Mugur Marinescu

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

Background: Coronary artery disease (CAD) remains a significant global health concern, being one of the most important contributors to morbidity and mortality worldwide. Accurate assessment of coronary lesions is crucial for guiding appropriate interventions and optimizing patient outcomes. Patients with acute myocardial infarction represent a population which is rarely selected in studies of intracoronary hemodynamics. Fractional Flow Reserve (FFR) has emerged as a valuable physiological index for evaluating the functional significance of coronary lesions, although the data of intravascular hemodynamic evaluation in patients with acute myocardial infarction is scarce [1-3]. In recent years, advancements in intravascular imaging techniques, such as Optical Coherence Tomography (OCT), have provided detailed insights into coronary anatomy both in acute or elective settings. [4-7]. Methods: This article aims to explore the correlation between different non-culprit vessel OCT-parameters and FFR value in the patients with recent acute myocardial infarction. The study included 114 patients with acute myocardial infarction (ST elevation myocardial infarction and non ST elevation myocardial infarction)for whom primary PCI (percutaneous coronary intervention) was performed for the culprit lesion. The non-culprit vessels with intermediate coronary stenoses (157 lesions) were evaluated in a staged procedure (during the index hospitalization) with OCT, FFR and revascularization was performed accordingly. Minimal luminal area (MLA) and percent luminal area stenosis (PSA) were analyzed in relation with the FFR value. Results: There is good correlation between OCT-derived parameters and FFR values in patients with recent acute myocardial infarction. Minimal luminal area (MLA) and percent luminal stenosis area (PSA) were independent predictors of FFR< 0,80 in multivariate logistic regression analysis. A value of 2,08 mm2 for the MLA and 76,85 % for the PSA have proved to be the best cut-offs for predicting a FFR< 0,80. Conclusions: OCT parameters are valuable additional tools in current angiographic practice, including patients with acute myocardial infarction, with the ability to bring numerous direct imagistic and indirect hemodynamic information.