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Sample records for acute st-elevation myocardial

  1. 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...

  2. 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...

  3. 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...

  4. 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.

  5. 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. .

  6. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011

    Kristensen, Steen D; Laut, Kristina G; Fajadet, Jean;

    2014-01-01

    AIMS: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society...

  7. Acute non-ST elevation myocardial infarction following paclitaxel administration for ovarian carcinoma: A case report and review of literature

    Kajal Shah; Sudeep Gupta; Jaya Ghosh; Jyoti Bajpai; Amita Maheshwari

    2012-01-01

    We report a case of an acute non-ST elevation myocardial infarction (AMI) induced by paclitaxel in a patient with ovarian cancer. A 45-year-old premenopausal lady without any co-morbidity was started on the first cycle of neoadjuvant chemotherapy with paclitaxel-based regimen for advanced stage ovarian cancer. The patient developed chest pain 3 h after paclitaxel infusion with characteristic electrocardiographic changes of antero-apical myocardial infarction. The patient recovered on conserva...

  8. Effects of IABP on patients with acute ST-elevated myocardial infarction

    Tai-lian HONG

    2016-06-01

    Full Text Available Objective  To evaluate the clinical efficacy and safety of intra-aortic balloon pump (IABP counterpulsation for the patients with acute ST-elevated myocardial infarction (STEMI. Methods  To retrospectively analyze the data collected from the Management System of Cardiovascular Interventional Treatment in Military Hospitals. A total of 8878 consecutive patients with acute STEMI undergoing percutaneous coronary intervention (PCI were recruited in present study, of whom 732 patients received IABP therapy were assigned into IABP group and the other 8146 patients received no IABP into control group. Contrastive analysis was performed to analyze the baseline data of the two groups, and 1:1 propensity matching was done to compare the differences between the two groups of intraoperative mortality, in-hospital mortality, stent thrombosis and postoperative hemorrhage. Results  Multi-logistic regression revealed that age, heart failure and renal dysfunction were the risk factors for in-hospital mortality. By 1:1 propensity matching analysis, no statistical differences were found between the two groups in intraoperative mortality, postoperative hemorrhage and stent thrombosis, and the in-hospital mortality was higher in IABP group than in control group (10.4% vs 2.5%, P<0.05. Conclusion  IABP can't reduce the in-hospital mortality of patients with STEMI. DOI: 10.11855/j.issn.0577-7402.2016.06.02

  9. 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

  10. Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

    Oliver Koeth

    2010-01-01

    Full Text Available Takotsubo cardiomyopathy (TCM is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM.

  11. Paramedical risk framing during field referral of acute stroke and S-T elevation myocardial infarction patients.

    Campeau, Anthony Gerard

    2016-06-01

    Field referral of emergency ambulance patients by paramedics on a widespread basis is a relatively new aspect of paramedicine. Its implementation involves a significant revision to paramedics' clinical responsibilities and level of interaction with medical specialists. Using grounded theory methodology, this qualitative study uses interviews with paramedics from Ontario, Canada, to explore the framing of risk associated with these referrals in the context of caring for patients with two high-stakes medical conditions: acute stroke and S-T elevation myocardial infarction. The results outline how paramedics have incorporated risk framing into their practice. PMID:26819329

  12. IL-6 signalling in patients with acute ST-elevation myocardial infarction

    Vibeke N. Ritschel

    2014-01-01

    In conclusion, circulating levels of IL-6 and CRP, but not the soluble forms of the receptor (sIL-6R or the receptor signalling subunit (sgp130 were associated with the extent of myocardial necrosis. The biological importance of the IL-6/gp130-mediated signalling pathways in patients with acute myocardial infarction and dysglycemia should be further elucidated.

  13. ST Elevation Myocardial Infarction in the elderly

    Marcelo Franken; Amit Nussbacher; Alberto Liberman; Mauricio Wajngarten

    2012-01-01

    Acute coronary syndromes (ACS) are the leading causes of death in the elderly. The suspicion and diagnosis of ACS in this age group is more difficult, since typical angina is less frequent. The morbidity and mortality is greater in older age patients presenting ACS. Despite the higher prevalence and greater risk, elderly patients are underrepresented in major clinical trials from which evidence based recommendations are formulated. The authors describe, in this article, the challenges in the diagnosis and management of ST elevation myocardial infarction in the elderly, and discuss the available evidence.

  14. Free triiodothyronine level indicates the degree of myocardial injury in patients with acute ST-elevation myocardial infarction

    WANG Wen-yao; TANG Yi-da; YANG Min; CUI Cheng; MU Mu; QIAN Jie; YANG Yue-jin

    2013-01-01

    Background Previous studies have suggested that hypothyroidism correlated with coronary heart diseases (CHD) mortality in long-term cohort,but whether the thyroid function status is associated with myocardial injury in acute ST-elevation myocardial infarction (STEMI) has not been investigated sufficiently.Methods Five hundred and eighty-two hospitalized patients from January 2010 to December 2011,with the diagnosis of STEMI,were enrolled in this study.All patients underwent testing for thyroid function status,cardiac troponin I (cTnl),cardiac enzymes,C-reactive protein (CRP).We investigated the association between thyroid hormone levels and cardiac markers (creatine kinase-MB and cTnl),and thus evaluated the potential role of thyroid function status in predicting the myocardial injury.Results There were 76 patients (13.06%)who had hypothyroidism including low-T3-syndrome (34 patients,5.84%),subclinical hypothyroidism (28 patients,4.81%) and clinical hypothyroidism (14 patients,2.41%).After adjusting for conventional risk factors (age,gender,smoking,diabetes mellitus,dyslipidemia,hypertension),free triiodothyronine (FT3) was significantly and negatively correlated with log-CKMB (r=-0.244,P <0.001) and log-cTnl (r=0.290,P <0.001),indicating that the lower thyroid hormone level correlates with the severer cardiac injury in STEMI patients.FT3 also had a moderate negative correlation with CRP (r=-0.475,P <0.001),which might indicate that hypothyroidism may activate the inflammation response.No significant correlation was found between other thyroid parameters (TSH,FT4) and cardiac markers.Conclusions As the lower FT3 level correlates with higher level of cardiac markers and lower left ventricular ejection fraction (LVEF),the hypothyroidism may be a predictor for myocardial injury in STEMI.And these results may warrant further study to investigate whether reversing the hypothyroidism could benefit the STEMI patients.

  15. 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...

  16. 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...

  17. 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.

  18. 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.

  19. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction

    Gu, Y. L.; van der Horst, I. C. C.; Douglas, Y. L.; Svilaas, T.; Mariani, M. A.; Zijlstra, F.

    2010-01-01

    Background/Objectives. We aimed to investigate the incidence and clinical outcome of coronary artery bypass grafting (CABG) performed in contemporary patients with ST-elevation myocardial infarction (STEMI) within 30 days after presentation. Methods. All 1071 patients enrolled in the Thrombus Aspira

  20. No-Reflow Phenomenon in Patients with ST-Elevation Acute Myocardial Infarction, Treated with Primary Percutaneous Coronary Intervention: A Study of Predictive Factors

    Seyed Hashem Danesh Sani; Ali Eshraghi; Bahram Shahri; Mohamad Vejdanparast

    2014-01-01

      Introduction: No-reflow phenomenon in coronary vessels, manifested in some patients with reperfused acute myocardial infarction (MI), is associated with poor clinical and functional outcomes. Therefore, evaluation of predisposing risk factors can be helpful in risk assessment and identification of patients at higher risk. Herein, we aimed to study the predictive factors for the development of no-reflow phenomenon in patients with ST-elevation acute MI (STEMI), following primary percutaneous...

  1. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries

    Widimsky, Petr; Wijns, William; Fajadet, Jean; de Belder, Mark; Knot, Jiri; Aaberge, Lars; Andrikopoulos, George; Baz, Jose Antonio; Betriu, Amadeo; Claeys, Marc; Danchin, Nicholas; Djambazov, Slaveyko; Erne, Paul; Hartikainen, Juha; Huber, Kurt

    2009-01-01

    Aims Patient access to reperfusion therapy and the use of primary percutaneous coronary intervention (p-PCI) or thrombolysis (TL) varies considerably between European countries. The aim of this study was to obtain a realistic contemporary picture of how patients with ST elevation myocardial infarction (STEMI) are treated in different European countries. Methods and results The chairpersons of the national working groups/societies of interventional cardiology in European countries and selected...

  2. 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

  3. Role of the chest pain center in treatment of patients with acute ST-elevated myocardial infarction

    Hai DONG

    2016-06-01

    Full Text Available Objective  To evaluate the role of establishment of the chest pain center in the treatment of patients with acute ST-elevated myocardial infarction (STEMI. Methods  Referring to the international association of chest pain centers, the chest pain center was established in the hospital the authors served, and the corresponding management system and treatment process were worked out. A total of 576 patients with acute STEMI, admitted after the establishment of the chest pain center (May 2015 Mar. 2016, were recruited as the observation group, and 512 STEMI patients admitted before the establishment of the chest pain center ( Jan. -Dec. 2014 were enrolled as control group. Patients in observation group were treated in the chest pain center, and those in control group received conventional treatment. The general situation, basic diseases, the finishing time of the first ECG and the completed number of ECG within 10 minutes, the success rate of stent implantation in percutaneous coronary intervention (PCI, the time of door-to balloon expansion (D2B, the length of hospital stay and in-hospital mortality were compared between the two groups. Results  No significant difference existed between the two groups in the species composition of diseases, age and sex. The average finishing time of the first ECG was shorter in observation group than in control group (P=0.001, the success rate of stent implantation in PCI was higher in observation group than in control group, but without statistical significance (P=0.222. The time of D2B and of hospital stay was shorter in observation group than in control group (P0.05. Conclusion  The establishment of the chest pain center may effectively shorten the rescue time for patients with STEMI, improve the efficiency of treatment and shorten the length of hospital stay, and is worthy of further clinical promotion. DOI: 10.11855/j.issn.0577-7402.2016.06.04

  4. Outcomes after primary coronary intervention with drug eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

    ZHANG Qi; HU Jian; YANG Zhen-kun; ZHENG Ai-fang; ZHANG Xian; SHEN Wei-feng; SHEN Jie; ZHANG Rui-yan; QIU Jian-ping; LU Ji-de; ZHANG Yu; CHEN Yue-hua; ZHANG Jun-feng; ZHANG Jian-sheng

    2007-01-01

    Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts.Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups.Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes,P=0.02) than those in non-diabetic group.The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P<0.001).Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG)≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0

  5. Thrombus Aspiration during Percutaneous coronary intervention in Acute non-ST-elevation myocardial infarction Study (TAPAS II)-Study design

    Kampinga, M. A.; Vlaar, P. J.; Fokkema, M. L.; Gu, Y. L.; Zijlstra, F.

    2009-01-01

    Background and Objective. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) has shown that thrombus aspiration improves myocardial perfusion and clinical outcome compared with conventional primary percutaneous coronary intervention (PCI) i

  6. The Effects of Oxygen Therapy on Myocardial Salvage in ST Elevation Myocardial Infarction Treated with Acute Percutaneous Coronary Intervention: The Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion (SOCCER) Study.

    Khoshnood, Ardavan; Carlsson, Marcus; Akbarzadeh, Mahin; Bhiladvala, Pallonji; Roijer, Anders; Bodetoft, Stefan; Höglund, Peter; Zughaft, David; Todorova, Lizbet; Erlinge, David; Ekelund, Ulf

    2015-01-01

    Despite a lack of scientific evidence, oxygen has long been a part of standard treatment for patients with acute myocardial infarction (AMI). However, several studies suggest that oxygen therapy may have negative cardiovascular effects. We here describe a randomized controlled trial, i.e. Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion (SOCCER), aiming to evaluate the effect of oxygen therapy on myocardial salvage and infarct size in patients with ST elevation myocardial in...

  7. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    Atar, Dan; Arheden, Håkan; Berdeaux, Alain;

    2015-01-01

    AIM: The MITOCARE study evaluated the efficacy and safety of TRO40303 for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). METHODS: Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303......-mass) or left ventricular ejection fraction (LVEF) (46 vs. 48%), or in the mean 30-day echocardiographic LVEF (51.5 vs. 52.2%) between TRO40303 and placebo. A greater number of adjudicated safety events occurred in the TRO40303 group for unexplained reasons. CONCLUSION: This study in STEMI patients treated...... (n = 83) or placebo (n = 80) via i.v. bolus injection prior to balloon inflation during primary percutaneous coronary intervention in a double-blind manner. The primary endpoint was infarct size expressed as area under the curve (AUC) for creatine kinase (CK) and for troponin I (TnI) over 3 days...

  8. Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction

    Min Li; Xiao Wang; Shu-Hua Mi; Zhe Chi; Qing Chen; Xin Zhao; Shao-Ping Nie

    2016-01-01

    Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI),and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods:This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients (399 men,114 women) with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R' or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events (MACE) were recorded.Results:In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P =0.042).There were fewer Killip Class Ⅰ patients in the fQRS group (P =0.019),while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group (P =0.019).Left ventricular ejection fraction levels were significantly lower in the fQRS group (P =0.021).Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein (CRP),and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE (MACE,P =0.028),revascularization (P =0.005),and recurrent angina (P =0.005) were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables

  9. Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: Rationale and design of the Sonolysis study

    van Dijk Arie PJ

    2008-12-01

    Full Text Available Abstract Background - Experimental studies have shown that ultrasound contrast agents enhance the effectiveness of thrombolytic agents in the presence of ultrasound in vitro and in vivo. Recently, we have launched a clinical pilot study, called "Sonolysis", to study this effect in patients with ST-elevation myocardial infarction based on proximal lesions of the infarct-related artery. Methods/design - In our multicenter, randomized, placebo controlled clinical trial we will include patients between 18 and 80 years of age with their first ST-elevation myocardial infarction based on a proximal lesion of the infarct-related artery. After receiving a single bolus alteplase 50 mg IV (Actilyse® Boehringer Ingelheim GmbH, a loading dose of aspirin 500 mg, and heparin 5000 IU in the ambulance according to the prehospital thrombolysis protocol, patients, following oral informed consent, are randomized to undergo 15 minutes of pulsatile ultrasound with intravenous administration of ultrasound contrast agent or placebo without ultrasound. Afterwards coronary angiography and, if indicated, percutaneous coronary intervention will take place. A total of 60 patients will be enrolled in approximately 1 year. The primary endpoints are based on the coronary angiogram and consist of TIMI flow, corrected TIMI frame count, and myocardial blush grade. Follow-up includes 12-lead ECG, 2D-echocardiography, cardiac MRI, and enzyme markers to obtain our secondary endpoints, including the infarct size, wall motion abnormalities, and the global left ventricular function. Discussion - The Sonolysis study is the first multicenter, randomized, placebo controlled clinical trial investigating the therapeutic application of ultrasound and microbubbles in acute ST-elevation myocardial infarction patients. A positive finding may stimulate further research and technical innovations to implement the treatment in the ambulance and maybe obtain even more patency at an earlier stage

  10. A simple slide test to assess erythrocyte aggregation in acute ST-elevated myocardial infarction and acute ischemic stroke: Its prognostic significance

    Atla Bhagya Lakshmi

    2011-01-01

    Full Text Available A simple slide test and image analysis were used to reveal the presence of an acute-phase response and to determine its intensity in subjects of acute myocardial infarction and acute ischemic stroke. Erythrocytes tend to aggregate during an inflammatory process. Evaluation of erythrocyte adhesiveness/aggregation is currently available to the clinicians indirectly by erythrocyte sedimentation rate (ESR, but ESR correlates poorly with erythrocyte aggregation, hence a simple slide technique using citrated blood was used to evaluate erythrocyte aggregation microscopically and also by using image analysis. Aims: (1 To study erythrocyte aggregation/adhesiveness by a simple slide test in subjects with acute ST-elevated myocardial infarction (STEMI, acute ischemic stroke and healthy controls. (2 To study the prognostic significance of ESR and erythrocyte aggregation/adhesiveness test (EAAT in predicting the outcome after 1 week in subjects of acute myocardial infarction and acute ischemic stroke. Patients and Methods: Three groups of subjects were included in the study; 30 patients of acute STEMI, 30 patients of acute ischemic stroke, and 30 subjects with age- and gender-matched healthy controls. Citrated blood was subjected to simple slide test and ESR estimation by Westergren′s method. Stained smears were examined under 400Χ and graded into four grades. Images were taken from nine fields; three each from head, body, and tail of the smear. The degree of erythrocyte aggregation was quantified using a variable called erythrocyte percentage (EP, by using the software MATLAB Version 7.5. A simple program was used to count the number of black and white pixels in the image by selecting a threshold level. Results: The mean ESR of the subjects with acute myocardial infarction (29 + 17.34 was significantly higher (P = 0.001 than the mean ESR of the control group (15.5 + 12.37. The mean EP of the subjects with acute myocardial infarction (69.91 + 13.25 was

  11. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction

    Reza Hajizadeh

    2016-06-01

    Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF.

  12. Demographics and Angiographic Findings in Patients under 35 Years of Age with Acute ST Elevation Myocardial Infarction

    Ali Abbasi

    2011-05-01

    Full Text Available Background: ST-elevation myocardial infarction (STEMI is a major cause of cardiovascular mortality worldwide.There are differences between very young patients with STEMI and their older counterparts. This study investigates the demographics and clinical findings in very young patients with STEMI.Methods: Through a review of the angiography registry, 108 patients aged ≤ 35 years (Group I were compared with 5544 patients aged > 35 years (Group II who underwent coronary angiography after STEMI.Results: Group I patients were more likely to be male (92.6%, smokers, and have a family history of cardiovascular diseases (34.6%. The prevalence of diabetes, dyslipidemia, and hypertension was higher in the old patients. Triglyceride and hemoglobin were significantly higher in Group I. Normal coronary angiogram was reported in 18.5% of the young patients, and in 2.1% of the older patients. The prevalence of single-vessel and multi-vessel coronary artery disease was similar in the two groups (34.3% vs. 35.2%. The younger subjects were more commonly candidates for medical treatmentand percutaneous coronary intervention (PCI (84.2%, while coronary artery bypass grafting (CABG was considered for the 39.5% of their older counterparts.Conclusion: In the young adults with STEMI, male gender, smoking, family history, and high triglyceride level were moreoften observed. A considerable proportion of the young patients presented with multi-vessel coronary disease. PCI or medicaltreatment was the preferred treatment in the younger patients; in contrast to their older counterparts, in whom CABG was more commonly chosen for revascularization.

  13. Factors Associated with Delay in Thrombolytic Therapy in Patients with ST-Elevation Myocardial Infarction

    Shahrooz Yazdani; Nazanin Kiapour; Amir Alishahi Tabriz; Mohammad-Reza Sohrabi

    2012-01-01

    Background: Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Methods: Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was reco...

  14. Acute ST elevation myocardial infarction after intravenous immunoglobulin infusion in a young patient: a rare but probable adverse effect of immunoglobulin

    Manish Ruhela

    2014-06-01

    Full Text Available Intravenous immunoglobulin (IVIG is used in the treatment of a variety of disorders, including autoimmune conditions. IVIG has been considered a safe medication, with minor and transient adverse effects. With the wider use of IVIG, the reported rate of adverse effects has been increased, some of them are potentially fatal cardiovascular reactions due to induction of hypercoagulable state. We report a 40-year-old female treated with IVIG for Guillain-Barre syndrome, who developed chest pain 1 hr following IVIG infusion. The symptoms were associated with ST elevation in anterior leads on electrocardiogram. This anterior wall myocardial infarction (MI is compatible with IVIG-induced hypercoagulability and considered as a probable adverse effect of this medication. To the best of our knowledge, this is probably the first case report where a young patient developed acute MI without any cardiac risk factors after IVIG infusion. [Int J Basic Clin Pharmacol 2014; 3(3.000: 569-571

  15. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

    Machado Cristiano V

    2011-06-01

    Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

  16. Comparison of Noninvasively and Invasively Managed Patients, With or Without Revascularization in Non-ST Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey).

    Blatt, Alex; Kalmanovich, Eran; Karny-Rahkovich, Orit; Brener, Svetlana; Shlezinger, Meital; Shlomo, Nir; Vered, Zvi; Hod, Hanoch; Goldenberg, Ilan; Elbaz-Greener, Gabby

    2016-07-01

    Patients with non-ST elevation myocardial infarction who are managed noninvasively at presentation or are catheterized but without revascularization represent a heterogeneous and understudied population. We evaluated the clinical characteristics, management strategies, and outcomes of patients with non-ST elevation myocardial infarction (NSTEMI) who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys from 2004 to 2013. Patients were divided into 3 groups: no catheterization (no angio), catheterization with revascularization (angio-revascularized), and catheterization without revascularization (angio-nonrevascularized) groups. The study included 3,198 patients with NSTEMI. Coronary angiography was performed in 2,525 (79%) during the index hospitalization, of whom 1899 (59%) underwent revascularization. Evidence-based therapies were administered during the index hospitalization at a significantly higher rate to those in the angio-revascularized group compared with the other 2 groups. Multivariate analysis showed that compared with those in the angio-revascularized and angio-nonrevascularized groups, patients in the no angio group experienced a significantly higher risk for 1-year mortality (hazard ratio 2.04 [p ≤0.0001] and 1.21 [p = 0.01], respectively). The risk associated with no revascularized was consistent in each risk subset analyzed, including an older age, and increased creatinine levels. In conclusion, our data, from a large real-world contemporary experience, suggest that patients with NSTEMI who do not undergo coronary revascularization during the index hospitalization represent a greater risk and undertreated group with increased risk for long-term mortality. PMID:27217207

  17. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

    Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde;

    2011-01-01

    Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate the...

  18. The Impact of Type 2 Diabetes on the Efficacy of ADP Receptor Blockers in Patients with Acute ST Elevation Myocardial Infarction: A Pilot Prospective Study

    Fedor, Marián; Kovář, František; Galajda, Peter; Bolek, Tomáš; Stančiaková, Lucia; Fedorová, Jana; Staško, Ján; Kubisz, Peter; Mokáň, Marián

    2016-01-01

    Background. The aim of this study was to validate the impact of type 2 diabetes (T2D) on the platelet reactivity in patients with acute ST elevation myocardial infarction (STEMI) treated with adenosine diphosphate (ADP) receptor blockers. Methods. A pilot prospective study was performed. Totally 67 patients were enrolled. 21 patients had T2D. Among all study population, 33 patients received clopidogrel and 34 patients received prasugrel. The efficacy of ADP receptor blocker therapy had been tested in two time intervals using light transmission aggregometry with specific inducer and vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) flow cytometry assay. Results. There were no significant differences in platelet aggregability among T2D and nondiabetic (ND) group. The platelet reactivity index of VASP-P did not differ significantly between T2D and ND group (59.4 ± 30.9% versus 60.0 ± 25.2% and 33.9 ± 25.3% versus 38.6 ± 29.3% in second testing). The number of ADP receptor blocker nonresponders did not differ significantly between T2D and ND patients. The time interval from ADP receptor blocker loading dosing to the blood sampling was similar in T2D and ND patients in both examinations. Conclusion. This prospective study did not confirm the higher platelet reactivity and higher prevalence of ADP receptor blocker nonresponders in T2D acute STEMI patients. PMID:27493970

  19. Efficacy and safety of thrombolytic therapy for acute ST elevation myocardial infarction%急性ST段抬高型心肌梗死溶栓治疗的疗效与安全性

    王云飞; 华琦; 李静

    2013-01-01

    For patients with acute ST elevation myocardial infarction, early reperfusion therapy can recanalize infarction related artery, minimize myocardial injury, improve cardiac function. This article reviews the progress of thrombolytic therapy for acute ST elevation myocardial infarction, analyze the advantages and problems need to be solved on thromboltic therapy.%  对于急性ST段抬高型心肌梗死患者,早期的再灌注治疗能有效开通梗死相关血管,减少心肌损伤,促进心功能的恢复。本文就近年来急性ST段抬高型心肌梗死溶栓治疗的发展进行综述,分析心肌梗死溶栓治疗的优势和需要解决的问题。

  20. Effectiveness of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction from a 5-year single-center experience.

    Tadel-Kocjancic, Spela; Zorman, Simona; Jazbec, Anja; Gorjup, Vojka; Zorman, Darko; Noc, Marko

    2008-01-15

    Primary percutaneous coronary intervention (PCI) is currently viewed as the preferred reperfusion strategy in patients with ST-elevation acute myocardial infarction (STEMI). This method was introduced in our hospital in 2000. From January 1, 2000, to December 31, 2004, a total of 2,393 consecutive patients with STEMI were admitted (27% transferred from 9 non-PCI hospitals and 31 prehospital emergency units/outpatient clinics). Of these patients, 1,666 (70%) underwent urgent coronary angiography and primary PCI. Platelet glycoprotein llb/llla inhibitors were used in 40% and stent placement, in 78%. Postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow was documented in 86%. Intra-aortic balloon counterpulsation was used in 6%; mechanical ventilation, in 8.6%; and inotropic drugs/vasopressors, in 15.8%. Mortality rates in patients with Killip's class I or II ranged from 1% to 4.9% without negative influence of ischemic time. In patients with Killip's class III or IV, mortality rates increased from 18% to 54% with increasing ischemic delay up to 6 hours (p = 0.06) and remained at around 40% afterward. Independent predictors of mortality were age (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01 to 1.64, p = 0.04), resuscitated cardiac arrest (OR 2.44, 95% CI 1.18 to 5.05, p = 0.02), and postprocedural TIMI flow (OR 0.31, 95% CI 0.16 to 0.59). Overall mortality rates of patients who underwent a primary PCI strategy from 2000 to 2004 were significantly lower than in the control group of 152 consecutive patients who underwent thrombolysis from 1995 to 1996 (6.2% vs 16.4%; p importance of shortening myocardial ischemic time, particularly in the presence of severe heart failure on admission. PMID:18178400

  1. The Relationship among N-Terminal Pro-B-Type Natriuretic Peptide, High-Sensitivity C-Reactive Protein and Infarct Size in Patients with Acute ST-Elevation Myocardial Infarction

    Sim, Doo Sun; Ahn, Youngkeun; Kim, Yun-Hyeon; Seon, Hyun Ju; Park, Keun Ho; Yoon, Hyun Ju; Yoon, Nam Sik; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun

    2015-01-01

    Background and Objectives We sought to investigate the relationship between levels of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the infarct size and left ventricular (LV) volume after acute myocardial infarction (MI). Subjects and Methods Eighty-six patients with acute ST-elevation MI underwent delayed enhancement multidetector computed tomography immediately after they underwent percutaneous coronary intervention to determine t...

  2. Comparison of biolimus eluted from an erodible stent coating with bare metal stents in acute ST-elevation myocardial infarction (COMFORTABLE AMI trial): rationale and design

    Räber, Lorenz; Kelbaek, Henning; Ostoijc, Miodrag; Baumbach, Andreas; Tüller, David; von Birgelen, Clemens; Roffi, Marco; Pedrazzini, Giovanni; Kornowski, Ran; Weber, Klaus; Heg, Dik; Matter, Christian; Lüscher, Thomas; Taniwaki, Masanori; Meier, Bernhard

    2012-01-01

    Compared with bare metal stents (BMS), early generation drug-eluting stents (DES) reduce the risk of revascularisation in patients with ST-elevation myocardial infarction (STEMI) at the expense of an increased risk of very late stent thrombosis (ST). Durable polymer coatings for controlled drug release have been identified as a potential trigger for these late adverse events and this has led to the development of newer generation DES with durable and biodegradable polymer surface coatings wit...

