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Sample records for acute st segment

  1. Acute Coronary Syndrome and ST Segment Monitoring.

    Carey, Mary G

    2016-09-01

    Acute coronary syndrome (ACS) is caused by a critical obstruction of a coronary artery because of atherosclerotic coronary artery disease. Three specific conditions are included: ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. The ST segment on the electrocardiogram is a sensitive and specific marker of myocardial ischemia and infarction; however, ST segment deviation is regional not global, thus the ECG lead must be placed over the affected region of the myocardium. This article describes ACS and infarction and the use of ST segment monitoring to detect these conditions. PMID:27484662

  2. REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

  3. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita; Tantry, Udaya; Jeong, Young-Hoon; Kozinski, Marek; Engstrøm, Thomas; Di Pasquale, Giuseppe; Kochman, Waclaw; Ardissino, Diego; Kedhi, Elvin; Stone, Gregg W; Kubica, Jacek

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  4. The changes of inflammatory cytokines and their clinical significance in patients of inferior ST-segment elevation acute myocardial infarction with anterior ST-segment depression

    叶明

    2014-01-01

    Objective To investigate the level of Hs-CRP,Fib,IL-6,TNF-α,MDA,SOD,and analyze the correlation between the level of plasma inflammatory cytokines and clinical significance in patients with anterior ST-segment depression.Methods We chose 360 patients with inferior ST Segment elavation acute myocardial infarction from May 2007 to Sep 2012 in emergency department of

  5. Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction

    Herning, Margrethe; Hansen, Peter R; Bygbjerg, B;

    2011-01-01

    BACKGROUND: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay...

  6. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

    Riezebos, R.K.; Ronner, E.; Bals, ter, E.; Slagboom, T.; Smits, P.C.; Berg, ten, A.J.W.M.; Kiemeneij, F.; Amoroso, G.; Patterson, M S; Suttorp, M J; Tijssen, J.G.P.; Laarman, G.J.

    2009-01-01

    BACKGROUND: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data. OBJECTIVE: To compare immediate versus deferred angioplasty in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS: A randomised, prospective multicentre trial was performed in patients admitted with NSTE-ACS, eligible for percutaneous coronary in...

  7. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

  8. Predictive factors predicting inadequate ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

    刘晓宇

    2014-01-01

    Objective To survey ST-segment resolution in STEMI patients undergoing emergency percutaneous coronary intervention(PCI)and to find the specific clinical features of patients with inadequate ST-segment resolution.Methods A total of 198 patients were divided into two groups according to the ratio of ST-segment resolution:relatively adequate ST-segment resolution group(>50%)and inadequate ST-segment resolution group(<50%).

  9. Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations

    The cause and associated pathophysiology of precordial ST-segment depression during acute inferior myocardial infarction (IMI) are controversial. To investigate this problem, electrocardiographic findings in 48 consecutive patients with acute IMI were prospectively compared with results of coronary angiography, submaximal exercise thallium-201 (201Tl) scintigraphy and multigated blood pool imaging, all obtained 2 weeks after IMI, and with clinical follow-up at 3 months. Patients were classified according to the admission ECG obtained 3.3 +/- 3.1 hours after the onset of chest pain. Twenty-one patients (group A) had no or 201Tl perfusion abnormalities (p201Tl defects or wall motion abnormalities in anterior or septal segments

  10. Retrospective Analysis of Thrombolysis Therapy for 64 Cases of Acute Myocardial Infarction with Elevated ST Segment

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

    Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XS...

  11. Latest Advancement of Non ST-segment Elevation Acute Coronary Syndrome

    2008-01-01

    Further understanding of the pathphophisyology, advance of the diagnosis instrument and renovation of the risk delamination standard can offer better therapy evidence for the non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Drugs, such as trigeminy antiplatelet drug, prasugrel, fondaparinux and bivalirudin, have brought great clinical effect to the high risk patients. Since the result of the ICTUS test announced and the drug eluting balloon developed, we have reached the newest recognition of how to select a chance for intervention and how to prevent and cure the restenosis of in-stent.

  12. Thallium-201 evidence that anterior ST segment depression during early acute inferior myocardial infarction reflects septal or posterolateral ischemic injury

    The pathogenesis of anterior (ANT) ST segment depression (ST decreasing) during acute inferior myocardial infarction (IMI) remains controversial. To evaluate the role of septal (S) or posterolateral (PL) ischemic injury (IS), resting thallium-201 (T1-201) scintigrams closely timed to ECG findings (mean 21+-21 minutes) were evaluated in 49 consecutive pts during the first 5 hrs of a first acute IMI. ANT ST decreasing (any lead V1-V4) of ≥ 1.0 mm was considered significant. All 49 pts had inferior T1-201 defects. In all 38 pts with ANT ST decreasing, there was T1-201 evidence of PL and/or S IS. In 9 of 11 pts without ANT ST decreasing, IS was confined to the inferior wall. The magnitude of inferior lead ST segment elevation correlated well with ST decreasing in leads 1 and AVL (r=0.88) and poorly with ST decreasing in anterior leads (r=0.32, supporting the concept that in acute IMI, ST decreasing in 1 and AVL is a reciprocal electrical phenomenon, but that ANT ST decreasing has a different pathogenesis. Thus the authors conclude that anterior ST depression in acute inferior myocardial infarction is associated with additional septal and/or posterolateral ischemic injury and does not reflect a benign reciprocal electrical phenomenon

  13. THE ROLE OF ECG IN LOCALIZING THE CULPRIT VESSEL OCCLUSION IN ACUTE ST SEGMENT ELEVATION MYOCARDICAL INFARCTION WITH ANGIOGRAPHIC CORRELATION

    Markandeya Rao; Ravindra Kumar; Nanditha

    2015-01-01

    BACKGROUND & OBJECTIVES The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to identify the culprit vessel from ECG in patients with acute ST elevation myocardial infarction and correlate with coronary angiogram. MATERIALS & METHODS This is a prospective study, condu...

  14. LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH AND WITHOUT ST SEGMENT ELEVATION

    N. E. Zakirova

    2016-05-01

    Full Text Available Aim. To study the remodeling of the left ventricle (LV in patients with ST segment elevation (STEMI and non-ST segment elevation (non-STEMI myocardial infarction (MI. Materials and methods. Patients (n=99 with acute MI (48 – with STEMI, 51 – with non-STEMI were examined. Diagnosis of MI was set on the basis of the dynamics of myocardial damage markers, data of clinical and electrocardiogram examination. The comparison group consisted of 33 patients with stable angina functional class 2. The control group included 35 healthy men. Structural and functional state of the LV myocardium and types of its remodeling were assessed by echocardiography.Results. It was found that the LV eccentric hypertrophy was the predominated type of LV remodeling in patients with STEMI. Besides, these patients demonstrated disorders of the LV contractile function (LV ejection fraction 40.2±5.49% vs. 61.4±3.91% in control; p<0.05, the LV dilatation (end-systolic volume index 54.1±5.27 vs. 25.2±2.22 ml/m2 in the control; p<0.05, the lowest LV wall thickness (relative wall thickness 0.36±0.01 vs. 0.44±0.01 in control; p<0.05, increase in the LV myocardial stress (168.3±20.17 vs. 108.6±9.82 dynes/cm2 in control; p<0.05, and LV spherification. The majority of patients with non-STEMI revealed combination of concentric and eccentric types of LV remodeling. Their hemodynamic parameters were comparable to those in patients with stable angina, but exceed the control data.Conclusion. In patients with acute MI severity of the LV remodeling correlated with the depth and vastness of myocardial damage. The most significant hemodynamic changes were observed in STEMI.

  15. Prognostic Importance of ST-Segment Resolution in Acute Myocardial Infarction

    Eroğlu M et al.

    2011-02-01

    Full Text Available Some factors may affect prognosis and may be used to determine long term life duration after myocardial infarction. Hence, risk classification after myocardial infarction is of great importance. Coronary reperfusion following fibrinolytic therapy may be detected invasively and non-invasively in myocardial infarction with ST-segment elevation. ST-segment resolution, which is one of non-invasive reperfusion criteria, might be used to determine prognosis, since it reflects myocardial microcirculatory circulation better, and it is an easy, simple, and inexpensive parameter used in clinical practice. In the present study, we evaluated the prognostic importance of ST-segment resolution degree.

  16. Urine cardiac specific microRNA-1 level in patients with ST segment elevation acute myocardial infarction

    段晓霞

    2013-01-01

    Objective To observe the change of urine level of cardiac specific microRNA-1(miR-1) in patients with ST segment elevation acute myocardial infarction(STEAMI) and investigate its potential applications. Methods Urine samples were collected from 20 STEAMI patients within

  17. Use of pharmacoinvasive approach to the treatment of patients with ST segment elevation acute coronary syndrome: state of the problem

    S. R. Gilyarevskiy

    2015-12-01

    Full Text Available Role of pharmacoinvasive tactics in the treatment of patients with ST-segment elevation acute myocardial infarction is considered. The expert opinions reflected in the final version of the guideline are given, as well as the results of clinical trials in which the efficacy of thrombolytic therapy at early stage after acute myocardial infarction onset comparedwith primary percutaneous coronary intervention. The place of pharmacoinvasive tactics in real clinical practice is discussed.

  18. Prognostic Importance of ST-Segment Resolution in Acute Myocardial Infarction

    Eroğlu M et al.

    2011-01-01

    Some factors may affect prognosis and may be used to determine long term life duration after myocardial infarction. Hence, risk classification after myocardial infarction is of great importance. Coronary reperfusion following fibrinolytic therapy may be detected invasively and non-invasively in myocardial infarction with ST-segment elevation. ST-segment resolution, which is one of non-invasive reperfusion criteria, might be used to determine prognosis, since it reflects myocardial microcircul...

  19. Cytotoxic T lymphocyte antigen 4 gene polymorphism associated with ST-segment elevation acute myocardial infarction

    Cytotoxic T lymphocyte antigen 4 (CTLA-4) is a particularly important molecule in down-regulating T-cell expansion and cytokine production. The purpose of the present study was to determine the frequency distribution of an A/G single nucleotide polymorphism at position 49 in exon 1 of the CTLA-4 gene, which may be a functional related-genetic risk marker for the development of ST-segment elevation (ST-se) acute myocardial infarction (AMI). A total of 503 consecutive patients, consisting of 250 ST-se AMI patients undergoing primary coronary angioplasty (group 1), 203 angina pectoris patients undergoing elective coronary angioplasty (group 2) and 50 patients with chest pain and normal coronary angiographic findings (group 3), were enrolled in the present study. The frequency of the G/G genotype was significantly higher in group 1 (53.2%) than in groups 2 (33.0%) and 3 (36.0%) (p=0.0005). In group 1, patients with a G/G genotype had significantly higher levels of high-sensitivity C-reactive protein and white blood cell counts, and much higher incidences of multi-vessel disease, greater lesion lengths, advanced congestive heart failure (≥class 3) and 30-day mortality, than patients with G/A or A/A genotypes (p values<0.05 in all cases). Multivariate analysis of the enrolled baseline variables (age, gender, diabetes mellitus, smoking, hypertension and hypercholesterolemia) and the genotypes (G/G, A/G and A/A) demonstrated that G/G genotype is the only independent predictor of development of AMI (p<0.0001). The G/G genotype polymorphism of the CTLA-4 gene is associated with increased risk of AMI. (author)

  20. THE ROLE OF ECG IN LOCALIZING THE CULPRIT VESSEL OCCLUSION IN ACUTE ST SEGMENT ELEVATION MYOCARDICAL INFARCTION WITH ANGIOGRAPHIC CORRELATION

    Markandeya Rao

    2015-12-01

    Full Text Available BACKGROUND & OBJECTIVES The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to identify the culprit vessel from ECG in patients with acute ST elevation myocardial infarction and correlate with coronary angiogram. MATERIALS & METHODS This is a prospective study, conducted on 126 patients in Osmania General Hospital, Hyderabad. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and later correlated with coronary angiogram. RESULTS Amongst 126 patients in this study, 70 patients had anterior wall and 56 patients had inferior wall myocardial infarction. ST> 1mm in V4R, ST  V3/ST  LIII Lead II was the most sensitive and ratio of STV3/STLIII >1.2 was the most specific criteria. ST in inferior leads > 1mm had maximum sensitivity in localizing occlusion in proximal D1 occlusion proximal to S1 as well. Absence of ST i in inferior leads is the most sensitive criteria in occlusion distal to S1 as well as in distal D1 in AWMI. CONCLUSION The admission ECG in patients with ST elevation AMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

  1. Precordial ST segment depression during acute inferior myocardial infarction: early thallium-201 scintigraphic evidence of adjacent posterolateral or inferoseptal involvement

    To investigate the myocardial perfusion correlates of precordial ST segment depression during acute inferior myocardial infarction, a rest thallium-201 scintigram and a closely timed 12 lead electrocardiogram were obtained within 6 hours of the onset of infarction in 44 patients admitted with their first acute inferior myocardial infarction. Thirty-six patients demonstrated precordial ST segment depression (group 1) and eight did not (group 2). A perfusion defect involving the inferior wall was present in all 44 patients. Additional perfusion defects of the adjacent posterolateral wall (n . 20), the ventricular septum (n . 9) or both (n . 6) were present in 35 of 36 patients from group 1 compared with only 1 of 8 patients from group 2 (p less than 0.001). There was no significant difference in the frequency of multivessel coronary artery disease or disease of the left anterior descending artery between group 1 and group 2 or between patients with and those without a thallium-201 perfusion defect involving the ventricular septum. Thus, precordial ST segment depression during an acute inferior myocardial infarction is associated with thallium-201 scintigraphic evidence of more extensive involvement of the adjacent posterolateral or inferoseptal myocardial segments, which probably reflects the extent and pattern of distribution of the artery of infarction, rather than the presence of coexistent multivessel coronary artery disease or disease of the left anterior descending artery

  2. The effects of tirofiban on acute non-ST segment elevation myocardial infarction patients not receiving early reperfusion intervention

    张大鹏

    2014-01-01

    Objective To study the efficacy of tirofiban in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)without early reperfusion intervention.Methods A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group(n=76)and the control group(n=75).Coronary angiography was performed at day 3 and day 7,while percutaneous coronary

  3. Prognostic Usefulness of Low Ischemic Risk SPECT in non-ST Segment Elevation Acute Coronary Syndromes

    Background: Myocardial perfusion imaging tests are used for the clinical assessment of patients hospitalized with non-ST segment elevation acute coronary syndromes (NSTACS) who have favorable in-hospital outcomes with medical therapy. However, the prognostic relevance of a .low ischemic risk. (LR) single photon emission computed tomography (SPECT) in patients with NSTACS managed with a conservative approach is uncertain, as most of the information derives from patients with chronic coronary artery disease. Objectives: 1) To analyze the outcomes of patients with NSTACS and LR SPECT at discharge, 2) to compare the results of a normal SPECT with transient perfusion defects (TPDs), permanent perfusion defects (PPDs) or combined defects (CDs), and 3) to determine the additional value of SPECT to classic risk variables. Material and Methods: Patients admitted to the CCU with a NSTACS were included. Follow-up was continued during 12 months. Definitions: Clinical risk based on TIMI risk score. LR SPECT (under exercise or pharmacological stress): TPDs ≤ 3/17 segments, PPDs ≤ 3/17 segments, CPDs: TPDs + PPDs and normal: absence of defects. Clinical events (CEs): death/infarction or rehospitalization due to angina. Results: A total of 137 patients were included (median age 59 years, 60% were men). A low TIMI risk score was present in 54% of patients and 46% presented a moderate risk. CE: 5.8%. The incidence of clinical events related to perfusion defects was as follows: normal: 2.1%, TPD: 4.5%, PPD: 5.9% and CPD: 25% (p<0.02). At multivariate analysis, which included age, previous myocardial infarction, TIMI risk score and TPD, only CPD was identified as an independent variable for CEs: OR 7.8 (95% CI 1.2-49); p=0.02. Positive predictive value, negative predicted value, positive likelihood ratio and negative likelihood ratio were 25%, 96%, 5.3 and 0.7, respectively. Conclusions: A LR SPECT is useful for the prognostic assessment of patients with low or moderate risk

  4. Anterior ST segment depression in acute inferior myocardial infarction as a marker of greater inferior, apical, and posterolateral damage

    The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% [mean +/- S.E.M.] vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04) compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury

  5. Acute and subacute stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction : incidence, predictors and clinical outcome

    Hesstermans, A. A. C. M.; van Werkum, J. W.; Zwart, B.; van der Heyden, J. A.; Kelder, J. C.; Breet, N. J.; van't Hof, A. W. J.; Koolen, J. J.; Brueren, B. R. G.; Zijlstra, F.; ten Berg, J. M.; Dambrink, Jan Hendrik Everwijn

    2010-01-01

    Background: Early coronary stent thrombosis occurs most frequent after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Objectives: To identify the specific predictors of, respectively, acute and subacute stent thrombosis in patients after prim

  6. Increasing of the ST segment in the derivations with Q wave in the early effort test after acute myocardial infarction

    Full text: : The objective of this work is to evaluate the raising of the ST segment in the Q wave derivations in the precocious effort test (ET) after acute myocardial infarction (AMI) in patients with AMI of the anterior wall, submitted to thrombolysis. It is a prospective study involving 36 patients (P) with AMI of the anterior wall, consecutively interned in the Coronary Unit and submitted to thrombolysis, between June 1995 to June 1996. All the patients realized ET, according Bruce protocol and isotopic study with Thallium 201, with reinjection until 24 h, both without anti-ischemic therapy. The additional raising of ST greater or equal to 1mm, in two or more consecutive Q wave derivations was considered as positivity criterion in the ET. The quantification of the ischemia and/or viability in Thallium-201 was made through analysis of the tomographic images and the bull's eye, using the habitual criterion of positivity. The obtained results were compared and the sensibility, the specificity, the acuity and the positive and negative predictive values of the ST segment raising were evaluated, in the identification of the ischemia and/or viability detected in the isotopic study. The average age was of 53,4 years old (36-73), 29 (80,5%) were male. From the 21 (58,3%) of the patients who had ischemia and/or viability in Thallium-201, 18 (86%) presented alterations in the ST segment in ET. 24 (66,7%) of the patients who presented alterations in the ST segment in ET, 18 (75%) had also ischemia and/or viability in Thallium-201. Relatively to Thallium-201, the sensibility, specificity, acuity and positive and negative predictive values of the ST segment raising in the Q wave derivations in ET were, respectively of 86%, 60%, 75%, 75% and 75%. The ST segment raising in the Q wave derivations were positively correlated with the existence of ischemia and/or viability in the infarction area. However, it is necessary to continue the study and increase the sample size to

  7. ST-segment analysis to predict infarct size and functional outcome in acute myocardial infarction treated with primary coronary intervention and adjunctive abciximab therapy.

    R. Sciagrà; Parodi, G.; A. Migliorini; Valenti, R.; ANTONIUCCI D; Sotgia, B; Pupi, A

    2006-01-01

    ST-segment resolution is used to classify the response to reperfusion therapy in acute myocardial infarction, but the possibility to predict outcome in individual patients is unclear, particularly in the setting of primary percutaneous coronary intervention (PCI) and abciximab therapy. We studied 213 patients who underwent successful revascularization with PCI. Maximal ST-segment elevation was measured before and 30 minutes after PCI. Patient outcome was defined on the basis of infarct size a...

  8. Virtual histology study of atherosclerotic plaque composition in patients with stable angina and acute phase of acute coronary syndromes without ST segment elevation

    Ivanović Miloš

    2013-01-01

    Full Text Available Introduction. Rupture of vulnerable atherosclerotic plaques is the cause of most acute coronary syndromes (ACS. Postmortem studies which compared stable coronary lesions and atherosclerotic plaques in patients who have died because of ACS indicated high lipid-core content as one of the major determinants of plaque vulnerability. Objective. Our primary goal was to assess the potential relations of plaque composition determined by IVUS-VH (Intravascular Ultrasound - Virtual Histology in patients with stable angina and subjects in acute phase of ACS without ST segment elevation. Methods. The study comprised of 40 patients who underwent preintervention IVUS examination. Tissue maps were reconstructed from radio frequency data using IVUS-VH software. Results. We analyzed 53 lesions in 40 patients. Stable angina was diagnosed in 24 patients (29 lesions, while acute phase of ACS without ST elevation was diagnosed in 16 patients (24 lesions. In the patients in acute phase of ACS without ST segment elevation IVUS-VH examination showed a significantly larger area of the necrotic core at the site of minimal lumen area and a larger mean of the necrotic core volume in the entire lesion comparing to stable angina subjects (1.84±0.90 mm2 vs. 0.96±0.69 mm2; p<0.001 and 20.94±15.79 mm3 vs. 11.54±14.15 mm3; p<0.05 respectively. Conclusion. IVUS-VH detected that the necrotic core was significantly larger in atherosclerotic lesions in patients in acute phase of ACS without ST elevation comparing to the stable angina subjects and that it could be considered as a marker of plaque vulnerability.

  9. Toward a comprehensive approach to pharmacoinvasive therapy for patients with ST segment elevation acute myocardial infarction.

    Dauerman, Harold L; Sobel, Burton E

    2012-08-01

    What exactly is "pharmacoinvasive therapy" for treatment of patients with ST segment elevation myocardial infarction (STEMI)? When this term was introduced in 2003, it addressed the need for clinical trials besides those comparing fibrinolysis with primary percutaneous coronary intervention (PCI). Primary PCI is recognized as the best strategy for treatment of patients for whom it is applicable. However, use of fibrinolytic drugs initially is necessary in many patients for logistic reasons. Studies of pharmacoinvasive therapy addressed the question of what should be done after initial fibrinolysis. Confusion of the terms pharmacoinvasive therapy, facilitated PCI, rescue PCI, and delayed invasive approaches has obscured the principles that have emerged from such studies. In our view, a uniform conceptualization of pharmacoinvasive therapy emerges on the basis of three key considerations--transfer time, initial pharmacologic therapy, and time to PCI. We propose the following definition: Pharmacoinvasive therapy is the treatment of choice for patients with STEMI who require greater than a 60 min transfer time to a PCI center. It entails immediate use of full doses of fibrinolytic agents followed by prompt transfer to a PCI center and a plan to implement PCI within 2-12 h of the time of onset of initial therapy. PMID:22484515

  10. A patient with non-ST-segment elevation acute coronary syndrome: Is it possible to predict the culprit coronary artery?

    Lindow, Thomas; Pahlm, Olle; Nikus, Kjell

    2016-01-01

    In acute coronary syndromes without ST-segment elevation (NSTE-ACS), identification of the culprit artery is, most often, not possible. In this case report, we elaborate on the likelihood of different culprit arteries in a patient with NSTE-ACS. While her symptoms were progressing, typical ECG findings of ischemia in the left coronary territories were diminishing. Instead, dynamic T-wave changes in the inferior leads were present and were most likely postischemic and "reischemic." Although the culprit artery could not be identified with certainty by means of these subtle changes, they correlated well with the findings on angiography and the ECG recorded afterward. This case report demonstrates the importance of analyzing ECG and its temporal changes in conjunction with evolving symptoms. PMID:27212142

  11. Changes in cardiac specific microRNA-208a level in peripheral blood in ST segment elevation acute myocardial infarction patients

    姚怡

    2013-01-01

    Objective To observe serum cardiac specific microRNA-208a(miR-208a) levels in ST segment elevation acute myocardial infarction(STEAMI) patients,and to explore the role of serum miR-208a levels in the diagnosis of STEAMI. Methods The serum miR-208a concentrations were assessed within 12 hours after STEAMI,while

  12. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction.

    Fakhri, Yama; Schoos, Mikkel M; Clemmensen, Peter; Sejersten, Maria

    2014-01-01

    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins estimating the acuteness of myocardial ischemia and Sclarovsky-Birnbaum's grades of ischemia evaluating the severity of ongoing ischemia. PMID:24792905

  13. Pregnancy associated plasma protein A, a potential marker for vulnerable plaque in patients with non-ST-segment elevation acute coronary syndrome

    Iversen, Kasper; Teisner, Ane S; Teisner, Borge;

    2009-01-01

    OBJECTIVES: To describe the presence and time-related pattern of circulating pregnancy associated plasma protein A (PAPP-A) levels in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS). DESIGN AND METHODS: Consecutively admitted patients (N=573) with clinical signs of NSTE-...

  14. Short- or long-outcome of early tirofiban in ST-segment elevated acute myocardial infarction undergoing elective percutaneous coronary intervention

    张优

    2014-01-01

    Objective To explore the optimal timing of tirofiban early treatment in ST-segment elevated acute myocardial infarction(STEMI)undergoing elective percutaneous coronary intervention(PCI).Methods A total of 118 consecutive STEMI patients were enrolled in the study.They were randomly assigned to the tirofiban early treatment

  15. Referral of patients with ST-segment elevation acute myocardial infarction directly to the catheterization suite based on prehospital teletransmission of 12-lead electrocardiogram

    Sillesen, Martin; Sejersten, Maria; Strange, Søren;

    2008-01-01

    BACKGROUND: Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-lead electrocardiogram (ECG) transmission can reduce time to reperfusion. PURPOSE: Determine 12-lead ECG transmission...

  16. Combination therapy reduces the incidence of no-reflow after primary per-cutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction

    Zhou, Shan-shan; Tian, Feng; Chen, Yun-Dai; Jing WANG; Sun, Zhi-Jun; guo, Jun; Jin, Qin-Hua

    2015-01-01

    Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction (AMI) undergoing primary PCI. Methods A tot...

  17. Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome

    This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting

  18. Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome

    Natarajan, Deepak, E-mail: deepaknatarajan@me.com

    2015-06-15

    This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting.

  19. Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography

    Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p 1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 ± 13.9 HU vs. 43.5 ± 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.

  20. Patterns of ST segment resolution after guidewire passage and thrombus aspiration in primary percutaneous coronary intervention (PPCI) for acute myocardial infarction

    Russhard, Paul; Al Janabi, Firas; Parker, Michael; Clesham, Gerald J

    2016-01-01

    Background ST segment elevation allows the rapid identification of patients with acute myocardial infarction who benefit from emergency reperfusion. Primary percutaneous coronary intervention (PPCI) has emerged as the preferred perfusion strategy for patients presenting with ST segment elevation myocardial infarction (STEMI). Methods and results We studied the effects of the simple passage of an angioplasty guidewire followed by mechanical thrombus aspiration on the ST segment displacement in 289 patients presenting with acute STEMI. Simple guidewire passage led to a statistically significant fall in the mean ST elevation from 5.9 to 4.9 mm (p<0.001), but the mean ST displacement after subsequent mechanical thrombus aspiration was 4.8 mm, not statistically significantly different from guidewire passage. When compared with simple guidewire passage, thrombus aspiration resulted in more patients achieving more than 50% ST resolution (21.8% vs 15.2%, p=0.009), but a higher proportion had a worsening of ST elevation compared to baseline (19.7% vs 13.5%, p=0.041). Conclusions Mechanical thrombus aspiration in acute STEMI did not improve the mean ST resolution compared with simple guidewire passage. Thrombus aspiration increased the proportion achieving 50% resolution but also increased the proportion who had a worsening of ST elevation. These data may help explain some of the uncertainties surrounding the routine use of thrombus aspiration in STEMI and potentially supports the use of ‘time to angioplasty guidewire passage’ as one of the ways to judge the promptness of PPCI services. PMID:27335657

  1. Early exercise testing after treatment with thrombolytic drugs for acute myocardial infarction: importance of reciprocal ST segment depression.

    Stevenson, R N; Umachandran, V.; Ranjadayalan, K; Roberts, R. H.; Timmis, A D

    1994-01-01

    OBJECTIVE--To investigate the clinical importance of reciprocal ST depression induced by exercise testing early after acute myocardial infarction in patients treated with thrombolysis. DESIGN--Prospective observational study. SETTING--District general hospital in London. SUBJECTS--202 patients (170 men) aged 33-69 with acute myocardial infarction treated with thrombolysis. MAIN OUTCOME MEASURES--All patients underwent exercise testing and coronary arteriography. ST depression induced by exerc...

  2. Long-term prognostic value of ST-segment resolution in patients treated with fibrinolysis or primary percutaneous coronary intervention results from the DANAMI-2 (DANish trial in acute myocardial infarction-2)

    Sejersten, Maria; Valeur, Nana; Grande, Peer;

    2009-01-01

    . The ST-segment resolution was grouped as follows: 1) complete > or =70%; 2) partial 30% to <70%; and 3) no resolution <30%. End points were 30-day and long-term mortality and reinfarction. RESULTS: The ST-segment resolution at 90 min was more pronounced after pPCI (median 60% vs. 45%, p < 0.0001), and......OBJECTIVES: The purpose of this study was to determine the prognostic value of ST-segment resolution after primary percutaneous coronary intervention (pPCI) versus fibrinolysis. BACKGROUND: Resolution of the ST-segment has been used as a surrogate end point in trials evaluating reperfusion in acute...... a catch-up phenomenon was observed at 4 h. In the fibrinolysis group, 30-day and long-term mortality rates were significantly higher among patients without ST-segment resolution, whereas reinfarction rates were higher with complete ST-segment resolution. The ST-segment resolution was not associated...

