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The Recanalization After Thrombolysis as Surrogate for Clinical Outcomes in Patients with ST-segment Elevation Acute Myocardial Infarction: A Systematic Review and Meta-Regression Analysis of Data from Randomized Controlled Trials.

Br J Clin Pharmacol 2021 Jul 26. Epub 2021 Jul 26.

Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.

Aim: Thrombolytic therapy has been known to be effective in reducing clinical outcomes and increasing recanalization rate among patients with ST-segment elevation acute myocardial infarction (STEMI). However, whether post-thrombolysis recanalization could be used as a surrogate for clinical outcomes is unknown.

Methods: We systematically searched PubMed, EMBASE and the Cochrane Library database to identify randomized controlled trials (RCT) that examined effects of thrombolytic agents in STEMI. Read More

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Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0.

Circ J 2021 Jul 20. Epub 2021 Jul 20.

Department of Cardiology, Fujieda Municipal General Hospital.

Background: The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0.Methods and Results:In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Read More

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Angiographic flow velocity predicts lower limb outcomes after endovascular therapy: Application of the frame count method.

Vasc Med 2021 Jul 21:1358863X211025613. Epub 2021 Jul 21.

Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.

Introduction: Several factors related to lesion characteristics and endovascular therapy (EVT) procedures have been reported to affect primary patency after EVT. However, it is unknown why these factors were associated with primary patency. We hypothesized patency failure was related to poor blood flow in affected arteries. Read More

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The CHA2DS2-VASc Risk Score Predicts Total Occlusion in Infarct-Related Arteries in Patients With Non-ST Elevation Myocardial Infarction.

Angiology 2021 Jul 17:33197211031324. Epub 2021 Jul 17.

Department of Cardiology, 506082Malatya Training and Research Hospital, Malatya, Turkey.

Early detection of total coronary artery occlusion (TO) in non-ST elevation myocardial infarction (NSTEMI) patients may be beneficial since invasive treatments are initiated more rapidly in appropriate patients. Previous studies have shown that the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score is associated with thrombus burden in acute coronary syndromes. We investigated the association between the CHA2DS2-VASc risk score and TO in patients with NSTEMI who underwent coronary angiography. Read More

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Vitamin D deficiency is associated with impaired reperfusion in STEMI patients undergoing primary percutaneous coronary intervention.

Vascul Pharmacol 2021 Jul 15:106897. Epub 2021 Jul 15.

Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy. Electronic address:

Background And Aims: Vitamin D displays a broad spectrum of cardioprotective effects, preventing oxidative stress, inflammation and thrombosis and improving endothelial function. Previous studies have associated vitamin D deficiency with more extended and severe coronary artery disease (CAD) and worse outcome, and especially among patients with ST-segment elevation myocardial infarction (STEMI). However, few data have been reported on the association of vitamin D levels with the angiographic findings and epicardial reperfusion in STEMI patients undergoing primary percutaneous coronary intervention (pPCI), that was therefore the aim of the present study. Read More

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Clinical and imaging predictors of impaired myocardial perfusion in symptomatic patients after percutaneous coronary intervention: insights from dynamic CT myocardial perfusion imaging.

Quant Imaging Med Surg 2021 Jul;11(7):3327-3337

Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: We aimed to investigate the relationship between baseline clinical characteristics and postprocedural myocardial perfusion as determined by dynamic computed tomography myocardial perfusion imaging (CT-MPI).

Methods: We retrospectively included consecutive symptomatic post percutaneous coronary intervention (PCI) patients, who underwent dynamic CT-MPI + coronary CT angiography (CCTA) and who were revealed to have patent stents on previously revascularized lesions. Myocardial blood flow (MBF) was measured for stented territories and reference territories. Read More

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Mechanical aspiration thrombectomy using the penumbra CAT RX system for patients presenting with acute coronary syndrome.

Cardiovasc Revasc Med 2021 Jul 2. Epub 2021 Jul 2.

Stony Brook University Medical Center, Cardiovascular Division, Department of Medicine, Stony Brook, NY, USA.

