NHLBI) decided to study the efficacy and safety of the treatment of acute myocardial infarction with an emerging therapy, coronary thrombolysis, and thus the TIMI (Thrombolysis In Myocardial Infarction) Study Group was born. Following completion of 3 clinical trials of thrombolytic therapy supported by the NHLBI, TIMI became an academic research organization headquartered at Brigham and Women's Hospital and subsequently branched out to study a wide range of patients, including those with stable coronary, cerebrovascular, and peripheral arterial disease; dyslipidemia; heart failure; atrial fibrillation; diabetes; and obesity. TIMI also began to study a wide range of interventions including thrombolytic, antithrombotic, lipid-modifying, anti-inflammatory, heart failure, glucose-lowering, and weight loss agents. TIMI, now in its 37th year, has completed >70 trials. This review describes the origins of the TIMI Study Group, summarizes several of its completed trials and the major lessons learned from them, and discusses ongoing trials and future directions.

We investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. The primary outcome was the occurrence of net adverse clinical events (NACE), defined as a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events (MACCE) within 12-mo following PCI. The secondary outcomes were the occurrence of the individual components of TIMI bleedings and MACCE. In the pre-TIMI 0/1 group, the primary and second outcomes were not significantly different between the 3-mo and 12-mo DAPT groups. However, in the pre-TIMI 2/3 group, the occurrences of TIMI minor (adjusted hazard ratio [aHR]: 0.294; p = 0.016) and major or minor bleeding (aHR: 0.483; p = 0.014) on intention-to-treat analysis were significantly higher in the 12-mo than in the 3-mo DAPT group. The occurrence of MACCE was similar between the two groups. A higher bleeding tendency in 12-mo DAPT compared with 3-mo DAPT was more obvious in the pre-TIMI 2/3 group than in the pre-TIMI 0/1 group.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02494895.

BACKGROUND Data on the clinical outcomes of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) in patients with acute coronary syndrome (ACS) are limited. Therefore, this study aimed to assess the clinical outcome of patients with ACS who underwent PCI for LMCA culprit lesion.Methods and Results:Of 1,809 patients enrolled in the Assessing Optimal Percutaneous Coronary Intervention for the LMCA (AOI-LMCA) registry (a retrospective 6-center registry of consecutive patients undergoing LMCA stenting in Japan), the current study population consisited of 1,500 patients with unprotected LMCA stenting for LMCA ACS (ACS with shock: 115 patients, ACS without shock: 281 patients) and stable CAD (1,104 patients). The cumulative 180-day incidence of death was markedly higher in the ACS with shock group than in the other groups (49.5%, 8.6%, and 3.3%, respectively; P

ObjectiveTo investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes.MethodsSCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221).ResultsSCAD-PCI patients were high risk at presentation with only 8.8% undergoing PCI outside the context of ST-elevation myocardial infarction/cardiac arrest, thrombolysis in myocardial infarction (TIMI) 0/1 flow or proximal dissections. PCI complications occurred in 38.6% (83/215), with 13.0% (28/215) serious complications. PCI-related complications were associated with more extensive dissections (multiple vs single American Heart Association coronary segments, OR 1.9 (95% CI: 1.06–3.39),p=0.030), more proximal dissections (proximal diameter per mm, OR 2.25 (1.38–3.67), p=0.001) and dissections with no contrast penetration of the false lumen (Yip-Saw 2 versus 1, OR 2.89 (1.12–7.43), p=0.028). SCAD-PCI involved long lengths of stent (median 46mm, IQR: 29–61mm). Despite these risks, SCAD-PCI led to angiographic improvements in those with reduced TIMI flow in 84.3% (118/140). Worsening TIMI flow was only seen in 7.0% (15/215) of SCAD-PCI patients. Post-PCI major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular function outcomes were favourable.ConclusionWhile a conservative approach to revascularisation is favoured, SCAD cases with higher risk presentations may require PCI. SCAD-PCI is associated with longer stent lengths and a higher risk of complications but leads to overall improvements in coronary flow and good medium-term outcomes in patients.

