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Background: No-reflow (NRF) phenomenon is a significant challenge in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Accurate prediction of NRF may help improve clinical outcomes of patients. This retrospective study aimed at creating an optimal model based on machine learning (ML) to predict NRF in these patients, with the additional objective of guiding pre- and intra-operative decision-making to reduce NRF incidence. Methods: Data were collected from 321 STEMI patients undergoing pPCI between January 2022 and May 2023, with the dataset being randomly divided into training and internal validation sets in a 7:3 ratio. Selected features included pre- and intra-operative demographic data, laboratory parameters, electrocardiogram, comorbidities, patients' clinical status, coronary angiographic data, and intraoperative interventions. Post comprehensive feature cleaning and engineering, three logistic regression (LR) models [LR-classic, LR-random forest (LR-RF), and LR-eXtreme Gradient Boosting (LR-XGB)], a RF model and an eXtreme Gradient Boosting (XGBoost) model were developed within the training set, followed by performance evaluation on the internal validation sets. Results: Among the 261 patients who met the inclusion criteria, 212 were allocated to the normal flow group and 49 to the NRF group. The training group consisted of 183 patients, while the internal validation group included 78 patients. The LR-XGB model, with an area under the curve (AUC) of 0.829 [95% confidence interval (CI): 0.779-0.880], was selected as the representative model for logistic regression analyses. The LR model had an AUC slightly lower than XGBoost model (AUC 0.835, 95% CI: 0.781-0.889) but significantly higher than RF model (AUC 0.731, 95% CI: 0.660-0.802). Internal validation underscored the unique advantages of each model, with the LR model demonstrating the highest clinical net benefit at relevant thresholds, as determined by decision curve analysis. The LR model encompassed seven meaningful features, and notably, thrombolysis in myocardial infarction flow after initial balloon dilation (TFAID) was the most impactful predictor in all models. A web-based application based on the LR model, hosting these predictive models, is available at https://l7173o-wang-lyn.shinyapps.io/shiny-1/. Conclusions: A LR model was successfully developed through ML to forecast NRF phenomena in STEMI patients undergoing pPCI. A web-based application derived from the LR model facilitates clinical implementation.

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Takayasu arteritis (TA) is a rare form of large vessel arteritis that predominantly affects the aorta and its major branches. This inflammation leads to thickening, fibrosis, and stenosis of the arterial walls, which may lead to thrombus formation. The resulting symptoms are typically due to ischemia of the end organs. Coronary artery involvement is uncommon and primarily affects the ostia of the arteries. Ostial involvement of the coronary arteries can have a dramatic course, including fatal outcomes. We present the case of a 16-year-old female with TA involving the ostium of the left main coronary artery, causing severe stenosis. A successful percutaneous coronary intervention was performed on the left main artery with snorkel stent placement, which was complicated by cardiac arrest seven months later due to complete thrombosis of the proximal opening of the protruding stent.

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Objective: To assess the changes in QRS duration (△QRSd) before and after primary percutaneous coronary intervention(PPCI) regarding the relation of left ventricular ejection fraction (LVEF) in patients after a first acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: A total of 244 patients with STEMI were enrolled, and clinical, biochemical, and angiographic parameters were compared between two groups based on LVEF at 6 months post-discharge. QRS duration (QRSd) was analyzed in relation to LVEF, and feature selection using least absolute shrinkage and selection operator(LASSO) regression was performed. Logistic regression analysis and receiver operating characteristic (ROC) curve evaluation were conducted to identify predictors and assess model efficacy. Results: Significant differences were observed between the two groups in terms of various parameters, including age, time from symptom onset to balloon dilation (STB), N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, Left ventricular end-diastolic volume(LVEDV) at baseline, left ventricular end-systolic volume(LVESV)at baseline, left ventricular end-diastolic diameter (LVDD)at baseline and six months, hospital length of stay(days), ST-segment resolution (STR), the left anterior descending artery as the infarction-related artery (IRA-LAD), frequency of TIMI 3 flow post PPCI, thrombus aspiration and/or intracoronary thrombolysis, the use of tirofiban, and the number of implanted stents(stents).In addition, postoperative QRSd and △QRSd were significantly higher in patients with left ventricular systolic dysfunction(LVSD). LASSO regression selected six variables as predictors of postoperative LVEF. Logistic regression analysis identified age, STB, NT-proBNP, LVESV at baseline,△QRSd, and stents, as independent factors associated with LVSD within six months for patients with a first occurrence of STEMI. The models achieved AUC values of 0.906 (using ΔQRSd),0.922(using 6 variables excluding ΔQRSd) and 0.962 (using 6 variables). Conclusion: This study identified ΔQRSd as a potential predictor of LVSD in patients with STEMI. The developed models showed good efficacy in predicting postoperative LVEF changes. These findings may contribute to risk stratification and individualized management strategies for STEMI patients.