  3. Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction by Biomarkers

    2016-01-25

    Acute Myocardial Infarction (AMI); Acute Coronary Syndrome (ACS); ST Elevation (STEMI) Myocardial Infarction; Ischemic Reperfusion Injury; Non-ST Elevation (NSTEMI) Myocardial Infarction; Angina, Unstable

  4. Identification and predictive value of interleukin-6+ interleukin-10+ and interleukin-6-interleukin-10+ cytokine patterns in st-elevation acute myocardial infarction

    Ammirati, Enrico

    2012-08-29

    RATIONALE: At the onset of ST-elevation acute myocardial infarction (STEMI), patients can present with very high circulating interleukin-6 (IL-6) levels or very low-IL-6 levels. OBJECTIVE: We compared these 2 groups of patients to understand whether it is possible to define specific STEMI phenotypes associated with outcome based on the cytokine response. METHODS AND RESULTS: We compared 109 patients with STEMI in the top IL-6 level (median, 15.6 pg/mL; IL-6 STEMI) with 96 in the bottom IL-6 level (median, 1.7 pg/mL; IL-6 STEMI) and 103 matched controls extracted from the multiethnic First Acute Myocardial Infarction study. We found minimal clinical differences between IL-6 STEMI and IL-6 STEMI. We assessed the inflammatory profiles of the 2 STEMI groups and the controls by measuring 18 cytokines in blood samples. We exploited clustering analysis algorithms to infer the functional modules of interacting cytokines. IL-6 STEMI patients were characterized by the activation of 2 modules of interacting signals comprising IL-10, IL-8, macrophage inflammatory protein-1α, and C-reactive protein, and monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, and monokine induced by interferon-γ. IL-10 was increased both in IL-6 STEMI and IL-6 STEMI patients compared with controls. IL-6IL-10 STEMI patients had an increased risk of systolic dysfunction at discharge and an increased risk of death at 6 months in comparison with IL-6IL-10 STEMI patients. We combined IL-10 and monokine induced by interferon-γ (derived from the 2 identified cytokine modules) with IL-6 in a formula yielding a risk index that outperformed any single cytokine in the prediction of systolic dysfunction and death. CONCLUSIONS: We have identified a characteristic circulating inflammatory cytokine pattern in STEMI patients, which is not related to the extent of myocardial damage. The simultaneous elevation of IL-6 and IL-10 levels distinguishes STEMI patients with worse clinical outcomes

  5. Omega-3 index and smoking in patients with acute ST-elevation myocardial infarction taking statins: a case-control study in Korea

    Kim Young

    2012-03-01

    Full Text Available Abstract Background n-3 fatty acids and lifestyle also are closely related to risk of CVD. Most Koreans have higher fish consumption than people of Western populations. However, little is known about the recommended value of omega-3 index in Korean patients with acute ST-elevation myocardial infarction (STEMI taking statins. Here, we tested the hypothesis that lower omega-3 fatty acids and/or smoking are associated with acute STEMI, even though patients with dyslipidemia who were taking statins and who attained their LDL-C goals. Methods We conducted a case-control study in which omega-3 fatty acids and lifestyle factors were determined in 24 consecutive Korean patients taking statins with angiographically confirmed acute STEMI and 68 healthy controls without acute STEMI. The omega-3 index was calculated by the sum of eicosapentaenoic acid and docosahexaenoic acid in erythrocyte membranes. Multivariable adjusted regression analysis was used to assess independent associations between acute STEMI, omega-3 index, and lifestyle factors after adjusting for age, sex, and body mass index (BMI. Results The mean age of total subjects was 59.9 years, and 57.6% of the subjects were male. The omega-3 index was significantly lower in cases (8.83% than controls (11.13%; P trans-fatty acids were not different between the two groups. The omega-3 index was inversely associated with odds for being a case (OR 0.16 (95% CI 0.03-1.14; P = 0.047, while smoking was positively associated with odds for being a case (OR 6.67 (95% CI 1.77-25.23; P = 0.005 after adjusting for all confounding variables. Conclusion This study shows that relative to controls, acute STEMI cases are more likely to be smokers and to have a lower omega-3 index, even though the cases were taking statins. An omega-3 index of at least 11% and abstinence from smoking are associated with cardioprotection for Koreans.

  6. The Kinetics of Circulating Monocyte Subsets and Monocyte-Platelet Aggregates in the Acute Phase of ST-Elevation Myocardial Infarction

    Zhou, Xin; Liu, Xin-Lin; Ji, Wen-Jie; Liu, Jun-Xiang; Guo, Zhao-Zeng; Ren, Dong; Ma, Yong-Qiang; Zeng, Shan; Xu, Zhong-Wei; Li, Hong-Xia; Wang, Peizhong Peter; Zhang, Zhuoli; Li, Yu-Ming; Benefield, Brandon C.; Zawada, Adam M.; Thorp, Edward B.; Lee, Daniel C.; Heine, Gunnar H.

    2016-01-01

    Abstract In experimental myocardial infarction (MI), a rise in cell counts of circulating monocyte subsets contributes to impaired myocardial healing and to atherosclerotic plaque destabilization. In humans, the prognostic role of monocyte subsets in patients suffering ST-elevation MI (STEMI) is still unclear. In the present study, we aimed to determine the kinetics of the 3 monocyte subsets (classical CD14++CD16–, intermediate CD14++CD16+, and nonclassical CD14+CD16++ monocytes), as well as the subset-specific monocyte–platelet aggregates (MPA), in acute STEMI followed by primary percutaneous coronary intervention (PCI), and their relationships with cardiovascular outcomes during a 2-year follow-up. Monocyte subsets and MPA were measured in 100 STEMI patients receiving primary PCI on days 1, 2, 3, 5, and 7 of symptom onset, which were compared with 60 stable coronary heart disease patients and 35 healthy volunteers. From day 1 to day 7, significant increases in the counts of CD14++CD16+ monocytes and CD14++CD16+ MPA were observed, with peak levels on day 2. During a median follow-up of 2.0 years, 28 first cardiovascular events (defined as cardiovascular death, nonfatal ischemic stroke, recurrent MI, need for emergency or repeat revascularization, and rehospitalization for heart failure) were recorded. After adjustment for confounders, CD14++CD16+ monocytosis (day 1 [HR: 3.428; 95% CI: 1.597–7.358; P = 0.002], day 2 [HR: 4.835; 95% CI: 1.106–21.13; P = 0.04], day 3 [HR: 2.734; 95% CI: 1.138–6.564; P = 0.02], and day 7 [HR: 2.647; 95% CI: 1.196–5.861; P = 0.02]), as well as increased levels of CD14++CD16+ MPA measured on all time points (days 1, 2, 3, 5, and 7), had predictive values for adverse cardiovascular events. In conclusion, our data show the expansion of the CD14++CD16+ monocyte subset during acute phase of STEMI has predictive values for 2-year adverse cardiovascular outcomes in patients treated with primary PCI. Future studies

  7. Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: meta-analysis of diagnostic performance of multi-detector computed tomographic angiography

    Sarno Giovanna

    2007-12-01

    Full Text Available Abstract Background Multi-detector computed tomography angiography (MDCTA has been increasingly used in the evaluation of the coronary arteries. The purpose of this study was to review the literature on the diagnostic performance of MDCTA in the acute setting, for the detection of non-ST-elevation myocardial infarction (NSTEMI and unstable angina pectoris (UAP. Methods A Pubmed and manual search of the literature published between January 2000 and June 2007 was performed. Studies were included that compared MDCTA with clinical outcome and/or CA in patients with acute chest pain, presenting at the emergency department. More specifically, studies that only included patients with initially negative cardiac enzymes suspected of having NSTEMI or UAP were included. Summary estimates of diagnostic odds ratio (DOR, sensitivity and specificity, negative (NLR and positive likelihood ratio (PLR were calculated on a patient basis. Random-effects models and summary receiver operating curve (SROC analysis were used to assess the diagnostic performance of MDCTA with 4 detectors or more. The proportion of non assessable scans (NAP on MDCTA was also evaluated. In addition, the influence of study characteristics of each study on diagnostic performance and NAP was investigated with multivariable logistic regression. Results Nine studies totalling 566 patients, were included in the meta-analysis: one randomised trial and eight prospective cohort studies. Five studies on 64-detector MDCTA and 4 studies on MDCTA with less than 64 detectors were included (32 detectors n = 1, 16 detectors n = 2, 16 and 4 detectors n = 1. Pooled DOR was 131.81 (95%CI, 50.90–341.31. The pooled sensitivity and specificity were 0.95 (95%CI, 0.90–0.98 and 0.90 (95%CI, 0.87–0.93. The pooled NLR and PLR were 0.12 (95%CI, 0.06–0.21 and 8,60 (95%CI, 5.03–14,69. The results of the logistic regressions showed that none of the investigated variables had influence on the diagnostic

  8. A randomized, prospective, two-center comparison of sirolimus-eluting stent and zotarolimus-eluting stent in acute ST-elevation myocardial infarction: The SEZE trial

    Woo-Young Chung; Sang-Hyun Kim; In-Ho Chae; Joo-Hee Zo; Myung-A Kim; Dong-Ju Choi; Jeehoon Kang; Young-Seok Cho; Hae-Jun Park; Han-Mo Yang; Jae-Bin Seo; Jung-Won Suh; Kwang-Il Kim; Tae-Jin Youn

    2012-01-01

    Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies.However,this has not been thoroughly evaluated in ST elevation myocardial infarction.Methods This was a prospective,randomized,controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction,treated with zotarolimus-eluting stents or sirolimus-eluting stents.From March 2007 to February 2009,122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion.The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography,and secondary endpoints were percent diameter stenosis,binary restenosis rate,major adverse cardiac events (a composite of cardiac death,non-fatal myocardial infarction,and target vessel revascularization),and late-acquired incomplete stent apposition.Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs.(0.10±0.46) mm,P=0.001).Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs.(17.6±14.0)%,P <0.001).In-segment analysis showed similar findings.There were no significant differences in binary restenosis rate,major adverse cardiac events,and late-acquired incomplete stent apposition.Conclusions Compared to sirolimus-eluting stents,the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction.Although there was no significant difference in 1-year clinical outcomes,the clinical implication of increased late lumen loss should be further studied.

  9. A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction

    Chao Li; Dayi Hu; Xubo Shi; Li Li; Jingang Yang; Li Song; Changsheng Ma

    2015-01-01

    Background:Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods:This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction (eGFR ≥ 90 ml·min-1·1.73 m-2),mild RI (60 ml·min-1· 1.73 m-2 < eGFR < 90 ml·min-1· 1.73 m2) and moderate or severe RI (eGFR < 60 ml·min-1· 1.73 m2).The association between RI and inhospital and 6-year mortality of was evaluated.Results:Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years.Two hundred and eighty patients (39.0%) had RI,in which 61 patients (8.5%) reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality (1.4% vs.5.9% vs.22.9%,P < 0.001),6-year all-cause mortality (9.5% vs.19.8 vs.45.2%,P < 0.001) and 6-year cardiac mortality (2.9% vs.12.2% vs.23.8%,P < 0.001) were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an

  10. Is coding for myocardial infarction more accurate now that coding descriptions have been clarified to distinguish ST-elevation myocardial infarction from non-ST elevation myocardial infarction?

    Steinberg, Benjamin A; French, William J; Peterson, Eric; Frederick, Paul D; Cannon, Christopher P

    2008-09-01

    Outcomes are typically graded on the basis of diagnoses coded according to the International Classification of Diseases, Ninth Revision (ICD-9). To facilitate performance measurement, the ICD-9 codes for acute myocardial infarction changed in October 2005 to completely separate non-ST elevation myocardial infarction (NSTEMI; code 410.71) and ST elevation myocardial infarction (STEMI; all other codes 410.x), yet it is unclear whether these changes have been implemented by coders. Patients in the National Registry of Myocardial Infarction (NRMI), version 5, were categorized in 2 ways: by electrocardiographic (ECG) findings and ICD-9 codes. Agreement between ECG findings and ICD-9 codes for type of myocardial infarction (STEMI or NSTEMI) was assessed before and after ICD-9 revision. Mortality rates were measured in a subgroup of patients discharged without transfer after the coding change. There were 102,679 hospitalizations before October 2005 and 63,012 hospitalizations after the coding change, among which the mean age was 66.7 years. Previously, 81% of NSTEMIs (by ECG diagnosis) were coded ICD-9 410.71; after the reclassification of code 410.71 to reflect NSTEMI, 82% of NSTEMIs were coded 410.71 (p <0.001). Overall, the correlation of ECG diagnosis with ICD-9 code improved only slightly after the coding change. In conclusion, despite more distinctly separated definitions of STEMI and NSTEMI in the new ICD-9 coding system as of October 2005, there appears to be little change in coding, which may reflect a lack of awareness of this substantial change in classification. PMID:18721504

  11. Utilization of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction in a tertiary referral medical center in a developing country.

    Abdallah, Mouhamad; Karrowni, Wassef; Dakik, Habib A

    2007-01-01

    We analyze the patterns of utilization of glycoprotein (GP) IIb/IIIa inhibitors in patients with non-ST-elevation myocardial infarction (NSTEMI) in a tertiary medical center in a developing country and we compare it to data from the national registry of myocardial infarction 4 (NRMI 4) in the USA. GP IIb/IIIa inhibitors were used in 28% of patients. The significant multivariate predictors of GP IIb/IIIa inhibitors utilization were Age or =4 (p=0.002), and the absence of congestive heart failure (p=0.01) or prior infarction (p=0.04). Our results show striking similarity to what has been reported by the NRMI 4 registry, in terms of the overall underutilization of GP IIb/IIIa inhibitors in NSTEMI patients, and particularly in elderly patients and women. These findings underscore the importance of initiating a worldwide campaign to educate physicians about the pivotal role of GP IIb/IIIa inhibitors in the management of patients with NSTEMI. PMID:16581145

  12. Differentiating ST elevation myocardial infarction and nonischemic causes of ST elevation by analyzing the presenting electrocardiogram

    Jayroe, Jason B; Spodick, David H; Nikus, Kjell; Madias, John; Fiol, Miguel; De Luna, Antoni Bayés; Goldwasser, Diego; Clemmensen, Peter; Fu, Yuling; Gorgels, Anton P; Sclarovsky, Samuel; Kligfield, Paul D; Wagner, Galen S; Maynard, Charles; Birnbaum, Yochai

    2008-01-01

    Guidelines recommend that patients with suggestive symptoms of myocardial ischemia and ST-segment elevation (STE) in > or =2 adjacent electrocardiographic leads should receive immediate reperfusion therapy. Novel strategies aimed to reduce door-to-balloon time, such as prehospital wireless...... electrocardiographic transmission, may be dependent on the interpretation accuracy of the electrocardiogram (ECG) readers. We assessed the ability of experienced electrocardiographers to differentiate among STE, acute STE myocardial infarction (STEMI), and nonischemic STE (NISTE). A total of 116 consecutive ECGs...... electrocardiographers in reading ECGs with STE and differentiating STEMI with need for PPCI from NISTE. There is a need to revise our current electrocardiographic criteria for differentiating STEMI from NISTE....

  13. 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...

  14. Safety and effectiveness of the Genous™ endothelial progenitor cell-capture stent in the first year following ST-elevation acute myocardial infarction: A single center experience and review of the literature

    Purpose: The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. Methods and Materials: All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12 months. Results: In the cohort of 109 patients (73.4% male, 59 ± 12 years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00 mm (2.50–4.00) and median length of 15 mm (9–33). Cumulative MACEs were 2.8% at one month and 6.4% at 12 months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12 months, 33.9% of patients were not on dual antiplatelet therapy. Conclusions: GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. Summary: We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction

  15. Safety and effectiveness of the Genous™ endothelial progenitor cell-capture stent in the first year following ST-elevation acute myocardial infarction: A single center experience and review of the literature

    Pereira-da-Silva, Tiago, E-mail: tiagopsilva@sapo.pt; Bernardes, Luís; Cacela, Duarte; Fiarresga, António; Sousa, Lídia; Patrício, Lino; Ferreira, Rui Cruz

    2013-11-15

    Purpose: The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. Methods and Materials: All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12 months. Results: In the cohort of 109 patients (73.4% male, 59 ± 12 years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00 mm (2.50–4.00) and median length of 15 mm (9–33). Cumulative MACEs were 2.8% at one month and 6.4% at 12 months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12 months, 33.9% of patients were not on dual antiplatelet therapy. Conclusions: GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. Summary: We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction.

  16. Machine Learning Methods for Mortality Prediction in Patients with ST Elevation Myocardial Infarction

    Vomlel, Jiří; Kružík, H.; Tůma, P.; Přeček, J.; Hutyra, M.

    Prague : Faculty of Management, University of Economics, Prague, 2012 - (Kroupa, T.; Vejnarová, J.), s. 204-213 ISBN 978-80-245-1885-5. [The Ninth Workshop on Uncertainty Processing. Mariánské Lázně (CZ), 12.09.2012-15.09.2012] R&D Projects: GA ČR GA201/08/0539 Institutional support: RVO:67985556 Keywords : Machine Learning * Acute Myocardial Infarction * Mortality Prediction Subject RIV: JD - Computer Applications, Robotics http://library.utia.cas.cz/separaty/2012/MTR/vomlel-machine learning methods for mortality prediction in patients with st elevation myocardial infarction.pdf

  17. Are patients with non-ST elevation myocardial infarction undertreated?

    Gosselink AT Marcel

    2007-03-01

    Full Text Available Abstract Background The worse prognosis in patients without ST-elevation (non-STEMI as compared to ST-elevation myocardial infarction (STEMI, may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population. Methods Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI. Results A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation were independent and significant predictors of long-term mortality. Conclusion In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.

  18. Typical chest pain and precordial leads ST-elevation in patients with pacemakers - are we always looking at an acute myocardial infarction?

    Ostojić Marina M.; Potpara Tatjana S.; Polovina Marija M.; Ostojić Mladen M.; Ostojić Miodrag C.

    2015-01-01

    Introduction. Electrocardiographic (ECG) diagnosis of acute myocardial infarction (AMI) in patients with paced rhythm is difficult. Sgarbossa’s criteria represent helpful diagnostic ECG tool. Case report. A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarboss...

  19. Prehospital Nitroglycerin Safety in Inferior ST Elevation Myocardial Infarction.

    Robichaud, Laurie; Ross, Dave; Proulx, Marie-Hélène; Légaré, Sébastien; Vacon, Charlene; Xue, Xiaoqing; Segal, Eli

    2016-01-01

    Patients with inferior ST elevation myocardial infarction (STEMI), associated with right ventricular infarction, are thought to be at higher risk of developing hypotension when administered nitroglycerin (NTG). However, current basic life support (BLS) protocols do not differentiate location of STEMI prior to NTG administration. We sought to determine if NTG administration is more likely to be associated with hypotension (systolic blood pressure vs. 8.9%, p = 0.73. A drop in systolic blood pressure ≥ 30 mmHg post NTG occurred in 23.4% of inferior STEMIs and 23.9% of non-inferior STEMIs, p = 0.87. Interrater agreement for chart review of the primary outcome was excellent (κ = 0.94). NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories. Computer interpretation of inferior STEMI cannot be used as the sole predictor for patients who may be at higher risk for hypotension following NTG administration. PMID:26024432

  20. The influence of residential distance on time to treatment in ST-elevation myocardial infarction patients

    Postma, S.; Dambrink, J.H.E.; de Boer, M.J.; Gosselink, A. T. M.; Ottervanger, J.P.; Koopmans, P. C.; ten Berg, J M; Suryapranata, H; van ’t Hof, A.W.J.

    2014-01-01

    Aims To evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI). Methods STEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI ‘spoke' centre (‘spoke’ patients) and 2725 patients (66 %) were referred via field triage in the ambu...

  1. The Influence of Autologous Bone Marrow Stem Cell Transplantation on Matrix Metalloproteinases in Patients Treated for Acute ST-Elevation Myocardial Infarction

    Eline Bredal Furenes

    2014-01-01

    Full Text Available Background. Matrix metalloproteinase-9 (MMP-9, regulated by tissue inhibitor of metalloproteinase-9 (TIMP-1 and the extracellular matrix metalloproteinase inducer (EMMPRIN, contributes to plaque instability. Autologous stem cells from bone marrow (mBMC treatment are suggested to reduce myocardial damage; however, limited data exists on the influence of mBMC on MMPs. Aim. We investigated the influence of mBMC on circulating levels of MMP-9, TIMP-1, and EMMPRIN at different time points in patients included in the randomized Autologous Stem-Cell Transplantation in Acute Myocardial Infarction (ASTAMI trial (n=100. Gene expression analyses were additionally performed. Results. After 2-3 weeks we observed a more pronounced increase in MMP-9 levels in the mBMC group, compared to controls (P=0.030, whereas EMMPRIN levels were reduced from baseline to 2-3 weeks and 3 months in both groups (P<0.0001. Gene expression of both MMP-9 and EMMPRIN was reduced from baseline to 3 months. MMP-9 and EMMPRIN were significantly correlated to myocardial injury (CK: P=0.005 and P<0.001, resp. and infarct size (SPECT: P=0.018 and P=0.008, resp.. Conclusion. The results indicate that the regulation of metalloproteinases is important during AMI, however, limited influenced by mBMC.

  2. Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps)

    AlHabib, Khalid F.; Sulaiman, Kadhim; Al Suwaidi, Jassim; Almahmeed, Wael; Alsheikh-Ali, Alawi A.; Amin, Haitham; Al Jarallah, Mohammed; Alfaleh, Hussam F.; Panduranga, Prashanth; Hersi, Ahmad; Kashour, Tarek; Al Aseri, Zohair; Ullah, Anhar; Altaradi, Hani B.; Nur Asfina, Kazi; Welsh, Robert C.; Yusuf, Salim

    2016-01-01

    Background Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015. Results We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes. Conclusion Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities. PMID:26807577

  3. Feasibility and safety of prehospital administration of bivalirudin in patients with ST-elevation myocardial infarction

    Sejersten, Maria; Nielsen, Søren Loumann; Engstrøm, Thomas;

    2009-01-01

    of this preliminary study was to describe the feasibility and safety of a switch from prehospital administration of unfractionated heparin to bivalirudin in ST-elevation acute myocardial infarction (STEMI) patients referred for primary percutaneous coronary intervention. Patients with STEMI treated...... GPI. A total of 102 patients (59%) receiving bivalirudin and 72 receiving heparin were followed during hospitalization. The baseline characteristics and prehospital treatment times were comparable between the 2 groups. The thrombolysis in myocardial infarction flow before and after primary......The selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but to significantly reduce the risk of bleeding complications in patients with acute coronary syndromes. The aim...

  4. Typical chest pain and precordial leads ST-elevation in patients with pacemakers - are we always looking at an acute myocardial infarction?

    Ostojić Marina M.

    2015-01-01

    Full Text Available Introduction. Electrocardiographic (ECG diagnosis of acute myocardial infarction (AMI in patients with paced rhythm is difficult. Sgarbossa’s criteria represent helpful diagnostic ECG tool. Case report. A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarbossa’s criterion for AMI in patients with dual pacemakers (ST-segment elevation of ≥ 5 mm in the presence of the negative QRS complex. The patient was sent to catheterization lab where coronary angiogram reveled normal findings. ECG changes occurred due to pericardial reaction following two interventions: pacemaker implantation a month before and radiofrequency catheter ablation of AV junction two weeks before presentation in Emergency Department. Conclusion. This case report points out to the limitations of proposed criteria that aid in the recognition of AMI in patients with underlying paced rhythm and possible cause(s of transient electrocardiographic abnormalities.

  5. The Time Profile of Pentraxin 3 in Patients with Acute ST-Elevation Myocardial Infarction and Stable Angina Pectoris Undergoing Percutaneous Coronary Intervention

    Ragnhild Helseth

    2014-01-01

    Full Text Available Background. High levels of Pentraxin 3 (PTX3 are reported in acute myocardial infarction (AMI. Aim. To investigate circulating levels and gene expression of PTX3 in patients with AMI and stable angina pectoris (AP undergoing PCI. Methods. Ten patients with AP and 20 patients with AMI were included. Blood samples were drawn before PCI in the AP group and after 3 and 12 hours and days 1, 3, 5, 7, and 14 in both groups. Results. Circulating PTX3 levels were higher in AMI compared to AP at 3 and 12 hours (P<0.001 and P=0.003. Within the AMI group, reduction from 3 hours to all later time points was observed (all P≤0.001. Within the AP group, increase from baseline to 3 hours (P=0.022, followed by reductions thereafter (all P<0.05, was observed. PTX3 mRNA increased in the AMI group from 3 hours to days 7 and 14 in a relative manner of 62% and 73%, while a relative reduction from baseline to 3 and 12 hours of 29% and 37% was seen in the AP group. Conclusion. High circulating PTX3 levels shortly after PCI in AMI indicate that AMI itself influences PTX3 levels. PTX3 mRNA might be in response to fluctuations in circulating levels.

  6. B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocardial infarction, single-vessel disease, and complete revascularization: follow-up study.

    Manola, Sime

    2012-01-31

    AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg\\/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg\\/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.

  7. Should primary percutaneous coronary intervention be always the first option for patients with an ST elevation myocardial infarction?

    LI Jian-ping; HUO Yong

    2010-01-01

    @@ Acute ST elevation myocardial infarction, caused by the acute occlusion of a coronary artery, is a life-threating emergency. Reperfusion therapy, namely, using the mechanical or chemical method to open the infarction related artery (IRA), has become the key treatment for such patients. As the duration of a coronary occlusion is the main determinant of final infarct size, and the latter determines the outcome of acute myocardial infarction (AMI) patients, the time issue has long been the most important topic in reperfusion therapy. Besides the time issue, several other factors must be considered: the efficiency of the reperfusion therapy, and the availability of the reperfusion therapy.

  8. Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    Tuseth Vegard

    2010-09-01

    Full Text Available Abstract Background In the setting of primary percutaneous coronary intervention, patients with a chronic total occlusion in a non-infarct related artery were recently identified as a high-risk subgroup. It is unclear whether ST-elevation myocardial infarction patients with a chronic total occlusion in a non-infarct related artery should undergo additional percutaneous coronary intervention of the chronic total occlusion on top of optimal medical therapy shortly after primary percutaneous coronary intervention. Possible beneficial effects include reduction in adverse left ventricular remodeling and preservation of global left ventricular function and improved clinical outcome during future coronary events. Methods/Design The Evaluating Xience V and left ventricular function in Percutaneous coronary intervention on occLusiOns afteR ST-Elevation myocardial infarction (EXPLORE trial is a randomized, prospective, multicenter, two-arm trial with blinded evaluation of endpoints. Three hundred patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction with a chronic total occlusion in a non-infarct related artery are randomized to either elective percutaneous coronary intervention of the chronic total occlusion within seven days or standard medical treatment. When assigned to the invasive arm, an everolimus-eluting coronary stent is used. Primary endpoints are left ventricular ejection fraction and left ventricular end-diastolic volume assessed by cardiac Magnetic Resonance Imaging at four months. Clinical follow-up will continue until five years. Discussion The ongoing EXPLORE trial is the first randomized clinical trial powered to investigate whether recanalization of a chronic total occlusion in a non-infarct related artery after primary percutaneous coronary intervention for ST-elevation myocardial infarction results in a better preserved residual left ventricular ejection fraction, reduced end-diastolic volume

  9. Combination of Evidence-Based Medical Therapy in Acute Phase of Non-ST-Elevation Myocardial Infarction and Reduction of In-Hospital Mortality

    Monhart, Z.; Grünfeldová, H.; Zvárová, Jana; Janský, P.

    2010-01-01

    Roč. 122, č. 2 (2010), e244. ISSN 0009-7322. [World Congress of Cardiology . 16.06.2010-19.06.2010, Beijing] Institutional research plan: CEZ:AV0Z10300504 Keywords : cardioloy * myocardial infarction * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  10. Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction

    Khan, Jamal N; Razvi, Naveed; Nazir, Sheraz A; Singh, Anvesha; Masca, Nicholas GD; Gershlick, Anthony H.; Squire, Iain; McCann, Gerry P.

    2014-01-01

    Background Microvascular obstruction (MVO) describes suboptimal tissue perfusion despite restoration of infarct-related artery flow. There are scarce data on Infarct Size (IS) and MVO in relation to the mode and timing of reperfusion. We sought to characterise the prevalence and extent of microvascular injury and IS using Cardiovascular magnetic resonance (CMR), in relation to the mode of reperfusion following acute ST-Elevation Myocardial Infarction (STEMI). Methods CMR infarct characteristi...

  11. [Characteristics and management of ST-elevation myocardial infarction in France: Regional variations in 2010].