The 2-year clinical outcomes according to pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow grade and reperfusion timing were investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who received newer-generation drug-eluting stents. A total of 7506 NSTEMI patients were divided into 2 groups: early (PCI ≤ 24 hours: n = 6398; pre-PCI TIMI 0/1 [n = 2729], pre-PCI TIMI 2/3 [n = 3669]) and delayed (PCI > 24 hours: n = 1108; pre-PCI TIMI 0/1 [n = 428], pre-PCI TIMI 2/3 [n = 680]) invasive groups. Major adverse cardiac events were defined as all-cause death, recurrent myocardial infarction, or any repeat revascularization. All-cause death ( P = 0.005 and 0.009, respectively) and cardiac death ( P = .003 and 0.046, respectively) were significantly higher in pre-PCI TIMI 0/1 patients than in pre-PCI TIMI 2/3 patients both in the early and delayed invasive groups. In pre-PCI TIMI 0/1 patients, all-cause death rate was significantly higher in the delayed group ( P = .023). In pre-PCI TIMI 2/3 patients, the clinical end point was similar between the 2 groups. An early invasive strategy is preferred to a delayed invasive strategy in reducing all-cause death in patients with pre-PCI TIMI 0/1. However, in patients with pre-PCI TIMI 2/3, both treatment strategies are acceptable.

Aneurysmal coronary artery disease includes coronary artery aneurysms and ectasia; this condition has been associated with poor long-term outcomes. Few studies have explored myocardial blood flow 13N-ammonia PET/CT MPI added value. We present a 45-year-old man who came to the emergency department with chest pain. After a physical examination and laboratory studies, he was diagnosed with very high-risk unstable angina and referred to the catheterization laboratory. Coronary angiography showed the culprit lesion in the LCx and was treated by angioplasty and stent. LAD was found with coronary artery ectasia (TIMI 2 flow grade) and the RCA with aneurysmal disease in the proximal and middle segments (TIMI 3 flow grade). Medical treatment was decided for these findings and the patient was discharged. Two weeks later, we performed a 13N-ammonia PET/CT MPI founding apical, inferior, and inferoseptal severe ischemia, and reduced hyperemic coronary blood flow and coronary flow reserve in the RCA territory. Flow was normal in the LAD territory. Although coronary angiography remains the gold standard for evaluating these coronary abnormalities, it does not show the physiological compromise. Therefore 13N-ammonia PET/CT MPI should be performed as a complementary noninvasive imaging approach.

Post-procedure myocardial injury/infarction following percutaneous coronary mediation (PCI) is regular in clinical practice and is showed by the rise of heart biomarkers, for example, creatinine kinase or cardiovascular troponin. to show that focused energy plaques on non-contrast T1-weighted MRI imaging may mirror the potential for plaque weakness on IVUS evaluation, and that focused energy plaques may assume a critical part in foreseeing the frequency of postprocedural myocardial injury. This is a forthcoming non-randomized relative investigation was led on 55 patients with ongoing stable angina. Patients were exposed to coronary MRI with non-contrast T1-weighted imaging. They were chosen from cardiovascular medication office, Faculty of Medicine, Benha University, Egypt, Saudi German Hospital, Jeddah, and Saudia Arabia during the time frame from September 2018 till March 2020. There was no huge contrast among IVUS and MRI discoveries with respect to IVUS brings about negative and positive MRI patients (P>0.05). The affectability and particularity of MRI-HIP in foreseeing moderate were 75% and 51.16%, separately. Additionally, the affectability and particularity of IVUS low weakening in foreseeing moderate stream were 75% and 59.53%, separately. Our examination reasoned that, underlying coronary patency upon demonstrative angiography is altogether connected with quick post PCI TIMI stream. Additionally, MRI appraisal of coronary plaques reflecting structure encourages more exact danger delineation and forecast of PMI after elective PCI in stable CAD patients. Further investigations are expected to explain the coronary plaque qualities addressing HIP on non-contrast T1WI.

