Prediction of Reperfusion Outcome using Platelet Indices in Primary Percutaneous Coronary Intervention- A Prospective Cohort Study
Thomas Varghese AttumalilSam Jacob ChirameRadhakrishnan VvK. Sunitha ViswanathanAlummoottil George KoshyNini Prabha Gupta
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Introduction: Platelets play a vital role in systemic inflammation and thrombus formation in ST Elevation Myocardial Infarction (STEMI). Understanding its role has diagnostic and prognostic implications in developing therapeutic strategies. Aim: To estimate the prognostic accuracy of platelet indicesMean Platelet Volume (MPV), Platelet Distribution Width (PDW) and MPV/Platelet Count (PC) Ratio (MPV/PC ratio) on reperfusion outcome in STEMI patients. Materials and Methods: This prospective cohort study enrolled 262 subjects, who presented with acute chest pain within a window period of 12 hours, and an Electrocardiogram (ECG) suggestive of STEMI. Blood samples collected on admission were measured for MPV and PDW. The major endpoints studied were angiographic thrombus burden and in-hospital Major Adverse Cardiovascular Events (MACE). Data was summarised by Mean and SD for continuous variables, frequency and percentage for categorical variables. Results: This study demonstrated that Acute Coronary Syndrome- STEMI (ACS-STEMI) patients with larger PDW had Larger Thrombus Burden (LTB). PDW of more than 13 fL was the best cut off for predicting LTB with a sensitivity of 67.01% and a specificity of 53.23%. There was no significant difference between the means of MPV in LTB and small thrombus burden. The total in-hospital MACE at the end of one week was 20.99% (n=55/262 patients). The maximum MACE was contributed by acute heart failure (12.6%), followed by cardiac death (6.1%) and stent thrombosis (1.5%). There was a significant association between increased PDW and in-hospital MACE, mortality and acute heart failure (p-value=0.024, p-value=0.03, p-value=0.02, respectively). The best cut-off PDW value for prediction of the composite MACE endpoint was 14.7 fL with sensitivity of 75.6% and specificity of 51.4% and the area under the Receiver Operating Characteristic (ROC) curve was 0.63 (95% CI, 0.57 to 0.69). Conclusion: The study emphasises the use of platelet indices, especially PDW, as a predictor of poorer reperfusion outcomes in primary Percutaneous Coronary Intervention (PCI) as evidenced by higher MACE rates in patients with higher PDW. Hence, PDW can help in predicting the thrombus burden even before doing the angiogram and such high-risk patients could benefit from early initiation of stronger antiplatelets, Gp IIb/IIIa (Glycoprotein) antagonist drugs and thrombus aspiration techniques.Keywords:
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Objective To compare primary and facilitated percutaneous coronary intervention(PCI)for therapy of acute myocardial infarction and to evaluate the efficacy and safety of facilitated PCI.Methods Two hundred and four patients with ST-segment elevation myocardial infarction(STEMI) were divided into facilitated PCI group(n=83) and primary PCI group(n=121).The patients in facilitated PCI group firstly received 50 mg rt-PA in 30min after giving heparin,then treated with PCI immediately.The patients in primary PCI group were treated only with PCI but without thrombolysis.Thrombolysis in myocardial infarction(TIMI)grade,the rate of recanalization of infart-related artery(IRA)before and after PCI,left ventricular ejection(LVEF) after PCI,and major adverse cardiac events(MACE),major hemorrhage in hospital in the two groups were compared.In each group,clinical data were analyzed by dividing sub-groups according to symptom-to-ballon time.Results The rate of recanalization,TIMI grade of IRA before PCI and left ventricular ejection in facilitated PCI group were higher than those in primary PCI group.There was no significant difference between the MACE and major hemorrhage of the two groups.In patients with STEMI treated with a facilitated PCI strategy using half dose rt-PA,myocardial reperfusion,cardiac function,the rate of TIMI grade were impoved without increasing MACE and major hemorrhage compared with primary PCI.Conclusion Facilitated PCI is an effective and safe treatment for acute myocardial infarction.
