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Sample records for acute non-st-elevation myocardial

  1. Acute versus subacute angiography in patients with non-ST-elevation myocardial infarction - the NONSTEMI trial phase I

    DEFF Research Database (Denmark)

    Stengaard, Carsten; Sørensen, Jacob T; Rasmussen, Martin B

    2017-01-01

    BACKGROUND: The 2015 European Society of Cardiology non-ST-elevation myocardial infarction (NSTEMI) guidelines recommend angiography within 24 h in high-risk patients with NSTEMI. An organized STEMI-like approach with pre-hospital or immediate in-hospital triage for acute coronary angiography (CAG......) may be of therapeutic benefit but it remains unknown whether the patients can be properly diagnosed in the pre-hospital setting. We aim to evaluate whether it is feasible to diagnose patients with NSTEMI in the pre-hospital phase or immediately upon admission. METHODS AND RESULTS: We randomized 250...... patients to either acute or subacute CAG (i.e. Pre-hospital electrocardiogram acquisition and point-of-care troponin-T measurement ensured that 148 (59%) patients were identified already in the ambulance, whereas the remaining 102 (41%) patients were identified immediately after...

  2. Blood Leukocyte Count on Admission Predicts Cardiovascular Events in Patients with Acute Non-ST Elevation Myocardial Infarction.

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    Dharma, Surya; Hapsari, Rosmarini; Siswanto, Bambang B; van der Laarse, Arnoud; Jukema, J Wouter

    2015-06-01

    We aim to test the hypothesis that blood leukocyte count adds prognostic information in patients with acute non-ST-elevation myocardial infarction (non-STEMI). A total of 585 patients with acute non-STEMI (thrombolysis in myocardial infarction risk score ≥ 3) were enrolled in this cohort retrospective study. Blood leukocyte count was measured immediately after admission in the emergency department. The composite of death, reinfarction, urgent revascularization, and stroke during hospitalization were defined as the primary end point of the study. The mean age of the patients was 61 ± 9.6 years and most of them were male (79%). Using multivariate Cox regression analysis involving seven variables (history of smoking, hypertension, heart rate > 100 beats/minute, serum creatinine level > 1.5 mg/dL, blood leukocyte count > 11,000/µL, use of β-blocker, and use of angiotensin-converting enzyme inhibitor), leukocyte count > 11,000/µL demonstrated to be a strong predictor of the primary end point (hazard ratio = 3.028; 95% confidence interval = 1.69-5.40, p leukocyte count on admission is an independent predictor of cardiovascular events in patients with acute non-STEMI.

  3. A new risk scoring model for prediction of poor coronary collateral circulation in acute non-ST-elevation myocardial infarction.

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    İleri, Mehmet; Güray, Ümit; Yetkin, Ertan; Gürsoy, Havva Tuğba; Bayır, Pınar Türker; Şahin, Deniz; Elalmış, Özgül Uçar; Büyükaşık, Yahya

    2016-01-01

    We aimed to investigate the clinical features associated with development of coronary collateral circulation (CCC) in patients with acute non-ST-elevation myocardial infarction (NSTEMI) and to develop a scoring model for predicting poor collateralization at hospital admission. The study enrolled 224 consecutive patients with NSTEMI admitted to our coronary care unit. Patients were divided into poor (grade 0 and 1) and good (grade 2 and 3) CCC groups. In logistic regression analysis, presence of diabetes mellitus, total white blood cell (WBC) and neutrophil counts and neutrophil to lymphocyte ratio (NLR) were found as independent positive predictors of poor CCC, whereas older age (≥ 70 years) emerged as a negative indicator. The final scoring model was based on 5 variables which were significant at p risk score ≤ 1, 29 had good CCC (with a 97% negative predictive value). On the other hand, 139 patients had risk score ≥ 4; out of whom, 130 (with a 93.5% positive predictive value) had poor collateralization. Sensitivity and specificity of the model in predicting poor collateralization in patients with scores ≤ 1 and ≥ 4 were 99.2% (130/131) and +76.3 (29/38), respectively. This study represents the first prediction model for degree of coronary collateralization in patients with acute NSTEMI.

  4. French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction 2010. FAST-MI 2010

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    Hanssen, Michel; Cottin, Yves; Khalife, Khalife; Hammer, Laure; Goldstein, Patrick; Puymirat, Etienne; Mulak, Geneviève; Drouet, Elodie; Pace, Benoit; Schultz, Eric; Bataille, Vincent; Ferrières, Jean; Simon, Tabassome

    2012-01-01

    Aim of FAST-MI 2010 To gather data on characteristics, management and outcomes of patients hospitalised for acute myocardial infarction (AMI) at the end of 2010 in France. Interventions To provide cardiologists and health authorities national and regional data on AMI management every 5 years. Setting Metropolitan France. 213 academic (n=38), community (n=110), army hospitals (n=2), private clinics (n=63), representing 76% of centres treating AMI patients. Inclusion from 1 October 2010. Population Consecutive patients included during 1 month, with a possible extension of recruitment up to one additional month (132 centres); 4169 patients included over the entire recruitment period, 3079 during the first 31 days; 249 additional patients declining participation (5.6%). Startpoints Consecutive adults with ST-elevation and non-ST-elevation AMI with symptom onset ≤48 h. Patients with AMI following cardiovascular procedures excluded. Data capture Web-based collection of 385 items (demographic, medical, biologic, management data) recorded online from source files by external research technicians; case-record forms with automatic quality checks. Centralised biology in voluntary centres to collect DNA samples and serum. Long-term follow-up organised centrally with interrogation of municipal registry offices, patients' physicians, and direct contact with the patients. Data quality Data management in Toulouse University. Statistical analyses: Université Paris Descartes, Université de Toulouse, Université Pierre et Marie Curie-Paris 06, Paris. Endpoints and linkages to other data In-hospital events; cardiovascular events, hospital admissions and mortality during follow-up. Linkage with Institute for National Statistics. Access to data Available for research to any participating clinician upon request to executive committee (fastmi2010@yahoo.fr). PMID:22523054

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

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    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

  6. Correlation between turbidimetric and nephelometric methods of measuring C-reactive protein in patients with unstable angina or non-ST elevation acute myocardial infarction

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    Luis C. L. Correia

    2003-08-01

    Full Text Available OBJECTIVE: To evaluate the performance of the turbidimetric method of C-reactive protein (CRP as a measure of low-grade inflammation in patients admitted with non-ST elevation acute coronary syndromes (ACS. METHODS: Serum samples obtained at hospital arrival from 68 patients (66±11 years, 40 men, admitted with unstable angina or non-ST elevation acute myocardial infarction were used to measure CRP by the methods of nephelometry and turbidimetry. RESULTS: The medians of C-reactive protein by the turbidimetric and nephelometric methods were 0.5 mg/dL and 0.47 mg/dL, respectively. A strong linear association existed between the 2 methods, according to the regression coefficient (b=0.75; 95% C.I.=0.70-0.80 and correlation coefficient (r=0.96; P<0.001. The mean difference between the nephelometric and turbidimetric CRP was 0.02 ± 0.91 mg/dL, and 100% agreement between the methods in the detection of high CRP was observed. CONCLUSION: In patients with non-ST elevation ACS, CRP values obtained by turbidimetry show a strong linear association with the method of nephelometry and perfect agreement in the detection of high CRP.

  7. [Usefulness of copeptin in discarding non-ST elevation acute myocardial infarction in patients with acute chest pain and negative first troponin I].

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    Esteban-Torrella, P; García de Guadiana-Romualdo, L; Consuegra-Sánchez, L; Dau-Villarreal, D; Melgarejo-Moreno, A; Albaladejo-Otón, M D; Villegas-García, M

    2015-11-01

    To evaluate the usefulness of copeptin as a rapid and reliable marker for discarding non-ST elevation acute myocardial infarction (NSTEMI) in patients attended in an Emergency Care Department due to acute chest pain with a normal or non-diagnostic electrocardiogram and a negative first troponin I result. A prospective observational study was carried out. The Emergency Care Department of a university hospital. The study comprised a total of 97 patients attended in the Emergency Care Department due to chest pain suggestive of acute coronary syndrome with an evolution of under 12h, a non-diagnostic electrocardiogram and a negative first troponin I result. None. Patient demographic data and baseline characteristics, copeptin upon admission, troponin I upon admission and after 6h, and final diagnosis. The final diagnosis was NSTEMI in 14 patients (14.4%) -no significant differences in copeptin concentration being observed between the 2 groups, though a tendency towards higher values was recorded in the NSTEMI group (median: 24.6pmol/l [interquartile range: 42.0] vs. 12.0pmol/l [16.1]; P=.06). The AUC ROC for copeptin upon admission was 0.657 (95%CI: 0.504-0.810), with a negative predictive value of 92% for a cutoff point of 14pmol/l. Copeptin determination upon admission to the Emergency Care Department in patients with chest pain for ≤12h, suggestive of acute coronary syndrome, with a non-diagnostic electrocardiogram and a negative first troponin I determination does not allow rapid and reliable exclusion of the presence of NSTEMI. Serial troponin I measurements are needed in this respect. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  8. Pre-hospital transthoracic echocardiography for early identification of non-ST-elevation myocardial infarction in patients with acute coronary syndrome.

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    Bergmann, Ingo; Büttner, Benedikt; Teut, Elena; Jacobshagen, Claudius; Hinz, José; Quintel, Michael; Mansur, Ashham; Roessler, Markus

    2018-02-07

    Non-ST elevation myocardial infarction (NSTEMI) is a common manifestation of acute coronary syndrome (ACS), but delayed diagnosis can increase mortality. In this proof of principle study, the emergency physician performed transthoracic echocardiography (TTE) on scene to determine whether NSTEMI could be correctly diagnosed pre-hospitalization. This could expedite admission to the appropriate facility and reduce the delay until initiation of correct therapy. Pre-hospital TTE was performed on scene by the emergency physician in patients presenting with ACS but without ST-elevation in the initial 12-lead electrocardiography (ECG) (NSTE-ACS). A presumptive NSTEMI diagnosis was made if regional wall motion abnormalities (RWMA) were detected. These patients were admitted directly to a specialist cardiac facility. Patient characteristics and pre-admission and post-admission clinical, pre-hospital TTE data, and therapeutic measures were recorded. Patients with NSTE-ACS (n = 53; 72.5 ± 13.4 years of age; 23 female) were studied. The 20 patients with pre-hospital RWMA and presumptive NSTEMI, and two without RWMA were conclusively diagnosed with NSTEMI in hospital. Percutaneous coronary intervention was performed in 50% of the patients presumed to have NSTEMI immediately after admission. The RWMA seen before hospital TTE corresponded with the in-hospital ECG findings and/or the supply regions of the occluded coronary vessels seen during PCI in 85% of the cases. The diagnostic sensitivity of pre-hospital TTE for NSTEMI was 90.9% with 100% specificity. Pre-hospital transthoracic echocardiography by the emergency physician can correctly diagnose NSTEMI in more than 90% of cases. This can expedite the initiation of appropriate therapy and could thereby conceivably reduce morbidity and mortality. Deutsche Register klinischer Studien, DRKS00004919 . Registered on 29 April 2013.

  9. 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

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    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

  10. Frequency of diabetes in non st elevation myocardial infarction

    International Nuclear Information System (INIS)

    Rafiq, I.; Khan, A.N.

    2017-01-01

    To determine the frequency of diabetes mellitus in non ST segment elevation myocardial infarction. Study Design: Cross-sectional. Place and Duration of Study: The study was carried out at the Armed Forces Institute of Cardiology (AFIC) Rawalpindi, from Apr 2010 to Oct 2010. Material and Methods: In this study three hundred fifty two patients with non ST elevation myocardial infarction (NSTEMI) who fulfilled the inclusion criteria were studied while they were admitted to the hospital. They were divided into diabetic and non diabetic groups. Frequency of age, gender, rising levels of cardiac biochemical markers, plasma glucose and HbA1c were seen in both diabetic and non diabetic patients. Results were obtained by using chi-square method and independent t-test. Results: Out of 352 patients of NSTEMI 193 were diabetics. The study population was categorized in three groups according to age as; 30-45, 46-60, and 61-75 years respectively. It was found that 46-60 years group was most frequently affected with frequency of 46.1%, p<0.001 with male predominance as 67.9% and females as 32.1%. Cardiac biochemical markers were raised with mean for CK 528.51 U/L SD +- 275.82 and CK MB 79.39 U/L SD +- 32.5, p<0.001 respectively. Raised fasting plasma glucose was found in 189 patients mean 8.74 mmol/L SD +- 1.52, p<0.001 and elevated HbA1c seen in 187 patients mean 7.94% SD +- 0.83, p<0.001. Conclusion: Despite modern therapies for unstable angina (UA)/NSTEMI diabetes is an independent cardiovascular risk factor, therefore we need aggressive strategies to manage the high risk group of patients. (author)

  11. Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction.

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    González-Cambeiro, María Cristina; López-López, Andrea; Abu-Assi, Emad; Raposeiras-Roubín, Sergio; Peña-Gil, Carlos; García-Acuña, José; González-Juanatey, Ramón

    2016-12-01

    Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI). We analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up. There were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01). After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03). In this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction

    NARCIS (Netherlands)

    Mol, K. A.; Rahel, B. M.; Meeder, J. G.; van Casteren, B. C. A. M.; Doevendans, P. A.; Cramer, M. J. M.

    2016-01-01

    Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital

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

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    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.

  14. Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction.

    Science.gov (United States)

    Mol, K A; Rahel, B M; Meeder, J G; van Casteren, B C A M; Doevendans, P A; Cramer, M J M

    2016-10-15

    Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement. Patients with chest pain most often contact the general practitioner (GP) instead of the recommended EMT, increasing delays as well. To decrease the delays by referring all patients promptly and without restriction to the emergency department (ED) is not feasible. Up to 80% of the patients with chest pain do not have a cardiac diagnosis and thus referral of all these patients would result in overcrowding of the ED. Triage is therefore crucial. Triage of patients with chest pain is therefore imperative and there is a great need of (validated) triage tools. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Long-term mortality in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: a real world clinical scenario

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Saaby, Lotte; Poulsen, Tina Svenstrup

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

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

    Czech Academy of Sciences Publication Activity Database

    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

  17. [Kounis syndrome: a paradoxal non-ST elevation myocardial infarction case after triamcinolone treatment for dermatitis].

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    Yılmaz, Mücahid; Korkmaz, Hasan

    2018-04-01

    Kounis syndrome is defined as the clinical development of acute coronary syndrome caused by the activation of inflammatory cells due to an allergy, hypersensitivity, anaphylaxis, or anaphylactic reaction. Corticosteroids that are used in the treatment of many inflammatory conditions may paradoxically cause allergic reactions and even anaphylaxis. This article is a description of the case of a 52-yearold female patient who had a non-ST elevation myocardial infarction after the administration of triamcinolone that was relieved with antihistaminic treatment. The patient had been diagnosed with dermatitis at another medical center and injected with 40 mg/mL (intravenous [IV]) of triamcinolone acetonide and developed chest pain 15 minutes after the first dose. Despite a normal physical examination and echocardiogram, laboratory tests revealed troponin positivity and an inferolateral ST depression was present on an electrocardiogram (ECG). The ECG findings and clinical symptoms resolved completely after conservative anti-ischemic treatment and antihistaminic therapy (pheniramine maleate 45.5 mg/2 mL, Avil ampoule, IV; Sanofi-Aventis, Paris, France) and coronary angiography evaluation of the arteries was normal. The heart, and in particular the coronary arteries, are among the organs that are most damaged during hypersensitivity reactions and anaphylaxis. Although Kounis syndrome is not a rare condition, few cases have been reported in clinical practice. The failure to recognize Kounis syndrome due to inadequately defined cases may lead to unwanted medical results. Kounis syndrome should be kept in mind in order to make a rapid and accurate diagnosis.

  18. Non-ST Elevation Myocardial Infraction after High Dose Intravenous Immunoglobulin Infusion

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    Meir Mizrahi

    2009-01-01

    Full Text Available Intravenous immunoglobulins (IVIgs are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4–6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI. The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization. This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.

  19. Osteoprotegerin and cardiovascular mortality in patients with non-ST elevation acute coronary syndromes

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    Røysland, Ragnhild; Bonaca, Marc P; Sabatine, Marc; Murphy, Sabina A; Scirica, Benjamin M; Bjerre, Mette; Flyvbjerg, Allan; Braunwald, Eugene; Morrow, David A

    2012-01-01

    Objective To assess the relationship between osteoprotegerin (OPG) and cardiovascular death, and the pathobiological mechanisms contributing to the association, in acute coronary syndromes (ACS). Design Prospective observational. Setting Biomarker substudy of MERLIN-TIMI 36, a randomised, placebo controlled trial of ranolazine in non-ST elevation (NSTE)-ACS. Patients 4463 patients with NSTE-ACS. Interventions Ranolazine or placebo. Main outcome measures Incidence of cardiovascular death (CV death); additionally, heart failure (HF), cardiac arrhythmias, inhospital ischaemia, severe recurrent ischaemia or recurrent myocardial infarction (MI). Results During a median follow-up of 341 days, 208 patients died of cardiovascular causes. The OPG baseline concentration was strongly associated with both 30 day and 1 year incidence of CV death. After adjustment for conventional risk markers, OPG concentrations (log transformed) remained a significant predictor of CV death by 30 days (HR (95% CI) 2.32 (1.30 to 4.17); p=0.005) and by 1 year (HR 1.85 (1.33 to 2.59); p<0.001). Baseline levels of OPG were also an independent predictor of new or worsening HF at 30 days (HR 2.25 (1.38 to 3.69); p=0.001) and 1 year (HR 1.81 (1.26 to 2.58) p=0.001). By univariable analysis, higher OPG was associated with both early ischaemic and arrhythmic events. Although OPG levels were associated with recurrent MI within 12 months, this association was attenuated and no longer significant after multivariable adjustment. Conclusions OPG is independently associated with 30 day and 1 year risk of cardiovascular mortality and HF development after NSTE-ACS. As no independent relationship between OPG levels and recurrent ischaemia or MI was observed, myocardial dysfunction may be a more important stimulus for OPG production than ischaemia in ACS. PMID:22373720

  20. Tissue characterization of non-culprit intermediate coronary lesions in non ST elevation acute coronary syndromes

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    Helmy Hassan Elghawaby

    2018-03-01

    Full Text Available Background: Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting. Methods: IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter. Results: Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%. Smoking in 17 (60.7%, hypertension in 16 (57.1%, Dyslipidemia in 12 (42.9% and DM in 8 (28.6%. Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P < 0.001 while a higher calcific content in lesions of non-culprit vessels (P < 0.001. Higher calcific content of proximal more than distal lesions (P = 0.048. Negative remodeling in 55.7% of lesions. Conclusions: A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well. Keywords: ACS: Acute coronary syndrome, Intermediate lesions, IVUS: Intravascular ultrasound, Vulnerable plaques, MHz: Mega Hertz

  1. Tissue characterization of non-culprit intermediate coronary lesions in non ST elevation acute coronary syndromes.

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    Elghawaby, Helmy Hassan; Shawky, Mohamed Ashraf; Mowafi, Ahmed Hossam; Abd-Elbary, Akram Mohamed; Faris, Farouk Mostafa

    2018-03-01

    Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting. IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter. Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) and DM in 8 (28.6%). Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels ( P  < 0.001) while a higher calcific content in lesions of non-culprit vessels ( P  < 0.001). Higher calcific content of proximal more than distal lesions ( P  = 0.048). Negative remodeling in 55.7% of lesions. A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well.

  2. In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry.

    Science.gov (United States)

    Donataccio, Maria Pia; Puymirat, Etienne; Parapid, Biljana; Steg, Philippe Gabriel; Eltchaninoff, Hélène; Weber, Simon; Ferrari, Emile; Vilarem, Didier; Charpentier, Sandrine; Manzo-Silberman, Stéphane; Ferrières, Jean; Danchin, Nicolas; Simon, Tabassome

    2015-12-15

    The early mortality of acute myocardial infarction (AMI) has dramatically decreased in the recent past. Whether the previously reported sex disparities in use of invasive strategies (IS) persist and translate into differences in outcomes deserves to be examined. We used the data from a nationwide French prospective multicentre registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%)) recruited in 223 centres in 2005 and followed-up for 5 years. We examined in-hospital outcomes and 5-year mortality in patients categorized according to sex and use of IS (i.e. coronary angiography during the hospitalisation with a view to revascularisation). IS was less frequently used in women than in men (adjusted OR=0.66; 95% CI: 0.52-0.85), regardless of the type of AMI, age group or risk category, while use of recommended medications was similar at 48 hours and discharge. In-hospital mortality did not differ according to sex, whatever the age group and use of an IS. At 5 years, overall and post-discharge mortality were similar in men and women. However, IS was associated with lower 5-year mortality in women (HR=0.66; 95% CI: 0.51-0.86) as in men (HR=0.48; 95% CI: 0.38-0.60) and there was no sex-strategy interaction. Invasive strategy remains less frequently used in women than in men, yet is associated with improved five-year survival irrespective of sex. Whether reducing the sex gap in its use would translate into a higher survival in women remains an open question. NCT 00673036. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Angiographic validation of magnetic resonance assessment of myocardium at risk in non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Buckert, Dominik; Mariyadas, Manuela; Walcher, Thomas; Rasche, Volker; Wöhrle, Jochen; Rottbauer, Wolfgang; Bernhardt, Peter

    2013-08-01

    In the setting of acute myocardial ischemia, the hypoperfused portion of the myocardium is in danger of becoming irreversibly injured. This portion is called the area at risk (AAR). It is of clinical interest to be able to estimate the AAR for further evaluation and improvement of different revascularization strategies. The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Score (APPROACH-score) has been shown to be a jeopardy score with a good performance for angiographic assessment of the myocardium supplied by a coronary vessel, representing the AAR. Recently, cardiac magnetic resonance imaging (CMR) has been demonstrated to also provide good results in determining the AAR, especially in the setting of acute ST-elevation infarction patients. Therefore, the aim of our trial was to compare T2-weighted CMR imaging for assessment of AAR in patients with non-ST-elevation myocardial infarction (NSTEMI) and to validate this approach against the angiographic APPROACH-score. We enrolled sixty-four patients presenting with acute NSTEMI that underwent coronary X-ray angiography within 72 h of symptom onset. Two blinded readers performed offline angiographic AAR assessment using the modified APPROACH-score, as being described elsewhere. Furthermore, with the use of a semi-automatic T2w-CMR approach, the AAR was quantified by two fully blinded readers. The resulting mean AAR determined by the modified APPROACH-score was 28.6 ± 10.0 %. The mean CMR derived AAR was 27.6 ± 12.7 %. CMR assessment tended to slightly underestimate the AAR in comparison to angiographic scoring (difference -0.09 ± 7.6 %). There is a good correlation between the AAR assessed by CMR and by angiography (r = 0.65, p < 0.001). T2-weigthed CMR is able to quantify the AAR with very good correlation to the angiographic APPROACH-score in NSTEMI patients.

  4. [Registry of non-ST elevation acute coronary syndromes in a tertiary hospital (RESCATA-SEST registry)].

    Science.gov (United States)

    González-Pliego, José Angel; Gutiérrez-Díaz, Gonzalo Israel; Celis, Alfredo; Gudiño-Amezcua, Diego Armando

    2014-01-01

    To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  5. Mode of hospital presentation in patients with non-ST-elevation myocardial infarction: implications for strategic management.

    Science.gov (United States)

    Tymchak, Wayne; Armstrong, Paul W; Westerhout, Cynthia M; Sookram, Sunil; Brass, Neil; Fu, Yuling; Welsh, Robert C

    2011-09-01

    Contemporary non-ST-elevation myocardial infarction-acute coronary syndrome guidelines emphasize early-risk stratification and optimizing therapy including an invasive strategy in high-risk patients. To assess the feasibility of initiating this strategy in the prehospital environment, we examined how such patients are transported to hospital, their risk profile, and the proportion potentially eligible for such a strategy. Consecutive patients with ST-segment elevation myocardial infarction admitted in Edmonton were studied between September and November 2008 and divided according to their mode of transport to hospital: emergency medical services (EMS) versus self-presenting. Baseline characteristics, GRACE Risk Score, blinded core laboratory electrocardiogram analysis, cardiac biomarkers, in-hospital procedures, and outcomes were analyzed. Thirty-five percent (93/263) of patients presented via EMS and often to percutaneous coronary intervention hospitals, that is, 64.5% versus 44.1% (P = .0016). They were older (75 vs 62 years, P < .001), more often female (43% vs 28.1%, P < .001), diabetic (34.4% vs 22.9%, P = .045), and hypertensive (72.0% vs 57.1%, P = .017) and had higher GRACE Risk Scores (median 166 vs 130, P < .001). Electrocardiogram analysis revealed more baseline Q waves (38.8% vs 25.5%, P = .031) and ST depression ≥2 mm (P = .027) in EMS-transported patients. Fewer EMS patients underwent cardiac catheterization (60.2% vs 88.2%, P < .001), and a paradoxical relationship existed between catheterization rates and GRACE Risk Score in the total cohort (low-risk: 93.4% vs high-risk: 59.3%, P < .001). The composite of death/re-myocardial infarction/congestive heart failure/shock was greater in EMS patients (unadjusted odds ratio 3.96, 95% CI 1.80-8.69, P = .001); these differences were attenuated after GRACE Risk Score adjustment. Regional strategies using risk-based triage, early medical therapy, and timely triage to percutaneous coronary intervention

  6. [Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial].

