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Aim: We aimed to investigate the 6-month efficacy and safety of postprocedural 12-hour tirofiban administration versus 24-hour tirofiban administration in patients with ST-segment elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI)., Methods: This retrospective study enrolled 349 patients with STEMI who underwent primary PCI. Following the administration of bolus tirofiban after primary PCI, those receiving a 12-hour tirofiban infusion as the maintenance dose were classified as group 1 (n = 123) while those receiving a 24-hour infusion were classified as group 2 (n = 226). In-hospital and 6-month major adverse cardiac events were recorded., Results: There were no statistically significant differences between the 2 groups regarding in-hospital efficacy (in-hospital death: 4.4% vs 5.7%, P = .600 and stent thrombosis 1.8% vs 1.6%, P = .921) and in-hospital safety (2.6% vs 1.6% for major bleeding and 5.3% vs 4.1% for minor bleeding, P = .562). During the 6-month follow-up period, the incidence of the recurrent revascularization (16.1% vs 15.5%, odds ratio [OR] = 1.05 [0.47-3.67]), the repeated nonfatal acute coronary syndrome and/or stent thrombosis (27% vs 24.4%, P = .598, OR = 1.02 [0.42-2.48]), and the cardiovascular deaths (6.6% vs 6.5%, P = .943, OR = 1.03 [0.43-2.43]) were comparable between group 1 and group 2., Conclusion: Our study revealed that 12-hour tirofiban administration versus 24-hour tirofiban administration in STEMI who underwent primary PCI was similar with respect to in-hospital efficacy and safety and major adverse cardiac events during 6-month follow-up., (© The Author(s) 2014.)

Objective: The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone., Methods: Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke., Results: Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups., Conclusion: This meta-analysis is the first updated analysis after publishing the 1-year result of the "Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction" trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke.

We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14-28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality. The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion.

Background: We aimed to investigate the association between electrocardiographic (ECG) grade III ischemia and angiographic thrombus burden in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI)., Methods: The study population consisted of 307 patients with STEMI. Baseline ECGs of the patients were analyzed for grade III ischemia; angiographic thrombus burden was assessed by thrombolysis in myocardial infarction thrombus classification., Results: A total of 108 (35%) patients had low thrombus burden whereas 199 (65%) patients had high thrombus burden. Grade III ischemia was more prevalent in patients with high thrombus burden (25.1% vs 11.1%, P = .004). Only grade III ischemia (odds ratio: 2.59, 95% confidence interval 1.24-5.39, P = .011) and history of coronary artery disease (CAD) were found to be the independent predictors of high thrombus burden., Conclusion: Grade III ischemia on ECG and previous history of CAD were independent predictors of coronary thrombus burden in patients with STEMI who underwent pPCI.

One of the major concerns remaining in the treatment with stenting is the occurrence of stent thrombosis (ST). We reviewed 1960 consecutive patients (mean age 56 ± 11.6 years, 84.6% males) treated with primary coronary stenting for ST elevation myocardial infarction between 2003 and 2008. All clinical, angiographic, and follow-up data were retrospectively collected. The data when the patient had angina pectoris was obtained from medical record. Early ST was observed in 89 (4.5%) patients. We identified 86 patients with early ST and known date and time of symptom onset. In these patients (mean age 59.2 ± 13.9, 83.7% males), symptoms occurred mostly at night time (00.00-6.00 am) and during winter months but the day of the week effect was not presence. In conclusion, occurrences of early ST throughout the week were equally distributed, but early ST was more likely to occur in the winter months and night hours.

Aim: We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty., Methods: One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n=98) or rosuvastatin 40 mg (n= 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission., Results: The incidence of CIN was 8.9% (n= 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular filtration rate (eGFR), creatinine at 48 h, eGFR at 48 h, difference between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P< or = 0.001). Left ventricular ejection fraction exhibited borderline statistical significance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07)., Conclusion: Atorvastatin and rosuvastatin had similar efficacy in preventing CIN in patients with STEMI undergoing P-PCI.

