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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Correlation between culprit vessel/tirofiban and reperfusion bradyarrhythmia in patients with ST-segment elevation
1Department of Cardiology, Fuyang People's Hospital of Anhui Province, Fuyang, China. lvlingma0323@163.com.
Insights
Tirofiban does not appear to cause reperfusion bradyarrhythmia (RB) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, right coronary artery culprit vessels may increase the risk of RB.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Percutaneous coronary intervention (PCI) is a standard treatment for STEMI.
- Reperfusion arrhythmias (RA), including bradyarrhythmias (RB), can occur during or after PCI.
Purpose of the Study:
- To investigate the association between culprit vessel and tirofiban use with reperfusion bradyarrhythmia (RB) in STEMI patients undergoing emergency PCI.
- To identify risk factors for RA and RB in this patient population.
Main Methods:
- A retrospective study of 123 STEMI patients undergoing emergency PCI.
- Patients were categorized into reperfusion arrhythmia (RA) and non-RA groups, and reperfusion bradyarrhythmia (RB) and non-RB groups.
- Statistical analyses included univariate analysis, ROC curves, and multivariate logistic regression.
Main Results:
- RA occurred in 59.35% of patients; RB was the most common type (63 cases).
- Patient age (>57 years), inferior wall infarction, and TIMI grade 0 flow were associated with RA.
- Tirofiban was not linked to RB, but culprit vessel location (right coronary artery) and TIMI grade 0 flow were independent risk factors for RB.
Conclusions:
- Tirofiban is not associated with RB in STEMI patients post-PCI.
- Culprit vessel, specifically the right coronary artery, is a significant risk factor for developing RB.
- Managing reperfusion damage is crucial, especially in patients with right coronary artery involvement.
Objective:
To evaluate the correlation between culprit vessel/tirofiban and reperfusion bradyarrhythmia in patients with ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI).
Patients And Methods:
A total of 123 STEMI patients undergoing emergency PCI in our hospital from September 2018 to September 2019 were selected and divided into the reperfusion arrhythmias (RA) group (50 cases) and non-RA group (NRA, 73 cases) according to whether RA occurring during PCI. The baseline data such as age and underlying disease were statistically analyzed. Then, the differences were compared between the two groups. According to whether reperfusion bradyarrhythmia (RB) occurring during PCI, 123 STEMI patients were divided into the RB group (63 cases) and non-RB group (60 cases). The relation between culprit vessel/tirofiban and RB was analyzed. ROC curves analysis and multivariate logistic regression were conducted for the risk factors of RA and RB.
Results:
Among 123 patients with STEMI after PCI treatment, 73 patients had RA (59.35%), including RB 63 cases and tachyarrhythmia 10 cases. Results of single factor analysis showed that there was statistical significance in 3 factors including the patient age, infarction area and vascular blood flow TIMI classification between RA group and NRA group (p<0.05). ROC curve analysis indicated that the continuous variable patent ages had predictive value in the prevalence of RA, which resulting in an AUC 0.624 and a cut-off pointed age 57 (sensitivity 72.60, specificity 52.00). Multivariate regression analysis showed that the patient age (>57 years old), infarction area in inferior wall and grade 0 lesion vascular blood flow TIMI classification in RA group was significantly higher than that in NRA group (p<0.05). Tirofiban was not associated with RB in STEMI patients treated with emergency PCI, while culprit vessel was statistically significant between RB group and NRB group (p<0.05). Multivariate regression analysis indicated that culprit vessel of the right coronary artery and grade 0 lesions vascular blood flowed TIMI classification was independent risk factors to occurring RB in the STEMI patients with emergency PCI.
Conclusions:
Tirofiban was not associated with RB in STEMI patients treated with emergency PCI. However, it may increase the risk of RB development when the culprit vessel is the right coronary artery. Therefore, timely corresponding treatments and reduction of reperfusion damage are of great significance for those patients.
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