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BACKGROUND: Chronic total occlusion (CTO) lesions are the most challenging subset of coronary lesions. For lesions with a failed antegrade approach, the initial retrograde, followed by a combined retrograde and antegrade approach, remains the mainstay of therapy. OBJECTIVE: The study evaluated a technique of initial retrograde followed by an antegrade approach to treat lesions with a failed antegrade approach. METHODS: We have adopted this technique to treat 31 CTO lesions with a failed antegrade approach, where a floppy wire was advanced antegrade through the tract created by a retrograde balloon advanced over the retrograde wire (antegrade wire tracking of the retrograde tract (ATRT)), which was advanced into the aorta retrogradely. RESULT: In 31 patients with failed antegrade approaches, the ATRT technique was tried, which was successful in 25 patients (the success rate was 80.6%). There was a failure to cross the microchannel in four patients, although angiographically, it looked promising. In two patients, it was impossible to advance the microcatheter or the smallest profile balloon retrogradely until the entire length of the CTO body. So, a reverse controlled antegrade and retrograde subintimal tracking (CART) was performed on these two patients excluded from the study. CONCLUSION: ATRT is a useful technique for CTO percutaneous coronary intervention (PCI) for patients with failed antegrade approaches with acceptable success rates. The procedure is safe in terms of procedural complications.

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BACKGROUND: Primary percutaneous coronary intervention (PPCI) is pivotal in treating ST-elevation myocardial infarction (STEMI) patients, yet ischemia time significantly impacts outcomes, particularly left ventricular failure (LVF). OBJECTIVE: This study aimed to investigate the impact of ischemia duration and other variables associated with severe left ventricular systolic dysfunction in STEMI patients receiving PPCI treatment. METHODOLOGY: This prospective cohort was carried out at Lady Reading Hospital in Peshawar, Pakistan, from January to June 2023. The study included 236 patients aged 18 to 70 with acute myocardial infarction who underwent PPCI within 12 hours of symptom onset. Patients with coronary dissection, late presenters (more than 12 hours after onset), those without stenting, and those with prior coronary artery intervention were excluded. Additionally, patients with systolic heart failure, a history of arrhythmias such as ventricular tachycardia or ventricular fibrillation, or a previous acute coronary syndrome event were excluded. Demographic information, clinical background, and ischemia duration were recorded and associated with left ventricular ejection fraction (LVEF) after PPCI. To identify predictors of severe left ventricular dysfunction, statistical analysis using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) included multivariate regression, Pearson's correlation, and descriptive statistics. RESULTS: The patients' average age was 61.2 years (SD ± 12.3), with 35.59% of them being female (84 patients) and 64.41% of them being male (152 patients). Diabetes (33.05%, 78 patients) and hypertension (43.22%, 102 patients) were common comorbidities, and 14.41% (34 patients) had previously had a cardiac episode. Fifty-two patients (22.03%) of the total had ischemia within three hours, 94 patients (39.83%) had ischemia within six hours, 60 patients (25.42%) had ischemia within nine hours, and 30 patients (12.71%) had ischemia within 12 hours. Analysis of LVEF showed that 9.32% of patients (n=22) had LVEF <30% and 24.58% of patients (n=58) had LVEF 30-40%. Significant predictors of severe left ventricular systolic dysfunction were shown by multivariate regression to include ischemia duration (OR 1.45, p<0.001), age (OR 1.02, p=0.015), diabetes (OR 2.34, p=0.001), hypertension (OR 1.76, p=0.031), and previous cardiac events (OR 2.89, p=0.002); 20.33% of the patients (n=48) had LVF during the six-month follow-up, highlighting the therapeutic significance of prompt management in STEMI patients after PPCI. CONCLUSION: Prolonged ischemia, advanced age, diabetes, hypertension, and previous cardiac events that predict severe left ventricular dysfunction are associated with a greater risk of LVF following PPCI. Timely intervention and thorough therapy are essential for enhancing results for STEMI patients at high risk.