  3. Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography

    Huang, W.-C. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: w.c.huang@yahoo.com.tw; Liu, C.-P. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: cpliu@isca.vghks.gov.tw; Wu, M.-T. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: wu.mingting@gmail.com; Mar, G.-Y. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: gymar@isca.vghks.gov.tw; Lin, S.-K. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: skyii89@yahoo.com.tw; Hsiao, S.-H. [Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: a841120@ms3.hinet.net; Lin, S.-L. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: sllin@isca.vghks.gov.tw; Chiou, K.-R. [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan (China)], E-mail: krchiou@isca.vghks.gov.tw

    2010-01-15

    Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p < 0.001). The STE-ACS culprit lesions (n = 54) had significantly higher luminal area stenosis (78.6 {+-} 21.2% vs. 66.7 {+-} 23.9%, p = 0.006), larger plaque burden (0.91 {+-} 0.10 vs. 0.84 {+-} 0.12, p = 0.007) and remodeling index (1.28 {+-} 0.34 vs. 1.16 {+-} 0.22, p = 0.021) than those with NSTE-ACS (n = 66). The percentage of expanding remodeling index (remodeling index >1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 {+-} 13.9 HU vs. 43.5 {+-} 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.

  4. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

    R.K. Riezebos; E. Ronner; E. ter Bals; T. Slagboom; P.C. Smits; J.M. ten Berg; F. Kiemeneij; G. Amoroso; M.S. Patterson; M.J. Suttorp; J.G.P. Tijssen; G.J. Laarman

    2009-01-01

    BACKGROUND: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data. OBJECTIVE: To compare immediate versus deferred angioplasty in patients with non-S

  5. Questing for circadian dependence in ST-segment-elevation acute myocardial infarction: A multicentric and multiethnic study

    Ammirati, Enrico

    2013-05-09

    Rationale: Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment-elevation acute myocardial infarction (STEMI). Objective: To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population. Methods and Results: We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6:00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI. Conclusions: Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time-dynamic mechanisms underlying such a relation. © 2013 American Heart Association, Inc.

  6. Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing PCI for non-ST-segment elevation acute coronary syndromes: impact of clinical status and procedural characteristics

    Bauer, Timm; Möllmann, Helge; Weidinger, Franz; Zeymer, Uwe; Seabra-Gomes, Ricardo; Eberli, Franz Robert; Serruys, Patrick; Vahanian, Alec; Silber, Sigmund; Wijns, William; Hochadel, Matthias; Nef, Holger; Hamm, Christian; Marco, Jean; Gitt, Anselm

    2010-01-01

    textabstractBackground: The most recent ESC guidelines for percutaneous coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa inhibitors (GPI) in high risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known about the adherence to these guidelines within Europe. Methods and results: Between May 2005 and April 2008 a total of 47,407 consecutive patients undergoing PCI were prospectively enrolled into the PCI-Re...

  7. Baseline characteristics, time-to-hospital admission and in-hospital outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes, 2002 to 2005

    Pehnec, Zlatko; Sinkovič, Andreja; Kamenik, Borut; Marinšek, Martin; Svenšek, Franci

    2009-01-01

    Objective. The purpose of this study was to retrospectively determine baseline patient characteristics, time-to-hospital admission, utilization of reperfusion therapy and outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes (ACS) between 2002 and 2005, particularly after 24-h primary percutaneous coronary intervention (PCI) was introduced in 2004. Methods. Included were all patients admitted to the intensive care unit (ICU) from 2002 to 2005 who met the crit...

  8. Clinical outcomes of patients with major bleeding after primary coronary intervention for acute ST-segment elevation myocardial infarction

    Objective: To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: During the period of January 2004-January 2008, primary PCI was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results: Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P=0.04), mainly the females (51.9% vs 23.1%, P=0.001) and treated more often with glycoprotein (GP) IIb / IIIa receptor inhibitor (88.9% vs 69.4%, P=0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P=0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively,which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P=0.008 and P=0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP IIb/IIIa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P<0.001). Conclusion: In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment.Feminine gender, aged patient and use of GPIIb/IIIa receptor inhibitor are independent predictors to increase the danger of major bleeding. (authors)

  9. Diagnostic Accuracy of Adenosine Stress Cardiovascular Magnetic Resonance Following Acute ST-segment Elevation Myocardial Infarction Post Primary Angioplasty

    Wong Dennis TL

    2011-10-01

    Full Text Available Abstract Background Adenosine stress cardiovascular magnetic resonance (CMR has been proven an effective tool in detection of reversible ischemia. Limited evidence is available regarding its accuracy in the setting of acute coronary syndromes, particularly in evaluating the significance of non-culprit vessel ischaemia. Adenosine stress CMR and recent advances in semi-quantitative image analysis may prove effective in this area. We sought to determine the diagnostic accuracy of semi-quantitative versus visual assessment of adenosine stress CMR in detecting ischemia in non-culprit territory vessels early after primary percutaneous coronary intervention (PCI for ST-segment elevation myocardial infarction (STEMI. Methods Patients were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment 3 days after successful primary-PCI for STEMI. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. Diagnostic accuracy of both methods was compared with non-culprit territory vessels utilising quantitative coronary angiography (QCA with significant stenosis defined as ≥70%. Results Fifty patients (age 59 ± 12 years admitted with STEMI were evaluated. All subjects tolerated the adenosine stress CMR imaging protocol with no significant complications. The cohort consisted of 41% anterior and 59% non anterior infarctions. There were a total of 100 non-culprit territory vessels, identified on QCA. The diagnostic accuracy of semi-quantitative analysis was 96% with sensitivity of 99%, specificity of 67%, positive predictive value (PPV of 97% and negative predictive value (NPV of 86%. Visual analysis had a diagnostic accuracy of 93% with sensitivity of 96%, specificity of 50%, PPV of 97% and NPV of 43%. Conclusion Adenosine stress CMR allows accurate detection of non-culprit territory stenosis in patients

  10. ST-segment depression on the initial electrocardiogram in acute myocardial infarction-prognostic significance and its effect on short-term mortality: A report from the National Registry of Myocardial Infarction (NRMI-2, 3, 4).

    Pitta, Sridevi R; Grzybowski, Mary; Welch, Robert D; Frederick, Paul D; Wahl, Robert; Zalenski, Robert J

    2005-04-01

    This study analyzed 255,256 patients who had acute myocardial infarction and were enrolled in the National Registry of Myocardial Infarction 2, 3, and 4 (1994 to 2002). The objective was to determine in-hospital mortality rate among patients who had ST-segment depression on the initial electrocardiogram. Patients who had ST-segment depression had an in-hospital mortality rate (15.8%) similar to that of patients who had ST-segment elevation or left bundle branch block (15.5%). After adjusting for observed differences, ST-segment depression was associated with only a slightly lower odds ratio (0.91) of mortality compared with ST-segment elevation or left bundle branch block. PMID:15781012

  11. Serial Holter ST-segment monitoring after first acute myocardial infarction. Prevalence, variability, and long-term prognostic importance of transient myocardial ischemia

    Mickley, H; Nielsen, J R; Berning, J; Junker, A; Møller, M

    1998-01-01

    Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121...... consecutive male patients <70 years old were studied. The prevalence of TMI on different Holter recordings varied around 20% ranging between 18 and 27%. Fifty-five of the patients (46%) had TMI on at least 1 of the 7 Holter recordings. Considerable variability was found within and between patients for the...

  12. Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera

    Ekarat Rattarittamrong; Lalita Norasetthada; Adisak Tantiworawit; Chatree Chai-Adisaksopha; Sasinee Hantrakool; Thanawat Rattanathammethee; Pimlak Charoenkwan

    2015-01-01

    Thrombosis is a major complication of polycythemia vera (PV) and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI) in a 17- year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/μL) and three months later developed an acute STEMI. Coronar...

  13. Influence of concomitant heparin administration on pregnancy-associated plasma protein-A levels in acute coronary syndrome with ST segment elevation

    Hájek, Petr; Macek, Milan; Lashkevich, Andrej; Klučková, Hana; Hladíková, Marie; Hansvenclová, Eva; Malý, Martin; Veselka, Josef; Krebsová, Alice

    2011-01-01

    Introduction The time course of pregnancy-associated plasma protein-A (PAPP-A) levels was studied at admission, immediately after percutaneous coronary intervention (PCI) and 1, 2, 4, 6, 12, 24 and 48 h after PCI in acute coronary syndrome with ST segment elevation (ACS-STE) to determine the impact of PCI, concomitant clinical complications and heparin administration. Material and methods Pregnancy-associated plasma protein-A serum levels, examined by the KryptorTM system, were studied in 30 ...

  14. Effect of aspirin plus clopidogrel on inflammatory markers in patients with non-ST-segment elevation acute coronary syndrome

    2006-01-01

    Background Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Methods One hundred and fifteen patients with NSTEACS were randomized into two groups: group A (aspirin alone, n=58) and group B (aspirin plus clopidogrel, n=57). Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α(TNF-α) were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls (group C).Results Baseline levels of hs-CRP and TNF-αin group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A: (6.15 ± 1.39) mg/L vs (9.18 ± 1.62) mg/L, P <0.01; Group B:(4.99 ± 1.62) mg/L vs (10.29 ± 1.47) mg/L, P<0.01]. Similarly, levels of TNF-αin both groups decreased at 7 days compared to baseline [Group A: (90.99 ± 28.91) pg/ml vs (117.20 ± 37.13) pg/ml, P <0.01; Group B: (74.32± 21.83) pg/ml vs (115.27 ± 32.11) pg/ml, P <0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to (3.49 ± 1.53) mg/L, and (2.40 ± 1.17) mg/L respectively (P <0.01 for both comparisons). Levels of TNF-αin groups A and B also decreased significantly between 7 and 30 days, to 63.28 ± 29.01 pg/ml (group A) and (43.95 ± 17.10) pg

  15. Acute non-atherosclerotic ST-segment elevation myocardial infarction in an adolescent with concurrent hemoglobin H-Constant Spring disease and polycythemia vera

    Ekarat Rattarittamrong

    2015-09-01

    Full Text Available Thrombosis is a major complication of polycythemia vera (PV and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI in a 17- year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/μL and three months later developed an acute STEMI. Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque. He was treated with plateletpheresis, hydroxyurea and antiplatelet agents. The platelet count decreased and his symptoms improved. This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

  16. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes

    To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels. (orig.)

  17. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes

    Schepis, Tiziano; Achenbach, Stephan; Marwan, Mohamed; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Pflederer, Tobias [University of Erlangen, Department of Internal Medicine 2 (Cardiology), Erlangen (Germany)

    2010-07-15

    To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels. (orig.)

  18. Persistent elevation of neutrophil/lymphocyte ratio associated with new onset atrial fibrillation following percutaneous coronary intervention for acute st segment elevation myocardial infarction

    Increasing evidence suggests that inflammation plays an important role in initiation and maintaining of atrial fibrillation (AF). The Neutrophil to Lymphocyte (N/L) Ratio is an easily derived and readily available parameter that has emerged as marker of inflammation with predictive and prognostic value. We investigated the association between N/L ratio and incidence of atrial fibrillation in patients undergoing cardiac catheterization for acute ST-segment elevation myocardial infarction (STEMI). Methods: This cross sectional descriptive study was carried out at New York Hospital Queens. We retrospectively analysed clinical, hematologic and angiographic data of 290 patients who underwent coronary angiography with stent placement for acute ST-segment elevation myocardial infarction between 2008-2011. Results: Study cohort of 290 patients had mean age 63.3 ± 13.0 years consisting of 81.4% male. The N/L ratio was measured at time points: <6 hours pre-catheterization, <12, 48 and 96 hours post catheterization. Patients who developed AF (n=40, 13.8%), had higher post catheterization N/L ratios at 48 hours (median 5.23 vs 3.00, p=0.05) and 96 hours (median 4.67 vs 3.56, p=0.03), with no differences in the immediate pre and post procedural measurements, <6 hours pre catheterization (median 2.49 vs 2.82, p=0.467) and <12 hours post catheterization (median 5.93 vs 5.03, p=0.741) respectively. Conclusion: In conclusion, these findings support an inflammatory aetiology contributing to new onset AF following percutaneous coronary intervention for acute STEMI. Further studies are warranted to elucidate these findings. (author)

  19. Challenges in predicting the need for coronary artery bypass grafting at presentation in patients with non-ST-segment elevation acute coronary syndromes.

    Mehta, Rajendra H; Chen, Anita Y; Pollack, Charles V; Roe, Matthew T; Zalenski, Robert J; Clements, Elizabeth A; Gibler, W Brian; Ohman, E Magnus; Harrington, Robert A; Peterson, Eric D

    2006-09-01

    In the case of non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), the acute use of certain antiplatelet agents is complicated by concerns about perioperative bleeding risks in patients requiring coronary artery bypass grafting (CABG) during the index hospitalization. As a result, clinicians often withhold potentially useful agents, such as clopidogrel, before determining patients' coronary anatomy. An accurate predictive model could allow for a better balance of this safety concern with the demonstrated benefits of agents such as clopidogrel. To create an accurate decision-making tool that would assess, at hospital presentation, the need for CABG in patients with NSTE-ACSs, we studied 61,974 high-risk patients with NSTE-ACS admitted to 311 CABG-capable hospitals participating in Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) from 2001 to 2003. A total of 8,395 patients (14%) underwent CABG during their initial hospital stay. A multivariate model was developed and identified 13 presenting clinical characteristics significantly associated with the likelihood of CABG (previous CABG, male gender, previous heart failure, diabetes, hyperlipidemia, renal insufficiency, ST depression and transient ST elevation, age > or = 75 years, previous percutaneous coronary intervention, family history of coronary artery disease, hypertension, trends in CABG rates, and previous stroke). This model had only modest predictive accuracy and calibration (c-index = 0.67). In conclusion, although certain presenting clinical features are associated with an increased likelihood of CABG in patients with NSTE-ACSs during the index hospitalization, it remains difficult to reliably identify, before diagnostic angiography, those who will subsequently undergo surgical revascularization. PMID:16923449

  20. Value of posterior and right ventricular leads in comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial infarction.

    Zalenski, R J; Rydman, R J; Sloan, E P; Hahn, K H; Cooke, D; Fagan, J; Fligner, D J; Hessions, W; Justis, D; Kampe, L M; Shah, S; Tucker, J; Zwicke, D

    1997-06-15

    In this multicenter prospective trial, we studied posterior (V7 to V9) and right ventricular (V4R to V6R) leads to assess their accuracy compared with standard 12-lead electrocardiograms (ECGs) for the diagnosis of acute myocardial infarction (AMI). Patients aged >34 years with suspected AMI received posterior and right ventricular leads immediately after the initial 12-lead ECG. ST elevation of 0.1 mV in 2 leads was blindly determined and inter-rater reliability estimated. AMI was diagnosed by World Health Organization criteria. The diagnostic value of nonstandard leads was determined when 12-lead ST elevation was absent and present and multivariate stepwise regression analysis was also performed. Of 533 study patients, 64.7% (345 of 533) had AMI and 24.8% received thrombolytic therapy. Posterior and right ventricular leads increased sensitivity for AMI by 8.4% (p = 0.03) but decreased specificity by 7.0% (p = 0.06). The likelihood ratios of a positive test for 12, 12 + posterior, and 12 + right ventricular ECGs were 6.4, 5.6, and 4.5, respectively. Increased AMI rates (positive predictive values) were found when ST elevation was present on 6 nonstandard leads (69.1%), on 12 leads only (88.4%), and on both 6 and 12 leads (96.8%; p <0.001). Treatment rates with thrombolytic therapy increased in parallel with this electrocardiographic gradient. Logistic regression analysis showed that 4 leads were independently predictive of AMI (p <0.001): leads I, II, V3, V5R; V9 approached statistical significance (p = 0.055). The standard ECG is not optimal for detecting ST-segment elevation in AMI, but its accuracy is only modestly improved by the addition of posterior and right ventricular leads. PMID:9202344

  1. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction

    Fakhri, Yama; Schoos, Mikkel M; Clemmensen, Peter;

    2014-01-01

    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins...

  2. Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non-ST-Segment Elevation Acute Myocardial Infarction.

    Agrawal, Sahil; Garg, Lohit; Sharma, Abhishek; Mohananey, Divyanshu; Bhatia, Nirmanmoh; Singh, Amitoj; Shirani, Jamshid; Dixon, Simon

    2016-09-01

    Patients with myocardial infarction admitted on weekends have been reported to less frequently undergo invasive angiography and experience poorer outcomes. We used the Nationwide Inpatient Sample database (2003 to 2011) to compare differences in all-cause inhospital mortality between patients admitted on a weekend versus weekday for an acute non-ST-segment elevation myocardial infarction (NSTEMI) and to determine if rates and timing of coronary revascularization contributed to this difference. A total of 3,625,271 NSTEMI admissions were identified, of which 909,103 (25.1%) were weekend and 2,716,168 (74.9%) were weekday admissions. Admission on a weekend versus weekday was independently associated with lower rates of coronary angiography (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.89 to 0.90; p acute NSTEMI, admission on a weekend was associated with higher inhospital mortality compared with admission on a weekday and that lower rates of utilization of EIS contributed significantly to this disparity. PMID:27381668

  3. Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction.

    Thomas Pilgrim; Dik Heg; Kali Tal; Paul Erne; Dragana Radovanovic; Stephan Windecker; Peter Jüni

    2015-01-01

    BACKGROUND Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) according to the patient's age and gender. METHODS We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS) registry presenting to one of 11 centers in Switzerland providing primar...

  4. ST segment elevation in a patient presenting with renal colic pain

    Zohair Al Aseri

    2011-01-01

    Full Text Available ST segment elevation of more than 1 mm from the baseline is an electrocardiographic presentation of acute myocardial injury. This phenomenon is not confined only to ischemic injury, and various other etiological factors have been described in relation to ST segment elevation. We report the case of a young man who presented in the emergency department complaining of loin pain. He was subsequently found to have transient ST segment elevation, but a thorough evaluation showed no evidence of coronary artery disease. ST segment elevation is one of the best tools for diagnosing acute myocardial infarction, of which reperfusion therapy is the treatment of choice thus making it important to make the diagnosis as quickly as possible. It is equally important, however, not to misdiagnose acute myocardial infarction, as there are other causes of ST segment elevation. Therefore, we report this unique case of renal pain due to stone causing ST segment elevation.

  5. Imaging QRS complex and ST segment in myocardial infarction

    Bacharova, Ljuba; Bang, Lia E; Szathmary, Vavrinec; Mateasik, Anton

    2014-01-01

    BACKGROUND: Acute myocardial infarction creates regions of altered electrical properties of myocardium resulting in typical QRS patterns (pathological Q waves) and ST segment deviations observed in leads related to the MI location. The aim of this study was to present a graphical method for imaging...... magnitude of the instantaneous QRS vectors, and the estimated "myocardium at risk" based on the ST segment deviation. RESULTS: The images are presented as Mercator projections with the texture of anatomical segments of the heart and the corresponding coronary artery distribution. The changes in...... depolarization sequence were visible as dislocations of activated areas circumventing the affected areas, while the "myocardium at risk" estimated from the ST segment deviation pointed to the affected area. CONCLUSION: The presented method of imaging ECG allows visualizing changes in sequence of depolarization...

  6. Long-term follow-up and analysis of prediction of mortality after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

    Dan BAO

    2015-06-01

    Full Text Available Objective To explore the risk factors for mortality after percutaneous coronary intervention (PCI in patients with acute ST segment elevation myocardial infarction (STEMI. Methods The patients who were admitted with STEMI to our hospital between July 2008 and November 2012 undergoing PCI during hospitalization were enrolled. Case control study was conducted to observe these patients during the follow-up period for exploring the independent predictors of survival. Results  A total of 3551 consecutive patients were enrolled in this study. These patients were followed up for 5 years with a median followup time of 406[179, 892] days. A total of 106 deaths occurred during the follow-up period. Estimated 5-year survival rate was 88.6% by Kaplan-Meier method. Female, age, diabetes, stroke, dysarteriotony, renal insufficiency, elevation of creatinine kinase isoenzyme MB (CK-MB, left ventricular end diastolic dimension, anemia, anterior myocardial infarction, PCI complications and intra-aortic balloon pump (IABP were independent risk factors for mortality, whereas complete revascularization was associated with decreased risk of mortality. Conclusions Long-term mortality rate of patients with STEMI is higher even after successful PCI. Less PCI complications and early complete revascularization are independent predictors for decreasing mortality rate during follow-up period. DOI: 10.11855/j.issn.0577-7402.2015.04.05

  7. The effect of tobacco smoking and treatment strategy on the one-year mortality of patients with acute non-ST-segment elevation myocardial infarction

    Roislien Jo

    2010-12-01

    Full Text Available Abstract Background The aim of the present study was to investigate whether a previously shown survival benefit resulting from routine early invasive management of unselected patients with acute non-ST-segment elevation myocardial infarction (NSTEMI may differ according to smoking status and age. Methods Post-hoc analysis of a prospective observational cohort study of consecutive patients admitted for NSTEMI in 2003 (conservative strategy cohort [CS]; n = 185 and 2006 (invasive strategy cohort [IS]; n = 200. A strategy for transfer to a high-volume invasive center and routine early invasive management was implemented in 2005. Patients were subdivided into current smokers and non-smokers (including ex-smokers on admission. Results The one-year mortality rate of smokers was reduced from 37% in the CS to 6% in the IS (p Conclusions The treatment effect of an early invasive strategy in unselected patients with NSTEMI was more pronounced among smokers than non-smokers. The benefit for smokers was not entirely explained by differences in baseline confounders, such as their younger age.

  8. Reperfusion Strategy for Acute ST-segment Elevation Myocardial Infarction%急性ST段抬高心肌梗死再灌注策略

    付艳东; 高海春; 刘丽

    2013-01-01

    急性ST段抬高心肌梗死是冠心病患者死亡的主要原因,再灌注治疗的方法包括药物溶栓与介入治疗两大类。溶栓简便易行,但有一定的时间限制,是基层医院再灌注治疗的主要措施,PCI是治疗心肌梗死最有效的方法,有直接PCI、转运PCI、易化PCI 延迟PCI 补救PCI等,本文就STEAMI再灌注策略做重点阐述。%acute ST-segment elevation myocardial infarction is the leading cause of death in patients with coronary heart disease,reperfusion therapy including thrombolytic and intervention treatment of two categories. Thrombolysis is easy, but there is a certain amount of time restrictions, Thrombolysis is the important reperfusion categories in. primary hospital , PCI is the most ef ective method for the treatment of myocardial infarction, including direct PCI transit PCI, facilitated PCI delayed PCI and rescue PCI,This article focuses on STEAMI reperfusion strategy.

  9. Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction.

    Thomas Pilgrim

    Full Text Available Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI for acute myocardial infarction (AMI according to the patient's age and gender.We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age.A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28% were women and 2172 (54% were ≥65 years of age. More than 90% of patients 90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40-1.95, p<0.001 and females (adj HR 1.57 (95% CI 1.27-1.93, p<0.001, as well as in females <65 years (adj HR 1.47 (95% CI 1.13-1.91, p = 0.004 as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours.In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI.

  10. ST-Segment Resolution Prior to Primary Percutaneous Coronary Intervention Is a Poor Indicator of Coronary Artery Patency in Patients with Acute Myocardial Infarction

    N.J. Verouden; J.D. Haeck; K.T. Koch; J.P. Henriques; J. Baan; R.J. van der Schaaf; M.M. Vis; R.J. Peters; A.A. Wilde; J.J. Piek; J.G. Tijssen; R.J. de Winter

    2010-01-01

    Background: The prognostic value of ST-segment resolution (STR) after initiation of reperfusion therapy has been established by various studies conducted in both the thrombolytic and mechanic reperfusion era. However, data regarding the value of STR immediately prior to primary percutaneous coronary

  11. Clinical Profile, Acute Care, and Middle-Term Outcomes of Cocaine-Associated ST-Segment Elevation Myocardial Infarction in an Inner-City Community.

    Shitole, Sanyog G; Kayo, Noel; Srinivas, Vankeepuram; Alapati, Venkatesh; Nordin, Charles; Southern, William; Christia, Panagiota; Faillace, Robert T; Scheuer, James; Kizer, Jorge R

    2016-04-15

    Although cocaine is a well-recognized risk factor for coronary disease, detailed information is lacking regarding related behavioral and clinical features of cocaine-associated ST-segment elevation myocardial infarction (STEMI), particularly in socioeconomically disadvantaged urban settings. Nor are systematic or extended follow-up data available on outcomes for cocaine-associated STEMI in the contemporary era of percutaneous coronary intervention. We leveraged a prospective STEMI registry from a large health system serving an inner-city community to characterize the clinical features, acute management, and middle-term outcomes of cocaine-related versus cocaine-unrelated STEMI. Of the 1,003 patients included, 60% were black or Hispanic. Compared with cocaine-unrelated STEMI, cocaine-related STEMI (n = 58) was associated with younger age, male gender, lower socioeconomic score, current smoking, high alcohol consumption, and human immunodeficiency virus seropositivity but less commonly with diabetes or hypertension. Cocaine users less often received drug-eluting stents or β blockers at discharge. During median follow-up of 2.7 years, rates of death, death or any rehospitalization, and death or cardiovascular rehospitalization did not differ significantly between cocaine users and nonusers but were especially high for death or any hospitalization in the 2 groups (31.4 vs 32.4 per 100 person-years, p = 0.887). Adjusted hazard ratios for outcomes were likewise not significantly different. In conclusion, in this low-income community, cocaine use occurred in a substantial fraction of STEMI cases, who were younger than their nonuser counterparts but had more prevalent high-risk habits and exhibited similarly high rates of adverse outcomes. These data suggest that programs targeting cocaine abuse and related behaviors could contribute importantly to disease prevention in disadvantaged communities. PMID:26897639

  12. Antiplatelet and Anticoagulation Treatment in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: Comparison of the Updated North American and European Guidelines.

    Eisen, Alon; Giugliano, Robert P

    2016-01-01

    In 2014, the American Heart Association and the American College of Cardiology (AHA/ACC) published their guideline for the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), whereas the European Society of Cardiology published their latest guideline for the management of patients with NSTE-ACS in 2011. In this article, we review the main updates in antiplatelet and anticoagulation therapy in the 2014 AHA/ACC guideline and compare them with the 2011 European guidelines. Key recommendations in the AHA/ACC guidelines include the addition of ticagrelor to a broad spectrum of patients with NSTE-ACS, narrowing of the role of prasugrel to patients who undergo coronary stenting, and limiting the use of glycoprotein IIb/IIIa receptor inhibitors mainly to high-risk patients during percutaneous coronary intervention. These modifications bring the North American and the European guidelines closer together. The recommendations regarding anticoagulants still differ between the 2 guidelines, although all 4 parenteral agents (unfractionated heparin, low-molecular-weight heparin, bivalirudin, and fondaparinux) are now considered acceptable by both guidelines. We also review new data from clinical trials that became available after the 2014 guidelines were finalized, including studies with cangrelor, rivaroxaban, vorapaxar, ticagrelor, and long-term use of dual antiplatelets that will be considered in future guidelines. As the 2014 guidelines represent the most comprehensive and authoritative document for the management of patients with NSTE-ACS, clinicians who manage these patients should be familiar with their recommendations to ensure optimal patient care. PMID:26186386

  13. Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial).

    Daaboul, Yazan; Korjian, Serge; Weaver, W Douglas; Kloner, Robert A; Giugliano, Robert P; Carr, Jim; Neal, Brandon J; Chi, Gerald; Cochet, Madeleine; Goodell, Laura; Michalak, Nathan; Rusowicz-Orazem, Luke; Alkathery, Turky; Allaham, Haytham; Routray, Sujit; Szlosek, Donald; Jain, Purva; Gibson, C Michael

    2016-09-01

    Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72 hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n = 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p = 0.02, TnI AUC p = 0.03) and MSI (p = 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size. PMID:27392509

  14. The study of the prognostic value scales of assessing the risk of adverse coronary events in patients with acute coronary syndrome without ST-segment elevation in combination with comorbid conditions

    Dorokhova O.V.