    Sokoloff, A; Lefèvre, G; Teixeira, N; Puymirat, E; Beygui, F; Vanzetto, G; Richard, P; Khalife, K; Blanchard, D; Gilard, M; Coste, P; Farah, B; Elbaz, M; Leclercq, F; Ferrari, E; Bonnet, J-L; Meyer, P; Belle, L; Funck, F; Motreff, P; Virot, P; Geugniaud, P-Y; Ferrières, J; Simon, T; Danchin, N

    2015-12-01

    Data on regional variations in the characteristics, management and early outcome of patients admitted with ST-elevation myocardial infarction (STEMI) in France are limited. We used data from the FAST-MI 2010 registry to determine whether regional specificities existed, dividing the French territory into 6 larger geographical regions. Variations in the patients' characteristics were found, partly related to regional variations in demography. Acute reperfusion strategy showed more use of primary percutaneous coronary intervention in the greater Paris area, compared to other regions, which would be expected owing to geography and local availability of catheterization laboratories. Overall, however, in-hospital management showed more similarities than differences across regions. Complications, and in particular in-hospital mortality, did not differ significantly among regions. PMID:26547524

  12. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor

  13. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    Ribeiro, Daniel Rios Pinto; Ramos, Adriane Monserrat; Vieira, Pedro Lima; Menti, Eduardo; Bordin, Odemir Luiz Jr.; Souza, Priscilla Azambuja Lopes de; Quadros, Alexandre Schaan de; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia - Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-07-15

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor

  14. Stem cell mobilization induced by subcutaneous granulocyte-colony stimulating factor to improve cardiac regeneration after acute ST-elevation myocardial infarction: result of the double-blind, randomized, placebo-controlled stem cells in myocardial infarction (STEMMI) trial

    Ripa, Rasmus Sejersten; Jørgensen, Erik; Wang, Yongzhong;

    2006-01-01

    BACKGROUND: Phase 1 clinical trials of granulocyte-colony stimulating factor (G-CSF) treatment after myocardial infarction have indicated that G-CSF treatment is safe and may improve left ventricular function. This randomized, double-blind, placebo-controlled trial aimed to assess the efficacy of......: Bone marrow stem cell mobilization with subcutaneous G-CSF is safe but did not lead to further improvement in ventricular function after acute myocardial infarction compared with the recovery observed in the placebo group....

  15. Platelet indices and platelet-to-lymphocyte ratio predict coronary chronic total occlusion in patients with acute ST-elevation myocardial infarction

    Hadadi Laszlo

    2015-12-01

    Full Text Available Coronary chronic total occlusion (CTO is caused by organized thrombi or atherosclerotic plaque progression. The presence of a CTO is an independent predictor of mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI. Platelets have a crucial role in the pathophysiology of atherosclerosis. The aim of this retrospective study was to investigate platelet indices as predictors of CTO in patients with STEMI treated with primary percutaneous coronary intervention (pPCI. A total number of 334 patients admitted for STEMI between January 2011 and December 2013 were included and divided in two groups based on the presence of CTO (48 patients in CTO+ group, 286 patients in CTO-group. Platelet count, mean platelet volume (MPV, platelet distribution width (PDW, platelet-large cell ratio (P-LCR, lymphocyte and neutrophil count determined on admission were analyzed. MPV was larger in patients with CTO compared with patients without CTO (p=0.02, as were PDW (p=0.03 and P-LCR (p=0.01. Platelet-to-lymphocyte ratio (PLT/LYM was lower in patients with CTO: 105.2 (75.86-159.1 compared to 137 (97-188.1, p<0.01. Receiver-operator characteristic curve analysis identified an area under the curve of 0.61 (95%CI=0.57-0.67, p< 0.01 for PLT/LYM in predicting the presence of a CTO, with a cut-off value at 97.73. Lower values than this were independent predictors of a CTO in multivariate logistic regression analysis, with an Odds Ratio of 2.2 (95%CI=1.15-4.20, p=0.02. Our results support the use of platelet indices and PLT/LYM as predictors of CTO in patients presenting with STEMI.

  16. In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    Noohi, Fereydoon; Hashemi, Isa; Sanati, Hamid Reza; Peighambari, Mohammad Mehdi; Kiavar, Majid; Maadani, Mohsen; Bassiri, Hossein Ali; Zahedmehr, Ali; Shakerian, Farshad; Firouzi, Ata; Kiani, Reza; Abdi, Seifollah

    2016-01-01

    BACKGROUND Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in-hospital and 6-month outcomes of primary PCI in elderly patients (≥ 75 years) with STEMI. METHODS A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0% were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged ≥ 75 years, [hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001]. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability. PMID:27114734

  17. Factors Associated with Delay in Thrombolytic Therapy in Patients with ST-Elevation Myocardial Infarction

    Shahrooz Yazdani

    2012-06-01

    Full Text Available Background: Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Methods: Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was recorded. Medical history and socio-demographic characteristics of the patients treated within two hours after the onset of symptoms and patients treated after two hours from the onset of symptoms were compared, and the odds ratios were calculated using logistic regression. Results: The mean age of the patients was 61.2 (SD = 11.1 years, and 76% of the patients were male. The median time between the onset of symptoms and treatment was 158 (SD = 30.4 minutes. Mean for decision time was 61 (SD = 19, which was responsible for 83% of the entire treatment delay. The mean transportation time was 34 (SD = 12 minutes, and the median door-to-needle time was 44 minutes. Odds ratio for history of diabetes mellitus was 1.90 (95% CI: 1.26-2.87, for hypertension was 1.55 (95% CI: 1.08-2.23, and for prior coronary heart disease was 1.47 (95% CI: 1.17-1.84. Conclusion: The most important factor associated with delay in treatment was decision time. Improving emergency medical services dispatch time, obtaining pre-hospital electrocardiograms for early diagnosis, and pre-hospital initiation of thrombolytic therapy may reduce the delay time.

  18. Gender disparity in early death after ST-elevation myocardial infarction

    ZHANG Bo; ZHANG Wei; HUANG Rong-chong; ZHANG Yan; LIU Jun; ZHENG Zheng-guo; JIANG Da-ming

    2013-01-01

    Background Females with acute myocardial infarction (AMI) have a higher risk of adverse outcomes because of receiving less evidence-based medical care.Our aim was to investigate the gender disparity in early death after ST-elevation myocardial infarction (STEMI) in the current era.Methods A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed.We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset.Results In the emergency reperfusion group (n=754),in-hospital mortality occurred in 4.2% of the males and 11.2% of the females (P=0.001).In the non-emergency reperfusion group (n=675),in-hospital mortality occurred in 13.0% of the males and 22.9% of the females (P=0.001).Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization (OR=1.691,P=0.007).After controlling for patients who died within 24 hr after admission,female sex was no longer an independent risk factor (OR=1.409,P=0.259).Conclusion Female sex was an independent risk factor for in-hospital mortality of STEMI patients,which is explained by an excess of very early deaths.

  19. Predictors and importance of prolonged hospital stay after primary PCI for ST elevation myocardial infarction

    Schellings, D.A.; Ottervanger, J.P.; Hof, A.W. van 't; Boer, M.J. de; Dambrink, J.H.; Hoorntje, J.C.A.; Gosselink, A.T.M.; Suryapranata, H.

    2011-01-01

    OBJECTIVE: Although most patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention (PCI) have a good prognosis and can be discharged from hospital very soon, some patients must be admitted longer. We performed the current analysis to assess predictors and

  20. A single dose of erythropoietin in ST-elevation myocardial infarction

    Voors, Adriaan A.; Belonje, Anne M. S.; Zijlstra, Felix; Hillege, Hans L.; Anker, Stefan D.; Slart, Riemer H. J. A.; Tio, Rene A.; Van't Hof, Arnoud; Jukema, J. Wouter; Peels, Hans Otto J.; Henriques, Jose P. S.; ten Berg, Jurrien M.; Vos, Jeroen; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2010-01-01

    Cardioprotective effects of erythropoietin (EPO) have been shown in experimental and smaller clinical studies. We performed a prospective, multicentre, randomized trial to assess the effects of a single high dose of EPO after primary coronary intervention (PCI) for an ST-elevation myocardial infarct

  1. Primary percutaneous coronary intervention as a national Danish reperfusion strategy of ST-elevation myocardial infarction

    Sørensen, Jacob Thorsted; Steengaard, Carsten; Holmvang, Lene;

    2013-01-01

    The use of primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) requires optimal systems-of-care and logistics in order to enable rapid treatment of all patients. In Denmark, this has been achieved through prehospital...

  2. Activation of catheterization lab in ambulance: new direction in ST-elevation myocardial infarction care

    YAN Hong-bing

    2011-01-01

    @@ Primary percutaneous coronary intervention (PPCI) is the cornerstone of treatment to reduce infarct size and improve outcomes in patients with ST-elevation myocardial infarction (STEMI).1 The optimal site for initiation of reperfusion strategies is the patient's home or place where the infarction occurs.

  3. Mechanical Chest Compressions in Prolonged Cardiac Arrest due to ST Elevation Myocardial Infarction Can Cause Myocardial Contusion.

    Stechovsky, Cyril; Hajek, Petr; Cipro, Simon; Veselka, Josef

    2016-09-01

    Acute coronary syndrome is a common cause of sudden cardiac death. We present a case report of a 60-year-old man without a history of coronary artery disease who presented with ST-elevation myocardial infarction. During transportation to the hospital, he developed ventricular fibrillation (VF) and later pulseless electrical activity. Chest compressions with LUCAS 2 (Medtronic, Minneapolis, MN) automated mechanical compression-decompression device were initiated. Coronary angiography showed total occlusion of the left main coronary artery and primary percutaneous coronary intervention (PCI) was performed. After the PCI, his heart started to generate effective contractions and LUCAS could be discontinued. Return of spontaneous circulation was achieved after 90 minutes of cardiac arrest. The patient died of cardiogenic shock 11 hours later. An autopsy revealed a transmural anterolateral myocardial infarction but also massive subepicardial hemorrhage and interstitial edema and hemorrhages on histologic samples from regions of the myocardium outside the infarction itself and also from the right ventricle. These lesions were concluded to be a myocardial contusion. The true incidence of myocardial contusion as a consequence of mechanical chest compressions is not known. We speculate that severe myocardial contusion might have influenced outcome of our patient. PMID:27574387

  4. Brugada ECG Sign & Chest Pain Mimicking ST Elevation Myocardial Infarction

    Omar Mousa

    2013-11-01

    Full Text Available Background: Management of patients with the brugada ECG sign who have no previous history of syncope is still negotiable. We present a case of a 57 year-old Caucasian lady who presented to the emergency department with substernal chest pain. Results: Her past medical history showed that she had two previous episodes of lightheadedness, but no syncope. She had a family history of sudden death secondary to unknown cause in her aunt at the age of 61. Physical exam was unremarkable except for diaphoresis. Electrocardiography (ECG showed ST elevation in the right precordial leads (V1-V2 with T inversion, mimicking a STEMI. Emergent cardiac catheterization revealed normal coronary arteries. Echocardiogram was normal. Again, interpretation of ECG revealed a Brugada type 1 pattern, characterized by coved-type, gradually descending ST-T segment, elevated J point of more than 2 mm and T wave inversion. Electrophysiological (EPS testing with a Sodium channel blocker challenge showed a persistent Brugada type 1 pattern with non inducible ventricular tachycardia. This patient had Brugada type 1 ECG pattern with no previous history of syncope (asymptomatic. Thus she was considered at low risk of developing a serious arrhythmogenic event in the future. Conclusion: A history of syncope remains the best available predictor for arrhythmogenic events. EPS testing in such patients, to stratify the risk and predict for any future events, is still controversial. It is still unjustified to place an implantable cardioverter-defibrillator in asymptomatic non-inducible individuals with the Brugada pattern. These patients should follow up closely with a cardiologist and be aware of the risk of possible triggers of ventricular arrhythmias.

  5. 27. The impact of introduction of code-stemi program on clinical outcomes of acute st-elevation myocardial infarction (stemi patients undergoing primary pci: Single center study in Saudi Arabia

    A. ALYAHYA

    2016-07-01

    Full Text Available This study was conducted to evaluate the effect of direct Emergency Department activation of the Catheterization Lab on door to balloon (D2B time and outcomes of acute ST-elevation myocardial infarction (STEMI patients in King Khalid University Hospital (KKUH. Establishing dedicated comprehensive STEMI programs aiming at reducing door to balloon time will impact favourably the outcomes of patients presenting with acute STEMI. This was a retrospective cohort study that involved 100 patients in KKUH who presented with acute STEMI and underwent primary percutaneous intervention (PPCI, between June 2010 and January 2015. The cohort was divided into two groups, the first group consisted of 50 patients who were treated before establishing the Code-STEMI protocol, whereas the second group were 50 patients who were treated according to the protocol, which was implemented in June 2013. Code-STEMI program is a comprehensive program that includes direct activation of the cath lab team using a single call system, data monitoring and feedback, and standardized order forms. The mean age in both groups was 54 ± 12 years and 86% (43 and 94% (47 of the patients in the two groups were males, respectively. 90% (90 of patients in both groups had one or more comorbidities.Code-STEMI group had a significantly lower D2BT with 70% of patients treated within the recommended 90 minutes (median = 76.5 min, IQR: 63–90 min compared to only 26% of pre code-STEMI patients (median = 107 min, IQR: 74–149 min In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction, (8% vs. 0%, p = 0.043. In addition, the number of patients with more than one in-hospital complications was also reduced by 20%.Implementation of direct ER-Catheterization lab activation protocol was associated with a significant reduction in D2B time, and an overall improvement of in-hospital outcomes.

  6. Strategies to improve outcome in patients with ST elevation myocardial infarction treated with primary PCI

    Tödt, Tim

    2012-01-01

    Background: ST elevation myocardial infarction (STEMI) caused by a ruptured atherosclerotic plaque with overlying thrombosis leads to ischemia and progressively to the death of the myocardial cells supplied by the affected coronary artery. Rapid reperfusion with primary Percutaneous Coronary Intervention (PCI) in an experienced centre is the preferred therapy for these patients. The aim of the research program on which this thesis is based was to study the effect of antiplatelet therapy with ...

  7. The effect of metformin on cardiovascular risk profile in patients without diabetes presenting with acute myocardial infarction: data from the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) trial

    Lexis, Chris P H; van der Horst-Schrivers, Anouk N A; Lipsic, Erik; Valente, Mattia A E; Muller Kobold, Anneke C; de Boer, Rudolf A; van Veldhuisen, Dirk J; van der Harst, Pim; van der Horst, Iwan C C

    2015-01-01

    Objective In patients with diabetes mellitus, metformin treatment is associated with reduced mortality and attenuation of cardiovascular risk. As a subanalysis of the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) study, we evaluated whether metformin treatment in patients with ST-segment elevation myocardial infarction (STEMI) without diabetes improves the cardiovascular risk profile. Methods A total of 379 patients, without known diabetes, presenting with STEMI were randomly allocated to receive metformin 500 mg twice daily or placebo for 4 months. Results After 4 months, the cardiovascular risk profile of patients receiving metformin (n=172) was improved compared with placebo (n=174); glycated hemoglobin (5.83% (95% CI 5.79% to 5.87%) vs 5.89% (95% CI 5.85% to 5.92%); 40.2 mmol/mol (95% CI 39.8 to 40.6) vs 40.9 mmol/mol (40.4 to 41.2), p=0.049); total cholesterol (3.85 mmol/L (95% CI 3.73 to 3.97) vs 4.02 mmol/L (95% CI 3.90 to 4.14), p=0.045); low-density lipoprotein cholesterol (2.10 mmol/L (95% CI 1.99 to 2.20) vs 2.3 mmol/L (95% CI 2.20 to 2.40), p=0.007); body weight (83.8 kg (95% CI 83.0 to 84.7) vs 85.2 kg (95% CI 84.4 to 86.1), p=0.024); body mass index (26.8 kg/m2 (95% CI 26.5 to 27.0) vs 27.2 kg/m2 (95% CI 27.0 to 27.5), p=0.014). Levels of fasting glucose, postchallenge glucose, insulin, high-density lipoprotein cholesterol, and blood pressure were similar in both groups. Conclusions Among patients with STEMI without diabetes, treatment with metformin for 4 months resulted in a modest improvement of the cardiovascular risk profile compared with placebo. Trial register number NCT01217307. PMID:26688733

  8. ST Elevation Myocardial Infarction Due to Carbon Monoxide Poisoning

    2011-01-01

    Carbon monoxide is formed as a result of combustion of any carbon compound and can lead to hypoxia in many organs including the brain and the heart. Carbon monoxide poisoning in the United States is the leading cause of the fatal poisonings. In this study we present a case with no-known accompanying disease in the light of literature where myocardial infarction was developed as a result of carbon monoxide poisoning.

  9. ST Elevation Myocardial Infarction Due to Carbon Monoxide Poisoning

    Hayriye Gonullu

    2011-08-01

    Full Text Available Carbon monoxide is formed as a result of combustion of any carbon compound and can lead to hypoxia in many organs including the brain and the heart. Carbon monoxide poisoning in the United States is the leading cause of the fatal poisonings. In this study we present a case with no-known accompanying disease in the light of literature where myocardial infarction was developed as a result of carbon monoxide poisoning.

  10. Impact of thrombus aspiration during ST-Elevation Myocardial Infarction

    Olivecrona, Göran K; Lagerqvist, Bo; Fröbert, Ole;

    2016-01-01

    analysed the quadruple composite endpoint of cardiovascular death, cardiogenic shock, rehospitalisation for myocardial infarction, or new hospitalisation for heart failure. Furthermore, an extended net-benefit composite endpoint including stent thrombosis, target vessel revascularization or stroke within......-benefit composite endpoint in 12.0 % (436) vs. 13.2 % (479) (HR, 0.90; 95 % CI; 0.79 - 1.03, P = 0.12). Stroke within 30 days occurred in 0.7 % (27) vs. 0.7 % (24) (HR, 0.89; 95 % CI; 0.51-1.54, P = 0.68). CONCLUSIONS: A large and an extended composite endpoint analysis from the TASTE trial did not demonstrate any...... clinical benefit of routine thrombus aspiration during PCI in patients with STEMI. There was no evidence of an increased risk of stroke with thrombus aspiration....

  11. Influence of preinfarction angina pectoris on patients with primary ST elevation acute myocardial in-farction%梗死前心绞痛对初发ST段抬高的急性心肌梗死的影响

    夏树涛; 赵施竹

    2014-01-01

    Objective:To observe influence of preinfarction angina pectoris (PAP)on primary ST elevation acute my-ocardial infarction (AMI).Methods:A total of 280 patients with primary ST elevation AMI received coronary angi-ography (CAG)within 24h after symptoms occurred,and they received ECG and QRS scoring on hospitalization. According to PAP or not,patients were divided into PAP group (n=102)and non PAP group (n=178).According to attack to CAG time,patients were divided into early stage group (<2h,n=60),mid-term group (2~6h,n=150)and advanced stage group (6~24h,n=70).Results:QRS score of PAP patients [(2.4±2.4)scores]was sig-nificantly lower than that of non PAP patients [(3.2±3.0)scores],percentage of high QRS score in PAP group (8.0%)was also significantly lower than that of non PAP group (18.4%),P<0.05 both.In early stage group, there was no significant difference in QRS score [(2.0±1.8)scores vs.(2.6±2.8)scores,P=0.35]between PAP and non PAP patients;The QRS score of PAP patients [(2.0±2.1)scores]was significantly lower than that of non PAP group [(3.0 ±3.0)scores]in mid-term group,P=0.03;in advanced stage group,the QRS score all signifi-cantly rose in PAP patients [(4.1 ±3.3)scores]and non PAP patients [(5.5±2.9)scores],P=0.13;QRS score gradually rose along with onset time prolonged in non PAP group.Conclusion:Preinfarction angina pectoris can de-lay progress of acute myocardial infarction and expand therapeutic window of reperfusion.%目的:观察梗死前心绞痛(PAP)对初发 ST段抬高急性心肌梗死(AMI)进展的影响。方法:280例初发ST段抬高 AMI患者,发病后24h内进行冠脉造影,心电图检查并作 QRS记分。根据有无PAP,患者被分为 PAP (102例)和非PAP组(178例)。根据发病至造影时间患者被分为:早期组(<2h,60例)、中期组(2~6h,150例)和晚期组(6~24h,70例)。结果:伴有PAP患者较无PAP患者 QRS记分显著降低[(2.4±2.4)分比(3.2±3

  12. VALOR PREDICTIVO DE ALGUNOS MODELOS DE ESTRATIFICACIÓN DE RIESGO EN PACIENTES CON INFARTO AGUDO DE MIOCARDIO CON ELEVACIÓN DEL ST / Predictive value of some risk stratification models in patients with acute myocardial infarction with ST elevation

    Osvaldo González Alfonso

    2013-01-01

    this study was to determine the predictive value of three risk stratification models in patients with acute myocardial infarction with ST elevation. Method: A longitudinal study was conducted in 150 patients with this disease, admitted to the cardiology department of Arnaldo Milian Castro Provincial University Hospital in Villa Clara, Cuba, from January 2010 to December 2011. Results: Patients had a mean age of 66.47 years. Males (62% and inferior infarction (57.3% were predominant. All complicated or dead patients were classified as high risk, according to the GRACE registry, and the "C" index for serious complications and in-hospital death had very good predictive ability. In the prognostic index, 57.2% of patients with complications and 46.4% of deaths were high risk, with a "C" index of 0.67 and 0.65, respectively; there was also a poor predictive ability for both events. The ICR scale obtained a "C" index of 0.45 for severe complications and 0.41 for in-hospital mortality, both with very poor predictive ability. Conclusions: The GRACE registry presented very good ability to predict severe complications and in-hospital death, however, the predictive index scale showed poor prognostic ability for both events by failing to properly classify patients with extreme values. The ICR scale presented a "C" index with poor predictive ability for both events.

  13. Pregnancy associated plasma protein A, a novel, quick, and sensitive marker in ST-elevation myocardial infarction

    Iversen, K.K.; Teisner, A.S.; Teisner, B.; Kliem, A.; Thanning, P.; Grande, P.; Clemmensen, P.

    2008-01-01

    acute coronary syndromes earlier than traditionally used biomarkers. Information regarding circulating PAPP-A levels in patients with ST elevation myocardial infarctions (STEMIs) is limited and contradictory. The aim of the present study was to describe the presence and time-related pattern of...... circulating PAPP-A levels in patients with STEMIs. Consecutive patients (n = 354) referred for primary percutaneous intervention because of STEMI were included in the study. Blood samples for the analysis of PAPP-A, creatine kinase-MB (CKMB), and troponin T were drawn at admission and every 6 to 8 hours until...... conclusion, PAPP-A levels are elevated in >90% of patients presenting with STEMIs if measured <6 hours after the onset of symptoms or <2 hours of primary percutaneous coronary intervention. In the early stages of STEMI, PAPP-A seems to be a more sensitive marker of myocardial infarction than CKMB and...

  14. Effect of Metformin Treatment on Lipoprotein Subfractions in Non-Diabetic Patients with Acute Myocardial Infarction: A Glycometabolic Intervention as Adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III Trial.

    Ruben N Eppinga

    Full Text Available Metformin affects low density lipoprotein (LDL and high density (HDL subfractions in the context of impaired glucose tolerance, but its effects in the setting of acute myocardial infarction (MI are unknown. We determined whether metformin administration affects lipoprotein subfractions 4 months after ST-segment elevation MI (STEMI. Second, we assessed associations of lipoprotein subfractions with left ventricular ejection fraction (LVEF and infarct size 4 months after STEMI.371 participants without known diabetes participating in the GIPS-III trial, a placebo controlled, double-blind randomized trial studying the effect of metformin (500 mg bid during 4 months after primary percutaneous coronary intervention for STEMI were included of whom 317 completed follow-up (clinicaltrial.gov Identifier: NCT01217307. Lipoprotein subfractions were measured using nuclear magnetic resonance spectroscopy at presentation, 24 hours and 4 months after STEMI. (Apolipoprotein measures were obtained during acute STEMI and 4 months post-STEMI. LVEF and infarct size were measured by cardiac magnetic resonance imaging.Metformin treatment slightly decreased LDL cholesterol levels (adjusted P = 0.01, whereas apoB remained unchanged. Large LDL particles and LDL size were also decreased after metformin treatment (adjusted P<0.001. After adjustment for covariates, increased small HDL particles at 24 hours after STEMI predicted higher LVEF (P = 0.005. In addition, increased medium-sized VLDL particles at the same time point predicted a smaller infarct size (P<0.001.LDL cholesterol and large LDL particles were decreased during 4 months treatment with metformin started early after MI. Higher small HDL and medium VLDL particle concentrations are associated with favorable LVEF and infarct size.

  15. Effect of Metformin Treatment on Lipoprotein Subfractions in Non-Diabetic Patients with Acute Myocardial Infarction: A Glycometabolic Intervention as Adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) Trial

    Eppinga, Ruben N.; Hartman, Minke H. T.; van Veldhuisen, Dirk J.; Lexis, Chris P. H.; Connelly, Margery A.; Lipsic, Erik; van der Horst, Iwan C. C.; van der Harst, Pim; Dullaart, Robin P. F.

    2016-01-01

    Objective Metformin affects low density lipoprotein (LDL) and high density (HDL) subfractions in the context of impaired glucose tolerance, but its effects in the setting of acute myocardial infarction (MI) are unknown. We determined whether metformin administration affects lipoprotein subfractions 4 months after ST-segment elevation MI (STEMI). Second, we assessed associations of lipoprotein subfractions with left ventricular ejection fraction (LVEF) and infarct size 4 months after STEMI. Methods 371 participants without known diabetes participating in the GIPS-III trial, a placebo controlled, double-blind randomized trial studying the effect of metformin (500 mg bid) during 4 months after primary percutaneous coronary intervention for STEMI were included of whom 317 completed follow-up (clinicaltrial.gov Identifier: NCT01217307). Lipoprotein subfractions were measured using nuclear magnetic resonance spectroscopy at presentation, 24 hours and 4 months after STEMI. (Apo)lipoprotein measures were obtained during acute STEMI and 4 months post-STEMI. LVEF and infarct size were measured by cardiac magnetic resonance imaging. Results Metformin treatment slightly decreased LDL cholesterol levels (adjusted P = 0.01), whereas apoB remained unchanged. Large LDL particles and LDL size were also decreased after metformin treatment (adjusted P<0.001). After adjustment for covariates, increased small HDL particles at 24 hours after STEMI predicted higher LVEF (P = 0.005). In addition, increased medium-sized VLDL particles at the same time point predicted a smaller infarct size (P<0.001). Conclusion LDL cholesterol and large LDL particles were decreased during 4 months treatment with metformin started early after MI. Higher small HDL and medium VLDL particle concentrations are associated with favorable LVEF and infarct size. PMID:26808474

  16. A review of the role of nurses and technicians in ST-elevation myocardial infarction (STEMI).

    Zughaft, David; Harnek, Jan

    2014-08-01

    The role of nurses and technicians in the treatment of ST-elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI) is vital for the success of the multidisciplinary Heart Team. Several editorials have emphasised the importance of a holistic treatment which links each step of care to the next, a chain that is essential for quality and efficacy in the management of STEMI patients. In pre-hospital acute coronary care, the first medical contact is most commonly a nurse and/or a paramedic. The time from symptom onset to reperfusion is crucial for the long-term outcome. On arrival at the hospital, it is important for the nurse or paramedic to share an overview of what has been done to the patient so far, in a structured and evidence-based way, with the receiving nurse and physician. During PPCI, the role of nurses and technicians includes puncture site assessment, administration of pharmaceuticals and the ability to anticipate and prevent complications. In patients with cardiogenic shock and cardiac arrest, advanced knowledge of haemodynamic support systems is required. In the future, this knowledge must be extended from a limited number of individuals in a small number of centres to a standard of care which is available for all citizens throughout Europe. This review demonstrates the necessity for a multidisciplinary team approach where every person plays an equal, important role in every element of PPCI. The future role of nurses and technicians is intriguing and demands education and experience from an advanced medical and nursing point of view, where the multidisciplinary Heart Team and the knowledge of the different key players are vital. PMID:25256539

  17. Impact of acute hyperglycemia on myocardial infarct size, area at risk and salvage in patients with ST elevation myocardial infarction and the association with exenatide treatment - results from a randomized study

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

    2014-01-01

    Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. ...

  18. The role of cardiovascular magnetic resonance imaging and computed tomography angiography in suspected non-ST-elevation myocardial infarction patients : Design and rationale of the CARdiovascular Magnetic rEsoNance imaging and computed Tomography Angiography (CARMENTA) trial

    Smulders, Martijn W.; Kietselaer, Bastiaan L. J. H.; Das, Marco; Wildberger, Joachim E.; Crijns, Harry J. G. M.; Veenstra, Leo F.; Brunner-La Rocca, Hans-Peter; van Dieijen-Visser, Marja P.; Mingels, Alma M. A.; Dagnelie, Pieter C.; Post, Mark J.; Gorgels, Anton P. M.; van Asselt, Antoinette D. I.; Vogel, Gaston; Schalla, Simon; Kim, Raymond J.; Bekkers, Sebastiaan C. A. M.

