الفهرس 
Acute Myocardial InfarctionOnly 14 pages are availabe for public view
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Abstract
Acute coronary syndrome (ACS), the acute manifestation of ischemic heart disease, remains a major cause of morbidity and mortality worldwide. Spontaneous ACS can caused by plaque fissure, plaque erosion, or functional alterations of epicardial coronary arteries or by vasoconstriction of the microcirculation. Patients with STEMI treated with primary percutaneous coronary intervention (PPCI), direct admission to a PCI center was associated with significantly lower rate of in–hospital and 12- month mortality vs. transfer to a PCI center through a regional non-PCI– capable facility. In our study, a group of 100 patients admitted to Tanta university hospital during the period from of March 2019 to December 2019, presented with ST segment elevation myocardial infarction (STEMI), patients underwent primary PCI within 12 hours of symptoms onset. All patients underwent physical examination and coronary risk factor assessment through a complete medical history , ECG , laboratory data Additionally, Killip class examinations of all patients were recorded thrombolysis in myocardial infarction (TIMI) risk score (TRS),global registry of acute coronary events (GRACE) risk score (GRS),TIMI risk index (TRI) were assessed for all patients . Coronary blood flow patterns after p-PCI subjected to a thorough evaluation based on TIMI flow grade, using grades 0, 1, 2, and the final TIMI flow grade and myocardial blush grade (MBG) were assessed using standard methods. Patients classified into two groups: • group A, Reflow group: Included 81 patients • group B, No reflow group: Included 19 patients We selected all Patients with ST segment elevation myocardial infarction that underwent primary PCI. STEMI diagnosed by elevation of cardiac biomarkers associated with symptoms of ischemia and a new ST elevation, or new onset left bundle branch block (LBBB). We excluded Patients with stable angina or unstable angina or NSTEMI, patient with renal impairment, patients who refused participation in our study and patients with delayed presentation with MI. The study showed statistical significant difference between two groups as regard age , it was more with group B ,The present study showed no statistical significant difference between the two groups as regard to gender and other demographic criteria , hypertension, dyslipidemia , smoking , family history and history of previous IHD, previous PCI. Our study showed statistically significant difference between the two groups regarding admission SBP, admission heart rate, Killip class; they were more with group B. In our study, we found that the time from onset of symptoms to presentation had significant difference between two groups. Regarding admission laboratory findings, we found no significant difference between the two groups in serum creatinine, serum CKMB was higher with group B. Regarding scores, we found the mean results of TIMI risk score, GRACE score, and TIMI risk index were higher in group B. Our study showed statistically significant difference regarding the Ejection fraction, LVEDV, LVESV, LA diameter. There was no statistically significant difference between the two groups according to infracted related artery (IRA), it was higher in group B with no significant difference regarding number of affected vessels. There was higher advanced heart failure, pulmonary edema, cardiogenic shock, cardiopulmonary resuscitation, ventricular arrhythmia and number of deaths in group B than group A, but with no statistically significant difference between the two groups regard to, complete atrioventricular block. our study demonstrated TRI which can predict mortality , may be easier to assess and can be scored with fewer parameters in patient with STEMI , our study demonstrated the relationship between risk score GRS ,TRS ,TRI and showed that these scores were significantly associated with angiographic no reflow(NRF) phenomenon and major acute cardiac events (MACEs) and PCI success.