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Objective To evaluate the impact of different treatment times on prognosis of primary percutaneous coronary intervention(PCI)for acute ST-elevation myocardial infarction(STEMI). Methods A total of 153 STEMI patients were enrolled from January 2004 to September 2006. According to the Symptom-onset-to-ballon time(SBT), the patients were divided into two groups. Group A consisted of 112 patients with SBT ≤ 6 hours, and Group B included 41 with SBT between 6 and 12 hours. The number of ECG leads with ST-elevation resolusion(STR) 70% after PCI was determined, and changes in left ventricular ejection fraction and incidence of major adverse cardac events(MACE)during one-year follow-up were also recorded. Results Clinical and angiographic characteristics were similar in the two groups. The number of ECG leads with STR 70% after PCI was significantly greater in Group A than that in Group B(P 0.05). During follow-up, left ventricular ejection fraction was higher, and the incidence of MACE was lower in Group A than those in Group B(all P 0.05). Conclusions Direct PCI ≤ 6 h after onset of symptoms results in significant improvement in myocardial reperfusion, better recovery of left ventricular function, and decrease in total MACE rate during follow-up.
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Objective
To investigate the predictive value of coronary calcium score (CCS) on prognoses of patients with myocardial infarction complicated with heart failure after percutaneous coronary intervention (PCI).
Methods
The clinical data from 121 patients with myocardial infarction complicated with heart failure admitted to Puyang People’s Hospital from March 2014 to March 2019 were retrospectively analyzed. All patients were given PCI for the first time, and given coronary computed tomography (CT) examination to calculate CCS. The patients were divided into group A (CCS≤100, n=37), group B (100 400, n=39) according to CCS levels. The differences of coronary artery lesions and complete target vessel revascularization rate after PCI were compared among the three groups. The occurrence of major adverse cardiovascular events (MACE) was recorded during 12 months of folllow-up. The survival curves of three groups without MACE after PCI were drawn, and the difference of cumulative survival rate of without MACE was compared.
Results
The incidence of multivessel disease in group C was higher than that in group A and B (χ2=15.253, 11.895; P 0.05). The Gensini score of coronary artery lesion in the group C was the highest, followed by group B and group C (P 0.05). After patients were followed up for 12 months, Kaplan-Meier survival analysis found that the cumulative survival rate of without MACE in the group A was the highest, followed by group B and group C (P 400 was an independent predictor of MACE after PCI in patients with myocardial infarction complicated with heart failure ( P<0.05).
Conclusions
In patients with myocardial infarction complicated with heart failure, the coronary lesions gets worse and the incidence of MACE after PCI gets higher, with the increase in CCS level. CCS is a powerful predictor of poor prognosis.
Key words:
Percutaneous coronary intervention; Coronary calcium score; Complete target vessel revascularization; Major adverse cardiovascular events; Predictor
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Objective:To study the long-term effect of delayed percutaneous coronary intervention(PCI) and percutaneous transluminal coronary angioplasty(PTCA) via radial artery in patients with acute myocardial infarction(AMI).Methods:A total of 133 AMI patients were divided into PCI group and non-PCI group,patients in PCI group were given PCI on a mean 13 days after the onset.Major adverse cardiovascular events(MACE) of the two groups were followed up.Results:During follow up period,compared with non-PCI group,incidence rate of MACE(80% vs.27.3%,P0.05) significantly decreased,left ventricular ejection fraction [(42±6.9) % vs.(57.4±3.5) %,P0.05] significantly increased in PCI group.Conclusion:Delayed percutaneous coronary intervention can significantly decrease cardiac events in patients with acute myocardial infarction.