    2013-01-01

    Background Although high-sensitivity cardiac troponin (hs-cTn) substantially improves the early detection of myocardial injury, it lacks specificity for acute myocardial infarction (MI). In suspected non-ST-elevation MI, invasive coronary angiography (ICA) remains necessary to distinguish between ac

  19. Gender-specific issues in the management of patients with acute coronary syndrome

    SHEN Wei-feng

    2008-01-01

    @@ Acute coronary syndrome (ACS) represents a continuum of acute myocardial ischemia including non-ST-elevation myocardial infarction and unstable angina, synonymous with non-ST-elevation ACS (NSTE-ACS),and ST-elevation myocardial infarction (STEMI).

  20. Safety and Efficacy of Intracoronary Vasodilators in the Treatment of No-Reflow after Primary Percutaneous Intervention in Patients with Acute ST-Elevation Myocardial Infarction: A Literature Review

    Mostafa Dastani

    2016-04-01

    Full Text Available Introduction: The investigation of no-reflow phenomenon after Percutaneous Coronary Intervention (PCI in patients with acute ST-segment Elevation Myocardial Infarction (STEMI has therapeutic implications. Several vasodilators were administered through intracoronary injection to treat this phenomenon. We aimed to elucidate the risk factors, predictors, and long-term effects of no-reflow phenomenon, and to compare the effects of various vasodilators on re-opening the obstructed vessels. Materials and Methods: All the reviewed articles were retrieved from MEDLINE and Science Direct (up to October 2014. All no-reflow cases were determined through Thrombolysis in Myocardial Infarction grading (TIMI system. Results: Four articles were included, two of which mainly focused on risk factors, predictors, and long-term prognosis of no-reflow phenomenon, and its association with patient mortality and morbidity. The other two articles evaluated therapeutic interventions and compared their efficacy in treating no-reflow. Conclusion: Development of no-reflow in patients with STEMI after primary PCI is associated with low myocardial salvage by primary PCI, large scintigraphic infarct size, deteriorated left ventricle ejection fraction at six months, and increased risk of first-year mortality. During primary PCI, intracoronary infusion of diltiazem and verapamil can reverse no-reflow more effectively than nitroglycerin.

  1. Management of Patients Aged ≥85 Years With ST-Elevation Myocardial Infarction.

    Yudi, Matias B; Jones, Nicholas; Fernando, Dharsh; Clark, David J; Ramchand, Jay; Jones, Elizabeth; Dakis, Robynne; Johnson, Douglas; Chan, Robert; Islam, Amirul; Farouque, Omar; Horrigan, Mark

    2016-07-01

    Guidelines mandate urgent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of age. Whether this strategy is optimal in patients aged ≥85 years remains uncertain. We aimed to assess the clinical characteristics and outcomes of patients aged ≥85 years with STEMI stratified by their management strategy. We analyzed baseline clinical characteristics of 101 consecutive patients aged ≥85 years who presented with STEMI to a tertiary Australian hospital. Patients were stratified based on whether they underwent invasive management with urgent coronary angiography ± percutaneous coronary intervention or conservative management. Our primary outcome was long-term mortality. Independent predictors of conservative management and long-term mortality were assessed by multivariate logistic regression and Cox proportional hazard modeling respectively. Of the 101 patients included, 45 underwent invasive management. Independent predictors of having conservative management were older age, anterior STEMI, and cognitive impairment (all p <0.01). Patients managed invasively had lower in-hospital (13.3% vs 32.1%, p = 0.03), 30-day (13.3% vs 37.5%, p <0.01), 12-month (22.2% vs 57.1%, p <0.01), and long-term (40.0% vs 75.0%, p <0.01) mortality. Invasive management was an independent predictor of lower long-term mortality (hazard ratio 0.29, 95% CI 0.11 to 0.76, p <0.01). In conclusion, patients aged ≥85 years with STEMI who were older, had cognitive impairment or presented with anterior ST-elevation were more likely to be managed conservatively. Those who underwent invasive management had reasonable short- and long-term outcomes. PMID:27217208

  2. NRMI and current treatment patterns for ST-elevation myocardial infarction.

    Gibson, C Michael

    2004-11-01

    The National Registry of Myocardial Infarction (NRMI) is one of the oldest and largest registries of acute myocardial infarction (AMI). Since 1990, 4 NRMI studies have been launched, one of which is ongoing (Table I). In all, 1600 hospitals have participated and >2.2 million patients have been followed. This paper highlights some of our discoveries pertaining to ST-segment elevation and subsequent contributions to patient care. PMID:15514631

  3. Cardiac function, perfusion, metabolism and innervation following autologous stem cell therapy for acute ST-elevation myocardial infarction. A FINCELL-INSIGHT sub-study with PET and MRI

    JuhaW.Koskenvuo

    2012-01-01

    Full Text Available Purpose: Beneficial mechanisms of bone marrow cell (BMC therapy for acute ST-segment elevation myocardial infarct (STEMI are largely unknown in humans. Therefore, we evaluated the feasibility of serial positron emission tomography (PET and MRI studies to provide insight into the effects of BMCs on the healing process of ischemic myocardial damage. Methods: Nineteen patients with successful primary reteplase thrombolysis (mean 2.4 hours after symptoms for STEMI were randomized for BMC therapy (2.9 x 106 CD34+ cells or placebo after bone marrow aspiration in a double-blind, multi-center study. Three days post-MI, coronary angioplasty and paclitaxel eluting stent implantation preceded either BMC or placebo therapy. Cardiac PET and MRI studies were performed 7-12 days after therapies and repeated after six months, and images were analyzed at a central core laboratory. Results: In BMC treated patients, there was a decrease in [11C]-HED defect size (-4.9±4.0% vs. -1.6±2.2%, p=0.08 and an increase in [18F]-FDG uptake in the infarct area at risk (0.06±0.09 vs. -0.05±0.16, p=0.07 compared to controls, as well as less left ventricular dilatation (-4.4±13.3 mL/m2 vs. 8.0±16.7 mL/m2, p=0.12 at six-months follow-up. However, BMC treatment was inferior to placebo in terms of changes in rest perfusion in the area at risk (-0.09±0.17 vs. 0.10±0.17, p=0.03 and infarct size (0.4±4.2 g vs. -5.1±5.9 g, p=0.047, and no effect was observed on ejection fraction (EF (p=0.37. Conclusions: After the acute phase of STEMI, BMC therapy showed only minor trends of long-term benefit in patients with rapid successful thrombolysis. There was a trend of more decrease in innervation defect size and enhanced glucose metabolism in the infarct related myocardium and also a trend of less ventricular dilatation in the BMC treated group compared to placebo. However, no consistently better outcome was observed in the BMC treated group compared to placebo.

  4. Multidetector computed tomography-guided treatment strategy in patients with non-ST elevation acute coronary syndromes: a pilot study

    Patients with non-ST elevation acute coronary syndrome (ACS) and evidence of myocardial ischaemia are scheduled for coronary angiography (CAG). In most patients CAG remains a single diagnostic procedure only. A prospective study was performed to evaluate whether 16-slice multidetector CT (MDCT) could predict treatment of the patients and to determine how many CAGs could have been prevented by MDCT scanning prior to CAG. Twenty-two patients with ACS were scanned prior to CAG. Based on MDCT data, a fictive treatment was proposed and compared to CAG-based treatment. Excellent accuracy was observed to detect significant stenoses using MDCT (sensitivity 94%, specificity 96%). In 45%, no PCI was performed during CAG, because of the absence of significant coronary artery disease (27%) or severe coronary artery disease, demanding CABG (18%). MDCT predicted correct treatment in 86%. By using MDCT data, 32% of the CAGs could have been prevented. (orig.)

  5. Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST-elevation myocardial infarction in Australia.

    Soo Hoo, Soon Yeng; Gallagher, Robyn; Elliott, Doug

    2016-06-01

    Cardiac rehabilitation is an important component of recovery and secondary prevention following urgent primary percutaneous coronary intervention. However, attendance and factors that predict participation by patients admitted with ST-elevation myocardial infarction remain unclear. This Australian study was conducted using a descriptive, comparative design. Consecutive patients (n = 246) at two hospitals were interviewed by telephone at four weeks and six months. Open-ended questions were used to assess cardiac rehabilitation attendance, sociodemographics, modifiable risk factors, clinical outcomes, and post-discharge health support. Post-discharge home visits at four weeks (odds ratio: 2.64, 95% confidence interval: 1.48-4.71) and at six months were associated with better cardiac rehabilitation attendance; more males participated at four weeks and at six months. The results suggest the need to integrate post-discharge health support with cardiac rehabilitation to facilitate recovery after primary percutaneous coronary intervention, particularly for females with ST-elevation myocardial infarction. PMID:26858136

  6. Histopathological features of aspirated thrombi after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

    Miranda C Kramer

    Full Text Available BACKGROUND: Plaque disruption with superimposed thrombus is the predominant mechanism responsible for the onset of acute coronary syndromes. Studies have shown that plaque disruption and thrombotic occlusion are frequently separated in time. We established the histopathological characteristics of material aspirated during primary percutaneous coronary intervention (PCI in a large consecutive ST-elevation myocardial infarction (STEMI population. METHODOLOGY/PRINCIPAL FINDINGS: Thrombus aspiration during primary PCI was performed in 1,362 STEMI patients. Thrombus age was classified as fresh (5 day. Further, the presence of plaque was documented. The histopathological findings were related to the clinical, angiographic, and procedural characteristics. Material could be aspirated in 1,009 patients (74%. Components of plaque were found in 395 of these patients (39%. Fresh thrombus was found in 577 of 959 patients (60% compared to 382 patients (40% with lytic or organized thrombi. Distal embolization was present in 21% of patients with lytic thrombus compared to 12% and 15% of patients with fresh or organized thrombus. CONCLUSIONS/SIGNIFICANCE: Material could be obtained in 74% of STEMI patients treated with thrombus aspiration during primary PCI. In 40% of patients thrombus age is older than 24 h, indicating that plaque disruption and thrombus formation occur significantly earlier than the onset of symptoms in many patients.

  7. Factors Associated With Infarct-Related Artery Patency Before Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (from the FAST-MI 2010 Registry).

    Bailleul, Clotilde; Puymirat, Etienne; Aissaoui, Nadia; Schiele, François; Ducrocq, Gregory; Coste, Pierre; Blanchard, Didier; Brasselet, Camille; Elbaz, Meyer; Steg, Philippe Gabriel; Le Breton, Hervé; Bonnefoy-Cudraz, Eric; Montalescot, Gilles; Cottin, Yves; Goldstein, Patrick; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

    2016-01-01

    Early infarct-related artery (IRA) patency is associated with better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Using the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated factors related to IRA patency (thrombolysis in myocardial infarction [TIMI] 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention. FAST-MI 2010 is a nationwide French registry including 4,169 patients with acute MI. Of 1,452 patients with STEMI with primary percutaneous coronary intervention, 466 (32%) had TIMI 2/3 flow of IRA before the procedure. Mean age (62 ± 14 years in both groups), Global Registry of Acute Coronary Event score (141 ± 31 vs 142 ± 34), and time from onset to angiography (472 ± 499 vs 451 ± 479 minutes) did not differ according to IRA patency (TIMI 2/3 vs TIMI 0/1). Using multivariate logistic regression analysis, IRA patency was more frequently found in patients having called earlier (time from onset to electrocardiogram [ECG] 90 minutes; OR 1.37, 95% CI 1.08 to 1.75). In conclusion, preprocedural IRA patency is observed in one third of patients with STEMI, it is more frequently found in patients having received fast-acting antiplatelet therapy before angiography, and in patients having called early. Higher IRA patency with increasing time delays from qualifying ECG to angiography suggests an additional role of spontaneous or medication-mediated fibrinolysis. PMID:26541905

  8. Role of Health Insurance Status in Interfacility Transfers of Patients With ST-Elevation Myocardial Infarction.

    Ward, Michael J; Kripalani, Sunil; Zhu, Yuwei; Storrow, Alan B; Wang, Thomas J; Speroff, Theodore; Munoz, Daniel; Dittus, Robert S; Harrell, Frank E; Self, Wesley H

    2016-08-01

    Lack of health insurance is associated with interfacility transfer from emergency departments for several nonemergent conditions, but its association with transfers for ST-elevation myocardial infarction (STEMI), which requires timely definitive care for optimal outcomes, is unknown. Our objective was to determine whether insurance status is a predictor of interfacility transfer for emergency department visits with STEMI. We analyzed data from the 2006 to 2011 Nationwide Emergency Department Sample examining all emergency department visits for patients age 18 years and older with a diagnosis of STEMI and a disposition of interfacility transfer or hospitalization at the same institution. For emergency department visits with STEMI, our multivariate logistic regression model included emergency department disposition status (interfacility transfer vs hospitalization at the same institution) as the primary outcome, and insurance status (none vs any [including Medicare, Medicaid, and private insurance]) as the primary exposure. We found that among 1,377,827 emergency department STEMI visits, including 249,294 (18.1%) transfers, patients without health insurance (adjusted odds ratio 1.6, 95% CI 1.5 to 1.7) were more likely to be transferred than those with insurance. Lack of health insurance status was also an independent risk factor for transfer compared with each subcategory of health insurance, including Medicare, Medicaid, and private insurance. In conclusion, among patients presenting to United States emergency departments with STEMI, lack of insurance was an independent predictor of interfacility transfer. In conclusion, because interfacility transfer is associated with longer delays to definitive STEMI therapy than treatment at the same facility, lack of health insurance may lead to important health disparities among patients with STEMI. PMID:27282834

  9. Kounis syndrome: a stinging case of ST-elevation myocardial infarction.

    Scherbak, Dmitriy; Lazkani, Mohamad; Sparacino, Nick; Loli, Akil

    2015-04-01

    Kounis syndrome is not a rare but an infrequently diagnosed non-thrombogenic cause of angina or myocardial infarction triggered by the release of inflammatory mediators following an allergic or anaphylactic reaction. This so-called "allergic angina" is seen in the setting of anaphylactic reactions and is believed to be due to mast cell release causing coronary vasospasm. The treatment of such cases is often with epinephrine, which has also been described in the literature as another rare cause of coronary vasospasm. We present a case of Kounis syndrome seen in a 46 year-old male who suffered two bee stings while landscaping in his yard. He developed an anaphylactic reaction and was promptly treated with IM epinephrine injection by paramedics at arrival and developed marked ST elevations on EKG in the inferior leads with reciprocal ST depressions in the anterior leads. His troponin peaked at 13 ng/mL and tryptase level was 15 ng/mL (normal <10 ng/mL). Coronary catheterisation showed non-diseased coronary arteries and a normal ejection fraction without evidence of vasospasm. He was afterwards treated with an epinephrine drip for distributive shock. Interestingly this syndrome was not provoked when re-challenged with this therapy, suggestive of an allergic reaction rather than epinephrine as the aetiology of his presumed vasospasm. This patient's ST segment elevation and troponin elevation was due to Kounis syndrome. Awareness that anaphylactic reactions can lead to Kounis syndrome can lead to prompt appropriate treatment for this life threatening condition. PMID:25547529

  10. Trans-radial Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction

    Objective: To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of A/sup 2/ 90 minutes in primary PCI percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012. Methodology: Systems goal for door-to-balloon time (DBT - time elapsed between first medical contact and restoration of flow in the infarct related artery (IRA)) was set at < 90 minutes. Procedural success was defined as restoration of TIMI 3 flow in the IRA with less than 30% residual stenosis and discharge from hospital. Non-infarct related arteries were not treated. Bleeding episodes were defined by TIMI definitions. Results: For vascular access for PPCI in a total of 207 patients, TRA was 91.3% (n = 189), transfemoral approach (TFA) 6.3% (n = 13) and brachial 2.4% (n = 5). Males represented 90.3% of cases and 7% were females. Mean age was 55 A +- 10.86 years. Procedural success rate was 97.1%. Mean DBT was 54.1 minutes. DBT was less A/sup 2/ 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT A/sup 2/ 89.50 minutes was achieved in 90% of patients. The difference in DBT between the different access groups was not markedly different between the three groups. There were 6 (2.9%) in-hospital deaths and no major bleeds. Conclusion: TRA for PPCI poses no hindrance to achieving a DBT of < 90 minutes in PPCI for STEMI. Furthermore, the in-hospital mortality rates are acceptable and within rational limits. (author)

  11. Association of admission serum calcium levels and in-hospital mortality in patients with acute ST-elevated myocardial infarction: an eight-year, single-center study in China.

    Xin Lu

    Full Text Available OBJECTIVE: The relationship between admission serum calcium levels and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI has not been well definitively explored. The objective was to assess the predictive value of serum calcium levels on in-hospital mortality in STEMI patients. METHODS: From 2003 to 2010, 1431 consecutive STEMI patients admitted to the First Affiliated Hospital of Nanjing Medical University were enrolled in the present study. Patients were stratified according to quartiles of serum calcium from the blood samples collected in the emergency room after admission. Between the aforementioned groups,the baseline characteristics, in-hospital management, and in-hospital mortality were analyzed. The association of serum calcium level with in-hospital mortality was calculated by a multivariable Cox regression analysis. RESULTS: Among 1431 included patients, 79% were male and the median age was 65 years (range, 55-74. Patients in the lower quartiles of serum calcium, as compared to the upper quartiles of serum calcium, were older, had more cardiovascular risk factors, lower rate of emergency revascularization,and higher in-hospital mortality. According to univariate Cox proportional analysis, patients with lower serum calcium level (hazard ratio 0.267, 95% confidence interval 0.164-0.433, p<0.001 was associated with higher in-hospital mortality. The result of multivariable Cox proportional hazard regression analyses showed that the Killip's class≥3 (HR = 2.192, p = 0.026, aspartate aminotransferase (HR = 1.001, p<0.001, neutrophil count (HR = 1.123, p<0.001, serum calcium level (HR = 0.255, p = 0.001, and emergency revascularization (HR = 0.122, p<0.001 were significantly and independently associated with in-hospital mortality in STEMI patients. CONCLUSIONS: Serum calcium was an independent predictor for in-hospital mortality in patients with STEMI. This widely

  12. Effects of intracoronary melatonin on ischemia-reperfusion injury in ST-elevation myocardial infarction

    Ekeløf, Sarah V; Halladin, Natalie L; Jensen, Svend E;

    2016-01-01

    Acute coronary occlusion is effectively treated by primary percutaneous coronary intervention. However, myocardial ischemia-reperfusion injury is at the moment an unavoidable consequence of the procedure. Oxidative stress is central in the development of ischemia-reperfusion injury. Melatonin, an...... endogenous hormone, acts through antioxidant mechanisms and could potentially minimize the myocardial injury. The aim of the experimental study was to examine the cardioprotective effects of melatonin in a porcine closed-chest reperfused infarction model. A total of 20 landrace pigs were randomized to a...... dosage of 200 mg (0.4 mg/mL) melatonin or placebo (saline). The intervention was administered intracoronary and intravenous. Infarct size, area at risk and microvascular obstruction were determined ex vivo by cardiovascular magnetic resonance imaging. Myocardial salvage index was calculated. The plasma...

  13. Impact of thrombus aspiration during ST-Elevation Myocardial Infarction : a six month composite endpoint and risk of stroke analyses of the TASTE trial

    Olivecrona, Goran K.; Lagerqvist, Bo; Frobert, Ole; Gudnason, Thorarinn; Maeng, Michael; Ramunddal, Truls; Haupt, Jan; Kellerth, Thomas; Stewart, Jason; Sarno, Giovanna; Jensen, Jens; Östlund, Ollie; James, Stefan K

    2016-01-01

    Background: Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the "A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI" (TOTAL) trial. We aimed to analyse a similar endpoint in "The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia" (TASTE) trial up to 180 days. Methods:...

  14. Individual patient-data meta-analysis comparing clinical outcome in patients with ST-elevation myocardial  nfarction treated with percutaneous coronary intervention with or without prior thrombectomy. ATTEMPT study: A pooled Analysis of Trials on ThrombEctomy in acute Myocardial infarction based on individual PatienT data

    Maria De Vita

    2009-02-01

    Full Text Available Maria De Vita1, Francesco Burzotta1, Giuseppe GL Biondi-Zoccai2, Thierry Lefevre3, Dariusz Dudek4, et al1Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy; 2Interventional Cardiology, University of Turin, Italy; 3ICPS, Massy, France; 4Department of Cardiology, Jagiellonian University, Kracow, Poland, et alBackground: Available data from randomized trials on thrombectomy in patients with ST-elevation myocardial infarction (STEMI have shown favorable trends in myocardial reperfusion. However, few data are available on the effect of thrombectomy on clinical outcome. Thus we have designed a collaborative individual patient-data meta-analysis which aimed to assess the long-term clinical outcome in STEMI patients randomized to percutaneous coronary intervention (PCI with or without thrombectomy.Method: After a thorough database search, the principal investigators of randomized trials comparing thrombectomy with standard PCI in patients with STEMI were contacted. Principal investigators as authors of 11 randomized studies agreed to participate and were asked to complete a structured database by providing a series of key pre-PCI clinical and angiographic data as well as the longest available clinical outcome of the patients enrolled in the corresponding trial. The primary end-point of this pooled analysis is the comparison of overall survival rates between patients randomized to PCI with thrombectomy or PCI without thrombectomy. The secondary end-points are survival free from myocardial infarction (MI, target lesion revascularization (TLR, major adverse coronary events (MACE: death + MI + TLR and death + MI between patients randomized to PCI with thrombectomy or PCI without thrombectomy. A pre-defined subgroup analysis is planned considering the following variables: type of thrombectomy device used, diabetes, rescue PCI, IIb/IIIa-inhibitors use, time-to-reperfusion, infarct-related artery, and pre-PCI TIMI flow.Implications: This

  15. Methylphenidatinduceret ST-elevations-myokardieinfarkt

    Ruwald, Martin Huth; Ruwald, Anne-Christine Huth; Tønder, Niels

    2012-01-01

    Adult attention deficit and hyperkinetic disorder (ADHD) is increasingly diagnosed and treated with methylphenidate. We present the case of an 20 year-old man, who was diagnosed with ADHD and suffered a ST elevation acute myocardial infarction due to coronary vasospasm related to an overdose, and...... subsequent episodes of myocardial injury due to the use and misuse of methylphenidate over a period of two years. We recommend an increased attention to the subscription of methylphenidate to patients, who are at risk of misuse and patients, who have a cardiovascular history....

  16. Earlier reperfusion in patients with ST-elevation Myocardial infarction by use of helicopter

    Knudsen Lars

    2012-10-01

    Full Text Available Abstract Background In patients with ST-elevation myocardial infarction (STEMI reperfusion therapy should be initiated as soon as possible. This study evaluated whether use of a helicopter for transportation of patients is associated with earlier initiation of reperfusion therapy. Material and methods A prospective study was conducted, including patients with STEMI and symptom duration less than 12 hours, who had primary percutaneous coronary intervention (PPCI performed at Aarhus University Hospital in Skejby. Patients with a health care system delay (time from emergency call to first coronary intervention of more than 360 minutes were excluded. The study period ran from 1.1.2011 until 31.12.2011. A Western Denmark Helicopter Emergency Medical Service (HEMS project was initiated 1.6.2011 for transportation of patients with time-critical illnesses, including STEMI. Results The study population comprised 398 patients, of whom 376 were transported by ambulance Emergency Medical Service (EMS and 22 by HEMS. Field-triage directly to the PCI-center was used in 338 of patients. The median system delay was 94 minutes among those field-triaged, and 168 minutes among those initially admitted to a local hospital. Patients transported by EMS and field-triaged were stratified into four groups according to transport distance from the scene of event to the PCI-center: ≤25 km., 26–50 km., 51–75 km. and > 75 km. For these groups, the median system delay was 78, 89, 99, and 141 minutes. Among patients transported by HEMS and field-triaged the estimated median transport distance by ground transportation was 115 km, and the observed system delay was 107 minutes. Based on second order polynomial regression, it was estimated that patients with a transport distance of >60 km to the PCI-center may benefit from helicopter transportation, and that transportation by helicopter is associated with a system delay of less than 120 minutes even at a transport

  17. Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report

    Kang, Seonghui; An, Sanghee; Yu, Hyung Min; Kim, Jiwan; Kim, Sung Hea; Kim, Hyun-Joong; Chung, Sang Man

    2013-01-01

    Background Dynamic left ventricular outflow tract obstruction with or without mitral regurgitation is typically observed in hypertrophic cardiomyopathy, but is also occasionally seen without left ventricular hypertrophy. In this report, we present a case of cardiogenic shock that mimics ST-elevation myocardial infarction, due to dynamic left ventricular outflow tract obstruction with transient mitral regurgitation and myocardial bridging after transient complete atrioventricular block. Case p...

  18. Postconditioning in ST-elevation myocardial infarction: a systematic review, critical appraisal, and meta-analysis of randomized clinical trials

    Abdelnoor M

    2014-08-01

    Full Text Available M Abdelnoor,1,2 I Sandven,1 S Limalanathan,3 J Eritsland3 1Centre of Epidemiology and Biostatistics, 2Centre of Clinical Heart Research, 3Department of Cardiology, Oslo University Hospital, Ullevål, NorwayObjective: We aimed to summarize the evidence from randomized clinical trials studies examining the efficacy of ischemic postconditioning (IPost in ST-elevation myocardial infarction. Design: The study was a systematic review and critical appraisal, with meta-analysis of randomized clinical trials. Materials and methods: We searched the literature. A total of 21 randomized clinical trials were identified. Both fixed effect and random effects models were used to synthesize the results of individual studies. Heterogeneity between studies was examined by subgroup and random effects meta-regression analyses, considering ptient-related and study-level variables. Publication bias, or “small-study effect”, was evaluated. Results: Substantial heterogeneity was present. The random effects model pooled estimate for the outcome infarct size assessed by cardiac magnetic resonance was estimated by the standardized mean difference (SMD =−0.06, 95% confidence interval (CI: −0.34 to 0.21, ie, no effect of IPost. For the end point infarct size, estimated by biomarkers of myocardial necrosis, an overall pooled effect was SMD =−0.58, 95% CI: −0.96 to −0.19. This effect disappeared in powered and nonbiased studies (SMD =0.03, 95% CI: −0.48 to 0.55. Finally, for the outcome left ventricular ejection fraction, SMD =0.47 95% CI: 0.20 to 0.74. Unfortunately, selection bias (small-study effect was present. For this outcome, the meta-regression showed that both presence of hypertension and the inclusion of nonbiased studies explained 28.3% of the heterogeneity among the studies. Simulation by the “trim and fill” method, which controlled for selection bias using random effects model, diluted the effect (SMD =0.17 95% CI: −0.13 to 0.48. No effects

  19. Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

    Gehani, Abdurrazzak; Al Suwaidi, Jassim; Arafa, Salah; Tamimi, Omer; Alqahtani, Awad; Al-Nabti, Abdulrahman; Arabi, Abdulrahman; Aboughazala, Tarek; Bonow, Robert O; Yacoub, Magdi

    2012-01-01

    Abstract: In this article, we outline the plans, protocols and strategies to set up the first nationwide primary Percutaneous Coronary Intervention (PCI) program for ST-elevation myocardial Infarction (STEMI) in Qatar, as well as the difficulties and the multi-disciplinary solutions that we adopted in preparation. We will also report some of the landmark literature that guided our plans. The guidelines underscore the need for adequate number of procedures to justify establishing a primary-PCI service and maintain competency. The number of both diagnostic and interventional procedures in our centre has increased substantially over the years. The number of diagnostic procedures has increased from 1470 in 2007, to 2200 in 2009 and is projected to exceed 3000 by the end of 2012. The total number of PCIs has also increased from 443 in 2007, to 646 in 2009 and 1176 in 2011 and is expected to exceed 1400 by the end of 2012. These figures qualify our centre to be classified as ‘high volume’, both for the institution and for the individual interventional operators. The initial number of expected primary PCI procedures will be in excess of 600 procedures per year. Guidelines also emphasize the door to balloon time (DBT), which should not exceed 90 minutes. This interval mainly represents in-hospital delay and reflects the efficiency of the hospital system in the rapid recognition and transfer of the STEMI patient to the catheterization laboratory for primary-PCI. Although DBT is clearly important and is in the forefront of planning for the wide primary PCI program, it is not the only important time interval. Myocardial necrosis begins before the patient arrives to the hospital and even before first medical contact, so time is of the essence. Therefore, our primary PCI program includes a nationwide awareness program for both the population and health care professionals to reduce the pre-hospital delay. We have also taken steps to improve the pre-hospital diagnosis of

  20. Morphine delays the onset of action of prasugrel in patients with prior history of ST-elevation myocardial infarction.

