The Influence of the Duration of Acute Coronary Syndrome on the Outcomes of Endovascular Treatment

Abstract

Multicenter studies have proven the high effectiveness of percutaneous coronary intervention (PCI) in terms of restoring patency of the infarct-related artery (IRA) and improving the prognosis in acute myocardial infarction (AMI). The mechanism of improvement of clinical result after PCI procedure appears to be multifactorial.

The aim. To investigate the effect of IRA stenting on the clinical course, prognosis and contractility of the heart in patients with different duration of acute myocardial infarction and its influence on the short-term and long-term effects after intervention. The main determinant for the favorable clinical course and improvement of the prognosis is early (within the first hours of the disease) restoration of antegrade blood flow by IRA stenting. Thus, it is possible to signifi-cantly improve the blood supply to the peri-infarct zone and limit the area of necrosis and maintain heart rate.

Materials and methods. The analyzed group included 684 patients with AMI who were endovascularly treated at the Department of Emergency Endovascular Heart Surgery of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 1, 2017 to January 1, 2021. Coronary artery stenting was performed in all the patients. STEMI occurred in 495 (72.4%) patients, and non-STEMI in 189 (27.6%) patients.

The mean age of the subjects was 61.8 ± 12.1 years. There were 289 women (42.3%) and 395 men (57.7%). Distribu-tion of the patients depending on the initial Killip class was as follows: 13 (1.9%) had class I, 199 (29.1%) had class II, and 472 (69.0%) had class III myocardial infarction. Atrial fibrillation occurred in 72 (10.5%) patients. Echocardiographic parameters were as follows: left ventricular (LV) end-systolic index 54.1 ± 12.8 ml/m2, LV ejection fraction 0.53 ± 0.05, left atrial diameter 39.5 ± 3.8 mm, systolic pulmonary artery pressure 44.8 ± 7.8 mmHg.

In this study, clinical condition and functional capacity of the heart muscle in patients with AMI depending on the condition of the stent segment and the timing of endovascular procedures after the onset of the disease were first inves-tigated in the long term.

Conclusions. High efficiency and safety of PCI have been proven, which makes it possible to recommend this pro-cedure for wide application. It has been proven that PCI using matrix and modular stents, as well as statins can reduce the frequency of in-stent stenosis and improve the clinical course of the disease in the long term. It has been proven that stenting in patients with AMI is most effective in the earliest stages of the disease with preservation of LV contractility with possibly complete myocardial revascularization, which contributes to the preservation of viable myocardium in the peri-infarct zone, improvement of myocardial contractility and prevention of myocardium remodeling.

