Background: Bleeding during or after primary percutaneous coronary intervention (PCI) is the most common noncardiac complication in patients treated for cardiac ischemic events. The present study aimed to compare bleeding complications between primary and rescue PCI procedures. Methods: In a prospective study, the recorded files of 95 consecutive patients who underwent one of the 2 procedures of primary PCI (n=90) or rescue PCI (n=5) were evaluated. The consequences of bleeding were assessed through the measurement of serum hemoglobin levels before, immediately after, and 24 hours after the procedures. Within the hospitalization period and before discharge, any occurrence of bleeding was recorded. Results: Regarding postoperative events, hematoma was revealed in 3. 3% in the primary PCI group and 20% in the rescue PCI group, with no significant difference (P=0. 224). Additionally, gastrointestinal bleeding was reported in 2. 2% of the patients who underwent primary PCI and none of those in the other group, without any difference (P=0. 999). In total, postoperative morbidity was seen in 5. 6% in the primary PCI group and in 20% in the rescue PCI group, with no difference (P=0. 314). The mean of the decreased level of serum hemoglobin in the primary PCI group and the rescue PCI group was 1. 22± 1. 31 and 1. 33± 0. 90, respectively, with no difference (P=0. 849). A multivariate linear regression model, after adjustments for the baseline parameters, showed no difference between the 2 procedures regarding the decreased level of serum hemoglobin. Advanced age was the only variable able to predict higher morbidity. Conclusions: There were no significant differences in postprocedural complications regarding major bleeding between the 2 procedures of rescue PCI and primary PCI. The main predictor for bleeding after PCI was advanced age.

Background: In patients with ST-segment elevation myocardial infarction (STEMI), Primary percutaneous coronary intervention (PCI) is the preferred reperfusion therapy. Timely primary PCI is essential in improving the clinical outcomes of these patients. The aim of this study was to evaluate the factors affecting balloon delay in STEMI treated patients by primary PCI and its relationship with major adverse cardiac events (MACE). Methods: This prospective observational study was conducted on 143 cases of STEMI patients, who had the inclusion criteria and were treated by primary PCI, after obtaining written consent in Imam Khomeini hospital in Ahvaz, between May 2019 to May 2020. Alltime components from symptom onset to PCI treatment include symptom-to-balloon time or ischemic time, symptom-to-door time and door-to-balloon time calculated. The incidence of major adverse cardiovascular events (MACE) including decompensated heart failure (DHF), acute coronary syndrome (ACS), sudden cardiac death (SCD) and cerebrovascular accident (CVA) was evaluated during 12 months follow up after primary PCI. left ventricular ejection fraction (LVEF) changes were evaluated 3 months after primary PCI. Results: The median symptom-to-door time was 200. 5 minutes (IQR: 90-438. 75 min), the median ischemic time was 406 minutes (IQR: 231-671 min), and most patients had an ischemic time ≥, 120 minutes (92. 4%) and door-to-device time ≥, 90 minutes (64. 3%). The most common delay for treatment was in the symptom-to-door time (76. 9%) and then the decision for primary PCI to transfer to the cat lab (17. 5%). Overall, 59 (41. 3%) of the patients experienced MACE during 1-year of follow-up, including ACS (13. 3%), DHF (22. 4%), cardiac death (9. 8%) and CVA (2. 1%). The patients age (OR: 0. 96, P=0. 020), LVEF changes (OR: 1. 123, P=0. 005) and STEMI type (OR: 0. 705,P=0. 039) predicted in-hospital MACE, while the symptom-to-balloon time (P=0. 607) and doorto-balloon time (P=0. 347) were not associated with MACE. Conclusion: None of the time intervals were associated with the occurrence of MACE in one-year follow-up, and most STEMI patients were admitted to the hospital with a long delay. Therefore, efforts to shorten the time of hospitalization admission can help improve the MACE in STEMI patients under primary PCI in our medical centers.

Background: Well-timed primary percutaneous coronary intervention (PCI) is known to improve survival, limit infarct size, and improve left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI). Nonetheless, many patients do not recover their LV contractile function after primary PCI and eventually progress to heart failure. This study aimed to assess the predictors of improvement in LVEF after successful primary PCI among patients presenting with STEMI within 12 hours of symptom onset. Methods: Our single-center, prospective, observational study enrolled 246 consecutive STEMI patients presenting within 12 hours of symptom onset. All the patients underwent echocardiography at presentation and at a 3-month follow-up. Multivariate analysis was used to identify the predictors of improvement in LVEF in the course of the convalescent phase. Results: Data of 239 patients were analyzed for the study. The mean age of the patients was 54. 2±, 11. 3 years, and 90% of the patients were male. Diabetes and hypertension were prevalent at 44. 8% and 38. 9%. The average total ischemic and door-to-balloon time was 260 (175–, 440) and 60 (40–, 65) minutes, respectively. LVEF showed improvement in more than half of the patients (57. 7%) at 3 months’,follow-up. The binomial regression analysis of various variables, predicting LVEF improvement at 3 months, showed that the most significant predictor of LVEF improvement was a shorter total ischemic time (P<0. 001,OR, 1. 01,95% CI, 1. 00 to 1. 01), followed by LVEF of 40% or higher at presentation (P<0. 02,OR, 1. 01,95% CI, 0. 95 to 1. 01). Conclusions: In patients with STEMI, the total ischemic time and LV systolic function at presentation can help predict EF recovery after successful primary PCI. Patients at risk can be treated with aggressive medical management.