    2014-12-01

    Full Text Available Objective: to identify the most prognostically significant scale risk assessment of patients with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2, chronic renal failure, multifo-cal coronarocardiosclerosis, dyscirculatory encephalopathy. Material and methods. 260 patients with acute coronary syndrome without ST-segment elevation were divided into 4 groups according to the presence of severe concomitant diseases: patients with diabetes mellitus type 2 (71 people, chronic renal failure (49, multifocal lesions of the coronary arteries (76 and patients with dyscirculatory encephalopathy of grade 2-3, including ischemic stroke (64. All patients were stratified by major scales risk: TIMI, GRACE, PURSUIT. The development of negative coronary events was assessed in hospital and during the year after discharge. On the basis of the results, all scales were studied using the criterion of Mann-Whitney and identified the most predictably significant groups of patients with specific comorbid conditions. Results. It is revealed that the significance of the scales TIMI and GRACE in the study of distant forecast (up to 6 months is the most reliable with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2. For the patients with combination with chronic renal insufficiency the best prognostic significance was obtained by the GRACE scale in the study of hospital risk and forecast up to 6 months. TIMI and GRACE scales in the study of hospital risk and forecast up to 6 months had the greatest prognostic significance for the patients with acute coronary syndrome without ST-segment elevation on the background of multifocal lesions of the coronary arteries. For the patients with dyscirculatory encephalopathy of the 2nd and 3rd grades, the greatest prognostic significance was obtained by stratification of risk on PURSUIT and GRACE scales in the study of hospital risk and

  15. Longitudinal Strain Is a Marker of Microvascular Obstruction and Infarct Size in Patients with Acute ST-Segment Elevation Myocardial Infarction

    Loïc Bière; Erwan Donal; Gwenola Terrien; Gaëlle Kervio; Serge Willoteaux; Alain Furber; Fabrice Prunier

    2014-01-01

    International audience Objectives: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI) in order to predict infarct size and functional recovery at 3-month follow-up. Methods: 44 patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.961.2 days after myocardial reperfusion, assessing circumferential (CGS), radial (RGS), and lo...

  16. Ambulatory ST segment monitoring after myocardial infarction

    Mickley, H

    1994-01-01

    as important reasons for the inconsistent findings. The precise role of ambulatory ST segment monitoring in clinical practice has yet to be established. Direct comparisons with exercise stress testing may not be appropriate for two reasons. Firstly, the main advantage of ambulatory monitoring may be...

  17. Safety and efficacy of early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis

    Liu Yangchun; Su Qiang; Li Lang

    2014-01-01

    Background Tirofiban has been widely used as an adjunctive pharmacologic agent for revascularization in patients undergoing percutaneous coronary intervention,and the outcomes appear attractive.However,the potential benefits from early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remain unclear.Methods We conducted a search in MEDLINE,EMBASE,and the Cochrane Central Register of Controlled Trials up to September 2012 without language restriction.A total of eight randomized trials (n=1 577 patients) comparing early (emergency department or ambulance) versus late (catheterization laboratory) administration of tiroflban in STEMI patients undergoing PPCI were included in this meta-analysis.Risk ratio (RR) was computed from individual studies and pooled with random-or fixed-effect models.Results There were no differences in post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and Corrected TIMI Frame Count (RR=1.02,95% confidence interval (C/):0.99-1.05,P=0.18; weighted mean difference (WMD)=-0.93,95% CI:-5.37-3.52,P=0.68,respectively) between the two groups.Similarly,there were no significant differences in the incidence of 30-day mortality (RR=1.69,95% CI:0.69-4.13,P=0.25) and re-myocardial infarction (RR=0.71,95% CI:0.21-2.35,P=0.57) between early and late administration of tirofiban.As to the safety end points,no significant difference was observed in hospital minor bleeding (RR=1.08,95% CI:0.54-2.14,P=0.83) and hospital and 30-day major bleeding between the two groups (RR=0.98,95% CI:0.46-2.10,P=0.96; RR=1.32,95% CI:0.59-2.97,P=0.49,respectively).Conclusions Early administration of tiroflban in patients undergoing PPCI for STEMI was safe,but no beneficial effects on post-procedural angiographic or clinical outcomes could be identified as compared with late administration.Besides the negative finding,more high

  18. Platelet inhibitors in non-ST-segment elevation acute coronary syndromes and percutaneous coronary intervention: glycoprotein IIb/IIIa inhibitors, clopidogrel, or both?

    Silva, Matthew A; Donovan, Jennifer L; Gandhi, Pritesh J; Volturo, Gregory A

    2006-01-01

    The role of glycoprotein (Gp) IIb/IIIa receptor antagonists remains controversial and these agents are infrequently utilized during non-ST-segment elevation acute coronary syndromes (NSTE-ACS) despite American Heart Association/American College of Cardiology guidelines. Despite recommendations, the NRMI-4 (National Registry of Myocardial Infarction 4) and CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines?) registries observed that only 25%-32% of eligible patients received early Gp IIb/IIIa therapy, despite a 6.3% absolute mortality reduction in NRMI-4 and a 2% absolute mortality reduction in CRUSADE. A pooled analysis of Gp IIb/IIIa data from these registries suggest a major reduction in mortality (Odds Ratio = 0.43, 95% Confidence Index 0.25-0.74, p = 0.002) with early Gp IIb/IIIa therapy, yet clinicians fail to utilize this option in NSTE-ACS. The evidence-based approach to NSTE-ACS involves aspirin, clopidogrel, low-molecular weight heparins, or unfractionated heparin in concert with Gp IIb/Ila receptor antagonists, however, newer percutaneous coronary intervention (PCI)-based trials challenge current recommendations. Novel strategies emerging in NSTE-ACS include omitting Gp IIb/Ila inhibitors altogether or using Gp IIb/IIIa inhibitors with higher doses of clopidogrel in selected patients. The ISAR-REACT (Intracoronary stenting and antithrombotic regimen-Rapid early action for coronary treatment) and ISAR-SWEET (ISAR-Is abciximab a superior way to eliminate elevated thrombotic risk in diabetics) trials question the value of abciximab when 600 mg of clopidogrel concurrently administered during PCI. The CLEAR-PLATELETS (Clopidogrel loading with eptifibatide to arrest the reactivity of platelets) and PEACE (Platelet activity extinction in non-Q-wave MI with ASA, clopidogrel, and eptifibatide) trials suggest more durable platelet inhibition when Gp IIb/IIIa inhibitors are

  19. Scintigraphic evaluation of routine filterwire distal protection in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a randomized controlled trial

    Kaltoft, Anne; Nielsen, Søren Steen; Terkelsen, Christian Juhl;

    2009-01-01

    AIM: Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in reduced myocardial perfusion, infarct extension and impaired prognosis. In a prospective randomized trial, we assessed the effect of routine filterwire...... distal protection on scintigraphic estimated infarct size. METHODS AND RESULTS: The effect of routine filterwire distal protection was evaluated in 344 patients with STEMI <12 hours undergoing primary PCI. Patients were randomized to distal protection with a filterwire or standard PCI. The primary...... endpoint was myocardial infarct size measured by Sestamibi SPECT after 30 days (%). Secondary endpoints included myocardial salvage, ST-segment resolution (STR), myocardial biomarker release and major adverse cardiac and cerebral events. Baseline characteristics including area at risk (estimated by...

  20. Field triage reduces treatment delay and improves long-term clinical outcome in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    Pedersen, Sune H; Haahr-Pedersen, Sune Ammentorp; Galatius, Soren;

    2009-01-01

    OBJECTIVES: We evaluated the independent impact of field triage on treatment delay and long-term clinical outcome in a large contemporary, consecutive population of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). BACKGROUND......: Reduction of treatment delay is crucial for patients with STEMI. METHODS: From January 2005 to July 2008, 1,437 STEMI patients were treated with pPCI at a single high-volume invasive center. We present the 1-year outcome in this observational registry study. RESULTS: A total of 616 patients were admitted by...... to 100 min vs. 103 min, interquartile range 80 to 135 min; p<0.001). Door-to-balloon times of less than the recommended 90 min were achieved in 61% of field triage patients, but only in 36% of nonfield-triage patients (p<0.001). After adjustment for relevant baseline variables, patients admitted by...

  1. Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment elevation myocardial infarction.

    Loïc Bière

    Full Text Available OBJECTIVES: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI in order to predict infarct size and functional recovery at 3-month follow-up. METHODS: 44 patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.9 ± 1.2 days after myocardial reperfusion, assessing circumferential (CGS, radial (RGS, and longitudinal global (GLS strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR, for assessing cardiac function, infarct size, and microvascular obstruction (MVO, was conducted 5.6 ± 2.5 days and 99.4 ± 4.6 days after myocardial reperfusion. RESULTS: GLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R = 0.601, p-6.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia (≥ 3 segments at 3-month follow-up. CONCLUSIONS: Speckle-tracking strain imaging performed early after a STEMI is easy-to-use as a marker for persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.

  2. Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

    Winkler, Jonathan; Chaudhry, Sunit-Preet; Stockwell, Philip H.

    2016-01-01

    Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myo...

  3. High-Bandpass Filters in Electrocardiography: Source of Error in the Interpretation of the ST Segment

    Buendía-Fuentes, F.; Arnau-Vives, M. A.; Arnau-Vives, A.; Jiménez-Jiménez, Y.; Rueda-Soriano, J.; Zorio-Grima, E.; Osa-Sáez, A.; Martínez-Dolz, L. V.; Almenar-Bonet, L.; Palencia-Pérez, M. A.

    2012-01-01

    Introduction. Artifactual variations in the ST segment may lead to confusion with acute coronary syndromes. Objective. To evaluate how the technical characteristics of the recording mode may distort the ST segment. Material and Method. We made a series of electrocardiograms using different filter configurations in 45 asymptomatic patients. A spectral analysis of the electrocardiograms was made by discrete Fourier transforms, and an accurate recomposition of the ECG signal was obtained from th...

  4. Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment Elevation

    Camila Pepe

    2012-07-01

    acute coronary syndrome without ST-segment elevation (ACSWSTE reduces cardiovascular events. Fondaparinux has demonstrated equivalence to enoxaparin in reducing cardiovascular events, but with a lower rate of bleeding in patients using fondaparinux. OBJECTIVE: Evaluate the cost-effectiveness of fondaparinux versus enoxaparin in patients with ACSWSTE in Brazil from the economic perspective of the Brazilian Unified Health System (SUS. METHODS: A decision analytic model was constructed to calculate the costs and consequences of the compared treatments. The model parameters were obtained from the OASIS-5 study (N = 20,078 patients with ACSWSTE randomized to fondaparinux or enoxaparin. The target outcome consisted of cardiovascular events (i.e., death, myocardial infarction, refractory ischemia and major bleeding on days 9, 30 and 180 after ACSWSTE. We evaluated all direct costs of treatment and ACSWSTE-related events. The year of the analysis was 2010 and the costs were described in reais (R$. RESULTS: On day 9, the cost of treatment per patient was R$ 2,768 for fondaparinux and R$ 2,852 for enoxaparin. Approximately 80% of total costs were associated with invasive treatments. The drug costs accounted for 10% of the total cost. The combined rates of cardiovascular events and major bleeding were 7.3% and 9.0% for fondaparinux and enoxaparin, respectively. Sensitivity analyses confirmed the initial results of the model. CONCLUSION: The use of fondaparinux for the treatment of patients with ACSWSTE is superior to that of enoxaparin in terms of prevention of further cardiovascular events at lower cost. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0

  5. Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction

    Jose F. Chavez

    2015-01-01

    Full Text Available Background. Drug-eluting stents (DES have proven clinical superiority to bare-metal stents (BMS for the treatment of patients with ST-segment elevation myocardial infarction (STEMI. Decision to implant BMS or DES is dependent on the patient’s ability to take dual antiplatelet therapy. This study investigated factors associated with DES placement in STEMI patients. Methods. Retrospective analysis was performed on 193 patients who presented with STEMI and were treated with percutaneous coronary intervention at an urban, tertiary care hospital. Independent factors associated with choice of stent type were determined using stepwise multivariate logistic regression. Odds ratio (OR was used to evaluate factors significantly associated with DES and BMS. Results. 128 received at least one DES, while 65 received BMS. BMS use was more likely in the setting of illicit drug or alcohol abuse ([OR] 0.15, 95% CI 0.05–0.48, p≤0.01, cardiogenic shock (OR 0.26, 95% CI 0.10–0.73, p=0.01, and larger stent diameter (OR 0.28, 95% CI 0.11–0.68, p≤0.01. Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use.

  6. Novel approach to evaluation of medical care quality delivered to patients with ST-segment elevation acute coronary syndrome: course to clinical result

    Posnenkova О.М.

    2014-09-01

    Full Text Available The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007 were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.

  7. Electrocardiogram ST-Segment Morphology Delineation Method Using Orthogonal Transformations

    Miha Amon; Franc Jager

    2016-01-01

    Differentiation between ischaemic and non-ischaemic transient ST segment events of long term ambulatory electrocardiograms is a persisting weakness in present ischaemia detection systems. Traditional ST segment level measuring is not a sufficiently precise technique due to the single point of measurement and severe noise which is often present. We developed a robust noise resistant orthogonal-transformation based delineation method, which allows tracing the shape of transient ST segment morph...

  8. INCIDENCE AND CLINICAL-SIGNIFICANCE OF ST SEGMENT ELEVATION AFTER ELECTRICAL CARDIOVERSION OF ATRIAL-FIBRILLATION AND ATRIAL-FLUTTER

    VANGELDER, IC; CRIJNS, HJ; VANDERLAARSE, A; VANGILST, WH; LIE, KI

    1991-01-01

    To study the incidence and clinical significance of postshock ST segment elevations, we recorded 12-lead ECGs immediately after transthoracic direct-current electrical cardioversion in 146 patients with atrial fibrillation or flutter. Among 23 patients (19%), acute ST segment elevations amounted to

  9. Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

    Vervaat, Fabienne E; Christensen, Thomas E; Smeijers, Loes;

    2015-01-01

    INTRODUCTION: Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required - ST-segment dev......INTRODUCTION: Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required - ST...

  10. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation

    Ivo Casagranda

    2013-10-01

    Full Text Available The purpose of this document is to develop recommendations on the use of the latest generation of cardiac troponins in emergency room settings for the diagnosis of myocardial infarction in patients with suspected acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS. The main points which have been addressed reaching a consensus are: i suitability and appropriateness of the terminology; ii appropriateness of the request; iii confirmation of the diagnosis of myocardial infarction (rule-in; iv exclusion of the diagnosis of myocardial infarction (rule-out. Each point has been analyzed by taking into account the evidence presented in medical publications. Recommendations were developed using the criteria adopted by the European Society of Cardiology and the American Heart Association/American College of Cardiology. Each point of the recommendation was submitted for validation to an external audit by a Group of Experts (named above.

  11. Acute non ST segment elevation myocardial infarction (mi) relations with drug-eluting stents%急性非ST段抬高型心肌梗死与药物洗脱支架植入的关系

    李英

    2015-01-01

    目的:研究急性非ST段抬高型心肌梗死与药物洗脱支架植入的影响关系,根据不同种药物洗脱支架对患者的疗效情况,得出有效结论。方法:随机选择急性非S T段抬高型心肌梗死患者115例,分为观察组60例,采用雷帕霉素、紫杉醇等药物洗脱支架植入术,对照组55例,未植入支架,对比两组患者支架植入后肌酐激酶、心肌肌钙蛋白指标数据,查看其12导联心电图是否正常,分析急性非ST段抬高型心肌梗死与药物洗脱支架植入的影响关系。结果:观察组患者两种药物洗脱支架植入术均成功,随访12个月,患者死亡、支架内血栓、疾病病变等不良事件的产生均可判定无差异影响,观察组随访调查中,患者肌酐激酶、心肌肌钙蛋白指标数据趋向正常,再狭窄率为7.59%,明显低于对照组,10.61%,差异具有统计学意义(P<0.05)。结论:药物洗脱支架植入与急性非ST段抬高型心肌梗死患者疾病变化有一定关联影响,在患者的预后治疗中,可设为独立预后指标,参考病情发展及变化情况。%Objective To study the acute non ST segment elevation myocardial infarction (mi) and the influence of the drug-eluting stent, according to the curative effect of different kinds of drug-eluting stents to patients condition and draw valid conclusions.Methods Randomly selected 115 patients with acute non ST segment elevation myocardial infarction patients, divided into observation group and control group, 60 cases with rapamycin, paclitaxel drug-eluting stents (des) implantation, such as the control group 55 cases, stent placement, compared two groups of patients after stenting creatinine kinase, myocardial troponin index data, check whether the 12-lead electrocardiogram is normal, analysis of acute non ST segment elevation myocardial infarction and the effect of drug-eluting stents.Results Observation group of patients with

  12. Electrocardiogram ST-Segment Morphology Delineation Method Using Orthogonal Transformations.

    Amon, Miha; Jager, Franc

    2016-01-01

    Differentiation between ischaemic and non-ischaemic transient ST segment events of long term ambulatory electrocardiograms is a persisting weakness in present ischaemia detection systems. Traditional ST segment level measuring is not a sufficiently precise technique due to the single point of measurement and severe noise which is often present. We developed a robust noise resistant orthogonal-transformation based delineation method, which allows tracing the shape of transient ST segment morphology changes from the entire ST segment in terms of diagnostic and morphologic feature-vector time series, and also allows further analysis. For these purposes, we developed a new Legendre Polynomials based Transformation (LPT) of ST segment. Its basis functions have similar shapes to typical transient changes of ST segment morphology categories during myocardial ischaemia (level, slope and scooping), thus providing direct insight into the types of time domain morphology changes through the LPT feature-vector space. We also generated new Karhunen and Lo ève Transformation (KLT) ST segment basis functions using a robust covariance matrix constructed from the ST segment pattern vectors derived from the Long Term ST Database (LTST DB). As for the delineation of significant transient ischaemic and non-ischaemic ST segment episodes, we present a study on the representation of transient ST segment morphology categories, and an evaluation study on the classification power of the KLT- and LPT-based feature vectors to classify between ischaemic and non-ischaemic ST segment episodes of the LTST DB. Classification accuracy using the KLT and LPT feature vectors was 90% and 82%, respectively, when using the k-Nearest Neighbors (k = 3) classifier and 10-fold cross-validation. New sets of feature-vector time series for both transformations were derived for the records of the LTST DB which is freely available on the PhysioNet website and were contributed to the LTST DB. The KLT and LPT

  13. Electrocardiogram ST-Segment Morphology Delineation Method Using Orthogonal Transformations.

    Miha Amon

    Full Text Available Differentiation between ischaemic and non-ischaemic transient ST segment events of long term ambulatory electrocardiograms is a persisting weakness in present ischaemia detection systems. Traditional ST segment level measuring is not a sufficiently precise technique due to the single point of measurement and severe noise which is often present. We developed a robust noise resistant orthogonal-transformation based delineation method, which allows tracing the shape of transient ST segment morphology changes from the entire ST segment in terms of diagnostic and morphologic feature-vector time series, and also allows further analysis. For these purposes, we developed a new Legendre Polynomials based Transformation (LPT of ST segment. Its basis functions have similar shapes to typical transient changes of ST segment morphology categories during myocardial ischaemia (level, slope and scooping, thus providing direct insight into the types of time domain morphology changes through the LPT feature-vector space. We also generated new Karhunen and Lo ève Transformation (KLT ST segment basis functions using a robust covariance matrix constructed from the ST segment pattern vectors derived from the Long Term ST Database (LTST DB. As for the delineation of significant transient ischaemic and non-ischaemic ST segment episodes, we present a study on the representation of transient ST segment morphology categories, and an evaluation study on the classification power of the KLT- and LPT-based feature vectors to classify between ischaemic and non-ischaemic ST segment episodes of the LTST DB. Classification accuracy using the KLT and LPT feature vectors was 90% and 82%, respectively, when using the k-Nearest Neighbors (k = 3 classifier and 10-fold cross-validation. New sets of feature-vector time series for both transformations were derived for the records of the LTST DB which is freely available on the PhysioNet website and were contributed to the LTST DB. The

  14. ST-segment elevation myocardial infarction management in Europe.

    Tubaro, Marco; Sonia Petronio, Anna

    2009-10-01

    The rate of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction varies between European countries, as does total mortality as a result of acute myocardial infarction. These differences arise partly because of differences between countries in the time delay from symptom onset to first medical contact, and from first medical contact to reperfusion with thrombolysis or PCI. The European Society of Cardiology guidelines emphasize the importance of early reperfusion therapy. There are, however, often logistical delays in transport of the patient, in diagnosis of myocardial infarction and in preparation of medical teams to be available to perform PCI. Studies have shown that door-to-balloon time may improve with an integrated approach coordinating systems, procedures and institutions, and steps such as including prehospital triage and prehospital electrocardiogram transmission can dramatically reduce door-to-balloon time. Early transfer to PCI is associated with fewer ischaemic complications. PMID:19851218

  15. Segmenting the Milk Market into bST-Produced and Non-bST-Produced Milk

    Tauer, Loren W.

    1993-01-01

    This paper discusses the value to milk producers and consumers of segmenting the milk market into bST-produced milk and non-bST-produced milk markets, versus losing milk consumption from consumers who will not consume bST-produced milk. Results indicate that both bST-using producers and non-bST-using producers benefit from a segmented market when compared to losing milk markets. Even if market loss does not occur, segmenting the market benefits producers not able to effectively use b~T and ma...

  16. Glycoprotein IIb/IIIa Receptor Inhibitors in Combination With Vorapaxar, a Platelet Thrombin Receptor Antagonist, Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes (from the TRACER Trial).

    Cornel, Jan H; Tricoci, Pierluigi; Lokhnygina, Yuliya; Moliterno, David J; Wallentin, Lars; Armstrong, Paul W; Aylward, Philip E; Clare, Robert M; Chen, Edmond; Leonardi, Sergio; Van de Werf, Frans; White, Harvey D; Held, Claes; Strony, John; Mahaffey, Kenneth W; Harrington, Robert A

    2015-05-15

    We evaluated the interaction between protease-activated receptor-1 antagonist vorapaxar and concomitant glycoprotein (GP) IIb/IIIa receptor inhibitors in patients with non-ST-segment elevation acute coronary syndromes who underwent PCI. In Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome trial, 12,944 patients with non-ST-segment elevation acute coronary syndromes were randomized to vorapaxar or placebo. Administration of GP IIb/IIIa receptor inhibitors was allowed at the treating physician's discretion. We investigated whether use of GP IIb/IIIa receptor inhibitors modified vorapaxar's effect on non-coronary artery bypass grafting (CABG)-related bleeding at 7 days and ischemic events at 30 days. In total, 7,455 patients underwent PCI during index hospitalization. Of these, 2,023 patients (27.1%) received inhibitors and 5,432 (72.9%) did not. Vorapaxar was associated with a numerically higher rate of non-CABG-related moderate/severe Global Use of Strategies to Open Occluded Arteries (GUSTO) bleeding at 7 days compared with placebo in those who did (1.3% vs 1.0%) and did not (0.6% vs 0.4%) receive GP IIb/IIIa receptor inhibitors. Ischemic end point rates at 30 days were not significantly lower with vorapaxar versus placebo. Increased rates of non-CABG GUSTO moderate/severe bleeding were observed in patients who received GP IIb/IIIa receptor inhibitors versus those who did not (adjusted hazard ratio [HR] 1.77, 95% confidence interval [CI] 0.43 to 7.35 in placebo arm; adjusted HR 2.02, 95% CI 0.62 to 6.61 in vorapaxar arm) and in those who received vorapaxar versus placebo (adjusted HR 1.54, 95% CI 0.36 to 6.56 in the GP IIb/IIIa group; adjusted HR 1.34, 95% CI 0.44 to 4.07 in the no-GP IIb/IIIa group). No interaction was found between vorapaxar and inhibitor use up to 7 days (P interaction = 0.89) nor at the end of the treatment (P interaction = 0.74); however, the event rate was low. Also, no interaction was observed for efficacy

  17. Prevalence and clinical significance of painless ST segment depression during early postinfarction exercise testing

    In a recent study of 190 survivors of acute myocardial infarction, the authors sought to determine whether exercise-induced painless ST segments depression indicates residual myocardial ischemia, as defined by 201Tl scintigraphic criteria. 2 weeks after uncomplicated myocardial infarction, and whether quantitative 201Tl imaging enhances the prognostic value of such an exercise electrocardiographic response

  18. Escore de risco Dante Pazzanese para síndrome coronariana aguda sem supradesnivelamento do segmento ST Score de riesgo dante pazzanese para síndrome coronario agudo sin supradesnivel del segmento ST Dante Pazzanese risk score for non-st-segment elevation acute coronary syndrome

    Elizabete Silva dos Santos

    2009-10-01

    desarrolló para prever el riesgo de muerte o de (reinfarto en 30 días. La exactitud predictiva del modelo fue determinada por el C statistic. RESULTADOS: El evento combinado ocurrió en 54 pacientes (5,3%. El score se creó por la suma aritmética de puntos de los predictores independientes, cuyos puntajes se designaron por las respectivas probabilidades de ocurrencia del evento. Se identificaron las siguientes variables: aumento de la edad (0 a 9 puntos; antecedente de diabetes mellitus (2 puntos o de accidente vascular cerebral (4 puntos; no utilización previa de inhibidor de la enzima conversora de la angiotensina (1 punto; elevación de la creatinina (0 a 10 puntos; y combinación de elevación de la troponina I cardíaca y depresión del segmento ST (0 a 4 puntos. Se definieron cuatro grupos de riesgo: muy bajo (até 5 puntos; bajo (6 a 10 puntos; intermedio (11 a 15 puntos; y alto riesgo (16 a 30 puntos. El C statistic para la probabilidad del evento fue de 0,78 y para el score de riesgo en puntaje de 0,74. CONCLUSIÓN: Se desarrolló un score de riesgo para prever muerte o (reinfarto en 30 días en una población brasileña con SCA sin SST, pudiendo fácilmente se aplicable en el departamento de emergencia.BACKGROUND: The probability of adverse events estimate is crucial in acute coronary syndrome condition. OBJECTIVES: To develop a risk score for the brazilian population presenting non-ST-segment elevation acute coronary syndrome. METHODS: One thousand and twenty seven (1,027 patients were investigated prospectively at a cardiology center in Brazil. A multiple logistic regression model was developed to estimate death or (reinfarction risk within 30 days. Model predictive accuracy was determined by C statistic. RESULTS: Combined event occurred in 54 patients (5.3%. The score was created by the arithmetic sum of independent predictors points. Points were determined by corresponding probabilities of event occurrence. The following variables have been identified: age

  19. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  20. Prognostic value of ST-segment resolution after percutaneous coronary intervention in the patients with acute ST-segment elevation myocardial infarction%急诊经皮冠状动脉介入治疗后心电图ST段回落程度与预后的观察

    李美红; 牛杰; 冯新恒; 郭丽君; 张福春; 王贵松; 郭静萱; 高炜

    2011-01-01

    Objective:This article was undertaken to investigate the relationship between the prognosis and the amount of ST segments resolution in patients with acute ST-segment elevation myocardial infarction (STEMI)treated by percutaneous coronary intervention (PCI). Method:Total of 225 cases of patients were divided into three groups according to sum of the relative ST-segments resolution (sumSTR): sumSTR>70 % (complete resolution group) , 30%<sumSTR≤70% (partial resolution group) and sumSTR≤30% (no resolution group). The values of left ventricular ejection fraction (LVEF) by UCG during hospitalization and the incidence of major adverse cardiac events (MACE) at 6 months post PCI were compared and analysed. In addition, multi factor regression analysis was used to identify the factors that may affect major adverse cardiovascular events in the follow up period.Result:Two hundred and twenty five patients aged 61.3 ± 12.7 were enrolled in this retrospective study, in which 156 were male, one hundred and eighteen patients had acute anterior infarction, and one hundred and seven had non-acute anterior infarction. Seventy patients had major adverse cardiovascular events in the follow-up period.Patients with sumSTR>70% had higher values of LVEF compared to patients with 30% < sumSTR≤ 70%(56.62±7.53 vs53.4±9.45, P=0.022) and patents with sumSTR≤30% (56.62±7.53 vs 54.3±8.66, P=0. 049, P=0.022). The incidence of MACE at 6 months post PCI was lower in the patients with sumSTR>70%compared to patients with 30%<sumSTR≤70% (16.3% vs 39.3%, P=0.001) and patients with sumSTR≤30% (16.3% vs 48.3%, P=0.001). Multivariate regression analysis showed that anterior infarction and poor sumSTR were independent predictors of major adverse cardiovascular events in 6 months follow up. Conclusion:This study show that amounts of sumSTR post primary PCI was closely correlated with the values of LVEF and incidence of MACE in the patients with

  1. Leukocytosis and clinical outcomes in patients with myocardial infarction with ST-segment elevation

    Panina A.V.; Dolotovskaya P.V.; Puchinyan N.F.; Dovgalevsky Ya.P.; Furman N.V.

    2013-01-01

    The aim of the study is to evaluate the frequency of occurrence of leukocytosis and its prognostic value for the course and outcome of myocardial infarction with ST-segment elevation. Material and Methods. The study included 245 patients aged 61,2 years, who were on treatment at the Department of Emergency Cardiology with diagnosis of acute myocardial infarction with ST-segment elevation. Results. Leukocytosis (white blood cell levels of more than 10*109/L) was observed in 34,7% of patients. ...

  2. Impact of Frailty and Other Geriatric Syndromes on Clinical Management and Outcomes in Elderly Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: Rationale and Design of the LONGEVO-SCA Registry.