References

  1. Maillard L, Hamon M, Monassier J-P, Raynaud P. STENTIM 2. Six months angiographic results. Elective Wiktor stent implantation in acute myocardial infarction compared with balloon angioplasty [abstract]. Circulation. 1998;98:1-21.
  2. Harjai KJ, Stone GW, Boura J, Mattos L, Chandra H, Cox D, Grines L, O’Neill W, Grines C; Primary Angioplasty in Myocardial Infarction Investigators. Comparison of outcomes of diabetic and nondiabetic patients undergoing primary angioplasty for acute myocardial infarction. Am J Cardiol. 2003;91(9):1041-1045. https://doi.org/10.1016/s0002-9149(03)00145-0.
  3. Maillard L, Hamon M, Khalife K, Steg PG, Beygui F, Guermonprez JL, Spaulding CM, Boulenc JM, Lipiecki J, Lafont A, Brunel P, Grollier G, Koning R, Coste P, Favereau X, Lancelin B, Van Belle E, Serruys P, Monassier JP, Raynaud P. A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators. J Am Coll Cardiol. 2000;35(7):1729-1736. https://doi.org/10.1016/s0735-1097(00)00612-4.
  4. Nairooz R, Sardar P, Amin H, Swaminathan RV, Kim LK, Chatterjee S, Feldman DN. Meta-analysis of randomized clinical trials comparing bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention and in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2014;114(2):250-259. https://doi.org/10.1016/j.amjcard.2014.04.033.
  5. Rao SV, Cohen MG, Kandzari DE, Bertrand OF, Gilchrist IC. The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions. J Am Coll Cardiol. 2010;55(20):2187-2195. https://doi.org/10.1016/j.jacc.2010.01.039.
  6. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):485-510. https://doi.org/10.1016/j.jacc.2012.11.018.
  7. Bernat I, Horak D, Stasek J, Mates M, Pesek J, Ostadal P, Hrabos V, Dusek J, Koza J, Sembera Z, Brtko M, Aschermann O, Smid M, Polansky P, Al Mawiri A, Vojacek J, Bis J, Costerousse O, Bertrand OF, Rokyta R. ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial. J Am Coll Cardiol. 2014 Mar 18;63(10):964-972. https://doi.org/10.1016/j.jacc.2013.08.1651.
  8. Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE Jr, Burke JA, et al. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures: a Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures). Circulation. 2013 Jul 23;128(4):436-72. https://doi.org/10.1161/CIR.0b013e318299cd8a.
  9. Bangalore S, Amoroso N, Fusaro M, Kumar S, Feit F. Outcomes with various drug-eluting or bare metal stents in patients with ST-segment-elevation myocardial infarction: a mixed treatment comparison analysis of trial level data from 34 068 patient-years of follow-up from randomized trials. Circ Cardiovasc Interv. 2013 Aug;6(4):378-390. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000415.
  10. Verdoia M, Secco GG, Cassetti E, Schaffer A, Barbieri L, Perrone-Filardi P, Marino P, Suryapranata H, Sinigaglia F, De Luca G. Platelet PIA1/PIA2 polymorphism and the risk of periprocedural myocardial infarction in patients with acute coronary syndromes undergoing coronary angioplasty. Blood Coagul Fibrinolysis. 2014;25(2):107-113. https://doi.org/10.1097/MBC.0b013e3283650717.
  11. Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL. Everolimus-eluting stents or bypass surgery for multivessel coronary disease. N Engl J Med. 2015 Mar 26;372(13):1213-1222. https://doi.org/10.1056/NEJMoa1412168.
  12. Waksman R, Bertrand O, Driesman M, Gruberg L, Rossi J, Mehta S, Swymelar S, Dvir D, Xue Z, Torguson R. Bivalirudin versus unfractionated heparin during percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome initially treated with fondaparinux: results from an international, multicenter, randomized pilot study (SWITCH III). J Interv Cardiol. 2013 Apr;26(2):107-113. https://doi.org/10.1111/joic.12005.
  13. Sakakura K, Wada H, Taniguchi Y, Mori M, Momomura S, Ako J. Intravascular ultrasound-guided coronary stenting without contrast medium for the treatment of catheter-induced aortocoronary dissection. Cardiovasc Interv Ther. 2013;28(1):71-75. https://doi.org/10.1007/s12928-012-0114-3.
  14. Harrison RW, Aggarwal A, Ou FS, Klein LW, Rumsfeld JS, Roe MT, Wang TY; American College of Cardiology National Cardiovascular Data Registry. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol. 2013 Jan 15;111(2):178-184. https://doi.org/10.1016/j.amjcard.2012.09.015.
  15. Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis. Eur Heart J. 2011 Aug;32(16):2059-2066. https://doi.org/10.1093/eurheartj/ehp034.
  16. Vranckx P, Farooq V, Garg S, Van Es GA, Silber S, Windecker S, Stone GW, Serruys PW. Different cardiac biomarkers to detect peri-procedural myocardial infarction in contemporary coronary stent trials: impact on outcome reporting. Heart. 2012 Oct;98(19):1424-1430. https://doi.org/10.1136/heartjnl-2012-302267.
  17. Zimarino M, Affinito V. The prognosis of periprocedural myocardial infarction after percutaneous coronary interventions. Cardiovasc Revasc Med. 2013 Jan-Feb;14(1):32-36. https://doi.org/10.1016/j.carrev.2012.10.006.
  18. Cox DA, Stone GW, Grines CL, Stuckey T, Cohen DJ, Tcheng JE, Garcia E, Guagliumi G, Iwaoka RS, Fahy M, Turco M, Lansky AJ, Griffin JJ, Mehran R; CADILLAC Investigators. Outcomes of optimal or “stent-like”balloon angioplasty in acutemyocardial infarction: the CADILLAC trial. J Am Coll Cardiol. 2003;42(6):971-977. https://doi.org/10.1016/s0735-1097(03)00911-2
Published
2021-09-21
How to Cite
Salo, S. V. (2021). The Influence of the Duration of Acute Coronary Syndrome on the Outcomes of Endovascular Treatment. Ukrainian Journal of Cardiovascular Surgery, (3 (44), 43-48. https://doi.org/10.30702/ujcvs/21.4409/s.044-43-48