Background: For several years now, primary percutaneous coronary intervention (PPCI) has been considered an effective treatment for ST-elevation myocardial infarction (STEMI). Efforts have been made to reduce the time interval between the patient’, s admission to the hospital and PPCI. We evaluated the effect of the time interval between patients’,admission to the emergency department and PPCI on left ventricular ejection fraction (LVEF) in patients with STEMI. Methods: The target population comprised patients who were admitted to the Emergency Department of Shahid Mohammadi Hospital with acute STEMI and scheduled for PPCI between 2017 and 2018. Eventually, 174 patients, who met the inclusion criteria, were investigated using a questionnaire, and the data were analyzed by SPSS20. Results: From the 174 patients diagnosed with acute STEMI, 72% were male and 28% were female. The mean age of the patients was 57. 2 years (SD= ±, 13). A statistically significant linear relationship existed between symptom-to-balloon time and LVEF (P≤, 0. 05), but no statistically significant linear relationship existed between the door-to-balloon time (DBT) and LVEF (P≤, 0. 05). Conclusions: Reducing symptom-to-balloon time in PPCI for patients with acute STEMI could preserve LVEF and improve prognosis.

Background: Primary percutaneous coronary intervention is the standard of care for ST-elevation myocardial infarction (STEMI). However, the proper management of the culprit artery with residual moderate-to-high thrombus burden after the initial restoration of flow is still unclear. Methods: One hundred patients with STEMI underwent primary percutaneous coronary intervention, through which the operators managed to establish thrombolysis in myocardial infarction (TIMI) II– III flow with minimal manipulation but with residual moderate-to-high thrombus burden in the culprit artery. The patients were categorized into 2 equal groups. Group A consisted of patients who underwent immediate stenting, and Group B was comprised of patients for whom the intervention was deferred. After 24 to 48 hours, coronary angiography was repeated in Group B, and stenting was done when needed. The patients had pre-discharge echocardiography and were followed for 4 weeks for major adverse cardiac events (MACE); additionally, echocardiography was repeated 1 month after discharge Results: There was no difference between the 2 groups regarding the TIMI flow of the culprit artery at the end of the revascularization procedure. There was a significant difference between the groups concerning the need for coronary stenting, which was lower in the deferral group (100% of the patients had stents in Group A vs 58% in Group B; P = 0. 000). No significant difference was observed between the immediate and the deferral groups apropos the in-hospital morbidity/mortality or left ventricular function. At follow-up, there was no difference between the 2 groups vis-à-vis MACE and left ventricular function. Conclusions: Deferred stenting is beneficial in reducing the need for stenting and the associated mortality/morbidity.

Background: Primary percutaneous angioplasty is a modality of choice to restore reperfusion in infarct related artery now. No-reflow phenomenon is a complication of this modality that increase mortality and morbidity of patients. Assessment of its associated and predictor factors may be useful to its prevention.Methods: All patients with ST elevation myocardial infarction (STEMI) who treated with primary percutaneous angioplasty during 30 months were enrolled to the study. Then patients with and without no-reflow phenomenon assigned to two groups and statistical analysis was performed.Results: Twenty one cases of no-reflow were found in total 263 cases of primary PCI (7.9%). Mean age and prevalence of risk factors such as diabetes mellitus, smoking, hypertension and hyperlipidemia wasn't different in two groups. No- reflow was observed more frequently in females (P<0.01). Mean symptom to balloon time was longer in No-reflow group (P<0.01). Patients with no- reflow phenomenon have more cardiogenic shock, less predischarge ejection fraction, more inhaspital mortality, longer stent length, more LAD as infarct related artery and more use of thrombectomy (p value <0.05). There wasn't statistical significant in presence of collateral vessels, visible calcification, GP IIb/IIIa inhibitors usage, predilation, post dilation, and stent diameter (p value >0.05).Conclusion: The study demonstrated that female gender, LAD as infarct related artery, use of long stents and primary PCI in prolonged symptom to balloon time could be predictors of no- reflow phenomenon.