    Alegre, Oriol; Ariza-Solé, Albert; Vidán, María T; Formiga, Francesc; Martínez-Sellés, Manuel; Bueno, Héctor; Sanchís, Juan; López-Palop, Ramón; Abu-Assi, Emad; Cequier, Àngel

    2016-07-01

    The incidence of acute coronary syndromes (ACS) is high in the elderly. Despite a high prevalence of frailty and other aging-related variables, little information exists about the optimal clinical management in patients with coexisting geriatric syndromes. The aim of the LONGEVO-SCA registry (Impacto de la Fragilidad y Otros Síndromes Geriátricos en el Manejo y Pronóstico Vital del Anciano con Síndrome Coronario Agudo sin Elevación de Segmento ST) is to assess the impact of aging-related variables on clinical management, prognosis, and functional status in elderly patients with ACS. A series of 500 consecutive octogenarian patients with non-ST-segment elevation ACS from 57 centers in Spain will be included. A comprehensive geriatric assessment will be performed during the admission, assessing functional status (Barthel Index, Lawton-Brody Index), frailty (FRAIL scale, Short Physical Performance Battery), comorbidity (Charlson Index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Patients will be managed according to current recommendations. The primary outcome will be the description of mortality and its causes at 6 months. Secondary outcomes will be changes in functional status and quality of life. Results from this study might significantly improve the knowledge about the impact of aging-related variables on management and outcomes of elderly patients with ACS. Clinical management of these patients has become a major health care problem due to the growing incidence of ACS in the elderly and its particularities. PMID:27362592

  3. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial

    Cannon, Christopher P; Husted, Steen; Harrington, Robert A;

    2007-01-01

    OBJECTIVES: Our goal was to compare the safety and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, with clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). BACKGROUND: AZD6140 achieves higher mean levels of...... platelet inhibition than clopidogrel in patients with stable coronary artery disease. METHODS: A total of 990 patients with NSTE-ACS, treated with aspirin and standard therapy for ACS, were randomized in a 1:1:1 double-blind fashion to receive either twice-daily AZD6140 90 mg, AZD6140 180 mg, or...... clopidogrel 300-mg loading dose plus 75 mg once daily for up to 12 weeks. RESULTS: The primary end point, the Kaplan-Meier rate of major or minor bleeding through 4 weeks, was 8.1% in the clopidogrel group, 9.8% in the AZD6140 90-mg group, and 8.0% in the AZD6140 180-mg group (p = 0.43 and p = 0...

  4. Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes

    Fox, Keith A A; Bassand, Jean-Pierre; Mehta, Shamir R; Wallentin, L; Theroux, Pierre; Piegas, Leopoldo Soares; Valentin, Vicent; Moccetti, Tiziano; Chrolavicius, Susan; Afzal, Rizwan; Yusuf, Salim; Husted, Steen

    2007-01-01

    rate (GFR) was calculated by using the Modification of Diet in Renal Disease formula. RESULTS: The absolute differences in favor of fondaparinux (efficacy and safety) were most marked in patients with a GFR less than 58 mL/min per 1.73 m2; the largest differences occurred in major bleeding events. At 9......BACKGROUND: A recent randomized, controlled trial, the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS 5) trial, reported that major bleeding was 2-fold less frequent with fondaparinux than with enoxaparin in acute coronary syndromes (ACS). Renal dysfunction increases the...... risk for major bleeding. OBJECTIVE: To compare the efficacy and safety of fondaparinux and enoxaparin over the spectrum of renal dysfunction observed in the OASIS 5 trial. DESIGN: Subgroup analysis of a randomized, controlled trial. SETTING: Patients presenting to the hospital with non...

  5. ST-segment elevation: Distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies

    Alok; Deshpande; Yochai; Birnbaum

    2014-01-01

    The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.

  6. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS

    Chin, Chee Tang; Roe, Matthew T; Fox, Keith A A; Prabhakaran, Dorairaj; Marshall, Debra A; Petitjean, Helene; Lokhnygina, Yuliya; Brown, Eileen; Armstrong, Paul W; White, Harvey D; Ohman, E Magnus; Clemmensen, Peter

    2010-01-01

    Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that provides...... higher and less variable levels of platelet inhibition than clopidogrel-has demonstrated benefit when used to treat ACS patients undergoing percutaneous coronary intervention. However, the optimal approach to antiplatelet therapy for high-risk, medically managed NSTE ACS patients remains uncertain, as...

  7. Impact of percutaneous coronary intervention timing on 5-year outcome in patients with non-ST-segment elevation acute coronary syndromes. The ‘wait a day’ approach might be safer

    E.F.J. Oosterwerff (Erik F. J.); N.D. Fagel; T. Slagboom (Ton); J.G.P. Tijssen (Jan G. P.); J.P.R. Herrman; P.C. Smits (Pieter); M.J. Suttorp (Maarten); E. Ronner (Eelko); G-J. Laarman (GertJan); M.S. Patterson (Mark); G. Amoroso (Giovanni); M.A. Vink; R.J. van der Schaaf; F.W.A. Verheugt (Freek); R.K. Riezebos

    2016-01-01

    textabstractBackground The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best

  8. Non-invasive versus invasive management in patients with prior coronary artery bypass surgery with a non-ST segment elevation acute coronary syndrome: study design of the pilot randomised controlled trial and registry (CABG-ACS)

    Lee, Matthew M Y; Petrie, Mark C; Rocchiccioli, Paul; Simpson, Joanne; Jackson, Colette; Brown, Ammani; Corcoran, David; Mangion, Kenneth; McEntegart, Margaret; Shaukat, Aadil; Rae, Alan; Hood, Stuart; Peat, Eileen; Findlay, Iain; Murphy, Clare; Cormack, Alistair; Bukov, Nikolay; Balachandran, Kanarath; Papworth, Richard; Ford, Ian; Briggs, Andrew; Berry, Colin

    2016-01-01

    Introduction There is an evidence gap about how to best treat patients with prior coronary artery bypass grafts (CABGs) presenting with non-ST segment elevation acute coronary syndromes (NSTE-ACS) because historically, these patients were excluded from pivotal randomised trials. We aim to undertake a pilot trial of routine non-invasive management versus routine invasive management in patients with NSTE-ACS with prior CABG and optimal medical therapy during routine clinical care. Our trial is a proof-of-concept study for feasibility, safety, potential efficacy and health economic modelling. We hypothesise that a routine invasive approach in patients with NSTE-ACS with prior CABG is not superior to a non-invasive approach with optimal medical therapy. Methods and analysis 60 patients will be enrolled in a randomised clinical trial in 4 hospitals. A screening log will be prospectively completed. Patients not randomised due to lack of eligibility criteria and/or patient or physician preference and who give consent will be included in a registry. We will gather information about screening, enrolment, eligibility, randomisation, patient characteristics and adverse events (including post-discharge). The primary efficacy outcome is the composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction and hospitalisation for heart failure. The primary safety outcome is the composite of bleeding, stroke, procedure-related myocardial infarction and worsening renal function. Health status will be assessed using EuroQol 5 Dimensions (EQ-5D) assessed at baseline and 6 monthly intervals, for at least 18 months. Trial registration number NCT01895751 (ClinicalTrials.gov). PMID:27110377

  9. Activated partial thromboplastin time measurement is not associated with clinical outcomes in patients with high-risk non-ST-segment elevation acute coronary syndromes treated with unfractionated heparin.

    Thomas, Michael P; Mahaffey, Kenneth W; Chiswell, Karen; Cohen, Marc; Kontos, Michael C; Antman, Elliott M; Ferguson, James J; Califf, Robert M; Goodman, Shaun G; Becker, Richard C

    2012-07-01

    Our objective was to determine the association of activated partial thromboplastin time (aPTT) with recurrent ischemic events and non-coronary artery bypass surgery-related thrombolysis in myocardial infarction major bleeding. We studied 4,985 patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACS) participating in SYNERGY, a prospective, randomized, international trial designed to emulate contemporary practice wherein unfractionated heparin (UFH) is given intravenously and titrated according to a weight-adjusted dosing nomogram to a target aPTT of 1.5-2 times the upper limit of normal (approximately 50-70 s). Aspirin was administered to 95% of patients, clopidogrel to 63%, and glycoprotein IIb/IIIa receptor inhibitors to 58%. More than 90% of patients underwent early coronary angiography, and 69% were revascularized. Used as a time-dependent covariate, aPTT was evaluated as a predictor of time to ischemic or major hemorrhagic events in proportional hazards regression models. Using discrete variable analysis, aPTT was categorized as persistently below a lower threshold of anticoagulation (70 vs. ≤70 s) for major hemorrhagic events. UFH treatment lasted a median of 42 (30, 78) h. At >6-12 (n = 3,021), >12-24 (n = 3,406), and >24-48 (n = 2,497) h, 34, 41, and 46% of patients achieved the target aPTT range, respectively. Both before and after adjusting for baseline predictors of anticoagulant response and risk score (age, hypertension, diabetes, smoking, ST depression, and renal function), no significant relationship between aPTT values and recurrent ischemic events or major bleeding was found. No relationship was observed between clinical outcomes and aPTT values persistently above or below the designated thresholds. Measurements of aPTT were not associated with clinical outcomes among patients with NSTE ACS treated with UFH. The required intensity of anticoagulation for benefit may be relatively modest when UFH is administered

  10. ANÁLISIS ELECTROCARDIOGRÁFICO DE LA DISPERSIÓN DEL INTERVALO TPICO-TFINAL EN EL INFARTO AGUDO DE MIOCARDIO CON ELEVACIÓN DEL ST / Electrocardiographic analysis of the T peak-T end interval dispersion in acute myocardial infarction with ST-segment elevation

    Raimundo Carmona Puerta

    2010-09-01

    Full Text Available Resumen Introducción y objetivos: La dispersión del intervalo TPICO-TFINAL (Tpeak-Tend constituye una novedosa variable electrocardiográfica asociada recientemente, al riesgo de arritmias ventriculares malignas en el síndrome de Brugada, pero apenas se ha estudiado en el infarto agudo de miocardio con elevación del segmento ST, por lo que se decidió analizarlo en este contexto. Métodos: Se realizó un estudio de corte transversal donde se compararon los electrocardiogramas de 37 pacientes con infarto con elevación del segmento ST y otros 37, supuestamente sanos con respecto a las variables electrocardiográficas que evalúan la repolarización ventricular. Resultados: Se encontraron diferencias altamente significativas (p<0,001 al comparar a los pacientes infartados (QT 416,9 ± 42,3; QTc 431,4 ± 36,2 con los sanos (QT 441,2 ± 57,4 y QTc 477,6 ± 58,5, y significativas (p < 0,05 en la TPICO-TFINAL (37.2 ms vs. 21,6 ms. Existió correlación significativa entre el QT y la TPICO-TFINAL en el IMACEST inferior y ántero-septal, la que fue doblemente intensa en la localización ántero-septal (r = 0,34 vs. r = 0,80. Conclusiones: La dispersión del intervalo TPICO-TFINAL fue significativamente mayor en pacientes con infarto agudo de miocardio con elevación del segmento ST, independientemente de la localización del infarto. / Abstract Introduction and objectives: Tpeak-Tend interval dispersion is a new electrocardiographic variable recently associated to the risk of malignant ventricular arrhythmias in Brugada syndrome but it has hardly been studied in the acute myocardial infarction with ST-segment elevation. That is why it was analyzed in this context. Methods: A cross-sectional study was carried out in which the electrocardiograms of 37 patients with ST-segment elevation myocardial infarctions and other 37 apparently healthy patients (regarding electrocardiographic variables that assess ventricular repolarization were compared. Results

  11. Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

    Armstrong, Paul W.; Gershlick, Anthony H; Goldstein, Patrick; Wilcox, Robert; Danays, Thierry; Lambert, Yves; Sulimov, Vitaly; Rosell Ortiz, Fernando; Ostojic, Miodrag; Welsh, Robert C.; Carvalho, Antonio C.; Nanas, John; Arntz, Hans-Richard; Halvorsen, Sigrun; Huber, Kurt

    2013-01-01

    BACKGROUND It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI). METHODS Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic th...

  12. ELECTROCARDIOGRAM ST SEGMENT DEPRESSION AND ELEVATION IN STRESS-TESTING

    D. A. Kuzhel

    2015-09-01

    Full Text Available The electrocardiogram remains a crucial tool for the identification of myocardial ischemia. Important information for patient management and prognosis determination can be derived from the stress testing electrocardiogram. Leads with ST-segment elevation indicate the ischemia related coronary artery.

  13. Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction.

    Fröbert, Ole; Lagerqvist, Bo; Olivecrona, Göran; Omerovic, Elmir; Gudnason, Thorarinn; Maeng, Michael; Aasa, Mikael; Angerås, Oskar; Calais, Fredrik; Danielewicz, Mikael; Erlinge, David; Hellsten, Lars; Jensen, Ulf; Johansson, Agneta C; Kåregren, Amra

    2013-01-01

    Background The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality. Methods We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (...

  14. Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment Elevation

    Camila Pepe; Márcio Machado; Alexandre Olimpio; Rui Ramos

    2012-01-01

    FUNDAMENTO: O uso combinado de agentes antitrombínicos, antiplaquetários e estratégias invasivas na síndrome coronariana aguda sem supradesnivelamento do ST (SCAsSST) reduz eventos cardiovasculares. O fondaparinux demonstrou equivalência à enoxaparina na redução de eventos cardiovasculares, porém com menor índice de sangramento nos pacientes que usaram fondaparinux. OBJETIVO: Avaliar o custo-efetividade de fondaparinux versus enoxaparina em pacientes com SCAsSST no Brasil a partir da perspect...

  15. 非ST段抬高型急性冠状动脉综合征的64排螺旋CT表现%The imaging of angiography of non-ST segment elevation acute coronary syndrome under 64-dector CT

    舒政; 邓小飞; 张家美; 葛琛瑾; 孟文斌

    2013-01-01

    目的:探讨非ST段抬高型急性冠状动脉综合征(NSTEACS)的64排螺旋CT冠状动脉造影的表现.方法:对实施64排螺旋CT冠状动脉造影的20名正常人及35例NSTEACS患者,研究其冠状动脉病变发生的部位、斑块累及血管支数、斑块性质(硬化斑块、非硬化斑块或混合斑块)、斑块所致的狭窄以及主要冠状动脉远段血管是否中断等影像特点.结果:在NSTEACS患者中,硬化斑块的发生率、斑块累及冠状动脉支数均明显高于正常人群(P0.05).NSTEACS组冠状动脉狭窄率范围较广,狭窄率达15%~100%.结论:冠状动脉多发硬化斑块、斑块累及数支冠状动脉、冠状动脉狭窄率范围较广为NSTEACS影像特点,对于临床治疗有一定的指导意义.%Objective:To explore the imaging of angiography of non-ST segment elevation acute coronary syndrome(NSTEACS) under 64-dector CT. Methods: Coronary artery angiography of twenty normal persons and thirty-five patients with NSTEACS were detected using 64-detector computed tomography,64-MDCT. The data of the lesion site,vessel involved number,plaque nature(calcified plaque, non-calcified plaque or mixed plaque) , stenosis (degree and length) and the obstructed vessel were analysed. Results: There was significant statistic difference in the incidence of calcified plaque and plaques involving the coronary artery number(P 0.05) ,and the narrow rates of coronary artery ranged from 15% to 100% in NSTEACS group. Conclusions: The imaging features of NSTEACS show extensive calcified plaque, multiple vessels involved and the wide stenosis of coronary artery,which can guide, clinical service.

  16. RESULTS OF TREATMENT OF ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: DATA OF A RETROSPECTIVE, SINGLE-CENTER STUDY (IN-HOSPITAL PERIOD

    D. B. Nemick

    2015-12-01

    Full Text Available Myocardial infarction significantly contributes to mortality rates in patients with chronic obstructive pulmonary disease (COPD. The influence of COPD on the course of acute ST-segment elevation myocardial infarction (STEMI is controversial.Aim. To evaluate characteristics of coronary artery lesions and cardiovascular complications in STEMI patients with and without COPD depending on a reperfusion treatment method during in-hospital stay.Material and methods. A total of 1112 cases of STEMI treatment within the first 6 hours of the symptoms onset were analyzed. All of these patients have undergone reperfusion treatment: primary percutaneous coronary intervention (PPCI or pharmacoinvasive strategy (PIS methods. All the patients were divided into two groups: patients without COPD (952 persons; 83.2% and those with COPD (160 patients; 16.8%. COPD impact on in-hospital course of STEMI was assessed.Results. The presence of COPD had no influence on STEMI in-hospital mortality. Mortality rates in patients with COPD (12 subjects; 7.5% and without COPD (83 subjects; 8.7% did not differ significantly (p=0.2. The study has demonstrated the significant influence of COPD on the patients’ baseline characteristics and treatment results, which can have an impact on long-term prognosis. According to our data COPD presence was associated with more severe coronary artery lesions in both PPCI and PIS subgroups (p<0.001. This has determined more frequent transmural myocardial damage in STEMI patients with COPD regardless of reperfusion strategy and time factor (79% in patients with COPD and 50% in those without one, p<0.001. The incidence of hemorrhagic complications also didn’t depend on COPD presence and remained low in all groups.Conclusion. At COPD presence STEMI was associated with more severe coronary artery lesions and increased frequency of transmural myocardial damage and residual stenosis after thrombolytic therapy. COPD did not lead to the

  17. Detection and Classification of QRS and ST segment using WNN

    Surendra Dalu

    2012-06-01

    Full Text Available ECG consists of various waveforms of electric signals.In order to decide wavelet generating function that canremove baseline by minimizing the distortion of rawsignals, we apply various wavelet generating functionsto remove baseline. We have evaluated the algorithmon MIT-BIH Database for validation purpose. ECGsignal was de-noised by removing the correspondingwavelet coefficients at higher scales. In this processwe use Maxima – Minima algorithm to extract QRSand ST segment of ECG. The detected QRS and STsegment is compared with normal QRS and STsegment value. On this basis we find abnormalities inQRS and ST segment, which helps us to detect thediseases. We authenticate the results with thecardiologists data. This is done using LVQ neuralnetworks. Almost 300 samples of different patientsfrom cardiologists with attributes was normalized totrain neural network. Neural Network normally obtainthe results around 90 percent efficiency. All results weobtain using MATLAB

  18. Effect of intravenous FX06 as an adjunct to primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) trial

    Atar, Dan; Petzelbauer, Peter; Schwitter, Jürg;

    2009-01-01

    by mitigating reperfusion injury. METHODS: In all, 234 patients presenting with acute ST-segment elevation myocardial infarction were randomized in 26 centers. FX06 or matching placebo was given as intravenous bolus at reperfusion. Infarct size was assessed 5 days after myocardial infarction by late...... gadolinium enhanced cardiac magnetic resonance imaging. Secondary outcomes included size of necrotic core zone and microvascular obstruction at 5 days, infarct size at 4 months, left ventricular function, troponin I levels, and safety. RESULTS: There were no baseline differences between groups. On day 5...

  19. Detection and Classification of QRS and ST segment using WNN

    Surendra Dalu; Nilesh Pawar

    2012-01-01

    ECG consists of various waveforms of electric signals.In order to decide wavelet generating function that canremove baseline by minimizing the distortion of rawsignals, we apply various wavelet generating functionsto remove baseline. We have evaluated the algorithmon MIT-BIH Database for validation purpose. ECGsignal was de-noised by removing the correspondingwavelet coefficients at higher scales. In this processwe use Maxima – Minima algorithm to extract QRSand ST segment of ECG. The detecte...

  20. Air Pollution and ST-Segment Depression in Elderly Subjects

    MacCallum, Gail; Canner, Marina J.; Gold, Diane R.; Litonjua, Augusto Ampil; Zanobetti, Antonella; Coull, Brent Andrew; Schwartz, Joel David; Verrier, Richard Leonard; Nearing, Bruce David; Suh MacIntosh, Helen H.; Stone, Peter Howard

    2005-01-01

    Increased levels of daily ambient particle pollution have been associated with increased risk of cardiovascular morbidity. Black carbon (BC) is a measure of the traffic-related component of particles. We investigated associations between ambient pollution and ST-segment levels in a repeated-measures study including 269 observations on 24 active Boston residents 61–88 years of age, each observed up to 12 times from June through September 1999. The protocol involved continuous Holter electrocar...

  1. Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction

    C.S. Thejanandan Reddy; D Rajasekhar; Vanajakshamma, V.

    2013-01-01

    The electrocardiogram (ECG) remains a crucial tool in the identification and management of acute myocardial infarction (MI). A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of reperfusion therapy. The early and accurate identification of the infarct-related artery on the ECG can help predict the amount of myocardium at risk and guide decisions regarding the urgency of revascularization. The specificity of the ECG in acute MI is lim...

  2. Optical coherence tomography plaque characterization in a patient with ST segment elevation myocardial infarction after cocaine intake.

    Hansen, Morten Steen Svarer; Antonsen, Lisbeth; Jensen, Lisette Okkels

    2016-01-01

    A 28-year old man presented to the Emergency Department with malaise after cocaine intake. After arrival he developed retrosternal chest pain and the electrocardiogram showed ST segment elevations in V1-V2 and ST segment depressions in V5-V6. An acute coronary angiogram revealed a focal non-occlusive lesion with thrombus in the left anterior descending artery. Supplementary optical coherence tomography (OCT) detected plaque erosion with adherent thrombus to be the responsible underlying pathophysiological mechanism. The patient received an effective antithrombotic regimen. Repeat angiogram with additional OCT one month later documented thrombus resolution and complete restoration of the previously eroded coronary vascular surface area. PMID:26905053

  3. Prevalence of electrocardiographic ST-T changes during acute ischemic stroke in patients without known ischemic heart disease

    Jensen, Jesper K; Bak, Søren; Flemming Høilund-Carlsen, Poul;

    2008-01-01

    We evaluated characteristics and prevalence of ST-segment depression and/or T-wave inversion in the resting electrocardiogram of 244 consecutive patients with acute ischemic stroke, but without ischemic heart disease. The prevalence of ST-T changes ranged from 13% to 16% and this is what to expect...

  4. PROFILAXIS DE LA NEFROPATÍA INDUCIDA POR CONTRASTE EN PACIENTES DE ALTO RIESGO CON SÍNDROME CORONARIO AGUDO SIN ELEVACIÓN DEL SEGMENTO ST / Prophylaxis of contrast-induced nephropathy in high risk patients with non-ST-segment elevation acute coronary syndrome

    Pilar Portero Pérez

    2012-07-01

    Full Text Available ResumenIntroducción y objetivos: La eficacia de la administración conjunta de suero salino isotónico y N-acetilcisteína presenta resultados dispares en la prevención de la nefropatía por contraste yodado. Nuestro objetivo fue valorar la posible eficacia de esta estrategia combinada en pacientes con alto riesgo de desarrollar nefropatía inducida por contraste, ingresados y sometidos a intervencionismo coronario percutáneo por síndrome coronario agudo sin elevación del segmento ST en nuestro centro. Método: Se aplicó esta estrategia en los pacientes referidos, con al menos un factor de alto riesgo para desarrollar la nefropatía inducida por contraste: mayores de 80 años, diabetes mellitus, creatinina basal mayor de 1,5 mg/dl o alto volumen de contraste (mayor de 400 ml. El protocolo se aplicó durante 12 meses (pacientes que recibieron el protocolo de prevención y se comparó con similares pacientes en los 12 meses previos que no recibieron profilaxis. Resultados: Un total de 30 pacientes (24 % desarrollaron nefropatía inducida por contraste. El porcentaje fue significativamente mayor en el grupo que no recibió profilaxis: 35,9 % vs. 11,5 % (p = 0.003. Conclusiones: La combinación de N-acetilcisteína por vía oral e hidratación parenteral en pacientes de alto riesgo, con síndrome coronario agudo sin elevación de ST, podría ser beneficiosa para evitar la aparición de la nefropatía inducida por contraste. /Abstract Introduction and Objectives: The effectiveness of the administration of isotonic saline solution and N-acetylcysteine shows different results in the prevention of iodine contrast nephropathy. Our objective was to assess the potential effectiveness of this combined strategy in patients at high risk for contrast-induced nephropathy, who were admitted in our center for percutaneous coronary intervention due to non-ST-segment elevation acute coronary syndrome. Method: This strategy was applied in the patients

  5. Prognostic Value of Cardiac Time Intervals by Tissue Doppler Imaging M-Mode in Patients With Acute ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

    Biering-Sørensen, Tor; Mogelvang, Rasmus; Søgaard, Peter;

    2013-01-01

    Background- Color tissue Doppler imaging M-mode through the mitral leaflet is an easy and precise method to estimate all cardiac time intervals from 1 cardiac cycle and thereby obtain the myocardial performance index (MPI). However, the prognostic value of the cardiac time intervals and the MPI...... examined by echocardiography a median of 2 days after the ST-segment-elevation MI. Outcome was assessed according to death (n=33), hospitalization with heart failure (n=53), or new MI (n=25). Follow-up time was a median of 25 months. The population was stratified according to tertiles of the MPI. The risk...... of new MI, being admitted with congestive heart failure or death, increased with increasing tertile of MPI, being ≈3 times as high for the third tertile compared with the first tertile (hazard ratio, 2.8; 95% confidence interval, 1.7-4.7; P...

  6. ST-Segment Elevation Myocardial Infarction in Women With Type 2 Diabetes

    Radomska, Edyta; Sadowski, Marcin; Kurzawski, Jacek; Gierlotka, Marek; Poloński, Lech

    2013-01-01

    OBJECTIVE To evaluate the effect of type 2 diabetes on the clinical course and prognosis of women with ST-segment elevation myocardial infarction (STEMI) and diabetes. RESEARCH DESIGN AND METHODS A total of 26,035 consecutive patients with STEMI who were hospitalized in 456 hospitals in Poland during 1 year were analyzed. The data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS). RESULTS Type 2 diabetes occurred more frequently in women than in men (28 vs. 16.6%; P ...

  7. ST peak during percutaneous coronary intervention serves as an early prognostic predictor in patients with ST-segment elevation myocardial

    Lønborg, Jacob; Kelbæk, Henning; Engstrøm, Thomas;

    2014-01-01

    AIMS: To evaluate the clinical importance of the ST peak phenomenon during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: Continuous ST monitoring was performed in 942 STEMI patients from arrival until 90...... primary PCI, we demonstrated that ST peak is a strong predictor of adverse long-term outcome and provides independent prognostic information beyond that provided by ST resolution and epicardial flow....

  8. ST Segment Extraction from Exercise ECG Signal Based on EMD and Wavelet Transform

    You Jia; Jiang Kai; Chen Hang; Wen Haoxiang

    2015-01-01

    Myocardial ischemia is always characterized by the changes in ST complex. But ischemia is not obvious at rest. Only in the state of exercise, abnormal ST will appear. The signal of ST is susceptible to noise interference which causes the inaccuracy of the ST segment detection. Combining the advantages of empirical mode decomposition (EMD), the paper proposes a modified threshold method to filter a serious of noise from exercise ECG. Extracted from the ECG feature, it includes ST segment detec...

  9. Unexpected ST segment changes in children--a case report.

    Alfirevic, Andrej; Mossad, Emad; Niezgoda, Julie

    2005-01-01

    In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation. PMID:15649167

  10. Leukocytosis and clinical outcomes in patients with myocardial infarction with ST-segment elevation

    Panina A.V.

    2013-12-01

    Full Text Available The aim of the study is to evaluate the frequency of occurrence of leukocytosis and its prognostic value for the course and outcome of myocardial infarction with ST-segment elevation. Material and Methods. The study included 245 patients aged 61,2 years, who were on treatment at the Department of Emergency Cardiology with diagnosis of acute myocardial infarction with ST-segment elevation. Results. Leukocytosis (white blood cell levels of more than 10*109/L was observed in 34,7% of patients. The presence of leukocytosis was associated with increased incidence of congestive heart failure class IV at Killip, ventricular fibrillation and lethal outcomes during hospitalization. There were no significant differences in the incidence of adverse events in the long-term period between the patients with leukocytosis and with normal level of white blood cells. Conclusion. Increased levels of white blood cells (more than 10*109/L in patients with myocardial infarction with ST-segment elevation is associated with a significantly increase relative risk of cardiogenic shock (Odds ratio 5,2, 95% Cl, 1,7-15,8, p=0.001, ventricular fibrillation (Odds ratio 8,5, 95% Cl, 1,9-38,3, p=0.001 and death during hospitalization (Odds ratio 2,47, 95% Cl, 1,87-38,4, p=0,03. The level of white blood cells on admission to hospital may be used as one of the additional factors predicting the risk of patients with myocardial infarction with ST-segment elevation during hospitalization.

