Can exercise capacity assessed by the 6 minute walk test predict the development of major adverse cardiac events in patients with STEMI after fibrinolysis?

BACKGROUND: To assess the added value of the 6 minute walk test distance (6MWTD) in the risk-stratification methods for patients with ST -segment elevation myocardial infarction (STEMI) treated with fibrinolysis. METHODOLOGY/PRINCIPAL FINDINGS: This is a prospective cohort study of one hundred consecutive patients with STEMI, who had received fibrinolysis, at Assuit University Hospital. All patients underwent 6MWT pre- discharge and were followed up for 3 months to monitor the incidence of major adverse cardiac events (MACE). Patients were divided into 3 groups according to the level of 6MWTD (level I>450 m, level II = 300-450 m and level III<300 m). Among the study population, the median 6MWT distance was 370 meters (interquartile range 162-462). The mean age was 60.9±10.7 years, 71.9% of them were males, 2/3 had anterior MI. only 10.5% had successful thrombolysis. Compared to patients in level I (>450 m), patients in level III (<300 m) were more likely to have clinical risk factors as hypertension, diabetes and impaired renal function. The patient's mean TIMI score was 3.4±2.2, the mean GRACE score was 150.5±27.7. There was a significant negative correlation between the 6 MWTD and GRACE risk score (r = -0.80, p<0.001). At 3 months of follow-up, 51% had MACE including 16% were dead. Multivariate logistic regression analysis identified that the GRACE risk score and 6MWT distance levels were the best predictors of the MACE at 3 month of follow up. The incidence of MACE was 4 times higher in patients with high GRACE risk score who couldn't walk more than 300 meters (OR = 4.66, 95% CI = 1.1-14.5, p = 0.006). CONCLUSIONS/SIGNIFICANCE: In patients with STEMI treated with fibrinolysis, the addition of 6MWTD assessment pre-discharge to the traditional GRACE risk score improved the risk prediction of cardiovascular events at 3 month follow up

Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study

Objective: The purpose of our study was to assess the incidence and predictors of contrast induced nephropathy (CIN) in unselected patients undergoing coronary intervention either coronary angiography (CA) or percutaneous coronary interventions (PCI), at Assiut university hospitals. Background: CIN is a frequent, potentially lethal complication after coronary intervention. It is the 3rd most common cause of hospital-acquired acute renal failure. Patients and methods: This is an observational prospective cohort study. Two hundred consecutive patients between December 2011 and August 2012 underwent CA and PCI were enrolled in the study. Blood samples were collected at baseline and 3 days after interventions. All patients were followed up for 2 weeks for major adverse events. Results: CIN was observed in 23 (11.5%) patients. According to Mehran risk score, 84.5% of our patients had low risk for CIN, 15.5% had moderate risk for CIN, and no one had high risk score. Multivariate logistic regression analysis of predictors for CIN, showed that the use of high osmolar contrast media (CM) (Telebrix) was associated with 4 times higher incidence of CIN than the use of low osmolar CM (Ultravest) (OR = 4.07; 95% CI = 1.1–15.1). None of our patients had clinical signs or symptoms of acute renal failure, or required haemodialysis at 2 weeks of follow up. Conclusion: Although most of our study population was at low risk, the incidence of CIN was relatively high due to the use of high osmolar CM. Further studies are needed for cost effectiveness in light of negligible clinical impact

Laboratory, electrocardiographic and risk scoring results of the study population by levels of sex-minute walk test distance.

<p>Data are presented as mean ± standard deviation, number (%) of patients.</p><p>*Compared using ANOVA test.</p>†<p>Compared using Chi-square or Fisher exact test. TIMI =  Thrombolysis In Myocardial Infarction; CK =  creatine kinase; 6MWT =  sex-minute walk test; <i>GRACE</i> =  Global Registry of Acute Coronary Events; NS = not significant.</p

Logistic regression analysis for prediction of MACE.

<p>MI: myocardial infarction, PPCI: primary percutanious coronary intervention, TIMI =  Thrombolysis In Myocardial Infarction; CK =  creatine kinase; 6MWT =  sex-minute walk test; <i>GRACE</i> =  Global Registry of Acute Coronary Events.</p

Baseline characteristics of the study population by levels of sex-minute walk test distance.

<p>Data are presented as mean ± standard deviation, number (%) of patients.</p><p>*Compared using ANOVA test.</p>†<p>Compared using Chi-square or Fisher exact test. BP =  blood pressure; MI =  myocardial infarction; TIMI =  Thrombolysis In Myocardial Infarction; CK =  creatine kinase; 6MWT =  sex-minute walk test; PCI =  percutaneous coronary intervention; CABG = coronary artery bypass graft; NS = not significant.</p

Clinical outcomes and complications at 90 days follow-up in the study population by levels of sex-minute walk test distance.

<p>Data are presented as number (%) of patients.</p>†<p>Compared using Chi-square or Fisher exact test. MACE =  major adverse cardiac events; MI =  myocardial infarction.</p

Novel strategy in endovascular treatment of coronary steal using histoacryl®

Background: Coronary steal is an often encountered clinical condition attributable to multiple etiologies. Diverse treatment modalities have been previously elucidated. Aim: To elucidate the potential role of interventional approach using N-butyl Cyanoacrylate (Histoacryl®) to treat coronary steal. Material and methods: We present four patients with coronary steal due to different causes. Three patients had coronary arterial fistulas, and the fourth patient underwent prior Coronary Artery Bypass Graft (CABG) surgery with a patent unligated Left Internal Mammary Artery (LIMA) side-branch. We report the attempted trans-catheter closure of the fistulas and LIMA side-branch using n-butyl cyanoacrylate as an embolic agent. Results: In our series, Coronary angiography was the imaging modality used for diagnosing and guiding the treatment of all cases. Multi-detector CT was used to track the pathway and termination of the fistula in one case only. From the three fistula cases, two originated from the left anterior descending (LAD) coronary artery and one from the left circumflex (LCX) coronary artery. We accomplished successful occlusion in two of the three fistula cases and in the LIMA side-branch case as well. Conclusion: N-butyl Cyanoacrylate (Histoacryl®) is a useful interventional embolic agent that could be used to treat coronary steal of diverse etiology