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Objective To evaluate the effect of strain rate imaging in quantitative detection of regional myocardial function in patients with acute myocardial infarction after primary or delayed percutaneous coronary intervention (PCI).Methods Totally 30 patients with acute myocardial infarction with ST-segment elevation were divided as the primary and delayed treatment groups.The peak strain rates (SR) at systolic,early and late diastolic phases were detected before PCI operation and one week,1 month and 3 months after PCI.Results In the primary PCI group the systolic SR,early diastolic SR and late diastolic SR at 1 month and 3 months after the PCI operation increased significantly as compared with those before PCI (P0.01).In the delayed PCI group,only early diastolic SR at 3 months after PCI increased significantly as compared with that before PCI (P0.05).Conclusion Strain rate imaging can quantitatively evaluate the regional myocardial function in acute myocardial infarction with ST-segment elevation after primary or delayed PCI.
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Objective To compare the efficacy of primary percutaneous coronary intervention ( PCI) in diabetic versus nondiabetic patients with acute myocardial infarction(AMI). Methods A retrospective study of 88 diabetic and 216 nondiabetic patients with AMI undergoing primary PCI during Feb ,1997-Dec, 1999. Results PCI success rate was 94.0% (78/83) .mortality was 4.5% (4/88) and acute CABG was 5 in diabetic patients. After(11.7 ±7.8) months of clinical follow-up, the major adverse cardiac events(MACE, defined as death, reinfarction, target lesion revascularization) is 28.2% (22/78) in diabetics. PCI success rate was 97. 1% (201/207) , mortality was 1.9% (4/216) and acute CABG was 10 in nondiabetics. MACE was 18.0% (32/178) during(12. 6±8.3) months follow-up in nondiabetcs. Conclusion Primary PCI is safe and feasible in diabetics.
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AIM:To investigate the clinical significance and predictive value of high-sensitivity C-reactive protein(hs-CRP) and N-terminal pro-brain natriuretic peptide in patients with acute coronary syndrome(ACS) after primary percutaneous coronary intervention(PCI).METHODS:We summarized consecutive patients with ACS from February 2007 to April 2011 in Hunan Mawangdui Hospital and Changsha Central Hospital.A total of 101 ACS patients successfully underwent primary PCI and in whom plasma hs-CRP and NT-proBNP were measured,respectively,24 h,72 h-7 days and 3-6 months after PCI.Major adverse cardiac events(MACE) were observed during hospitalization and within 3-6 months after PCI.Plasma hs-CRP and NT-proBNP levels as well as incidence of MACE in 52 ACS patients in medically treated group and 40 healthy controls were also examined during the same period and compared with those in PCI group.RESULTS:Short-term plasma NT-proBNP levels in medically treated group were significantly higher than those in PCI group,but plasma hs-CRP levels within 72 h-7 days were significantly higher in PCI group compared with those in medicine treatment group.MACE in PCI group was lower than that in medically treated group.CONCLUSION:Both plasma hs-CRP and NT-proBNP are good predictors for mortality and MACE incidence in ACS patients treated with PCI or medications.hs-CRP is a short-term prognostic factor for ACS patients treated with primary PCI,whereas NT-proBNP is a long-term prognostic factor for ACS patients.
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Objective To compare the procedural difficulty index (PDI) and immediate outcome (IM) of percutaneous coronary intervention (PCI) in patients with various stages of myocardial infarction.Methods Ninety-four patients with myocardial infarction were divided into three groups, direct PCI(n=38), delayed PCI(n=22) and late PCI(n=34). The characteristics of infarct-related coronary artery, PDI and IM of PCI were evaluated angiographically, and severe procedural complications (SPC) and major adverse cardiac events (MACE) during hospitalstay were documented. Results In the three groups, PDI was 1.47 ±1.79, 1.82 ±1.72 and 2.85 ±2.83, respectively (P 0.05), IM was 92.0%, 91.0% and 76.5%, respectively(P 0.05), SPC was 5.3%, 0 and 5.9%, respectively (P=NS) and MACE was 0, 9.1% and 0, respectively(P=NS).Conclusions The procedural difficulty increases and immediate outcome reduces with time increasing from acute myocardial infarction to PCI.
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