    Science.gov (United States)

    Namal, Esat; Sener, Nur; Ulaş, Turgay; Akçalı, Zafer; Oztekin, Erkan; Borlu, Fatih

    2011-12-01

    The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20 mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months . Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (punstable angina and non ST elevation myocardial infarction.

  7. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study

    NARCIS (Netherlands)

    Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; Verheugt, Freek W. A.; Hein Cornel, Jan; de Winter, Robbert J.

    2007-01-01

    BACKGROUND: The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or

  8. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study.

    NARCIS (Netherlands)

    Hirsch, A.; Windhausen, F.; Tijssen, J.G.P.; Verheugt, F.W.A.; Cornel, J.H.; Winter, R.J. de

    2007-01-01

    BACKGROUND: The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or

  9. Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary syndrome: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

    NARCIS (Netherlands)

    Damman, Peter; Kempf, Tibor; Windhausen, Fons; van Straalen, Jan P.; Guba-Quint, Anja; Fischer, Johan; Tijssen, Jan G. P.; Wollert, Kai C.; de Winter, Robbert J.; Hirsch, Alexander

    2014-01-01

    No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary

  10. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Wang, Tracy Y.; Bhatt, Deepak L.; Wiviott, Stephen D.; Amsterdam, Ezra A.; Li, Shuang; Thomas, Laine; de Winter, Robbert J.; Roe, Matthew T.

    2014-01-01

    Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. We evaluated patterns of use and patient features

  11. Application of current guidelines to the management of unstable angina and non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Braunwald, Eugene

    2003-10-21

    Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) is a common but heterogeneous disorder with patients exhibiting widely varying risks. Early risk stratification is at the center of the management program and can be achieved using clinical criteria and biomarkers, or a combination. In addition to anti-ischemic therapy and aspirin, the thienopyridine clopidogrel is indicated except in patients who are potential candidates for urgent coronary artery bypass grafting (CABG). Platelet glycoprotein (GP) IIb/IIIa antagonists are indicated in high-risk patients likely to undergo percutaneous coronary intervention (PCI) but are not indicated in the management of lower-risk patients who do not undergo PCI. There is a growing body of evidence to support the substitution of the low-molecular-weight heparin (LMWH) enoxaparin for unfractionated heparin (UFH). Three recent trials have demonstrated the benefit of an early invasive strategy with catheterization followed by revascularization in patients at high and intermediate risk. Lower-risk patients should undergo early noninvasive stress testing. An intensive program of secondary prevention is mandatory and should be begun before hospital discharge.

  12. Early invasive versus early conservative strategy in non-ST-elevation acute coronary syndrome: An outcome research study.

    Science.gov (United States)

    Tubaro, Marco; Sciahbasi, Alessandro; Ricci, Roberto; Ciavolella, Massimo; Di Clemente, Domenico; Bisconti, Carmela; Ferraiuolo, Giuseppe; Del Pinto, Maurizio; Mennuni, Mauro; Monti, Francesco; Vinci, Eugenio; Semeraro, Raffaella; Greco, Cesare; Berti, Sergio; Romano, Carlo; Aiello, Alessandro; Lo Bianco, Francesco; Pellecchia, Raffaele; Azzolini, Paolo; Ciuffetta, Domenico; Zappulo, Renato; Gigantino, Alberto; Arima, Serena; Colivicchi, Furio; Santini, Massimo

    2017-09-01

    An early invasive strategy (EIS) has been shown to yield a better clinical outcome than an early conservative strategy (ECS) in patients with non-ST-elevation acute coronary syndromes (NSTEACSs), particularly in those at higher risk according to the GRACE risk score. However, findings of the clinical trials have not been confirmed in registries. To investigate the outcome of patients with NSTEACS treated according to an EIS or a ECS in a real-world all-comers outcome research study. The primary hypothesis of the study was the non-inferiority of an ECS in comparison with an EIS as to a combined primary end-point of death, non-fatal myocardial infarction and hospital readmission for acute coronary syndromes at one year. Participating centres were divided into two groups: those with a pre-specified routine EIS and those with a pre-specified routine ECS. Two statistical analyses were performed: a) an 'intention to treat' analysis: all patients were considered to be treated according to the pre-specified routine strategy of that centre; b) a 'per protocol' analysis: patients were analysed according to the actual treatment applied. Cox model including propensity score correction was applied for all analyses. The intention to treat analysis showed an equivalence between EIS and ECS (11.4% vs. 11.1%) with regard to the primary end-point incidence at one year. In the three subgroups of patients according to the GRACE risk score (⩽ 108, 109-140, > 140), EIS and ECS confirmed their equivalence (5.3% vs. 3.9%, 8.4% vs. 7.6%, and 20.3% vs. 20.9%, respectively). When the per protocol analysis was applied, a reduction of the primary end-point at one year with EIS vs. ECS was demonstrated (6.2% vs. 15.3%, p=0.021); analysis of the subgroups according to the GRACE risk score numerically confirmed these data (3.1% vs. 6.5%, 5.1% vs. 10.0%, and 10.8% vs. 24.5%, respectively). In a real-life registry of all-comers NSTEACS patients, ECS was non-inferior to EIS; however, when EIS was

  13. Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Ängerud, Karin H; Sederholm Lawesson, Sofia; Isaksson, Rose-Marie; Thylén, Ingela; Swahn, Eva

    2017-11-01

    In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001). Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in patients with non-ST elevation acute coronary syndromes

    DEFF Research Database (Denmark)

    Zeymer, Uwe; Montalescot, Gilles; Ardissino, Diego

    2016-01-01

    The optimal time-point of the initiation of P2Y12 antagonist therapy in patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is still a matter of debate. European guidelines recommend P2Y12 as soon as possible after first medical contact. However, the only trial which compared the t...

  16. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    Science.gov (United States)

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

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

    Directory of Open Access Journals (Sweden)

    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.

  18. At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.

    Science.gov (United States)

    Zorzi, Alessandro; Turri, Riccardo; Zilio, Filippo; Spadotto, Veronica; Baritussio, Anna; Peruzza, Francesco; Gasparetto, Nicola; Marra, Martina Perazzolo; Cacciavillani, Luisa; Marzari, Armando; Tarantini, Giuseppe; Iliceto, Sabino; Corrado, Domenico

    2014-12-01

    Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients. We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)140 (OR=14.6; 95% CI 3.4-62) and LV-EF 140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%. Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality. © The European Society of Cardiology 2014.

  19. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care.

    Science.gov (United States)

    Youssef, G S; Kassem, H H; Ameen, O A; Al Taaban, H S; Rizk, H H

    2017-09-01

    Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities. To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country. Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related. We recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h. Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  20. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015.

    Science.gov (United States)

    Puymirat, Etienne; Simon, Tabassome; Cayla, Guillaume; Cottin, Yves; Elbaz, Meyer; Coste, Pierre; Lemesle, Gilles; Motreff, Pascal; Popovic, Batric; Khalife, Khalife; Labèque, Jean-Noel; Perret, Thibaut; Le Ray, Christophe; Orion, Laurent; Jouve, Bernard; Blanchard, Didier; Peycher, Patrick; Silvain, Johanne; Steg, Philippe Gabriel; Goldstein, Patrick; Guéret, Pascal; Belle, Loic; Aissaoui, Nadia; Ferrières, Jean; Schiele, François; Danchin, Nicolas

    2017-11-14

    ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010. © 2017 American Heart Association, Inc.

  1. Platelet and leukocyte ROS production and lipoperoxidation are associated with high platelet reactivity in Non-ST elevation myocardial infarction (NSTEMI) patients on dual antiplatelet treatment.

    Science.gov (United States)

    Becatti, Matteo; Fiorillo, Claudia; Gori, Anna Maria; Marcucci, Rossella; Paniccia, Rita; Giusti, Betti; Violi, Francesco; Pignatelli, Pasquale; Gensini, Gian Franco; Abbate, Rosanna

    2013-12-01

    High platelet reactivity (HPR) on dual antiplatelet therapy is a risk factor for adverse vascular events in acute coronary syndrome (ACS) patients. Several studies have shown that reactive oxygen species (ROS) may be involved in modulating platelet function. In Non-ST elevation myocardial infarction (NSTEMI) patients (n = 132) undergoing percutaneous coronary intervention (PCI) on dual antiplatelet therapy blood samples were collected within 24 h from 600 mg clopidogrel loading dose. Platelet reactivity was assessed by light transmission aggregometry using 10 μM ADP, 1 mM arachidonic acid (AA) and 2 μg/ml collagen. ROS production and lipoperoxidation of circulating cells were determined. by FACSCanto flow cytometry. In these patients, we investigated: 1) the relationship between the amount of cellular ROS production/lipoperoxidation and platelet reactivity; 2) the association of cellular ROS production with the presence of high platelet reactivity to ADP and arachidonic acid (AA). Significantly higher levels of platelet and leukocyte-derived ROS were detected in 49 dual HPR (with platelet aggregation by AA ≥ 20% and by ADP ≥ 70%) compared to non-HPR patients (n = 49) [Platelet-derived ROS: +142%; Leukocyte-derived ROS: +14%, p ROS and platelet and leukocyte lipoperoxidation remained significantly associated to dual HPR. The significant predictors of ADP, AA, and collagen platelet aggregation at multiple linear regression analysis, after adjusting for age, cardiovascular risk factors, procedural parameter, medications, leukocyte number and MPV, were platelet-, leukocyte-derived ROS and platelet and leukocyte lipoperoxidation (p ROS production by and lipoperoxidation of platelets are strictly correlated to the different pathways of platelet aggregation and that ROS production and lipoperoxidation of platelets and leukocytes are predictors of non responsiveness to dual antiplatelet treatment. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy.

    Science.gov (United States)

    Roldán Torres, Ildefonso; Salvador Mercader, Inmaculada; Cabadés Rumbeu, Claudia; Díez Gil, José Luis; Ferrando Cervelló, José; Monteagudo Viana, Marta; Fernández Galera, Rubén; Mora Llabata, Vicente

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m 2 . The composite primary end-point was cardiac death and non fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3-years according to the presence or absence of CKD. We included 248 p with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; P<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank P=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome.

    Science.gov (United States)

    Turner, Richard M; Yin, Peng; Hanson, Anita; FitzGerald, Richard; Morris, Andrew P; Stables, Rod H; Jorgensen, Andrea L; Pirmohamed, Munir

    High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice. To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM). A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months. There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14-2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30-14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25-3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38-4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence. Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  4. Preinfarct Health Status and the Use of Early Invasive Versus Ischemia-Guided Management in Non-ST-Elevation Acute Coronary Syndrome.

    Science.gov (United States)

    Qintar, Mohammed; Smolderen, Kim G; Chan, Paul S; Gosch, Kensey L; Jones, Philip G; Buchanan, Donna M; Girotra, Saket; Spertus, John A

    2017-10-01

    Early invasive management improves outcomes in non-ST-elevation myocardial infarction (NSTEMI). The association between preinfarct health status and the selecting patients for early invasive management is unknown. The Prospective Registry Evaluating outcomes after Myocardial Infarctions: Events and Recovery and Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health status are consecutive US multicenter registries, in which the associations between preinfarct angina frequency and quality of life (both assessed by the Seattle Angina Questionnaire on admission) and the Global Registry of Acute Coronary Events (GRACE) risk score and referral to early invasive management (coronary angiography within 48 hours) were evaluated using Poisson regression, after adjusting for site, demographics, and clinical and psychosocial variables. Of 3,768 patients with NSTEMI, 2,182 (57.9%) patients were referred for early invasive treatment. Patients with excellent, good, or very good baseline angina-specific quality of life, respectively, were more likely to receive early angiography, even after adjustment, as compared with patients reporting poor baseline quality of life because of angina (62.1.0%, 60.9%, 59.6%, vs 51.2%; adjusted relative risk [RR] = 1.09, 95% confidence interval [CI] 1.04 to 1.16; RR = 1.13, 95% CI 1.01 to 1.27; RR 1.14, 95% CI 0.99 to 1.31, respectively). Finally, patients with a GRACE score in the highest risk decile (199.5 to management. Further work is needed to understand the role of preinfarct health status and in-hospital treatment strategy. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Predictive value of neutrophil to lymphocyte ratio in clinical outcomes of non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

    Science.gov (United States)

    Gul, Mehmet; Uyarel, Huseyin; Ergelen, Mehmet; Ugur, Murat; Isık, Turgay; Ayhan, Erkan; Turkkan, Ceyhan; Aksu, Hale Unal; Akgul, Ozgur; Uslu, Nevzat

    2014-05-01

    We sought to determine the prognostic value of neutrophil to lymphocyte ratio (NLR) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). A total of 308 (mean age 59.22 ± 11.93) patients with NSTEMI and UAP were prospectively evaluated. The study population was divided into tertiles based on admission NLR values. The patients were followed for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, 3-year mortality was 21.6% in patients with high NLR versus 3% in the low-NLR group (P 3.04 yielded a sensitivity of 79% and specificity of 71%. Admission NLR is the strong and independent predictor of a 3-year cardiovascular mortality in patients with NSTEMI and UAP.

  6. Patient perspectives on engagement in decision-making in early management of non-ST elevation acute coronary syndrome: a qualitative study.

    Science.gov (United States)

    Wilson, Todd; Miller, Jean; Teare, Sylvia; Penman, Colin; Pearson, Winnie; Marlett, Nancy J; Shklarov, Svetlana; Diane Galbraith, P; Southern, Danielle A; Knudtson, Merril L; Norris, Colleen M; James, Matthew T; Wilton, Stephen B

    2017-11-28

    Surveys of patients suggest many want to be actively involved in treatment decisions for acute coronary syndromes. However, patient experiences of their engagement and participation in early phase decision-making have not been well described. We performed a patient led qualitative study to explore patient experiences with decision-making processes when admitted to hospital with non-ST elevation acute coronary syndrome. Trained patient-researchers conducted the study via a three-phase approach using focus groups and semi-structured interviews and employing grounded theory methodology. Twenty patients discharged within one year of a non-ST elevation acute coronary syndrome participated in the study. Several common themes emerged. First, patients characterized the admission and early treatment of ACS as a rapidly unfolding process where they had little control. Participants felt they played a passive role in early phase decision-making. Furthermore, participants described feeling reduced capacity for decision-making owing to fear and mental stress from acute illness, and therefore most but not all participants were relieved that expert clinicians made decisions for them. Finally, once past the emergent phase of care, participants wanted to retake a more active role in their treatment and follow-up plans. Patients admitted with ACS often do not take an active role in initial clinical decisions, and are satisfied to allow the medical team to direct early phase care. These results provide important insight relevant to designing patient-centered interventions in ACS and other urgent care situations.

  7. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners’ perceptions.

    NARCIS (Netherlands)

    Engel, J.; Heeren, M.J.; Wulp, I. van der; Bruijne, M.C. de; Wagner, C.

    2014-01-01

    Background Cardiac risk scores estimate a patient’s risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and

  8. 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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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

    DEFF Research Database (Denmark)

    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......). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. Methods: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR...... was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days...

  10. Correlation of cardiac Troponin I levels (10 folds upper limit of normal) and extent of coronary artery disease in Non-ST elevation myocardial infarction

    International Nuclear Information System (INIS)

    Qadir, F.; Khan, M.; Hanif, B.; Lakhani, S.L.; Farooq, S.

    2010-01-01

    Objective: To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). Methods: A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis > 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. Results: Out of 230 patients, in 111 patients with cTnI levels 10 folds ULN, 23(19.3%) had single vessel, 37(31.1 %) had two vessel and 55(46.2%) had three vessel significant CAD. The results suggest that there was an insignificant association between the cTnI levels and single vessel, two vessel and the overall CAD extent (p= 0.35, p= 0.21 and p= 0.13 respectively), however there was a statistically significant association between the cTnI levels and three vessel CAD (p < 0.04). Conclusion: Higher cTnI levels are associated with an increased proportion of severe three vessel CAD involvement. Prompt identification and referral of this patient subset to early revascularization strategies would improve clinical outcomes. (author)

  11. Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non-ST Elevation Myocardial Infarction: Insights From the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (NCDR ACTION Registry-GWTG).

    Science.gov (United States)

    Pandey, Ambarish; McGuire, Darren K; de Lemos, James A; Das, Sandeep R; Berry, Jarett D; Brilakis, Emmanouil S; Banerjee, Subhash; Marso, Steven P; Barsness, Gregory W; Simon, DaJuanicia N; Roe, Matthew; Goyal, Abhinav; Kosiborod, Mikhail; Amsterdam, Ezra A; Kumbhani, Dharam J

    2016-05-01

    Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; Ptrend=0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; ptrend=0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. © 2016 American Heart Association, Inc.

  12. ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes - A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial

    NARCIS (Netherlands)

    Windhausen, Fons; Hirsch, Alexander; Tijssen, Jan G. P.; Cornel, Jan Hein; Verheugt, Freek W. A.; Klees, Margriet I.; de Winter, Robbert J.

    2007-01-01

    Background: We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive

  13. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

    NARCIS (Netherlands)

    Windhausen, Fons; Hirsch, Alexander; Sanders, Gerard T.; Cornel, Jan Hein; Fischer, Johan; van Straalen, Jan P.; Tijssen, Jan G. P.; Verheugt, Freek W. A.; de Winter, Robbert J.

    2007-01-01

    BACKGROUND: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this

  14. [Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome].

    Science.gov (United States)

    de Miguel-Balsa, E; Baeza-Román, A; Pino-Izquierdo, K; Latour-Pérez, J; Coves-Orts, F J; Alcoverro-Pedrola, J M; Pavía-Pesquera, M C; Felices-Abad, F; Calvo-Embuena, R

    2014-11-01

    To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS). A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression. Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72 h). Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode. Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p 80 years (OR 0.48, 95% CI 0.27 to 0.82, p=0.009), known coronary lesions (OR 0.47, 95% CI 0.26-0.84, p=0.011), and heart rate (OR 0.98, 95% CI 0.97-0.99, p=0.003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p=0.013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p 80 years and increased heart rate were independent factors associated to conservative treatment. Copyright © 2012 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  15. Role of 64-slice cardiac computed tomography in the evaluation of patients with non-ST-elevation acute coronary syndrome.

    Science.gov (United States)

    Romagnoli, A; Martuscelli, E; Sperandio, M; Arganini, C; De Angelis, B; Acampora, V; Patrei, A; Bazzocchi, G; Romeo, F; Simonetti, G

    2010-04-01

    This study was done to evaluate the feasibility, sensitivity and specificity of 64-slice computed tomography (CT) in identifying haemodynamically significant (>50%) coronary artery stenoses in patients with suspected acute coronary syndrome (ACS) by correlating the CT findings with the clinical event and data provided by conventional coronary angiography (CCA). Sixty-four patients (38 men and 26 women; mean age 65 years; range+/-10 years) presenting to our hospital's emergency department with a clinical suspicion of ACS were studied with 64-slice CT followed by CCA within 24 h of arrival. Two patients (3.1%) were excluded from the analysis due to artefacts. Per-patient analysis in the remaining 62 patients identified 24 cases (38.7%) of negative CT findings (no stenoses or stenoses 50%, seven overestimated vessels (3.7%) due to extensive calcifications, three vessels (1.6%) with underestimated stenosis and 98 vessels (52.6%) without stenosis. Sensitivity and specificity were 95.3% and 93.3%, respectively. In this type of emergency, coronary CT angiography could lead to considerably lower healthcare costs by identifying patients without coronary disease and allowing immediate discharge without any need for further diagnostic procedures.

  16. Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.

    Science.gov (United States)

    Jobs, Alexander; Mehta, Shamir R; Montalescot, Gilles; Vicaut, Eric; Van't Hof, Arnoud W J; Badings, Erik A; Neumann, Franz-Josef; Kastrati, Adnan; Sciahbasi, Alessandro; Reuter, Paul-Georges; Lapostolle, Frédéric; Milosevic, Aleksandra; Stankovic, Goran; Milasinovic, Dejan; Vonthein, Reinhard; Desch, Steffen; Thiele, Holger

    2017-08-19

    A routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality. We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988). We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180-360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64-1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581-0·996), diabetes (0·67, 0·45-0·99), a GRACE risk score more than 140 (0·70, 0·52-0·95), and aged 75 years older (0·65, 0·46-0·93), although tests for interaction were inconclusive. An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial.

    Science.gov (United States)

    Windhausen, Fons; Hirsch, Alexander; Tijssen, Jan G P; Cornel, Jan Hein; Verheugt, Freek W A; Klees, Margriet I; de Winter, Robbert J

    2007-01-01

    We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive treatment strategy. A 12-lead ECG obtained at admission was available for analysis from 1163 patients. The presence and magnitude of ST-segment deviation was measured in each lead, and absolute ST-segment deviation was summed. The effect of treatment strategy was assessed for patients with or without SigmaST-segment deviation of at least 1 mm. The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 mm, the incidence of death or MI was 21.9% in the early invasive group compared with 14.2% in SI group (P < .01). However, we observed a significantly higher rate of MI after hospital discharge among patients with SigmaST-segment deviation of at least 1 mm randomized to SI who did not undergo angiography compared with patients who underwent angiography before discharge (10.9% vs 2.4%, P = .003). In a forward logistic regression analysis, the presence of ST-segment deviation was an independent predictor for failure of medical therapy (coronary angiography within 30 days after randomization in the SI group) (odds ratio, 1.56; 95% confidence interval, 1.12-2.18; P = .009). Patients with non-ST-elevation acute coronary syndrome and an elevated troponin T and SigmaST-segment deviation of at least 1 mm are at increased risk of death or MI, more often fail on medical therapy, and more often experience a spontaneous MI after discharge when angiography was not performed during initial hospitalization.

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

    Czech Academy of Sciences Publication Activity Database

    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

  19. Clinical characteristics, process of care and outcomes among Mexican, Hispanic and non-Hispanic white patients presenting with non-ST elevation acute coronary syndromes: Data from RENASICA and CRUSADE registries

    OpenAIRE

    Sánchez-Diaz,Carlos Jerjes; García-Badillo,Edgar; Sánchez-Ramírez,Carlos Jerjes; Juárez,Úrsulo; Martínez-Sánchez,Carlos

    2012-01-01

    Introduction: Data regarding management characteristics of non-ST elevation acute coronary syndromes (NSTE ACS) in Mexican, Hispanic and Non- Hispanic white patients are scarce. Methods: We sought to describe the clinical characteristics, process of care, and outcomes of Mexicans, Hispanics and non-Hispanic whites presenting with NSTE ACS at Mexican and US hospitals. We compared baseline characteristics, resource use, clinical practice guidelines (CPGs) compliance and in-hospital mortality am...

  20. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores.

    Science.gov (United States)

    Schellings, Dirk Aam; Adiyaman, Ahmet; Dambrink, Jan-Henk E; Gosselink, At Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; Van't Hof, Arnoud Wj

    2016-01-01

    The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable. To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS. Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement. A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p =0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 ( p =0.57), integrated discrimination improvement 0.04 ( p =0.003), net reclassification improvement 0.12 ( p =0.21). In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated.

  1. Trends in time to invasive examination and treatment from 2001 to 2009 in patients admitted first time with non-ST elevation myocardial infarction or unstable angina in Denmark

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2014-01-01

    OBJECTIVE: To investigate trends in time to invasive examination and treatment for patient with first time diagnosis of non-ST elevation myocardial infarction (NSTEMI) and unstable angina during the period from 2001 to 2009 in Denmark. DESIGN: From 1 January 2001 to 31 December 2009 all first time...... hospitalisations with NSTEMI and unstable angina were identified in the National Patient Registry (n=65 909). Time from admission to initiation of coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was calculated. We described the development in invasive...... increased substantially over time while the proportion receiving a CABG decreased for both NSTEMI and unstable angina. For both NSTEMI and unstable angina, a significant increase in invasive examination and treatment probability at 3 days for CAG and PCI were seen especially from 2007 through to 2009...