    Thomas, Mark R; Morton, Allison C; Hossain, Rashed; Chen, Beining; Luo, Lei; Shahari, Nur Nazihah B Md; Hua, Peng; Beniston, Richard G; Judge, Heather M; Storey, Robert F

    2016-07-01

    Delays in the onset of action of prasugrel during primary percutaneous coronary intervention (PPCI) have been reported and could be related to the effects of morphine on gastric emptying and subsequent intestinal absorption. The study objective was to determine whether morphine delays the onset of action of prasugrel in patients with a prior history of ST-elevation myocardial infarction (STEMI) treated with PPCI. This was a crossover study of 11 aspirin-treated patients with prior history of STEMI treated with PPCI, for which prasugrel and morphine had been previously administered. Patients were randomised to receive either morphine (5 mg) or saline intravenously followed by 60 mg prasugrel. Blood samples were collected before randomised treatment and over 24 hours after prasugrel administration. The inhibitory effects of prasugrel on platelets were determined using the VerifyNow P2Y12 assay and light transmission aggregometry. Plasma levels of prasugrel and prasugrel active metabolite were measured. Platelet reactivity determined by VerifyNow PRU, VerifyNow % Inhibition and LTA was significantly higher at 30-120 minutes (min) when morphine had been co-administered compared to when saline had been co-administered. Morphine, compared to saline, significantly delayed adequate platelet inhibition after prasugrel administration (158 vs 68 min; p = 0.006). Patients with delayed onset of platelet inhibition also had evidence of delayed absorption of prasugrel. In conclusion, prior administration of intravenous morphine significantly delays the onset of action of prasugrel. Intravenous drugs may be necessary to reduce the risk of acute stent thrombosis in morphine-treated STEMI patients undergoing PPCI. PMID:27099137

  1. 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)

  2. Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience

    Taillon Heather

    2009-07-01

    Full Text Available Abstract Background The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. Methods We prospectively determined the impact on hospital finances of (1 emergency department physician activation of the catheterization lab and (2 immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004–August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005–June 26, 2006 after protocol implementation. Results Per hospital admission, insurance payments (hospital revenue decreased ($35,043 ± $36,670 vs. $25,329 ± $16,185, P = 0.039 along with total hospital costs ($28,082 ± $31,453 vs. $18,195 ± $9,242, P = 0.009. Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95 as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 ± $74,033 vs. $53,514 ± $23,378, P = 0.059, diagnosis related group relative weight (3.7479 ± 2.6731 vs. 2.9729 ± 0.8545, P = 0.017 and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022 all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 ± $53,741 vs. $35,937 ± $23,125, P = 0.044; Total hospital costs: $39,974 ± $37,434 vs. $26,778 ± $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855. Conclusion All of the financial benefits of reducing

  3. ECG phenomena: pseudopreexcitation and repolarization disturbances resembling ST-elevation myocardial infarction caused by an intraatrial rhabdomyoma in a newborn.

    Paech, Christian; Gebauer, Roman Antonin

    2014-01-01

    As is known from other reports, a rhabdomyoma or tumor metastasis may alter intracardiac electrical conduction, producing electrical phenomena like pseudopreexcitation or repolarization disturbances resembling ST-elevation myocardial infarction or Brugada's syndrome. We present a newborn with a giant atrial rhabdomyoma and additionally multiple ventricular rhabdomyomas. He presented with several electrocardiogram (ECG) phenomena due to tumor-caused atrial depolarization and repolarization disturbances. Except from the cardiac tumors, the physical status was within normal range. Initial ECG showed a rapid atrial tachycardia with a ventricular rate of 230 bpm, which was terminated by electrical cardioversion. Afterwards, the ECG showed atrial rhythm with frequent atrial premature contractions and deformation of the PR interval with large, broad P waves and loss of discret PR segment, imposing as pseudopreexcitation. The following QRS complex was normal, with seemingly abnormal ventricular repolarization resembeling ST-elevation myocardial infarction. The atrial tumor was resected with consequent vast atrial reconstruction using patch plastic. The ventricular tumors were left without manipulation. After surgery, pseudopreexcitation and repolarization abnormalities vanished entirely and an alternans between sinus rhythm and ectopic atrial rhythm was present. These phenomena were supposably caused by isolated atrial depolarization disturbances due to tumor-caused heterogenous endocardial activation. The seemingly abnormal ventricular repolarization is probably due to repolarization of the atrial mass, superimposed on the ventricular repolarization. Recognizably, the QRS complex before and after surgical resection of the rhabdomyoma is identical, underlining the atrial origin of the repolarization abnormalities before surgery. PMID:23663513

  4. Direct intracoronary delivery of tirofiban during primary percutaneous coronary intervention for ST-elevation myocardial infarction

    SHEN Wei-feng

    2012-01-01

    ST-segment elevation myocardial infarction (STEMI)is usually caused by acute occlusion of an infarct-related coronary artery (IRA),resulting from rupture or erosion of an atherosclerotic plaque and subsequent platelet aggregation and thrombosis.1-3Prompt reperfusion is the key aspect of the optimal management,4-7 and timely expert primary percutaneous coronary intervention (PCI) becomes the best reperfusion strategy with respect to improvement in survival and reduction of combined clinical endpoints in the treatment of STEMI.8-11 Given the high thrombotic risk of patients with STEMI,pretreatment with a high clopidogrel loading dose before primary PCI was advised to reduce distal thrombotic embolization and angiographic no-reflow and improve clinical outcomes.12,13 The use of adjunctive intravenous glycoprotein (GP) Ⅱb/Ⅲa inhibitors following oral dual-antiplatelet therapy enhances thrombus disaggregation by inhibiting fibrinogen binding to the active receptor complex and subsequently disrupting platelet cross-linking,14 and improves IRA patency and myocardial perfusion,14 and has been recommended as class Ⅱa (at the time of primary PCI) or Ⅱb (before primary angiography and PCI)indication in the recent practice guidelines for the management of patients with STEMI.9,10 Tirofiban (a small-molecule platelet GP Ⅱb/Ⅲa inhibitor) seems even more attractive,because of its consistent and rapidly reversible platelet inhibition at increased dose and efficient penetration into the platelet-fibrin thrombus.15 In a broad population of largely unselected patients undergoing primary PCI for STEMI,tirofiban was associated with a noninferior complete resolution of ST-segment elevation (an indirect measure of myocardial reperfusion after PCI14,16) compared with abciximab,17 and was well tolerated and effective in reducing ischemic acute coronary syndrome complications in patients with mild-to-moderate renal insufficiency.18 Previous studies have shown that an upstream

  5. Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention

    SHEN Xu-hua; CHEN Qi; SHI yan; LI Hong-wei

    2010-01-01

    Background Primary percutaneous coronary interventions (PCI) have been proposed as a novel superior management strategy in patients with ST elevation myocardial infarction (STEMI). This study tested the hypothesis that in the acute phase of myocardial infarction with ST-segment elevation, the neutrophil/lymphocyte (N/L) ratio is a predictor of long-term prognosis.Methods We analyzed 551 consecutive STEMI patients treated with primary PCl at a single university center. Patients were stratified according to quartiles of the mean neutrophil/lymphocyte ratio.Results Kaplan-Meier survival analysis showed a cumulative eight-year survival of 94.2% in the first quartile, 92.0% in the second quartile, 91.3% in the third quartile, and 75.4% in the fourth quartile (P <0.001 by log rank). Relative to patients in the other three lower N/L ratio quartiles, patients in the highest quartile were more than four times more likely to die during hospitalization (P <0.001) and during long-term follow-up (P <0.001). By multivariate Cox regression analysis including baseline demographic, clinical, and angiographic covariables, the N/L ratio in the highest quartile remained an independent predictor of mortality (hazard ratio 2.38, 95% confidence interval (CI) 1.42 to 3.98; P=0.001).Conclusion The neutrophil/lymphocyte ratio is a strong independent predictor of long-term mortality after ST elevation myocardial infarction treated with very early revascularization.

  6. Long-term safety and feasibility of three-vessel multimodality intravascular imaging in patients with ST-elevation myocardial infarction

    Taniwaki, Masanori; Radu, Maria D; Garcia-Garcia, Hector M;

    2015-01-01

    We assessed the feasibility and the procedural and long-term safety of intracoronary (i.c) imaging for documentary purposes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary PCI in the...... setting of IBIS-4 study. IBIS4 (NCT00962416) is a prospective cohort study conducted at five European centers including 103 STEMI patients who underwent serial three-vessel coronary imaging during primary PCI and at 13 months. The feasibility parameter was successful imaging, defined as the number of...... results from a cohort of 485 STEMI patients undergoing primary PCI without additional imaging. Imaging of the infarct-related artery at baseline (and follow-up) was successful in 92.2% (96.6%) of patients using OCT and in 93.2% (95.5%) using IVUS. Imaging of the non-infarct-related vessels was successful...

  7. 急性ST段抬高型心肌梗死患者心型脂肪酸结合蛋白水平与GRACE危险评分的相关性研究%Relationship between Heart-type Fatty Acid-binding Protein and GRACE Risk Score in Patients with Acute ST-elevation Myocardial Infarction

    魏庆民; 周彬; 王晓纲; 樊延明; 王爱平; 刘翠华

    2013-01-01

    Objective To study the relationship between heart - type fatty acid - binding protein ( H - FABP ) level and Global Registry of Acute Coronary Events ( GRACE ) risk score in patients with acute ST - elevation myocardial infarction ( STEMI ). Methods From April 2010 to December 2011 , 60 STEM patients admitted to our hospital within 2 hours of symptom onset were enrolled in this study. Twelve hours after admission, blood samples were obtained for H - FABP measurement every two hours. Then, H - FABP peak values were found. The baseline data were recorded and the GRACE risk score were calculated. The Pearson's correlation analysis were used to analyze the relationship between the H - FABP peak value and GRACE risk score. Results The peak value of H - FABP was ( 59. 4 ± 23. 1 ) μg/L, which occmed 4~8 hours after admission. It was positively correlated with GRACE risk score in these patients ( r = 0.701 , P<0. 05 ). Conclusion H -FABP peak value is directly relevant with GRACE risk score in STEMI patients. Measurement of H - FABP level can provide additional risk stratification information in these patients.%目的 探讨急性ST段抬高型心肌梗死(STEMI)患者血浆心型脂肪酸结合蛋白(H-FABP)的峰值水平与全球急性冠状动脉事件注册(GRACE)风险评分的相关性.方法 选择2010年4月-2011年12月我科收治的发病2 h内的STEMI患者60例,于患者发病后2、4、6、8、10、12 h采血,检测H-FABP水平,找出其峰值.记录患者的基线资料,计算GRACE风险评分,对GRACE评分和H-FABP的峰值水平进行Pearson直线相关分析.结果 H-FABP的达峰时间为4~8 h,平均峰值为(59.4±23.1)μg/L;STEMI患者H-FABP峰值水平与GRACE危险评分呈正相关(r=0.701,P<0.05).结论 STEMI的H-FABP峰值水平与GRACE评分相关,检测H-FABP峰值水平可以为STEMI患者的危险分层提供参考.

  8. Comparison of usefulness of C-reactive protein versus white blood cell count to predict outcome after primary percutaneous coronary intervention for ST elevation myocardial infarction

    Smit, Jaap Jan J.; Ottervanger, Jan Paul; Slingerland, Robbert J.; Kolkman, J. J. Evelien; Suryapranata, Harry; Hoorntje, Jan C. A.; Dambrink, Jan-Henk E.; Gosselink, A. T. Marcel; de Boer, Menko-Jan; Zijlstra, Felix; van 't Hof, Arnoud W. J.

    2008-01-01

    White blood cell (WBC) count and high-sensitive C-reactive protein (hs-CRP) are both used as markers of inflammation and prognosis after an ST elevation myocardial infarction (STEMI), but it is unknown whether they have independent prognostic value. We investigated the association and independent pr

  9. Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction : A meta-analysis of individual patient data

    Fokkema, Marieke L.; van der Meer, Peter; Rao, Sunil V.; Belonje, Anne M.; Ferrario, Maurizio; Hillege, Hans L.; Katz, Stuart D.; Lipsic, Erik; Ludman, Andrew J.; Ott, Ilka; Prunier, Fabrice; Choi, Dong-Ju; Toba, Ken; van Veldhuisen, Dirk J.; Voors, Adriaan A.

    2014-01-01

    Background Erythropoiesis-stimulating agents (ESAs) have been investigated in small studies in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Erythropoiesis-stimulating agents did not show a clear effect on left ventricular funct

  10. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  11. Rationale and design of a double-blind, multicenter, randomized, placebo-controlled clinical trial of early administration of intravenous beta-blockers in patients with ST-elevation myocardial infarction before primary percutaneous coronary intervention : EARLY beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction trial

    Roolvink, Vincent; Rasoul, Saman; Ottervanger, Jan Paul; Dambrink, Jan-Henk E.; Lipsic, Erik; van der Horst, Iwan C. C.; de Smet, Bart; Kedhi, Elvin; Gosselink, A. T. Marcel; Piek, Jan J.; Sanchez-Brunete, Vicente; Ibanez, Borja; Fuster, Valentin; van't Hof, Arnoud W. J.

    2014-01-01

    Background beta-Blockers have a class 1a recommendation in the treatment of patients with ST-elevation myocardial infarctions (STEMIs), as they are associated with a reduced mortality, recurrent myocardial infarction, life-threatening arrhythmias, and with prevention of unfavorable left ventricular

  12. 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.

  13. Influence of the Timing of Percutaneous Coronary Intervention on Clinical Outcomes in Non-ST-Elevation Myocardial Infarction

    Cagliyan, Caglar Emre; Tanboga, Ibrahim Halil; Balli, Mehmet; Uysal, Onur Kadir; Ozkan, Bugra; Arik, Osman Ziya; Cayli, Murat

    2013-01-01

    Background and Objectives We have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI). Subjects and Methods A total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months. Results Third month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9±6.0% vs. 54.1±8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065). Conclusion The early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy. PMID:24363747

  14. Pregnancy associated plasma protein A, a novel, quick, and sensitive marker in ST-elevation myocardial infarction

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

    2008-01-01

    Traditional biomarkers in acute coronary syndromes reflect myocardial necrosis but not the underlying arteriosclerotic disease. Pregnancy-associated plasma protein A (PAPP-A) is a new biomarker in acute coronary syndromes that detects vulnerable plaques in arteriosclerotic disease and identifies ...

  15. Sheathless transradial coronary angioplasty in an achondroplasic patient with ST elevation myocardial infarction.

    Rahman, Nasir; Nabi, Amjad; Gul, Ibrahim

    2015-01-01

    We present a case of a 50-year-old man with achondroplasia, who presented with anterior ST segment myocardial infarction (STEMI). He was taken urgently to the catheterisation laboratory. Owing to his short stature, it was not possible to insert a radial artery sheath so he underwent a sheathless primary percutaneous coronary intervention (PCI) through the right radial artery, with no complication. He was shifted to the coronary care unit and had an uneventful hospital course. He was discharged in stable condition and follows up regularly as an outpatient. PMID:26508119

  16. microRNA-133 a对非ST抬高型急性心肌梗死老年患者的诊断价值%Diagnostic value of serum microRNA-133 a in older patients with acute non ST-elevation myocar-dial infarction

    王静

    2015-01-01

    目的:心电图改变及肌钙蛋白T( cTnT)在非ST抬高型心肌梗死( NSTEMI)老年患者中的诊断价值有限, microRNA在心肌梗死病变过程中具有重要的调控作用。探讨microRNA-133a作为老年NSTEMI患者生物标志物的可能性。方法:选择2011年7月—2014年1月于北京市石景山医院重症监护室( CCU)就诊的年龄﹥65岁患者59例,其中NSTEMI 28例( NSTEMI组),无冠状动脉病变急性心力衰竭患者31例(急性心衰组)。另选择年龄大于65岁无心血管疾病的健康人33例为对照组。除常规cTnT检测外,3组患者分别经RT-PCR检测血清microRNA-1,mi-croRNA-21和microRNA-133a的表达,并且对microRNA和cTnT表达进行相关分析。结果:与健康对照组相比, NSTEMI组microRNA-1,microRNA-21和microRNA-133a的表达显著增高,而与急性心衰组相比,microRNA-1和microRNA-133a表达均显著增高。而且在老年NSTEMI患者中,microRNA-133a具有和cTnT一致的判断价值。此外,对cTnT中度升高(0.03~0.10 ng/mL)的老年患者,microRNA-133a在NSTEMI与急性心衰的鉴别诊断中具有更高的准确性( ROC曲线下面积0.85对0.73,P﹤0.05)。结论:microRNA-133a在老年NSTEMI患者中血清表达显著增高,在cTnT中度升高的患者中具有重要的鉴别诊断价值。%Objective:AbstractObjective:ThediagnosticvalueofelectrocardiogramandcardiactroponinT(cTnT)eleva-tion in geriatric patients( ﹥65 years old)patients with acute non ST-elevation myocardial infarction( NSTEMI)always pres-ent are limited. And microRNA has key roles in the pathophysiology of acute myocardial infarction. To discusse whether mi-croRNA-133a to be a potential biomarkers of patients with NSTEMI. Methods:Patients with a diagnosis of NSTEMI group( n=28),acute heart failure with non coronary artery etiology group(n=31)and healthy control group(n=33)were enrolled in Shijingshan Hospital of Beijing from July 2011 to

  17. Von Willebrand Factor Antigen Predicts Response to Double Dose of Aspirin and Clopidogrel by PFA-100 in Patients Undergoing Primary Angioplasty for St Elevation Myocardial Infarction

    Jacopo Gianetti

    2013-01-01

    Full Text Available Von Willebrand factor (VWF is an emerging risk factor in acute coronary syndromes. Platelet Function Analyzer (PFA-100 with Collagen/Epinephrine (CEPI is sensitive to functional alterations of VWF and also identifies patients with high on-treatment platelet reactivity (HPR. The objective of this study was to verify the effect of double dose (DD of aspirin and clopidogrel on HPR detected by PFA-100 and its relation to VWF and to its regulatory metalloprotease ADAMTS-13. Between 2009 and 2011 we enrolled 116 consecutive patients with ST elevation myocardial infarction undergoing primary PCI with HPR at day 5 after PCI. Patients recruited were then randomized between a standard dose (SD, n=58 or DD of aspirin and clopidogrel (DD, n=58, maintained for 6 months follow-up. Blood samples for PFA-100, light transmittance aggregometry, and VWF/ADAMTS-13 analysis were collected after 5, 30, and 180 days (Times 0, 1, and 2. At Times 1 and 2 we observed a significantly higher CEPI closure times (CT in DD as compared to SD (P<0.001. Delta of CEPI-CT (T1-T0 was significantly related to VWF (P<0.001 and inversely related to ADAMTS-13 (0.01. Responders had a significantly higher level of VWF at T0. Finally, in a multivariate model analysis, VWF and ADAMTS-13 in resulted significant predictors of CEPI-CT response (P=0.02. HRP detected by PFA-100 in acute myocardial infarction is reversible by DD of aspirin and clopidogrel; the response is predicted by basal levels of VWF and ADAMTS-13. PFA-100 may be a useful tool to risk stratification in acute coronary syndromes given its sensitivity to VWF.

  18. Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI) caused by the spontaneous coronary dissection?

    Jović Zoran; Obradović Slobodan; Đenić Nemanja; Mladenović Zorica; Đurić Predrag; Spasić Marijan; Tavčiovski Dragan

    2015-01-01

    Introduction. Spontaneous coronary artery dissection (SCAD) is a very rare disease with poor prognosis. It mainly affects young women free of risk factors for coronary artery disease (CAD) and women during the peripartum period. The prognosis for myocardial infarction caused by SCAD is poor, management is often difficult and guidelines still missing. Case report. We presented a woman with acute myocardial infarction of anterior wall of the left ventricle, c...

  19. Treatment of Non-ST Elevation Myocardial Infarction: A Process Analysis of Patient and Program Factors in a Teaching Hospital.

    Shepple, Benjamin I; Thistlethwaite, William A; Schumann, Christopher L; Akosah, Kwame O; Schutt, Robert C; Keeley, Ellen C

    2016-09-01

    As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay. A total of 242 patients with type 1 non-STEMI were included. The majority of patients received aspirin early after presentation to the emergency department; however, there was significant variability in the time from presentation to administration of other medications, including anticoagulation and P2Y12 therapy, even after an elevated troponin level was documented in the chart. Lack of a standardized non-STEMI admission order set, inconsistency regarding whether the emergency department physician or the cardiology admitting team order these medications after the diagnosis is made, and per current protocol, the initial call regarding the patient made to the cardiology fellow, not the admitting house staff, were identified as possible contributors to the delay. Patients who presented during "nighttime" hours had higher rates of atypical symptoms (P = 0.036) and longer delays to coronary angiography (46.5 versus 24 hours, P quality improvement measures. PMID:27465006

  20. Effects of Obstructive Sleep Apnea on Cardiac Function and Clinical Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

    Baoxin Liu

    2014-01-01

    Full Text Available Aim. The objective of this study was to investigate the influence of OSA on cardiac function in Chinese patients with ST-elevation myocardial infarction (STEMI and determine the prognostic impact of OSA among these patients. Methods. In this retrospective study, 198 STEMI patients were enrolled. Doppler echocardiography was performed to detect the effect of OSA on cardiac function. Major adverse cardiac events (MACE and cardiac mortality were analyzed to determine whether OSA was a clinical prognostic factor; its prognostic impact was then assessed adjusting for other covariates. Results. The echocardiographic results showed that the myocardium of STEMI patients with OSA appeared to be more hypertrophic and with a poorer cardiac function compared with non-OSA STEMI patients. A Kaplan-Meier survival analysis revealed significantly higher cumulative incidence of MACE and cardiac mortality in the OSA group compared with that in the non-OSA group during a mean follow-up of 24 months. Multivariate Cox regression analysis revealed that OSA was an independent risk factor for MACE and cardiac mortality. Conclusion. These results indicate that the OSA is a powerful predictor of decreased survival and exerts negative prognostic impact on cardiac function in STEMI patients.

  1. In-Hospital Mortality and Treatment in Elderly Patients with ST-Elevation Myocardial Infarction

    Sinkovic A

    2005-01-01

    Full Text Available Background. In STEMI early reperfusion therapy improves survival irrespective of age, though caution is recommended for iv. fibrinolysis in the elderly due to increased risk for brain haemorrhage. Primary percutaneous coronary intervention (PCI improves survival in the elderly with STEMI most effectively, if performed without a delay – within 90 minutes from the first medical contact to balloon inflation. If primary PCI is unaccessible, iv. fibrinolysis in comparison to placebo significantly decreases mortality within first few hours of chest pain. Our aim was to compare retrospectively clinical characteristics and inhospital mortality among consecutive STEMI patients ≥ 65 years treated either with primary PCI, or iv. fibrinolysis, or medically, and to evaluate the differences between elderly survivors and non-survivors. Methods. Out of 343 patients with STEMI 171 were ≥ 65 years, treated with iv. fibrinolysis, or primary PCI, or medical therapy. Results. 13.4 % of elderly with STEMI were treated with iv. fibrinolysis, 33.3 % with primary PCI and 42.6 % medically. Among the treatment groups we observed non-significant differences in in-hospital mortality (19.88 % vs. 15.8 % vs 24.65 %, p ≥ 0.05. Between elderly survivors and nonsurvivors we observed significant differences in peak mean Troponin T (4.1 ± 5.2 vs. 6.6 ± 7.3, p 0.05, in presence of anterior infarction (40 % vs. 73.8 %, p 0.05 and in admission cardiogenic shock (3.6 % vs. 64.7 %, p 0.05, but non-significant differences in treatments. Conclusion. In-hospital mortality in the elderly with STEMI was significantly associated with an extensive anterior myocardial infarction with Q and cardiogenic shock on admission.

  2. Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

    Lin Yuan; Shao-Ping Nie

    2016-01-01

    Background:Previous studies showed that patients with cardiogenic shock (CS) from ST-elevation acute myocardial infarction (STEMI) supported by intra-aortic balloon pump (IABP) before primary percutaneous coronary intervention (PCI) decreased the risk of in-hospital mortality than patients who received IABP after PCI.However,little evidence is available on the optimal order of IABP insertion and primary PCI.The aim of this study was to investigate the impact of the sequence of IABP support and PCI and its association with major adverse cardiac and cerebrovascular events (MACCEs).Methods:Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014,who were treated with IABP and PCI.The patients were divided into two groups:Group A in whom IABP received before PCI (n =106)and Group B in whom IABP received after PCI (n =112).We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation.The primary endpoint was 12-month risk of MACCE.Results:Most baseline characteristics were similar in patients between the two groups.However,patients received IABP before PCI were associated with a delay of door-to-balloon time (DBT) and higher troponin Ⅰ level (P < 0.05).However,myocardial perfusion was significantly improved in patients treated with IABP before PCI (P < 0.05).Overall,IABP support before PCI was not associated with significantly lower risk of MACCE (P > 0.05).In addition,risk of all-cause mortality,bleeding,and acute kidney injury (AKI)was similar between two groups (P > 0.05).Multivariate analysis showed that DBT (odds ratio [OR] 2.5,95% confidence interval [CI]1.1-4.8,P=0.04),IABP support after PCI (OR 5.7,95% CI 2.7-8.4,P=0.01),and AKI (OR 7.4,95% CI 4.9-10.8,P=0.01) were the independent predictors of mortality at 12-month follow-up.Conclusions:Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT

  3. Impact of newly diagnosed abnormal glucose regulation on long-term prognosis in low risk patients with ST-elevation myocardial infarction: A follow-up study

    Abdelnoor Michael

    2011-07-01

    Full Text Available Abstract Background Patients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI without known diabetes. Methods Patients (n = 224, age 58 years with a primary percutanous coronary intervention (PCI treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke. The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes. Results The number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47% and 50 (25%, respectively. During the follow up time of (median 33 (27, 39 months, 58 (25.9% patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4 and re-classified three months later (p = 0.3. Conclusions Patients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent

  4. Can cardiac rehabilitation programs improve functional capacity and left ventricular diastolic function in patients with mechanical reperfusion after ST elevation myocardial infarction?: A double-blind clinical trial

    Golabchi, Allahyar; Basati, Fatemeh; Kargarfard, Mehdi; Sadeghi, Masoumeh

    2012-01-01

    BACKGROUND Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However, research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function. METHODS This randomized, clinical trial included 29 men with ST elevation myocardial infarct...

  5. Non-ST elevation myocardial infarction (NSTEMI) in three hospital settings in South Africa: does geography influence management and outcome? A retrospective cohort study

    Moses, Jane; Doubell, Anton F; Herbst, Philip G; Weich, Hellmuth SVH; Klusmann, Karl JC

    2013-01-01

    Background Guidelines advise early angiography in non-ST elevation myocardial infarction (NSTEMI) to ensure an optimal outcome. Resource limitations in secondary hospitals in the Western Cape dictate a local guideline to treat NSTEMIs medically with out-patient assessment for angiography, unless mandatory indications for early angiography occur. Methods A retrospective cohort study assessed NSTEMIs at Tygerberg Hospital (TBH), Karl Bremer Hospital (KBH) and Worcester Hospital (WH) over one ye...

  6. Effectiveness of Percutaneous Coronary Intervention within 12 Hours to 28 Days of ST-Elevation Myocardial Infarction in a Real-World Chinese Population

    Xingli Wu; Dingyou Yang; Yusheng Zhao; Caiyi Lu; Yu Wang

    2013-01-01

    OBJECTIVES: Percutaneous coronary intervention( PCI) for ST-elevation myocardial infarction (STEMI) has been widely accepted for patient who come within 12 hours, but for those who come to the hospital late (12 hours to 28 days) the long-term data and possible predictors are limited regarding 'hard' endpoints in 'real world'. METHODS: The registry data of all 5523 consecutive patients admitted due to an incident STEMI (12 hours to 28 days) in our center were analyzed. Patients were divided in...