Background: Some recent trials reported that, low admission low-density lipoprotein-cholesterol (LDL-C) levels were associated with increased mortality in patients with acute coronary syndromes. We aimed to compare the effect of very low admission LDL-C levels on prognosis in statin-pretreated and statin-naive patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty., Methods: The study population consisted of 1808 patients with acute STEMIs who underwent primary angioplasty. The patients were categorized into four groups as: statin-pretreated/LDL-C<70 mg/dl (n=128), statin-pretreated/LDL-C ≥ 70 mg/dl (n=290), statin-naive/LDL-C <70 mg/dl (n=146), statin-naive/LDL-C ≥ 70 mg/dl (n=1244). The median follow-up was 40 months., Results: The incidences of diabetes mellitus, hypertension, renal insufficiency, anemia, cardiogenic shock on presentation and the mean age were significantly higher in the statin-naive/LDL-C < 70 mg/dl group. In-hospital (2.3% vs 2.4% vs 12.3% vs 3.9%, respectively p<0.001) and long-term mortalities (6.3% vs 7.3% vs 25.9% vs 11.3% respectively, p<0.001) were significantly lower in the "statin-pretreated/LDL-C<70" group. Statin pretreatment was independently predicting lower long-term mortality irrespective of LDL-C level [for the subgroup with LDL-C < 70 mg/dl, Hazard Ratio (HR) 0.24, 95% CI 0.10-0.59, p=0.013; for the subgroup with LDL-C ≥ 70 mg/dl, HR 0.31, 95% CI 0.14-0.83, p=0.022]. LDL-C levels on admission had no independent predictive role on long-term mortality., Conclusions: Statin induced low LDL-C levels on admission are associated with better short- and long-term outcomes in patients with STEMI and independently predict lower long-term mortality. However, spontaneously low admission LDL-C levels were associated with increased short- and long-term mortalities., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Although monocyte chemoattractant protein-1 (MCP-1) levels are increased in patients with ST-segment elevation myocardial infarction, the prognostic value of MCP-1 in primary percutaneous coronary intervention (pPCI) is not clear. The goal of the present study was to investigate the association of MCP-1 levels with myocardial perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing pPCI. Consecutive pPCI patients (n = 192) were assigned to tertiles according to their admission serum MCP-1 levels. Angiographic no-reflow, Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, and ST-segment resolution were assessed. Mortality and major adverse cardiac events were evaluated during hospitalization and at the 3-year clinical follow-up visit. Failure of ST resolution was associated with greater admission MCP-1 levels. The risk of no-reflow (Thrombolysis In Myocardial Infarction flow ≤2 or Thrombolysis In Myocardial Infarction flow 3 with final myocardial blush grade ≤2 after pPCI and ST resolution <30%) increased as the admission MCP-1 increased. The 3-year mortality increased as the MCP-1 level increased (8% vs 22% vs 28% for the 3 tertiles, p <0.01). Multivariate logistic regression analysis demonstrated that MCP-1 levels at admission are a significant independent correlate of 3-year mortality in patients with no-reflow as detected by myocardial blush grade. A receiver operating characteristics analysis identified an optimum cut point of ≥254 pg/ml, which was associated with a negative predictive value of 95% in association with 1-year mortality. In conclusion, the plasma MCP-1 levels at admission are independently associated with the development of no-reflow and 3-year mortality in patients with ST-segment elevation myocardial infarction undergoing pPCI., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

This study investigated the effects of altitude on occurrence of mid-term negative events among patients presenting with ST elevation myocardial infarction (STEMI). This study enrolled 492 patients with STEMI. 119 of those patients were living at an intermediate altitude (1960 m, Group I) and 373 were living at sea level (0 m, Group II). There was no significant difference between the different altitude groups in terms of the incidence of cardiac death, urgent target vessel revascularization (TVR), stroke/transient ischemic attack (TIA) and composite endpoints. However, Group I had a significantly higher reinfarction incidence when compared with the Group II. Independent predictors of 6-month composite endpoints were history of statin use, presentation with acute stent thrombosis, peak CK-MB level, success of procedure, Killip classification, and left ventricular ejection fraction. In conclusion, altitude status and altitude-related hematologic changes had no influence over the mid-term outcomes in STEMI patients treated with percutaneous intervention.

Objectives: In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI)., Background: The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status., Methods: In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution)., Results: Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow ≤ 2 or TIMI flow 3 with final myocardial bush grade ≤ 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events., Conclusions: In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Hypoalbuminemia is associated with a poor prognosis in patients with end-stage renal disease, chronic ischemic heart disease, heart failure (HF), and stroke. We aimed to investigate its prognostic value in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by a primary percutaneous coronary intervention (p-PCI)., Materials and Methods: We retrospectively enrolled 1706 patients with STEMI treated by p-PCI. We prospectively followed up the patients for a median duration of 40 months., Results: On admission, hypoalbuminemia (<3.5 g/dl) was present in 519 (30.4%) patients. The incidence of final TIMI grade 3 flow (84 vs. 91.4%, P<0.001) was lower in the patients with hypoalbuminemia. In-hospital mortality (9.4 vs. 2%), HF (20.2 vs. 8.6%), and major bleeding (6 vs. 2.5%) rates were significantly higher in patients with hypoalbuminemia. However, in-hospital stroke and reinfarction rates were similar in both groups. At long-term follow-up (median duration: 42 months), all-cause mortality (23.3 vs. 8.4%, P<0.001), reinfarction (11.6 vs. 7.7%, P=0.013), stroke (2.6 vs. 1.1%, P=0.031), and advanced HF (13.3 vs. 6.1%, P<0.001) rates were significantly higher in patients with hypoalbuminemia. In the Cox proportional hazard model, hypoalbuminemia was determined as an independent predictor of long-term mortality [hazard ratio 2.98, 95% confidence interval 1.35-6.58, P=0.007) and development of advanced HF (hazard ratio 2.96, 95% confidence interval 1.44-6.08, P=0.003)., Conclusion: Hypoalbuminemia on admission is a strong independent predictor for long-term mortality and development of advanced HF in patients with STEMI undergoing p-PCI.