  2. Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2016-01-01

    Aims: Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial...... infarction (NSTEMI) in Denmark. Methods and results: All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary...... artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality. Conclusions: Despite...

  3. Rationale and design of the DEAR-OLD trial: Randomized evaluation of routinely Deferred versus EARly invasive strategy in elderly patients of 75 years or OLDer with non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Leng, Wen-Xiu; Yang, Jingang; Li, Wei; Wang, Yang; Yang, Yue-Jin

    2018-02-01

    Comparing with conservative strategy, early invasive approach has been shown to be beneficial for initially stabilized patients with non-ST-elevation myocardial infarction (NSTEMI). However, concerns of increased risk of bleeding and other complications associated with early revascularization in patients aged ≥75 years persist. A routinely deferred invasive strategy aiming to facilitate revascularization after stabilizing the culprit lesion predominates across China. The aim was to compare efficacy and safety of deferred invasive strategy versus guideline-recommended early invasive strategy in initially stabilized Chinese patients aged ≥75 years with NSTEMI. Twenty qualified centers from 10 different provinces throughout mainland China will contribute to the study. Eligible patients will be central randomized to a routine deferred invasive approach or an early invasive approach (coronary angiography >72 hours or evaluating efficacy and safety of routinely deferred invasive strategy compared with early invasive strategy in Chinese elderly patients with NSTEMI. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort.

    Science.gov (United States)

    Miyachi, Hideki; Takagi, Atsushi; Miyauchi, Katsumi; Yamasaki, Masao; Tanaka, Hiroyuki; Yoshikawa, Masatomo; Saji, Mike; Suzuki, Makoto; Yamamoto, Takeshi; Shimizu, Wataru; Nagao, Ken; Takayama, Morimasa

    2016-11-01

    Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009-2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p < 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p < 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients.

  5. Rule-out of non-ST elevation myocardial infarction by five point of care cardiac troponin assays according to the 0 h/3 h algorithm of the European Society of Cardiology.

    Science.gov (United States)

    Suh, Durie; Keller, Dagmar I; Hof, Danielle; von Eckardstein, Arnold; Gawinecka, Joanna

    2018-03-28

    Point of care (POC) assays for cardiac troponins I or T (cTnI or cTnT) may accelerate the diagnosis of patients with suspected acute coronary syndrome (ACS). However, their clinical utility according to the 0 h/3 h algorithm recommended by the European Society of Cardiology (ESC) for non-ST elevation myocardial infarction (NSTEMI) is unknown. Blood samples from 90 patients with suspected ACS were obtained at hospital admission and 3 h later. Concentrations of cTn were determined using five POC assays (AQT90 FLEX cTnI and cTnT; PATHFAST™ cTnI; Stratus CS 200 cTnI; and Triage MeterPro cTnI) and two guideline-acceptable high-sensitivity (hs) immunoassays. For the diagnosis of NSTEMI (n=15), AUCs for Abbott hs-cTnI and Roche hs-cTnT were 0.86 [95% confidence interval (CI), 0.75-0.96] and 0.88 (95% CI, 0.80-0.95), respectively, at admission, and 0.96 and 0.94, respectively, 3 h later. With the 99th percentile cutoff, their sensitivities were 62% and 92%, respectively, at admission, and 77% and 100%, respectively, 3 h later. The PATHFAST™ cTnI assay showed AUCs of 0.90 (95% CI, 0.82-0.97) and 0.94 (95% CI, 0.89-1.00), respectively, and sensitivities of 67% and 75% at admission and 3 h later, respectively. The other cTn POC assays had AUCs of 0.71 (95% CI, 0.53-0.89) to 0.84 (95% CI, 0.71-0.96) and 0.86 (95% CI, 0.72-0.99) to 0.87 (95% CI, 0.75-0.99) and sensitivities of 39%-50% and 62%-77% at admission and 3 h later, respectively. PATHFAST™ cTnI assay proved itself as comparable to ESC-guideline acceptable hs-cTn assays. The lower sensitivity of the other POC assays limits their clinical utility and would require longer follow-up monitoring of patients for the safe NSTEMI rule-out.

  6. Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary syndrome: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.

    Science.gov (United States)

    Damman, Peter; Kempf, Tibor; Windhausen, Fons; van Straalen, Jan P; Guba-Quint, Anja; Fischer, Johan; Tijssen, Jan G P; Wollert, Kai C; de Winter, Robbert J; Hirsch, Alexander

    2014-03-15

    No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This is a subanalysis from the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial, including troponin positive NSTE-ACS patients. The main outcome for the current analysis was 5-year death or spontaneous MI. GDF-15 samples were available in 1151 patients. The prognostic value of GDF-15, categorized into 1800 ng/L, was assessed in unadjusted and adjusted Cox regression models. Adjustments were made for identified univariable risk factors. The additional discriminative and reclassification value of GDF-15 beyond the independent risk factors was assessed by the category-free net reclassification improvement (1/2 NRI(>0)) and the integrated discrimination improvement (IDI) RESULTS: Compared to GDF-151800 ng/L was associated with an increased hazard ratio for death or spontaneous MI, mainly driven by mortality. GDF-15 levels were predictive after adjustments for other identified predictors. Additional discriminative value was shown with the IDI, not with the NRI. In patients presenting with NSTE-ACS and elevated troponin T, GDF-15 provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study.

    Science.gov (United States)

    Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; Verheugt, Freek W A; Cornel, Jan Hein; de Winter, Robbert J

    2007-03-10

    The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or rehospitalisation after 1 year. We did a follow-up study to assess the effects of these treatment strategies after 4 years. 1200 patients with nSTE-ACS and an elevated cardiac troponin were enrolled from 42 hospitals in the Netherlands. Patients were randomly assigned either to an early invasive strategy, including early routine catheterisation and revascularisation where appropriate, or to a more selective invasive strategy, where catheterisation was done if the patient had refractory angina or recurrent ischaemia. The main endpoints for the current follow-up study were death, recurrent myocardial infarction, or rehospitalisation for anginal symptoms within 3 years after randomisation, and cardiovascular mortality and all-cause mortality within 4 years. Analysis was by intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN82153174. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the combined endpoint was 30.0% in the early invasive group compared with 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI 0.97-1.50; p=0.09). Myocardial infarction was more frequent in the early invasive strategy group (106 [18.3%] vs 69 [12.3%]; HR 1.61; 1.19-2.18; p=0.002). Rates of death or spontaneous myocardial infarction were not different (76 [14.3%] patients in the early invasive and 63 [11.2%] patients in the selective invasive strategy [HR 1.19; 0.86-1.67; p=0.30]). No difference in all-cause mortality (7.9%vs 7.7%; p=0.62) or cardiovascular mortality (4.5%vs 5.0%; p=0.97) was seen within 4 years. Long-term follow-up of

  8. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners' perceptions.

    Science.gov (United States)

    Engel, Josien; Heeren, Marie-Julie; van der Wulp, Ineke; de Bruijne, Martine C; Wagner, Cordula

    2014-09-22

    Cardiac risk scores estimate a patient's risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and evidence of their prognostic value, they seem underused in practice. The purpose of the study was to gain insight in the motivation for implementing cardiac risk scores, and perceptions of health care practitioners towards the use of these instruments in clinical practice. This qualitative study involved semi-structured interviews with 31 health care practitioners at 11 hospitals throughout the Netherlands. Participants were approached through purposive sampling to represent a broad range of participant- and hospital characteristics, and included cardiologists, medical residents, medical interns, nurse practitioners and an emergency physician. The Pettigrew and Whipp Framework for strategic change was used as a theoretical basis. Data were initially analysed through open coding to avoid forcing data into categories predetermined by the framework. Cardiac risk score use was dependent on several factors, including IT support, clinical relevance for daily practice, rotation of staff and workload. Both intrinsic and extrinsic drivers for implementation were identified. Reminders, feedback and IT solutions were strategies used to improve and sustain the use of these instruments. The scores were seen as valuable support systems in improving uniformity in treatment practices, educating interns, conducting research and quantifying a practitioner's own risk assessment. However, health care practitioners varied in their perceptions regarding the influence of cardiac risk scores on treatment decisions. Health care practitioners disagree on the value of cardiac risk scores for clinical practice. Practitioners driven by intrinsic motivations predominantly experienced benefits in policy-making, education and research

  9. 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

    International Nuclear Information System (INIS)

    Mahmood, M.; Achakzai, A.S.; Akhtar, P.; Zaman, K.S.

    2013-01-01

    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)

  10. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.

    Science.gov (United States)

    Windhausen, Fons; Hirsch, Alexander; Sanders, Gerard T; Cornel, Jan Hein; Fischer, Johan; van Straalen, Jan P; Tijssen, Jan G P; Verheugt, Freek W A; de Winter, Robbert J

    2007-04-01

    New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (> or = 1170 ng/L for men, > or = 2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

  11. Meta-Analysis of Randomized Trials of Long-Term All-Cause Mortality in Patients With Non-ST-Elevation Acute Coronary Syndrome Managed With Routine Invasive Versus Selective Invasive Strategies.

    Science.gov (United States)

    Elgendy, Islam Y; Mahmoud, Ahmed N; Wen, Xuerong; Bavry, Anthony A

    2017-02-15

    Randomized trials and meta-analyses demonstrated that a routine invasive strategy improves outcomes in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) compared to a selective invasive strategy. Benefit was driven primarily by a reduction in the risk of myocardial infarction. However, the impact of either strategy on long-term mortality is unknown. Trials that compared a routine invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and reported data on all-cause mortality ≥1 year were included. Summary odds ratios (OR) were constructed using Peto's model for all-cause mortality using the longest available follow-up data. Subgroup analysis was performed for follow-up at 1 to ≤5 years and >5 years. Eight trials with 6,657 patients were available for analysis. At a mean of 10.3 years, the risk of all-cause mortality was similar with both strategies (28.5% vs 28.5%; OR 1.00, 95% confidence interval [CI] 0.90 to 1.12, p = 0.97). This effect was similar on subgroup analysis for follow-up at 1 to ≤5 years (OR 0.89, 95% CI 0.77 to 1.04, p = 0.15) and >5 years (OR 1.02, 95% CI 0.90 to 1.14, p = 0.79). There was no difference in treatment effect across various study-level covariates such as age, gender, diabetes, and positive troponin (all P for interaction >0.05). In conclusion, in patients with NSTE-ACS, both routine invasive and selective invasive strategies have a similar risk of all-cause mortality at ∼10 years. This illustrates there are still opportunities to change the trajectory of mortality events among invasively treated patients with NSTE-ACS. Published by Elsevier Inc.

  12. Non-ST Elevation Myocardial Infarction and Severe Peripheral Artery Disease in a 20-Year-Old with Perinatally Acquired Human Immunodeficiency Virus Infection

    Directory of Open Access Journals (Sweden)

    Purva Sharma

    2018-01-01

    Full Text Available Human immunodeficiency virus (HIV infection confers an increased risk of cardiovascular disease, including acute coronary syndrome (ACS. Patients with perinatally acquired HIV may be at increased risk due to the viral infection itself and exposure to HAART in utero or as part of treatment. A 20-year-old female with transplacentally acquired HIV infection presented with symptoms of transient aphasia, headache, palpitations, and blurry vision. She was admitted for hypertensive emergency with blood pressure 203/100 mmHg. Within a few hours, she complained of typical chest pain, and ECG showed marked ST depression. Troponin I levels escalated from 0.115 to 10.8. She underwent coronary angiogram showing 95% stenosis of the right coronary artery (RCA and severe peripheral arterial disease including total occlusion of both common iliacs and 95% infrarenal aortic stenosis with collateral circulation. She underwent successful percutaneous intervention with a drug-eluting stent to the mid-RCA. Patients with HIV are at increased risk for cardiovascular disease. Of these, coronary artery disease is one of the most critical complications of HIV. Perinatally acquired HIV infection can be a high-risk factor for cardiovascular disease. A high degree of suspicion is warranted in such patients, especially if they are noncompliant to their ART.

  13. [Combined high-sensitivity copeptin and troponin T evaluation for the diagnosis of non-ST elevation acute coronary syndrome in the emergency department].

    Science.gov (United States)

    Alquézar, Aitor; Santaló, Miguel; Rizzi, Miguel; Gich, Ignasi; Grau, Margarita; Sionis, Alessandro; Ordóñez-Llanos, Jordi

    2017-07-01

    To assess the diagnostic yield of a high-sensitivity copeptin (hs-copep) assay alone or in combination with a high-sensitivity cardiac troponin T (hs-cTnt) assay for the diagnosis of non-ST segment elevation acute coronary syndrome (NSTEMI) in patients with chest pain in the emergency department (ED). The secondary aim was to assess the 1-year prognostic utility of these biomarkers in this clinical context. Retrospective observational study of a series of patients attended for chest pain suggesting myocardial ischemia in 5 Spanish ED. The first blood drawn in the ED was used for hs-copep and hs-cTnt assays, which were processed in a single laboratory serving all centers. Diagnostic utility was assessed by sensitivity, specificity, positive and negative predictive values and likelihood ratios, and the area under the receiver operating characteristic curve (ROC). We also performed a separate analysis with data for the subgroup of patients with early detection of symptoms (3 h of onset of symptoms). We recorded complications, mortality or reinfarction occurring within a year of the index event. We included 297 patients; 63 (21.2%) with NSTEMI. The median age was 69 years (interquartile range, 70-76 years), and 199 (67%) were men. The ROC was 0.89 (95% CI, 0.85-0.94) for the hs-cTnt assay, 0.58 (95% CI, 0.51-0.66) for the hscopep assay, and 0.90 (95% CI, 0.86-0.94) for the 2 assays combined. The ROC for the 2 assays combined was not significantly better than the ROC for the hs-cTnt by itself (P=.89). We saw the same pattern of results when we analyzed the subgroup of patients who presented early. Sixty percent of the complications occurred in patients with elevated findings on both assays. Elevated hs-copep findings did not provide prognostic information that was not already provided by hs-cTnt findings (P=.56). The hs-copep assay does not increase the diagnostic or prognostic yield already provided by the hs-cTnt assay in patients suspected of myocardial infarction in

  14. The relationship between red blood cell distribution width and the clinical outcomes in non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

    Science.gov (United States)

    Gul, Mehmet; Uyarel, Huseyin; Ergelen, Mehmet; Karacimen, Denizhan; Ugur, Murat; Turer, Ayca; Bozbay, Mehmet; Ayhan, Erkan; Akgul, Ozgur; Uslu, Nevzat

    2012-08-01

    Red blood cell distribution width (RDW), a marker of variation in the size of the circulating red blood cells, was evaluated in patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). Higher RDW is associated with mortality in the general population, particularly in those with symptomatic cardiovascular disease, and heart failure. We hypothesized that admission RDW might be predictive of adverse clinical outcomes for patients with NSTEMI and UAP. We prospectively enrolled 310 patients with NSTEMI and UAP (mean age 59.3±11.9 years; 236 men, 74 women) in this study. Admission RDW was measured and the study population was classified on the basis of RDW tertiles. A high RDW (n=95) was defined as a value in the upper third tertile (>14%) and a low RDW (n=215) was defined as any value in the lower two tertiles (≤14%). The patients were followed up for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, the 3-year mortality rate was 19% in the high RDW group versus 5.6% in the low RDW group (P<0.001). In the receiver operating characteristic curve analysis, an RDW value of more than 14% yielded a sensitivity of 60% and a specificity of 72.5%. A significant association was found between a high admission RDW level and the adjusted risk of cardiovascular mortality (hazard ratio: 3.2, 95% confidence interval: 1.3-7.78, P=0.01). RDW is a readily available clinical laboratory value associated with long-term cardiovascular mortality in NSTEMI and UAP.

  15. Pre-event quality of life and its influence on the post-event quality of life among patients with ST elevation and non-ST elevation myocardial infarctions of a premier province of Sri Lanka.

    Science.gov (United States)

    Mahesh, P K B; Gunathunga, M W; Jayasinghe, Saroj; Arnold, S M; Haniffa, R; De Silva, A P

    2017-08-01

    Pre-event Quality of Life (QOL) reflects the true social circumstances in which people live prior to the onset of myocardial infarctions. It is believed to be a predictor of the post-event QOL. The aim of this study was to describe the pre-event QOL and its influence on the post-event Quality of Life among patients with ST elevation (STEMI) and Non-ST elevation myocardial infarctions (NSTEMI) using Short Form-36 (SF-36), a generic QOL tool with 8 domains. Documented literature is rare in this regard in Sri Lanka, which is a lower-middle-income country. A cross-sectional study with a 28-day post-discharge follow-up was carried out in 13 hospitals. Three hundred and forty-four patients who were diagnosed with STEMI or NSTEMI were recruited during the hospital stay. The pre-event QOL was measured using an interviewer-administered questionnaire which included the SF-36 QOL tool and medical details. Follow-up QOL was gathered using a questionnaire that was filled and posted back by participants. Of the recruited sample, 235 responded for the follow-up component. Analysis was conducted for associations between pre- and post-discharge QOL. Furthermore, comparisons were made between the STEMI and NSTEMI groups. Mann Whiney U test, Wilcoxon signed rank test and chi square test were used in the analysis. The post-event QOL was lower in seven out of eight domains than the pre-event QOL (p event QOL for seven domains (p  0.05) between the STEMI and NSTEMI groups. Post-discharge general-health QOL domain score was higher than the pre-MI score (p = 0.028) and was higher in the STEMI group compared to the NSTEMI group (p = 0.042). Regression analysis showed a significant beta coefficient between pre- and post-QOL for five domains in STEMI and for all domains in NSTEMI groups when adjusted for the disease severity. The R square values ranged from 12.3 to 62.3% for STEMI and 7.3 to 64.8% for NSTEMI. Pre-event QOL is lower in the NSTEMI group compared to the STEMI group

  16. Timing of Angiography With a Routine Invasive Strategy and Long-Term Outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome A Collaborative Analysis of Individual Patient Data From the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials

    NARCIS (Netherlands)

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A. A.; Clayton, Tim; Pocock, Stuart J.; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; de Winter, Robbert J.

    2012-01-01

    Objectives This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. Background The optimal timing of angiography in patients with nSTE-ACS is currently

  17. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial.

    Science.gov (United States)

    Tegn, Nicolai; Abdelnoor, Michael; Aaberge, Lars; Endresen, Knut; Smith, Pål; Aakhus, Svend; Gjertsen, Erik; Dahl-Hofseth, Ola; Ranhoff, Anette Hylen; Gullestad, Lars; Bendz, Bjørn

    2016-03-12

    Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540. During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent

  18. Role of 2D speckle tracking echocardiography in predicting acute coronary occlusion in patients with non ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Viola William Keddeas

    2017-06-01

    Conclusion: Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

  19. Prognostic comparison between creatinine-based glomerular filtration rate formulas for the prediction of 10-year outcome in patients with non-ST elevation acute coronary syndrome treated by percutaneous coronary intervention.

    Science.gov (United States)

    Ballo, Piercarlo; Chechi, Tania; Spaziani, Gaia; Fibbi, Veronica; Conti, Duccio; Ferro, Giuseppe; Nigrelli, Santi; Dattolo, Pietro; Fazi, Antonio; Santoro, Giovanni Maria; Zuppiroli, Alfredo; Pizzarelli, Francesco

    2017-03-01

    Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), but which estimation formula provides the best long-term risk stratification in this setting is still unclear. We compared the prognostic performance of four creatinine-based formulas for the prediction of 10-year outcome in a NSTE-ACS population treated by percutaneous coronary intervention. In 222 NSTE-ACS patients submitted to percutaneous coronary intervention, eGFR was calculated using four formulas: Cockcroft-Gault, re-expressed modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-Epi), and Mayo-quadratic. Predefined endpoints were all-cause death and a composite of cardiovascular death, non-fatal reinfarction, clinically driven repeat revascularisation, and heart failure hospitalisation. The different eGFR values showed poor agreement, with prevalences of renal dysfunction ranging from 14% to 35%. Over a median follow-up of 10.2 years, eGFR calculated by the CKD-Epi and Mayo-quadratic formulas independently predicted outcome, with an increase in the risk of death and events by up to 17% and 11%, respectively, for each decrement of 10 ml/min/1.73 m 2 . The Cockcroft-Gault and MDRD equations showed a borderline association with mortality and did not predict events. When compared in terms of goodness of fit, discrimination and calibration, the Mayo-quadratic outperformed the other formulas for the prediction of death and the CKD-Epi showed the best performance for the prediction of events (net reclassification improvement values 0.33-0.35). eGFR is an independent predictor of long-term outcome in patients with NSTE-ACS treated by percutaneous coronary intervention. The Mayo-quadratic and CKD-Epi equations might be superior to classic eGFR formulas for risk stratification in these patients.

  20. 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

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

    2015-01-01

    ,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...

  1. 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.

    Science.gov (United States)

    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

    2015-09-15

    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-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical 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 women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women. Published by Elsevier Inc.

  2. 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

    Directory of Open Access Journals (Sweden)

    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

  3. Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials)

    DEFF Research Database (Denmark)

    Damman, Peter; Holmvang, Lene; Tijssen, Jan G P

    2012-01-01

    the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set, admission ECG characteristics provided long-term prognostic value for cardiovascular death or myocardial infarction. Quantitative...... ECG characteristics provided no incremental discrimination compared to qualitative data.......The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During...

  4. Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials).

    Science.gov (United States)

    Damman, Peter; Holmvang, Lene; Tijssen, Jan G P; Lagerqvist, Bo; Clayton, Tim C; Pocock, Stuart J; Windhausen, Fons; Hirsch, Alexander; Fox, Keith A A; Wallentin, Lars; de Winter, Robbert J

    2012-01-01

    The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data, were included in this analysis. The main outcome was 5-year cardiovascular death or myocardial infarction. Hazard ratios (HRs) were calculated with Cox regression models, and adjustments were made for established outcome predictors. The additional discriminative value was assessed with the category-less net reclassification improvement and integrated discrimination improvement indexes. In the 5,420 patients, the presence of ST-segment depression (≥1 mm; adjusted HR 1.43, 95% confidence interval [CI] 1.25 to 1.63) and left bundle branch block (adjusted HR 1.64, 95% CI 1.18 to 2.28) were independently associated with long-term cardiovascular death or myocardial infarction. Risk increases were short and long term. On quantitative ECG analysis, cumulative ST-segment depression (≥5 mm; adjusted HR 1.34, 95% CI 1.05 to 1.70), the presence of left bundle branch block (adjusted HR 2.15, 95% CI 1.36 to 3.40) or ≥6 leads with inverse T waves (adjusted HR 1.22, 95% CI 0.97 to 1.55) was independently associated with long-term outcomes. No interaction was observed with treatment strategy. No improvements in net reclassification improvement and integrated discrimination improvement were observed after the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set

  5. A importância de um EGC normal em síndromes coronarianas agudas sem supradesnivelamento do segmento ST La importancia de un ECG normal en síndromes coronarios agudos sin supradesnivel del segmento ST The importance of a normal ECG in non-ST elevation acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Rogério Teixeira

    2010-01-01

    . METHODS: Patients were divided in 2 groups: A (n=538 - Abnormal ECG and B (n=264 - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate. RESULTS: Group A patients were older (68.7±11.7 vs. 63.4±12.7Y, p<0.001, had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF (52.01±10.55 vs. 55.34± 9.51%, p<0.001, glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001 and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45. There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054. Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012 survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97. There were no differences regarding the MACE rate. CONCLUSION: In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.

  6. Usefulness of the Admission Electrocardiogram to Predict Long-Term Outcomes After Non-ST-Elevation Acute Coronary Syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials)

    NARCIS (Netherlands)

    Damman, Peter; Holmvang, Lene; Tijssen, Jan G. P.; Lagerqvist, Bo; Clayton, Tim C.; Pocock, Stuart J.; Windhausen, Fons; Hirsch, Alexander; Fox, Keith A. A.; Wallentin, Lars; de Winter, Robbert J.

    2012-01-01

    The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During

  7. Níveis de PCR são maiores em pacientes com síndrome coronariana aguda e supradesnivelamento do segmento ST do que em pacientes sem supradesnivelamento do segmento ST Niveles de PCR son mayores en pacientes con síndrome coronario agudo y supradesnivel del segmento ST que en pacientes sin supradesnivel del segmento ST CRP levels are higher in patients with ST elevation than non-ST elevation acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Syed Shahid Habib

    2011-01-01

    presentaban infarto agudo de miocardio (IAM. Tres niveles seriados de PCR-us, a nivel basal en la hospitalización antes de 12 horas después del inicio de los síntomas, niveles de pico 36-48 horas después de hospitalización y niveles de control después de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST y sin supradesnivel del segmento ST (IAMSSST. RESULTADOS: Pacientes con IAMCSST tenían IMC significativamente más alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fracción MB (CK-MB y aspartato aminotransferasa (AST eran significativamente más altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (pBACKGROUND: There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS, prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE: Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI and ST myocardial infarction (STEMI patients. METHODS: This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI. Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS: STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB and Aspartate aminotransferase (AST levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05. CRP levels at baseline and at follow up did not significantly differ between the two groups (p= 0.2152, p=0.4686 respectively. There was a significant difference regarding

  8. Correlação dos escores de risco com a anatomia coronária na síndrome coronária aguda sem supra-ST Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Elizabete Silva dos Santos

    2013-01-01

    Full Text Available FUNDAMENTO:Há poucas publicações sobre a correlação entre escores de risco e anatomia coronária na síndrome coronária aguda (SCA. OBJETIVO: Correlacionar os escores de risco com a gravidade da lesão coronária na SCA sem supra-ST. MÉTODOS: Foram analisados 582 pacientes entre julho de 2004 e outubro de 2006. Avaliou-se a correlação entre os escores de risco TIMI, GRACE hospitalar e em seis meses com lesão coronária > 50%, por método não paramétrico de Spearman. Modelo de regressão logística múltipla foi realizado para determinar a habilidade preditiva dos escores em discriminar quem terá ou não lesão coronária > 50%. RESULTADOS: Foram 319 (54,8% homens e a média de idade era 59,9 (± 10,6 anos. Correlação positiva foi observada entre a pontuação dos escores de risco e lesão coronária > 50% (escore de risco TIMI r = 0,363 [p 50% foi: TIMI = 0,704 [IC95% 0,656-0,752; p BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months scores was performed for patients with coronary lesion > 50%, using Spearman´s non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion > 50%. RESULTS: Most subjects were male (319 or 54.8%, mean age of 59.9 (± 10.6 years. A positive correlation was observed between risk scores and >coronary lesion > 50% (TIMI r = 0.363 [p 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was

  9. Long-Term Cardiovascular Mortality After Procedure-Related or Spontaneous Myocardial Infarction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome A Collaborative Analysis of Individual Patient Data From the FRISC II, ICTUS, and RITA-3 Trials (FIR)

    NARCIS (Netherlands)

    Damman, Peter; Wallentin, Lars; Fox, Keith A. A.; Windhausen, Fons; Hirsch, Alexander; Clayton, Tim; Pocock, Stuart J.; Lagerqvist, Bo; Tijssen, Jan G. P.; de Winter, Robbert J.

    2012-01-01

    Background-The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome. Methods and Results-Five-year follow-up after

  10. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes.

    Science.gov (United States)

    Chan, Christina; Elliott, John; Troughton, Richard; Frampton, Christopher; Smyth, David; Crozier, Ian; Bridgman, Paul

    2013-01-01

    Christchurch, New Zealand, was struck by 2 major earthquakes at 4:36 am on 4 September 2010, magnitude 7.1 and at 12:51 pm on 22 February 2011, magnitude 6.3. Both events caused widespread destruction. Christchurch Hospital was the region's only acute care hospital. It remained functional following both earthquakes. We were able to examine the effects of the 2 earthquakes on acute cardiac presentations. Patients admitted under Cardiology in Christchurch Hospital 3 week prior to and 5 weeks following both earthquakes were analysed, with corresponding control periods in September 2009 and February 2010. Patients were categorised based on diagnosis: ST elevation myocardial infarction, Non ST elevation myocardial infarction, stress cardiomyopathy, unstable angina, stable angina, non cardiac chest pain, arrhythmia and others. There was a significant increase in overall admissions (pearthquake. This pattern was not seen after the early afternoon February earthquake. Instead, there was a very large number of stress cardiomyopathy admissions with 21 cases (95% CI 2.6-6.4) in 4 days. There had been 6 stress cardiomyopathy cases after the first earthquake (95% CI 0.44-2.62). Statistical analysis showed this to be a significant difference between the earthquakes (pearthquake triggered a large increase in ST elevation myocardial infarction and a few stress cardiomyopathy cases. The early afternoon February earthquake caused significantly more stress cardiomyopathy. Two major earthquakes occurring at different times of day differed in their effect on acute cardiac events.

  11. Myocardial scintigraphy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Faerestrand, S.

    1984-01-01

    The sensitivity and specificity of 99m Tc-PYP myocardial scintigraphy for detecting an acute myocardial infarction were studied in 39 patients hospitalized because of central chest pain. One myocardial scintigraphic examination was done in each patient between the first and sixth day after the chest pain had started. Twenty-two patients had a myocardial infarction based on history, ECG and enzym values and myocardial scintigraphy was positive in twenty of these. Three patients with left bundle branch block and myocardial infarction all had a positive myocardial scintigram and the one patient with negative ECG and myocardial infarction also had a positive myocardial scintigram. The sensitivity is 91% and the specificity is 91.7% for 99m Tc-PYP myocardial scintigraphy in the detection of acute myocardial infarction. No complications were seen. (Auth.)

  12. Non-ST-elevation myocardial infarction with the use of oxymetazoline nasal spray.

    Science.gov (United States)

    Rajpal, Saurabh; Morris, Liam A; Akkus, Nuri I

    2014-01-01

    Oxymetazoline is an alpha-1 adrenergic receptor agonist that is commonly used for nasal decongestion and is readily available without a prescription. We report the case of a 64-year-old woman who developed prolonged chest pain associated with elevation of cardiac biomarkers after using oxymetazoline. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Differences in the Korea Acute Myocardial Infarction Registry Compared with Western Registries

    Science.gov (United States)

    2017-01-01

    The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients. PMID:29035427

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

    DEFF Research Database (Denmark)

    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 at...

  15. [Bonsai induced acute myocardial infarction].

    Science.gov (United States)

    Ayhan, Hüseyin; Aslan, Abdullah Nabi; Süygün, Hakan; Durmaz, Tahir

    2014-09-01

    Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai.

  16. Review Paper: Myocardial Rupture After Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical ...

  17. Acute myocardial infarction and lesion location in the left circumflex artery

    DEFF Research Database (Denmark)

    Waziri, Homa; Jørgensen, Erik; Kelbæk, Henning

    2016-01-01

    AIMS: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance...

  18. Thrombolysis in acute myocardial infarction

    NARCIS (Netherlands)

    F. Vermeer (Frank)

    1987-01-01

    textabstractThe purpose of this study was to analyse the effects of thrombolytic therapy with intracoronary streptokinase in patients with acute myocardial infarction. Five centres participated in the study, the Thorax center in Rotterdam (237 patients), the Academic Hospital of the Free

  19. Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR).

    Science.gov (United States)

    Damman, Peter; Wallentin, Lars; Fox, Keith A A; Windhausen, Fons; Hirsch, Alexander; Clayton, Tim; Pocock, Stuart J; Lagerqvist, Bo; Tijssen, Jan G P; de Winter, Robbert J

    2012-01-31

    The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome. Five-year follow-up after procedure-related or spontaneous MI was investigated in the individual patient pooled data set of the FRISC-II (Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Intervention Trial of Unstable Angina 3) non-ST-elevation acute coronary syndrome trials. The principal outcome was cardiovascular death up to 5 years of follow-up. Cumulative event rates were estimated by the Kaplan-Meier method; hazard ratios were calculated with time-dependent Cox proportional hazards models. Adjustments were made for the variables associated with long-term outcomes. Among the 5467 patients, 212 experienced a procedure-related MI within 6 months after enrollment. A spontaneous MI occurred in 236 patients within 6 months. The cumulative cardiovascular death rate was 5.2% in patients who had a procedure-related MI, comparable to that for patients without a procedure-related MI (hazard ratio 0.66; 95% confidence interval, 0.36-1.20, P=0.17). In patients who had a spontaneous MI within 6 months, the cumulative cardiovascular death rate was 22.2%, higher than for patients without a spontaneous MI (hazard ratio 4.52; 95% confidence interval, 3.37-6.06, P<0.001). These hazard ratios did not change materially after risk adjustments. Five-year follow-up of patients with non-ST-elevation acute coronary syndrome from the 3 trials showed no association between a procedure-related MI and long-term cardiovascular mortality. In contrast, there was a substantial increase in long-term mortality after a spontaneous MI.

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

    LENUS (Irish Health Repository)

    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.

  1. Frequency of acute right ventricular myocardial infarction in patients with acute inferior myocardial infarction

    International Nuclear Information System (INIS)

    Iqbal, M.A.; Shah, I.; Rauf, M.A.; Khan, N.; Khan, S.B.; Hafizullah, M.

    2012-01-01

    Objective: To determine the frequency of acute right ventricular myocardial infarction (RVMI) in patients with acute inferior myocardial infarction. Methodology: This prospective case series study was conducted at Cardiology Department in a period from May to October 2009. A total of 174 patients with acute inferior myocardial infarction were evaluated for the presence of acute right ventricular myocardial infarction (RVMI). Results: Male patients were 135 (77.6%) and females 39 (24.4%). Patient's age ranged from 28 to 82 years with majority in the age group 40 to 60 years. Frequency of RVMI was 27% among patients presenting with acute inferior myocardial infarction. Among patients presenting with acute RVMI, 64 % patients received thrombolysis. Overall 65% patients of RVMI had hospital stay of more than 4 days. Conclusion: Frequency of RVMI among inferior MI patients was 27 % with longer hospital stay. (author)

  2. Thallium-201 myocardial imaging in acute-myocardial infarction

    International Nuclear Information System (INIS)

    Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Wellens, H.J.J.; Samson, G.; Schoot, J.B. van der

    1980-01-01

    Thallium-201 scintigraphy has proven to be an early and highly sensitive technique to detect myocardial perfusion abnormalities in patients with acute myocardial infarction. During the early phase of acute myocardial infarction, patients may be hemodynamically and electrically unstable. Therefore, scintigraphy is performed preferably at the bed side in the Coronary Care Unit using a mobile gamma camera. Additionally, in order to shorten imaging time in these often critically ill patients, the authors recommend injecting no less than 2 mCi of 201 Tl. Using this dosage, the imaging time per view will be approximately five minutes. Routinely, three views are taken: the first view is a supine 45 0 left-anterior-oblique view, followed by a supine anterior view and finally a left-lateral view, the latter with the patient turned on the right side. (Auth.)

  3. 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?

    Directory of Open Access Journals (Sweden)

    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.

  4. Magnetic resonance imaging (MRI) of inflamed myocardium using iron oxide nanoparticles in patients with acute myocardial infarction - preliminary results.

    Science.gov (United States)

    Yilmaz, Ali; Rösch, Sabine; Klingel, Karin; Kandolf, Reinhard; Helluy, Xavier; Hiller, Karl-Heinz; Jakob, Peter M; Sechtem, Udo

    2013-02-20

    Superparamagnetic iron oxide nanoparticle (SPIO)-based molecular imaging agents targeting macrophages have been developed and successfully applied in animal models of myocardial infarction. The purpose of this clinical trial was to investigate whether magnetic resonance imaging (MRI) of macrophages using ferucarbotran (Resovist®) allows improved visualisation of the myocardial (peri-)infarct zone compared to conventional gadolinium-based necrosis/fibrosis imaging in patients with acute myocardial infarction. The clinical study NIMINI-1 was performed as a prospective, non-randomised, non-blinded, single agent phase III clinical trial (NCT0088644). Twenty patients who had experienced either an acute ST-elevation or non-ST-elevation myocardial infarction (STEMI/NSTEMI) were included to this study. Following coronary angiography, a first baseline cardiovascular magnetic resonance (CMR) study (pre-SPIO) was performed within seven days after onset of cardiac symptoms. A second CMR study (post-SPIO) was performed either 10 min, 4h, 24h or 48h after ferucarbotran administration. The CMR studies comprised cine-CMR, T2-weighted "edema" imaging, T2-weighted cardiac imaging and T1-weighted late-gadolinium-enhancement (LGE) imaging. The median extent of short-axis in-plane LGE was 28% (IQR 19-31%). Following Resovist® administration the median extent of short-axis in-plane T2-weighted hypoenhancement (suggestive of intramyocardial haemorrhage and/or SPIO accumulation) was 0% (IQR 0-9%; p=0.68 compared to pre-SPIO). A significant in-slice increase (>3%) in the extent of T2-weighted "hypoenhancement" (post-SPIO compared to pre-SPIO) was seen in 6/16 patients (38%). However, no patient demonstrated "hypoenhancement" in T2-weighted images following Resovist® administration that exceeded the area of LGE. T2/T2-weighted MRI aiming at non-invasive myocardial macrophage imaging using the approved dose of ferucarbotran does not allow improved visualisation of the myocardial (peri

  5. B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation.

    Science.gov (United States)

    Bassan, Roberto; Potsch, Alfredo; Maisel, Alan; Tura, Bernardo; Villacorta, Humberto; Nogueira, Mônica Viegas; Campos, Augusta; Gamarski, Roberto; Masetto, Antonio Cláudio; Moutinho, Marco Aurélio

    2005-02-01

    This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation. A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cut-off value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P<0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model. BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.

  6. Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population: A Single-center Study.

    Science.gov (United States)

    Meng, Pei-Na; Xu, Chen; You, Wei; Wu, Zhi-Ming; Xie, Du-Jiang; Zhang, Hang; Pan, Chang; Ye, Fei

    2017-07-05

    Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction (AMI). The previous reports were restricted to other countries' population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China. This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography (CAG) and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed. A total of 60 young female AMI (SCAD in young female AMI population was 35% (21/60), the prevalence of coronary atherosclerostic heart disease was 65% (39/60). In the SCAD group, 43% (9/21) presented with non-ST-elevation myocardial infarction (NSTEMI) and the remainder presenting as STEMI. SCAD usually occurred in a single vessel (20/21, 95%), especially in left anterior descending artery (14/21, 67%). Eighteen patients (18/21, 86%) underwent conservative treatment, whereas the remaining three patients (3/21, 14%) underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% (20/21), and Type I imaging was observed in 5% (1/21), Type II was observed in 67% (14/21), and Type III was 29% (6/21). The average stenosis in the group was 76.9% ± 20.6%, and the mean lesion length was 36.6 ± 8.6 mm. SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.

  7. Thrombolytic therapy of acute myocardial infarction alters collagen metabolism

    DEFF Research Database (Denmark)

    Høst, N B; Hansen, S S; Jensen, L T

    1994-01-01

    infarction and receiving thrombolytic therapy. Regardless of whether acute myocardial infarction was confirmed or not, S-PIIINP increased (94-120%) 4 h after streptokinase therapy (p ....02). With confirmed acute myocardial infarction, S-PIIINP increased from 24 h towards a plateau reached at day 2-3 (p acute myocardial infarction had S-PICP above baseline at 1, 2, and 6 months (p ....05). A less pronounced S-PIIINP increase was noted with tissue-plasminogen activator than with streptokinase. Thrombolytic therapy induces collagen breakdown regardless of whether acute myocardial infarction is confirmed or not. With confirmed acute myocardial infarction collagen metabolism is altered...

  8. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade

    NARCIS (Netherlands)

    Henriques, JPS; Zijlstra, F; van 't Hof, AWJ; de Boer, MJ; Gosselink, M; Hoorntje, JCA; Suryapranata, H; Dambrink, Jan Hendrik Everwijn

    2003-01-01

    Background-Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that

  9. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade

    NARCIS (Netherlands)

    Henriques, Jose P. S.; Zijlstra, Felix; van 't Hof, Arnoud W. J.; de Boer, Menko-Jan; Dambrink, Jan-Henk E.; Gosselink, Marcel; Hoorntje, Jan C. A.; Suryapranata, Harry

    2003-01-01

    Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that optimal

  10. Comparison of blood biochemics between acute myocardial infarction models with blood stasis and simple acute myocardial infarction models in rats

    International Nuclear Information System (INIS)

    Qu Shaochun; Yu Xiaofeng; Wang Jia; Zhou Jinying; Xie Haolin; Sui Dayun

    2010-01-01

    Objective: To construct the acute myocardial infarction models in rats with blood stasis and study the difference on blood biochemics between the acute myocardial infarction models with blood stasis and the simple acute myocardial infarction models. Methods: Wistar rats were randomly divided into control group, acute blood stasis model group, acute myocardial infarction sham operation group, acute myocardial infarction model group and of acute myocardial infarction model with blood stasis group. The acute myocardial infarction models under the status of the acute blood stasis in rats were set up. The serum malondialdehyde (MDA), nitric oxide (NO), free fatty acid (FFA), tumor necrosis factor-α (TNF-α) levels were detected, the activities of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and the levels of prostacycline (PGI2), thromboxane A 2 (TXA 2 ) and endothelin (ET) in plasma were determined. Results: There were not obvious differences in MDA, SOD, GSH-Px and FFA between the acute myocardial infarction models with blood stasis in rats and the simple acute myocardial infarction models (P 2 and NO, and the increase extents of TXA 2 , ET and TNF-α in the acute myocardial infarction models in rats with blood stasis were higher than those in the simple acute myocardial infarction models (P 2 and NO, are significant when the acute myocardial infarction models in rats with blood stasis and the simple acute myocardial infarction models are compared. The results show that it is defective to evaluate pharmacodynamics of traditional Chinese drug with only simple acute myocardial infarction models. (authors)

  11. Clinical value of delayed thallium-201 myocardial imaging in suspected acute myocardial infarction.

    Science.gov (United States)

    McKillop, J H; Turner, J G; Gray, H W; Bessent, R G; Greig, W R

    1978-01-01

    Fifty patients with acute chest pain had thallium-201 myocardial imaging performed three to six days after emergency admission to hospital. The image was abnormal in 20 out of 22 patients with acute transmural myocardial infarcts but in only 1 of 5 with acute subendocardial infarcts. Indistinguishable scan abnormalities caused by old infarcts were seen in 7 patients, and caused by myocardial ischaemia in 1 patient. A single thallium-201 myocardial scan some days after the onset of symptoms appears to be of little value in the clinical assessment of patients with suspected acute myocardial infarction. Images PMID:687488

  12. Acute myocardial infarction as a result of stress

    OpenAIRE

    Bakusová, Tereza

    2007-01-01

    This thesis aims to describe acute myocardial infarction as a psychosomatic disease. Represents acute myocardial infarction as a result of stress and type A behavior. Research part reveals number of respondents, affected by stresss at the time of myocardial infarction and respondents with type A behavior.

  13. Acute myocardial infarction after mediastinal radiotherapy

    International Nuclear Information System (INIS)

    Gagliardi, Juan; Tezanos Pinto, Miguel; Avalos, Adolfo; Sarubbi, Augusto; Padilla, Lucio; Espinosa, Daniel

    2004-01-01

    Mediastinal radiotherapy can affect the heart and great vessels to different degrees. It may turn up as coronary heart disease and less frequently as acute myocardial infarction. We report the case of a patient without coronary risk factors and an antecedent of mediastinal radiotherapy for Hodgkin's lymphoma. Considerations about mediastinal radiation as a risk factor for early development of coronary heart diseases are exposed. (author) [es

  14. Acute perimyocarditis mimicking transmural myocardial infarction

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2009-12-01

    Full Text Available Abstract Although acute pericarditis has charachteristic electrocardiographic (ECG findings that differentiate it from acute ST segment elevation myocardial infarction (MI; in certain cases diagnosis is somewhat difficult especially when the ECG reveals focal instead of diffuse changes and moreover when pericarditis is associated with an underlying myocarditis causing elevation of the cardiac biomarkers therefore increasing the difficulty in differentiating between both enteties. This is especially important because adverse lethal side effect can occur if thrombolytic therapy is administered for a patient with acute pericarditis, or if a diagnosis of transmural MI is missed. In this case report we are describing an 18 year old male patient who presented with an acute onset of severe chest pain associated with focal ECG changes and elevated cardiac enzymes mimicking transmural MI. This report aims to sensitize readers to this debate and create awareness among cardiologists and intensivists with both presentations and how to reach an accurate diagnosis.

  15. Acute myocardial infarction in young adults with Antiphospholipid ...

    African Journals Online (AJOL)

    Abstract Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes ...

  16. Association of elevated radiation dose with mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

    Energy Technology Data Exchange (ETDEWEB)

    Parikh, Puja B.; Prakash, Sheena; Tahir, Usman; Kort, Smadar; Gruberg, Luis; Jeremias, Allen, E-mail: allen.jeremias@stonybrook.edu

    2014-09-15

    Objectives: This study sought to identify clinical and procedural predictors of elevated radiation dose received by patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to determine if elevated radiation dose was predictive of mortality in this population. Background: Little data exist regarding the impact of excessive radiation burden on clinical outcomes in patients undergoing PCI. Methods: The study population included 1,039 patients who underwent PCI for an AMI between January 1, 2007 and December 31, 2008 at an academic tertiary care teaching hospital. Cumulative skin dose (measured in milligray [mGy]) was selected as a measurement of patient radiation burden. Clinical and procedural variables were analyzed in multiple logistic and linear regression models to determine predictors of higher skin dose, and its impact was evaluated on all-cause intermediate-term mortality at two years. Results: Median skin dose was 2120 mGy (IQR 1379–3190 mGy) in the overall population, of which 153 (20.8%) patients received an elevated skin dose (defined as a skin dose > 4,000 mGy). Independent predictors of elevated skin dose included male gender, obesity, multivessel intervention, and presentation with a non-ST-elevation MI (NSTEMI) versus an ST-elevation MI (STEMI). Increased skin dose was not predictive of intermediate-term mortality by multivariate analysis in the overall population or in either subgroup of STEMI and NSTEMI. Conclusions: In this contemporary observational study examining patients with AMI undergoing PCI, male gender, obesity, multivessel intervention, and presentation with a NSTEMI were associated with increased radiation exposure.

  17. Association of elevated radiation dose with mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Parikh, Puja B.; Prakash, Sheena; Tahir, Usman; Kort, Smadar; Gruberg, Luis; Jeremias, Allen

    2014-01-01

    Objectives: This study sought to identify clinical and procedural predictors of elevated radiation dose received by patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to determine if elevated radiation dose was predictive of mortality in this population. Background: Little data exist regarding the impact of excessive radiation burden on clinical outcomes in patients undergoing PCI. Methods: The study population included 1,039 patients who underwent PCI for an AMI between January 1, 2007 and December 31, 2008 at an academic tertiary care teaching hospital. Cumulative skin dose (measured in milligray [mGy]) was selected as a measurement of patient radiation burden. Clinical and procedural variables were analyzed in multiple logistic and linear regression models to determine predictors of higher skin dose, and its impact was evaluated on all-cause intermediate-term mortality at two years. Results: Median skin dose was 2120 mGy (IQR 1379–3190 mGy) in the overall population, of which 153 (20.8%) patients received an elevated skin dose (defined as a skin dose > 4,000 mGy). Independent predictors of elevated skin dose included male gender, obesity, multivessel intervention, and presentation with a non-ST-elevation MI (NSTEMI) versus an ST-elevation MI (STEMI). Increased skin dose was not predictive of intermediate-term mortality by multivariate analysis in the overall population or in either subgroup of STEMI and NSTEMI. Conclusions: In this contemporary observational study examining patients with AMI undergoing PCI, male gender, obesity, multivessel intervention, and presentation with a NSTEMI were associated with increased radiation exposure

  18. Acute myocardial infarction associated with dietary supplements containing 1,3-dimethylamylamine and Citrus aurantium.

    Science.gov (United States)

    Smith, Triston B; Staub, Brian A; Natarajan, Gayathri M; Lasorda, David M; Poornima, Indu G

    2014-02-01

    We describe the case of a previously healthy 22-year-old man who presented with anginal chest pain and was diagnosed with a non-ST-elevation myocardial infarction. For 3 weeks, he had been ingesting the dietary supplements Jack3d® (principal ingredient, 1,3-dimethylamylamine) and Phenorex™ (principal ingredient, Citrus aurantium) daily, before undertaking physical activity. Coronary angiograms revealed a proximal left anterior descending coronary artery thrombus with distal embolization. A combined medical regimen led to resolution of the thrombus. Three months later, the patient was asymptomatic with no evidence of ischemia. The primary ingredients in the sympathomimetic supplements taken by our patient are controversial in the medical community and have been individually associated with adverse cardiac events. There are no safety data on their simultaneous use. We discuss other reports of adverse effects associated with these supplements and recommend that the relevant safety guidelines be revised.

  19. Nursing Care in Patient with Acute Myocardial Infarction

    OpenAIRE

    Němec, Pavel

    2016-01-01

    This thesis deals with the issue of acute myocardial infarction in context of prehospital, and hospital care. Specific clinical symptoms, diagnostic procedures, and treatment of acute myocardial infarction are described in the theoretical part. The part is also devoted to nursing care. Emphasis is put especially on prevention of cardiovascular diseases development. The goal is to evaluate nursing care of patients with acute myocardial infarction in prehospital, and later on, hospital care. Th...