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p Conclusion. TLT should be considered effective in patients with inferior myocardial infarction with the right ventricle lesion, if ST-segment decreases to isoline in 90 minutes from the TLT start.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality across the world, warranting continuous research in this field. The elucidation of the atherogenesis mechanism is considered one of the most relevant scientific accomplishments of the last century. This has led to the clinical development of various novel therapeutic interventions for patients with or at risk of ASCVD, in which randomized clinical trials played a crucial role. The Thrombolysis in Myocardial Infarction (TIMI) Study Group was initially established to conduct a clinical trial studying thrombolysis for treatment of myocardial infarction. However, over the years, the TIMI Study Group has expanded their research interests to include antithrombotic therapy, lipid lowering, anti-diabetes, anti-obesity, and even heart failure. By leading large-scale, international, randomized, controlled trials of novel therapeutics, the TIMI Study Group has helped shape the very practice of cardiovascular medicine for over a quarter of a century, and decades of research continue to provide future promise for further advancement. Through a mutual goal to improve the care of ASCVD patients, the Japanese scientific community has become one of the important contributors to the TIMI Study Group’s clinical research. In this review article, the authors aim to summarize major research lead by the TIMI Study Group in the ASCVD field.

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI). Although previous studies have investigated mortality rates and the incidences of adverse events associated with new-onset AF (NOAF) in patients with AMI, the effects of emergency percutaneous coronary intervention (PCI) on the incidence of NOAF in patients with AMI remain unclear. The purpose of this study was to investigate the relationship of clinical characteristics, medical history, and the coronary flow disturbance phenomenon (TIMI3) following emergency PCI with NOAF in patients with AMI. Between 2012 and 2016, 731 patients with AMI underwent PCI at our facility. Among these, 52 had a history of chronic/paroxysmal AF before admission and were excluded. The remaining 679 patients (mean age 66.4 years, 532 males) were analyzed in this retrospective observational study.New-onset AF was observed in 45 patients (6.6%). In univariate analysis, the hazard ratios (HRs) for patient age (HR 1.04, 95%CI 1.02-1.07), Killip II-IV (HR 2.34, 95%CI 1.29-4.23), elevated D-dimer level (1.0 μg/mL; HR 3.32; 95%CI 1.77-6.23), and coronary flow disturbance phenomenon (HR 5.61; 95%CI 2.88-10.9) were significantly higher in the NOAF group. In multivariate analysis, an elevated D-dimer level (1.0 μg/mL; HR 2.44; 95%CI 1.17-5.11) and coronary flow disturbance phenomenon (HR 4.61; 95%CI 2.29-9.27) were found to be independent risk factors for NOAF. An elevated D-dimer level at admission and the presence of coronary flow disturbance phenomenon after PCI were risk factors for NOAF following emergency PCI in patients with AMI.

Background The atherogenic index of plasma (AIP) is calculated by logarithmic transformation of the ratio of triglyceride (TG) and high‐density lipoprotein cholesterol (HDL‐C) concentrations. Although previous studies have demonstrated that the AIP is associated with coronary artery disease, its association with chronic total occlusion (CTO) requires elucidation. Hypothesis We hypothesized that the AIP would have diagnostic value in cases of CTO and could be used to predict adverse events. Methods This study involved 1131 inpatients who underwent coronary angiography. Data on demographic and clinical characteristics, coronary artery stenosis rated by the Gensini score, and clinical assessment by the Global Registry of Acute Coronary Events and thrombolysis in myocardial infarction (TIMI) scores were collected by cardiovascular doctors. Serum AIP values were evaluated by logarithmic transformation of the ratio of TG and HDL‐C concentrations. The correlations of AIP values with clinical parameters were assessed, and receiver‐operating characteristic curves were constructed for CTO diagnosis. Results Overall, 1131 inpatients were assigned to the CTO (n = 398) and control (n = 733) groups. Compared with the control group, the CTO group showed a significantly higher AIP (p