  11. Midterm follow-up outcomes of ticagrelor on acute ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention%替格瑞洛对急性ST段抬高型心肌梗死患者行急诊介入治疗的中期随访

    夏经钢; 曲杨; 胡少东; 许骥; 尹春琳; 徐东

    2015-01-01

    Objective:To evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary in-tervention. Methods:In the study, 96 patients suffering from acute ST segment elevation myocardial infarction onset within 12 h undergoing primary percutaneous coronary intervention from May to October in 2013 were randomly divided into ticagrelor group (n=48) and clopidogrel group (n=48) by using the method of random number table. Ticagrelor and clopidogrel antiplatelet treatment were used before and after operation. Their baseline data, coronary artery disease characteristics, platelet count, adenosine diphosphate(ADP)-induced platelet inhibition rate by thrombelastograph after 5 days of treatment, the major adverse cardiovascular events of the follow up for 6 months and bleeding complications were observed and compared in the two groups. Re-sults:The differences between the two groups of patients with their baseline data, the features of coronary ar-tery lesions, platelet count before and after 5 days of treatment had no statistical significance (P>0. 05). ADP induced platelet inhibition rate [(80. 2 ± 10. 7)%] after 5 days of treatment in ticagrelor group was sig-nificantly higher than that in clopidogrel group [(75. 3 ± 12. 1)%, P0. 05). Conclusion: Antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing emergency PCI has good efficacy and safety.%目的::评价替格瑞洛对急性 ST 段抬高型心肌梗死( acute ST segment elevation myocardial infarction, STEMI)行急诊经皮冠状动脉介入治疗( percutaneous coronary intervention,PCI)患者抗血小板治疗的有效性及安全性。方法:选择2013年5至10月收治的96例发病12 h以内、接受急诊PCI的急性STEMI患者为研究对象,采用随机数字表分为替格瑞洛组(48例)和氯吡格雷组(48例)。术

  12. Pacing-induced ST segment deviation in patients with unstable angina: clinical, angiographic, and hemodynamic correlation.

    Hussain, K M; Gould, L; Pomerantsev, E V; Angirekula, M; Bharathan, T

    1995-07-01

    To assess the clinical, coronary arteriographic, and hemodynamic differences between the unstable angina patients manifesting ST segment depression and those showing ST segment elevation as well as those demonstrating chest pain only without ST segment deviation during pacing, low-dose digital subtraction ventriculography was performed in 33 patients before and after abrupt cessation of atrial pacing during selective coronary arteriography. Transient ST segment depression during pacing was observed in 17 patients (52%), whereas 6 patients (18%) showed ST segment elevation; however, 10 patients (30%) did not manifest any ST segment deviation in spite of typical chest pain. Hypertension and a history of myocardial infarction were observed in a significantly higher (P < 0.05) proportion of patients with ST segment depression than in those with ST elevation. Patients who manifested ST segment depression during pacing had a higher incidence of triple-vessel disease (65 vs 17%; P < .05) as compared with the patients with ST segment elevation. Indirect evidence of intracoronary thrombi (complicated lesion, abrupt occlusion, and intraluminal filling defect) was noticed in a higher frequency (P < 0.05) in the group of patients with ST elevation during pacing. In patients with ST segment depression, no significant changes of global left ventricular (LV) functional parameters were observed. However, the length of the LV severe hypokinetic region was increased significantly (6.2 +/- 3.1 vs 23.5 +/- 6.2%; P < 0.005) during pacing in this group of patients. The shortening of the affected segments of the left ventricle was decreased significantly (52.3 +/- 3.6 vs 38.3 +/- 4.9%; P < 0.05) in these patients during pacing. In the group of patients with ST segment elevation during pacing, decrease in ejection fraction was associated with significant (P < 0.01) increase in midwall equatorial diastolic stress as compared with the patients with pacing-induced ST segment depression as

  13. Prothrombotic markers and early spontaneous recanalization in ST-segment elevation myocardial infarction. : Thrombin and plasmin generation in early recanalization

    Huisse, Marie-Geneviève; Lanoy, Emilie; Tcheche, Didier; Feldman, Laurent,; Bezeaud, Annie; Anglès-Cano, Eduardo; Mary-Krause, Murielle; de Prost, Dominique; Guillin, Marie-Claude; Steg, Ph.Gabriel

    2007-01-01

    28 pages International audience We tested the hypothesis that selected prothrombotic biomarkers might be associated with early spontaneous coronary recanalization in patients with ST-segment elevation acute myocardial infarction (STEMI). We prospectively enrolled 123 patients with STEMI including 53 patients with spontaneous coronary recanalization (cases) and 70 patients with persistent occlusion (controls) at the time of emergent coronary angiography and before angioplasty. All had re...

  14. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS

    Chin, Chee Tang; Roe, Matthew T; Fox, Keith A A;

    2010-01-01

    Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that provides...... higher and less variable levels of platelet inhibition than clopidogrel-has demonstrated benefit when used to treat ACS patients undergoing percutaneous coronary intervention. However, the optimal approach to antiplatelet therapy for high-risk, medically managed NSTE ACS patients remains uncertain, as...... weight or=75 years). TRILOGY ACS is the largest randomized clinical trial to date focusing exclusively on medically managed NSTE ACS patients and will provide important information regarding the optimal approach to oral antiplatelet therapy for this high-risk, understudied population....

  15. 急性 ST段抬高型心肌梗死延期经皮冠状动脉介入术研究进展及疗效%Current Research on Curative Effect of Delayed Percutaneous Coronary Intervention in ST-segment Elevation Acute Myocardial Infarction

    徐莉(综述); 马依彤(审校)

    2015-01-01

    ST-segment elevation acute myocardial infarction is often complicated by heart failure, cardiogenic shock, and malignant arrhythmia.The standard treatment is to use primary percutaneous coronary intervention (PCI).However, due to its limitations,many pa-tients do not receive reperfusion in the optimal amount of time.Internationally, a consensus has not been reached regarding patients receiving delayed PCI.This article summarizes the current research in the curative effect of delayed PCI in patients with ST-segment elevation acute myocardial infarction.%急性ST段抬高型心肌梗死是冠心病中最严重、危害最大的疾病之一,常并发心力衰竭、心源性休克、恶性心律失常,是临床上常见的严重危害人类健康的心血管危急症。目前处理的原则是尽早(<12 h)开通梗死相关动脉,其中直接经皮冠状动脉介入术为最佳手段。但由于直接经皮冠状动脉介入术的局限性,很大一部分患者不能在最佳时间接受再灌注治疗。对于这部分患者是否可行延期经皮冠状动脉介入术,目前国际上尚未达成共识。现对延期经皮冠状动脉介入术的研究现状及疗效做一综述。

  16. Primary percutaneous coronary intervention in elderly patients with ST-elevation acute myocardial infarction

    SHEN Wei-feng

    2006-01-01

    @@ The elderly constitute a rapidly growing segment of our population and cardiovascular disease becomes more prevalent with increasing age,accounting for majority of their morbidity and mortality.1,2 ST-elevation acute myocardial infarction (STEMI) is the result of an abrupt cessation of blood supply caused by coronary occlusion, its process involving atherosclerotic plaque rupture or erosion,platelet aggregation and thrombus formation.

  17. Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 3-year follow-up of the randomized DEDICATION (Drug Elution and Distal Protection in Acute Myocardial Infarction) Trial

    Kaltoft, Anne; Kelbaek, Henning; Thuesen, Leif;

    2010-01-01

    The purpose of this study was to compare long-term clinical outcomes after implantation of drug-eluting stents (DES) and bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI).......The purpose of this study was to compare long-term clinical outcomes after implantation of drug-eluting stents (DES) and bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI)....

  18. Diagnostic and prognostic value of ST segment depression limited to the recovery phase of exercise stress test

    Lanza, G A; Mustilli, M; Sestito, A; Infusino, F; Sgueglia, G A; Crea, F

    2004-01-01

    Objectives: To investigate the diagnostic and prognostic value of ST segment depression limited to the recovery phase of an exercise stress test, as compared with that of ST segment depression appearing during exercise.

  19. ST Segment Extraction from Exercise ECG Signal Based on EMD and Wavelet Transform

    You Jia

    2015-01-01

    Full Text Available Myocardial ischemia is always characterized by the changes in ST complex. But ischemia is not obvious at rest. Only in the state of exercise, abnormal ST will appear. The signal of ST is susceptible to noise interference which causes the inaccuracy of the ST segment detection. Combining the advantages of empirical mode decomposition (EMD, the paper proposes a modified threshold method to filter a serious of noise from exercise ECG. Extracted from the ECG feature, it includes ST segment detection, with wavelet transform. In the end, the method is tested with synthetic exercise data and real exercise ECG data. The results of ST segment detection are accurate and this method can be applied in practical exercise.

  20. ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis.

    Predescu, L M; Zarma, L; Platon, P; Postu, M; Bucsa, A; Croitoru, M; Prodan, B; Chioncel, O; Deleanu, D

    2016-01-01

    Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction. PMID:27141575

  1. Relationship of acute left main coronary artery occlusion and ST-segmentelevation in lead aVR

    于富军; 傅向华; 卫亚丽; 李寿霖; 肖蕴陟; 丁超; 赵战勇

    2004-01-01

    @@It is well known that acute left main coronary artery (LMCA) occlusion is one of the most severe lesions associated with coronary artery disease. A large number of LMCA patients die suddenly at the very beginning of a heart attack. Noninvasive identification of acute LMCA occlusion is very important for patient prognosis and survival, especially to predict the need of the invasive procedure of coronary artery reconstruction. In this study, we sought to evaluate retrospectively the value of ST-segment elevation in lead aVR in predicting acute myocardial infarction (AMI) and acute LMCA obstruction.

  2. Clinical significance of stress-induced ST segment changes in patients with previous myocardial infarction

    To explain the clinical significance of stress(st)-induced ST-segment (ST) changes postinfarction, 93 patients with previous myocardial infarction (MI) were performed st-201Tl myocardial single photon emission computed tomography (SPECT) and compared ST changes with SPECT, coronary arteriographic and left ventriculographic findings. 30 out of 93 cases (32%) had ST depression, 20 (21.5%) had ST elevation, 9 (10%) had both ST depression and elevation and remaining 34 (36.5 %) had no significant ST changes. In single vessel disease, ST depression were noted in 29% (12/42), while in multivessel disease, 53% (27/51). 35 out of 39 cases (90%) with ST depression had transient perfusion defect but no apparent relation was noted between location of ST depression on ECG and region of transient perfusion defect in SPECT. All of 28 cases with ST elevation were noted in anterior MI cases, and 26 out of these showed severe LV wall motion abnormality in contrast left ventriculography and broad anterior permanent defect in SPECT. Only 15 cases (54%) showed slight redistribution. Thus, we conclude that in patients with previous MI, st-induced ST depression seems to reflect myocardial ischemia and ST elevation possibly related abnormal LV wall motion. (author)

  3. 24 hour ST segment analysis in transient left ventricular apical ballooning.

    Frank Bode

    Full Text Available OBJECTIVE: The etiologic basis of transient left ventricular apical ballooning, a novel cardiac syndrome, is not clear. Among the proposed pathomechanisms is coronary vasospasm. Long-term ST segment analysis may detect vasospastic episodes but has not been reported. METHODS: 30 consecutive patients with transient left ventricular apical ballooning, left ventricular dysfunction and normal or near-normal coronary arteries were investigated. A 24-hour Holter ECG was obtained after emergency admission. ST segment analysis was performed automatically in 2 leads and confirmed by visual inspection. Criteria for an ischemic event were: 1. ST elevation or 2. horizontal or down-sloping ST segments ≥1 min duration and ≥100 µV J+80 point deviation corrected for baseline ST-deviation. RESULTS: Patients presented with ST segment elevation (n = 19 and/or T wave inversion (n = 20 on admission ECG. Ejection fraction was 50±12%. No transient ST elevations were observed during Holter ECG analysis. In 3 patients, 8 transient episodes of ST depression were recorded. Durations of episodes varied between 75 s and 790 s (mean 229 s. Maximal ST deviation averaged -191±71 µV. Ischemic burden was -1 to -22 mVs (mean -8 mVs. 27 patients showed no ischemic events. CONCLUSIONS: ST segment analysis of 24 h Holter recordings revealed minor ischemic events in only 10% of patients with transient left ventricular apical ballooning. Overall, ST segment changes were not indicative of recurrent coronary spasm playing a major role in the genesis of transient left ventricular apical ballooning.

  4. Clinical and Angiographic Significance of Exercise-induced ST-segment Elevation in Patients without Previous Myocardial Infarction

    王立军; 王晓军; 蔡卫东; 崔连群

    2002-01-01

    Objective To study the clinical significance of exercise- induced ST- segment elevation(STE) in patients without previous myocardial infarction(MI) Methods Ten patients without previous MI who developed STE during exercise testing were underwent coronary angiography, left ventriculography and rest electrocardiography, and Bruce protocol were used during exercise test. Results The incidence of exercise-induced STE in patients without previous MI was 0. 28 % (10/3564)One of the 10 patients had only a mild coronary lesion (stenosis < 35 % in diameter) in left anterior descending artery, but she developed an acute myocardial infarction 4 weeks after coronary angiography , and the leads of myocardial infarction and the leads of exercise-induced STE elevation were same, the others all had severe coronary stenosis(90 % ~ 100 % ) . There was a good correlation between leads of ST-segment elevation and ischemic related artery. Nine patients received invasive therapy. During a period of 28months (range 8 to 48 months) of follow-up, 2 of them received PTCA again at 11 and 19 months after their discharge, prospectively. Conclusions The findings indicats ST-elevation during exercise is a specific marker of severe transmural regional ischemia and should be an indication for coronary angiography. Most patients with exercise-induced ST-segment elevation have critical organic stenosis of the ischemic- related coronary artery and are candidates for myocardial revascularization. In a few patients, ST-segment elevation during exercise may be caused by coronary artery spasm in the absence of significant organic lesions, and they may have a poor prognosis.

  5. Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

    Richard; A; Brogan; Christopher; J; Malkin; Philip; D; Batin; Alexander; D; Simms; James; M; McLenachan; Christopher; P; Gale

    2014-01-01

    Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

  6. Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

    The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both

  7. [ST-segment elevation myocardial infarction in a patient with thrombophilia taking new oral anticoagulants].

    Li Calzi, Mauro; Placci, Angelo; Lina, Daniela; Grassi, Francesca; Paoli, Giorgia; Bianconcini, Michele; Cattabiani, Maria Alberta; Menozzi, Alberto

    2016-06-01

    We report the case of a 65--year-old woman admitted for inferior ST-segment elevation myocardial infarction complicated by complete atrioventricular block. The patient was under treatment with a novel oral anticoagulant (NOAC, rivaroxaban) because of a history of recurrent idiopathic pulmonary embolism. Emergency angiography showed complete acute thrombotic occlusion of the right coronary artery. After manual thrombectomy, there was no angiographic evidence of underlying atherosclerosis, therefore no further percutaneous coronary intervention was performed. Subsequent clinical course was uneventful. Laboratory tests demonstrated the presence of a heterozygous mutation of the factor II gene (G20210A), confirming the clinical evidence of a thrombophilic state. As rivaroxaban seemed to be ineffective in preventing spontaneous coronary thrombosis in this patient, antithrombotic therapy was shifted to warfarin plus low-dose aspirin. No further ischemic events occurred during the 1-year follow-up. It can be hypothesized that factor Xa inhibition by NOACs, such as rivaroxaban, could be insufficient in case of a thrombophilic state due to thrombin mutation. A brief review of the current literature on use of NOACs in acute coronary syndromes is also reported. PMID:27384603

  8. Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases

    Background: Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI). Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction (AMI). Methods: The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase (SK) were enrolled in the study. Result: Of the total 1023, 689 (67.3%) patients were males and 334 (32.6%) were females. Six hundred and twenty-nine (61.5%) were successfully resolved after thrombolytic therapy while in 395 (38.5%) patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve (30%) and 444 (43.4%) with complete resolution, 344 (33.62%) and 325 (31.76%) with partial resolution, 367 (35.8%) and 491 (19.29%) were with no resolution at 60 and 90 minutes respectively. Conclusion: Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution. (author)

  9. Serum Potassium Levels and Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction.

    Ma, Wenfang; Liang, Yan; Zhu, Jun; Yang, Yanmin; Tan, Huiqiong; Yu, Litian; Gao, Xin; Feng, Guangxun; Li, Jiandong

    2016-09-01

    Current guidelines recommend maintaining serum potassium levels between 4.0 and 5.0 mEq/L (1 mEq/L = mmol/L) in patients with acute myocardial infarction. However, these guidelines are based on studies conducted before the β blocker and reperfusion era. We retrospectively analyzed 6613 patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who presented without renal insufficiency. Patients were categorized into 5 groups according to mean serum potassium levels: 4.5 mEq/L significantly increased mortality risk. PMID:26626107

  10. Detection of ST segment deviation episodes in ECG using KLT with an ensemble neural classifier

    In this paper, we describe a technique for automatic detection of ST segment deviations that can be used in the diagnosis of coronary heart disease (CHD) using ambulatory electrocardiogram (ECG) recordings. Preprocessing is carried out prior to the extraction of the ST segment which involves noise and artifact filtering using a digital bandpass filter, baseline removal and application of a discrete wavelet transform (DWT) based technique for detection and delineation of the QRS complex in ECG. Lead-dependent Karhunen–Loève transform (KLT) bases are used for dimensionality reduction of the ST segment data. ST deviation episodes are detected by a classifier ensemble comprising backpropagation neural networks. Results obtained through the use of our proposed method (sensitivity/positive predictive value = 90.75%/89.2%) compare well with those given in the existing research. Hence, the proposed method exhibits the potential to be adopted in the design of a practical ischemia detection system

  11. Detection of ST segment deviation episodes in ECG using KLT with an ensemble neural classifier.

    Afsar, Fayyaz A; Arif, M; Yang, J

    2008-07-01

    In this paper, we describe a technique for automatic detection of ST segment deviations that can be used in the diagnosis of coronary heart disease (CHD) using ambulatory electrocardiogram (ECG) recordings. Preprocessing is carried out prior to the extraction of the ST segment which involves noise and artifact filtering using a digital bandpass filter, baseline removal and application of a discrete wavelet transform (DWT) based technique for detection and delineation of the QRS complex in ECG. Lead-dependent Karhunen-Loève transform (KLT) bases are used for dimensionality reduction of the ST segment data. ST deviation episodes are detected by a classifier ensemble comprising backpropagation neural networks. Results obtained through the use of our proposed method (sensitivity/positive predictive value = 90.75%/89.2%) compare well with those given in the existing research. Hence, the proposed method exhibits the potential to be adopted in the design of a practical ischemia detection system. PMID:18560057

  12. 急诊与择期经皮冠状动脉介入治疗急性 ST 段抬高型心肌梗死临床疗效的比较研究%Comparative Study for Clinical Effect on Acute ST-segment Elevation Myocardial Infarction between Emergency PCI and Delayed PCI

    吴先明; 周建军; 何辉; 陈芳; 徐锋; 赵亮; 朱冰坡; 李一德

    2015-01-01

    目的:比较急诊与择期经皮冠状动脉介入(PCI)治疗急性 ST 段抬高型心肌梗死(ASTEMI)的临床疗效。方法选取2010年1月—2014年6月益阳市中心医院收治的行 PCI 治疗的 ASTEMI 患者388例,将167例接受急诊 PCI(发病至 PCI 时间﹤12 h)治疗者作为急诊 PCI 组,221例接受择期 PCI(发病至 PCI 时间≥12 h)治疗者作为择期 PCI 组。比较两组患者 PCI 即刻成功率、住院时间、住院及随访期间心脏事件(心力衰竭、恶性心律失常、再梗死、心源性死亡)发生情况,PCI 前后 Killip 分级、左心室射血分数(LVEF)、脑钠肽(BNP)水平。随访时间截至2015年1月。结果急诊 PCI 组 PCI 即刻成功率为96.4%,择期 PCI 组为95.8%,差异无统计学意义(P ﹥0.05)。急诊 PCI 组患者住院期间心力衰竭发生率低于择期 PCI 组,恶性心律失常发生率高于择期 PCI 组(P ﹤0.05);两组患者住院期间再梗死及心脏事件总发生率比较,差异无统计学意义(P ﹥0.05);两组患者住院期间均未出现死亡病例。急诊 PCI 组患者住院时间为(10.1±1.3) d,短于择期 PCI 组的(13.4±1.9) d( P ﹤0.05)。急诊 PCI 组患者术前Killip 分级劣于择期 PCI 组,LVEF 低于择期 PCI 组,BNP 水平高于择期 PCI 组(P ﹤0.05);急诊 PCI 组患者术后 Killip分级优于择期 PCI 组,LVEF 高于择期 PCI 组,BNP 水平低于择期 PCI 组(P ﹤0.05)。急诊 PCI 组患者随访期间心力衰竭、再梗死及心脏事件总发生率低于择期 PCI 组(P ﹤0.05);两组患者随访期间恶性心律失常、心源性死亡发生率比较,差异无统计学意义(P ﹥0.05)。结论急诊 PCI 较择期 PCI 能更有效地改善 ASTEMI 患者心功能,有助于减少心脏事件的发生及缩短住院时间。%Objective To compare the clinical effect on acute ST-segment elevation myocardial infarction

  13. A Retrospective Clinical Analysis of 216 Patients With Non-ST Segment Elevation Myocardial Infarction

    Manish Pradhan; Shuxian Zhou; Juan Lei; Zesheng Liu

    2008-01-01

    Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarc-tion (NSTEMI). Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divid-ed into two groups: ①according to the age: age 178 μmol. L-1 group. Seven hundred and eighty six acute myocardial infarction (AMI) patients during the same period were divided into ST seg-ment elevation myocardial infarction (STEMI) group and NSTEMI group. Clinical characteristics of the patients in th e two groups were compared. Results ① The number of NSTEMI patients in age ≥65 years group is significantly grea-ter than that in age 178 μmol· L-1) and triple ves-sel disease. Fewer patients in this group received coronary artery angiography (CAG), percutaneous coronary interven-tion (PCI) and coronary artery bypass graft (CABG). More number of deaths in this group compared with the age 4 group is significantly greater than that in TIMI score 4 group comparing with TIMI score ≤4 group. ③ Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus (NIDDM), patients with cardiac troponin T (CTnT) >3.0 ng · L-1 and deaths occurred in sCr > 178 μmol · L-1 group. @ STEMI and NSTEMI patients were compared in same time frame as follows: fewer NSTEMI patients and more elderly patients had no chest pain, NID-DM, hypertension, dyslipidemia, left main coronary artery (LMCA) disease while CTnT ≥3.0 ng· ml-1; fewer pa- tients with aneurysm (30 days) underwent CAG, PCI and CABG treatment. However, there were no significant differ-ences in smokers, patients with less than 50% stenosis in any vessel, 1 -3 vessel disease, acute left ventricle heart fail-ure, cardiogenic shock, serious arrhythmia and deaths. ⑤ The multivariate logistic regression analysis showed that death in NSTEMI was directly influenced by malignant arrhythmias with age ≥ 70 years. Conclusions Patients with NSTEMI were older, had more risk factors

  14. ST segment elevation after myocardial infarction: Viability or ventricular dysfunction? Comparison with myocardial scintigraphy

    The detection of viable myocardium after myocardial infarction is an important indication for revascularization. We compared exercise-induced ST segment elevation with reversibility at Thallium-201 SPECT scintigraphy and regional wall motion assessment by ventriculography. Thirty two patients with previous myocardial infarction and with left ventricular ejection fraction of < 50% were studied. Patients underwent coronary angiography and Thallium-201 SPECT scintigraphy with re-injection protocol before and after coronary artery bypass graft surgery. Group I comprised 11 patients with ST segment elevation during treadmill stress testing. Group II comprised 21 patients without ST segment elevation. Minimal or moderate hypokinesis was present in 2 patients of Group I and in 4 patients of Group II. Nine patients of Group I and 17 patients of Group II had severe hypokinetic, akinetic or dyskinetic myocardium. Scintigraphy revealed reversibility in the myocardial infarction area in 4 patients from Group I (36.4%) and 11 (52.4%) patients from Group II. Improvement in perfusion after coronary artery bypass grafting was observed in 4 patients from Group I and 8 patients from Group II. Sensitivity, specificity, accuracy, and positive and negative predictive values of ST segment elevation were 33.3, 70.6, 55.2, 44.5 and 60% respectively. It was concluded that exercise-induced ST segment elevation after myocardial infarction is present more frequently in cases of severe regional myocardial dysfunction. (author)

  15. Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty

    To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappered during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present. (author)

  16. Tratamento de uma coorte de pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST Tratamiento de una cohorte de pacientes con infarto agudo de miocardio con supradesnivel del segmento ST Treatment of a cohort of patients with acute myocardial infarction and ST-segment elevation

    Jamil da Silva Soares

    2009-06-01

    Full Text Available FUNDAMENTO: Trombólise e angioplastia transluminal coronariana (ATC primária são técnicas bem estabelecidas, mas grande parte dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM com SST não as recebem quando do atendimento hospitalar. OBJETIVO: Descrever tratamentos inicial e final e desfechos de uma coorte com IAM com SST. MÉTODOS: Analisados, da internação até a alta, 158 pacientes com IAM com SST, de uma população total de 351 pacientes internados com (SCA nos hospitais de Campos dos Goytacazes, entre 2004 e 2006. RESULTADOS: Dos 158 pacientes com IAM com SST, 67,7% chegaram ao hospital nos primeiros 180 minutos, 81,3% em 360 minutos e 8,4% após doze horas. Realizados 148 estudos cinecoronariográficos (93,7%. Observadas lesões de mais de 70% em 266 territórios arteriais. Tratamento inicial foi ATC em 41(26%, trombolíticos em 50 (32%, com 80% de sucesso. Tratamento clínico em 67 (42%. Cerca de 35% dos pacientes deveriam ser trombolizados mas não o foram. No tratamento final foram 93 ATCs, 89 delas com sucesso angiográfico (95,7, sangramento 2 (2,2, oclusão subaguda 2 (2,2%, dissecção tronco 1 (1,1, pseudo aneurisma 1 (1,1. Nenhum óbito durante angioplastia; na evolução, houve dois óbitos (2,1%. Doze pacientes submetidos a cirurgia de revascularização miocárdica (CRM. Tratamento clínico 53 (33%, com 11 óbitos (20,7%. Letalidade global 9,5%, consideradas as três formas de tratamento. CONCLUSÃO: Pacientes atendidos em tempo adequado para reperfusão, porém 1/3 deles não recebeu o procedimento. Tratamento predominante foi ATC, com baixa morbidade. Dois óbitos na evolução. Baixa letalidade global.FUNDAMENTO: La trombólisis y la angioplastia transluminal coronaria (ATC primaria son técnicas bien establecidas, sin embargo gran parte de los pacientes con infarto agudo de miocardio con supradesnivel del segmento ST (IAM con SST no las reciben cuando de la atenci

  17. Sub aortic tendon induced ST segment elevation – a new echo electrocardiographic phenomenon?

    Ker James

    2009-03-01

    Full Text Available Abstract The causes for ST-segment elevation other than myocardial infarction are numerous. The existence of left ventricular false tendons has been known for more than a century. Currently, the clinical entities associated with these left ventricular false tendons include innocent murmurs and premature ventricular contractions. A case report is presented where such a false tendon, attached to the interventricular septum, is responsible for striking ST-segment elevation in the anterior precordial leads. It is proposed that this is a newly observed entity – that of subaortic tendon-induced ST-segment elevation. This is proposed as a totally benign phenomenon with the clinical importance in that it should not be confused with other pathological processes, such as the Brugada syndrome.

  18. Bilirubin Levels and Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction.

    Hamur, Hikmet; Duman, Hakan; Bakirci, Eftal Murat; Kucuksu, Zafer; Demirelli, Selami; Kalkan, Kamuran; Degirmenci, Husnu

    2016-07-01

    We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of thrombus burden in patients with acute myocardial infarction. Patients (n = 229; male 72.9%; mean age 63 ± 13.4 years) who were admitted with ST-segment elevation myocardial infarction (STEMI) were enrolled. Patients were divided into 2 groups. Group 1 was defined as low thrombus burden and group 2 was defined as high thrombus burden. Patients with high thrombus burden had higher total bilirubin levels (14.4 [4.3-22.9] vs 7.7 [2.4-20.3] µmol/L, P ≤ .001), (0.84 [0.25-1.34] vs 0.45 [0.14-1.19] mg/dL P ≤ .001) and direct bilirubin levels (3.1 [2.1-8.4] vs 1.7 [0.5-6.5] µmol/L, P ≤ .001), (0.18 [0.03-0.49] vs 0.10 [0.03-0.38] mg/dL, P ≤ .001). At multivariate analysis, total bilirubin (odds ratio: 1.05, 95% confidence interval: 1.03-1.08, P ≤ .001) was the independent predictor of high thrombus burden. In conclusion, total bilirubin level is independently associated with high thrombus burden in patients with STEMI. PMID:26339042

  19. Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction

    Lønborg, Jacob; Vejlstrup, Niels Grove; Kelbæk, Henning Skov;

    2011-01-01

    Aims Exenatide, a glucagon-like-peptide-1 analogue, increases myocardial salvage in experimental settings with coronary occlusion and subsequent reperfusion. We evaluated the cardioprotective effect of exenatide at the time of reperfusion in patients with ST-segment elevation myocardial infarctio......= 0.11). No difference was observed in left ventricular function or 30-day clinical events. No adverse effects of exenatide were observed. Conclusion In patients with STEMI undergoing pPCI, administration of exenatide at the time of reperfusion increases myocardial salvage....... (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods and results A total of 172 patients with STEMI and Thrombolysis in Myocardial Infarction flow 0/1 were randomly assigned to exenatide or placebo (saline) intravenously. Study treatment was commenced 15 min before intervention...... and maintained for 6 h after the procedure. The primary endpoint was salvage index calculated from myocardial area at risk (AAR), measured in the acute phase, and final infarct size measured 90 ± 21 days after pPCI by cardiac magnetic resonance (CMR). In 105 patients evaluated with CMR, a...

