Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy.

BACKGROUND: Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI). METHODS: This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018-2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again. RESULTS: In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07). CONCLUSION: The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.

The factors related to hospitalization period in patients with acute myocardial infarction treated after primary percutaneous coronary intervention.

BACKGROUND: Decreasing the hospital length of stay (LOS) in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is an issue which is related to reducing hospital costs. This study was aimed to determine the average number of hospital LOS among patients with STEMI treated by PPCI and predictors of longer LOS. METHODS: This cross-sectional study was performed on 561 patients with STEMI who referred to Heshmat Hospital, Rasht, north of Iran, within 2015-2018. As soon as STEMI was detected, patients were transferred to the catheterization laboratory (cath lab) in the shortest possible time and underwent PPCI. A questionnaire including characteristics of patients, procedures, and in-hospital adverse events was completed. Data were analyzed with SPSS software. RESULTS: The mean age of patients was 59.36 ± 11.90 years. 74.2% (n = 416) of subjects were men and 25.8% (n = 145) were women. The hospital LOS of 3 to 6 days had the highest prevalence up to 47%. The results of the multiple logistic regression showed that risk of hospital LOS > 6 days in unsuccessful percutaneous coronary intervention (PCI) was 33.2 versus 66.8 in successful PCI (P = 0.001). Moreover, the risk of hospital LOS > 6 days in subjects who had post-procedure complication, problems at admission, and primary comorbidities was 9.13 (7.22-11.53)-fold, 4.09 (2.86-5.85)-fold, and 1.75 (1.35-2.27)-fold more than those who had not, respectively. CONCLUSION: By identifying controllable predictive factors associated with prolonged hospitalization after PPCI, the length of hospitalization can be decreased; also, the patient remission can be enhanced and hospital costs reduced.

Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention.

Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00-1.09), hypertension (OR=2.91, 95% CI:1.35-6.27), diabetes (OR=4.18, 95% CI:1.89-9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02-12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88-9.77), chronic heart failure (OR=4.96, 95% CI:1.23-20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46-39.2 ), anemia (OR=3.42, 95% CI:1.33-8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19-0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow.

Prevention of Contrast-induced Nephropathy With Oxygen Supplementation: a Randomized Controlled Trial.

INTRODUCTION: The aim of the study was to investigate the efficacy of nasal oxygen as a supplementation to hydration therapy in reducing the risk of developing contrast-induced nephropathy (CIN). MATERIALS AND METHODS: In a randomized controlled trial, 348 patients scheduled to undergo elective coronary angiography were randomly allocated to standard hydration plus 2 L/min to 3 L/min nasal oxygen (from 10 minutes before the procedure until the end of the procedure) (n = 176) or standard hydration alone (n = 176). The primary outcome measure was development of CIN defined as either an increase of 25% or more in serum creatinine concentrations or an increment of at least 0.5 mg/dL in serum creatinine concentrations 48 hours after catheterization. RESULTS: Of the 348 patients who completed the study, 105 developed CIN (30.2%; 95% confidence interval, 25.4% to 35.0%). A diagnosis of CIN was made in 32 (18.6%) and 73 (41.5%) patients in the nasal oxygen and control arms, respectively (P < .001). In the intervention arm, creatinine concentrations postcontrast remained relatively constant (average change, 2.7%), whereas a significant increase of 17.3% was recorded in the control arm (P < .001; effect size, 11.8%). CONCLUSIONS: Supplementation with nasal oxygen in addition to standard hydration appears to be an effective strategy in reducing CIN. The effect size for this intervention seems to be moderate.

Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery.

BACKGROUND: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. OBJECTIVE: To determine the impact of postoperative AF (POAF) on long-term outcome in a large cohort of patients who underwent CABG. PATIENTS AND METHODS: We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. RESULTS: In this study, atrial fibrillation developed after CABG in 156 patients (15.8%). Patients with POAF were generally older (P = 0.001) and presented more often with comorbidities including congestive heart failure (P = 0.001), hypertension (P = 0.001), peripheral vascular disease (P = 0.001), hyperlipidemia (P = 0.009), and renal failure (P = 0.001). Five-year mortality was observed in 23 (2.3%) patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality (HR, 3.3; 95% CI, 0.04-10.8, P = 0.04) and morbidity rates (HR, 4.0; 95% CI, 2.35-6.96, P = 0.001). CONCLUSIONS: Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft.