Strategies to Reduce the Door-to-Device Time in ST-Elevation Myocardial Infarction Patients.

Background: Performing primary percutaneous coronary intervention (PPCI) in a timely fashion is a crucial part of the management of ST-elevation myocardial infarction (STEMI). We aimed to evaluate the contributing factors to and the etiologies of a prolonged door-to-device (D2D) time. Methods: In 2016, the D2D time was measured in all patients who were treated with PPCI at Tehran Hear Center. The major causes of a prolonged D2D time (>90 min) were determined. The second phase was then started in 2017 by focusing on the determined causes, and direct feedback was given to anyone having contributed to the delayed D2D time. The D2D time was compared between these 2 years. Results: The mean age of the patients was 59.54±11.82 years, and 82.2% of them were men. The median D2D time decreased from 55 minutes (IQR25-75%: 40-82) in 2016 to 46 minutes (IQR25-75%: 34-70) in 2017 (P<0.001). In the first year, 79.8% of the patients had a D2D time of below 90 minutes; the figure rose to 84.1% of the patients in the second year (P=0.017). The first cause of a prolonged D2D time was missed ST-elevation in the first electrocardiogram by physician or nurse (8.4% of the cases). Along with a declining rate of missed STE to 6.7%, the median D2D time in the missed patients also decreased from 205 minutes to 177 minutes (P=0.011). The rate of ambulance arrival increased from 10.2% to 20.7% of the cases, and the median D2D time also declined from 45 (IQR25-75%: 34-55) to 34 (IQR25-75%: 25-55) in these patients (P<0.001). Conclusion: Even in the setting of a 24/7 on-site interventionist in the hospital, the dispatch system and prehospital electrocardiograms, along with regular assessment and feedback, may improve the D2D time.

The Effect of Omega-3 Fatty Acids on Serum Apelin Levels in Cardiovascular Disease: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Omega-3 fatty acids have been shown to have both anti-atherogenic and anti-inflammatory effects through inducing the expression and production of adipokines. Adipokines such as apelin, have been observed to play a protective role in the incidence and progression of CVD. The aim of this study was to assess the influence of omega-3 fatty acids supplementation on the serum apelin levels in patients with cardiovascular disease. METHODS: Forty-six male patients with CVD participated in the study. Patients were randomly allocated into two groups receiving either omega-3 fatty acids or a placebo. Participants received 4 g of omega-3 fatty acids (EPA: 720 mg, DHA: 480 mg) or a placebo (edible paraffin) for 8 weeks. Serum apelin levels, high sensitive C-reactive protein (hs-CRP), and lipid profiles were measured. Dietary intake, anthropometric parameters, body composition, systolic and diastolic blood pressure were evaluated before and after the 8 weeks of intervention. Statistical analyses were performed using SPSS version 22. RESULTS: Two participants from the placebo group withdrew from the study. Prior to the intervention, no significant differences were present between the two groups in age, body mass index, body composition, dietary intakes, lipid profiles and blood pressure. Compared to placebo, the intake of omega-3 fatty acids increased serum apelin levels (p= 0.018), decreased the levels of LDL cholesterol, and decreased serum hs-CRP concentrations (p= 0.007, p= 0.011 respectively). Additionally, the concentrations of VLDL, TG and hs-CRP (p= 0.037, p= 0.037 and p= 0.016 respectively) declined compared to baseline and final values in the omega-3 fatty acids group. CONCLUSION: Omega-3 fatty acid supplementation increases serum apelin and HDL concentrations, while decreasing serum LDL-C and hs-CRP levels.

Demographics and Angiographic Findings in Patients under 35 Years of Age with Acute ST Elevation Myocardial Infarction.

BACKGROUND: ST-elevation myocardial infarction (STEMI) is a major cause of cardiovascular mortality worldwide. There are differences between very young patients with STEMI and their older counterparts. This study investigates the demographics and clinical findings in very young patients with STEMI. METHODS: Through a review of the angiography registry, 108 patients aged ≤ 35 years (Group I) were compared with 5544 patients aged > 35 years (Group II) who underwent coronary angiography after STEMI. RESULTS: Group I patients were more likely to be male (92.6%), smokers, and have a family history of cardiovascular diseases (34.6%). The prevalence of diabetes, dyslipidemia, and hypertension was higher in the old patients. Triglyceride and hemoglobin were significantly higher in Group I. Normal coronary angiogram was reported in 18.5% of the young patients, and in 2.1% of the older patients. The prevalence of single-vessel and multi-vessel coronary artery disease was similar in the two groups (34.3% vs. 35.2%). The younger subjects were more commonly candidates for medical treatment and percutaneous coronary intervention (PCI) (84.2%), while coronary artery bypass grafting (CABG) was considered for the 39.5% of their older counterparts. CONCLUSION: In the young adults with STEMI, male gender, smoking, family history, and high triglyceride level were more often observed. A considerable proportion of the young patients presented with multi-vessel coronary disease. PCI or medical treatment was the preferred treatment in the younger patients; in contrast to their older counterparts, in whom CABG was more commonly chosen for revascularization.

In-hospital and mid-term clinical outcomes after percutaneous coronary intervention with the use of sirolimus- or paclitaxel-eluting stents.

BACKGROUND: Drug-eluting stents improved the outcome after percutaneous coronary intervention (PCI), however, there may be significant differences in their safety and efficacy. AIM: To compare the in-hospital and mid-term clinical outcomes of stenting with sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) for the treatment of coronary artery lesions in our routine practice. METHODS: This study was performed on 1311 consecutive patients treated exclusively either with SES or PES in our hospital between March 2003 and March 2007. Patients with acute myocardial infarction (MI) within the preceding 48 hours were excluded. The data were recorded in our computerised database, and analysed with appropriate statistical methods. RESULTS: The frequency of angulated segments and proximal segment tortuosity was higher in the PES group (p = 0.001 and p < 0.001, respectively), while ostial and left anterior descending artery lesions were more frequently treated with SES (p < 0.001 and p = 0.022, respectively). The rate of in-hospital non-Q wave MI was higher in the SES vs. PES group (2.2 vs. 0.7%, p = 0.039). In multivariate analysis, the relationship between type of stent and in-hospital non-Q-wave MI became less significant (p = 0.083). During follow-up, 5 patients in the SES vs. 3 in the PES group died (0.7% in each group, p = 0.749). The frequency of major adverse cardiac events (MACE) and target vessel revascularisation (TVR) in the SES vs. PES group was similar (5.5 vs. 3.3%, p = 0.138, and 2.9 vs. 1.6%, p = 0.213, respectively). In multivariate analysis, reference vessel diameter was an independent predictor of both TVR (HR = 0.170, 95% CL 0.034-0.837, p = 0.029) and MACE (HR = 0.333, 95% CL 0.120-0.925, p = 0.035). CONCLUSION: During mid-term follow-up, sirolimus-eluting stents and paclitaxel-eluting stents demonstrate similar clinical outcomes.