  20. How reliable is myocardial imaging in the diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Willerson, J.T.

    1983-01-01

    Myocardial scintigraphic techniques available presently allow a sensitive and relatively specific diagnosis of acute myocardial infarction when they are used correctly, although every technique has definite limitations. Small myocardial infarcts (less than 3 gm.) may be missed, and there are temporal limitations in the usefulness of the scintigraphic techniques. The development of tomographic methodology that may be used with single-photon radionuclide emitters (including technetium and 201 Tl will allow the detection of relatively small abnormalities in myocardial perfusion and regions of myocardial infarction and will help to provide a more objective interpretation of the myocardial scintigrams. The use of overlay techniques allowing simultaneous assessment of myocardial perfusion, infarct-avid imaging, and radionuclide ventriculograms will provide insight into the relevant aspects of the extent of myocardial damage, the relationship of damage to myocardial perfusion, and the functional impact of myocardial infarction on ventricular performance

  1. Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Y. Alsancak

    2015-01-01

    Full Text Available Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.

  2. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital

    Directory of Open Access Journals (Sweden)

    Lotze U

    2011-08-01

    Full Text Available Ulrich Lotze1, Holger Lemm2, Anke Heyer2, Karin Müller31Department of Internal Medicine, German Red Cross Hospital Sondershausen, Sondershausen, 2Department of Internal Medicine, 3Department of Laboratory Medicine, Saale-Unstrut Hospital Naumburg, Naumburg, GermanyBackground: The purpose of this observational study was to test the diagnostic performance of the Elecsys® troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI in clinical practice.Methods: Troponin T high-sensitive (diagnostic cutoff: <14 pg/mL and copeptin (diagnostic cutoff: <14 pmol/L levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months.Results: Data from 142 consecutive patients (mean age 71.2 ± 13.5 years, 76 men were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2% unstable angina pectoris in three (2.1%, cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%, and noncardiac disease in 47 patients (33.1%. The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (>150 pmol/L, one of whom had a level of >700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of <14 pg/mL in combination with copeptin <14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%, each with a sensitivity and negative predictive value of 100%.Conclusion: According to this early experience, a single determination of troponin T high-sensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.Keywords: highly sensitive troponin T

  3. 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?

    Science.gov (United States)

    Souza, Lilian P; Campos, Orlando; Peres, Clovis A; Machado, Cristiano V; Carvalho, Antonio C

    2011-06-03

    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. 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. 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 < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients. 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.

  4. The prognostic importance of creatinine clearance after acute myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, C R; Brendorp, B; Rask-Madsen, C

    2002-01-01

    AIMS: The purpose of this study was to assess renal dysfunction as an independent predictor of mortality after acute myocardial infarction. METHODS: The study population was 6252 patients with a myocardial infarction admitted alive from 1990 to 1992. The mortality status was obtained after at least.......9-1.3) respectively. CONCLUSION: Renal dysfunction is an important risk factor after acute myocardial infarction. When the risk is adjusted for available competing risk factors only severely reduced renal function is associated with an important and independent risk of mortality after acute myocardial infarction...

  5. Benefits and risks of thrombolysis for acute myocardial infarction

    NARCIS (Netherlands)

    A.E.R. Arnold (Alfred); M.L. Simoons (Maarten)

    1990-01-01

    textabstractThrombolytic therapy is a major step forward in the treatment of acute myocardial infarction and may result in up to 50% mortality reduction, provided that it is administered early (chapter 1). In 80 to 85% of patients with suspected acute myocardial infarction, a coronary artery is

  6. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction

    DEFF Research Database (Denmark)

    Aplin, Mark; Engstrøm, Thomas; Vejlstrup, Niels G

    2003-01-01

    Third-degree atrioventricular block after acute myocardial infarction is considered to have prognostic importance. However, its importance in conjunction with thrombolytic therapy and its relation to left ventricular function remains uncertain. This report also outlines an important distinction...... between atrioventricular block in the setting of anterior and inferior wall acute myocardial infarction, with profound clinical and prognostic implications....

  7. Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization

    Directory of Open Access Journals (Sweden)

    José Ribamar Costa Jr.

    2003-03-01

    Full Text Available OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorporeal circulation. We assessed 178 patients (89 patients in each group undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002. This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001. Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.

  8. Early assessment of infarct size and prediction of functional recovery by quantitative myocardial blush grade in patients with acute coronary syndromes treated according to current guidelines.

    Science.gov (United States)

    Riedle, Nina; Dickhaus, Hartmut; Erbacher, Markus; Steen, Henning; Andrassy, Martin; Lossnitzer, Dirk; Hardt, Stefan; Rottbauer, Wolfgang; Zugck, Christian; Giannitsis, Evangelos; Katus, Hugo A; Korosoglou, Grigorios

    2010-10-01

    To determine whether quantification of myocardial blush grade (MBG) during cardiac catheterization can aid the determination of follow-up left ventricular (LV)-function in patients with ST-elevation and non-ST-elevation myocardial infarction (STEMI and NSTEMI). We prospectively examined patients with first STEMI (n = 46) and NSTEMI (n = 49). ECG-gated angiographic series were used to quantify MBG by analyzing the time course of contrast agent intensity rise. Hereby, the parameter G(max)/T(max) was calculated, derived from the plateau of grey-level intensity (G(max)), divided by the time-to-peak intensity (T(max)). Cardiac magnetic resonance imaging (CMR) deemed as the standard reference for the estimation of infarct size, transmurality and of the LV-function at 6 months of follow-up. Cut-off values of G(max)/T(max)=5.7/sec and 3.8/sec, respectively, yielded similar accuracy as infarct transmurality for the prediction of follow-up ejection fraction >55% (AUC = 0.86 for STEMI and AUC = 0.90 for NSTEMI, by G(max)/T(max) and AUC = 0.85 for STEMI and AUC = 0.89 for NSTEMI, by infarct transmurality, respectively, P = NS). Both clearly surpassed the predictive value of visual MBG (AUC = 0.69 for STEMI and AUC = 0.68 for NSTEMI, P < 0.05). G(max)/T(max) is an easy to acquire but highly valuable surrogate parameter for infarct size, which yields equally high accuracy with infarct transmurality and favorably compares with visually assessed blush grades for the prediction of follow-up LV-function in patients with acute ischemic syndromes. © 2010 Wiley-Liss, Inc.

  9. Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1992-01-01

    In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy...... less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144...... myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study....

  10. Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Bridal Løgstrup, Brian; Hofsten, D. E.; Christophersen, T. B.

    2012-01-01

    . Assessment of CFR by TTE was performed in a modified apical view using color Doppler guidance. Results: The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty-nine (49%) patients had a non-ST elevation myocardial infarction and 94 (51%) patients had a ST...... elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1...

  11. Acute myocardial infarction in infectious endocarditis. Report of one case

    International Nuclear Information System (INIS)

    Parietti, G; Artucio, C.; Fernandez, A; Areco, D.; Mallo, D; Lluberas, R.

    2012-01-01

    The acute myocardial infarction is a rare complication in the course of an acute endocarditis. It takes place in the first weeks infection. Although is not associated with any particular microorganism it has been associated with virulent microorganism and is common in aortic valve endocarditis insufficiency. This report is a case of a patient who suffered a myocardial infarction during a acute endocarditis of native valve

  12. MR imaging of acute myocardial infarction

    International Nuclear Information System (INIS)

    Revel, D.; Dandis, G.; Pichard, J.B.; Ovize, M.; DeLorgeril, M.; Amiel, M.

    1990-01-01

    This paper reports on superparamagnetic iron oxide particles (AMI-25) evaluated in comparison with paramagnetic Gd-DOTA for the MR evaluation of acute myocardial infarct size. Twelve openchest dogs underwent 2 hours of LAD occlusion followed by 6 hours of reperfusion. AMI-25 and Gd-DOTA were intravenously injected 1 hour and 10 minutes before euthanasia, respectively, in two groups of six dogs. Gradient-echo and T1- and T2-weighted spin-echo images were obtained in six AMI-25-injected excised hearts, and T1- and T2-weighted images in six Gd-DOTA injected excised hearts. Infarct size was evaluated by planimetry of each 8-mm-thick transverse slice after ex vivo double staining and correlated with the planimetry of each 8-mm-thick transverse MR section

  13. Aeromedical transport after acute myocardial infarction

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Bruun, Niels Eske; Nielsen, Henrik

    2009-01-01

    BACKGROUND: No guidelines exist for the planning of aeromedical repatriation after acute myocardial infarction (AMI). In 2004, we employed a risk evaluation-based decision-making system for repatriation of patients after AMI. The objective was to evaluate the safety of transports during 2005...... managed by this system. METHODS: A total of 116 patients were transported according to the algorithm, 64 unescorted and 52 escorted. The decision-making system was based on the recommendations given by the European Society of Cardiology. Whenever possible, patients were evaluated by coronary angiogram...... of death of any cause during transport or departure from the planned repatriation due to worsening of the condition was registered. RESULTS: No patients reached the end point. Patients who were not risk evaluated more often needed escort (p

  14. Correlation of acute myocardial infarct scintigraphy with postmortem studies

    International Nuclear Information System (INIS)

    Holman, L.; Ehrie, M.; Lesch, M.

    1976-01-01

    Acute myocardial infarct scintigraphy with technetium-99m-pyrophosphate was performed in a patient with an acute massive transmural infarct. The patient died 12 hours later, and postmortem tracer studies demonstrated a tracer concentration ratio of 13:1 between acutely infarcted myocardium and normal myocardium remote from the infarct. The concentration of tracer in tissue bordering on the infarct but without histologic evidence of acute infarction was 1.5 times that in normal tissue remote from the infarct. In vitro scintigraphy of the excised heart revealed a pattern of tracer distribution similar to that of scintiscans obtained before death. The biologic distribution of /sup 99m/Tc-pyrophosphate, with large tracer concentrations only within the acutely infarcted tissued, suggests that acute myocardial infarct scintigraphy can be used to estimate the extent of an acute myocardial infarct

  15. Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study

    DEFF Research Database (Denmark)

    Hammer-Hansen, Sophia; Kofoed, Klaus Fuglsang; Kelbaek, Henning

    2009-01-01

    BACKGROUND: We hypothesized that unstable clinical presentation of coronary artery disease is associated with distinct characteristics of culprit lesions identifiable by multislice computed tomography (MSCT). METHODS: Patients with non-ST-elevation myocardial infarction (NSTEMI) (n = 57) or stable...... angina (SA) pectoris (n = 19) were studied. Coronary culprit lesions in patients with NSTEMI and symptomatic lesions in patients with SA were evaluated with 64-slice MSCT and a volumetric plaque imaging tool. Plaque volumes of lipid, fibrous tissue, or calcification according to signal intensity were...

  16. Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Tei, C

    2000-01-01

    Prospective assessment of a nongeometric Doppler-derived index of combined systolic and diastolic myocardial performance was performed in 64 patients with acute myocardial infarction (MI) within 1 hour after their arrival to the hospital and in 39 age-matched healthy subjects. The index is defined...

  17. Temporal course of pregnancy-associated plasma protein-A in angioplasty-treated ST-elevation myocardial infarction patients and potential significance of concomitant heparin administration

    DEFF Research Database (Denmark)

    Terkelsen, Christian J; Oxvig, Claus; Nørgaard, Bjarne L

    2009-01-01

    understood, and the potential role of concomitant heparin administration has not previously been evaluated. The purposes of the present study were to evaluate in-hospital levels of PAPP-A compared with other circulating biomarkers in patients with acute myocardial infarctions and to explore the potential...... impact of concomitant heparin administration on PAPP-A levels in an animal experiment. Group A comprised 84 patients with ST elevation myocardial infarctions (STEMIs) who were treated with heparin and transferred for primary percutaneous coronary intervention. Plasma samples were obtained at the time...... were also determined in 2 historical cohorts not given heparin: 14 patients with STEMIs (group B) and 56 patients with non-ST elevation myocardial infarctions (group C). The impact of concomitant heparin administration on the clearance of PAPP-A from the circulation was also explored in mice. In group...

  18. Acute myocardial infarction in middle-aged male Nigerian with ...

    African Journals Online (AJOL)

    ... are associated with accelerated atherosclerosis. The relationship between pemphigus vulgaris and myocardial infarction is not clear. This report highlights the presentation and management of myocardial infarction and the possible relationship of acute coronary events with autoimmune disease and chronic steroid use.

  19. Acute aortic dissection mimics acute inferoposterior wall myocardial infarction in a Marfan syndrome patient.

    Science.gov (United States)

    Phowthongkum, Prasit

    2010-01-01

    A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography. After a failed coronary angiography, an echocardiogram revealed an aortic intimal flap after which acute aortic dissection was diagnosed. The patient received a successful Bentall operation without immediate complication. Retrospective examination then confirmed the diagnosis of Marfan syndrome. This case demonstrates acute aortic dissection may mimic acute myocardial infarction.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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 reperfusion...

  1. [Acute myocardial infarct caused by nicotine-induced erythrocytosis].

    Science.gov (United States)

    Andreas, S; Herrmann, K S; Kreuzer, H; Wiegand, V

    1989-10-02

    A 29-year-old heavy smoker presented with an acute myocardial infarction and hematocrit of 70%. At immediate coronary angiography a complete occlusion of the right coronary artery was found. After intracoronary urokinase the coronary arteries were found to be completely normal. Causes for the erythrocytosis other than smoking could be excluded. We conclude that thrombotic coronary occlusion with acute myocardial infarction was caused by erythrocytosis due to heavy smoking.

  2. Renal function and outcomes in acute coronary syndrome: impact of clopidogrel.

    Science.gov (United States)

    Keltai, Mátyás; Tonelli, Marcello; Mann, Johannes F E; Sitkei, Eva; Lewis, Basil S; Hawken, Steven; Mehta, Shamir R; Yusuf, Salim

    2007-04-01

    Patients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes. Patients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12 253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel to standard treatment in non-ST elevation acute coronary syndrome was observed in all three tertiles of renal function {(lower third relative risk (RR)=0.89 [95% confidence interval (CI) 0.76-1.05]; medium third RR=0.68 (95% CI 0.56-0.84); upper third RR=0.74 (95% CI 0.60-0.93) (P for heterogeneity=0.11)}. Clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function. The risk of major or life-threatening bleeding increased moderately with the addition of clopidogrel to standard treatment [lower third RR=1.12 (95% CI 0.83-1.51); medium third RR=1.4 (95% CI 0.97-2.02); upper third RR=1.83 (95% CI 1.23-2.73)], but this did not appear to be greatest in those with the lowest renal function. Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes. Clopidogrel was beneficial and safe in patients with and without chronic kidney disease.

  3. Gadolinium-enhanced magnetic resonance imaging in acute myocardial infarction

    International Nuclear Information System (INIS)

    Dijkman, P.R.M. van; Wall, E.E. van der; Roos, A. de; Doornbos, J.; Laarse, A. van der; Voorthuisen, A.E. van; Bruschke, A.V.G.; Rossum, A.C. van

    1990-01-01

    To evaluate he usefulness of the paramagnetic contrast agent Gadolinium-DTPA (diethylenetriaminepentaacetic acid) in Magnetic Resonance. Imaging of acute myocardial infarction, we studied a total of 45 patients with a first acute myocardial infarction by ECG-gated magnetic resonance imaging before and after intravenous administration of 0.1 mmol/kg Gadolinium-DTPA. All patients received thrombolytic treatment by intravenous streptokinase. The magnetic resonance imaging studies were preformed after a meam of 88 h (range 15-241) after the acute onset of acute myocardial infarction. Five patients without evidence of cardiac disease served as controls. Spin-echo measurements (TE 30 ms) were made using a Philips Gyroscan (0.5 Tesla) or a Teslacon II (0.6 Tesla). The 45 patients were divided into four groups of patients. In Group I( patients) Gadolinium-DTPA improved the detection of myocardial infarction by Gadolinium-DTPA. In Group II (20 patients) the magnetic resonance imaging procedure was repeated every 10 min for up to 40 min following administration of Gadolinium-DTPA. Optimal contrast enhancement was obtained 20-25 min after Gadolinium-DTPA. In Group III (27 patients) signal intensities were significantly higher in the patients who underwent the magnetic resonance imaging study more than 72 h (mean 120) after the acute event, suggesting increased acculumation of Gadolinium-DTPA in a more advanced stage of the infarction process. In Group IV (45 patients) Gadolinium-DTPA was administered in an attempt to distinguish between reperfused and nonreperfused myocardial areas after thrombolytic treatment for acute myocardial infarction. The signal intensities did not differ, but reperfused areas showed a more homogeneous aspect whereas nonreperfused areas were visualized as a more heterogeneous contrast enhancement. It is concluded that magnetic resonance imaging using the contrast agent Gadolinium-DTPA significantly improves the detection of infarcted myocardial areas

  4. Does overprotection cause cardiac invalidism after acute myocardial infarction?

    Science.gov (United States)

    Riegel, B J; Dracup, K A

    1992-01-01

    To determine if overprotection on the part of the patient's family and friends contributes to the development of cardiac invalidism after acute myocardial infarction. Longitudinal survey. Nine hospitals in the southwestern United States. One hundred eleven patients who had experienced a first acute myocardial infarction. Subjects were predominantly male, older-aged, married, caucasian, and in functional class I. Eighty-one patients characterized themselves as being overprotected (i.e., receiving more social support from family and friends than desired), and 28 reported receiving inadequate support. Only two patients reported receiving as much support as they desired. Self-esteem, emotional distress, health perceptions, interpersonal dependency, return to work. Overprotected patients experienced less anxiety, depression, anger, confusion, more vigor, and higher self-esteem than inadequately supported patients 1 month after myocardial infarction (p Overprotection on the part of family and friends may facilitate psychosocial adjustment in the early months after an acute myocardial infarction rather than lead to cardiac invalidism.

  5. Exercise Training Protects Against Acute Myocardial Infarction via Improving Myocardial Energy Metabolism and Mitochondrial Biogenesis.

    Science.gov (United States)

    Tao, Lichan; Bei, Yihua; Lin, Shenghui; Zhang, Haifeng; Zhou, Yanli; Jiang, Jingfa; Chen, Ping; Shen, Shutong; Xiao, Junjie; Li, Xinli

    2015-01-01

    Acute myocardial infarction (AMI) represents a major cause of morbidity and mortality worldwide. Exercise has been proved to reduce myocardial ischemia-reperfusion (I/R) injury However it remains unclear whether, and (if so) how, exercise could protect against AMI. Mice were trained using a 3-week swimming protocol, and then subjected to left coronary artery (LCA) ligation, and finally sacrificed 24 h after AMI. Myocardial infarct size was examined with triphenyltetrazolium chloride staining. Cardiac apoptosis was determined by TUNEL staining. Mitochondria density was checked by Mito-Tracker immunofluorescent staining. Quantitative reverse transcription polymerase chain reactions and Western blotting were used to determine genes related to apoptosis, autophagy and myocardial energy metabolism. Exercise training reduces myocardial infarct size and abolishes AMI-induced autophagy and apoptosis. AMI leads to a shift from fatty acid to glucose metabolism in the myocardium with a downregulation of PPAR-α and PPAR-γ. Also, AMI induces an adaptive increase of mitochondrial DNA replication and transcription in the acute phase of MI, accompanied by an activation of PGC-1α signaling. Exercise abolishes the derangement of myocardial glucose and lipid metabolism and further enhances the adaptive increase of mitochondrial biogenesis. Exercise training protects against AMI-induced acute cardiac injury through improving myocardial energy metabolism and enhancing the early adaptive change of mitochondrial biogenesis. © 2015 S. Karger AG, Basel.

  6. Exercise Training Protects Against Acute Myocardial Infarction via Improving Myocardial Energy Metabolism and Mitochondrial Biogenesis

    Directory of Open Access Journals (Sweden)

    Lichan Tao

    2015-08-01

    Full Text Available Background/Aims: Acute myocardial infarction (AMI represents a major cause of morbidity and mortality worldwide. Exercise has been proved to reduce myocardial ischemia-reperfusion (I/R injury However it remains unclear whether, and (if so how, exercise could protect against AMI. Methods: Mice were trained using a 3-week swimming protocol, and then subjected to left coronary artery (LCA ligation, and finally sacrificed 24 h after AMI. Myocardial infarct size was examined with triphenyltetrazolium chloride staining. Cardiac apoptosis was determined by TUNEL staining. Mitochondria density was checked by Mito-Tracker immunofluorescent staining. Quantitative reverse transcription polymerase chain reactions and Western blotting were used to determine genes related to apoptosis, autophagy and myocardial energy metabolism. Results: Exercise training reduces myocardial infarct size and abolishes AMI-induced autophagy and apoptosis. AMI leads to a shift from fatty acid to glucose metabolism in the myocardium with a downregulation of PPAR-α and PPAR-γ. Also, AMI induces an adaptive increase of mitochondrial DNA replication and transcription in the acute phase of MI, accompanied by an activation of PGC-1α signaling. Exercise abolishes the derangement of myocardial glucose and lipid metabolism and further enhances the adaptive increase of mitochondrial biogenesis. Conclusion: Exercise training protects against AMI-induced acute cardiac injury through improving myocardial energy metabolism and enhancing the early adaptive change of mitochondrial biogenesis.

  7. New Horizons of Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry

    Science.gov (United States)

    Lee, Ki Hong; Ahn, Youngkeun; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo

    2013-01-01

    As the first nationwide Korean prospective multicenter data collection registry, the Korea Acute Myocardial Infarction Registry (KAMIR) launched in November 2005. Through a number of innovative approaches, KAMIR suggested new horizons about acute myocardial infarction (AMI) which contains unique features of Asian patients from baseline characteristics to treatment strategy. Obesity paradox was existed in Korean AMI patients, whereas no gender differences among them. KAMIR score suggested new risk stratifying method with increased convenience and an enhanced accuracy for the prediction of adverse outcomes. Standard loading dose of clopidogrel was enough for Asian AMI patients. Triple antiplatelet therapy with aspirin, clopidogrel and cilostazol could improve clinical outcomes than dual antiplatelet therapy with aspirin and clopidogrel. Statin improved clinical outcomes even in AMI patients with very low LDL-C levels. The rate of percutaneous coronary intervention was higher and door-to-balloon time was shorter than the previous reports. Zotarolimus eluting stents as the 2nd generation drug-eluting stent (DES) was not superior to the 1st generation DES, in contrast to the western AMI studies. KAMIR made a cornerstone in the study of Korean AMI and expected to be new standards of care for AMI with the renewal of KAMIR design to overcome its pitfalls. PMID:23399991

  8. Left ventricular global longitudinal strain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads

    Systolic dysfunction, clinical heart failure and elevated levels of neurohormonal peptides are major predictors of adverse outcome after acute myocardial infarction (MI). In the present thesis we evaluated global longitudinal strain (GLS) in patients with acute MI in relation to neurohormonal...

  9. Nifedipine for angina and acute myocardial ischemia

    NARCIS (Netherlands)

    P.G. Hugenholtz (Paul); J.W. de Jong (Jan Willem); P.D. Verdouw (Pieter); P.W.J.C. Serruys (Patrick)

    1983-01-01

    textabstractThis paper reviews the mechanisms believed to be responsible for myocardial ischaemia and the mode of action of calcium antagonist drugs. The clinical management of patients with myocardial ischaemia is discussed in the context of current knowledge about patho-physiology and drug action.

  10. Localization and quantification of acute myocardial infarction by myocardial perfusion tomographic imaging

    International Nuclear Information System (INIS)

    Lin Xiufang; Min Changgeng; Lin Zhihu; Ke Ruoyi

    1994-01-01

    The authors reported the result of the quantification and localization of 30 clinically confirmed acute myocardial infarction patients in comparison with that of ECG. A left ventricle model was used to correct the area calculated by the method of Bull's eye. The result indicated that the infarction area calculated by the corrected Bull's eye method correlated closely with that determined by the ECG QRS scoring method (r = 0.706, P<0.01). Myocardial infarctions of all 30 patients were detected by both ECG and myocardial perfusion tomographic imaging. The accuracy of localization of myocardial infarction by myocardial perfusion imaging was similar to that of ECG in the anterior wall, anterior septum, anterior lateral and inferior wall, but superior to that of ECG in the apex, posterior lateral, posterior septum, and posterior wall

  11. Clinical Manifestation of Acute Myocardial Infarction in the Elderly

    Directory of Open Access Journals (Sweden)

    Miftah Suryadipradja

    2003-12-01

    Full Text Available A retrospective study were performed in patients with acute myocardial infarction (AMI that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2% were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non- Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35 Keywords: clinical manifestation, acute myocardial infarction, elderly

  12. Degeneration of capsaicin sensitive sensory nerves enhances myocardial injury in acute myocardial infarction in rats.

