Comparison of clinical outcomes between proximal and non-proximal right coronary artery occlusion in patients with inferior ST-segment elevation myocardial infarction.

The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) due to the occlusion of left coronary artery are worse in patients with proximal occlusion than in those with non-proximal occlusion. However, there are few reports that focus on the comparison of clinical outcomes in patients with STEMI between proximal and non-proximal right coronary artery (RCA) occlusions. We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (n = 129) and the non-proximal group (n = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization. Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (p = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (p = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, p = 1.000). The MACE-free survival curves were not different between the 2 groups (p = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691-1.737, p = 0.699). Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.

Hamaguchi K ，Sakakura K ，Jinnouchi H ，Taniguchi Y ，Yamamoto K ，Tsukui T ，Hatori M ，Kasahara T ，Watanabe Y ，Ishibashi S ，Seguchi M ，Fujita H ... -  《-》

[Long-term clinical outcomes after percutaneous coronary intervention for ST-segment elevation myocardial infarction due to late and very late stent thrombosis].

Li X ，Yang Y ，Gao M ，Li C ，Wu X ，Liu Y ，Gao J ... -  《-》

Electrocardiographic findings for predicting the left anterior descending artery chronic total occlusion in patients with inferior ST-segment elevation myocardial infarction.

In determining the culprit vessel responsible for inferior ST-segment elevation myocardial infarction (STEMI) as either the right coronary artery (RCA) or left circumflex (LCX), the electrocardiographic value has been validated. However, its ability to predict whether inferior STEMI is complicated by left anterior descending artery (LAD) chronic total occlusion remains uncertain. Based on the involvement of arteries other than the culprit vessels, 189 patients with inferior STEMI from our chest pain center were categorized into four groups: LAD occlusion group (n = 20), LAD stenosis > 50% group (n = 116), normal LAD group (n = 27), and other vessel stenosis > 50% group (n = 26). All groups underwent coronary angiography within 24 h of admission, and electrocardiogram (ECG) and clinical data were retrospectively analyzed. In the LAD occlusion group, hypertension was significantly more prevalent (P = 0.015). Although there was a trend toward higher previous cerebral infarction and lower diabetes prevalence in the Normal LAD group, neither was statistically significant (P = 0.070 and P = 0.088). The LAD occlusion group demonstrated the highest serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the most reduced LVEF, with a higher susceptibility to cardiogenic shock (P < 0.01). This group also had a higher use of intra-aortic balloon pump (IABP) and a greater occurrence of ventricular fibrillation or tachycardia compared to the other groups (P < 0.05). The QRS duration in lead V4 (QRS V4) was 99.4 ± 19.1 ms in the LAD occlusion group, 87.5 ± 14.9 ms in the LAD stenosis group, 89.6 ± 11.4 ms in the normal LAD group, and 87.7 ± 11.7 ms in the other vessel stenosis group (P = 0.010). The difference between ST-segment depression in V4 and ST-segment elevation in lead III (ST V4↓- ST III↑) in the LAD occlusion group was the largest at -0.06 (-1.19, 1.05) mm (P = 0.029). ROC curve analysis revealed that the sensitivity of QRS V4 > 97.7ms and ST V4↓- ST III↑> 0 mm diagnosing inferior STEMI complicated with LAD occlusion was 54.5% and 50%, with a specificity of 75.1% and 78.0%, respectively. Multivariate logistic regression analysis indicated that QRS V4 (OR = 1.062, P = 0.003), ST V4↓- ST III↑ (OR = 1.641, P = 0.050), and Killip classification (OR = 2.115, P = 0.004) were all independent risk factors for LAD occlusion. In patients with inferior STEMI complicated by LAD occlusion without anterior myocardial infarction, cardiac function is poorer. The ST-segment deviation between the leads V4 and III, and the duration of QRS in the lead V4, can aid in diagnosis.

Zheng X ，Zhang Z ，Yao B ，Wu H ... -  《Scientific Reports》

Comparison of clinical outcomes between direct and indirect transfer in patients with ST-segment elevation myocardial infarction.

Primary percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-segment elevation myocardial infarction (STEMI). Previous studies suggest that direct transport by ambulance to a primary PCI facility is associated with better clinical outcomes in patients with STEMI. However, those studies included seriously ill patients for whom direct transport is the only option. We included 462 patients with STEMI who were supposed to select either direct transport by ambulance or indirect transport via primary care doctor, and compared the clinical outcomes between the direct transfer group (n = 172) and the indirect transfer group (n = 290). The primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, and target vessel revascularization. The median follow-up duration was 540 days (86-1266 days). Age was significantly higher in the indirect transfer group [72.0 (64-80) years] than in the direct transfer group [69.5 (58.3-77) years] (p = 0.013). Onset to balloon time was significantly shorter in the direct transport group (p < 0.001). The Kaplan-Meier curves revealed that MACE were similarly observed between the two groups (31.4% vs. 27.2%; p = 0.330). After adjusting for potential confounders, indirect transfer was not associated with MACE (adjusted hazard ratio: 0.740, 95% confidence interval: 0.485-1.128, p = 0.161). In conclusion, indirect transfer was not associated with poor clinical outcomes in patients with STEMI who were supposed to select either direct transport or indirect transport.

Hai Y ，Sakakura K ，Jinnouchi H ，Taniguchi Y ，Yamamoto K ，Tsukui T ，Hatori M ，Kasahara T ，Watanabe Y ，Ishibashi S ，Seguchi M ，Fujita H ... -  《-》

Comparison of Clinical Outcomes Between Early and Delayed Percutaneous Coronary Intervention for the Culprit Lesion in Patients with Non-ST-Segment Elevation Myocardial Infarction.

Ota Y ，Sakakura K ，Jinnouchi H ，Taniguchi Y ，Yamamoto K ，Tsukui T ，Hatori M ，Kasahara T ，Watanabe Y ，Ishibashi S ，Seguchi M ，Fujita H ... -  《-》