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Background: The coronary no-reflow (NR) phenomenon is an independent predictor of major adverse cardiac events (MACEs). This study aimed to establish a clinical and comprehensive nomogram for predicting NR in acute myocardial infarction (AMI) patients after primary percutaneous coronary intervention (pPCI). Methods: The multivariable logistic regression analysis was performed to determine the NR-related factors. A nomogram was established via several clinical and biochemical factors, and the performance was evaluated via discrimination, calibration, and clinical factors. Results: The study consisted of 3041 AMI patients after pPCI, including 2129 patients in the training set (70%) and 912 patients in the validation set (30%). The NR event was 238 in the training set and 87 in the validation set. The level of N-terminal prohormone B-type natriuretic peptide (NT-proBNP), basophil count (BASO), neutrophil count (NEUBC), D-dimer, hemoglobin (Hb), and red blood cell distribution width (RDW.CV) in NR patients showed statistically significant differences. In the training set, the C-index was 0.712, 95% CI 0.677 to 0.748. In the validation set, the C-index was 0.663, 95% CI 0.604 to 0.722. Conclusions: A nomogram that may predict NR in AMI patients undergoing pPCI was established and validated. We hope this nomogram can be used for NR risk assessment and clinical decision-making and significantly prevent potentially impaired reperfusion associated with NR.

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Background and Aims: Atrial fibrillation (AF) is a common arrhythmia that occurs following ST-elevation myocardial infarction (STEMI) and can significantly impact clinical outcomes. We investigated the incidence and predictors of AF following STEMI in patients, as well as its association with major adverse cardiac and cerebrovascular events (MACCE). Methods: We conducted a retrospective cohort study, including all STEMI patients who presented under code 247 to Tehran Heart Center between 2016 and 2020 and completed a 1-year follow-up. Patients were divided into two groups based on the development of AF during follow-up, and their baseline and clinical characteristics were compared. We used multivariable regression models to identify predictors of MACCE. Results: Out of 3647 STEMI patients, 84 (2.3%) developed new-onset AF (NOAF). Patients with AF were significantly older and had lower levels of total and low-density lipoprotein cholesterol, triglyceride, and hemoglobin, but higher levels of fasting blood sugar and creatinine. AF patients were also more likely to have a history of hypertension, chronic kidney disease (CKD), congestive heart failure, and cerebrovascular accidents. The multivariable logistic regression model identified the CHA2DS2-VASc score and CKD as independent predictors of NOAF following primary percutaneous coronary intervention. Furthermore, the incidence of MACCE was higher in the AF group, and AF independently predicted MACCE with a hazard ratio of 2.766. Conclusion: The CHA2DS2-VASc score and the presence of CKD can serve as useful predictors of NOAF among patients with STEMI. Early detection and appropriate management are crucial to improve outcomes.

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Development of ventricular failure and pulmonary edema is associated with a worse prognosis in ST-elevation myocardial infarction (STEMI). We aimed to evaluate the prognostic ability of a novel classification combining lung ultrasound (LUS) and left ventricular outflow tract (LVOT) velocity time integral (VTI) in patients with STEMI. LUS and LVOT-VTI were performed within 24 h of admission in STEMI patients. A LUS combined with LVOT-VTI (LUV) classification was developed based on LUS with < or ≥ 3 positive zone scans, combined with LVOT-VTI > or ≤ 14. Patients were classified as A (< 3zones/ > 14 cm VTI), B (≥ 3zones/ > 14 cm VTI), C (< 3zones/ ≤ 14 cm VTI) and D (≥ 3zones/ ≤ 14 cm VTI). Primary outcome was occurrence of in-hospital mortality. Development of cardiogenic shock (CS) within 24 h was also assessed. A total of 308 patients were included. Overall in-hospital mortality was 8.8%, while mortality for LUV A, B, C, and D was 0%, 3%, 12%, and 45%, respectively. The area under the curve (AUC) for predicting in-hospital mortality was 0.915. Moreover, after exclusion of patients admitted in Killip IV, at each increasing degree of LUV, a higher proportion of patients developed CS within 24 h: LUV A = 0.0%, LUV B 5%, LUV C = 12.5% and LUV D = 30.8% (p < 0.0001). The AUC for predicting CS was 0.908 (p < 0.001). In a cohort of STEMI patients, LUV provided to be an excellent method for prediction of in-hospital mortality and development of CS. LUV classification is a fast, non-invasive and very user-friendly ultrasonographic evaluation method to stratify the risk of mortality and CS.