    Science.gov (United States)

    Zhang, Rui-Lin; Guo, Zheng; Wang, Li-Li; Wu, Jie

    2012-09-20

    Evidence indicated an involvement of afferent nerves in the pathology of acute myocardial infarction. This study was undertaken to clarify the role and mechanisms by which the sensory afferent degeneration exacerbates the myocardial injury in acute myocardial infarction in rats. The myocardial injury was assessed by analysis of 1) the differences in the infarct size, myocyte apoptosis, the caspase activity in the myocardium and cardiac troponin I in serum between the denervated and non-denervated rats; 2) the differences in the size of infarctiom with and without antagonisms of endogenous neurokinin 1 receptor or calcitonin gene related peptide receptor in acute myocardial infarction. Degeneration of the afferent nerves resulted in marked increase in the pain threshold and decrease in substance P and calcitonin gene related peptide in dorsal root ganglia, spinal dorsal horn and myocardium. Increases of the infarction size (39% ± 4% vs. 26% ± 4%,), troponin-I (28.4 ± 8.89 ng/ml, vs. 14.6 ± 9.75 ng/ml), apoptosis of myocytes (by 1.8 ± 0.2 folds) and caspase-3 activity (1.6 ± 0.3 vs. 1.05 ± 0.18) were observed in the denervated animals at 6h of myocardial infarction, compared with the non-denervated rats. Antagonisms of the endogenous neurokinin 1 receptor or calcitonin gene related peptide receptor caused increase of the size of infarction in the animals. Degeneration of capsaicin sensitive afferent nerves enhances the myocardial injury of acute myocardial infarction, possibly due to reduction of endogenous calcitonin gene related peptide and substance P. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Design and baseline characteristics of a coronary heart disease prospective cohort: two-year experience from the strategy of registry of acute coronary syndrome study (ERICO study

    Directory of Open Access Journals (Sweden)

    Alessandra C. Goulart

    2013-01-01

    Full Text Available OBJECTIVES: To describe the ERICO study (Strategy of Registry of Acute Coronary Syndrome, a prospective cohort to investigate the epidemiology of acute coronary syndrome. METHODS: The ERICO study, which is being performed at a secondary general hospital in São Paulo, Brazil, is enrolling consecutive acute coronary syndrome patients who are 35 years old or older. The sociodemographic information, medical assessments, treatment data and blood samples are collected at admission. After 30 days, the medical history is updated, and additional blood and urinary samples are collected. In addition, a retinography, carotid intima-media thickness, heart rate variability and pulse-wave velocity are performed. Questionnaires about food frequency, physical activity, sleep apnea and depression are also applied. At six months and annually after an acute event, information is collected by telephone. RESULTS: From February 2009 to September 2011, 738 patients with a diagnosis of an acute coronary syndrome were enrolled. Of these, 208 (28.2% had ST-elevation myocardial infarction (STEMI, 288 (39.0% had non-ST-elevation myocardial infarction (NSTEMI and 242 (32.8% had unstable angina (UA. The mean age was 62.7 years, 58.5% were men and 77.4% had 8 years or less of education. The most common cardiovascular risk factors were hypertension (76% and sedentarism (73.4%. Only 29.2% had a prior history of coronary heart disease. Compared with the ST-elevation myocardial infarction subgroup, the unstable angina and non-ST-elevation myocardial infarction patients had higher frequencies of hypertension, diabetes, prior coronary heart disease (p<0.001 and dyslipidemia (p = 0.03. Smoking was more frequent in the ST-elevation myocardial infarction patients (p = 0.006. CONCLUSIONS: Compared with other hospital registries, our findings revealed a higher burden of CV risk factors and less frequent prior CHD history.

  14. Acute myocarditis mimicking myocardial infarction can misdirect the diagnostic approach

    Directory of Open Access Journals (Sweden)

    Erkan Yildirim

    2016-03-01

    Full Text Available Acute myocarditis is a well-recognized but rare manifestation of mostly viral infections. It can present with various clinical manifestations and may mimic myocardial infarction (MI since patients usually present with chest pain, and the electrocardiographic changes similar to those observed in acute ST-elevation MI. We, herein, present such an extreme case of acute myocarditis characterized by dynamic ST segment elevation with reciprocal changes in the electrocardiogram.

  15. Implication of Tc-99m tetrofosmin myocardial scintigraphy in patients with acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kajiya, Teishi; Yasaka, Yoshinori; Kurogane, Hiroyuki; Hayashi, Takatoshi; Takarada, Akira; Yoshida, Akihiro; Mori, Masuki; Itagaki, Tuyoshi; Yoshida, Yutaka [Himeji Cardiovascular Center, Hyogo (Japan)

    1997-02-01

    Usefulness of the 99mTc-tetrofosmin (TF) scintigraphy was evaluated for acute coronary events. Subjects were 182 patients with pectoralgia, who involved 110 cases with myocardial infarction (MI) and 72 cases with unstable angina. Following echocardiography for evaluation of wall move, they were subjected to imaging with gamma camera or with SPECT after intravenous administration of 99mTc-TF (222 MBq) before treatment for re-perfusion. The area at risk for evaluation was a sum of defect scores graded from 0 (normal) to 3 (defect) on images. Low local perfusion was seen in 101 cases of 102 acute MI and lowered blood flow, in 48 patients with unstable angina. FT scintigraphy was useful in the following points; diagnosis by exclusion was possible for acute ischemic heart disease, myocardial salvage after the treatment could be quantified, blood flow in ischemic region before the treatment was indicative of myocardial viability at that region. (K.H.)

  16. Computational modeling of acute myocardial infarction.

    Science.gov (United States)

    Sáez, P; Kuhl, E

    2016-01-01

    Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size.

  17. Limited clinical diagnostic specificity of /sup 99m/Tc stannous pyrophosphate myocardial imaging in acute myocardial infarction

    International Nuclear Information System (INIS)

    Ahmad, M.; Dubiel, J.P.; Logan, K.W.; Verdon, T.A.; Martin, R.H.

    1977-01-01

    To test the sensitivity and specificity of technetium-99m stannous pyrophosphate myocardial imaging in the diagnosis of acute myocardial infarction, myocardial scintigrams were performed in 115 patients. Positive scintigrams were found in all 48 patients with acute myocardial infarction; uptake was localized in 29 patients with transmural infarction and diffuse in 2 patients with transmural infarction and in the remaining 17 patients with subendocardial myocardial infarction. Positive scintigrams were also found in 31 of 67 patients without clinical evidence of acute myocardial infarction. Our data confirm the previously reported sensitivity of /sup 99m/Tc-pyrophosphate imaging in detection of acute myocardial infarction but indicate that positive scintigrams are not specific for this entity

  18. Prognostic usefulness of repeated echocardiographic evaluation after acute myocardial infarction. TRACE Study Group. TRAndolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Korup, E; Køber, L; Torp-Pedersen, C

    1999-01-01

    The prognostic value of repeated echocardiographic measurement of left ventricular function after acute myocardial infarction was evaluated. We found that repeated measurements of wall motion index in survivors of acute myocardial infarction, with no reinfarction, provide important prognostic...

  19. The value of exercise tests after acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F

    1992-01-01

    The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after.......6% did not return to work because of the heart disease. 80 patients were in function groups I-II and 10 in function groups III-IV (New York Heart Association's Classification). Occurrence of ST-segment displacements was without prognostic value. Left ventricular function index (dRPP) and working capacity...

  20. Acute myocardial infarction in a young patient

    International Nuclear Information System (INIS)

    Hameed, A.; Ata-ur-Rehman Quraishi

    2004-01-01

    Myocardial infarction (MI) is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL (high density lipoprotein) and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease. (author)

  1. ST segment elevations: Always a marker of acute myocardial infarction?

    Directory of Open Access Journals (Sweden)

    G. Coppola

    2013-07-01

    Full Text Available Chest pain is one of the chief presenting complaints among patients attending Emergency department. The diagnosis of acute myocardial infarction may be a challenge. Various tools such as anamnesis, blood sample (with evaluation of markers of myocardial necrosis, ultrasound techniques and coronary computed tomography could be useful. However, the interpretation of electrocardiograms of these patients may be a real concern. The earliest manifestations of myocardial ischemia typically interest T waves and ST segment. Despite the high sensitivity, ST segment deviation has however poor specificity since it may be observed in many other cardiac and non-cardiac conditions. Therefore, when ST–T abnormalities are detected the physicians should take into account many other parameters (such as risk factors, symptoms and anamnesis and all the other differential diagnoses. The aim of our review is to overview of the main conditions that may mimic a ST segment Elevation Myocardial Infarction (STEMI.

  2. Acute aortic dissection mimics acute inferoposterior wall myocardial infarction in a Marfan syndrome patient

    OpenAIRE

    Phowthongkum, Prasit

    2010-01-01

    A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography. After a failed coronary angiography, an echocardiogram revealed an aortic intimal flap after which acute aortic dissection was diagnosed. The patient received a successful Bentall operation without immediate complication. Retrospective examination then confirmed the diagnosis of Marfan syndrome. This case demonstrates acute aortic dissection may mimic acut...

  3. Left ventricular global longitudinal strain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads

    Systolic dysfunction, clinical heart failure and elevated levels of neurohormonal peptides are major predictors of adverse outcome after acute myocardial infarction (MI). In the present thesis we evaluated global longitudinal strain (GLS) in patients with acute MI in relation to neurohormonal act...... activation, in-hospital heart failure and prognosis with specific attention to the group of patients with preserved LVEF that currently do not meet the criteria for anti remodeling therapies.......Systolic dysfunction, clinical heart failure and elevated levels of neurohormonal peptides are major predictors of adverse outcome after acute myocardial infarction (MI). In the present thesis we evaluated global longitudinal strain (GLS) in patients with acute MI in relation to neurohormonal...

  4. Thrombolytic therapy of acute myocardial infarction alters collagen metabolism

    DEFF Research Database (Denmark)

    Høst, N B; Hansen, S S; Jensen, L T

    1994-01-01

    The objective of the study was to monitor collagen metabolism after thrombolytic therapy. Sequential measurements of serum aminoterminal type-III procollagen propeptide (S-PIIINP) and carboxyterminal type-I procollagen propeptide (S-PICP) were made in 62 patients suspected of acute myocardial...

  5. Clinical features of acute myocardial infarction: A report from Halibet ...

    African Journals Online (AJOL)

    Introduction. Acute myocardial infarction (AMI) still remains a major reason for ICU admission although mortality ... of patients admitted to the ICU with AMI during four years period from May 1997 to June 2001 were ... Characteristic findings on 12 lead electrocardiogram tracing of elevation of ST segment in contiguous leads ...

  6. Myocardial stress in patients with acute cerebrovascular events

    DEFF Research Database (Denmark)

    Jespersen, C.M.; Hansen, J.F.

    2008-01-01

    Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third...

  7. The inflammatory response in myocarditis and acute myocardial infarction

    NARCIS (Netherlands)

    Emmens, R.W.

    2016-01-01

    This thesis is about myocarditis and acute myocardial infarction (AMI). These are two cardiac diseases in which inflammation of the cardiac muscle occurs. In myocarditis, inflammation results in the elimination of a viral infection of the heart. During AMI, one of the coronary arteries is occluded,

  8. Thrombolysis in acute myocardial infarction : factors determining its efficacy

    NARCIS (Netherlands)

    Brügemann, Johannes

    1994-01-01

    Insight in the mechanisms leading to acute myocardial infarction (MI) has resulted in the administration of exogenous plasminogen activator, later called thrombolytic therapy. This treatment was associated with a significant reduction in mortality and morbidity. However, success has not always been

  9. Silent ischemia and severity of pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F

    1991-01-01

    An overall low tendency to complain of pain, due to a low perception of pain, has been suggested in the pathogenesis of silent ischemia, independent of the extent of the diseased coronaries and a history of previous acute myocardial infarction. This hypothesis has been tested indirectly...

  10. Depressed natural killer cell activity in acute myocardial infarction

    DEFF Research Database (Denmark)

    Klarlund, K; Pedersen, B K; Theander, T G

    1987-01-01

    Natural killer (NK) cell activity against K562 target cells was measured in patients within 24 h of acute myocardial infarction (AMI) and regularly thereafter for 6 weeks. NK cell activity was suppressed on days 1, 3, and 7 (P less than 0.01), day 14 (P less than 0.05) and at 6 weeks (P = 0.05) w...

  11. Frequency and Pattern of Acute Myocardial Infarction in the ...

    African Journals Online (AJOL)

    Acute myocardial infarction has been regarded as one of the rarest cardiovascular diseases in the African continent. Recent findings have shown that the incidence is on the increase. To provide more information on the burden of this deadly disease in Nigeria and in the West African sub –region. This study is a 10 - year ...

  12. Acute myocardial infarction mortality in Cuba, 1999-2008.

    Science.gov (United States)

    Armas, Nurys B; Ortega, Yanela Y; de la Noval, Reinaldo; Suárez, Ramón; Llerena, Lorenzo; Dueñas, Alfredo F

    2012-10-01

    Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care

  13. An Unusual Case of Recurrent Hypersensitivity Reaction Associated with Kounis-Like Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Shanker Kundumadam

    2017-01-01

    Full Text Available There have been multiple reports of allergic reactions associated with acute coronary syndromes. This has been classically described as Kounis syndrome. We present an unusual case of 70-year-old male with multiple prior hypersensitivity reactions and history of coronary artery bypass grafting who presented recurrent episode of severe angioedema and anaphylaxis. He responded to epinephrine but subsequently developed a non-ST elevation myocardial infarction with worsening heart failure. Our case is unique in that, unlike classic Kounis syndrome, the acute coronary event in this case did not present concurrently with the allergic reaction; rather it took nearly 48 hours to present. Subsequent angiogram revealed patent grafts and significant decline in the left ventricular systolic function as compared to his own ECHO a year ago. We postulate that slow mediators of inflammation may play a role in delayed development of acute coronary events with associated LV dysfunction following episodes of angioedema and anaphylaxis.

  14. Impaired myocardial microcirculation in the flow-glucose metabolism mismatch regions in revascularized acute myocardial infarction.

    Science.gov (United States)

    Fukuoka, Yoshitomo; Nakano, Akira; Tama, Naoto; Hasegawa, Kanae; Ikeda, Hiroyuki; Morishita, Tetsuji; Ishida, Kentaro; Kaseno, Kenichi; Amaya, Naoki; Uzui, Hiroyasu; Okazawa, Hidehiko; Tada, Hiroshi

    2017-10-01

    In successfully revascularized acute myocardial infarction (AMI), microvascular function in a myocardial flow-glucose metabolism mismatch pattern has not been reported. We aimed to elucidate myocardial flow reserve (MFR) and myocardial viability in mismatch segments. 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and adenosine stress 13 N-ammonia PET were performed in eighteen AMI patients to evaluate myocardial glucose metabolism, myocardial blood flow (MBF), and MFR. Infarct segments were classified into 3 groups: normal (preserved resting MBF), mismatch (preserved FDG uptake but reduced resting MBF), and match (reduced FDG uptake and resting MBF). Regional wall motion score (WMS) was assessed immediately after reperfusion and recovery periods. MFR in the mismatch group was significantly lower than that in non-infarct-related segments (1.655 ± 0.516 vs 2.282 ± 0.629, P mismatch group was significantly improved (3.07 ± 0.48 vs 2.07 ± 1.14, P = .003); however, in recovery periods, WMS in the mismatch group was significantly higher than that in the normal group (1.05 ± 1.04, P mismatch segments.

  15. The Influence of findings of coronary artery on myocardial salvage in acute myocardial infarction

    International Nuclear Information System (INIS)

    Itano, Midoriko; Naruse, Hitoshi; Morita, Masato; Kawamoto, Hideo; Yamamoto, Juro; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru

    1992-01-01

    201 Tl stress myocardial scintigraphy was performed in convalescent patients with acute myocardial infarction, to evaluate the influence of stenosis and collateral circulation of coronary artery in acute phase, on myocardial salvage in chronic phase. In 14 cases of unsuccessful coronary revascularization (complete occlusion), a complete defect of thallium imaging in chronic phase was seen in only one case of four cases with good collateral circulation, while eight of 10 cases with poor collateral circulation. In 16 cases with collateral circulation, six cases showed a complete defect, although the target vessel had improved to less than 75% of stenosis. However, in cases of good collateral circulation, no case showed a complete defect when the target vessel had improved to less than 75% of stenosis. The myocardial salvage is quite possible (p<0.05), when the coronary angiography in acute phase showed the forward flow (99% or 90% of stenosis) before coronary revascularization and/or good collateral circulation (Rentrop 2deg or 3deg). (author)

  16. Technetium-99m stannous pyrophosphate myocardial scintigraphy. Reliability and limitations in assessment of acute myocardial infraction

    International Nuclear Information System (INIS)

    Cowley, M.J.; Mantle, J.A.; Rogers, W.J.; Rossell, R.O. Jr.; Rackley, C.E.; Logic, J.R.

    1977-01-01

    Two hundred-three patients had technetium 99m (stannous) pyrophosphate myocardial scintigrams for the evaluation of chest pain and suspected acute myocardial infarction. In addition to routine imaging at 60 to 90 minutes after injection of the radiopharmaceutical, the blood pool was imaged immediately in each patient for comparison with routine anterior, left anterior oblique, and left lateral views. Further delayed studies were obtained when residual blood pool activity was identified. Seventy patients had acute myocardial infarction by clinical, electrocardiographic, and enzymatic (CK-MB) criteria. Sixty-five of these 70 patients with acute infarction had positive myocardial scintigrams, with one technically unsatisfactory study. Only four of the 70 patients had negative scintigrams when imaged 18 to 72 hours after infarction in this study. Technically satisfactory scintigrams were recorded in 125 patients without evidence of infarction. Ninety-six had negative scintigrams at 60 to 90 minutes, while 19 patients (15%) had precordial activity at 60 to 90 minutes which was identical in distribution to early blood pool images and cleared with further delay. With these included, the true negative incidence was 92%. Ten of 125 patients had false positive scintigrams; two had recent cardioversion with resultant chest wall damage. The other eight patients had previous infarction 1 1 / 2 to 72 months earlier and had akinetic segments shown angiographically in the areas of the persistently positive scintigrams

  17. Association between coronary flow reserve, left ventricular systolic function, and myocardial viability in acute myocardial infarction

    DEFF Research Database (Denmark)

    Løgstrup, Brian Bridal; Høfsten, Dan E; Christophersen, Thomas B

    2010-01-01

    /s (8.5;12.5), P = 0.04] and end-systolic volume increased [49.5 mL (38;66) vs. 42 (31;61), P = 0.04] in patients with low compared with preserved CFR. Among 87 (58%) patients with resting wall motion abnormalities, 28 met the criteria for viability. One of 53 (2%) met the criteria for viability......AIMS: To investigate the relationships between coronary flow reserve (CFR), left ventricular (LV) systolic function, and myocardial viability in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: In 149 patients with a first AMI, we estimated CFR non-invasively and assessed LV...

  18. Suspected acute myocardial infarction in a dystrophin-deficient dog.

    Science.gov (United States)

    Schneider, Sarah Morar; Coleman, Amanda Erickson; Guo, Lee-Jae; Tou, Sandra; Keene, Bruce W; Kornegay, Joe N

    2016-06-01

    Golden retriever muscular dystrophy (GRMD) is a model for the genetically homologous human disease, Duchenne muscular dystrophy (DMD). Unlike the mildly affected mdx mouse, GRMD recapitulates the severe DMD phenotype. In addition to skeletal muscle involvement, DMD boys develop cardiomyopathy. While the cardiomyopathy of DMD is typically slowly progressive, rare early episodes of acute cardiac decompensation, compatible with myocardial infarction, have been described. We report here a 7-month-old GRMD dog with an apparent analogous episode of myocardial infarction. The dog presented with acute signs of cardiac disease, including tachyarrhythmia, supraventricular premature complexes, and femoral pulse deficits. Serum cardiac biomarkers, cardiac-specific troponin I (cTnI) and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), were markedly increased. Echocardiography showed areas of hyperechoic myocardial enhancement, typical of GRMD cardiomyopathy. Left ventricular dyskinesis and elevated cTnI were suggestive of acute myocardial damage/infarction. Over a 3-year period, progression to a severe dilated phenotype was observed. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Rat Models of Ventricular Fibrillation Following Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Hundahl, Laura A.; Tfelt-Hansen, Jacob; Jespersen, Thomas

    2017-01-01

    A number of animal models have been designed in order to unravel the underlying mechanisms of acute ischemia-induced arrhythmias and to test compounds and interventions for antiarrhythmic therapy. This is important as acute myocardial infarction (AMI) continues to be the major cause of sudden car...... for ventricular arrhythmias occurring during the acute phase of AMI. It provides a description of models developed, advantages and disadvantages of rats, as well as an overview of the most important interventions investigated and the relevance for human pathophysiology....

  20. B lymphocytes trigger monocyte mobilization and impair heart function after acute myocardial infarction

    Science.gov (United States)

    Zouggari, Yasmine; Ait-Oufella, Hafid; Bonnin, Philippe; Simon, Tabassome; Sage, Andrew P; Guérin, Coralie; Vilar, José; Caligiuri, Giuseppina; Tsiantoulas, Dimitrios; Laurans, Ludivine; Dumeau, Edouard; Kotti, Salma; Bruneval, Patrick; Charo, Israel F; Binder, Christoph J; Danchin, Nicolas; Tedgui, Alain; Tedder, Thomas F; Silvestre, Jean-Sébastien; Mallat, Ziad

    2014-01-01

    Acute myocardial infarction is a severe ischemic disease responsible for heart failure and sudden death. Here, we show that after acute myocardial infarction in mice, mature B lymphocytes selectively produce Ccl7 and induce Ly6Chi monocyte mobilization and recruitment to the heart, leading to enhanced tissue injury and deterioration of myocardial function. Genetic (Baff receptor deficiency) or antibody-mediated (CD20- or Baff-specific antibody) depletion of mature B lymphocytes impeded Ccl7 production and monocyte mobilization, limited myocardial injury and improved heart function. These effects were recapitulated in mice with B cell–selective Ccl7 deficiency. We also show that high circulating concentrations of CCL7 and BAFF in patients with acute myocardial infarction predict increased risk of death or recurrent myocardial infarction. This work identifies a crucial interaction between mature B lymphocytes and monocytes after acute myocardial ischemia and identifies new therapeutic targets for acute myocardial infarction. PMID:24037091

  1. A CLINICAL CASE OF ACUTE ALLERGIC MYOCARDITIS SIMULATING MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2015-01-01

    Full Text Available Objective: to describe a clinical case of evolving acute eosinophilic myocarditis simulating coronary heart disease. Subjects and methods. Patient B. aged 62 years was admitted to Intensive Care Unit Fifteen, N.I. Pirogov First Moscow City Clinical Hospital, by being transferred from Thailand with a referral diagnosis of acute myocardial infarction made on November 1, 2012, with complaints of pressing and aching heart pains. At a Phuket hospital, his electrocardiogram recorded atrial fibrillation; indirect cardiac massage, electric pulse therapy, and mechanical ventilation were performed. After being admitted to the N.I. Pirogov First Moscow City Clinical Hospital, the patient underwent examination: estimation of laboratory indicators over time, electrocardiography (ECG, echocardiography, Holter ECG monitoring, and myocardial scintigraphy. Results. The patient had a history of an allergic reaction as urticaria to the ingestion of fish products. His examination showed practically all diagnostic criteria for allergic myocarditis: hypereosinophilia (the admission level of eosinophils was 9% with their further normalization; the characteristic clinical presentation of myocarditis (pressing retrosternal pain; elevated levels of cardiac specific enzymes (creatinine phosphokinase-MB, lactate dehydrogenase, troponin T; ECG changes – myocardial hypokinesis in the acute period, followed by its pattern normalization. of the pattern. Myocardial scintigraphy (by taking into account the fact that the patient had had a new allergic reaction episode, the investigators decided not to perform coronary angiography revealed decreased radiopharmaceutical accumulation in the lower left ventricular wall in the right coronary arterial bed; perfusion remained in the other myocardial walls. Conclusion. This clinical case reflects the specific features of the course of and difficulties in the diagnosis of acute allergic myocarditis that, in most cases, has no specific

  2. Myocardial infarction with acute valvular regurgitation.

    Science.gov (United States)

    Murthy, Sandhya; Greenberg, Mark; Wharton, Ronald

    2012-08-01

    Left-sided valvular lesions are commonly associated with acute and chronic coronary syndromes. Ischemic mitral regurgitation is well described in the literature. We report a case of acute ischemic right-sided valvular disease in which the presenting symptom of an infarction was severe tricuspid regurgitation. This rare entity is usually caused by distortion of the valve apparatus due to underlying wall motion abnormalities. In conclusion, tricuspid regurgitation is an important yet uncommon presentation of acute ischemia that requires a high degree of suspicion for diagnosis.