  7. Right Coronary Artery Distribution of Myocardial Bridging: An Unusual Case Presenting with ST-Elevation Myocardial Infarction

    Nguyen, Trung H.; Burnside, Patrick R.; Dieter, Robert S.; Nanjundappa, Aravinda

    2007-01-01

    Myocardial bridging has been observed to provoke symptoms in association with strenuous physical activity and hypertrophic cardiomyopathy; more recently, bridging has been thought to cause coronary vasospasm. Autopsy findings tend to reveal higher incidences of bridging than do angiography series, but both show an almost uniform predilection for left coronary artery distribution—especially in regard to bridging that manifests itself clinically. Herein, we report an unusual case of myocardial ...

  8. Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

    Yuan, Lin; Nie, Shao-Ping

    2016-01-01

    Background: Previous studies showed that patients with cardiogenic shock (CS) from ST-elevation acute myocardial infarction (STEMI) supported by intra-aortic balloon pump (IABP) before primary percutaneous coronary intervention (PCI) decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PCI and its association with major adverse cardiac and cerebrovascular events (MACCEs). Methods: Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014, who were treated with IABP and PCI. The patients were divided into two groups: Group A in whom IABP received before PCI (n = 106) and Group B in whom IABP received after PCI (n = 112). We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. Results: Most baseline characteristics were similar in patients between the two groups. However, patients received IABP before PCI were associated with a delay of door-to-balloon time (DBT) and higher troponin I level (P 0.05). In addition, risk of all-cause mortality, bleeding, and acute kidney injury (AKI) was similar between two groups (P > 0.05). Multivariate analysis showed that DBT (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1–4.8, P = 0.04), IABP support after PCI (OR 5.7, 95% CI 2.7–8.4, P = 0.01), and AKI (OR 7.4, 95% CI 4.9–10.8, P = 0.01) were the independent predictors of mortality at 12-month follow-up. Conclusions: Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS. PMID:27270533

  9. Use of microvena snare catheter in non-ST elevation myocardial infarction due to saphenous vein graft occlusive thrombi

    Mohammed Balghith

    2012-01-01

    Full Text Available Percutaneous coronary intervention of grafts vessel is more challenging due to a higher incidence of periprocedural distal micro-emobilization and myocardial infarction. Percutaneous coronary intervention current guidelines advocate usage of distal embolic protection devices, especially in patients with a large thrombus burden, undergoing percutaneous intervention for vein graft disease. We present a 75-year-old man with acute coronary syndrome who had saphenous vein graft thrombus. This patient was treated successfully by manual aspiration of graft thrombus using a microvena catheter. There is yet no best available therapeutic options for patients undergoing percutaneous coronary intervention of saphenous vein graft lesions.

  10. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig;

    2016-01-01

    -hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition of...... myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence...... intervention was successful in 68% versus 36% (P<0.001) of STE compared to no STE patients. No significant difference was found in 180-day mortality rates between STE and no STE patients (36% vs. 30%, Plogrank=0.37). CONCLUSION: The pre-hospital ROSC-ECG is a suboptimal diagnostic tool to predict STEMI and...

  11. Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI caused by the spontaneous coronary dissection?

    Jović Zoran

    2015-01-01

    Full Text Available Introduction. Spontaneous coronary artery dissection (SCAD is a very rare disease with poor prognosis. It mainly affects young women free of risk factors for coronary artery disease (CAD and women during the peripartum period. The prognosis for myocardial infarction caused by SCAD is poor, management is often difficult and guidelines still missing. Case report. We presented a woman with acute myocardial infarction of anterior wall of the left ventricle, caused by spontaneous dissection of medial segment of the left anterior descending coronary artery. We treated the patient with thrombolytic therapy and performed coronary angiography after that. Finally we decided to do nothing more. Two years later we performed coronary angiography again and founded the coronary artery normal. We also analyzed 19 cases publiched from 1996 to 2012 when coronary artery dissection had been treated with thrombolytic agent. Analysis revealed only one case of 19, with complication after treating SCAD with thrombolysis. Conclusion. Sometimes, regarding myocardial infarction in young women with no risk factors for CAD, especially in young women in peripartum, we should think about SCAD. The presented case, like eight others, demonstrates that good clinical outcomes can be achieved with thrombolysis. In spite of all this, we still need more data to verify that thrombolysis does not have to harm the therapy for SCAD. For the time being thrombolytic therapy could be an option.

  12. 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

  13. ST-elevation acute coronary syndromes in the Platelet Inhibition and Patient Outcomes (PLATO) trial

    Armstrong, Paul W; Siha, Hany; Fu, Yuling;

    2012-01-01

    ) trial. This prespecified ECG substudy explored whether ticagrelor's association with vascular death and myocardial infarction within 1 year would be amplified by (1) the extent of baseline ST shift and (2) subsequently associated with fewer residual ST changes at hospital discharge....

  14. Frequency of infarct-related artery with myocardial bridging in patients with ST-elevation myocardial infarction and its impact upon percutaneous coronary intervention

    2006-01-01

    Background Myocardial bridging (MB) as a congenital condition with a reported frequency of 5%-12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery (IRA) of patients with ST-elevation myocardial infarction (STEMI) and the impact upon percutaneous coronary intervention (PCI) remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI.Methods The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events (MACE) (death, recurrent myocardial infarction, target lesion or vessel revascularization) between the MB patients and the non-MB patients.Results A frequency of MB in the IRA of 46 patients (8.3%) was identified in this series; it was more common in patients ≥65 years old (36/206) than in those <65 years old (10/348) (17.5% vs 2.9%, P<0.001). The trend of MB in the IRA was observed more frequently in women without significant difference than in men (10.2% vs 7.8%). TIMI grade III flow was achieved in 91.9% (509/554) of all patients following primary PCI, in 60.9% (28/46) of the MB patients and in 94.7% (481/508) of the non-MB patients respectively (P<0.001). The in-hospital mortality was 4.7% (26/554) in this series including 13.0% (6/46) of the MB patients and 3.9% (20/508) of the non-MB patients (P<0.001). A significant difference in 6 months MACE was seen between the MB patients (19%) and the non-MB patients (6.2%) (P<0.001). Conclusions MB in the IRA is relatively common in elderly patients with STEMI with a more evident

  15. Role of endothelin in microvascular dysfunction following percutaneous coronary intervention for non-ST elevation acute coronary syndromes: a single-centre randomised controlled trial

    Guddeti, Raviteja R; Prasad, Abhiram; Matsuzawa, Yasushi; Aoki, Tatsuo; Rihal, Charanjit; Holmes, David; Best, Patricia; Lennon, Ryan J; Lerman, Lilach O; Lerman, Amir

    2016-01-01

    Objectives Percutaneous coronary intervention (PCI) for acute coronary syndromes frequently fails to restore myocardial perfusion despite establishing epicardial vessel patency. Endothelin-1 (ET-1) is a potent vasoconstrictor, and its expression is increased in atherosclerosis and after PCI. In this study, we aim to define the role of endothelin in regulating coronary microvascular blood flow and myocardial perfusion following PCI in patients with non-ST elevation acute coronary syndromes (NSTACS), by assessing whether adjunctive therapy with a selective endothelin A (ETA) receptor antagonist acutely improves postprocedural coronary microvascular blood flow. Methods In a randomised, double-blinded, placebo-controlled trial, 23 NSTACS patients were enrolled to receive an intracoronary infusion of placebo (n=11) or BQ-123 (n=12) immediately before PCI. Post-PCI coronary microvascular blood flow and myocardial perfusion were assessed by measuring Doppler-derived average peak velocity (APV), and cardiac biomarker levels were quantified. Results Compared with the placebo group, APV was significantly higher in the drug group immediately after PCI (30 (20, 37) vs 19 (9, 26) cm/s; p=0.03). Hyperaemic APV, measured post-adenosine administration, was higher in the BQ-123 group, but the difference did not achieve statistical significance (56 (48, 72) vs 46 (34, 64) cm/s; p=0.090). Maximum coronary flow reserve postprocedure was not different between the two groups (2.1 (1.6, 2.3) vs 2.5 (1.8, 3.0)). Per cent change in creatine kinase isoenzyme MB from the time of PCI to 8 and 16 hours post-PCI was significantly lower in the drug group compared with the placebo group (−17 (−26, −10) vs 26 (−15, 134); p=0.02 and −17 (−38, 14) vs 107 (2, 446); p=0.007, respectively). Conclusions Endothelin is a mediator of microvascular dysfunction during PCI in NSTACS, and adjunctive selective ETA antagonist may augment myocardial perfusion during PCI. Trial registration number

  16. Perfusion scintigraphy in acute myocardial infarction

    The Tc-99m sestamibi perfusion SPECT scintigraphy in acute myocardial infarction is a feasible method to assess the size of area at risk and the residual blood flow to this area as the most important determinants of final infarct size without any delay in treatment. In combination with a follow-up study final infarct size as well as myocardial salvage can be quantified. Clinical indications for the use of Tc-99m sestamibi scintigraphy are the noninvasive identification of arterial occlusion in patients suspected to acute myocardial infarction without electrocardiographic ST-elevation and the assessment of reperfusion success. In clinical trials Tc-99m sestamibi scintigraphy has proven to be a useful method to assess the impact of varying reperfusion therapies. The present review article discusses the indication, the study protocol, the interpretation of results and the clinical and scientifically importance of this method. (orig.)

  17. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction : a meta-analysis of randomized trials

    De Luca, Giuseppe; Dudek, Dariusz; Sardella, Gennaro; Marino, Paolo; Chevalier, Bernard; Zijlstra, Felix

    2008-01-01

    The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendl

  18. When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?

    Pedro Gabriel Melo de Barros e Silva

    2016-03-01

    Full Text Available Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS, with class I of recommendation (level of evidence A in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

  19. Antithrombotic strategies in non-ST elevation acute coronary syndromes: focus on bivalirudin.

    Nikolsky, Eugenia; Stone, Gregg W

    2007-07-01

    Acute coronary syndromes (ACS) are a common presentation of coronary artery disease, accounting for more than one million hospital admissions in the US annually. Owing to high rates of mortality and reinfarction, ACS represent a major public health concern. The following review discusses the pathogenesis of ACS and optimal approaches for the management of patients with ACS, with special focus on new antithrombotic strategies, including the direct thrombin inhibitor bivalirudin. Bivalirudin has several notable mechanistic advantages compared with unfractionated heparin, including activity against clot-bound thrombin, inhibition of thrombin-induced platelet activation, short plasma half-life in patients with normal or mildly impaired renal function (25 minutes), and linear pharmacokinetics less affected by plasma proteins and renal insufficiency. These properties provide a more predictable inhibition of coagulant activity than unfractionated heparin, with less degree of inter-patient variability in anticoagulation response. The findings from the several clinical trials assessing safety and efficacy of bivalirudin are analyzed in detail, including the recent randomized controlled Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Based on the results of the ACUITY trial, a newer streamlined strategy for the invasive treatment of moderate- and high-risk patients with ACS is discussed. PMID:19804226

  20. Predictive value of elevated D-dimer in patients undergoing primary angioplasty for ST elevation myocardial infarction.

    Akgul, Ozgur; Uyarel, Huseyin; Pusuroglu, Hamdi; Gul, Mehmet; Isiksacan, Nilgun; Turen, Selahattin; Erturk, Mehmet; Surgit, Ozgur; Cetin, Mustafa; Bulut, Umit; Baycan, Omer F; Uslu, Nevzat

    2013-10-01

    The aim of this study was to evaluate the prognostic value of D-dimer in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). The prognostic value of D-dimer has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We prospectively enrolled 453 consecutive STEMI patients (mean age 55.6 ± 12.4 years, 364 male, 89 female) undergoing primary PCI. The study population was divided into tertiles based on admission D-dimer values. The high D-dimer group (n = 151) was defined as a value in the third tertile [>0.72 ug/ml fibrinogen equivalent units (FEU)], and the low D-dimer group (n = 302) included those patients with a value in the lower two tertiles (≤0.72 ug/ml FEU). Clinical characteristics, in-hospital and 6-month outcomes of primary PCI were analyzed. The patients of the high D-dimer group were older (mean age 60.1 ± 13.5 versus 52.4 ± 10.6, P 0.72 ug/ml FEU) was found to be a powerful independent predictor of 6-month all-cause mortality (odds ratio: 10.1, 95% confidence interval: 1.24-42.73, P = 0.03). These results suggest that a high admission D-dimer, level was associated with increased in-hospital cardiovascular mortality and 6-month all-cause mortality in patients with STEMI undergoing primary PCI. PMID:23571687

  1. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    David Corcoran

    2015-09-01

    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  2. MRI discriminates thrombus composition and ST resolution after percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

    Ignasi Barba

    Full Text Available Histological composition of material obtained by thrombus aspiration during percutaneous coronary intervention (PCI in patients with ST-segment elevation acute myocardial infarction (STEMI is highly variable. We aimed to characterize this material using magnetic resonance imaging (MRI and to correlate MRI findings with the success of PCI in terms of ST-segment resolution. Thrombus aspiration during primary or rescue PCI was attempted in 100 consecutive STEMI patients, of whom enough material for MRI was obtained in 59. MR images were obtained at 9.4T and T1 and T2 values were measured. Patients with (n = 31 and without (n = 28 adequate ST resolution 120 min after PCI (≥70% of pre-PCI value had similar baseline characteristics except for a higher prevalence of diabetes mellitus in the latter (10 vs. 43%, p = 0.003. T1 values were similar in both groups (1248±112 vs. 1307±85 ms, respectively, p = 0.7. T2 values averaged 31.2±10.3 and 36.6±12.2 ms; in thrombus from patients with and without adequate ST resolution (p = 0.09. After adjusting for diabetes and other baseline characteristics, lower T2 values were significantly associated with inadequate ST resolution (odds ratio for 1 ms increase 1.08, CI 95% 1.01-1.16, p = 0.027. Histology classified thrombus in 3 groups: coagulated blood (n = 38, fibrin rich (n = 9 and lipid-rich (n = 3. Thrombi composed mostly of coagulated blood were characterized as being of short (n = 10, intermediate (n = 15 or long evolution (n = 13, T2 values being 34.0±13.2, 31.9±8.3 and 31.5±7.9 ms respectively (p = NS. In this subgroup, T2 was significantly higher in specimens from patients with inadequate perfusion (35.9±10.3 versus 28.6±6.7 ms, p = 0.02. This can be of clinical interest as it provides information on the probability of adequate ST resolution, a surrogate for effective myocardial reperfusion.

  3. Intra-Hospital Outcomes in ST Elevation Myocardial Infarction: Comparison of Diabetic and Non-Diabetic Patients

    Toba Kazemi

    2015-12-01

    Full Text Available We read the interesting article entitled “the Effect of Diabetes Mellitus on Short Term Mortality and Morbidity after Isolated Coronary Artery Bypass Grafting Surgery” (1. We performed a study on intra-hospital complications in diabetic and non-diabetic patients with Acute Myocardial Infarction (AMI in Birjand, east of Iran in 2012. In our study, 479 patients with AMI (243 diabetics and 236 non-diabetics were assessed. The subjects’ mean age was 61.95 ± 13.18 years. Assessment of intra-hospital complications in the two groups revealed that recurrent angina and mortality were significantly higher in the diabetics compared to the non-diabetics (52.5% vs. 39.3%, P = 0.009; 11.2% vs. 2.6%, P = 0.012, respectively. Besides, the mean Ejection Fraction (EF was lower in the diabetics in comparison to the non-diabetics (45.26 ± 11.37% vs. 49.98 ± 10.39%, P = 0.014. Moreover, the incidence rates of intra-hospital mortality and heart failure were higher in the diabetics with AMI. This can be due to the higher prevalence of the associated risk factors, such as hypertension, dyslipidemia, and hyperglycemia, in diabetic patients and their effects on the heart. Hyperglycemia occurring after AMI is a strong and independent prognostic marker of post-MI complications. Stress, which occurs following AMI, increases insulin resistance and hyperglycemia and decreases glucose tolerance. Un-controlled diabetes in patients having AMI is accompanied by an unfavorable prognosis and may increase the risk of life-threatening complications (2. The increased risk of complications can be a possible explanation for the increase in intra-hospital mortality after AMI is diabetic patients. Various studies have indicated that initial hyperglycemia associated with failure of ST segment resolution after streptokinase infusion is followed by more extensive infarction revealed in Single-Photon Emission Computerized Tomography (SPECT, less blood flow in coronary arteries in

  4. Establishment of a hybrid risk model to predict major cardiac adverse events in patients with non-ST-elevation acute coronary syndromes

    ZHANG, NING; LIU, WENXIAN

    2016-01-01

    The present study aimed to generate a hybrid risk model for the prediction of major cardiac adverse events (MACE) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS), by combining the Global Registry of Acute Coronary Events (GRACE) scoring system and the plasma concentration of N-terminal of the prohormone brain natriuretic peptide (lgNT-proBNP). A total of 640 patients with NSTE-ACS were randomly divided into either the model-establishing group (409 patients) or the prediction model group (231 patients). The clinical endpoint event was MACE, including cardiogenic death, myocardial infarction and heart failure-induced readmission. Among the 409 patients in the model-establishing group, 26 (6.6%) experienced MACE. The hybrid risk model was calculated using the following equation: Hybrid risk model = GRACE score + 20 × logarithm (lg)NT-proBNP + 15, in which the area under the receiver operating curves (ROCs) for the GRACE score and lgNT-proBNP were 0.807 and 0.798, respectively. From the equation, the area under the ROC for the hybrid risk model was 0.843; thus suggesting that the hybrid risk model may be better able to predict the occurrence of MACE compared with either of its components alone. Following re-stratification, 6% of patients in the hybrid risk model were re-grouped. A total of 15 patients in the prediction model group experienced MACE (6.5%). The areas under the ROCs for the hybrid risk model and the GRACE scores for the prediction model group were 0.762 and 0.748, respectively. The results of the present study suggested that the lgNT-proBNP and GRACE score-established hybrid risk model may improve the accuracy by which MACE are predicted. PMID:27347073

  5. Acute myocardial infarct imaging

    A brief review is presented of radiopharmaceuticals used for imaging acute myocardial infarction and instrumentation using the rectilinear scanner and the scintillation camera. Clinical experience indicates that myocardial imaging with /sup 99 m/Tc pyrophosphate is a useful adjunct to the electrocardiogram and serum enzyme activity in managing patients with myocardial infarction. The technique allows rapid diagnosis, accurate localization, and an estimate of the size of acute infarcts. It can also be used to document infarct extension and in association with myocardial perfusion imaging can help differentiate fresh from old myocardial infarction

  6. Search and rescue helicopter-assisted transfer of ST-elevation myocardial infarction patients from an island in the Baltic Sea

    Schoos, Mikkel Malby; Kelbæk, Henning Skov; Pedersen, Frants;

    2014-01-01

    . Individual-level data from the Central Population Registry provided outcome that was linked to our inhospital PCI database. RESULTS: Treatment delay was longer in patients from Bornholm (349 min (IQR 267-446)) vs Zealand (211 (IQR 150-315)) (p<0.001). In patients from Zealand, 30-day mortality did not...... improved survival. CONCLUSIONS: In this small population of STEMI patients from a remote island, airborne transfer appears feasible and safe, and their 30-day mortality after pPCI comparable with that of the mainland population despite inherent reperfusion delay exceeding guidelines.......BACKGROUND: Since 2005, ST-elevation myocardial infarction (STEMI) patients from the island of Bornholm in the Baltic Sea have been transferred for primary percutaneous coronary intervention (pPCI) by an airborne service. We describe the result of pPCI as part of the Danish national reperfusion...

  7. Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus

    Objective: This study compared the efficacy and safety of streptokinase as thrombolytic agent for ST-elevation myocardial infarction (STEMI) in patients with and without diabetes mellitus. Methodology: This prospective interventional study was carried out in the department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients admitted to coronary care unit with STEMI and eligible for thrombolytic therapy (no contraindications per AHA/ACC guidelines) were studied from December 2009 to December 2010. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Complications of streptokinase infusion including hypotension, shock and hemorrhage was noted. Results: Failed reperfusion (<30% ST resolution) was significantly higher in diabetic as compared to non-diabetic patients (21.6% vs. 9.5%; p<0.0003) while successful reperfusion (=70% ST-resolution) was significantly higher in non-diabetic than diabetic patients (66.7% vs. 49.1%; p<0.0001). Complication rates between the two groups were statistically similar. Hypotension occurred in 45 (20.3%) and 51 (23%); p=0.458 patients in non-diabetic and diabetic group respectively while shock occurred in 10 (4.5%) and 13 (5.9%); p= 0.506 and hemorrhagic manifestations in 13 (5.9%) and 10 (4.5%); p=0.294 patients respectively. Conclusion: The outcome of thrombolytic therapy is adversely affected by Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly the risk of hazards associated with thrombolytic therapy is same in both diabetic and non-diabetic patients. (author)

  8. Delayed educational reminders for long-term medication adherence in ST-elevation myocardial infarction (DERLA-STEMI: Protocol for a pragmatic, cluster-randomized controlled trial

    Ivers Noah M

    2012-06-01

    Full Text Available Abstract Background Despite evidence-based recommendations supporting long-term use of cardiac medications in patients post ST-elevation myocardial infarction, adherence is known to decline over time. Discontinuation of cardiac medications in such patients is associated with increased mortality. Methods/design This is a pragmatic, cluster-randomized controlled trial with blinded outcome assessment and embedded qualitative process evaluation. Patients from one health region in Ontario, Canada who undergo a coronary angiogram during their admission for ST-elevation myocardial infarction and who survive their initial hospitalization will be included. Allocation of eligible patients to intervention or usual care will take place within one week after the angiogram using a computer-generated random sequence. To avoid treatment contamination, patients treated by the same family physician will be allocated to the same study arm. The intervention consists of recurrent, personalized, paper-based educational messages and reminders sent via post on behalf of the interventional cardiologist to the patient, family physician, and pharmacist urging long-term adherence to secondary prevention medications. The primary outcome is the proportion of patients who report in a phone interview taking all relevant classes of cardiac medications at twelve months. Secondary outcomes to be measured at three and twelve months include proportions of patients who report: actively taking each cardiac medication class of interest (item-by-item; stopping medications due to side effects; taking one or two or three medication classes concurrently; a perfect Morisky Medication Adherence Score for cardiac medication compliance; and having a discussion with their family physician about long-term adherence to cardiac medications. Self-reported measures of adherence will be validated using administrative data for prescriptions filled. Discussion This intervention is designed to be

  9. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

    Orkun Özkurtul

    2015-09-01

    Conclusion: This case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion.

  10. Factors associated with failure to identify the culprit artery by the electrocardiogram in inferior ST-elevation myocardial infarction

    Tahvanainen, Minna; Nikus, Kjell C; Holmvang, Lene;

    2011-01-01

    Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored....

  11. P2Y12 Inhibitor Pre-Treatment in Non-ST-Elevation Acute Coronary Syndrome: A Decision-Analytic Model

    Gunton, James; Hartshorne, Trent; Langrish, Jeremy; Chuang, Anthony; Chew, Derek

    2016-01-01

    Current guidelines recommend initiation of a P2Y12 inhibitor for all patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at the time of diagnosis (pre-treatment); however, there are no randomized trials directly comparing pre-treatment with initiation at the time of angiography to support this practice. We explore clinical and institutional parameters potentially associated with benefit with this strategy in a decision-analytic model based on available evidence from randomised trials. A decision analysis model was constructed comparing three P2Y12 inhibitors in addition to aspirin in patients with NSTE-ACS. Based on clinical trial data, the cumulative probability of 30 day mortality, myocardial infarction (MI) and major bleeding were determined, and used to calculate the net clinical benefit (NCB) with and without pre-treatment. Sensitivity analysis was performed to assess the relationship between NCB and baseline ischemic risk, bleeding risk, time to angiography and local surgical revascularization rates. Pre-treatment with ticagrelor and clopidogrel was associated with a greater than 50% likelihood of providing a >1% increase in 30 day NCB when baseline estimated ischemic risk exceeds 11% and 14%, respectively. Prasugrel pre-treatment did not achieve a greater than 50% probability of an increase in NCB regardless of baseline ischemic risk. Institutional surgical revascularization rates and time to coronary angiography did not correlate with the likelihood of benefit from P2Y12 pre-treatment. In conclusion, pre-treatment with P2Y12 inhibition is unlikely to be beneficial to the majority of patients presenting with NSTE-ACS. A tailored assessment of each patient’s individual ischemic and bleeding risk may identify those likely to benefit. PMID:27548237

  12. Rationale and design of the ETN-STEP (Early administration of Tirofiban in mid to high risk patients with non-ST elevation acute coronary syndrome referred for percutaneous coronary intervention) project: A multi-center, randomized, controlled clinic trial in Chinese patients

    Li, Jian-ping; Liu, Qun; Huo, Yong

    2012-01-01

    As a member of Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors, Tirofiban had been shown to improve myocardial reperfusion and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI), but the optimal timing of administration of Tirofiban remains unclear. In order to compare the effects of upstream versus downstream administration of Tirofiban in Chinese patients with mid to high risk, non-ST elevation acute coronary syndrome (ACS) referred for PCI, a multi-center, ran...

  13. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Seval İzdeş; Neriman Defne Altıntaş; Gülin Karaaslan; Recep Uygun; Abdulkadir But

    2011-01-01

    Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to dis...

  14. Evidence based medicine: clinical trials that guide the management of ST-elevation myocardial infarction of elderly patients

    Hoang Pham; James Nguyen; Liang Ge; Thach Nguyen

    2006-01-01

    @@ Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arrive at the emergency room with ST-segment elevation myocardial infarction(STEMI). About 60 percent of hospital admissions for AMI are of people older than 65 years. Their in-hospital, 1-month,and 1-year mortality is high. 1 In this article, we will provide a review on clinical trials that guide the management of STelevation myocardial infarction of the elderly patients.

  15. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

    Orkun Özkurtul; Andreas Höch; Andreas Reske; Carsten Hädrich; Christoph Josten; Jörg Böhme

    2015-01-01

    Introduction: Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment. Presentation of case: Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed...

  16. [Risk stratification in pre-hospital management of myocardial infarction with ST elevation: value of a risk score profile].

    Zeller, M; Ravisy, J; Beer, J C; Laurent, Y; Janin-Manificat, L; Cabrita, B; L'Huillier, I; Wolf, J E; Freysz, M; Cottin, Y

    2005-11-01

    The aims of this study were to evaluate new tools of risk stratification in an unselected population of myocardial infarction (MI), usable in a pre-hospital situation, and to compare the risk profile of these patients with those of other clinical trials or myocardial infarction registries. The risk scores of death at 30 days (TIMI score and TIMI risk index) based on data available in the context of coronary emergencies, were applied to the population base of the MI observatory of myocardial infarction in the Côte d'Or (RICO). The risk profile was expressed by the smoothed graph of frequency distribution of each score. The TIMI score applied to the RICO population had a high discriminating power (c = 0.80) for mortality whereas TIMI risk index was less powerful (c = 0.57). The risk profile of the RICO population was comparable to that of InTIME II, ASSENT 2 and the NRMI with reperfusion registry. The NRMI without reperfusion and the MAGIC studies had different profiles characterised by a shift in the graph towards high risk patients. The authors conclude that risk stratification scores, like the TIMI score, are valuable tools for early triage in the management of MI patients. The risk profiles allow comparative analysis of risk levels of populations notably with respect to other registries and also with respect to randomised clinical trials. PMID:16379110

  17. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe; Aquino, Melissa; Stone, Gregg W; Sartori, Samantha; Steg, Philippe Gabriel; Wijns, William; Smits, Pieter C; Jeger, Raban V; Leon, Martin B; Windecker, Stephan; Serruys, Patrick W; Morice, Marie-Claude; Camenzind, Edoardo; Weisz, Giora; Kandzari, David; Dangas, George D; Mastoris, Ioannis; Von Birgelen, Clemens; Galatius, Soren; Kimura, Takeshi; Mikhail, Ghada; Itchhaporia, Dipti; Mehta, Laxmi; Ortega, Rebecca; Kim, Hyo-Soo; Valgimigli, Marco; Kastrati, Adnan; Chieffo, Alaide; Mehran, Roxana

    2015-01-01

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11......,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST...... presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In...

  18. Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    Kurtul, Alparslan; Murat, Sani Namik; Yarlioglues, Mikail; Duran, Mustafa; Celik, Ibrahim Etem; Kilic, Alparslan; Ocek, Adil Hakan

    2015-01-01

    OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial

  19. Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    Alparslan Kurtul

    2015-01-01

    Full Text Available OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST

  20. Long-term clinical results of autologous bone marrow CD 133+ cell transplantation in patients with ST-elevation myocardial infarction

    Kirgizova, M. A.; Suslova, T. E.; Markov, V. A.; Karpov, R. S.; Ryabov, V. V.

