Background:
Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trialMethods:
Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality.Results:
Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29–2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10–2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09–2.28, p = 0.02).Interpretation:
The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. Clinical Trials.gov registration no. The clinical outcome of patients with ST-segment elevation myocardial infarction (STEMI) is directly related to the extent of myocardial necrosis. NCT003918721 Because the extent of necrosis is strongly influenced by the duration of symptoms, time is a key clinical proxy for the stage of evolution of STEMI.2 The length of time from the onset of symptoms is important in strategies for triage and management and for gauging prognosis. Although time from the occurrence of epicardial artery occlusion in a laboratory experimental model can be measured precisely, time from the onset of symptoms is often difficult to accurately estimate because of subjectivity and reliance on recall. Thus, establishing a more reliable method for determining the stage of myocardial infarction (MI) evolution in patients with STEMI would be useful for evaluating the potential for myocardial salvage and guiding clinical management.There is evidence that the assessment of Q waves on the baseline electrocardiogram (ECG) in the region of ST-segment elevation may be a useful predictor of left ventricular dysfunction and outcomes in patients with STEMI given streptokinase within four to six hours of the onset of symptoms.3,4 Because prior studies of the predictive value of baseline Q waves focused on patients receiving fibrinolytic therapy, we extended this question to a large population of patients with STEMI who were at high risk of adverse clinical outcomes (e.g., death, ardiogenic shock and heart failure) and undergoing mechanical reperfusion with percutaneous coronary intervention in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI)5 trial within six hours of symptom onset. A key finding of this study was that Q waves were a key prognostic factor of 90-day mortality and the composite measure of death, cardiogenic shock and heart failure; in addition, Q waves were better than time from symptom onset in predicting these 90-day outcomes.6 Whether these findings are applicable to a more general STEMI population studied prospectively is unclear.Given the increasing uptake of therapy for STEMI with primary percutaneous coronary intervention and the continuing challenges in achieving timely reperfusion, we sought to validate these findings in a more contemporary cohort. The PLATelet inhibition and patient Outcomes (PLATO) study not only provided this opportunity in a large population, but it also extended our evaluation to patients with less stringent ST-segment elevation entry criteria (1 mm in two contiguous leads) randomized over a wider entry window (24 h from symptom onset) and followed for a longer period (1 yr).7 In the current study, we aimed to prospectively evaluate whether Q waves in the region of qualifying ST-segment elevation on the baseline ECG provided additional value compared with time from symptom onset as a predictor of all-cause mortality in patients with ST-segment elevation undergoing primary percutaneous coronary intervention in the PLATO trial.7 We also assessed associations with vascular death, a prespecified component of the primary outcome in the PLATO trial. 相似文献Background
Low level of testosterone may be associated with cardiovascular diseases in men, as some evidence suggests a protective role for testosterone in cardiovascular system. Little is known about the possible role of serum testosterone in response to reperfusion therapy in ST-elevation myocardial infarction (STEMI) and its relationship with ST-segment recovery. The present study was conducted to evaluate the association of serum testosterone levels with ST-segment resolution following primary percutaneous coronary intervention (PPCI) in male patients with acute STEMI.Methods
Forty-eight men (mean age 54.55 ± 12.20) with STEMI undergoing PPCI were enrolled prospectively. Single-lead ST segment resolution in the lead with maximum baseline ST-elevation was measured and patients were divided into two groups according to the degree of ST-segment resolution: complete (> or =50%) or incomplete (<50%). The basic and demographic data of all patients, their left ventricular ejection fraction (LVEF) and laboratory findings including serum levels of free testosterone and cardiac enzymes were recorded along with angiographic finding and baseline TIMI (Thrombolysis in Myocardial Infarction) flow and also in-hospital complications and then these variables were compared between two groups.Results
A complete ST-resolution (≥50%) was observed in 72.9% of the patients. The serum levels of free testosterone (P = 0.04), peak cardiac troponin (P = 0.03) were significantly higher and hs-CRP (P = 0.02) were lower in patients with complete ST-resolution compared to those with incomplete ST-resolution. In-hospital complications were observed in 31.2% of patients. The patients with a lower baseline TIMI flow (P = 0.03) and those who developed complications (P = 0.04) had lower levels of free testosterone. A significant positive correlation was observed between the left ventricular function and serum levels of free testosterone (P = 0.01 and r = +0.362).Conclusion
This study suggests that in men with STEMI undergoing PPCI, higher serum levels of testosterone are associated with a better reperfusion response, fewer complications and a better left ventricular function.Aims
Everolimus-eluting stents (EES) were superior to sirolimus-eluting stents (SES) in a dedicated myocardial infarction trial, a finding that was not observed in trials with low percentages of ST-elevation myocardial infarction (STEMI). Therefore, this study sought to investigate the influence of clinical presentation on outcome after EES and SES implantation.Methods
A pooled population of 1602 randomised patients was formed from XAMI (acute MI trial) and APPENDIX-AMI (all-comer trial). Primary outcome was cardiac mortality, MI and target vessel revascularisation at 2 years. Secondary endpoints included definite/probable stent thrombosis (ST). Adjustment was done using Cox regression.Results
In total, 902 EES and 700 SES patients were included, of which 44 % STEMI patients (EES 455; SES 257) and 56 % without STEMI (EES 447; SES 443). In the pooled population, EES and SES showed similar outcomes during follow-up. Moreover, no differences in the endpoints were observed after stratification according to presentation. Although a trend toward reduced early definite/probable ST was observed in EES compared with SES in STEMI patients, long-term ST rates were low and comparable.Conclusions
EES and SES showed a similar outcome during 2-year follow-up, regardless of clinical presentation. Long-term safety was excellent for both devices, despite wide inclusion criteria and a large sub-population of STEMI patients. 相似文献Methods: This prospective study enrolled 187 patients with STEMI who were treated with primary percutaneous coronary intervention (pPCI). Blood samples were taken to determine serum HPA levels prior to coronary angiography and heparin administration. Serum HPA analysis was performed with a commercially available Human Elisa kit.
Results: Patients were divided into two groups: high TB (n:58) and low TB (n:129) group. Serum HPA levels were significantly higher in patients with high TB than low TB [250.1 (188.5–338.1) vs. 173.6 (134.3–219.8) pg/mL] (p?<?0.001). Serum HPA levels were higher in patients with no-reflow phenomenon compared with others [(409.3 (375.6–512.5) pg/mL vs. 186.2 (144.2–247.4) pg/mL, p?<?0.001]. In multiple logistic regression analysis HPA was a predictor of high TB.
Conclusion: Elevated HPA level in patients with STEMI is related to high TB. Furthermore, increased HPA level may be associated with thrombotic complications such as no-reflow phenomenon in patients with STEMI. 相似文献