Patient undergoing PCI can have distal embolization and microvascular obstruction despite normalization of epicardial blood flow. Aspiration thrombectomy has been studied previously to reduce infarct size, but prior methods of aspiration thrombectomy were associated with increased risk of stroke and is currently recommended as a bailout strategy. Penumbra CAT RX has been recently approved for aspiration thrombectomy, we evaluated the catheter's use in an academic cardiac catheterization lab. Read More

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Prognostic Utility of Culprit SYNTAX Score in Patients With Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction.

Am J Cardiol 2021 Jul 4. Epub 2021 Jul 4.

Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Jinju Hospital, Republic of Korea. Electronic address:

A higher SYNTAX score (SS) is strongly associated with poor prognosis in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). However, the predictive value of culprit-lesion SYNTAX score (cul-SS) and SS has not been compared although the culprit-lesion-only primary percutaneous coronary intervention (PCI) strategy showed improved long-term survival recently. This study compared the predictive utility of cul-SS and SS for in-hospital mortality among the patients with CS-STEMI from during 2010-2019. Read More

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Factors Associated with the Prognosis of Patients with Acute Myocardial Infarction and Cardiogenic Shock.

Med Sci Monit 2021 Jul 3;27:e929996. Epub 2021 Jul 3.

Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland).

BACKGROUND Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) usually have high mortality. This study aimed to identify factors related to the short-term survival of patients with AMI and CS treated by percutaneous coronary intervention (PCI) under intra-aortic balloon pump (IABP) support. MATERIAL AND METHODS This retrospective study included consecutive patients with AMI and CS treated with PCI under IABP support. Read More

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Pre-hospital heparin use for ST-elevation myocardial infarction is safe and improves angiographic outcomes.

Eur Heart J Acute Cardiovasc Care 2021 Jun 30. Epub 2021 Jun 30.

School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.

Aims: This study aims to evaluate if pre-hospital heparin administration by paramedics is safe and improves clinical outcomes.

Methods And Results: Using the multicentre Victorian Cardiac Outcomes Registry, linked with state-wide ambulance records, we identified consecutive patients undergoing primary percutaneous coronary intervention for STEMI between January 2014 and December 2018. Information on thrombolysis in myocardial infarction (TIMI) flow at angiography was available in a subset of cases. Read More

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One-Year Outcome of Patients with Coronary Artery Ectasia Undergoing Percutaneous Coronary Intervention: Clinical Implications and Question Marks.

J Tehran Heart Cent 2020 Oct;15(4):171-177

Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty. We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Read More

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October 2020

Aortic flow propagation velocity and neutrophil-to-lymphocyte ratio in coronary slow flow.

Bratisl Lek Listy 2021 ;122(7):513-518

Aim: A useful tool for determining the presence of systemic inflammation is the neutrophil-to-lymphocyte ratio (NLR). Chronic inflammation causes more microvascular resistance, which is known to be involved with coronary slow flow (CSF). Aortic flow propagation velocity (APV) can be used to evaluate the aorta's rigidity. Read More

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The correlation of the peripheral blood NT-proBNP and NF-κB expression levels with the myocardial infarct area and the post-treatment no-reflow in acute myocardial infarction patients.

Authors:
Long Zhang Yi Hao

Am J Transl Res 2021 15;13(5):4561-4572. Epub 2021 May 15.

Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University Beijing, China.

Objective: To explore the correlation of the peripheral blood NT-proBNP and NF-κB p65 expression levels in the peripheral blood with the myocardial infarct areas on the admission and post-treatment no-reflow of acute myocardial infarction patients.

Methods: A total of 124 acute myocardial infarction patients treated in our hospital were placed in an acute myocardial infarction group, 115 patients with stable coronary heart disease were placed in a coronary heart disease group, and 121 healthy people undergoing routine physical examinations were placed in a healthy examination group. After the treatment, the myocardial infarction patients were divided into grade I, grade II, grade III, and grade IV groups according to their Killip heart function classifications. Read More

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C-reactive protein velocity predicts microvascular pathology after acute ST-elevation myocardial infarction.