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INTRODUCTION: With the advent of reperfusion therapies, management of patients presenting with ST-elevation myocardial infarction (STEMI) has witnessed significant changes during the last decades. AIM: We sought to analyze temporal trends in reperfusion modalities and their prognostic impact over a 20-year period in patients presenting with STEMI the Monastir region (Tunisia). METHODS: Patients from Monastir region presenting for STEMI were included in a 20-year (1998-2017) single center registry. Reperfusion modalities, early and long-term outcomes were studied according to five four-year periods. RESULTS: Out of 1734 patients with STEMI, 1370 (79%) were male and mean age was 60.3 ± 12.7 years. From 1998 to 2017, primary percutaneous coronary intervention (PCI) use significantly increased from 12.5% to 48.3% while fibrinolysis use significantly decreased from 47.6% to 31.7% (p<0.001 for both). Reperfusion delays for either fibrinolysis or primary PCI significantly decreased during the study period. In-hospital mortality significantly decreased from 13.7% during Period 1 (1998-2001) to 5.4% during Period 5 (2014-2017), (p=0.03). Long-term mortality rate (mean follow-up 49.4 ± 30.7 months) significantly decreased from 25.3% to 13% (p<0.001). In multivariate analysis, age, female gender, anemia on-presentation, akinesia/dyskinesia of the infarcted area and use of plain old balloon angioplasty were independent predictors of death at long-term follow-up whereas primary PCI use and preinfaction angina were predictors of long-term survival. CONCLUSIONS: In this long-term follow-up study of Tunisian patients presenting for STEMI, reperfusion delays decreased concomitantly to an increase in primary PCI use. In-hospital and long-term mortality rates significantly decreased from 1998 to 2017.

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BACKGROUND: Door-to-balloon time (DTBT) for ST-elevation myocardial infarction (STEMI) is a performance metric by which primary percutaneous coronary intervention (PPCI) services are assessed. METHODS: Consecutive patients presenting with STEMI undergoing PPCI between January 2007 to December 2019 from the Singapore Myocardial Infarction Registry were included. Patients were stratified based on DTBT (≤60 min, 61-90 min, 91-180 min) and Killip status (I-III vs. IV). Outcomes assessed included all-cause mortality and major adverse cardiovascular events (MACE) at 30-days and 1-year. RESULTS: In total, 13,823 patients were included, with 82.59% achieving DTBT ≤90 min and 49.77% achieving DTBT ≤60 min. For Killip I-III (n = 11,591,83.85%), the median DTBT was 60[46-78]min. The 30-day all-cause mortality for DTBT of ≤60 min, 61-90 min and 91-180 min was 1.08%, 2.17% and 4.33% respectively (p < 0.001). On multivariate analysis, however, there was no significant difference for 30-day and 1-year outcomes across all DTBT (p > 0.05). For Killip IV, the median DTBT was 68[51-91]min. The 30-day all-cause mortality for DTBT of ≤60 min, 61-90 min and 91-180 min was 11.74%, 20.48% and 35.06% respectively (p < 0.001). On multivariate analysis for 30-day and 1-year outcomes, DTBT 91-180 min was an independent predictor of worse outcomes (p < 0.05), but there was no significant difference between DTBT of ≤60 min and 61-90 min (p > 0.05). CONCLUSION: In Killip I-III patients, DTBT had no significant impact on outcomes upon adjustment for confounders. Conversely, for Killip IV patients, a DTBT of >90 min was associated with significantly higher adverse outcomes, with no differences between a DTBT of ≤60 min vs. 61-90 min. Outcomes in STEMI involve a complex interplay of factors and recommendations of a lowered DTBT of ≤60 min will require further evaluation.

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Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS) that is increasingly recognized in young to middle-aged women without typical coronary risk factors. This case report describes a 46-year-old male with a rare presentation of SCAD involving the left main (LM) coronary artery. The patient underwent an emergency coronary angiogram for high-risk ACS and had percutaneous coronary intervention (PCI) of LM due to active ischemia and hemodynamic instability. The extension of intramural hematoma after the LM coronary artery stent confirmed the initial suspicion of SCAD. The diagnosis of SCAD is crucial, as its management differs from other causes of ACS. Coronary angiography is the gold standard for diagnosing SCAD, with adjunctive imaging using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). In this patient, his physical examination findings and further imaging raised a suspicion for systemic connective tissue disease. Genetic analysis was executed, but no reportable variants in any of the 29 genes studied were identified. This case highlights the importance of recognizing SCAD as a potential cause of ACS even in men and emphasizes the findings during coronary angiography that can aid in an accurate diagnosis and appropriate management.