    2015-11-01

    The aim of the study was investigate the long-term results of autologous bone marrow CD 133+ cell transplantation in patients with primary ST-Elevation Myocardial Infarction (STEMI). Methods and results: From 2006 to 2007, 26 patients with primary STEMI were included in an open randomized study. Patients were randomized to two groups: 1st - included patients underwent PCI and transplantation of autologous bone marrow CD 133+ cell (n = 10); 2nd - patients with only PCI (n = 16). Follow-up study was performed 7.70±0.42 years after STEMI and consisted in physical examination, 6-min walking test, Echo exam. Total and cardiovascular mortality in group 1 was lower (20% (n = 2) vs. 44% (n = 7), p = 0.1 and 22% (n = 2) vs. 25% (n = 4), (p=0.53), respectively). Analysis of cardiac volumetric parameters shows significant differences between groups: EDV of 100.7 ± 50.2 mL vs. 144.40±42.7 mL, ESV of 56.3 ± 37.8 mL vs. 89.7 ± 38.7 mL in 1st and 2nd groups, respectively. Data of the study showed positive effects of autologous bone marrow CD 133+ cell transplantation on the long-term survival of patients and structural status of the heart.

  1. Thrombolytic therapy in acute myocardial infarction.

    Woo, K S; White, H D

    1994-07-01

    Thrombolytic therapy has revolutionized the treatment of acute myocardial infarction by reducing mortality and preserving left ventricular function. It is relatively safe and cost-effective. However, it is currently underused in most countries. Patients in whom thrombolysis is indicated include those with ST elevation on the electrocardiogram or bundle branch block pattern who present within 12 hours of myocardial infarction; the indications should be widened to include the elderly, patients who have undergone nontraumatic cardiopulmonary resuscitation, and women during menstruation. The risk-benefit ratio should be assessed for the individual patient. Prehospital thrombolytic treatment has been shown to be feasible with the support of well-trained staff and resuscitation equipment, and may be cost-effective in communities with time delays before hospitalization greater than 1 hour. The most important strategy is to shorten the "door to needle" time in hospital. The importance of full infarct-related artery flow (Thrombolysis in Myocardial Infarction [TIMI] grade 3 flow) for preservation of ventricular function and survival has been documented in the second Thrombolysis Trial of Eminase in Acute Myocardial Infarction (TEAM 2) and the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) studies. Aspirin and heparin are beneficial adjunctive regimens to thrombolytic therapy but optimal epicardial reperfusion is achieved in only about half of patients. Improved thrombolytic, adjunctive antiplatelet, and antithrombotic regimens are required to achieve early full reperfusion, which is crucial to improve survival and quality of life. PMID:7919592

  2. Significance of fragmented QRS complexes for identifying culprit lesions in patients with non-ST-elevation myocardial infarction: a single-center, retrospective analysis of 183 cases

    Guo Rong

    2012-06-01

    Full Text Available Abstract Background Fragmented QRS (fQRS complexes are novel electrocardiographic signals, which reflect myocardial conduction delays in patients with coronary artery disease (CAD. The importance of fQRS complexes in identifying culprit vessels was evaluated in this retrospective study. Methods A 12-lead surface electrocardiogram was obtained in 183 patients who had non-ST-elevation myocardial infarction (NSTEMI and subsequently underwent coronary angiography (CAG. On the basis of the frequency of fQRS complexes, indices such as sensitivity, specificity, positive and negative predictive values, and likelihood ratio were evaluated to determine the ability of fQRS complexes to identify the culprit vessels. Results Among the patients studied, elderly patients (age ≥ 65 years and those with diabetes had a significantly higher frequency of fQRS complexes (p = 0.005, p = 0.003, respectively. The fQRS complexes recorded in the 4 precordial leads had the highest specificity (81.8% for indentifying the culprit vessel (left anterior descending artery. However, the specificity of fQRS complexes to identify lesions in the left circumflex and right coronary arteries was lower for the inferior and lateral leads than for the limb leads (65.5% versus 71.7%; however, the limb leads had higher sensitivity (92.3% versus 89.4%. And the total sensitivity and specificity of fQRS (77.1% and 71.5% were higher than those values for ischemic T-waves. Conclusions The frequency of fQRS complexes was higher in elderly and diabetic patients with NSTEMI. The frequency of fQRS complexes recorded in each of the ECG leads can be used to identify culprit vessels in patients with NSTEMI.

  3. White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

    Dehghani, Mohammad Reza; Rezaei, Yousef; Fakour, Sanam; Arjmand, Nasim

    2016-01-01

    Background and Objectives Leukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS. Subjects and Methods A total of 331 NSTE-ACS individuals (60±12.5 years, 57.4% male) were enrolled and followed for a median of 24 months. MetS was identified usi...

  4. Timing of intervention in high-risk non-ST-elevation acute coronary syndromes in PCI versus non-PCI centres

    Badings, E. A.; Remkes, W. S.; Dambrink, J-H. E.; The, S. H. K.; Wijngaarden, J.; TJEERDSMA, G; Rasoul, S.; Timmer, J. R.; van der Wielen, M. L. J.; Lok, D.J.A.; van ’t Hof, A.W.J.

    2016-01-01

    Aims To compare the effect of timing of intervention in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in percutaneous coronary intervention (PCI) versus non-PCI centres. Methods and results A post-hoc sub-analysis was performed of the ELISA III trial, a randomised multicentre trial investigating outcome of early ( 48 h) angiography and revascularisation in 542 patients with high-risk NSTE-ACS. 90 patients were randomised in non-PCI centres and tended to benefit more from a...

  5. Soluble form of membrane attack complex independently predicts mortality and cardiovascular events in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

    Lindberg, Søren; Pedersen, Sune H; Mogelvang, Rasmus;

    2012-01-01

    The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes to...

  6. In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

    XUN Yi-wen; YANG Jin-gang; SONG Li; SUN Yi-hong; LU Chang-lin; YANG Yue-jin; HU Da-yi

    2010-01-01

    Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P<0.001; 55 minutes vs. 45 minutes, P=0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

  7. Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study.

    Roman Pfister

    Full Text Available The impact of type of first medical contact (FMC in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI network providing obligatory primary percutaneous coronary intervention (PCI is unclear.3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS, 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115 for EMS, 107 minutes (IQR 85-148 for non-PCI- and 65 minutes (IQR 48-91 for PCI-capable hospitals (p < 0.001. TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01. The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.

  8. Intracoronary and systemic melatonin to patients with acute myocardial infarction

    Halladin, Natalie L; Busch, Sarah Ekeløf; Jensen, Svend Eggert;

    2014-01-01

    INTRODUCTION: Ischaemia-reperfusion injury following acute myocardial infarctions (AMI) is an unavoidable consequence of the primary percutaneous coronary intervention (pPCI) procedure. A pivotal mechanism in ischaemia-reperfusion injury is the production of reactive oxygen species following...... following pPCI in patients with AMI. MATERIAL AND METHODS: The IMPACT trial is a multicentre, randomised, double-blinded, placebo-controlled study. We wish to include 2 × 20 patients with ST-elevation myocardial infarctions undergoing pPCI within six hours from symptom onset. The primary end-point is the...... Myocardial Salvage Index assessed by cardiovascular magnetic resonance imaging on day 4 (± 1) after pPCI. The secondary end-points are high-sensitivity troponin, creatinekinase myocardial band and clinical events. CONCLUSION: The aim of the IMPACT trial is to evaluate the effect of melatonin on reperfusion...

  9. Impact of Combination Evidence-Based Medical Therapy Used at Admission on In-Hospital Mortality in Patients With Non-ST-Elevation Myocardial Infarction

    Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

    2008-01-01

    Roč. 117, č. 19 (2008), s. 21-22. ISSN 0009-7322. [The 2008 World Congress on Cardiology. 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * risk factors * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  10. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B;

    2012-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred and...

  11. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B;

    2011-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred and...

  12. Acute Myocardial Infarction 19922001

    Robert Schmitz

    2005-01-01

    Heart disease is the leading cause of hospitalization and death in the United States among persons age 65 and older. Acute myocardial infarction (AMI), more commonly known as heart attack, accounted for more than 321,000 hospitalizations among Medicare beneficiaries in 2001. This report presents trends in AMI hospitalization, readmission, and mortality rates from 1992 through 2001 among Medicare fee-for-service beneficiaries across various demographic groups.

  13. Thrombus aspiration in patients with large anterior myocardial infarction : A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy

    Calais, Fredrik; Lagerqvist, Bo; Leppert, Jerzy; James, Stefan K; Frobert, Ole

    2016-01-01

    Background The TASTE trial did not demonstrate clinical benefit of thrombus aspiration (TA). High-risk patients might benefit from TA. Methods The TASTE trial was a multicenter, randomized, controlled, open-label trial obtaining end points from national registries. Patients (n = 7,244) with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) were randomly assigned 1: 1 to TA and PCI or to PCI alone. We assessed the 1-year clinical effect of T...

  14. Clinical Features of Acute Myocardial Infarction in Elderly Patients

    Shiraki, Teruo; Saito, Daiji

    2011-01-01

    The aim of this study was to clarify the prevalence of coronary risk factors in order to characterize the prognostic factors in elderly patients and to also identify any factors beneficial for the prevention of further cardiac events and death. We studied 888 patients with ST-elevation acute myocardial infarction who were admitted within 48h of symptom onset. The patients were divided into 3 groups according to age for comparison of variables:a younger group (n=99) aged<50, a middle-aged grou...

  15. 急性ST段抬高型心肌梗死直接PCI术后ST段回落的临床研究%Study of ST segment resolution after direct percutaneous coronary intervention in patients with ST elevation myocardial infarction

    汪海涛; 郭敏

    2011-01-01

    Objective: To observe the correlation among ST segment resolution by electrocardiogram (ECG) aft er direct percutaneous coronary intervention (PCI) and myocardial damage, heart function in patients with acute ST elevation myocardial infarction (STEMI) and infarction relate artery (IRΛ) blood flow reached TIMI flow grade 3. Methods: Λ total of 115 STEMI patients with TIMI flow grade 3 after direct PCI within 12h were enrolled in the study. The ECG,levels of creatine kinase (CK), CK - MB and cardiac troponin T (cTnT) were examined before and after PCI. The left ventricular ejection fraction (LVEF) of patients were examined after PCI. Λccording to the resolution extent of ST segment (∑STR) the patients were divided into two groups: group Λ: ∑STR<50%, 21 cases, group B: ∑STR ≥50%, 94 cases. Λnalyze the relationship among ∑ STR and LVEF, levels of CK, CK - MB, cTnT in two groups. Results: (1) There were no significant difference between the two groups in sites of IRΛ, number of lesion vessel, TIMI flow grade, cTnT level before PCI, and time from morbidity to PCI (P>0. 05 all); (2) No significant difference existed between the two groups in levels of CK and CK -MB before and after PCI (P>0. 05); (3) After PCI, cTnT level of group Λ was significantly higher than that of group B [ (1. 30±0.43) μg/L vs. (1. 0±0.45) μg/L, P<0. 05]; (4) After PCI, LVEF of group Λ was significantly lower than that of group B [ (44. 13±4.83) % vs.(47.93 ± 5.23)%, P<0. 05]. Conclusion: The patients who reach TIMI flow grade 3 and had satisfactory ST seg ment resolution possess better cardiac function and less myocardial lesions in patients with acute ST elevation myocardi al infarction after direct PCI.%目的:通过观察急性ST段抬高型心肌梗塞(STEMI)直接经皮冠状动脉介入治疗(PCI)术后,梗塞相关动脉(IRA)达心肌梗塞溶栓(TIMI)血流 3级患者心电图ST段回落程度,探讨ST段回落与心肌损伤及心脏收缩功能

  16. Risk factors for post-acute myocardial infarction depression in elderly

    Cristina Moşuţan; Raluca E. Diaconu; Maria L. Rădulescu; Adela M. Şerban; Caius R. Duncea

    2011-01-01

    Objective: To determine risk factors for development of post-acute ST elevation myocardial infarction (STEMI) depression in elderly. Material and Methods: We included 104 elderly patients diagnosed with STEMI. Clinical, lab and imagistic data was recorded in the first week after STEMI. Six months after STEMI patients were evaluated for the presence of depression. Results: Bivariate analysis showed statistically significant association between post-STEMI depression and sex, arterial hypertensi...

  17. Acute myocardial infarction:myocardial salvage assessment

    NSENGIYUMVA Pierre; CHEN Li-juan; MA Gen-shan

    2015-01-01

    Primary coronary revascularization by means of percutaneous coronary intervention ( PCI) is a highly ef-fective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium .Single-photon emission computed tomography ( SPECT) is the most widely used mo-dality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event .SPECT allows quantification of area at risk( AAR) and final infarct size ( FIS) by tracer injection prior to revascularization and after 1 month, respective-ly.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomized clinical trials.However, SPECT is logistically challenging , expensive, and includes radiation exposure .More re-cently, a large number of studies have suggested that cardiac magnetic resonance ( CMR) can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement .

  18. Impact of invasive treatment strategy on health-related quality of life six months after non-ST-elevation acute coronary syndrome

    Li-Xia YANG; Yu-Jie ZHOU; Zhi-Jian WANG; Yue-Ping LI; Meng CHAI

    2014-01-01

    BackgroundFew studies have compared change in the health-related quality of life (HRQL) following treatment of non-ST-elevation acute coronary syndrome (NSTE-ACS) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up (P<0.001), the CABG relative to PCI group showed more significant improvements in angina frequency (P= 0.044) and quality of life (P= 0.028). In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency (OR: 1.62, 95%CI: 1.09-4.63,P= 0.042) and quality of life (OR: 2.04, 95%CI: 1.26-6.92,P= 0.038) relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.

  19. Effects of vorapaxar on platelet reactivity and biomarker expression in non-ST-elevation acute coronary syndromes. The TRACER Pharmacodynamic Substudy.

    Storey, Robert F; Kotha, Jayaprakash; Smyth, Susan S; Moliterno, David J; Rorick, Tyrus L; Moccetti, Tiziano; Valgimigli, Marco; Dery, Jean Pierre; Cornel, Jan H; Thomas, Gregory S; Huber, Kurt; Harrington, Robert A; Hord, Edward; Judge, Heather M; Chen, Edmond; Strony, John; Mahaffey, Kenneth W; Tricoci, Pierluigi; Becker, Richard C; Jennings, Lisa K

    2014-05-01

    Vorapaxar is an antagonist of the protease activated receptor-1 (PAR-1), the principal platelet thrombin receptor. The Thrombin Receptor Antagonist for Clinical Event Reduction (TRACER) trial evaluated vorapaxar compared to placebo in non-ST-elevation (NSTE)-acute coronary syndrome (ACS) patients. It was the study's objective to assess the pharmacodynamic effects of vorapaxar versus placebo that included aspirin or a thienopyridine or, frequently, a combination of both agents in NSTE-ACS patients. In a substudy involving 249 patients, platelet aggregation was assessed by light transmittance aggregometry (LTA) in 85 subjects (41 placebo, 44 vorapaxar) using the agonists thrombin receptor activating peptide (TRAP, 15 μM), adenosine diphosphate (ADP, 20 μM), and the combination of collagen-related peptide (2.5 μg/ml) + ADP (5 μM) + TRAP (15 μM) (CAT). VerifyNow® IIb/IIIa and vasodilator-stimulated phosphoprotein (VASP) phosphorylation assays were performed, and platelet PAR-1 expression, plasma platelet/endothelial and inflammatory biomarkers were determined before and during treatment. LTA responses to TRAP and CAT and VerifyNow results were markedly inhibited by vorapaxar. Maximal LTA response to TRAP (median, interquartile range) 2 hours post loading dose: placebo 68% (53-75%) and vorapaxar 3% (2-6%), p<0.0001. ADP inhibition was greater in the vorapaxar group at 4 hours and one month (p<0.01). In contrast to the placebo group, PAR-1 receptor number in the vorapaxar group at one month was significantly lower than the baseline (179 vs 225; p=0.004). There were significant changes in selected biomarker levels between the two treatment groups. In conclusion, vorapaxar caused a potent inhibition of PAR-1-mediated platelet aggregation. Further studies are needed to explore vorapaxar effect on P2Y12 inhibition, PAR-1 expression and biomarkers and its contribution to clinical outcomes. PMID:24402559

  20. Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction.

    Liu, Yuan-Hui; Liu, Yong; Zhou, Ying-Ling; He, Peng-Cheng; Yu, Dan-Qing; Li, Li-Wen; Xie, Nian-Jin; Guo, Wei; Tan, Ning; Chen, Ji-Yan

    2016-06-15

    Accurate risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We aimed to compare the prognostic value of validated risk scores for CIN. We prospectively enrolled 422 consecutive patients with STEMI undergoing PPCI. Mehran; Gao; Chen; age, serum creatinine (SCr), or glomerular filtration rate, and ejection fraction (ACEF or AGEF); and Global Registry for Acute Coronary Events risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (increase in SCr ≥0.5 mg/dl) or CIN broad (≥0.5 mg/dl and/or a ≥25% increase in baseline SCr). All risk scores had relatively high predictive values for CIN-narrow (c-statistic: 0.746 to 0.873) and performed well for prediction of in-hospital death (0.784 to 0.936), MACEs (0.685 to 0.763), and 3-year all-cause mortality (0.655 to 0.871). The ACEF and AGEF risk scores had better discrimination and calibration for CIN-narrow and in-hospital outcomes. However, all risk score exhibited low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). In conclusion, risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in patients with STEMI undergoing PPCI. The ACEF and AGEF risk scores appear to have greater prognostic value. PMID:27161818

  1. Familial sudden death is an important risk factor for primary ventricular fibrillation: a case-control study in acute myocardial infarction patients.

    Dekker, L.R.; Bezzina, C.R.; Henriques, J.P.; Tanck, M.W.; Koch, K.T.; Alings, M.W.; Arnold, A.E.R.; Boer, M.J. de; Gorgels, A.P.; Michels, H.R.; Verkerk, A.; Verheugt, F.W.A.; Zijlstra, F.; Wilde, A.A.M.

    2006-01-01

    BACKGROUND: Primary ventricular fibrillation (VF) accounts for the majority of deaths during the acute phase of myocardial infarction. Identification of patients at risk for primary VF remains very poor. METHODS AND RESULTS: We performed a case-control study in patients with a first ST-elevation myo

  2. Familial sudden death is an important risk factor for primary ventricular fibrillation : A case-control study in acute myocardial infarction patients

    Dekker, Lukas R. C.; Bezzina, Connie R.; Henriques, Jose P. S.; Tanck, Michael W.; Koch, Karel T.; Alings, Marco W.; Arnold, Alfred E. R.; de Boer, Menko-Jan; Gorgels, Anton P. M.; Michels, H. Rolf; Verkerk, Agnes; Verheugt, Freek W. A.; Zijlstra, Felix; Wilde, Arthur A. M.

    2006-01-01

    Background - Primary ventricular fibrillation (VF) accounts for the majority of deaths during the acute phase of myocardial infarction. Identification of patients at risk for primary VF remains very poor. Methods and Results - We performed a case-control study in patients with a first ST-elevation m

  3. Acute myopericarditis masquerading as acute myocardial infarction

    Wen Tian; Zixin Zhang; Xiaojuan Bai; Dingyin Zeng; Guoxian Qi

    2008-01-01

    Patients with abrupt onset of chest pain, ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction. However, some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal. Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy. The Herpes Simplex Virus Ⅱ was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir. A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.

  4. Time to Medical Management in Patients Presenting with Non-ST Elevation Myocardial Infarction: A Retrospective Analysis of Two Teaching Hospitals

    Darren R. Kagal

    2008-01-01

    Full Text Available Background: It is clear that early administration of antiplatelet and antithrombotic therapy in patients presenting with Non-ST elevation MI (NSTEMI is associated with improved outcomes. There are existing guidelines regarding early treatment in this patient population. We investigated how effectively patients are being managed for NSTEMI with respect to time to administration of indicated medical therapies in two teaching institutions.Methods: A retrospective analysis was performed on 100 consecutive patients with no prior history of coronary artery disease who presented to the Emergency Departments of two teaching hospitals affiliated with McMaster University with the diagnosis of NSTEMI (defined as ischemic symptoms in presence of elevated cardiac biomarkers with or without electrocardiographic changes. Times of medication administration were obtained from the nursing notes.Results: The mean age was 63.9 ± 14.1 years. The average time to administration of aspirin was 2.7 ± 4.3 hours, Unfractionated or Low Molecular Weight Heparin 5.4 ± 5.0 hours, and Clopidagrel 10.8 ± 16.5 hours from time of triage. Duration of symptoms prior to presentation were longer in patients with left ventricular (LV dysfunction (on echocardiography assessed in 73 patients compared to patients with normal LV, (7.5 h ± 8.3 vs. 3.3 h ± 3.4 p = 0.006. The average age of patients who had ASA, Heparin, and Clopidagrel initiated within 3 hours was lower than those after 6 hours (60.1 ± 12.7 years vs 68.1 ± 14.4 years, p = 0.01. The average age for those who underwent angiography ± percutaneous coronary intervention (PCI was also lower at 60.2 ± 11.8 versus 76.1 ± 14.4 years (p = 0.0001.Conclusions: There was a lag time in the administration of established medical therapies in patients presenting with first time NSTEMI. An age bias towards time to treat and selection for PCI may have also existed. The fact that increased duration of symptoms was associated with

  5. [Focal myocarditis mimicking ST-elevation myocardial infarction in a patient with Helicobacter pylori infection: role of magnetic resonance with late gadolinium enhancement].

    Navarese, Eliano P; Franceschi, Francesco; Aurelio, Andrea; Natale, Luigi; Rebuzzi, Antonio G; Gasbarrini, Giovanni

    2010-02-01

    Myocarditis is an emerging disease. We have investigated a case of focal myocarditis with ventricular thrombus in a patient with Helicobacter pylori infection who came to our attention for the persistence of chest pain one week after previous discharge. The patient was before and otherwise misunderstood as myocardial infarction and recognized in our Centre as myocarditis by magnetic resonance. Diagnostic iter was focused on understanding the pathogenesis of the previous reported cardiac event as well as a link with the persistence of chest pain finally found related to Helicobacter pylori infection. We briefly discuss about role and some caveats of magnetic resonance with late gadolinium enhancement as new diagnostic approach of myocarditis, compared to myocardial biopsy. PMID:20433002

  6. Delay From First Medical Contact to Primary PCI and All-Cause Mortality: A Nationwide Study of Patients With ST-Elevation Myocardial Infarction.

    Koul, Sasha; Andell, Pontus; Martinsson, Andreas; Smith, Gustav; vanderPals, Jesper; Scherstén, Fredrik; Jernberg, Tomas; Lagerqvist, Bo; Erlinge, David

    2014-01-01

    Background Early reperfusion in the setting of an ST‐elevation myocardial infarction (STEMI) is of utmost importance. However, the effects of early versus late reperfusion in this patient group undergoing primary percutaneous coronary intervention (PCI) have so far been inconsistent in previous studies. The purpose of this study was to evaluate in a nationwide cohort the effects of delay from first medical contact to PCI (first medical contact [FMC]‐to‐PCI) and secondarily delay from symptom‐...

  7. Comparison of the TIMI and the GRACE risk scores with the extent of coronary artery disease in patients with non-ST-elevation acute coronary syndrome

    Objective: To compare the accuracy of the Global Registry of Acute Coronary Events risk score and the Thrombolysis In Myocardial Infarction risk score in predicting the extent of coronary artery disease in patients with non-ST segment elevation acute coronary syndrome. Methods: The cross-sectional study comprising 406 consecutive patients was conducted at the National Institute of Cardiovascular Diseases, Karachi, from August 2010 to March 2011. For all patients, the GRACE and TIMI RS's relevant scores on the two indices were calculated on admission using specified variables. The patients underwent coronary angiography to determine the extent of the disease. A significant level was defined as >70% stenosis in any major epicardial artery or >50% stenosis in the left main coronary artery. SPSS 19 was used for statistical analysis. Results: Both the indices showed good predictive value in identifying the extent of the disease. A Thrombolysis In Myocardial Infarction score >4 and Global Registry of Acute Coronary Events score >133 was significantly associated with 3vessel disease and left main disease, while for the former score <4 and latter score <133 was associated with normal or non-obstructive coronary disease (p<0.01). On comparison of the two risk scores, the discriminatory accuracy of the latter was significantly superior to the former in predicting 2vessel, 3vessel and left main diseases (p<0.05). Conclusion: Although both the indices were helpful in predicting the extent of the disease, the Global Registry showed better performance and was more strongly associated with multi-vessel and left main coronary artery disease. (author)

  8. Enteroviruses in Acute Myocardial Infarction

    A Gholoobi; MS Nabavinia; T Mohamadpoor; MS Alavi; Z Meshkat

    2012-01-01

    Background: Human enteroviruses (EVs) may have a role as a possible risk factor in the pathogenesis of MI. The aim of this study was to evaluate the presence of enterovirus genomic RNA in peripheral blood samples of patients with acute myocardial infarction (MI). Methods: We investigated the presence of enterovirus genomic RNA in the peripheral blood of 115 patients with acute MI hospitalized in the Coronary Care Unit of Imam Reza and Ghaem University Hospitals (Mashhad, Iran) by RT-PCR using...

  9. Characteristics and Outcomes of Patients with Acute Myocardial Infarction at Non-PCI Capable Hospitals in 2007 and in 2014

    Egle Kalinauskiene; Dalia Gerviene; Inga Sabeckyte; Albinas Naudziunas

    2015-01-01

    Background. There is little known about whether characteristics and outcomes of patients with acute myocardial infarction (AMI) have changed over the years in non-PCI capable hospitals in real-life. Our aim was to assess them between 2007 and 2014. Methods. It was a retrospective cohort study. Characteristics and in-hospital mortality (standardized in cases of different characteristics between the groups by original simple method) were assessed for all patients with non-ST elevation myocardia...

  10. Diagnosis of Non-ST-Elevation Acute Coronary Syndrome by the Measurement of Heart-Type Fatty Acid Binding Protein in Serum: A Prospective Case Control Study

    Priscilla Abraham Chandran

    2014-01-01

    Full Text Available A prospective case control study was undertaken to evaluate the diagnostic performance of serum heart-type fatty acid binding protein (HFABP in comparison to cardiac TnT and TnI in 33 patients admitted with chest pain, diagnosed as NSTE-ACS (non ST elevation acute coronary syndrome and 22 healthy controls. Area under the receiver operating curve (AUC was highest for H-FABP (AUC 0.79; 95% CI 0.66–0.89 versus cTnI (AUC 0.73; 95% CI 0.59–0.84 and cTnT (AUC 0.71; 95% CI 0.57–0.83. The H-FABP level above 6.5 ng/mL showed 56.7% (CI 37.4–74.5 sensitivity, 0.5 (95% CI 0.3–0.7 negative likelihood ratio (−LR, 100% (CI 84.6–100.0 specificity, and 100% (CI 79.4–100.0 positive predictive value (PPV, 62.9% (CI 44.9–78.5 negative predictive value (NPV. cTnI level above 0.009 μg/L had 40% (CI 22.7–59.4 sensitivity, 0.6 (95% CI 0.4–0.8 −LR, 100% (CI 84.6–100.0 specificity, 100% (CI 73.5–100.0 PPV, and 55% (CI 38.5–70.7 NPV. cTnT showed 46.7% (CI 28.3–65.7 sensitivity, 0.5 (95% CI 0.4–0.7 −LR, 100% (CI 84.6–100.0 specificity, 100% (CI 76.8–100.0 PPV, and 57.9% (CI 40.8–73.7 NPV at level above 9 μg/L. +LR were 12.5 (95% CI 1.8–86.8, 1.7 (95% CI 1.0–3.0, and 1.2 (95% CI 0.8–1.9 for H-FABP, cTnI, and cTnT respectively. In conclusion measurement of H-FABP is a valuable tool in the early diagnosis of patients with chest pain (6–8 hrs and seems to be a preferred biomarker in the differential diagnosis of NSTE-ACS. More studies are needed to determine whether serum H-FABP further improves diagnostic performance.