  3. Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

    Energy Technology Data Exchange (ETDEWEB)

    Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel [University of Bonn, Department of Radiology, Bonn (Germany); Doerner, Jonas [University Hospital Cologne, Department of Radiology, Cologne (Germany); Fimmers, Rolf [University of Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Bonn (Germany)

    2017-11-15

    To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

  4. Justification for intravenous magnesium therapy in acute myocardial infarction

    DEFF Research Database (Denmark)

    Rasmussen, H S

    1988-01-01

    Recent studies have shown that patients with acute myocardial infarction (AMI) are magnesium-deficient and develop an additional transient decrease in serum magnesium concentrations (S-Mg c) during the acute phase of the infarct. Animal experiments, as well as studies on humans, have indicated...... that the acute decrease in S-Mg c as well as a more chronic magnesium (Mg) deficiency state are harmful to the myocardium in the setting of acute ischaemia. This knowledge has led during the last couple of years to the performance of four double-blind placebo controlled studies in which the effect of i.......v. magnesium therapy on mortality and incidence of arrhythmias in patients with AMI has been evaluated. Magnesium treatment more than halved the acute mortality and incidence of arrhythmias requiring treatment in three of the four intervention studies. The mechanisms behind the beneficial effect of magnesium...

  5. Effect of hydroxy safflower yellow A on myocardial apoptosis after acute myocardial infarction in rats.

    Science.gov (United States)

    Zhou, M X; Fu, J H; Zhang, Q; Wang, J Q

    2015-04-10

    This study aimed to investigate the effect of hydroxy safflower yellow A (HSYA) on myocardial apoptosis after acute myocardial infarction (AMI) in rats. We randomly divided 170 male Wistar rats into 6 groups (N = 23): normal control, sham, control, SY (90 mg/kg), HSYA high-dose (HSYA-H, 40 mg/kg), and HSYA low-dose groups (HSYA-L, 20 mg/kg). Myocardial ischemic injury was induced by ligating the anterior descending coronary artery, and the degree of myocardial ischemia was evaluated using electrocardiography and nitroblue tetrazolium staining. Bax and Bcl-2 expressions in the ischemic myocardium were determined using immunohistochemical analysis. Peroxisome proliferator-activated receptor-γ (PPAR-γ) expression in the myocardium of rats with AMI was determined using reverse transcription-polymerase chain reaction. Compared to rats in the control group, those in the HYSA-H, HSYA-L, and SY groups showed a decrease in the elevated ST segments and an increase in the infarct size. The rats in the drug-treated groups showed a significantly lower percentage of Bax-positive cells and a significantly higher percentage of Bcl-2-positive cells than those in the control group (P myocardial ischemia in rats, possibly by increasing the level of Bcl-2/Bax, and PPAR-γ may be not a necessary link in this process.

  6. [Social and occupational repercussions of acute myocardial infarction].

    Science.gov (United States)

    Ouldzein, Horma; Aounallah Skhiri, Hajer; Zouaoui, Walid; Nacef, Mzabi Hanane; Kafsi, Nacer; Ben Romdhane, Habiba; Ben Jemaa, Abdel Majid

    2005-05-01

    The aim of this work was to study the family, social and occupational repercussions of acute myocardial infarction. Our study concerns 70 patients less than 66 years old, working before their hospitalization and having been admitted for acute myocardial infarction between January 1st, 1999 and December 31, 2000 in the Department of Cardiac Resuscitation of hospital La Rabta of Tunis. Data were collected from retrospective review of folders and answers to a questionnaire. There were 70 patients almost exclusively men (n=69). The mean age was 49.0 +/- 6.8 years. The mean follow-up was 27.2 +/- 7.7 months. After the infarction, the majority of patients modified their activities (75.7%) notably their leisure activities (37.1%) and their travels (25.7%). Myocardial infarction had a bring about a bother in current life to 50.0% of the patients, had an influence on emotional life of 41.4% and on sexual activities of 50.0% of the population. The direct repercussions of myocardial infarction on the professional capacities was observed in the majority of the patients. The average delay of return to work has been 91 +/- 111 days. Fight against the isolation of the patient and its exclusion by an adequate and early psychological coverage is the best way to assure the return in a normal family and professional life.

  7. [Sexuality in acute myocardial infarction patients].

    Science.gov (United States)

    Casado Dones, Ma J; de Andrés Gimeno, B; Moreno González, C; Fernández Balcones, C; Cruz Martín, R Ma; Colmenar García, C

    2002-01-01

    We as nurses in the Coronary Unit we do not see the sexuality of the patients sufficiently addressed neither by us nor by the patients themselves. In this article we are trying to analize the reasons and to emphasize the need to include this subject in our Nursing Problem List. In it we explaine the fears and the wrong ideas that we have identified in our patients. The sexual function is not affected by a myocardial infarction but psychological factors, age, drugs and other associated diseases might be a reason. A quiet enviroment, a fit training plan and looking for personalise proper alternatives may help the patient to start a satisfactory sexual life again.

  8. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977...... in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early...... and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer...

  9. Histochemical and immunohistochemical analyses of the myocardial scar fallowing acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tatić Vujadin

    2012-01-01

    Full Text Available Background/Aim. The heart has traditionally been considered as a static organ without capacity of regeneration after trauma. Currently, the more and more often asked question is whether the heart has any intrinsic capacities to regenerate myocytes after myocardial infarction. The aim of this study was to present the existence of the preserved muscle fibers in the myocardial scar following myocardial infarction as well as the presence of numerous cells of various size and form that differently reacted to the used immunohistochemical antibodies. Methods. Histological, histochemical and immunohistochemical analyses of myocardial sections taken from 177 patients who had died of acute myocardial infarction and had the myocardial scar following myocardial infarction, were carried out. More sections taken both from the site of acute infarction and scar were examined by the following methods: hematoxylin-eosin (HE, periodic acid schiff (PAS, PAS-diastasis, Masson trichrom, Malory, van Gieson, vimentin, desmin, myosin, myoglobin, alpha actin, smoth muscle actin (SMA, p53, leukocyte common antigen (LCA, proliferating cell nuclear antigen (PCNA, Ki-67, actin HHF35, CD34, CD31, CD45, CD45Ro, CD8, CD20. Results. In all sections taken from the scar region, larger or smaller islets of the preserved muscle fibers with the signs of hypertrophy were found. In the scar, a large number of cells of various size and form: spindle, oval, elongated with abundant cytoplasm, small with one nucleus and cells with scanty cytoplasm, were found. The present cells differently reacted to histochemical and immunohistochemical methods. Large oval cells showed negative reaction to lymphocytic and leukocytic markers, and positive to alpha actin, actin HHF35, Ki-67, myosin, myoglobin and desmin. Elongated cells were also positive to those markers. Small mononuclear cells showed positive reaction to lymphocytic markers. Endothelial and smooth muscle cells in the blood vessel walls

  10. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning

    Directory of Open Access Journals (Sweden)

    2013-08-01

    Full Text Available Aluminum phosphide (AlP is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

  11. Acute myocardial infarction in a teenager due to Adderall XR.

    Science.gov (United States)

    Sylvester, Angela L; Agarwala, Brojendra

    2012-01-01

    Adderall XR is commonly prescribed for children and adolescents with attention deficit/hyperactivity disorder. We present a case of a 15-year-old male who suffered a myocardial infarction after starting Adderall XR. Patient was otherwise in good health with no previous cardiac abnormalities. Cardiac catheterization was normal, and etiology was presumed to be secondary to acute vasospasm. The patient improved with cessation of medication. Physicians need to carefully screen patients for cardiac abnormalities prior to starting amphetamine-based medications.

  12. Amphetamine Containing Dietary Supplements and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Julio Perez-Downes

    2016-01-01

    Full Text Available Weight loss is one of the most researched and marketed topics in American society. Dietary regimens, medications that claim to boost the metabolism, and the constant pressure to fit into society all play a role in our patient’s choices regarding new dietary products. One of the products that are well known to suppress appetite and cause weight loss is amphetamines. While these medications suppress appetite, most people are not aware of the detrimental side effects of amphetamines, including hypertension, tachycardia, arrhythmias, and in certain instances acute myocardial infarction. Here we present the uncommon entity of an acute myocardial infarction due to chronic use of an amphetamine containing dietary supplement in conjunction with an exercise regimen. Our case brings to light further awareness regarding use of amphetamines. Clinicians should have a high index of suspicion of use of these substances when young patients with no risk factors for coronary artery disease present with acute arrhythmias, heart failure, and myocardial infarctions.

  13. Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Paul Khairy

    2001-01-01

    Full Text Available A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

  14. Myocardial stress in patients with acute cerebrovascular events

    DEFF Research Database (Denmark)

    Jespersen, C.M.; Hansen, J.F.

    2008-01-01

    Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third of th...... and not coronary thrombosis. However, all patients with signs of cardiac involvement during acute cerebrovascular events should receive a cardiological follow-up in order to exclude concomitant ischemic heart disease. Copyright (C) 2007 S. Karger AG, Basel Udgivelsesdato: 2008...

  15. Circadian variation of transient myocardial ischemia in the early out-of-hospital period after first acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1991-01-01

    Circadian rhythms have been demonstrated in acute myocardial infarction (AMI) and in other clinical cardiac dysfunctions. The purpose of this study was to elucidate whether a circadian pattern of transient myocardial ischemia exists after first AMI. Prospectively, 24-hour ambulatory ST-segment mo...

  16. New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction.

    Science.gov (United States)

    Rossello, Xavier; Wiegerinck, Rob F; Alguersuari, Joan; Bardají, Alfredo; Worner, Fernando; Sutil, Mario; Ferrero, Andreu; Cinca, Juan

    2014-03-01

    Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute pericarditis and acute transmural myocardial ischemia. Clinical records and 12-lead electrocardiogram (ECG) at ×2 magnification were analyzed in 79 patients with acute pericarditis and in 71 with acute ST-segment elevation myocardial infarction (STEMI). ECG leads with maximal ST-segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85.9 ± 13.6 ms vs 81.3 ± 10.4 ms, P = .01; QT: 364.4 ± 38.6 vs 370.9 ± 37.0 ms, P = .04), but not in patients with pericarditis (QRS: 81.5 ± 12.5 ms vs 81.0 ± 7.9 ms, P = .69; QT: 347.9 ± 32.4 vs 347.3 ± 35.1 ms, P = .83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69.8 ± 20.8 ms vs 50.6 ± 20.2 ms, P pericarditis, show prolongation of QRS complex and shortening of QT interval in ECG leads with ST-segment elevation. These new findings may improve the differential diagnostic yield of the classical ECG criteria. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Myocardial infarction, acute ischemic stroke, and hyperglycemia triggered by acute chlorine gas inhalation.

    Science.gov (United States)

    Kose, Ataman; Kose, Beril; Açikalin, Ayça; Gunay, Nurullah; Yildirim, Cuma

    2009-10-01

    Chlorine is one of the most common substances involved in toxic inhalation. Until now, several accidental exposures have been reported. The damage to the respiratory tract in the immediate phase after exposure to chlorine is well defined. Death occurs particularly due to pulmonary edema with respiratory failure and circulatory collapse. On the other hand, no association with myocardial infarction, acute stroke, severe hyperglycemia, and acute chlorine inhalation has been reported in literature. In the present study, an elderly (74-year-old) and diabetic case with myocardial infarction, acute stroke, hyperglycemia, and respiratory failure associated with acute chlorine intoxication after a diagnosis of acute chlorine poisoning and treatment in the emergency department is reported and the literature is revisited. Physicians should know that in elderly patients with a systemic disease who apply with chlorine gas inhalation, more serious complications along with damage in respiratory tract might be observed.

  18. Secular trends and seasonality in first-time hospitalization for acute myocardial infarction

    DEFF Research Database (Denmark)

    Fischer, Thomas; Lundbye-Christensen, Søren; Johnsen, Søren Paaske

    2004-01-01

    The incidence of acute myocardial infarction has declined in several Western countries during the last decades. The incidence and mortality of acute myocardial infarction follow a seasonal pattern. We examined if changes in the incidence of acute myocardial infarction were associated with any...... was estimated using a Poisson regression model. Results: The incidence rate decreased by 3.2 % (95% confidence interval: 2.7-3.3%) annually. Hospitalizations followed different seasonal patterns depending on age, but not on gender. In the

  19. [Acute inflammation phase reactants and interleukin-8 in myocardial infarction].

    Science.gov (United States)

    Zorin, N A; Podkhomutnikov, V M; Iankin, M Iu; Zorina, V N; Arkhipova, S V; Riabicheva, T G

    2009-04-01

    The study was undertaken to search for additional diagnostic criteria allowing the depth of myocardial damage to be estimated in males aged 57.2 +/- 9.6 years. Few interrelated acute phase reaction indices, including the levels of interleukin-8 (IL-8), lactoferrin (LF), alpha2-macroglobulin (alpha2-MG), plasmin (PL) and alpha2-MG-PL circulating complexes, were studied in serum on days 1, 7, and 17 of the onset of the disease. In small-focal myocardial infarction, the levels of alpha2-MG and PL were decreased on day 1 and those of LF and IL-8 were increased on day 14. On the contrary, in large-focal myocardial infarction, the concentrations of IL-8 and LF rose just on day 1 while those of alpha2-MG and PL remained unchanged. The detected differences may be used as additional criteria in differential diagnosis, particularly when ECG was of no informative value. Further, the concurrent elevation of alpha2-MG, PL, and PL-alpha2MG concentrations in large-focal myocardial infarction is indicative of poor prognosis.

  20. 3D cardiac wall thickening assessment for acute myocardial infarction

    Science.gov (United States)

    Khalid, A.; Chan, B. T.; Lim, E.; Liew, Y. M.

    2017-06-01

    Acute myocardial infarction (AMI) is the most severe form of coronary artery disease leading to localized myocardial injury and therefore irregularities in the cardiac wall contractility. Studies have found very limited differences in global indices (such as ejection fraction, myocardial mass and volume) between healthy subjects and AMI patients, and therefore suggested regional assessment. Regional index, specifically cardiac wall thickness (WT) and thickening is closely related to cardiac function and could reveal regional abnormality due to AMI. In this study, we developed a 3D wall thickening assessment method to identify regional wall contractility dysfunction due to localized myocardial injury from infarction. Wall thickness and thickening were assessed from 3D personalized cardiac models reconstructed from cine MRI images by fitting inscribed sphere between endocardial and epicardial wall. The thickening analysis was performed in 5 patients and 3 healthy subjects and the results were compared against the gold standard 2D late-gadolinium-enhanced (LGE) images for infarct localization. The notable finding of this study is the highly accurate estimation and visual representation of the infarct size and location in 3D. This study provides clinicians with an intuitive way to visually and qualitatively assess regional cardiac wall dysfunction due to infarction in AMI patients.

  1. Bronchogenic Carcinoma with Cardiac Invasion Simulating Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Anirban Das

    2016-01-01

    Full Text Available Cardiac metastases in bronchogenic carcinoma may occur due to retrograde lymphatic spread or by hematogenous dissemination of tumour cells, but direct invasion of heart by adjacent malignant lung mass is very uncommon. Pericardium is frequently involved in direct cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threatening presentation in such cases. But direct invasion of myocardium and endocardium is very uncommon. Left atrial endocardium is most commonly involved in such cases due to anatomical contiguity with pulmonary hilum through pulmonary veins, and in most cases left atrial involvement is asymptomatic. But myocardial compression and invasion by adjacent lung mass may result in myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with the acute myocardial infarction (AMI. As a result, it leads to misdiagnosis and delayed diagnosis of lung cancer. Here we report a case of non-small-cell carcinoma of right lung which was presented with asymptomatic invasion in left atrium and retrosternal chest pain simulating AMI due to myocardial compression by adjacent lung mass, in a seventy-four-year-old male smoker.

  2. Ischemic mitral regurgitation in patients with acute myocardial infarction.

    Science.gov (United States)

    Petris, A O; Iliescu, D; Alexandrescu, D M; Costache, Irina-Iuliana

    2014-01-01

    Echocardiographic evaluation of mitral regurgitation (MR) during the evolution of patients with acute myocardial infarction (MI). The study included 104 patients (73 males and 31 females), aged between 38-85, diagnosed with acute myocardial infarction (based on clinical, ECG and enzymatic evidences), in order to assess the MR (clinically--a new systolic murmur, and by echocardiography--the severity of MR). Echocardiography was performed upon admission and at 10-30 and 180 days after the onset of acute MI. The evaluation of MR was based on the following parameters: jet area, jet area indexed to left atrium, regurgitated volume, left atrial and left ventricular size, the evaluation of mitral valve apparatus in order to eliminate other possible causes of MR. MR was found in 35 patients from 104 diagnosed with acute MI, as follows: severe in 20 patients (jet area > 8 square cm, jet area indexed to left atrium > 40%, regurgitated volume > 30 mL) and mild in 15 patients (jet area diagnosis of MR, estimating its severity, the mechanisms and also the prognosis.

  3. PSYCHOLOGICAL REACTIONS AND HEALTH BEHAVIOR FOLLOWING ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Tatjana Milenković

    2011-06-01

    Full Text Available Psychological reactions, risk health behavior and cardiac parameters can influence rehospitalization after acute myocardial infarction.The aim of the paper was to determine the presence of psychological reactions and risk health behavior in patients with acute myocardial infarction on admission as well as the differences after six months.The research included thirty-trhee patients of both sexes, who were consecutively hospitalized due to acute myocardial infarction. A prospective clinical investigation involved the following: semi-structured interview, Mini International Neuropsychiatric Interview (M.I.N.I for pcychiatric disorders, Beck Anxiety Inventory (BAI for measuring the severity of anxiety, Beck Depression Inventory (BDI for measuring the severity of depression, KON-6 sigma test for aggression, Holms-Rahe Scale (H-R for exposure to stressful events, and Health Behavior Questionnaire: alcohol consumption, cigarette smoking, lack of physical activity. Measurement of the same parameters was done on admission and after six months. The differences were assessed using the t-test and chi-square test for p<0.05.On admission, anxiety (BAI=8.15±4.37 and depression (BDI=8.67±3.94 were mild without significant difference after six months in the group of examinees. Aggression was elevated and significantly lowered after six monts (KON-6 sigma =53,26±9, 58:41,42±7.67, t=2,13 for p<0.05. Exposure to stressful events in this period decreased (H-R=113.19±67.37:91,65±63,81, t=3,14 for p<0.05; distribution of physical activity was significantly higher compared to admission values (54.83%: 84.84%. χ2=5.07 for p<0.01.In the group of examinees with acute myocardial infarction in the period of six months, anxiety and depression remained mildly icreased, while the levels of aggression and exposure to stressful events were lowered. Risk health behavior was maintained, except for the improvement in physical activity. In the integrative therapy and

  4. Secondary prevention with calcium antagonists after acute myocardial infarction

    DEFF Research Database (Denmark)

    Hansen, J F

    1992-01-01

    and preventing reinfarction, nevertheless demonstrated pronounced differences between the 3 drugs. Nifedipine had no effect on reinfarction or death. Diltiazem had no overall effect but prevented first reinfarction or cardiac death (cardiac events) in patients without heart failure, and increased cardiac events......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...... in patients with heart failure before randomisation. Verapamil prevented first reinfarction or death (major events); the most pronounced effect was found in patients without heart failure before randomisation. Verapamil did not have detrimental effects in patients treated for heart failure before...

  5. Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction

    DEFF Research Database (Denmark)

    Glinge, Charlotte; Sattler, Stefan; Jabbari, Reza

    2016-01-01

    of a family member is a risk factor for SCD and VF during acute myocardial infarction (MI), independent of traditional risk factors including family history of MI, suggesting a genetic component in the susceptibility to VF. To prevent SCD and VF due to MI, we need a better understanding of the genetic...... and molecular mechanisms causing VF in this apparently healthy population. Even though new insights and technologies have become available, the genetic predisposition to VF during MI remains poorly understood. Findings from a variety of different genetic studies have failed to reach reproducibility, although...... several genetic variants, both common and rare variants, have been associated to either VF or SCD. For this review, we searched PubMed for potentially relevant articles, using the following MeSH-terms: "sudden cardiac death", "ventricular fibrillation", "out-of-hospital cardiac arrest", "myocardial...

  6. Protein C deficiency in a patient of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tamzeed Ahmed

    2009-01-01

    Full Text Available A 42-year old male presented with acute myocardial infarction with no discernable risk factors; he never smoked; did not suffer from diabetes and had a well controlled blood pressure with single medication; plasma concentration of total cholesterol was on the upper normal limit, high and low density lipoprotein, cholesterol and triglyceride being normal. In addition to a single antihypertensive he received Allupurinol(Xanthine Oxidase inhibitorfor hyperuricaemia. Coronary angiogram revealed ectatic epicardial coronary arteries. The patient developed deep vein thrombosis of right leg after four days of the coronary angiogram. Coagulation analysis revealed protein C deficiency. The recognition of protein C deficiency as a risk factor for myocardial infarction is important as anticoagulators prevent further thrombotic events whereas inhibitors of platelet aggregation are ineffective. Ibrahim Med. Coll. J. 2009; 3(1: 34-35

  7. [Antagonistic effect and mechanism of Rosuvastatin on myocardial apoptosis in rats with acute myocardial infarction].

    Science.gov (United States)

    Song, Zhanchun; Bai, Jinghui; Wang, Qi; Chen, Liang; Guo, Qunping; Zhang, Di

    2015-12-01

    To investigate the protective effect of Rosuvastatin on myocardial cells in rats with acute myocardial infarction and its possible mechanism. Rats were randomly assigned to four groups: Control group, Sham group, AMI and Rosuvastatin group. The levels of lactate dehydrogenase (LDH) and creatine jubase (CK), the vitality of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) were detected by assay kits and the levels of C-reactive protein (CRP), tumor necrosis factor (TNF) alpha and interleukin (IL)-6 expression were detected by enzyme linked immunosorbent assay (ELISA). TTC/Evans blue staining was used to determine the relative myocardial infarction area, HE staining was used to detect pathologic changes and myocardial apoptosis was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). What's more, Western blot was used to detect the protein expression of B-cell lymphoma-2 (Bcl-2), Bax, cleaved-Caspase-3, Rock1, Rock2, I-κB and NF-κBp65. The model of acute myocardial infarction rats was established. Compared with Sham group, the myocardial pathological changes were more severe, and the apoptosis number, the production of inflammatory factors and oxidative damage were significantly increased in AMI group. Compared with AMI group, the relative area of infarction myocardium (43% ± 4% vs 31% ± 8%, P=0.004 3) was dramatically reduced, the levels of LDH (2 545.45 ± 613.67 U/L vs 1 573.43 ± 373.72 U/L, P=0.02) and CK (7.49 ± 1.75 U/ml vs 4.42 ± 1.28 U/ml, P=0.04) in serum were significantly lower (Pmyocardial pathological damage degree was relieved, the apoptosis number (41% ± 8% vs 23% ± 6%, P=0.014 7) was significantly decreased, the expression of Bax (1.17 ± 0.10 vs 0.57 ± 0.08, P=0.003) and cleaved-Caspase-3 (1.31 ± 0.07 vs 0.70 ± 0.01, P=0.004) were dramatically reduced, and the expression of Bcl-2 (0.19 ± 0.01 vs 0.32 ± 0.01, P=0.003) was enhanced in Rosuvastatin group. Furthermore, the production of

  8. Cells involved in extracellular matrix remodeling after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Larissa Ferraz [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Mataveli, Fábio D’Aguiar [Universidade Federal de São Paulo, São Paulo, SP (Brazil); Mader, Ana Maria Amaral Antônio; Theodoro, Thérèse Rachell [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Justo, Giselle Zenker; Pinhal, Maria Aparecida da Silva [Universidade Federal de São Paulo, São Paulo, SP (Brazil)

    2015-07-01

    Evaluate the effects of VEGF{sub 165} gene transfer in the process of remodeling of the extracellular matrix after an acute myocardial infarct. Wistar rats were submitted to myocardial infarction, after the ligation of the left descending artery, and the left ventricle ejection fraction was used to classify the infarcts into large and small. The animals were divided into groups of ten, according to the size of infarcted area (large or small), and received or not VEGF{sub 165} treatment. Evaluation of different markers was performed using immunohistochemistry and digital quantification. The primary antibodies used in the analysis were anti-fibronectin, anti-vimentin, anti-CD44, anti-E-cadherin, anti-CD24, anti-alpha-1-actin, and anti-PCNA. The results were expressed as mean and standard error, and analyzed by ANOVA, considering statistically significant if p≤0.05. There was a significant increase in the expression of undifferentiated cell markers, such as fibronectin (protein present in the extracellular matrix) and CD44 (glycoprotein present in the endothelial cells). However, there was decreased expression of vimentin and PCNA, indicating a possible decrease in the process of cell proliferation after treatment with VEGF{sub 165}. Markers of differentiated cells, E-cadherin (adhesion protein between myocardial cells), CD24 (protein present in the blood vessels), and alpha-1-actin (specific myocyte marker), showed higher expression in the groups submitted to gene therapy, compared to non-treated group. The value obtained by the relation between alpha-1-actin and vimentin was approximately three times higher in the groups treated with VEGF{sub 165}, suggesting greater tissue differentiation. The results demonstrated the important role of myocytes in the process of tissue remodeling, confirming that VEGF{sub 165} seems to provide a protective effect in the treatment of acute myocardial infarct.

