Prognosis in patients with myocardial infarction with ST-elevation depending on the timing of interventional revascularization

Проверена е прогнозата (болничния и следболничния леталитет до края на 6-ия месец) при 300 болни (212 мъже и 88 жени) с първи миокарден инфаркт със ST- елевация (STEMI) на средна възраст 62.9 год. в зависимост от срока на извършената първична коронарна интервенция (PCI) след началото на симптомите. В зависимост от срока на извършената РСІ болните са разделени на 4 групи: до 3-ия, до 6-ия, до 12-ия и до 24-ия час след началото на инфаркта. Болничният леталитет за всички болни е 6.3%, a до края на 6-ия месец - 13.3%, еднакъв при І-ва и ІІ-ра група и достоверно по-малък, отколкото при ІІІ-та и ІV-та група, по-голям при жените, при болните над 65 г., с ФИ <35.0% и с тромботична оклузия на LM и LAD.The prognosis (in-hospital and post-hospitalization lethality by the end of the 6th moth) of 300 patients (212 men and 88 women) with a first myocardial infarction with ST-elevation (STEMI) at an average age of 62.9 years was studied depending on the timing of the conducted primary coronary intervention (PCI) after the onset of symptoms. Depending on the timing of the conducted PCI, the patients were divided into 4 groups: by the 3rd, 6th, 12th, and 24th hour after the onset of the infarction. The patients` in-hospital lethality was 6.3%, and that by the end of the 6th month - 13.3%. It was the same for groups I and II and significantly lower than in groups III and IV; higher in women, in patients over 65 years of age, with ejection fraction (EF) <35.0% and with thrombotic occlusion of LM and LAD

Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

BACKGROUND: Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. METHODS: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. RESULTS: Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39-0.89]; P=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50-1.46]; P=0.57) in the influenza vaccine and placebo groups, respectively. CONCLUSIONS: Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02831608

Myocarditis - Diagnosis, treatment, use of cardiac magnetic resonance imaging and case report of a young athlete

Myocarditis is defined as the inflammation of the myocardium. It is an illness with many different faces at the  time of clinical presentation or suspicion. The clinical presentation is highly variable ranging from asymptomatic to rapidly progressive and fatal congestive heart failure. Myocarditis accounts for 2-42% of sudden cardiac deaths in young adults based on the autopsy data (1). Use of cardiac magnetic resonance expanded the possibilities of the non-invasive assessment of myocardial inflammation and opened new ways for risk stratification of patients

Acute myocardial infarction due to the left main coronary artery occlusion: Electrocardiographic patterns, angiographic findings, revascularization and in-hospital outcomes

AbstractBackgroundPrimary angioplasty improves outcomes of acute myocardial infarction (AMI). However, in the highest risk subgroups, the mortality remains high despite modern catheter-based reperfusion therapy. This study analyzed patients with AMI caused by the left main coronary artery unstable lesion, a subgroup considered to be associated with very high early mortality.MethodsA multicenter registry enrolled 6742 consecutive patients with AMI. Ninety-seven patients (1,4% of the entire study population) had left main as the infarct related artery. Baseline clinical characteristics, ECG patterns, coronary angiographic and echocardiographic data were correlated with the revascularization therapies used and with in-hospital outcomes.ResultsTwenty-five patients (25,8%) died during the hospital stay. The deceased patients were older, had more freqently bundle branch block on the admission ECG, had higher Killip class on presentation, more frequently had TIMI flow <3 and PCI success rate was 72% (vs. 100% among survivors). Left main coronary artery (LMCA) lesion impaired distal flow (TIMI flow 0–2 on presentation) in 35 patients: the most frequent ECG presentation pattern for these LMCA occlusions was ST segment elevation (n=17), followed by RBBB (n=9; with LAH 6 and without LAH 3), LBBB (n=6) and ST segment depression (n=3). In other words: acute LMCA occlusion presents in 51% with ECG changes other than ST segment elevations. Patients with TIMI flow 0–2 had higher Killip class on admission, lower ejection fraction and higher in-hospital mortality (37% vs. 20%), when compared to those with TIMI flow 3 on the initial angiogram.ConclusionsDespite modern interventional therapy, acute myocardial infarction caused by the left main coronary artery obstruction bears high early mortality. The presence of bundle branch block, diminished TIMI flow on the initial angiogram, higher age and Killip class are related with increased mortality

Nanoparticle-mediated cell capture enables rapid endothelialization of a novel bare metal stent

Incomplete endothelialization of intracoronary stents has been associated with stent thrombosis and recurrent symptoms, whereas prolonged use of dual antiplatelet therapy increases bleeding-related adverse events. Facilitated endothelialization has the potential to improve clinical outcomes in patients who are unable to tolerate dual antiplatelet therapy. The objective of this study was to demonstrate the feasibility of magnetic cell capture to rapidly endothelialize intracoronary stents in a large animal model. A novel stent was developed from a magnetizable duplex stainless steel (2205 SS). Polylactic-co-glycolic acid and magnetite (Fe₃O₄) were used to synthesize biodegradable superparamagnetic iron oxide nanoparticles, and these were used to label autologous blood outgrowth endothelial cells. Magnetic 2205 SS and nonmagnetic 316L SS control stents were implanted in the coronary arteries of pigs (n = 11), followed by intracoronary delivery of magnetically labeled cells to 2205 SS stents. In this study, we show extensive endothelialization of magnetic 2205 SS stents (median 98.4% cell coverage) within 3 days, whereas the control 316L SS stents exhibited significantly less coverage (median 48.9% cell coverage, p < 0.0001). This demonstrates the ability of intracoronary delivery of magnetic nanoparticle labeled autologous endothelial cells to improve endothelialization of magnetized coronary stents within 3 days of implantation.Brandon J. Tefft, Susheil Uthamaraj, Adriana Harbuzariu, J. Jonathan Harburn, Tyra A. Witt, Brant Newman, Peter J. Psaltis, Ota Hlinomaz, David R. Holmes, Jr., Rajiv Gulati, Robert D. Simari, Dan Dragomir-Daescu, and Gurpreet S. Sandh