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Spinal cord infarction (SCI) is an uncommon vascular syndrome that leads to neurologic abnormalities with multiple implicated causes. Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure used to relieve an arterial occlusion or narrowing that causes ischemia to the heart. This is usually performed by different methods and different arterial access sites. Here, we present a case of a patient who developed bilateral lower limb weakness eight days after a femoral artery PCI and was diagnosed with SCI. This case report aims to document a rare complication and highlight the most important demographic, investigation, management, risk factors, and prognosis data available in the literature.

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Background: The study was aimed to evaluate gender difference and age & gender specific interaction of in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: This was a prospective cohort study of 1748 patients with STEMI undergoing primary PCI. The study was dichotomised according to gender to evaluate the difference in the outcome. The study was further stratified based on an age cut-off of 75 years to examine the age-specific gender relationship in survival outcomes. Independent variables for in-hospital mortality were analysed through logistic regression. Results: There were 314 (17.96%) females with an average age of 60.80 years and 1434 (82.03%) males with an average age of 54.87 years. The prevalence of diabetes (24.8% vs. 13.2%) and hypertension (33.1% vs. 12.9%) was significantly higher in female patients compared to male patients, whereas the significantly higher number of male patients were smokers. On multivariate analysis, odds of female gender OR = 3.54 (1.37-9.17), killip class >2 OR = 3.05 (1.97-4.71) and baseline creatinine OR = 2.27 (1.22-4.23) were found as significant predictors of in-hospital mortality. The crude odds ratio of 2.35 (1.49-3.72) and adjusted OR of 2.05 (1.27-3.30) for female mortality was significant among patients aged <75-years. While patients with ≥75-years of age, the mortality difference was insignificant. Conclusion: Although the incidence of STEMI was higher in male compared to female patients, female patients had two-fold higher in-hospital mortality than male. Female gender was an independent predictor for in-hospital mortality in patients <75-years of age.

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Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.

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Patients with neurodevelopmental disorders (NDDs) encounter significant barriers to receiving quality health care, particularly for acute conditions such as non-ST segment elevation myocardial infarction (NSTEMI). This study addresses the critical gap in knowledge regarding in-hospital outcomes and the use of invasive therapies in this demographic. By analyzing data from the National Inpatient Sample database from 2011 to 2020 using the International Classification of Diseases, Ninth Edition (ICD-9) and Tenth Edition (ICD-10) codes, we identified patients with NSTEMI, both with and without NDDs, and compared baseline characteristics, in-hospital outcomes, and the application of invasive treatments. The analysis involved a weighted sample of 7,482,216 NSTEMI hospitalizations, of which 30,168 (0.40%) patients had NDDs. There were significantly higher comorbidity-adjusted odds of in-hospital mortality, cardiac arrest, endotracheal intubation, infectious complications, ventricular arrhythmias, and restraint use among the NDD cohort. Conversely, this group exhibited lower adjusted odds of undergoing left heart catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery. These findings underscore the disparities faced by patients with NDDs in accessing invasive cardiac interventions, highlighting the need for further research to address these barriers and improve care quality for this vulnerable population.

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BACKGROUND: Despite prompt reperfusion, the risk of adverse clinical outcomes following ST-segment-elevation myocardial infarction (STEMI) remains pronounced, owing partly to suboptimal reperfusion. However, coronary functional evaluation is seldom feasible during primary percutaneous coronary intervention (PPCI). We aimed to examine the clinical implication of a simple coronary assessment based on single-angiographic view (µQFR) during PPCI in discriminating impaired coronary flow and adverse outcomes for STEMI. METHODS: STEMI Patients undergoing successful PPCI were enrolled and followed up prospectively from 4 medical centers in China. Post-PPCI µQFR of culprit vessels were analyzed. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal MI, ischemia-driven target-vessel revascularization and readmission for heart failure. RESULTS: A total of 570 patients with STEMI were enrolled, and post-PCI µQFR was analyzable in 557 (97.7%) patients, with a median of 0.94. Patients with low post-PCI µQFR showed higher incidence of adverse outcomes than those with high µQFR, showing a 2.5-fold increase in the risk for MACE (hazard ratio: 2.51, 95% confidence intervals: 1.33 to 4.72; P = 0.004). Moreover, post-PCI µQFR significantly increased discriminant ability for the occurrence of MACE when added to traditional GRACE risk score for STEMI (integrated discrimination improvement: 0.029; net reclassification index: 0.229; P < 0.05). CONCLUSIONS: A low µQFR of culprit vessel in PPCI is independently associated with worse clinical outcomes in patients with STEMI. The single-angiographic-view-based coronary evaluation is a feasible tool for discriminating poor prognosis and could serve as a valuable complement in risk stratification for STEMI.

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