  11. Acute myocardial infarction.

    Rischpler, Christoph

    2016-09-01

    Inflammatory processes after myocardial infarction have gained major interest in recent cardiovascular research. It is believed that not only the degree of cell recruitment to the heart plays a pivotal role in the quality of wound healing after myocardial infarction, but also the balance between different types or even subtypes of cells. It is also this balance which is thought to control key processes in tissue repair, such as apoptosis and neoangiogenesis. In this paper, we aim to review imaging strategies (with a special focus on nuclear molecular imaging strategies) that target cells and processes involved in postischemic inflammation and that have a high potential to be translated into clinic or that are already being used and evaluated in humans. PMID:27225319

  12. Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome

    Paarup Dridi, Nadia; Johansson, Pär I; Lønborg, Jacob T;

    2015-01-01

    Abstract Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI...... least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy...... antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI....

  13. Acute myocardial infarction

    De la Vega-Vélez Henrique

    2012-01-01

    The prevalence of the myocardial infarction (MI) was increasing according to the decadesof the 20th century. In the second decade, the electrocardiogram was introduced, animportant diagnostic tool which still has full validity. The professor of the Facultadde Medicina of the Universidad de Cartagena, Colombia, Henrique de la Vega Vélezpublished in 1942 a thematic review that includes three clinical cases of MI. The textallows observing the conceptualization that was managed seventy years ago ...

  14. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial

    Kelbaek, Henning; Terkelsen, Christian J; Helqvist, Steffen;

    2008-01-01

    OBJECTIVES: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. BACKGROUND: Embolization of material from the infarct-related lesion during PCI may...... protection. The primary end point was complete (>or=70%) ST-segment resolution detected by continuous ST-segment monitoring. Blood levels of troponin-T and creatine kinase-MB were monitored before and after the procedure, and echocardiographic determination of the left ventricular wall motion index (WMI) was...... performed before discharge. RESULTS: Patients were well matched in terms of demographic and angiographic baseline characteristics. There was no significant difference in the occurrence of the primary end point (76% vs. 72%, p = 0.29), no difference in maximum troponin-T (4.8 microg/l and 5.0 microg/l, p = 0...

  15. PAPP-A and IGFBP-4 fragment levels in patients with ST-elevation myocardial infarction treated with heparin and PCI

    Hjortebjerg, Rikke; Lindberg, Søren; Jensen, Jan S;

    2015-01-01

    OBJECTIVES: Circulating levels of pregnancy-associated plasma protein-A (PAPP-A) predict outcome in patients with acute coronary syndrome (ACS). Unfortunately, administration of heparin to patients with ACS increases circulating PAPP-A, probably by a detachment of PAPP-A from cell surfaces...

  16. Comparison of bleeding and in-hospital mortality in Asian-Americans versus Caucasian-Americans with ST-elevation myocardial infarction receiving reperfusion therapy.

    Mehta, Rajendra H; Parsons, Lori; Peterson, Eric D

    2012-04-01

    Concern has been raised that Asian-Americans may have a higher bleeding risk than Caucasian-Americans when treated with fibrinolytic and antithrombotic agents. To date there is limited evidence to support or refute this hypothesis or evaluate bleeding risk and its related outcomes in Caucasian-Americans versus Asian-Americans with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PPCI). We evaluated Asian-Americans and Caucasian-Americans with STEMI receiving reperfusion therapy in the National Registry of Myocardial Infarction (NRMI) 4 and 5 (n = 90,317). We studied risk-adjusted major bleeding and in-hospital mortality. Major bleeding rates after fibrinolysis were similar in Asian-Americans (n = 705) and Caucasian-Americans (n = 42,243, 11.1% vs 10.3%, adjusted odds ratio [OR] 0.97, 95% confidence interval [CI] 0.69 to 1.36, p = 0.5002). Although the observed major bleeding rate was higher in Asian-Americans (n = 1,037) compared to Caucasian-Americans (n = 46,332) treated with PPCI (10.3% vs 7.8%, p = 0.0036), these rates differed only marginally after adjusting for baseline clinical variables (OR 1.24, 95% CI 0.97 to 1.59). Overall adjusted mortality was similar in Asian-Americans and Caucasian-Americans when treated with fibrinolysis (OR 0.96, 95% CI 0.56 to 1.65) or with PPCI (OR 1.35, 95% CI 0.85 to 2.13). Major bleeding after PPCI or fibrinolysis was associated with similar increased risks for mortality in these ethic groups. In conclusion, despite suggestions to the contrary, Asian-Americans with STEMI treated with fibrinolysis or PPCI had similar bleeding and bleeding-related mortality risks compared to Caucasian-Americans. Given the genotypic and phenotypic differences between the 2 cohorts, similar studies in the rapidly growing Asian-American population are needed to confirm our findings and to understand the safety and effectiveness of newer potent antiplatelet and antithrombotic agents in

  17. CLINICAL PROFILE OF ACUTE MYOCARDIAL INFARCTION YOUNG ADULTS

    Patel G. N

    2015-08-01

    Full Text Available BACKGROUND : Although acute myocardial infarction was believed to be an uncommon entity in the young, of late there has been a rising incidence in this group of population. The analysis of its clinical profile, including the etiologic and the risk factors gains much importance, for the preventive purpose. AIMS AND OBJECTIVES: To study the clinical profile of acute MI, including the evaluation of the cardiac enzyme markers, the risk factors, the management and the complications and outcome of this g roup of patients aged 40 years or younger. RESULTS: Majority of patients belonged to the age group of 36 - 40years. 31 patients were overweight and 16 patients were obese. 46 patients (67.64% had anterior wall myocardial infarction, 22 patients had inferior wall myocardial infarction (32.35% and ST - elevation myocardial infarction was found in 69.2% of patients. Smoking/tobacco use was the most common risk factor (64.70% followed by dyslipidemia (60.29%, metabolic syndrome (52.94% diabetes mellitus (52.94 %, hyperhomocysteinemia (52.94%, alcohol consumption (48.52%, hypertension (34%, family history (26.47%, obesity (23.52%. Other than these, two patients had chronic kidney disease stage 3, two female patients were irregular oral contraceptive pill us ers, one was diagnosed as systemic lupus erythematosus and another patient had antiphospholipid antibody syndrome. Conclusions: Apart from early diagnosis and adequate treatment of acute MI in young patients, it is also essential to identify and prevent or control the risk factors at primary and secondary level.

  18. Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST TIMI risk score validation for patients with acute coronary syndrome without ST elevation

    Rodrigo H. Bagur

    2009-10-01

    Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIMI (Thrombolysis in Myocardial Infarction en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5% pacientes tenían riesgo bajo, 106 (52% riesgo intermedio, y 46 (22.5% riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Non-ST elevation acute coronary syndromes (NSTE-ACS are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26

  19. Acute myocardial infarction related to smoke inhalation and myocardial bridging.

    McCabe, M J; Weston, C. F.; Fraser, A G

    1992-01-01

    A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may...

  20. Estimation of Subjective Stress in Acute Myocardial Infarction

    Chockalingam A

    2003-01-01

    Full Text Available BACKGROUND and AIMS: Mental stress is considered to be a precipitating factor in acute coronary events. We aimed to assess the association of subjective or 'perceived' mental stress with the occurrence of acute coronary events. SETTINGS AND DESIGN: Prospective case-control survey was carried out in a referral teaching hospital. subjects & METHODS: Consecutive patients with acute myocardial infarction and ST elevation on electrocardiogram who were admitted to the Coronary Care Unit of a referral teaching hospital were enrolled in the study as cases. Controls were unmatched and were enrolled from amongst patients with coronary artery disease who did not have recent acute coronary events. Subjective Stress Functional Classification (SS-FC for the preceding 2-4 weeks was assessed and assigned four grades from I to IV as follows: I - baseline, II - more than usual but not affecting daily routine, III - significantly high stress affecting daily routine and IV - worst stress in life. STATISTICAL ANALYSIS: Proportions of different characteristics were compared using chi-square test with Yates continuity correction. Student's unpaired t test was applied for mean age. 'p' value of < 0.05 was considered statistically significant. RESULTS: SS-FC could be reliably (99% and easily assessed. Eighty (53% of the total 150 patients with acute MI reported 'high' levels of stress (stress class III and IV. This is in contrast to only 30 (20% of 150 healthy controls reporting high stress for the same period (p value < 0.001. CONCLUSION: Patients with acute myocardial infarction report a higher subjective mental stress during 2 to 4 weeks preceding the acute coronary event.

  1. SNPs identified as modulators of ECG traits in the general population do not markedly affect ECG traits during acute myocardial infarction nor ventricular fibrillation risk in this condition

    Raha Pazoki; de Jong, Jonas S.S.G.; Marsman, Roos F; Nienke Bruinsma; Dekker, Lukas R. C.; Wilde, Arthur A. M.; Connie R Bezzina; Tanck, Michael W.T.

    2013-01-01

    BACKGROUND: Ventricular fibrillation (VF) in the setting of acute ST elevation myocardial infarction (STEMI) is a leading cause of mortality. Although the risk of VF has a genetic component, the underlying genetic factors are largely unknown. Since heart rate and ECG intervals of conduction and repolarization during acute STEMI differ between patients who do and patients who do not develop VF, we investigated whether SNPs known to modulate these ECG indices in the general population also impa...

  2. Detection of acute myocardial infarction using the 12-lead ECG plus inverted leads versus the 16-lead ECG (with additional posterior and right-sided chest electrodes).

    Trägårdh, Elin; Claesson, Mikaela; Wagner, Galen S.; Zhou, Sophia; Pahlm, Olle

    2007-01-01

    Background: The electrocardiographic (ECG) diagnosis of acute myocardial infarction (MI) should be improved. This might be done either by regarding all 24 aspects (both positive and negative leads), or a subset hereof (e.g. 19-lead ECG), of the conventional 12-lead ECG or by using additional electrodes. The purpose of this study was to investigate the accuracy of the different ECG methods in diagnosing acute ST-elevation MI. Methods: The study population consisted of 479 patients admitted to ...

  3. Effect of Losmapimod on Cardiovascular Outcomes in Patients Hospitalized With Acute Myocardial Infarction

    O'Donoghue, Michelle L; Glaser, Ruchira; Cavender, Matthew A;

    2016-01-01

    IMPORTANCE: p38 Mitogen-activated protein kinase (MAPK)-stimulated inflammation is implicated in atherogenesis, plaque destabilization, and maladaptive processes in myocardial infarction (MI). Pilot data in a phase 2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor losmapimod...... potentially eligible for enrollment if they had been hospitalized with an acute MI and had at least 1 additional predictor of cardiovascular risk. INTERVENTIONS: Patients were randomized to either twice-daily losmapimod (7.5 mg; n = 1738) or matching placebo (n = 1765) on a background of guideline-recommended...

  4. Switching between thienopyridines in patients with acute myocardial infarction and quality of care

    Schiele, Francois; Puymirat, Etienne; Bonello, Laurent; Meneveau, Nicolas; Collet, Jean-Philippe; Motreff, Pascal; Ravan, Ramin; Leclercq, Florence; Ennezat, Pierre-Vladimir; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

    2016-01-01

    Objective In acute coronary syndromes, switching between thienopyridines is frequent. The aims of the study were to assess the association between switching practices and quality of care. Methods Registry study performed in 213 French public university, public non-academic and private hospitals. All consecutive patients admitted for acute myocardial infarction (MI; cardiology unit, previous percutaneous coronary intervention, younger age, body weight >60 kg, no history of stroke, cardiac arrest, anaemia or renal dysfunction. In patients with a switch, eligibility for prasugrel was >82% and appropriate use of a switch was 86% from clopidogrel to prasugrel and 20% from prasugrel to clopidogrel. Quality indicators scored higher in the group with a switch and also in centres where the switch rate was higher. Conclusions As applied in the French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction (FAST-MI) registry, switching from one P2Y12 inhibitor to another led to a more appropriate prescription and was associated with higher scores on indicators of quality of care. PMID:27252877

  5. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  6. SERUM MAGNESIUM IN ACUTE MYOCARDIAL INFARCTION

    Nambakam Tanuja; Girish P

    2015-01-01

    BACKGROUND: In myocardial infarction, there occurs functional deficit of available magnesium due to trapping of free magnesium in adipocytes. Magnesium has been implicated in the pathogenesis of acute myocardial infarction and its complications. Magnesium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium concentration was found to have g reat significance in acute myocardial infarction. The present study was un...

  7. [Fibrinolysis in acute myocardial infarct].

    Bleifeld, W

    1987-10-24

    Fibrinolysis has opened up a new avenue in the treatment of acute myocardial infarction (AMI). In principle, the rate of reperfusion depends on the type of compound used, the mode of administration and the time between onset of symptoms and the beginning of treatment. With intracoronary streptokinase the reperfusion rate is of the order of 85%. Intravenous urokinase administered as a bolus results in a reopening rate of 50-60%; a similar rate of reperfusion is achieved with rt-PA as infusion, while i.v. streptokinase produces about 50% reopened coronary vessels. The final infarct size is decreased in 70% of patients if fibrinolysis is initiated within 2.5 hours after the onset of symptoms and followed by reopening of the occluded vessel. This results in a lowering of in-hospital mortality, which in various studies is of the order of 45-60%.- Bearing in mind the contraindications, fibrinolysis should be initiated within 3 hours. Hemodynamic improvement by a decrease of infarct size may also be achieved beyond 3 hours in large anterior myocardial infarctions and in posterior infarctions with cardiogenic shock. Early initiation of thrombolysis is of major importance in improving left ventricular function and lowering mortality following acute myocardial infarction. Therefore, prehospital thrombolytic therapy should be considered. - In the postinfarction phase coronary angiography is indicated in patients with angina at rest, stable angina of ECG signs of ischemia. In this situation transfer to a specialized cardiology division for possible percutaneous transluminal angioplasty is indicated. - Reocclusion after successful thrombolysis occurs in 20-30%, and it is therefore important to avoid reinfarction to improve the long term prognosis after AMI.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3321420

  8. Acute myocardial infarction following a hornet sting

    Cvetković-Matić Danica; Ašanin Milika; Matić Dragan; Ivanović Branislava; Simić Dragan; Kalezić Nevena; Stojanov Vesna

    2009-01-01

    Background. The occurrence of an acute myocardial infarction following a hornet sting has been very rarely reported in the previous literature. Pathogenetic mechanisms include direct action of the venom components on the coronary endothelium and allergic reaction with mediators released from mast cells. The anaphylactic reaction and venom components can produce acute coronary artery thrombosis. Case report. We reported a 45-year-old man with acute myocardial infarction after a hornet sting in...

  9. BET 2: Diagnosing acute myocardial infarction in the presence of ventricular pacing: can Sgarbossa criteria help?

    Jothieswaran, Arunan; Body, Richard

    2016-09-01

    The Sgarbossa criteria can be used to identify patients who have acute myocardial infarction (AMI) in the presence of left bundle branch block, which obscures the usual changes associated with ST elevation myocardial infarction. Patients with ventricular paced rhythm have ECG changes with similar morphology to left bundle branch block. A short-cut systematic review was carried out to establish whether the Sgarbossa criteria can accurately diagnose AMI in the presence of ventricular paced rhythm. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that. PMID:27539980

  10. Acute myocardial involvement after heroin inhalation

    Ritu Karoli; Fatima, J.; Pushker Singh; Kazmi, Khursheed I.

    2012-01-01

    Amongst the illicit drugs cocaine, amphetamines and cannabis have been studied and documented well to cause myocardial infarction by different mechanisms but there is very sparse data available on myocardial involvement after heroin abuse. We report a young man who developed acute myocardial injury after heroin inhalation and alcohol binge drinking. Heroin induced cardio toxic effect and vasospasm compounded by alcohol were suspected to be the cause of this.

  11. Clinical Practice Guidelines for Acute Myocardial Infarction.

    Francisco de Jesús Valladares Carvajal; Arelys Falcón Hernández; Félix Rolando Jorrín Román; Juan Emilio García Rivas

    2009-01-01

    Clinical Practice Guidelines for Acute Myocardial Infarction. It has been defined as the clinical condition caused by the ischemic myocardial necrosis, usually caused by abrupt reduction of coronary blood irrigation affecting one or more myocardial areas. The document includes a review and update of the concept, classification, diagnosis and therapy. Risk stratification and main aspects of rehabilitation are also stressed. It includes assessment guidelines focused on the most important aspect...

  12. Acute myocardial involvement after heroin inhalation

    Ritu Karoli

    2012-01-01

    Full Text Available Amongst the illicit drugs cocaine, amphetamines and cannabis have been studied and documented well to cause myocardial infarction by different mechanisms but there is very sparse data available on myocardial involvement after heroin abuse. We report a young man who developed acute myocardial injury after heroin inhalation and alcohol binge drinking. Heroin induced cardio toxic effect and vasospasm compounded by alcohol were suspected to be the cause of this.

  13. Clinical Practice Guidelines for Acute Myocardial Infarction.

    Francisco De Jesús Valladares Carvajal

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Acute Myocardial Infarction. It has been defined as the clinical condition caused by the ischemic myocardial necrosis, usually caused by abrupt reduction of coronary blood irrigation affecting one or more myocardial areas. The document includes a review and update of the concept, classification, diagnosis and therapy. Risk stratification and main aspects of rehabilitation are also stressed. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Clinical Features of Acute Myocardial Infarction in Elderly Patients

    Shiraki,Teruo

    2011-12-01

    Full Text Available The aim of this study was to clarify the prevalence of coronary risk factors in order to characterize the prognostic factors in elderly patients and to also identify any factors beneficial for the prevention of further cardiac events and death. We studied 888 patients with ST-elevation acute myocardial infarction who were admitted within 48h of symptom onset. The patients were divided into 3 groups according to age for comparison of variables:a younger group (n=99 aged<50, a middle-aged group (n=435>51 years but<70 years and an elderly group (n=354 aged>71 years. The elderly group had higher rates of female gender, pulmonary congestion, in-hospital mortality, and atrial fibrillation and a higher plasma concentration of high-sensitivity CRP (hs-CRP (p<0.05. Hypertension, diabetes mellitus, and dyslipidemia were more common in the middle-aged group (p<0.05. The prevalence of smokers and the plasma level of total cholesterol, LDL-cholesterol and triglycerides were lower in the elderly group (p<0.05. The grade of collateral circulation was highest in the elderly group, but the success rate of reperfusion therapy was lowest. Multiple regression analysis showed that age, pulmonary congestion, CKD and hs-CRP were predictors of in-hospital mortality.This investigation indicated that elderly patients with acute myocardial infarction have different clinical characteristics than younger patients. A specific algorithm might be needed in elderly patients, and could use hs-CRP, eGFR and atrial fibrillation as factors.

  15. Gender difference in patients with acute myocardial infarction treated by primary percutaneous coronary intervention in drug-eluting stent era

    GE Jun-bo

    2010-01-01

    @@ Primary percutaneous coronary intervention (PCI) has been the standard of care for patients with acuteST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset in modern era.~(1,2) The advances and applications of robust anti-platelet and anti-coagulation medicines further improve the outcome of STEMI patients undergoing primary PCI,~3 and drug-eluting stent (DES) has also been proven to be effective and safe when applying in primary PCI.~4 Historical data indicated that women undergoing PCI exerted worse outcomes than male patients, and the gender differences in outcome after PCI are still topical and of interest, especially the outcome after primary PCI.

  16. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

    Bousoula Eleni

    2011-08-01

    Full Text Available Abstract Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE are described.

  17. Reducing time to angiography and hospital stay for patients with high-risk non-ST-elevation acute coronary syndrome: retrospective analysis of a paramedic-activated direct access pathway

    Koganti, S; Patel, N; Seraphim, A; Kotecha, T; Whitbread, M; Rakhit, R D

    2016-01-01

    Objective To assess whether a novel ‘direct access pathway’ (DAP) for the management of high-risk non-ST-elevation acute coronary syndromes (NSTEACS) is safe, results in ‘shorter time to intervention and shorter admission times’. This pathway was developed locally to enable London Ambulance Service to rapidly transfer suspected high-risk NSTEACS from the community to our regional heart attack centre for consideration of early angiography. Methods This is a retrospective case–control analysis of 289 patients comparing patients with high-risk NSTEACS admitted via DAP with age-matched controls from the standard pan-London high-risk ACS pathway (PLP) and the conventional pathway (CP). The primary end point of the study was time from admission to coronary angiography/intervention. Secondary end point was total length of hospital stay. Results Over a period of 43 months, 101 patients were admitted by DAP, 109 matched patients by PLP and 79 matched patients through CP. Median times from admission to coronary angiography for DAP, PLP and CP were 2.8 (1.5–9), 16.6 (6–50) and 60 (33–116) hours, respectively (phospital stay for DAP and PLP was similar at 3.0 (2.0–5.0) days in comparison to 5 (3–7) days for CP (p<0.001). Conclusions DAP resulted in a significant reduction in time to angiography for patients with high-risk NSTEACS when compared to existing pathways. PMID:27324709

  18. THROMBOLYTIC THERAPY OF ACUTE MYOCARDIAL INFARCTION

    D. P. Sementsov

    2015-12-01

    Full Text Available Importance of thrombolytic therapy for restoration of coronary blood flow in acute myocardial infarction is emphasized. Indications and contraindications, advantages and disadvantages for thrombolysis therapy are discussed. The ways of different thrombolytics implementation, efficacy criteria and possible side effects are also presented.

  19. Primary coronary angioplasty in acute myocardial infarction.

    Grech, E. D.; Ramsdale, D. R.

    1996-01-01

    It is well established that recanalisation of the infarct-related artery is of great benefit in the early hours after acute myocardial infarction. This can be achieved by the use of thrombolytic agents and/or by percutaneous transluminal coronary angioplasty (PTCA). This article reviews data on the role of primary PTCA and summarises current opinion on its use.

  20. THROMBOLYTIC THERAPY OF ACUTE MYOCARDIAL INFARCTION

    D. P. Sementsov

    2015-01-01

    Importance of thrombolytic therapy for restoration of coronary blood flow in acute myocardial infarction is emphasized. Indications and contraindications, advantages and disadvantages for thrombolysis therapy are discussed. The ways of different thrombolytics implementation, efficacy criteria and possible side effects are also presented.

  1. Myocardial bridging as a cause of acute myocardial infarction: a case report

    Emiroglu Yunus; Gunduz Huseyin; Akdemir Ramazan; Uyan Cihangir

    2002-01-01

    Abstract Background Systolic compression of a coronary artery by overlying myocardial tissue is termed myocardial bridging. Myocardial bridging usually has a benign prognosis, but some cases resulting in myocardial ischemia, infarction and sudden cardiac death have been reported. We are reporting a case of myocardial bridging which was complicated with acute myocardial infarction associated with inappropriate blood donation. Case presentation A 33 year-old-man was admitted to our emergency wi...

  2. Effect of combined Antioxidants on Acute Myocardial infarction size

    B.Farahani; K.Hadiyan; A.Mohseni

    2001-01-01

    SummaryBackground and purpose : The role of oxygen-derived free radicals in destruction of myocardial cells during acute ischemia or reperfusion has been proved. This phenomenon made the workers to study and find the inhibitory therapeutic methods in order to reduce the myocardial cell destruction during acute myocardial infarction. This study evaluates the role of combined antioxidants on acute myocardial infarction sige in patients referring to vali asr hospital of Arak.Materials and Method...

  3. Global Ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction

    Stengaard, Carsten; Sørensen, Jacob Thorsted; Andersen, M.P.;

    2011-01-01

    Abstract: P5632 Global ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction Authors: C. Stengaard1, J.T. Sorensen2, M.P. Andersen3, K. Thygesen1, J.F. Lassen2, K. Nikus4, G. Wagner5, C.J. Terkel......Abstract: P5632 Global ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction Authors: C. Stengaard1, J.T. Sorensen2, M.P. Andersen3, K. Thygesen1, J.F. Lassen2, K. Nikus4, G. Wagner5, C...... ischemia ECG pattern (GIP) has been proposed for diagnosis of acute left main stem (LM) occlusion. The GIP is defined by ST-elevation of 1mm in lead aVR and ST-depression of 0.5mm in seven or more ECG leads. Previous studies focus on the sensitivity of GIP in patients with confirmed LM occlusion. We...... present data of prevalence and associated mortality of GIP in patients with suspected acute myocardial infarction (AMI). Methods: The study population consists of 4905 patients suspected of AMI, transported by emergency medical service, in whom a prehospital ECG was acquired. GIP was identified by...

  4. Contemporary management of acute coronary syndrome

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the pre...

  5. Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: The EQUIP-ACS project protocol and design

    Bardaji Alfredo

    2010-01-01

    Full Text Available Abstract Background Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients. There is evidence that systematic educational programmes can lead to improvement in the management of these patients. Since application of the results of important clinical trials and expert clinical guidelines into clinical practice leads to improved patient care and outcomes, we propose to test a quality improvement programme in a general group of hospitals in Europe. Methods/Design This will be a multi-centre cluster-randomised study in 5 European countries: France, Spain, Poland, Italy and the UK. Thirty eight hospitals will be randomised to receive a quality improvement programme or no quality improvement programme. Centres will enter data for all eligible non-ST segment elevation acute coronary syndrome patients admitted to their hospital for a period of approximately 10 months onto the study database and the sample size is estimated at 2,000-4,000 patients. The primary outcome is a composite of eight measures to assess aggregate potential for improvement in the management and treatment of this patient population (risk stratification, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose and at discharge. After the quality improvement programme, each of the eight measures will be compared between the two groups, correcting for cluster effect. Discussion If we can demonstrate important improvements in the quality of patient care as

  6. Trends in hospitalisation for acute myocardial infarction in Ireland, 1997-2008.

    Jennings, Siobhan M

    2012-07-16

    OBJECTIVE: To study the temporal and gender trends in age-standardised hospitalisation rates, in-hospital mortality rates and indicators of health service use for acute myocardial infarction (AMI), and the sub-categories, ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI), in Ireland, 1997-2008. DESIGN, SETTING, PATIENTS: Anonymised data from the hospital inpatient enquiry were studied for the ICD codes covering STEMI and NSTEMI in all 39 acute hospitals in Ireland over a 12-year period. Age standardisation (direct method) was used to study hospitalisation and in-hospital mortality rates. Joinpoint regression analysis was undertaken to identify significant inflection points in hospitalisation trends. MAIN OUTCOME MEASURES: Age-standardised hospitalisation rates, in-hospital mortality and indicators of health service use (length of stay, bed days) for AMI, STEMI and NSTEMI patients. RESULTS: From 1997 to 2008, hospitalisation rates for AMI decreased by 27%, and by 68% for STEMI patients (test for trend p<0.001), and increased by 122% for NSTEMI, (test for trend p<0.001). The mean age of male STEMI patients decreased (p<0.01), while those for the remaining groupings of AMI and subcategories increased. The proportion of males increased significantly for STEMI and NSTEMI (p<0.001). In-hospital mortality decreased steadily (p=0.01 STEMI, p=0.02 NSTEMI), as did median length of stay. CONCLUSIONS: The authors found a steady decrease in hospitalisation rates with AMI, and a shift away from STEMI towards rising rates of NSTEMI patients who are increasingly older. In an ageing population, and with increasing survival rates, surveillance of acute coronary syndrome and allied conditions is necessary to inform clinicians and policy makers.

  7. Secondary prevention with calcium antagonists after acute myocardial infarction

    Hansen, J F

    1992-01-01

    Experimental studies have demonstrated that the 3 calcium antagonists nifedipine, diltiazem, and verapamil have a comparable effect in the prevention of myocardial damage during ischaemia. Secondary prevention trials after acute myocardial infarction, which aimed at improving survival and...

  8. 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

  9. Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

    Jingkai Wei; Pratik Pimple; Shah, Amit J.; Cherie Rooks; Douglas Bremner, J.; Nye, Jonathon A.; Ijeoma Ibeanu; Nancy Murrah; Lucy Shallenberger; Paolo Raggi; Viola Vaccarino

    2014-01-01

    Objectives Depression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI. Methods We studied 98 patients (49 women and 49 men) age 38–60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion ...

  10. Acute Myocardial Infarction, 1992-2001.

    Robert Schmitz

    2005-01-01

    Heart disease is the leading cause of hospitalization and death in the United States among persons age 65 and older. Acute myocardial infarction (AMI), more commonly known as heart attack, accounted for more than 321,000 hospitalizations among Medicare beneficiaries in 2001. This report presents trends in AMI hospitalization, readmission, and mortality rates from 1992 through 2001 among Medicare fee-for-service beneficiaries across various demographic groups.