  20. 心肺复苏后心电图诊断急性心肌梗死的荟萃分析%The diagnostic value of ST-segment elevation in acute myocardial infarction in patients after resuscitation: a meta-analysis

    王书鹏; 秦历杰

    2013-01-01

    Objective To investigate the diagnostic value of ST segment elevation in acute myocardial infarction (AMI) occurred in patients after resuscitation.Methods The relevant articles about coronary angiography performed in an emergency for all the post-resuscitation patients without obvious noncardiac cause,regardless of the representation of the electrocardiography were searched in the databases of Pubmed,Ovid medline,EBSCO,CBM,Wanfang and VIP of Chongqing.The meta-analysis was carried out with the data from the included articles using the meta-disc 1.4 software.Results Five articles about retrospective analysis of consecutive patients were included.The meta-analysis of pooled statistics showed the sensitivity 0.59,the specificity 0.86,the positive likelihood ratio (LR) 4.4,the negative LR 0.39,the diagnostic odds ratio (OR) 12.28 and the area under the curve (AUC) 0.85.Conclusions Although the high specificity is in favor of making diagnosis of AMI in post-resuscitation patients,the low sensitivity makes the integrative diagnostic value of using sole ST-segment elevation of ECG relatively low.%目的 探讨心搏骤停患者复苏后心电图ST段抬高诊断急性心肌梗死(acute myocardial infarction,AMI)的作用.方法 收集1990年1月至2012年10月心肺复苏后自主循环恢复的患者,排除明显心脏外因素后急诊行冠状动脉造影的前瞻性或回顾性病例研究文献,利用Meta-disc1.4软件对所提取的心电图及冠脉造影结果等相关数据进行分析.结果 共纳入5篇文献,包括1017例患者,均为连续性病例回顾研究,Meta分析示心电图ST段抬高诊断AMI的敏感度(SEN) 0.59,特异度(SPE)0.86,阳性似然比(+LR)4.4,阴性似然比(-LR)0.39,诊断比值比(DOR) 12.28,曲线下面积(AUC)0.85.结论 心搏骤停心肺复苏后自主循环恢复患者心电图ST段抬高对于诊断AMI特异性高,但是敏感度低,整体诊断价值不高.

  1. Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction

    C.S. Thejanandan Reddy

    2013-07-01

    Full Text Available The electrocardiogram (ECG remains a crucial tool in the identification and management of acute myocardial infarction (MI. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of reperfusion therapy. The early and accurate identification of the infarct-related artery on the ECG can help predict the amount of myocardium at risk and guide decisions regarding the urgency of revascularization. The specificity of the ECG in acute MI is limited by individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease, particularly in patients with a previous MI, collateral circulation, or previous coronary-artery bypass surgery. The ECG is also limited by its inadequate representation of the posterior, lateral, and apical walls of the left ventricle. Despite these limitations, the electrocardiogram can help in identifying proximal occlusion of the coronary arteries, which results in the most extensive and most severe myocardial infarctions.

  2. Bone Marrow Mononuclear Cell Transplantation Restores Inflammatory Balance of Cytokines after ST Segment Elevation Myocardial Infarction.

    Kirsi Alestalo

    Full Text Available Acute myocardial infarction (AMI launches an inflammatory response and a repair process to compensate cardiac function. During this process, the balance between proinflammatory and anti-inflammatory cytokines is important for optimal cardiac repair. Stem cell transplantation after AMI improves tissue repair and increases the ventricular ejection fraction. Here, we studied in detail the acute effect of bone marrow mononuclear cell (BMMNC transplantation on proinflammatory and anti-inflammatory cytokines in patients with ST segment elevation myocardial infarction (STEMI.Patients with STEMI treated with thrombolysis followed by percutaneous coronary intervention (PCI were randomly assigned to receive either BMMNC or saline as an intracoronary injection. Cardiac function was evaluated by left ventricle angiogram during the PCI and again after 6 months. The concentrations of 27 cytokines were measured from plasma samples up to 4 days after the PCI and the intracoronary injection.Twenty-six patients (control group, n = 12; BMMNC group, n = 14 from the previously reported FINCELL study (n = 80 were included to this study. At day 2, the change in the proinflammatory cytokines correlated with the change in the anti-inflammatory cytokines in both groups (Kendall's tau, control 0.6; BMMNC 0.7. At day 4, the correlation had completely disappeared in the control group but was preserved in the BMMNC group (Kendall's tau, control 0.3; BMMNC 0.7.BMMNC transplantation is associated with preserved balance between pro- and anti-inflammatory cytokines after STEMI in PCI-treated patients. This may partly explain the favorable effect of stem cell transplantation after AMI.

  3. 持续ST段抬高病因分析%Cause Analysis of Continuous ST-segment Elevation

    李雪

    2016-01-01

    目的:探讨心电图持续ST段抬高患者的检查结果,进行病因分析。方法选取心电图持续的ST段抬高的患者25例,分别给予心电图、心肌酶、超声心动图、冠脉造影(CAG),心肌核素、心脏核磁等检查,并对结果进行统计学分析。结果心电图持续的ST段抬高的病因有多种,并非都为冠心病,急性心肌梗死。行心电图、心肌酶、超声心动图、冠脉造影(CAG),心肌核素、心脏核磁等检查,可对冠脉血管及心包、心肌等病变进行评价,有助于明确诊断。结论对于胸痛症状不典型,心动图呈持续性ST段抬高的患者,应完善相关检查,详细分析病因,不可盲目诊断急性心肌梗塞,行不必要的溶栓治疗。%Objective To discuss ECG ST-segment elevation in patients with test results and cause analysis.Methods Selected ECG showed 25 patients with persistent ST-segment elevation,were given ECG,cardiac enzymes,echocardiography,coronary angiography(CAG),myocardial perfusion, cardiac magnetic resonance imaging and other tests,and the results were statisticaly analyzed.Results ECG showed persistent ST-segment elevation causes varied,not al of coronary heart disease and acute myocardial infarction. Electrocardiogram,cardiac enzymes,echocardiography,coronary angiography(CAG),myocardial perfusion,cardiac magnetic resonance imaging and other tests,the coronary blood vessels and pericardium, myocardium lesions were evaluated,helped confirm the diagnosis.Conclusion For atypical chest pain,echocardiography showed patients with persistent ST-segment elevation,should improve the relevant examination,a detailed analysis of the cause. Can not be blindly diagnosis of acute myocardial infarction,for unnecessary thrombolytic therapy.

  4. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION)

    V. A. Sulimov

    2015-01-01

    Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI) in the early after acute ST-segment elevation myocardial infarction (STEMI), there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into t...

  5. Electrocardiographic precordial ST-segment deviations and the risk of cardiovascular death

    Rasmussen, Peter Vibe; Nielsen, Jonas Bille; Pietersen, Adrian;

    2014-01-01

    computerized analysis of ECGs from 285 194 persons, we evaluated the association between precordial ST-segment deviations and the risk of CVD. All data on medication, comorbidity, and outcomes were retrieved from Danish registries. After a median follow-up period of 5.8 years, there were 6679 cardiovascular...

  6. ST-Segment resolution and clinical outcome with ischemic postconditioning and comparison to magnetic resonance

    Lønborg, Jacob; Holmvang, Lene; Kelbæk, Henning;

    2010-01-01

    Ischemic postconditioning (IPost) during primary percutaneous coronary intervention (PPCI) is suggested to reduce myocardial damage. However, the association with ST-segment resolution (STR) and clinical outcome is not determined. The primary aim of this study was to evaluate the association of I...

  7. Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report

    Gamma Reto

    2011-08-01

    Full Text Available Abstract Introduction Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. Case presentation A 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died. Conclusion Clinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed.

  8. Plasma calprotectin predicts mortality in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    Jensen, Louise J N; Haahr-Pedersen, Sune Ammentorp; Bjerre, Mette;

    2010-01-01

    We investigated the predictive value of plasma calprotectin levels for mortality in patients with ST segment elevation myocardial infarction (STEMI) successfully treated with primary percutaneous coronary intervention (pPCI).......We investigated the predictive value of plasma calprotectin levels for mortality in patients with ST segment elevation myocardial infarction (STEMI) successfully treated with primary percutaneous coronary intervention (pPCI)....

  9. Outcome of Patients With Adenosine-Induced ST Segment Depression and Normal Myocardial Perfusion

    The aim of the present study was to determine the outcome of patients with normal MPS and adenosine-induced ST segment depression. A total of 1867 patients underwent adenosine Tc99m-tetrofosmin MPS in nuclear medicine unit in Saudi German Hospital, Saudi Arabia, between January 2004 and May 2008. Their ECGs were checked for ST segment depression during adenosine infusion. All patients with ≥ 1 mm horizontal or down-sloping ST segment depression or≥ 1.5 mm up-sloping ST segment depression were included in the study. Fifty-six patients met our inclusion criteria, of which 45 (80%) were females. During the follow-up period, a total of 15 of patients ended up doing coronary angiography, either for high clinical suspicion or following a second positive MPS performed 6-18 months after the first study. Seven of them were positive for coronary artery disease and were subsequently treated with revascularization procedure, and 8 returned either normal angiography or non-obstructive coronary artery disease. Male diabetic smoking patients were more prevalent and underwent revascularization. The patients were followed up for a mean of 22.8 ±7.8 months. No cardiac deaths or myocardial infarctions were reported. It could be concluded that adenosine-induced ST segment depression in patients with normal myocardial perfusion was a benign finding and did not increase the very low risk of cardiac events in those patients. However, male smokers and/or diabetics might need further investigation. This suggestion needs further evaluation

  10. Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction

    Luis C. L. Correia

    2014-08-01

    Full Text Available Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics and calibration (Hosmer-Lemeshow in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively, as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively. Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98, similar to GRACE (0.87, 95%CI = 0.75 to 0.99 - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92, well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08. This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively, differently to GRACE (2.4%, 25% and 73%, which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

  11. Mortality in patients with ST-segment elevation myocardial infarction who do not undergo reperfusion.

    Wood, Frances O; Leonowicz, Nicholas A; Vanhecke, Thomas E; Dixon, Simon R; Grines, Cindy L

    2012-08-15

    Reperfusion therapy reduces mortality in patients presenting with ST-segment elevation myocardial infarctions (STEMI). However, some patients may not receive thrombolytic therapy or undergo primary percutaneous coronary intervention. The decision making and clinical outcomes of these patients have not been well described. In this study, 139 patients were identified from a total of 1,126 patients with STEMI who did not undergo reperfusion therapy at a high-volume percutaneous coronary intervention center from October 2006 to March 2011. Clinical data, reasons for no reperfusion, management, and mortality were obtained by chart review. The mean age was 80 ± 13 years (61% women, 31% diabetic, and 37% known coronary artery disease). Of the 139 patients, 72 (52%) presented with primary diagnoses other than STEMI, and 39 (28%) developed STEMI >24 hours after admission. The most common reasons for no reperfusion were advanced age, co-morbid conditions, acute or chronic kidney injury, delayed presentation, advance directives precluding reperfusion, patient preference, and dementia. Eighty-four patients (60%) had ≥ 3 reasons for no reperfusion. Factors associated with hospital mortality were cardiogenic shock, intubation, and advance directives prohibiting reperfusion after physician consultation. In hospital and 1-year mortality were 53% and 69%, respectively. In conclusion, at a high-volume percutaneous coronary intervention center, most patients presenting with STEMI underwent immediate catheterization. The decision for no reperfusion was multifactorial, with advanced age reported as the most common factor. Outcomes were poor in this population, and fewer than half of these patients survived to hospital discharge. PMID:22633204

  12. Unstable angina and non-ST-segment myocardial infarction: an evidence-based approach to management.

    Kou, Victoria; Nassisi, Denise

    2006-01-01

    Unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) represent two common, closely related acute coronary syndromes with potentially high morbidity and mortality. Integration of information from the history, physical exam, electrocardiogram, and cardiac biomarkers is used to formulate both the diagnosis of UA/NSTEMI and the overall assessment of patient prognosis and risk. Early diagnosis and risk stratification of patients with UA/NSTEMI enable the physician to initiate timely, appropriate treatment. (There is strong clinical evidence supporting the tailoring of specific therapies to the risk profile of the patient.) In recent years, powerful new medical and invasive therapies have been developed. Pharmaceutical agents for UA/NSTEMI may be broadly grouped into one of three categories: anti-ischemic, anti-platelet, and anti-thrombotic agents. Standard therapy for UA/NSTEMI has commonly included oxygen, aspirin, nitrates, morphine, beta-blockers and heparin. Potent new anti-platelet agents, including inhibitors of platelet adenosine diphosphate and glycoprotein IIb/IIIa receptors, play important, expanding roles in the management of these syndromes. Low-molecular-weight heparins have been shown to be an effective alternative to unfractionated heparin in their treatment. Major advances in invasive techniques and devices over the last decade include revascularization with percutaneous coronary intervention and drug-eluting intracoronary stents. Strong interest exists in studying the potential benefits and risks associated with an early invasive therapeutic strategy rather than an aggressive medical regimen for patients with UA/NSTEMI. As new treatments are rapidly added to our growing arsenal of management options, clinicians are constantly challenged with incorporating complex new information and guidelines into their practices in a timely fashion. To assist clinicians with this challenge, this article will review the evidence to support

  13. Safety of eptifibatide when added to bivalirudin during ST-segment elevation myocardial infarction

    Baker, Nevin C.; Escarcega, Ricardo O.; Magalhaes, Marco A.; Lipinski, Michael J.; Torguson, Rebecca; Waksman, Ron, E-mail: ron.waksman@medstar.net

    2014-07-15

    Background: Patients presenting with ST-segment elevation myocardial infarction (STEMI) represent a high-risk group for in-hospital adverse events and bleeding. The safety and outcomes of eptifibatide in addition to bivalirudin in this population have not been determined. Methods: Over an 11-year period, we identified 1849 STEMI patients undergoing primary percutaneous coronary intervention (PCI), of which 1639 received bivalirudin monotherapy compared with 210 patients who received both bivalirudin and provisional eptifibatide. Safety of combination therapy was assessed by the occurrence of thrombolysis in myocardial infarction (TIMI) major bleeding. In-hospital event rates of death, Q-wave myocardial infarction (MI), and acute stent thrombosis were evaluated for efficacy. Multivariate analysis was used to adjust for significant differences between groups. Results: Patients treated with bivalirudin plus eptifibatide, when compared with patients with bivalirudin monotherapy, had increased rates of cardiogenic shock (15.7% vs. 9.4%), aspiration thrombectomy (48.5% vs. 23.7%), pre-TIMI flow ≤ 1 (63.5% vs. 40%), and higher peak troponin I (93.65 ± 92.7 vs. 49.16 ± 81.59; all p < 0.01). These, however, were not associated with differences in the primary end point after adjusting for significant baseline and procedural characteristics (OR: 1.63; 95% CI, 0.90–2.96, p = 0.12). Importantly, TIMI major bleeding was not significantly different between groups (OR 1.78; 95% CI, 0.79–2.95, p = 0.20). Conclusion: The addition of eptifibatide to bivalirudin during primary PCI reflects a high-risk STEMI population. This therapy results in similar in-hospital outcomes without an increase in major bleeding. Therefore, when required, combination therapy may be considered in this population.

  14. Myocardial protection of creatine phosphate sodium in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention%磷酸肌酸钠对急性ST段抬高型心肌梗死PCI术后的心肌保护作用

    覃秀川; 王春梅; 索旻; 穆希娟; 文勃

    2013-01-01

    Objective To observe the myocardial protective effects of creatine phosphate sodium in patients with acute myocardial infarction after percutaneous coronary intervention. Methods A total of 200 patients with acute ST segment elevation myocardial infarction successfully treated with coronary stent implantation were randomly assigned into two groups; the treatment group(100 cases) comprised 67 men and 33 women with average age of(61.7 ± 10.4)years,the control group(100 cases) comprised 64 men and 36 women with average age of(59.3 ± 11. 2) years. The control group was only treated with routine drug therapy after PCI. The treatment group was treated with routine drug therapy combined with 7 days of intravenous creatine phosphate sodium treatment after PCI. Before and after PCI creatine kinase( CK) , creatine kinase isoenzyme( CK-MB) ,troporin I( cTnl) , hypersensitive C-reaction proteion( hs-CRP) and left ventricular ejection fraction(LVEF)were monitored. Results The content of serum CK,CK-MB,cTnl and hs-CRP in the treatment group was lower than that in the control group. Left ventricular ejection fraction(LVEF) in the treatment group was higher than that in the control group. The differences were statistically significant All P < 0. 05) . Conclusion The application of creatine phosphate sodium in patients with acute myocardial infarction after PCI has a protective effect on myocardium.%目的 观察磷酸肌酸钠对急性心肌梗死PCI术后的心肌保护作用.方法 200例急性ST段抬高型心肌梗死均于急诊行冠脉内支架植入术后收入EICU,随机分为治疗组 100 例[男67例、女33 例,平均年龄(61.7±10.4)岁]和对照组 100 例[男 69 例、女31 例,平均年龄(59.3±11.2)岁].于 PCI术后,对照组给予常规药物治疗,治疗组在常规药物治疗基础上给予静点磷酸肌酸钠治疗 7 d.检测两组患者术前及术后血清中磷酸肌酸激酶(creatine kinase,CK)、磷酸肌酸激酶同工酶(creatine kinase isoenzyme

  15. Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion, case reports of STEMI equivalence.

    de Winter, Ruben W; Adams, Rob; Verouden, Niels J W; de Winter, Robbert J

    2016-01-01

    Timely reperfusion therapy by means of primary percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-segment elevation myocardial infarction. A significant number of patients with large acute myocardial infarction, caused by occlusion of an epicardial coronary artery, do not show ST-elevation on the electrocardiogram. Other ECG abnormalities may be present, the so called STEMI-equivalents. One such STEMI equivalent, junctional ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often in combination with slight ST-elevation in lead AVR, has been associated with proximal occlusion of the left anterior descending coronary artery. Recognition of this ECG pattern by ambulance staff, emergency physicians and interventional cardiologists envolved in STEMI networks, is important to ensure timely reperfusion therapy in these patients. In this paper we present three patients with typical symptoms of acute myocardial infarction and the ECG pattern with slight J-point depression combined with tall, symmetrical T-waves. PMID:26560436

  16. An ECG ambulatory system with mobile embedded architecture for ST-segment analysis.

    Miranda-Cid, Alejandro; Alvarado-Serrano, Carlos

    2010-01-01

    A prototype of a ECG ambulatory system for long term monitoring of ST segment of 3 leads, low power, portability and data storage in solid state memory cards has been developed. The solution presented is based in a mobile embedded architecture of a portable entertainment device used as a tool for storage and processing of bioelectric signals, and a mid-range RISC microcontroller, PIC 16F877, which performs the digitalization and transmission of ECG. The ECG amplifier stage is a low power, unipolar voltage and presents minimal distortion of the phase response of high pass filter in the ST segment. We developed an algorithm that manages access to files through an implementation for FAT32, and the ECG display on the device screen. The records are stored in TXT format for further processing. After the acquisition, the system implemented works as a standard USB mass storage device. PMID:21095640

  17. 24 Hour ST Segment Analysis in Transient Left Ventricular Apical Ballooning

    Frank Bode; Christof Burgdorf; Heribert Schunkert; Volkhard Kurowski

    2013-01-01

    OBJECTIVE: The etiologic basis of transient left ventricular apical ballooning, a novel cardiac syndrome, is not clear. Among the proposed pathomechanisms is coronary vasospasm. Long-term ST segment analysis may detect vasospastic episodes but has not been reported. METHODS: 30 consecutive patients with transient left ventricular apical ballooning, left ventricular dysfunction and normal or near-normal coronary arteries were investigated. A 24-hour Holter ECG was obtained after emergency admi...

  18. Detection of ST Segment Elevation Myocardial Infarction (STEMI Using Bacterial Foraging Optimization Technique

    Bensujin

    2014-05-01

    Full Text Available The rife of heart disease (HD is a comprehensive phenomenon, and the scale of the cardiovascular disease (CVD increases in prevalence in the developed world. Cardio vascular disease (CVD is the foremost cause of death worldwide; the World Health Organization (WHO estimates that globally 17.3 million people died from Heart Disease in 2008, representing 30% of global deaths. The forecast of heart disease is a multi-layered problem, which is not free from false assumptions. The eminence of the clinical decisions and the effect of the stratagems should optimize the patient’s outcomes and to lessen the risk of disease factors, if the methods are applied effectively and properly grounded on the expert analysis on the presented data. The major clinical information related to heart disease can be obtained by the analysis for electrocardiograph (ECG signal. The ST segment Myocardial Infarction (STEMI is the severe type and the elevated ST segment on the ECG data represents that large amount of heart muscle mutilation is stirring. In this paper we recommend a constructive approach to identify the STEMI in the ECG signal of a person. The sample ECG data’s are acquired from the MIT-BIH databases. Those data’s are subsequently pre-processed; the ST segment is extracted and then measured to identify the availability of the disease. During the ST segment analysis stage the beats generated by the ventricular in origin or ventricular paced are resolute. The fine-tuned data set is converted into a formatted data set and conceded to the Bacterial Foraging Optimization Algorithm (BFOA to detect the approximate solution. The proposed system overcomes the superseded algorithms by a focussed update in the methodology with reliable algorithms and techniques.

  19. ST segment elevation in the right precordial leads following administration of class Ic antiarrhythmic drugs

    Yasuda, M.; Nakazato, Y.; Yamashita, H.; Sekita, G; Kawano, Y.; Mineda, Y; Nakazato, K.; Tokano, T; Sumiyoshi, M; Nakata, Y.

    2001-01-01

    Electrocardiographic changes were evaluated retrospectively in five patients without previous episodes of syncope or ventricular fibrillation who developed abnormal ST segment elevation mimicking the Brugada syndrome in leads V1-V3 after the administration of class Ic antiarrhythmic drugs. Pilsicainide (four patients) or flecainide (one patient) were administered orally for the treatment of symptomatic paroxysmal atrial fibrillation or premature atrial contractions. The QRS duration, QTc, and...

  20. Association between fragmented QRS complexes and imperfect ST-segment resolution in patients with St-elevation myocardial infarction after primary percutaneous coronary intervention

    段雯婷

    2014-01-01

    Objective To explore the relationship between fragmented QRS complexes(fQ RS)and imperfect ST-segment resolution in ST elevation myocardial infarction(STEMI)patients undergoing primary percutaneous coronary intervention(p-PCI).Methods This study included 227 consecutive patients with STEMI who underwent p-PCI.They were divided into two groups:ECG with fQ RS(n=142)and without fQ RS(n=85).Baseline clinical characteristics,Gensini score,coronary angiography features and the rate of ST-segment resolution were compared between the two groups.Results(1)Patients

  1. Influence of ST-segment recovery on infarct size and ejection fraction in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

    Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per; Atar, Dan; Clemmensen, Peter M

    2010-01-01

    resonance imaging. All 3 ST-segment recovery algorithms predicted the final infarct size and cardiac function. Worst-lead residual STD performed the same as, or better than, the more complex methods and identified large subgroups at either end of the risk spectrum (median infarct size from the lowest to...... highest risk category (percentage of left ventricle: 7.7% [interquartile range 10.8], 13.1% [interquartile range 13.6]; 24.6% [interquartile range 21.1]); with adjusted odds ratios for infarct size greater than the median (reference or = 2 mm, odds ratio 6.3 (95% confidence interval 1.7 to 23.7; c-index 0.......781). In conclusion, an electrocardiogram obtained early after primary percutaneous coronary intervention analyzed by a simple algorithm provided prognostic information on the final infarct size and cardiac function....

  2. Plasma high-mobility group box 1 levels predict mortality after ST-segment elevation myocardial infarction

    Sørensen, Morten V; Pedersen, Sune; Møgelvang, Rasmus;

    2011-01-01

    We evaluated the potential association between plasma high-mobility group box 1 (HMGB1) levels and outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention....

  3. Culprit only or multivessel percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction and multivessel disease

    Jensen, Lisette Okkels; Thayssen, Per; Farkas, Dóra Körmendiné;

    2012-01-01

    Aims: In patients with ST-segment elevation myocardial infarction (STEMI), timely reperfusion with primary percutaneous coronary intervention (PPCI) is the preferred treatment. However, it remains unclear whether the optimal strategy is complete revascularisation or culprit vessel PPCI only...

  4. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction

    Palmerini, Tullio; Biondi-Zoccai, Giuseppe; Della Riva, Diego;

    2013-01-01

    The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis....

  5. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Terkelsen, Christian Juhl;

    2013-01-01

    BACKGROUND: Elderly patients with ST-segment elevation myocardial infarction (STEMI) constitute a particular risk group in relation to primary percutaneous coronary intervention (PPCI). OBJECTIVE: We examined the proportion of octogenarians and nonagenarians undergoing PPCI in Western Denmark...

  6. Exercise-induced ST-segment depression and myocardial ischemia in patients with hypertrophic cardiomyopathy. Myocardial scintigraphic study

    Patients with hypertrophic cardiomyopathy (HCM) sometimes develop myocardial ischemia during exercise in the absence of coronary lesions. The relationship between myocardial ischemia and ST-segment depression was investigated during exercise testing in patients with HCM. Regional hypoperfusion and/or transient left ventricular cavity dilation, a parameter of subendocardial hypoperfusion, were assessed on exercise 99mTc-tetrofosmin myocardial scintigraphy in 42 patients with non-obstructive HCM. The scintigraphic results were further correlated with the ST-segment responses to exercise. Regional hypoperfusion or transient left ventricular cavity dilation were observed in 19 (45%) or 16 (38%) patients with HCM, respectively. The incidence of ST-segment depression ≥0.1 mV during exercise testing was similar in HCM patients with regional hypoperfusion, with transient left ventricular cavity dilation, and without hypoperfusion (42%, 38%, 38%, p=0.95). Furthermore, exercise-induced ST-segment depression ≥0.1 mV occurred similarly irrespective of symptoms, exercise tolerance, the degree or the site of hypertrophy, or the presence or absence of resting ST-segment depression. ST-segment depression during exercise testing was common in patients with HCM, but seems to be an unreliable marker of myocardial ischemia as assessed by exercise scintigraphy. (author)

  7. One-year clinical outcomes in invasive treatment strategies for acute ST-elevation myocardial infarction complicated by cardiogenic shock in elderly patients

    Yoo, Yeon Pyo; Kang, Ki-Woon; Yoon, Hyeon Soo; Myung, Jin Cheol; Choi, Yu Jeong; Kim, Won Ho; Park, Sang Hyun; Jung, Kyung Tae; Jeong, Myung Ho; ,

    2013-01-01

    Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged ≥ 75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from majo...

