الفهرس 
IntroductionOnly 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 be 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 PCI, direct admission to a PCI center was associated with significantly lower in –hospital and 12-month mortality rate vs. transfer to a PCI center through a regional non-PCI–capable facility.
Repeated acute myocardial infarction (AMI) is a deteriorated condition with high in-hospital morbidity and mortality, which can be attributed to the frequent high in-hospital morbidity and mortality, which can be attributed to the frequent coexistence of multivessel disease and shock.
In our study ,A group of 100 patients admitted to National Heart Institute and cardiology department of Banha university , presented with acute myocardial infarction (STEMI) were included in this prospective study for collection of data and in hospital follow up and they were classified into two groups:
• group I: Included 50 patients presented with first time STEMI.
• group II: Included 50 patients presented with recurrent STEMI.
We selected all Patients with ST segment elevation myocardial infarction. STEMI was diagnosed by elevation of cardiac biomarkers associated with symptoms of ischemia and a new ST elevation, or new onset left bundle branch block (LBBB), that underwent primary PCI as a
revascularization treatment irrespective of age, gender, race and clinical severity
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.
All patients subjected to History taking, Clinical data ,ECG, Laboratory data, Echocardiography, Coronary angiography and primary PCI, In-hospital course and Informed written consent.
The present study showed no statistical significant difference between the two groups as regard to age and sex, hypertension, dyslipidemia and history of previous CABG of coronary artery disease.
Our study showed statistically significant difference between the two groups regarding diabetes mellitus ( DM ) , smoking , previous PCI and Killip’s class > 2, as they were more with recurrent MI group.
In our study, we found no significant difference between the two groups regarding Troponin level and lipid profile except for triglycerides as it was higher with recurrent MI group than first MI group.
Our study showed that group (2) had worse systolic function than group (1) with statistically significant difference regarding the Ejection fraction, and had no significant difference between the two groups regarding severity of mitral regurgitation and ECG changes .
In our study, we found that recurrent MI group showed more one culprit artery and multivessel disease than showed in the other group.
Regarding TIMI flow grades ,we found no significant difference between the two groups in pre PCI TIMI flow grade and post PCI TIMI flow grade.
There was higher all-cause mortality and number of deaths in recurrent MI group than the first MI group, but with no statistically significant difference between the two groups due to small size of the study groups, and the risk to develop in-hospital MI complication was higher in the group (2) especially heart failure and VT or VF .
The present study provides evidence that the number of diseased vessels ≥2 or diseased LMT, post TIMI flow, KILLIP class >2 and DM are an independent risk factors of in-hospital morbidity and mortality in recurrent-MI patients undergoing primary PCI, but we found KILLIP class >2 , more than one culprit vessel and post TIMI flow are the independent predictors of morbidities and mortality regarding to first MI group.It’s recommended to Improve health awareness and receive appropriate secondary prevention after the first AMI.