Assessment of the Relationship between Reperfusion Success and T-peak to T-end Interval in Patients with ST Elevation Myocardial Infarction Treated with Percutaneous Coronary Intervention or Pharmacoinvasive Therapy

Background: Acute coronary syndrome encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). STEMI is mostly caused by coronary artery occlusion which treated either by fibrinolytic therapy or primary percutaneous coronary intervention (pPCI). The aim of this work was to investigate the relationship between therapeutic plasma exchange (TPE) interval and successful perfusion in patients with STEMI treated with pPCI or pharmaco-invasive therapy.

Methods: This cohort prospective study was carried out on 60 patients admitted to cardiology department in Tanta University Hospitals with STEMI. All patients were subjected to full medical history taking, clinical examination, laboratory investigations, electrocardiography, transthoracic echo Doppler study, coronary angiography, follow up for early outcome during hospital stay and late outcome after 3 months and assessment of thrombolysis in myocardial infarction (TIMI) flow.

Results: There was a statistically non-significant difference regarding age, gender, hypertension and diabetes between both groups. Regarding vessel affected, in group I, there were 20% with RCA lesion, 46.7% with LAD lesion and 33.3% with LCX lesion while in group II there were 30% with RCA lesion, 43.3% with LAD lesion, 20% with LCX lesion and 6.7% was LM with statistically non-significant difference between the groups. In comparison TPE preprocedural and TPE post-procedural in successful PCI group, there was statistically highly significant difference with P value 0.001. While comparing TPE preprocedural and TPE Postprocedural in failed PCI group, there was statistically non-significant difference with P value =0.09. ROC curve analysis was done to pick up the best cut off value of TPE at admission for prediction of Pharmaco-invasive group which revealed TPE at admission more than 104.5 with sensitivity 73.3% and specificity 63.3%. Area under the curve 0.725 with 95% CI ranged from 0.596 to 0.854.

Conclusions: The present study demonstrated that prolonged TPE interval is associated with ischemia and thus shortened TPE could be used as a marker for reperfusion success. TPE prolongation also associated with poor prognosis in patients with STEMI