  8. The clinical characteristics and prognosis of non-ST segment elevation acute coronary syndrome in different genders%不同性别急性冠状动脉综合征患者的临床特征与预后

    邵春丽; 乔树宾; 朱俊; 陈珏; 杨伟宪; 章晏; 梁岩; 张峻; 张文佳

    2010-01-01

    Objective To determine gender differences in baseline characteristics and intervention treatment in relation to prognosis in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods A total of 814 patients (545 men and 269 women) with NSTEACS were randomized to early intervention (coronary angiography < 24 hours after randomization ) or delayed intervention (coronary angiography>36 hours after randomization). The primary outcome was a composite of death, myocardial infarction, or stroke at 6 months. Results Women were older and more frequently had hypertension, diabtetes, and history of coronary artery disease (CAD) or chronic angina (P<0.05 for all).Women less were smokers and had elevations in cardiac marker(P < 0. 05 for both). Women who underwent angiography had no significant lesions more often, but the left main stem and/or three-vessel diseases were similar with men. In adjusted multiple logistic regression analysis,the previous myocardial infarction and severe coronary artery disease were independently associated with the risk of primary endpoint in women. On multivariate analysis for men, severe coronary artery disease delayed intervention strategy and at least 3 risk factors for CAD were independently associated with the risk of primary endpoint. Conclusions In NSTEACS patients, different gender had the different prognostic predictor. Severe coronary diseases were as an independent predictor for both male and female patients. An early intervention strategy resulted in a beneficial effect in men which was not seen in women.%目的 比较不同性别非ST段抬高急性冠状动脉(冠脉)综合征(NSTEACS)患者临床特征和介入治疗对预后的影响.方法 814例NSTEACS患者,随机接受早期(<24 h)或延迟(>36 h)介入治疗,随访6个月,主要联合终点为死亡、心肌梗死(MI)和卒中.结果 女性患者年龄较大、更多有高血压、糖尿病、冠心病史和慢性心绞痛史.但入院时心

  9. 急性ST段抬高性心肌梗死经皮冠状动脉成形术后促红细胞生成素疗效的Meta分析%Comparison of curative effect between erythropoietin and non-erythropoietin in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a Meta-analysis

    李京宴; 玛依拉·吾甫尔; 时学昆; 陈凤辉; 程祖亨

    2013-01-01

    Objective: To evaluate the curative effect of erythropoietin and non-erythropoietin in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Method:In Medline (1966-01-2011-12), Pubmed (1980-01-2011-12), Embase (1990-01 - 2011-12), Science (1990-01-2011-12), Springer (1990-01-2011-12), CNKI (1994-2011) and Wan Fang (1982-2011) database, the randomized controlled study on effect of erythropoietin and non-erythropoietin in patients with acute STEMI undergoing PCI were retrieved. Then we extracted the data and made a Meta-analysis. Result; Six articles were accepted in our Meta-analysis and all of them were high quality researches by modified Jadad Scale. The combined WMD of infarct size was 2.03 [95%CI: (-0. 14, 4. 20), P = 0. 07]. The combined WMD of left ventricular end-diastolic volume (LVEDV) was 2. 93 [95%CI: (2. 03, 3. 83) , P<0. 01]. The combined WMD of left ventricular ejection function (LVEF) was 3. 62[95%CI: (2. 51, 4. 73), P<0. 01]. The combined WMD of cardiovascular accident was 0. 85 [95%CI: (0. 49, 1. 46), P = 0. 55]. Conclusion:Erythropoietin can improve cardiac function, decrease LVEDV and increase LVEF in patients with acute STEMI undergoing PCI. However, in the case of decreasing infarct size and preventing cardiovascular accident, erythropoietin treatment and non-erythropoietin treatment has no distinction.%目的:收集关于急性ST段抬高性心肌梗死经皮冠状动脉成形术(PCI)后应用促红细胞生成素(EPO)与不用EPO疗效比较的文献,并进行Meta分析.方法:检索Medline(1966-01-2011-12)、PubMed(1980-01-2011-12)、Embase(1990-01-2011-12)、Science(1990-01-2011-12)、Springer(1990-01-2011-12)、CNKI(1994-2011)、万方(1982-2011)等数据库中,有关急性ST段抬高性心肌梗死PCI术后EPO与非EPO疗效比较的随机对照研究,纳入符合标准的文献,提取相关数据进行统计学分析.结果:共6篇文献符合纳入标准,均

  10. Nondestructive examination of 51 fuel and reflector elements from Fort St. Vrain Core Segment 1

    Fifty-one fuel and reflector elements irradiated in core segment 1 of the Fort St. Vrain High-Temperature Gas-Cooled Reactor (HTGR) were inspected dimensionally and visually in the Hot Service Facility at Fort St. Vrain in July 1979. Time- and volume-averaged graphite temperatures for the examined fuel elements ranged from approx. 4000 to 7500C. Fast neutron fluences varied from approx. 0.3 x 1025 n/m2 to 1.0 x 1025 n/m2 (E > 29 fJ)/sub HTGR/. Nearly all of the examined elements shrank in both axial and radial dimensions. The measured data were compared with strain and bow predictions obtained from SURVEY/STRESS, a computer code that employs viscoelastic beam theory to calculate stresses and deformations in HTGR fuel elements

  11. [A squeeze approach for electrocardiogram ST-segment detection based on R-wave and T-wave].

    Song, Jinzhong; Yan, Hong; Li, Li; Yang, Xianglin

    2011-10-01

    ST-segment is the main clinical appearance in myocardial ischemia detection based on electrocardiogram (ECG) signals. However, it is highly sensitive to interferences (baseline wandering, postural changes, electrode interference, etc.), which cause the feature points of ECG ST-segment to be difficult to detect accurately. Currently, the common detection methods of ST-segment are: R+x and J+x, but they are affected badly by T-wave morphological variability and J point location. For these reasons, firstly we proposed a convenient and accurate approach for T-wave onset in this paper. It did not need to locate T-wave peak and was robust to baseline wandering and T-wave morphology. Secondly, we proposed a squeeze approach for ST-segment detection based on R-wave peak and T-wave onset. After the Long-Term ST database (LTST) verification, the proposed method has shown a good timeliness and robustness, and the accuracy of ST-segment detection has reached above 92%. PMID:22097243

  12. Complete versus culprit-only revascularization for ST-segment-elevation myocardial infarction and multivessel disease

    Bangalore, Sripal; Toklu, Bora; Wetterslev, Jørn

    2015-01-01

    increase in contrast volume use (mean difference 85.12 [70.41-83.00] ml) and procedure time (mean difference 16.42 [13.22-19.63] mins) with complete revascularization without increase in contrast-induced nephropathy. CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction, immediate or...... infarction. Efficacy outcomes were major adverse cardiovascular events, as well as death, cardiovascular death, myocardial infarction, and repeat revascularization. Safety outcomes were contrast-induced nephropathy, contrast volume used, and procedure time. Five trials with 1165 patients fulfilled the...

  13. Percutaneous coronary interventions during ST-segment elevation myocardial infarction: current status and future perspectives.

    Diletti, Roberto; Yetgin, Tuncay; Manintveld, Olivier C; Ligthart, Jurgen M R; Zivelonghi, Carlo; Zijlstra, Felix; Ribichini, Flavio

    2014-08-01

    The present article focuses on recent innovations and possible future perspectives in the reperfusion treatment of ST-segment elevation myocardial infarction (STEMI). Among these, the shift from the femoral to the radial vascular access, the recent availability of bioresorbable coronary scaffolds, other innovative forms of stent specifically designed for STEMI patients, the use of cardioprotective strategies, as well as the possibility of including autologous bone marrow stem cell transplantation as part of the treatment of patients with STEMI are described and commented on as a glance into the future. PMID:25256529

  14. Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention.

    Lønborg, Jacob; Kelbæk, Henning; Holmvang, Lene; Helqvist, Steffen; Vejlstrup, Niels; Jørgensen, Erik; Saunamäki, Kari; Dridi, Nadia P; Kløvgaard, Lene; Kaltoft, Anne; Bøtker, Hans-Erik; Lassen, Jens F; Clemmensen, Peter; Terkelsen, Christian Juhl; Engstrøm, Thomas

    2016-06-01

    Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution. PMID:27062938

  15. Is chronic ST segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal MI? Correlation with myocardial perfusion SPECT

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99mTc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. METHOD: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteri 1) Patients with Q Wave ASMt more than 1 month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99mTc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia / viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40 % and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results' Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  16. Is chronic st segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal mi? - correlation with myocardial perfusion SPECT

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99m-Tc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. Method: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteria: 1) Patients with Q Wave ASMI more than l month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99mTc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia/viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40% and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results: Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  17. Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction

    Marina Mustilli

    2012-06-01

    Full Text Available Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI during acute coronary syndromes (ACS. Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing transulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

  18. 不同时期中国非ST段抬高型急性冠状动脉综合征患者临床特征与预后%Clinical characteristics and prognosis comparison of Chinese non ST-segment elevation acute coronary syndrome patients in two different time periods

    白莹; 梁岩; 谭慧琼; 乔树宾; 张峻; 杨艳敏; 章晏; 朱俊

    2014-01-01

    心绞痛再入院事件(HR =0.17,95%CI:0.11 ~0.25,P<0.001)的风险降低.结论 TIMACS研究的患者在PCI治疗、冠心病二级预防等方面优于OASIS研究,180 d随访的联合终点事件发生明显少于后者.提示随着国内外指南的更新和临床诊治水平的提高,中国在NSTE-ACS治疗方面有明显的进步.%Objective To compare the clinical characteristics,treatment methods and outcomes in Chinese non ST-segment elevation acute coronary syndrome (NSTE-ACS) patients from two large clinical trials in different time periods.Methods All Chinese NSTE-ACS patients from two large International clinical trials (OASIS Registry and TIMACS) underwent coronary artery angiography after first admission were recruited in our analysis.The follow-up time was 180 days.A total of 1 473 NSTE-ACS patients were recruited in this analysis,in which 749 from Organization to Assess Strategies for Ischemic Syndromes (OASIS REISTRY) that completed in 38 centers in China from April 1999 to December 2000,and the rest 724 patients from The Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial in 24 centers in China performed from April 2007 to June 2008.Results Compared to OASIS patients,TIMACS group were older ((64.2 ± 10.1) years old vs.(58.7 ± 10.2) years old),and fewer male patients (66.3% (480/724) vs.74.4% (557/749)),lower blood pressure at admission,and more histories of previous PCI (9.4% (68/724 vs.6.4% (48/749)),stroke (8.8% (64/724) vs.5.1% (38/749)),hypertension (62.8% (455/724) vs.56.6% (424/749)) and diabetes (23.3% (169/724) vs.16.2% (121/749)),lower histories of coronary artery disease (37.4% (271/724) vs.59.1% (443/749)) and myocardial infarction (12.0% (87/724) vs.27.6% (207/749)) (all P < 0.05).After admission,comparing to OASIS group,TIMACS patients had significant higher PCI proportion (74.9% (524/724) vs.49.3% (369/749),P < 0.001).In addition,for secondary prevention,TIMACS patients had significant higher standard

  19. Primary PCI for ST-segment elevation myocardial infarction in a patient treated with subcutaneous enoxaparin utilizing point-of-care Enox test.

    Veerappan, Balaji; Latif, Faisal; Patibandla, Sushmitha; Hennebry, Thomas; Ghani, Mohammed; Saucedo, Jorge; Schechter, Eliot; Sadanandan, Saihari

    2003-05-01

    The superiority of enoxaparin compared with unfractionated heparin in the medical management of patients with non-ST elevation acute coronary syndromes (NSTE ACS) has been demonstrated in clinical trials. Further, enoxaparin has been shown to be safe and effective during PCI, including in combination with glycoprotein IIb/IIIa inhibitors. Whether enoxaparin is superior to unfractionated heparin in patients with NSTE ACS under-going early invasive strategy is currently being tested in a large clinical trial. Data on the use of enoxaparin in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction are limited. Unlike patients who present to the catheterization laboratory after several doses of enoxaparin where in a steady state anticoagulation might have been achieved, patients who present early after administration of a single dose of subcutaneous enoxaparin may not have an adequate level of anticoagulation for PCI. The ability to monitor activity of enoxaparin in such patients using a point-of-care test might be useful. This report describes a patient with ST-segment elevation myocardial infarction who presented for primary angioplasty 75 minutes after administration of subcutaneous enoxaparin. The Rapidpoint Enox test measured 135 seconds and the patient's corresponding serum anti-Xa level was 0.12 IU/mL indicating a suboptimal level of anticoagulation for PCI. Procedural success was attained using additional 0.3-mg/kg intravenous enoxaparin. PMID:12784820

  20. Effects of liraglutide on left ventricular function in patients with non-ST-segment elevation myocardial infarction.

    Chen, Wei-Ren; Shen, Xue-Qin; Zhang, Ying; Chen, Yun-Dai; Hu, Shun-Ying; Qian, Geng; Wang, Jing; Yang, Jun-Jie; Wang, Zhi-Feng; Tian, Feng

    2016-06-01

    The influence of glucagon-like peptide-1 has been studied in several studies in patients with acute myocardial infarction, but not in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We planned to evaluate the effects of liraglutide on left ventricular function in patients with NSTEMI. A total of 90 patients were randomized 1:1 to receive either liraglutide (0.6 mg for 2 days, 1.2 mg for 2 days, followed by 1.8 mg for 3 days) or placebo for 7 days. Eighty-three patients completed the trial. Transthoracic echocardiography was used to assess left ventricular function. At 3 months, the primary endpoint, the difference in the change in left ventricular ejection fraction between the two groups was +4.7 % (liraglutide vs. placebo 95 % CI +0.7 to +9.2 % P = 0.009) under intention-to-treat analysis. The difference in decrease in serum glycosylated hemoglobin levels was -0.2 % (liraglutide vs. placebo 95 % CI -0.1 to -0.3 %; P < 0.001). Inflammation and oxidative stress improved significantly in the liraglutide group compared to the placebo group. Liraglutide could improve left ventricular function in patients with NSTEMI, making it a potential adjuvant therapy for NSTEMI. PMID:26573925

  1. 非ST段抬高性心肌梗死与ST段抬高性心肌梗死的临床特征分析%The St-segment Elevation Myocardial Infarction Sex with St-segment Elevation Myocardial Infarction of the Clinical Characteristics Analysis

    简芳

    2012-01-01

    目的:分析非ST段抬高性心肌梗死与ST段抬高性心肌梗死的临床特征.方法:选择我院2010年6月~2011年12月急性心肌梗死患者92例,按临床心电图检查结果有无ST段抬高分为两组,42例ST段抬高性心肌梗死患者为STE MI组,50例非ST段抬高性心肌梗死患者为NSTE MI组,对两组患者临床特征进行分析.结果:非抬高组冠状动脉病变以3支病变为主,所占比例大大高于抬高组,抬高组单支病变所占比例较大,大大高于非抬高组,两组比较差异具有显著性,有统计学意义,P0.05.结论:糖尿病患者易发生非ST段抬高性心肌梗死,容易反复心绞痛发作,冠脉病变多为多支,患者预后较差.%Objective:To analyse the st-segment elevation myocardial infarction sex with st-segment elevation myocardial infarction of the clinical features.Methods:Choose our hospital in June 2010~2011 in December,92 patients with acute myocardial infarction,according to clinical ecg results for st-segment elevation divided into two groups,42 patients with st-segment elevation myocardial infarction patients up for sex group,50 cases of st-segment elevation myocardial infarction patients for the sex drive up group,two groups of patients for clinical characteristics are analyzed.Results:The drive up group coronary artery pathological changes to 3 branch of pathological changes is given priority to,much higher than the proportion of drive up,drive up group of single lesions large proportion,are much higher than the drive up group,two groups of comparisons with significant difference,there is statistical significance,P0.05.Conclusion:Patients with diabetes to occur the st-segment elevation myocardial infarction sex,easy to repeated heart attacks,coronary lesions for more teams,patients with poor prognosis.

  2. Transient ST-segment elevation after transseptal puncture for atrial fibrillation ablation in two cases

    CHENG Yan-li; DONG Jian-zeng; LIU Xing-peng; LONG De-yong; FANG Dong-ping; YU Rong-hui; TANG Ri-bo; MA Chang-sheng

    2012-01-01

    The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation.This rare complication of transseptal puncture was resolved quickly within several minutes.The most likely mechanism of this phenomenon is coronary vasospasm,although coronary embolism can not be ruled out completely.This complication is characterized as follows:(1) The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; (2) Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time.Though it appears to be a transient and completely reversible phenomenon,there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability.Clinical cardiologists should be aware of this rare complication and properly deal with it.

  3. Nondestructive examination of 54 fuel and reflector elements from Fort St. Vrain core segment 2

    Fifty-four fuel and reflector elements irradiated in core segment 2 of the Fort St. Vrain high-temperature gas-cooled reactor (HTGR) were nondestructively examined. The time- and volume-averaged graphite irradiation temperatures for the elements ranged from approx. 3500 to 7500C. The element-averaged fast neutron fluences ranged from approx. 0.2 to 1.6 x 1025 n/m2 (E > 29 fJ)/sub HTGR/. The elements, except for two fuel elements in which single localizeed cracks developed during irradiation, were in excellent condition. No evidence was observed of significant graphite oxidation or mechanical interaction beween elements. The cracks in the two elements did not affect their performance or handling. These elements were, otherwise, in excellent condition. Nearly all elements shrank in both the axial and radial directions, but the dimensional changes were relatively small

  4. Coronary atheroma composition and its association with segmental endothelial dysfunction in non-ST segment elevation myocardial infarction: novel insights with radiofrequency (iMAP) intravascular ultrasonography.

    Puri, Rishi; Nicholls, Stephen J; Brennan, Danielle M; Andrews, Jordan; Liew, Gary Y; Carbone, Angelo; Copus, Barbara; Nelson, Adam J; Kapadia, Samir R; Tuzcu, E Murat; Beltrame, John F; Worthley, Stephen G; Worthley, Matthew I

    2015-02-01

    Little is known of the relationship between coronary atheroma composition and corresponding endothelial dysfunction. We tested the hypothesis that segmental epicardial vasoreactivity relates to atheroma composition in patients with non-ST segment elevation myocardial infarction (NSTEMI) in vivo. In 23 NSTEMI patients referred for coronary angiography, a non-culprit vessel underwent intracoronary salbutamol (0.30 μg/min) provocation during automated IVUS pullback. A 40 MHz rotational IVUS catheter delivered radiofrequency signals at constant 67 μm intervals via a custom-built IVUS console (iMAP, iLAB, Boston Scientific). Macrovascular response [change in segmental lumen volume (SLV) at baseline and following salbutamol], percent atheroma volume (PAV) and tissue composition was evaluated in 187 contiguous non-overlapping 5 mm coronary segments. Compared with segments that dilated, constrictive segments showed similar SLV, but greater vessel volumes and PAV at baseline. The extent of necrotic and lipidic plaque was significantly greater in constrictive segments, whereas fibrotic plaque content was significantly greater in segments that dilated. Calcific plaque content did not relate to endothelium-dependent vasoreactivity. The change in SLV correlated inversely with the amount of lipidic and necrotic plaque (both r = -0.23, p = 0.002), and directly with fibrotic plaque content (r = 0.23, p = 0.002). In a multivariable model, the extent of both lipidic and necrotic plaque independently associated with segmental vasoconstriction (β = 1.2, p = 0.023; β = 0.66, p = 0.027). Following NSTEMI, both lipidic and necrotic plaque content each associate with segmental endothelial dysfunction. The link between plaque composition and vessel reactivity provides a mechanistic basis of the pathogenesis associated with vulnerable plaque in humans in vivo. PMID:25296909

  5. ST-segment elevation induced by ergometric stress during myocardial perfusion test with 99mTc-SESTAMIBI

    ST-segment elevation provoked by the exercise test is a low prevalence response. Two clinical cases in which such behavior arose during the myocardial technetium-99m-Sestamibi SPECT test are described. Physiopathological considerations in correlation with the bibliography linked to the subject are made. (authors)

  6. Exenatide reduces final infarct size in patients with ST-segment-elevation myocardial infarction and short-duration of ischemia

    Lønborg, J; Kelbæk, Henning Skov; Vejlstrup, Niels Grove;

    2012-01-01

    Exenatide has been demonstrated to be cardioprotective as an adjunct to primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction (STEMI). The aim of the post hoc analysis study was to evaluate the effect of exenatide in relation to system delay, defin...

  7. Analysis on influential factors of prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    张宇晨

    2013-01-01

    Objective To explore the gender difference of prognosis in patients with ST-segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(pPCI). Methods Between April 2003 and March 2009,743 patients undergoing pPCI in Beijing

  8. Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy in Patients With ST-Segment Elevation Myocardial Infarction

    Terkelsen, Christian J; Jensen, Lisette O; Hansen, Hans-Henrik Tilsted;

    2011-01-01

    In Denmark, primary percutaneous coronary intervention (PPCI) was chosen as a national reperfusion strategy for patients with ST-segment elevation myocardial infarction in 2003. This study describes the temporal implementation of PPCI in Western Denmark, the gradual introduction of field triage...

  9. High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

    Gang, Uffe Jakob Ortved; Hvelplund, Anders; Pedersen, Sune;

    2012-01-01

    Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only...

  10. Prognosis and high-risk complication identification in unselected patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    Andersson, Hedvig; Ripa, Maria Sejersten; Clemmensen, Peter;

    2010-01-01

    The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI).......The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI)....

  11. Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

    Akdemir, Ramazan; Karakurt, Özlem; Orcan, Salih; Karakoyunlu, Nihat; Mucahit Balci, Mustafa; SAĞNAK, Levent; Ersoy, Hamit; Bulent Vatan, Mehmet; Kilic, Harun; Yeter, Ekrem

    2012-01-01

    Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary an...

  12. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction

    Carrick, David; Haig, Caroline; Carberry, Jaclyn; Teng Tue May, Vanessa; Mccartney, Peter; Welsh, Paul; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Lindsay, Mitchell; Hood, Stuart; Watkins, Stuart; Mahrous, Ahmed; Rauhalammi, Samuli M.O.

    2016-01-01

    BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI dis...

  13. Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study

    Kim Sung

    2012-12-01

    Full Text Available Abstract Background Risk stratification of the early repolarization pattern (ERP is needed to identify malignant early repolarization. J-point elevation with a horizontal ST segment was recently suggested as a malignant feature of the ERP. In this study, the prevalence of the ERP with a horizontal ST segment was examined among survivors of sudden cardiac arrest (SCA without structural heart disease to evaluate the value of ST-segment morphology in risk stratification of the ERP. Methods We reviewed the data of 83 survivors of SCA who were admitted from August 2005 to August 2010. Among them, 25 subjects without structural heart disease were included. The control group comprised 60 healthy subjects who visited our health promotion center; all control subjects were matched for age, sex, and underlying disease (diabetes mellitus, hypertension. Early repolarization was defined as an elevation of the J point of at least 0.1 mV above the baseline in at least two continuous inferior or lateral leads that manifested as QRS slurring or notching. An ST-segment pattern of Results The SCA group included 17 men (64% with a mean age of 49.7 ± 14.5 years. The corrected QTc was not significantly different between the SCA and control groups (432.7 ± 37.96 vs. 420.4 ± 26.3, respectively; p = 0.089. The prevalence of ERP was not statistically different between the SCA and control groups (5/25, 20% vs. 4/60, 6.7%, respectively; p = 0.116. The prevalence of early repolarization with a horizontal ST segment was more frequent in the SCA than in the control group (20% vs. 3.3%, respectively; p = 0.021. Four SCA subjects (16% and one control subject (1.7% had a J-point elevation of >2 mm (p = 0.025. Four SCA subjects (16% and one (1.7% control subject had an ERP in the inferior lead (p = 0.025. Conclusion The prevalence of ERP with a horizontal ST segment was higher in patients with aborted SCA than in matched controls. This result suggests that ST morphology has

  14. Acute pancreatitis at the beginning of the 21st century: The state of the art

    Alfredo F Tonsi; Matilde Bacchion; Stefano Crippa; Giuseppe Malleo; Claudio Bassi

    2009-01-01

    Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.

  15. Increased platelet aggregation and turnover in the acute phase of ST-elevation myocardial infarction

    Jensen, Kristian Løkke Funck; Dalsgaard, Jens; Grove, Erik Lerkevang;

    2013-01-01

    Newly produced platelets are present in the acute phase of ST-elevation myocardial infarction (STEMI). This may influence the antiplatelet effect of aspirin and clopidogrel administered prior to primary percutaneous coronary intervention (PPCI). The aims of this study were to investigate the...

  16. Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI

    HamidReza Sanati

    2015-10-01

    Full Text Available Background: Although  percutaneous  coronary  intervention  (PCI  improves  outcomes  compared  to  thrombolysis,  a substantial number of ST-elevation myocardial infarction (STEMI patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI.Methods: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Results: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05. According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044 and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050 had reverse and male gender had direct significant associations with failed reperfusion (OR [95%CI]:0.34 [0.11 to 1.08]; p value = 0.068. More degrees of ST resolution occurred when the right coronary artery was the culpritvessel (p value = 0.001. The presence of more than three cardiac risk factors was associated with failed reperfusion (p value= 0.050.Conclusion: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a

  17. Collapsing Focal Segmental Glomerulosclerosis in a Patient with Acute Malaria

    Najamus Sehar

    2015-01-01

    seen in association with HIV infection. Rare data is available about the association between collapsing FSGS and malaria. Case Description. A 72-year-old African male patient presented to the hospital for generalized body aches, fatigue, fever, and night sweats for three days. He had history of recent travel to Ghana. Patient looked in acute distress and was shivering. Laboratory tests showed elevated serum creatinine (Cr of 2.09 mg/dL (baseline was 1.5 mg/dL in 2012. Hospital course was significant for rapid elevation of Cr to 9.5 mg/dL and proteinuria of 7.9 grams. Autoimmune studies resulted negative. Blood smear resulted positive for Plasmodium falciparum and patient was treated with Artemether/Lumefantrine. Patient’s fever and pain improved, but kidney function continued to deteriorate and he became oliguric. On day seven, he was started on Hemodialysis. Tests for different causes of glomerular pathology were also negative. He underwent left kidney biopsy which resulted in findings consistent with severe collapsing glomerulopathy. Discussion. This case illustrates a biopsy proven collapsing FSGS likely secondary to malarial infection requiring renal replacement therapy. Literature review revealed only few case reports that suggested the possible association of malaria with secondary form of FSGS.

  18. Hardware Segmentation on Digital Microscope Images for Acute Lymphoblastic Leukemia Diagnosis Using Xilinx System Generator

    Prof. Kamal A. ElDahshan

    2014-09-01

    Full Text Available Image segmentation is considered the most critical step in image processing and helps to analyze, infer and make decisions especially in the medical field. Analyzing digital microscope images for earlier acute lymphoblastic leukemia diagnosis and treatment require sophisticated software and hardware systems. These systems must provide both highly accurate and extremely fast processing of large amounts of image data. In this work, the hardware segmentation framework for Acute Lymphoblastic Leukemia (ALL images based color histogram of Hue channel of HSV color space is proposed to segment each leukemia image into blasts and background using Field Programmable Gate Array (FPGA. The main purpose of this work is to implement image segmentation framework in a FPGA with minimum hardware resources and low execution time to be suitable enough for medical applications. Hardware framework of segmentation is designed using Xilinx System Generator (XSG as DSP design tool that enables the use of Simulink models, implemented in VHDL and synthesized for Xilinx SPARTAN-3E Starter kit (XC3S500E-FG320 FPGA.

  19. Staged re-evaluation of non-culprit lesions in ST segment elevation myocardial infarction: a retrospective study

    Thim, Troels; Egholm, Gro; Olesen, Kevin Kris Warnakula; Kaltoft, Anne; Terkelsen, Christian Juhl; Krusell, Lars Romer; Kristensen, Steen Dalby; Bøtker, Hans Erik; Christiansen, Evald Høj; Maeng, Michael

    2016-01-01

    Objective It remains unknown whether complete revascularisation is optimally performed in patients with ST segment elevation myocardial infarction (STEMI) during the index or at staged procedures. The aims of this study were to quantify the number of primary percutaneous coronary intervention (PCI) procedures in which non-culprit lesions needed further evaluation, to determine the consequence of the re-evaluation and to quantify adverse cardiac events during the waiting time for re-evaluation...