Int J Cardiol 2021 Sep 18;338:30-36. Epub 2021 Jun 18.

University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.. Electronic address:

Background: The role of C-reactive protein velocity (CRPv) as an early and sensitive marker of an excessive inflammatory response in the setting of acute ST-elevation myocardial infarction (STEMI) is only poorly understood. The aim of this study was to investigate, in patients with STEMI treated with primary percutaneous coronary intervention (PCI), the association of CRPv with microvascular infarct pathology.

Methods And Results: This prospective cohort study included a total of 316 patients with STEMI undergoing PCI. Read More

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September 2021

Relationship Between C-Reactive Protein to Albumin Ratio and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction.

Angiology 2021 Jun 16:33197211024047. Epub 2021 Jun 16.

Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Read More

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Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry.

BMC Cardiovasc Disord 2021 Jun 14;21(1):297. Epub 2021 Jun 14.

Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland.

Background: The impact of acute total occlusion (TO) of the culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate the clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMI) compared to NSTEMI patients without TO (NSTEMI) and those with ST-segment elevation and TO (STEMI).

Methods: Demographic, clinical and procedure-related data of patients with acute myocardial infarction who underwent percutaneous coronary intervention (PCI) between 2014 and 2017 from the Polish National Registry were analysed. Read More

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To show the effect of intermittent fasting during ramadan on endothelial dysfunction via TIMI frame count.

Niger J Clin Pract 2021 Jun;24(6):943-947

Department of Cardiovascular Surgery, Bicard Clinic, Bishkek/, Kirghizstan.

Background: Fasting and coronary functions are prestige fields for the study. There are a limited number of studies on these topics. The effect of Ramadan fasting on endothelial dysfunction, which can be manifested by loss of nitric oxide bioavailability, has been demonstrated via flow-mediated vasomotion in patients with the slow coronary flow in a small number of studies. Read More

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Glycoprotein IIb/IIIa inhibitors use in the setting of primary percutaneous coronary intervention for ST elevation myocardial infarction in patients pre-treated with newer P2Y12 inhibitors.

Clin Cardiol 2021 Jun 11. Epub 2021 Jun 11.

CHU de Caen Normandie, Service de Cardiologie, Caen, France.

Objectives: We sought to investigate the safety and potential benefit of administrating glycoprotein IIb-IIIa inhibitors (GPIs) on top of more potent P2Y12 inhibitors.

Background: A number of clinical trials, performed at a time when pretreatment and potent platelet inhibition was not part of routine clinical practice, have documented clinical benefits of GPI in ST-segment elevation myocardial infarction (STEMI) patients at the cost of a higher risk of bleeding.

Methods: We used the data of a prospective, ongoing registry of patients admitted for STEMI in our center. Read More

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Impact of preprocedural coronary flow grade on duration of dual antiplatelet therapy in acute myocardial infarction.

Sci Rep 2021 Jun 3;11(1):11735. Epub 2021 Jun 3.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

We investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. Read More

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Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta-Analysis.

J Cardiovasc Transl Res 2021 Jun 3. Epub 2021 Jun 3.

Division of Cardiology, Peter Munk Cardiac Center, University of Toronto, Toronto, ON, Canada.

Background: Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI.

Methods: We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009. Read More

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Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery.

Cureus 2021 Apr 13;13(4):e14448. Epub 2021 Apr 13.

Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.

Introduction:  There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. Read More

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Diagnostic Performance of Selected Baseline Electrocardiographic Parameters for Prediction of Left Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction.

J Clin Med 2021 May 29;10(11). Epub 2021 May 29.

Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.

To evaluate the diagnostic performance of selected baseline electrocardiographic (ECG) parameters as predictors of left ventricular remodeling (LVR) in patients with a first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The study was performed as a single-center cohort study, with 249 patients (74.7% males) included in the final analysis. Read More

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Performance of Primary Angioplasty for STEMI during the COVID-19 Outbreak.

Int J Angiol 2021 Jun 20;30(2):148-154. Epub 2021 Apr 20.

Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

There has been concern whether the declining cases of ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) outbreak associate with primary angioplasty performance. We assessed the performance of primary angioplasty in a tertiary care hospital in Jakarta, Indonesia, by comparing the door-to-device (DTD) time and thrombolysis in myocardial infarction (TIMI) flow after angioplasty between two periods of admission: during the outbreak of COVID-19 (March 1 to May 31, 2020) and before the outbreak (March 1, to May 31, 2019). Overall, there was a relative reduction of 44% for STEMI admission during the outbreak (  = 116) compared with before the outbreak (  = 208). Read More

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Safety and efficacy of Everolimus-Eluting bioabsorbable Polymer-Coated stent in patients with long coronary lesions: The EVOLVE 48 study.

Catheter Cardiovasc Interv 2021 May 29. Epub 2021 May 29.

Boston Scientific Corporation, Marlborough, Massachusetts, USA.

Objectives: The EVOLVE 48 study evaluated the safety and effectiveness of the SYNERGY 48 mm stent for the treatment of long lesions.

Background: Clinical evidence supporting the use of very long stents during percutaneous coronary intervention (PCI) is limited. The bioabsorbable polymer SYNERGY stent has shown good long-term data in a broad population of patients undergoing PCI. Read More

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N-terminal pro-brain natriuretic peptide and coronary collateral formation in patients undergoing primary percutaneous coronary intervention.

Heart Vessels 2021 May 28. Epub 2021 May 28.

Department of Internal Medicine, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.

There is insufficient information on the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and collateral circulation (CC) formation after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. We analyzed 857 patients who underwent primary PCI. The serum NT-proBNP levels were measured on the day of admission, and the CC was scored according to Rentrop's classification. Read More

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CHA2DS2-VASc score predicts the slow flow/no-reflow phenomenon in ST-segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention.

Medicine (Baltimore) 2021 May;100(21):e26162

Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China.

Abstract: ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) have a higher incidence of slow-flow/no-reflow (SF-NR) phenomenon during primary percutaneous coronary intervention (PPCI) than those with single vessel disease. Currently, no effective tools exist to predict the risk of SF-NR in this population. The present study aimed to evaluate whether CHA2DS2-VASc score can be used as a simple tool to predict this risk. Read More

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Cardiovascular magnetic resonance image analysis and mechanism study for the changes after treatments for primary microvascular angina pectoris.

Medicine (Baltimore) 2021 May;100(21):e26038

Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine (HangZhou Red Cross Hospital), Hangzhou, Zhejiang, China.

Abstract: Most cases of primary microvascular angina pectoris (PMVA) are diagnosed clinically, but the etiology and pathological mechanisms are unknown. The effect of routine clinical medications is minimal, and PMVA can progress to serious cardiovascular events. To improve the diagnosis and effective treatment of this disease, this study was designed to diagnose PMVA via cardiovascular magnetic resonance (CMR) and the coronary angiography thrombolysis in myocardial infarction (TIMI) blood flow grade, as well as to analyze vascular endothelial function to elucidate the pathogenesis of PMVA and compare the effects of routine clinical medications. Read More

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Electrocardiographic criteria for anterior STEMI - Does the cut-off point affect treatment delay?

J Electrocardiol 2021 May 12;67:39-44. Epub 2021 May 12.

2(nd) Department of Cardiology, Poznan University of Medical Sciences, 28 Czerwca 1956r No 194, Poznan 61-485, Poland.

Background: Diagnostic criteria for anterior STEMI differ between the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC). A greater degree of ST-segment elevation is required to meet ERC criteria compared to ESC criteria. This may potentially lead to discrepancies in management between emergency teams and cardiologists, subsequent delay in reperfusion therapy and worse prognosis. Read More

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Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients.

Arq Bras Cardiol 2021 05;116(5):856-864

Yeni Yuzyil University, Faculty of Medicine, Department of Cardiology, Istambul - Turquia.

Background: Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE).

Objectives: This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI).

Methods: This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. Read More

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Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection.

Heart 2021 May 18. Epub 2021 May 18.

Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, Leicestershire, UK

Objective: To investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes.

Methods: SCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221). Read More

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