Background: Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population., Methods and Results: One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events., Conclusions: In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.

Background: The purpose of this study was to evaluate the predictive value of red cell distribution width (RDW) on the electrocardiographic no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PCI)., Methods: One-hundred consecutive patients (mean age 61.3 ± 12.8 years and male 77%) with ST-elevation myocardial infarction, who were treated with primary PCI, were analyzed prospectively. RDW and high sensitive C reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was obtained immediately before and 60 min after the restoration of coronary flow. The difference between two measurements was accepted as the amount of ST-segment resolution and was expressed as ∑STR. ∑STR < 50% was accepted as electrocardiographic sign of no-reflow phenomenon., Results: There were 30 patients in the no-reflow group (Group 1) and 70 patients in the normal re-flow group (Group 2). RDW and hs-CRP levels on admission were higher in Group 1. An RDW level ≥14% measured on admission had 70% sensitivity and 64% specificity in predicting no-reflow on ROC curve analysis. Mid-term cardiovascular events were significantly higher in Group 1. In multivariate analyses, RDW (OR 2.93, <95% CI 1.42-6.04; p = 0.004), and tirofiban (OR 0.16, <95% CI 0.05-0.48; p = 0.001) were independent predictors of no-reflow, and RDW (OR 5.89, <95% CI 1.63-21.24; p = 0.007), and creatine kinase-MB (CK-MB) on admission (OR 1.01, <95% CI 1.00-1.02; p = 0.006) were independent predictors of mid-term mortality., Conclusions: A greater baseline RDW value was independently associated with the presence of electrocardiographic no-reflow., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: We aimed to investigate the effect of coronary perfusion on QT interval dispersion in patients with acute myocardial infarction (MI)., Methods: Seventy-seven consecutive patients who had undergone primary percutaneous coronary intervention (PCI) for a first ST segment elevation MI during the first 12 h of symptom onset were included in the study. After achievement of thrombolysis in MI (TIMI) 3 flow of the infarct-related artery, corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG) were measured. ECGs were performed in the following manner: at baseline, within 1 h after completion of the procedure, 24 h after the procedure and 48 h after the procedure. The corrected QT dispersion (QTd) and ST segment resolution (STR) were calculated., Results: There was a difference between the durations of corrected QTd (cQTd) before PCI and cQTd just after PCI. On the first day, cQTd before PCI was significantly more prolonged (52.3 ± 80 vs. 41.5 ± 49, P = 0.05) than cQTd on second day (52.3 ± 80 vs. 37 ± 50, P = 0.001). In the correlation analysis conducted among the durations of cQTd, cTFC and TMPG, no significant association was established. STR was, however, inversely correlated with duration of cQTd., Conclusion: Our study results demonstrated that primary percutaneous coronary intervention leads to progressive shortening of QT dispersion in successful reperfusion, even in reduced cTFC.

This is a review of the literature comparing the efficacy and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with acute myocardial infarction (MI). The present article reviews whether DES are beneficial in the setting of primary percutaneous coronary intervention (PCI), and this has been the subject of many recent publications and debate among clinicians. To the best of our knowledge there are limited registries and randomized trials about DES for acute MI in the English literature. Bare-metal stents have a higher incidence of instent restenosis whereas DES might have a slightly higher late thrombosis risk. With the current data DES might still have an advantage over BMS in the treatment of ST-segment elevation MI (STEMI) patients with the vastly improved target vessel revascularization rates. Despite the lack of well-designed head-to-head long-term prospective clinical trials, DES may not be effective in patients who are on short-term dual antiplatelet therapy owing to an increased risk of late stent thrombosis. In conclusion, DES use in STEMI patients continuing long-term dual antiplatelet therapy is safe and effective.

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Penetrating atherosclerotic ulcers (PAU), aortic dissection, and intramural hematoma are the three most important diseases involving the aorta which are classified as acute aortic syndromes. Penetrating atherosclerotic aortic ulceration is characterized by ulceration of atheromatous plaque disrupting the internal elastic lamina. These aortic ulcers may penetrate through the media to cause aortic pseudoaneurysms or less often through the adventitia to cause transmural aortic rupture. We described a case of penetrating atherosclerotic ulcer of ascending aorta mimicking ST elevation myocardial infarction. To our knowledge, this is the first case reported in the literature of such a complication from PAU. [ABSTRACT FROM AUTHOR]