  20. Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

    Diego; Fernández-Rodríguez; Luis; Alvarez-Contreras; Victoria; Martín-Yuste; Salvatore; Brugaletta; Ignacio; Ferreira; Marta; De; Antonio; Montserrat; Cardona; Vicens; Martí; Juan; García-Picart; Manel; Sabaté

    2014-01-01

    AIM: To evaluate the impact of thrombus aspiration(TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction(STEMI) registry.METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.RESULTS: A total of 456 patients were analyzable and categorized in TA group(156 patients; 34.2%) and non-TA(NTA) group(300 patients; 65.8%). Patientstreated with TA had less prevalence of multivessel disease(39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow < 3(P < 0.001) than NTA group. There was a higher rate of direct stenting(58.7% vs 45.5%, P = 0.009), with shorter(24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents(3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P < 0.001) in the TA group as compared to NTA group. The number of implanted stents(1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION: In an “all-comers” STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

  1. 44. Copeptin as early marker of acute non-ST elevation myocardial infarction in patients suspected with acute coronary syndrome

    S. Rafla

    2016-07-01

    Full Text Available Rapid diagnosis and management of AMI have great impact on morbidity and mortality. Diagnosis which is based on elevation of cardiac biomarkers has its limitations. Copeptin is the C-terminal part of the vasopressin prohormone. The pathophysiology mode of release should theoretically add diagnostic information of cardiac cell necrosis. One of the major limitations of cardiac biomarkers is the delayed release in circulation. So looking for a new marker with a short diagnostic time window is needed. Aim is to determine the role of copeptin as an early marker for acute non-ST elevation MI (NSTEMI. This study included 88 patients with chest pain. They were divided into 2 groups. Group (1; included 30 patients with diagnosis of NSTEMI. Diagnosis of AMI was established according to the universal definition of MI. Group (2; included 58 patients with diagnosis of unstable angina (UA. Full medical history, physical examination, 12 lead ECG, random blood glucose level, renal function, total cholesterol, triglyceride, cardiac troponin I and Copeptin were obtained on admission. Follow up cardiac troponin I was done. Inclusion criteria: Defined as chest pain of ⩽6 h duration since onset, suggestive of myocardial ischemia, and lasting >20 min. at rest. Exclusion criteria: Patients with positive First cardiac troponin were rolled out, patients with ST segment elevation were rolled out. Other exclusion criteria: Patients presenting after a cardiac arrest, Trauma or major surgery within the last 4 week; pregnancy; IV drug abuse; age less than 18 years; shock and sepsis. Patients who were included had second troponin I re- done and copeptin analysis done. In group 1 (NSTEMI 28 patients had ECG changes and only 2 had NSTEMI without ECG changes. In group 2 (UA 23 patients had ECG changes and 35 patients had normal ECG. Males and females were 49 and 39. Age in G1 and G2 was 60 ± 4 and 53 ± 5. Copeptin analysis was done 6 h after Infarction or chest pain

  2. Comparison of enoxaparin and dalteparin with unfractionated heparin in the treatment of non-st elevated acute coronary syndrome

    The term non-ST elevated Acute Coronary Syndrome (ACS) encompasses unstable Angina (USA) and non-ST segment elevated Myocardial Infarction (NSTEMI), both of which may end up in death or a fatal/non-fatal Myocardial Infarction (MI). Unfractionated heparin (UFH) has been shown to reduce death and MI in patients with USA and NSTEMI. Of late, there has been a great interest in the role of low molecular weight heparins (LMWHs) in the two conditions and they have been found to be at least as effective as or even more effective than UFH. Methods: A total of 90 patients who presented to CCU of Khyber Teaching Hospital, Peshawar with USA or NSTEMI, from June 2008 to June 2009, were enrolled into the study. An equal number of patients were randomly assigned to one of the three arms for 5 days each: Group A received enoxaparin, group B received dalteparin and group C received UFH. The primary end points of the study were all cause mortality, STEMI, refractory USA, recurrent USA or a major bleed. The secondary end point was minor bleeding. Results: At the end of the study, there were 2 deaths each in the dalteparin and UFH group, whereas no such event was recorded in the enoxaparin group. Two patients had STEMI in the UFH group but none in the other two groups. (author)

  3. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction.

    Sharmini Selvarajah

    Full Text Available BACKGROUND: Risk stratification in ST-elevation myocardial infarction (STEMI is important, such that the most resource intensive strategy is used to achieve the greatest clinical benefit. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases. This study sought to validate the Thrombolysis In Myocardial Infarction (TIMI risk score for STEMI in a multi-ethnic developing country. METHODS: Data from a national, prospective, observational registry of acute coronary syndromes was used. The TIMI risk score was evaluated in 4701 patients who presented with STEMI. Model discrimination and calibration was tested in the overall population and in subgroups of patients that were at higher risk of mortality; i.e., diabetics and those with renal impairment. RESULTS: Compared to the TIMI population, this study population was younger, had more chronic conditions, more severe index events and received treatment later. The TIMI risk score was strongly associated with 30-day mortality. Discrimination was good for the overall study population (c statistic 0.785 and in the high risk subgroups; diabetics (c statistic 0.764 and renal impairment (c statistic 0.761. Calibration was good for the overall study population and diabetics, with χ2 goodness of fit test p value of 0.936 and 0.983 respectively, but poor for those with renal impairment, χ2 goodness of fit test p value of 0.006. CONCLUSIONS: The TIMI risk score is valid and can be used for risk stratification of STEMI patients for better targeted treatment.

  4. Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction

    Holmvang, Lene; Kelbæk, Henning; Kaltoft, Anne Kjer;

    2013-01-01

    This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.......This study sought to compare the long-term effects of drug-eluting stent (DES) compared with bare-metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention....

  5. Segmentation of White Blood Cell from Acute Lymphoblastic Leukemia Images Using Dual-Threshold Method

    Yan Li

    2016-01-01

    Full Text Available We propose a dual-threshold method based on a strategic combination of RGB and HSV color space for white blood cell (WBC segmentation. The proposed method consists of three main parts: preprocessing, threshold segmentation, and postprocessing. In the preprocessing part, we get two images for further processing: one contrast-stretched gray image and one H component image from transformed HSV color space. In the threshold segmentation part, a dual-threshold method is proposed for improving the conventional single-threshold approaches and a golden section search method is used for determining the optimal thresholds. For the postprocessing part, mathematical morphology and median filtering are utilized to denoise and remove incomplete WBCs. The proposed method was tested in segmenting the lymphoblasts on a public Acute Lymphoblastic Leukemia (ALL image dataset. The results show that the performance of the proposed method is better than single-threshold approach independently performed in RGB and HSV color space and the overall single WBC segmentation accuracy reaches 97.85%, showing a good prospect in subsequent lymphoblast classification and ALL diagnosis.

  6. Circadian variation in patient characteristics and outcomes in ST-segment elevation myocardial infarction.

    Mogabgab, Owen; Giugliano, Robert P; Sabatine, Marc S; Cannon, Christopher P; Mohanavelu, Satishkumar; Wiviott, Stephen D; Antman, Elliott M; Braunwald, Eugene

    2012-12-01

    A morning peak in ST-segment elevation myocardial infarction (STEMI) has been described. The authors explored the relationship between variation of symptom onset, patient characteristics, and outcomes in two worldwide fibrinolytic trials. A total of 35 492 patients with STEMI were grouped into 8-h intervals by time of symptom onset: early (06:00 to 13:59 h), late-day (14:00 to 21:59 h), overnight (22:00 to 05:59 h). The authors correlated timing with patient characteristics and outcomes (adjusted for thrombolysis in myocardial infarction [TIMI] risk score) first in InTIME II-TIMI 17 trial (N = 15 031), and confirmed in the ExTRACT-TIMI 25 trial (N = 20 461). Timing was similar in the derivation (early 49%, late-day 30%, and overnight 21%; p < .001) and validation set (48%, 31%, and 21%, respectively; p < .001). Some patient characteristics consistently varied with time of symptom onset. Patients in the early cohort were older with poorer renal function. The late-day group had more smokers with higher initial heart rate and systolic blood pressure. Those with overnight symptom onset had higher rates of obesity, prior myocardial infarction, and treatment delays. Prior use of aspirin and beta-blockers was also highest in the overnight group. Relative to the early cohort, adjusted mortality was higher with late-day onset (derivation odds ratio [OR]: 1.19, p = .04; validation OR: 1.18, p = .01), but there was no excess in mortality overnight compared with early (derivation OR: .97, p = .72; validation OR: 1.01, p = .90). Composite endpoints followed similar patterns. This study indicates that circadian patterns in onset of STEMI continue to exist with patient characteristics differing by time of day. Despite a potential physiologic resistance to morning thrombolysis, outcomes were best in the early cohort, intermediate overnight, and worst with late-day symptom onset. Efforts to reduce smoking and improve control of blood pressure

  7. Interrelation of ST-segment depression during bicycle ergometry and extent of myocardial ischaemia by myocardial perfusion SPECT

    The aim of this study was to compare ST-segment depression (STD) during bicycle ergometry and extent of myocardial ischaemia assessed by myocardial perfusion SPECT (MPS) in a large patient cohort. Consecutive patients (n = 955) referred for MPS with bicycle ergometry and interpretable stress ECG were evaluated with respect to ECG and MPS findings of ischaemia. The maximal STD was recorded and exercise ECG was considered ischaemic if STD was horizontal or downsloping (≥1 mm). MPS was interpreted using a 20-segment model with a scale of 0 to 4. A summed stress (SSS), summed rest (SRS) and summed difference score (SDS = SSS-SRS, e.g. extent of ischaemia) were derived. Ischaemia was defined as an SDS ≥ 2. An exercise-induced STD was present in 215 patients (22%) and myocardial ischaemia on MPS was present in 366 patients (38%). The extent of ST-segment depression and the number of ECG leads with significant STD were each strongly and significantly associated with increasing severity of ischaemia and the number of coronary territories involved (p < 0.01 for all correlations). These data demonstrate a strong correlation between the extent of STD, number of ischaemic leads and severity of myocardial ischaemia as assessed by MPS during bicycle ergometry. (orig.)

  8. Automatic classification of transient ischaemic and transient non-ischaemic heart-rate related ST segment deviation episodes in ambulatory ECG records

    In ambulatory ECG records, besides transient ischaemic ST segment deviation episodes, there are also transient non-ischaemic heart-rate related ST segment deviation episodes present, which appear only due to a change in heart rate and thus complicate automatic detection of true ischaemic episodes. The goal of this work was to automatically classify these two types of episodes. The tested features to classify the ST segment deviation episodes were changes of heart rate, changes of the Mahalanobis distance of the first five Karhunen–Loève transform (KLT) coefficients of the QRS complex, changes of time-domain morphologic parameters of the ST segment and changes of the Legendre orthonormal polynomial coefficients of the ST segment. We chose Legendre basis functions because they best fit typical shapes of the ST segment morphology, thus allowing direct insight into the ST segment morphology changes through the feature space. The classification was performed with the help of decision trees. We tested the classification method using all records of the Long-Term ST Database on all ischaemic and all non-ischaemic heart-rate related deviation episodes according to annotation protocol B. In order to predict the real-world performance of the classification we used second-order aggregate statistics, gross and average statistics, and the bootstrap method. We obtained the best performance when we combined the heart-rate features, the Mahalanobis distance and the Legendre orthonormal polynomial coefficient features, with average sensitivity of 98.1% and average specificity of 85.2%

  9. Automatic classification of transient ischaemic and transient non-ischaemic heart-rate related ST segment deviation episodes in ambulatory ECG records.

    Faganeli, J; Jager, F

    2010-03-01

    In ambulatory ECG records, besides transient ischaemic ST segment deviation episodes, there are also transient non-ischaemic heart-rate related ST segment deviation episodes present, which appear only due to a change in heart rate and thus complicate automatic detection of true ischaemic episodes. The goal of this work was to automatically classify these two types of episodes. The tested features to classify the ST segment deviation episodes were changes of heart rate, changes of the Mahalanobis distance of the first five Karhunen-Loève transform (KLT) coefficients of the QRS complex, changes of time-domain morphologic parameters of the ST segment and changes of the Legendre orthonormal polynomial coefficients of the ST segment. We chose Legendre basis functions because they best fit typical shapes of the ST segment morphology, thus allowing direct insight into the ST segment morphology changes through the feature space. The classification was performed with the help of decision trees. We tested the classification method using all records of the Long-Term ST Database on all ischaemic and all non-ischaemic heart-rate related deviation episodes according to annotation protocol B. In order to predict the real-world performance of the classification we used second-order aggregate statistics, gross and average statistics, and the bootstrap method. We obtained the best performance when we combined the heart-rate features, the Mahalanobis distance and the Legendre orthonormal polynomial coefficient features, with average sensitivity of 98.1% and average specificity of 85.2%. PMID:20130344

  10. Analysis of therapeutic effect of acupuncture at Neiguan(PC 6) and Zusanli(ST 36) on acute renal colic

    琚保军

    2013-01-01

    Objective To observe the efficacy differences among acupuncture at Neiguan(PC 6) and Zusanli(ST 36),dolantin and scopolamine in treatment of acute renal colic,and to verify the clinical effect of acupuncture at Neiguan(PC 6) and Zusanli(ST 36). Methods Two hundred and

  11. Characterization of Novel StAR (Steroidogenic Acute Regulatory Protein) Mutations Causing Non-Classic Lipoid Adrenal Hyperplasia

    Flück, Christa E.; Pandey, Amit V; Dick, Bernhard; Camats, Núria; Fernández-Cancio, Mónica; Clemente, María; Gussinyé, Miquel; Carrascosa, Antonio; Mullis, Primus E.; Audi, Laura

    2011-01-01

    Context Steroidogenic acute regulatory protein (StAR) is crucial for transport of cholesterol to mitochondria where biosynthesis of steroids is initiated. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH). Objective StAR gene mutations causing partial loss of function manifest atypical and may be mistaken as familial glucocorticoid deficiency. Only a few mutations have been reported. Design To report clinical, biochemical, genetic, protein structure a...

  12. Thallium-201 myocardial imaging in evaluation of asymptomatic individuals with ischaemic ST segment depression on exercise electrocardiogram

    This study showed that asymptomatic adults with normal physical examination, normal resting electrocardiogram, and normal routine laboratory evaluation who had a positive exercise electrocardiogram and abnormal exercise thallium-201 myocardial image had a very high probability of angiographically significant coronary artery disease. If, on the other hand, the exercise electrocardiogram was positive for 'ischaemic' ST segment changes, but the exercise thallium image was normal, the probability for coronary disease was low. The exercise electrocardiogram combined with thallium-201 myocardial image are safe non-invasive methods which can be performed on an out-patient basis. (author)

  13. PCI Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease.

    Bates, Eric R; Tamis-Holland, Jacqueline E; Bittl, John A; O'Gara, Patrick T; Levine, Glenn N

    2016-09-01

    Recent randomized controlled trials have suggested that patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease may benefit more from multivessel percutaneous coronary intervention (PCI) compared with culprit vessel-only primary PCI. The American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions recently published an updated recommendation on this topic. The purpose of this State-of-the-Art Review is to accurately document existing published reports, describe their limitations, and establish a base for future studies. PMID:27585512

  14. The use of low molecular weight heparins in patients with acute ST-elevated myocardial infarction

    Petrović Milovan

    2006-01-01

    Full Text Available Introduction. According to the published guidelines for the management of acute coronary syndromes (ACS, treatment of acute ST-elevated myocardial infarction is based on rapid revascularization, either mechanical or pharmacological. Pharmacological revascularization consists of fibrinolytic therapy with antiplatelet and anticoagulant therapy. In regard to the anticoagulant therapy, low molecular weight heparins (LMWHs are of special importance. LMWHs cause less complications (bleeding, thrombocytopenia, better bioviability in comparison with unfractionated heparin (UFH. Some studies on use of LMWHs in ACS, show that LMWHs are equally efficient and safe as UFH, causing less complications (different types of hemorrhagic complications (ESSENCE, TIMI 11B (enoxaparin, FRAXIS - fraxiparin, whereas some studies show better efficacy and safety of enoxaparin in therapy of acute ST-elevated myocardial infarction (ASSENT 3, ASSENT 3 PLUS, HART II, AMI-SK. Material and methods. Inclusion criteria: acute anterior myocardial infarction with ST-elevation, first myocardial infarction, no other structural heart defects, no signs of cardiogenic shock. Our study included 30 patients receiving fibrinolytic therapy with streptokinase, antiplatelet therapy and LMWH during 6 days, and 30 patients receiving UFH instead of LMWH. The follow-up period lasted for 6 months. Results. Significantly more patients receiving unfractionated heparin presented with major adverse cardiac events (73.3% in regard to patients in the study group (44,2% nadroparin, 39.8% enoxaparin (p=0.025. In the group receiving UFH, 6.7% patients had hemorrhagic complications, while none of patients receiving LMWHs. An equal number of patients died. Conclusion. Patients who were treated with LMWHs experienced less major adverse cardiac events and lower mortality. None suffered from hemorrhagic complications. .

  15. Relationship Between Adenosine - Induced ST Segment Depression During 99mTc-MIBI Scintigraphy and The Severity of Coronary Artery Disease

    Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed 99m-MIBI imaging after intravenous infusion of adenosine in 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-MIIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at a dose of 0.14 mg/kg per minute for 6 minutes and 99MmTc-MIB1 was injected at 3 minute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased 90 ± 19 beats/minute in the group with ST depression compared with 80 ±16 beats/minute in the group without ST depression(p9mTc-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

  16. Usefulness of pregnancy-associated plasma protein A in patients with acute coronary syndrome

    Iversen, Kasper K; Dalsgaard, Morten; Teisner, Ane S; Schoos, Mikkel; Teisner, Borge; Nielsen, Henrik; Clemmensen, Peter; Grande, Peer

    2009-01-01

    To investigate whether pregnancy-associated plasma protein-A (PAPP-A) is a prognostic marker in patients admitted with high-risk acute coronary syndrome. In patients admitted with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation myocardial infarction...

  17. Significance of initial ST segment changes for thrombolytic treatment in first inferior myocardial infarction.

    Schröder, K; Wegscheider, K; Neuhaus, K. L.; Tebbe, U; Schröder, R.

    1997-01-01

    OBJECTIVE: To evaluate the benefit to risk ratio of thrombolytic treatment in patients with small inferior acute myocardial infarction (AMI). Controlled studies relating the benefit from thrombolysis with initial electrocardiographic features are scarce and of limited sample size. DESIGN: Retrospective study of 728 patients with a first inferior AMI of six hours' duration from the Intravenous Streptokinase in Acute Myocardial Infarction (ISAM) study comparing streptokinase with placebo strati...

  18. Comparison of Outcomes of Patients ≥80 Years of Age Having Percutaneous Coronary Intervention According to Presentation (Stable vs Unstable Angina Pectoris/Non-ST-Segment Elevation Myocardial Infarction vs ST-Segment Elevation Myocardial Infarction)

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Thayssen, Per;

    2011-01-01

    prognosis. From 2002 through 2009 all elderly patients treated with PCI were identified in a population of 3.0 million based on the Western Denmark Heart Registry. Cox regression analysis was used to compare mortality rates according to clinical indications controlling for potential confounding. In total 3......,792 elderly patients (≥ 80 years old) were treated with PCI and the annual proportion increased from 224 (5.4%) in 2002 to 588 (10.2%) in 2009. The clinical indication was stable angina pectoris (SAP) in 30.2%, ST-segment elevation myocardial infarction (STEMI) in 35.0%, UAP/non-STEMI in 29.7%, and......Patients ≥ 80 years old with coronary artery disease constitute a particular risk group in relation to percutaneous coronary intervention (PCI). From 2002 through 2008 we examined the annual proportion of patients ≥ 80 years old undergoing PCI in western Denmark, their indications for PCI, and...

  19. Potential generation of geographical inequities by the introduction of primary percutaneous coronary intervention for the management of ST segment elevation myocardial infarction

    Kanka David

    2007-09-01

    Full Text Available Abstract Background Primary Percutaneous Coronary Intervention (PCI is more efficacious than thrombolysis in the management of acute myocardial infarction, but, because of the requirement for prompt treatment, there are practical challenges in developing such services. We examined the proportion of patients with ST segment Elevation Myocardial Infarction (STEMI who could receive timely treatment from a primary Percutaneous Coronary Intervention (PCI service assuming different geographical locations of potential treatment centres in three English counties. Methods and results Information on the residential location of patients with new STEMI hospitalisations recorded in Hospital Episodes Statistics was analysed and the proportion of episodes of STEMI within 60' and 45' travel time isochrones from potential primary PCI centres in three English counties was calculated. There were on average 1,815 new STEMI hospitalisations per year occurring in the studied population. Introduction of a primary PCI service in one, two or three potential treatment centres would have covered respectively 28%, 73% and 90% of such episodes within 60 minutes travel time, and 17%, 51% and 69% within 45 minutes travel time. Conclusion In the study context, a primary PCI service in an existing tertiary centre would only cover a minority of STEMI events and would generate geographical inequities. A two-centre model would improve coverage and equity considerably, but may be associated with practical, clinical quality and financial challenges.

  20. 消化道穿孔误诊为非ST段抬高心肌梗死1例分析%Analysis of 1 case of digestive tract perforation misdiagnosed as non ST segment elevation myocardial infarction

    王树碧

    2015-01-01

    Perforation of digestive tract and acute myocardial infarction are common diseases in clinic,and their clinical manifestations have some similarities,so,in the clinical treatment,some patients with acute myocardial infarction were often misdiagnosed as acute abdomen,however,less acute abdomen were misdiagnosed as acute myocardial infarction.In this article,the author briefly describes 1 case of digestive tract perforation misdiagnosed as non ST segment elevation myocardial infarction,to provide discuss for clinic.%消化道穿孔和急性心肌梗死都是临床常见疾病,它们的临床表现有一些相似之处,所以,在临床诊治中,一些急性心肌梗死患者常被误诊为急腹症,而急腹症较少被误诊为急性心肌梗死。本文简要介绍消化道穿孔被误诊为非ST段抬高心肌梗死1例,为临床提供探讨。

  1. Influence of multivessel disease with or without additional revascularization on mortality in patients with ST-segment elevation myocardial infarction

    Jensen, Lisette Okkels; Terkelsen, Christian Juhl; Horváth-Puhó, Erzsébet;

    2015-01-01

    patients presenting with STEMI and treated with primary PCI were identified from the Western Denmark Heart Registry, which covers a population of 3.0 million. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounding. RESULTS: The study cohort......BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), timely reperfusion with primary percutaneous coronary intervention (PCI) is the preferred treatment. In primary PCI patients with multivessel disease, it is unclear whether culprit vessel PCI only is the preferred...... treatment. We compared mortality among (1) STEMI patients with single-vessel disease and those with multivessel disease and (2) multivessel disease patients with and without additional revascularization of nonculprit lesions within 2 months after the index PCI. METHODS: From January 2002 to June 2009, all...

  2. Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for Acute ST elevation MI: A Meta-Analysis of Randomized Controlled Trials

    Grossman P Michael

    2010-02-01

    Full Text Available Abstract Background Clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI in patients with acute ST elevation myocardial infarction (STEMI have produced conflicting results. The objective of our study was to systematically evaluate currently available data comparing thrombectomy followed by PCI with conventional PCI alone in patients with acute STEMI. Methods Seventeen randomized trials (n = 3,909 patients of thrombectomy versus PCI were included in this meta-analysis. We calculated the summary odds ratios for mortality, stroke, post procedural myocardial blush grade (MBG, thrombolysis in myocardial infarction (TIMI grade flow, and post procedural ST segment resolution (STR using random-effects and fixed-effects models. Results There was no difference in risk of 30-day mortality (44/1914 vs. 50/1907, OR 0.84, 95% CI 0.54-1.29, P = 0.42 among patients randomized to thrombectomy, compared with conventional PCI. Thrombectomy was associated with a significantly greater likelihood of TIMI 3 flow (1616/1826 vs. 1533/1806, OR 1.41, P = 0.007, MBG 3 (730/1526 vs. 486/1513, OR 2.42, P Conclusions Thrombectomy devices appear to improve markers of myocardial perfusion in patients undergoing primary PCI, with no difference in overall 30-day mortality but an increased likelihood of stroke. The clinical benefits of thrombectomy appear to be influenced by the device type with a trend towards survival benefit with MAT and worsening outcome with mechanical devices.

  3. Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

    Andreas; Kumar; Rodrigo; Bagur; Patrick; Béliveau; Jean-Michel; Potvin; Pierre; Levesque; Nancy; Fillion; Benoit; Tremblay; éric; Larose; Valérie; Gaudreault

    2014-01-01

    A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.

  4. Analysis of the Best Timing for Applying Tirofiban in PCI Operation for the Patients with ST Segment Elevation Myocardial Infarction

    Lei Zhang

    2015-01-01

    Full Text Available This study is a comparative analysis of the best timing for applying tirofiban in the PCI emergency treatment for STEMI patients. We selected 109 patients with ST-segment elevation myocardial infarction from October 2013 to October 2014 and divided them into two groups, the early treatment group (53 cases received tirofiban during the operation and the later treatment group (56 cases received tirofiban after operation. The analysis was then conducted. Results: The proportion of IRA forward flow in TIMI2-3 for the 1st group during the radiography was higher than 2nd group, 50 cases with TIMI3 blood flow and 52 cases with TIMI3 blood flow in later treatment group. Comparing the TIMI3 flow of both groups, the difference was not statistically significant; for the CK-MB 4h and 8h after operation as well as the LVEF after operation, the differences are were not statistically significant. The occurrence rate of hemorrhage complication was low for both groups. The early use of tirofiban can make the thrombus fully dissolve and coronary blood flow remains in a good state, which is not only beneficial for myocardial perfusion but also helpful for deciding the length and side branch situation of coronary artery pathological changes.

  5. ST elevation without myocardial infarction.

    Bitar, Zouheir Ibrahim; Swede, Mohammad; Almerri, Khaled

    2014-01-01

    Acute myocarditis may mimic myocardial infarction because the affected patients report 'classical' chest pain; the ECG changes and echocardiography are identical to those observed in acute coronary syndromes, and serum markers are increased. We describe a case with ST segment elevation on admission ECG, and coronary angiography was normal. Cardiac magnetic resonance with myocardial delayed enhancement sequences is a non-invasive alternative for diagnosing myocarditis. PMID:24711464

  6. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER)

    Kelbæk, Henning; Høfsten, Dan Eik; Køber, Lars; Helqvist, Steffen; Kløvgaard, Lene; Holmvang, Lene; Jørgensen, Erik; Pedersen, Frants; Saunamäki, Kari; De Backer, Ole; Bang, Lia E; Kofoed, Klaus F; Lønborg, Jacob; Ahtarovski, Kiril; Vejlstrup, Niels; Bøtker, Hans E; Terkelsen, Christian J; Christiansen, Evald H; Ravkilde, Jan; Tilsted, Hans-Henrik; Villadsen, Anton B; Aarøe, Jens; Jensen, Svend E; Raungaard, Bent; Jensen, Lisette O; Clemmensen, Peter; Grande, Peer; Madsen, Jan K; Torp-Pedersen, Christian; Engstrøm, Thomas

    2016-01-01

    to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST...... stent implantation (hazard ratio 0·99, 95% CI 0·76-1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent...... implantation group, with no significant differences between groups. INTERPRETATION: In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing...

  7. Impact of early, late, and no ST-segment resolution measured by continuous ST Holter monitoring on left ventricular ejection fraction and infarct size as determined by cardiovascular magnetic resonance imaging

    J.D.E. Haeck; N.J.W. Verouden; W.J. Kuijt; K.T. Koch; M. Majidi; A. Hirsch; J.G.P. Tijssen; M.W. Krucoff; R.J. de Winter

    2011-01-01

    Background: The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at follow-u

  8. Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring

    Mickley, H; Pless, P; Nielsen, J R; Møller, M

    1993-01-01

    the infarction. The prevalence of exercise-induced ischaemic manifestations in the infarct types was similar: chest pain 14% vs 16% and ST-segment depression 54% vs 54%. The ischaemic threshold did not differ either (heart rate at 1 mm of ST-segment depression 120 +/- 27 vs 119 +/- 25 beats.min-1......). During early post-discharge daily activities, more patients with non-Q wave infarction demonstrated transient episodes of ST-segment depression: 28% vs 14% (ns). Furthermore, ischaemic episodes were significantly longer (42.5 +/- 50.1 vs 22.0 +/- 20.6 min; P < 0.001), and the ischaemic threshold was...... significantly lower in non-Q wave infarction (heart rate at onset of ST-segment depression 84 +/- 11 vs 88 +/- 9 beats.min-1; P < 0.05). During 3.5 +/- 0.9 years of follow-up the proportion of patients with > or = 1 ischaemic event (non-fatal reinfarction, angina pectoris, revascularization) was significantly...

  9. Elevated Serum Tryptase and Endothelin in Patients with ST Segment Elevation Myocardial Infarction: Preliminary Report

    Lukasz Lewicki

    2015-01-01

    Full Text Available An inflammatory response plays a crucial role in myocardial damage after an acute myocardial infarction. Objectives. To measure serum concentrations of several mediators in patients with an acute myocardial infarction (STEMI and to assess their potential relationship with a risk of coronary instability. Patients and Methods. The 33 patients with STEMI and 19 healthy volunteers were analyzed. The clinical data were obtained; as well serum concentrations of tryptase, endothelin (ET-1, angiogenin, soluble c-kit, and PDGF were measured. Results. Patients with STEMI had higher serum tryptase and ET-1 than healthy volunteers (2,5 ± 0,4 ng/mL versus 1,1 ± 0,4 ng/mL and 0,7 ± 0,1 ng/mL versus 0,3 ± 0,1 ng/mL, resp.. Subjects with significant lesion in left anterior descending artery (LAD had lower serum ET-1 compared to those with normal LAD (0,6 ± 0,2 pg/mL versus 0,9 ± 0,4 pg/mL. Patients with three-vessel coronary artery disease (CAD had higher level of soluble c-kit compared to those with one- or two-vessel CAD: 19,9 ± 24,1 ng/mL versus 5,6 ± 1,9 ng/mL. Conclusions. Elevated serum tryptase and ET-1 may be markers of increased coronary instability; some cytokines may be related to the extension of CAD.

  10. The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke

    Jensen, Jesper K; Korsholm, Lars; Høilund-Carlsen, Poul Flemming;

    2007-01-01

    in patients with an acute ischemic stroke exists. METHODS: Serial measurements of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 12-lead ECGs were obtained in 192 consecutive patients with an acute ischemic stroke without ischemic heart disease, atrial fibrillation, heart- or renal failure......-T changes in the ECG remained associated with increased levels of NT-proBNP (beta=76.5, p=0.011). CONCLUSIONS: ST-T changes suggestive of myocardial ischemia are independently associated with the levels of NT-proBNP in patients with acute ischemic stroke. The clinical importance of this observation remains...