  9. Cells involved in extracellular matrix remodeling after acute myocardial infarction.

    Science.gov (United States)

    Garcia, Larissa Ferraz; Mataveli, Fábio D'Aguiar; Mader, Ana Maria Amaral Antônio; Theodoro, Thérèse Rachell; Justo, Giselle Zenker; Pinhal, Maria Aparecida da Silva

    2015-01-01

    Evaluate the effects of VEGF165 gene transfer in the process of remodeling of the extracellular matrix after an acute myocardial infarct. Wistar rats were submitted to myocardial infarction, after the ligation of the left descending artery, and the left ventricle ejection fraction was used to classify the infarcts into large and small. The animals were divided into groups of ten, according to the size of infarcted area (large or small), and received or not VEGF165 treatment. Evaluation of different markers was performed using immunohistochemistry and digital quantification. The primary antibodies used in the analysis were anti-fibronectin, anti-vimentin, anti-CD44, anti-E-cadherin, anti-CD24, anti-alpha-1-actin, and anti-PCNA. The results were expressed as mean and standard error, and analyzed by ANOVA, considering statistically significant if p≤0.05. There was a significant increase in the expression of undifferentiated cell markers, such as fibronectin (protein present in the extracellular matrix) and CD44 (glycoprotein present in the endothelial cells). However, there was decreased expression of vimentin and PCNA, indicating a possible decrease in the process of cell proliferation after treatment with VEGF165. Markers of differentiated cells, E-cadherin (adhesion protein between myocardial cells), CD24 (protein present in the blood vessels), and alpha-1-actin (specific myocyte marker), showed higher expression in the groups submitted to gene therapy, compared to non-treated group. The value obtained by the relation between alpha-1-actin and vimentin was approximately three times higher in the groups treated with VEGF165, suggesting greater tissue differentiation. The results demonstrated the important role of myocytes in the process of tissue remodeling, confirming that VEGF165 seems to provide a protective effect in the treatment of acute myocardial infarct.

  10. Serum aminoterminal type III procollagen peptide reflects repair after acute myocardial infarction

    DEFF Research Database (Denmark)

    Jensen, L T; Hørslev-Petersen, K; Toft, P

    1990-01-01

    similar to changes observed during wound healing in humans. PIIINP is cleaved off procollagen type III during the biosynthesis of type III collagen, which characterizes the early stages of repair and inflammation. Our findings suggest that serum PIIINP reflects the repair processes and scar formation...... following acute myocardial infarction. The serum PIIINP alterations in acute myocardial infarction differ essentially from the changes in myocardial enzymes reflecting myocardial injury. Serum PIIINP may therefore provide new and clinically relevant information on the healing of myocardial infarction....

  11. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Cardiology (SIC), Italian Association of Interventional Cardiology (SICI-GISE) and Italian Society of Cardiac Surgery (SICCH): clinical approach to pharmacologic pre-treatment for patients undergoing myocardial revascularization procedures

    Science.gov (United States)

    Geraci, Giovanna; Gulizia, Michele Massimo; Borzi, Mauro; Colivicchi, Furio; Menozzi, A.; Musumeci, Giuseppe; Scherillo, Marino; Ledda, Antonietta; Tarantini, Giuseppe; Gerometta, Piersilvio; Casolo, Giancarlo; Formigli, Dario; Romeo, Francesco; Di Bartolomeo, Roberto

    2017-01-01

    Abstract The wide availability of effective drugs in reducing cardiovascular events together with the use of myocardial revascularization has greatly improved the prognosis of patients with coronary artery disease. The combination of antithrombotic drugs to be administered before the knowledge of the coronary anatomy and before the consequent therapeutic strategies, can allow to anticipate optimal treatment, but can also expose the patients at risk of bleeding that, especially in acute coronary syndromes, can significantly weigh on their prognosis, even more than the expected theoretical benefit. In non ST-elevation acute coronary syndromes patients in particular, we propose a ‘selective pre-treatment’ with P2Y12 inhibitors, based on the ischaemic risk, on the bleeding risk and on the time scheduled for the execution of coronary angiography. Much of the problems concerning this issue would be resolved by an early access to coronary angiography, particularly for patients at higher ischaemic and bleeding risk. PMID:28751841

  12. Factors associated with myocardial salvage immediately after emergent percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction

    International Nuclear Information System (INIS)

    Yoshida, Susumu; Nakamura, Seishi; Sugiura, Tetsuro

    2009-01-01

    The amount of myocardial salvage after percutaneous coronary intervention (PCI) is reported to be a major determinant of functional recovery in patients with ST-elevation acute myocardial infarction (MI). However, factors related to the amount of myocardial salvage remain unknown. The goal of this study was to investigate the factors related to the amount of myocardial salvage after emergent PCI in patients with ST-elevation acute MI by incorporating pre- and post-treatment indices and adjunctive treatments. Technetium-99m myocardial imaging was performed before, immediately after, and one month after emergent PCI in 161 patients with ST-elevation acute MI, and the defect score was serially evaluated. A good myocardial salvage was defined as ≥4 change (before minus immediately after PCI) of the defect score. Good myocardial salvage was observed in 89 patients. Based on nine clinical variables, logistic regression analysis was performed to determine the important variables related to myocardial salvage. Multivariate analysis revealed that earlier time from onset to PCI (χ 2 =6.55, P=0.01, odds ratio=2.78), larger defect score before PCI (χ 2 =7.29, P=0.01, odds ratio=1.13) and administration of nicorandil before PCI (χ 2 =9.88, P=0.008, odds ratio=4.42) were independently associated with good myocardial salvage. Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 =4.91, P=0.03, odds ratio=0.36) and TIMI flow grade ≤2 after PCI (χ 2 =4.82, P=0.03, odds ratio=0.31) were independently associated with poor myocardial salvage. In contrast, the number of asynergic segments before PCI, infarct-related artery, adequate collaterals before PCI and stent implantation were not determinants of myocardial salvage. This study demonstrated that patients with a greater improvement of 99 mTc tetrofosmin myocardial uptake immediately after PCI had better recovery of left ventricular function and smaller final infarct size. Reperfusion time and TIMI flow grade ≤2 after

  13. New echocardiographic technologies in the study of acute myocardial infarction.

    Science.gov (United States)

    Colonna, Paolo; D'Agostino, Carlo; Del Salvatore, Bibiana; Sorino, Margherita

    2004-06-01

    Echocardiography has a key role in the diagnostic and prognostic evaluation of patients in the different phases of acute myocardial infarction. Despite this important role of the conventional echocardiographic technologies, novel echocardiographic applications are under development or already used in the clinical practice. It is very difficult to distinguish which of these techniques will play a consistent role and will cover important diagnostic, prognostic and therapeutic use. The wise cardiologist will be the one who will choose the appropriate technology for the right subset of patients. In this review paper we try to assign to each novel echocardiographic technique its actual clinical weight in every pathophysiological condition: myocardial contrast echocardiography, contrast opacification of the left ventricle, coronary flow reserve study, integrated backscatter, tissue Doppler and strain rate imaging. For the best treatment choice, each patient has to be perfectly diagnosed and characterized in order to have a tailored therapy. A correct diagnosis of the extension of myocardial necrosis cannot ignore the transmural wavefront development, the amount of viable myocardium or the presence of microvascular damage. Also the simple echocardiographic wall motion akinesia can be caused by a variable extension of non-contracting, scarred myocardium. The different anatomic and functional intramyocardial patterns represent the basis for different functional outcome of regional and hence global left ventricular function. The greatest understanding of the pathology always leads to the best treatment.

  14. Increased risk of acute myocardial infarction in systemic sclerosis: a nationwide population-based study.

    Science.gov (United States)

    Chu, Szu-Ying; Chen, Yi-Ju; Liu, Chia-Jen; Tseng, Wei-Cheng; Lin, Ming-Wei; Hwang, Chian-Yaw; Chen, Chih-Chiang; Lee, Ding-Dar; Chen, Tzeng-Ji; Chang, Yun-Ting; Wang, Wen-Jen; Liu, Han-Nan

    2013-11-01

    Systemic sclerosis is a life-threatening autoimmune disease characterized by vasculopathy, which results in myocardial involvement in an extremely high percentage of patients. Nevertheless, there have been no large-scale epidemiological studies about the risk of acute myocardial infarction in patients with systemic sclerosis. The aims of this study were to evaluate the hazard ratio (HR) and risk factors of acute myocardial infarction in patients with systemic sclerosis, as well as to compare the risks of acute myocardial infarction among systemic sclerosis patients taking different immunosuppressors. The study cohort included 1344 patients with systemic sclerosis and 13,440 (1:10) age-, sex-, and comorbidity-matched controls during the period between 1997 and 2006, from the National Health Insurance Research Database. We compared the risk of acute myocardial infarction between patients with systemic sclerosis and controls and calculated the adjusted HRs for acute myocardial infarction in systemic sclerosis patients taking immunosuppressors and not taking immunosuppressors. The incidence rates of acute myocardial infarction were 535 and 313 cases per 100,000 person-years for systemic sclerosis cohort and reference cohort, respectively (P systemic sclerosis was found to be an independent risk factor for acute myocardial infarction (HR 2.45). Other risk factors included hypertension (HR 2.08) and diabetes (HR 2.14). The multivariate adjusted HR for acute myocardial infarction did not decrease among the systemic sclerosis patients taking systemic steroids, penicillamine, cyclophosphamide, azathioprine, methotrexate, or cyclosporine. Systemic sclerosis is independently associated with an increased risk of acute myocardial infarction. Immunosuppressors do not lower the risk of acute myocardial infarction in our study. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Nuclear myocardial perfusion imaging with a cadmium-telluride semiconductor detector gamma camera in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Fukushima, Yoshimitsu; Kumita, Shin-ichiro; Kawaguchi, Tsuneaki; Maruyama, Takatoshi; Kawasaki, Yoshiyuki; Shinkai, Yasuhiro

    2014-01-01

    Since myocardial perfusion imaging (MPI) with conventional sodium iodine (NaI) device has low spatial resolution, there have been some cases in which small structures such as non-transmural myocardial infarction could not be properly detected. The purpose of this study was to evaluate potential usefulness of cadmium-telluride (CdTe) semiconductor detector-based high spatial resolution gamma cameras in detecting myocardial infarction sites, especially non-transmural infarction. A total of 38 patients (mean age ± SD: 64 ± 21 year) who were clinically diagnosed with acute myocardial infarction were included. Twenty-eight cases of them were with ST segment elevation myocardial infarction (STEMI) and 10 cases with non-ST segment elevation myocardial infarction (NSTEMI). In all patients, myocardial perfusion single photon emission computed tomography images were acquired with Infinia (NaI device) and R1-M (CdTe device), and the images were compared concerning the detectability of acute myocardial infarction sites. The detection rates of the myocardial infarction site in cases with STEMI were 100% both by NaI and CdTe images. In cases with NSTEMI, detection rate by NaI images was 50%, while that of CdTe images was 100% (p=0.033). The summed rest score (SRS) value derived from CdTe images was significantly higher than that from NaI images in cases with STEMI [NaI images: 12 (7-18) versus CdTe images: 14 (9-20)] (p < 0.001). SRS derived from CdTe images was significantly higher than that derived from NaI images in cases with NSTEMI [NaI images: 2 (0-5) versus CdTe images: 6 (6-8)] (p=0.006). These results indicate that MPI using CdTe-semiconductor device will provide a much more accurate assessment of acute myocardial infarction in comparison to current methods. (author)

  16. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  17. THE SPEKL-TREKING PREDICTIVE VALUE OF THE ECHOCARDIOGRAPHY AT THE ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    N. A. Kosheleva

    2016-01-01

    Full Text Available Speckle-tracking echocardiography is a non-invasive method  for assessment of myocardial deformation, which is closely associated with its regional and global function. Although it is not yet introduced into clinical practice, deformation parameters are actively studied in different clinical conditions, particularly in acute myocardial infarction. Numerous studies show deformation  impairment may have important prognostic value at patients with a acute myocardial infarction.

  18. Detection of acute myocardial infarction with digital image processing of two-dimensional echocardiograms

    NARCIS (Netherlands)

    Tak, T.; Visser, C.; Rahimtoola, S. H.; Chandraratna, P. A.

    1992-01-01

    We have previously described the ability of a computer-based image digitizing system to assess early textural changes in acute canine myocardial infarction. To determine whether this technique could be applied to human beings, we studied 12 patients with a first acute transmural myocardial

  19. Abnormal glucose metabolism in acute myocardial infarction: influence on left ventricular function and prognosis

    DEFF Research Database (Denmark)

    Høfsten, Dan E; Løgstrup, Brian B; Møller, Jacob E

    2009-01-01

    OBJECTIVES: We studied the influence of abnormal glucose metabolism on left ventricular (LV) function and prognosis in 203 patients with acute myocardial infarction. BACKGROUND: Abnormal glucose metabolism is associated with increased mortality after acute myocardial infarction. This appears to b...... alone did not explain the excess mortality in patients with newly detected or known diabetes....

  20. Significance of the invasive strategy after acute myocardial infarction on prognosis and secondary preventive medication

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Galatius, Søren; Madsen, Mette

    2012-01-01

    To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI).......To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI)....

  1. Delayed percutaneous coronary intervention in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zhu Weiming; Tian Fang; Shi Li; Lan Xi

    2004-01-01

    Objective: To observe the clinical effects, safeness and prognosis of delayed percutaneous coronary intervention (PCI) for infarct related artery (IRA) in post-infarct patients. Methods: In total 53 patients with acute myocardial infarction (AMI) underwent delayed PCI within 5-15 days after the acute event. Conventional treatment (including thrombolytic therapy) was given in all patients as they were admitted. Results: Intervention was performed in 68 branches of IRA were, including 64 cases of PTCA followed by stent implantation and 4 cases of direct stent implantation. In total 68 stents were implanted. The TIMI classification was improved from the pre-PCI 0-2 to post-PCI 3. No patient died during the treatment. No repeated AMI, post-infarct angina and repeated recanalization happened in the hospitalization. A 5-48 month follow up showed there was 1 death (1.9%), 1 case of repeated myocardial infarction (1.9%), 3 cases of unstable angina (5.7%), 2 cases of repeated PCI and 1 case of CABG. The rate of repeated recanalization was 5.7%. Seven patients (13.2%) were admitted for the second time, who survived 6-48 months after the intervention. Conclusion: Delayed PCT can obviously improve the short and long term prognosis as well as the life quality of patients with AMI, which is a safe interventional procedure

  2. Serum magnesium status among acute myocardial infarction patients in Bangladesh.

    Science.gov (United States)

    Chakraborty, P K; Hoque, M R; Islam, M R; Paul, U K; Husain, F

    2014-01-01

    This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with Cardiology Department of Mymensingh Medical College Hospital, Mymensingh during the period of July 2004 to June 2005. The aim of the study was to explore the status of serum magnesium among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 100 subjects were selected and were grouped as Group I (50 healthy control subjects) and Group II (50 subjects of AMI Cases). Serum magnesium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum magnesium were 2.16±0.25 and 1.71±0.17mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum magnesium (p<0.001). It is evident from the study that serum magnesium level significantly decreases among acute myocardial infarction patients in Bangladesh.

  3. Clinical evaluation of myocardial involvement in acute myopericarditis in young adults.

    Science.gov (United States)

    Saricam, Ersin; Saglam, Yasemin; Hazirolan, Tuncay

    2017-05-22

    Myocardial involvement in young adults has various causes. Acute myopericarditis is one of the myocardial involvements in young adults. It is easy to confuse with acute ST-elevation myocardial infarction because of the electrocardiographic features. This study aims to investigate a number of imaging techniques and clinical features for acute myopericarditis in young adults (defined as myocardial brightness in the left ventricle regions, especially in posterior and lateral wall. Focal echobright was observed in the 75 of 77 cases of acute myopericarditis in transthoracic echocardiogram. This sign was confirmed by cardiac magnetic resonance imaging. Focal echobright sensitivity was 95%; its specificity was 93%; its predictive was 95.2%. Pericardial effusion (83%) was observed in group I behind posterior wall. Its specificity was 81%; its sensitivity was 65%; predictivity was 73%. Pericardial effusion and myocardial focal echobright in echocardiography can be quite sensitive indicators for acute myopericarditis in young adults.

  4. Detecting Acute Myocardial Infarction by Diffusion-Weighted versus T2-Weighted Imaging and Myocardial Necrosis Markers.

    Science.gov (United States)

    Jin, Jiyang; Chen, Min; Li, Yongjun; Wang, YaLing; Zhang, Shijun; Wang, Zhen; Wang, Lin; Ju, Shenghong

    2016-10-01

    We used a porcine model of acute myocardial infarction to study the signal evolution of ischemic myocardium on diffusion-weighted magnetic resonance images (DWI). Eight Chinese miniature pigs underwent percutaneous left anterior descending or left circumflex coronary artery occlusion for 90 minutes followed by reperfusion, which induced acute myocardial infarction. We used DWI preprocedurally and hourly for 4 hours postprocedurally. We acquired turbo inversion recovery magnitude T2-weighted images (TIRM T2WI) and late gadolinium enhancement images from the DWI slices. We measured the serum myocardial necrosis markers myoglobin, creatine kinase-MB isoenzyme, and cardiac troponin I at the same time points as the magnetic resonance scanning. We used histochemical staining to confirm injury. All images were analyzed qualitatively. Contrast-to-noise ratio (the contrast between infarcted and healthy myocardium) and relative signal index were used in quantitative image analysis. We found that DWI identified myocardial signal abnormity early (acute myocardial infarction and identified the infarct-related high signal more often than did TIRM T2WI: 7 of 8 pigs (87.5%) versus 3 of 8 (37.5%) ( P =0.046). Quantitative image analysis yielded a significant difference in contrast-to-noise ratio and relative signal index between infarcted and normal myocardium on DWI. However, within 4 hours after infarction, the serologic myocardial injury markers were not significantly positive. We conclude that DWI can be used to detect myocardial signal abnormalities early after acute myocardial infarction-identifying the infarction earlier than TIRM T2WI and widely used clinical serologic biomarkers.

  5. Effect of Glucocorticoids on Ultrastructure of Myocardial Muscle in the Course of Experimentally Induced Acute Myocardial Ischemia

    Directory of Open Access Journals (Sweden)

    Piotr Kuropka

    2017-01-01

    Full Text Available The search for effective methods of myocardial cytoprotection against ischemia is the most significant issue in modern cardiology and cardiac surgery. Glucocorticoids are deemed very strong modulators of inflammatory response and thus can potentially protect heart muscle from postreperfusion injury and myocardial ischemia during cardiac surgery. Ultrastructural examination of the left ventricle heart samples revealed that the intravenous application of dexamethasone and hydrocortisone proved to exert cytoprotective effect on cardiomyocytes during experimentally induced acute ischemia in rats.

  6. Elevated levels of adipokines predict outcome after acute myocardial infarction: A long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort.

    Science.gov (United States)

    Ritsinger, Viveca; Brismar, Kerstin; Malmberg, Klas; Mellbin, Linda; Näsman, Per; Rydén, Lars; Söderberg, Stefan; Tenerz, Åke; Norhammar, Anna

    2017-03-01

    Adiponectin and leptin are associated with insulin resistance and cardiovascular disease. Information on the prognostic value after an acute myocardial infarction is still conflicting. Patients (n = 180) without known diabetes and with admission glucose of acute myocardial infarction in 1998-2000 were followed for mortality and cardiovascular events (first of cardiovascular mortality/acute myocardial infarction/stroke/heart failure) until the end of 2011 (median: 11.6 years). Plasma adiponectin and leptin were related to outcome in Cox proportional-hazard regression analyses. Median age was 64 years and 69% were male. Total mortality was 34% (n = 61) and 44% (n = 80) experienced a cardiovascular event. Adiponectin at discharge predicted cardiovascular events (hazard ratio; 95% confidence interval; 1.45; 1.02-2.07, p = 0.038), total mortality (2.53; 1.64-3.91, p myocardial infarction and heart failure, adiponectin predicted total mortality (1.79; 1.07-3.00, p = 0.027) but not cardiovascular events. High levels of leptin were associated with cardiovascular events during the first 7 years, after which the association was attenuated. Leptin did not predict total mortality. In patients with acute myocardial infarction but without previously known diabetes, high levels of adiponectin at discharge predicted total mortality. The present results support the hypothesis that high rather than low levels of adiponectin predict mortality after acute myocardial infarction.

  7. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners' perceptions

    NARCIS (Netherlands)

    Engel, J.; Heeren, M.J.; van der Wulp, I.; de Bruijne, M.C.; Wagner, C.

    2014-01-01

    METHODS: This qualitative study involved semi-structured interviews with 31 health care practitioners at 11 hospitals throughout the Netherlands. Participants were approached through purposive sampling to represent a broad range of participant- and hospital characteristics, and included

  8. Translation of Methdology used in Human Myocardial Imaging to a Sheep Model of Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Elizabeth A Bailey

    2013-10-01

    Full Text Available Introduction: Pre-clinical investigation of stem cells for repairing damaged myocardium predominantly used rodents, however large animals have cardiac circulation closely resembling the human heart. The aim of this study was to evaluate whether SPECT/CT myocardial perfusion imaging (MPI could be used for assessing sheep myocardium following an acute myocardial infarction (MI and response to intervention. Method: 18 sheep enrolled in a pilot study to evaluate [99mTc]-sestamibi MPI at baseline, post-MI and after therapy. Modifications to the standard MPI protocols were developed. All data was reconstructed with OSEM using CT-derived attenuation and scatter correction. Standard analyses were performed and inter-observer agreement were measured using Kappa (. Power determined the sample sizes needed to show statistically significant changes due to intervention. Results: Ten sheep completed the full protocol. Data processed were performed using pre-existing hardware and software used in human MPI scanning. No improvement in perfusion was seen in the control group, however improvements of 15% - 35% were seen after intra-myocardial stem cell administration. Inter-observer agreement was excellent (К=0.89. Using a target power of 0.9, 28 sheep were required to detect a 10-12% change in perfusion. Conclusions: Study demonstrates the suitability of large animal models for imaging with standard MPI protocols and it’s feasibility with a manageable number of animals. These protocols could be translated into humans to study the efficacy of stem cell therapy in heart regeneration and repair.

  9. Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review

    OpenAIRE

    Abid, Leila; Frikha, Faten; Bahloul, Zouhir; Kammoun, Samir

    2011-01-01

    Abstract Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS) in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high...

  10. Acute ST Elevation Myocardial Infarction in Patients With Immune Thrombocytopenia Purpura: A Case Report.

    Science.gov (United States)

    Dhillon, Sandeep K; Lee, Edwin; Fox, John; Rachko, Maurice

    2011-02-01

    Acute myocardial infarction (AMI) in patients with immune thrombocytopenic purpura (ITP) is rare. We describe a case of AMI in patient with ITP. An 81-year-old woman presented with acute inferoposterior MI with low platelet count on admission (34,000/µl). Coronary angiography revealed significant mid right coronary artery (RCA) stenosis with thrombus, subsequently underwent successful percutaneous coronary intervention (PCI). In some patients with immune thrombocytopenia purpura and acute myocardial infarction, percutaneous coronary intervention is a therapeutic option.

  11. The Frequency of Cerebral Microembolism in Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Masoud Mehrpour

    2010-11-01

    Full Text Available ABSTRACT Introduction: Stroke is more common in patients with cerebral microembolisms. Frequency of cerebral microembolisms (high intensity transient signals, HITS in acute myocardial infarction has been reported about 17%. The factors that influence on microembolism after myocardial infarction (MI are not definitive. Type of MI, Ejection fraction, Hx of Streptokinase is the factors that were studied. Methods: During three years we studied the frequency of cerebral microembolisms in AMI patients, we studied forty patients with microembolism as a case group and ninety patients without microembolism as a control group. We detected microembolism in patients by transcranial doppler study within 72 houre after myocardial infarction. Two-dimensional echocardiogram was performed for all patients during hospitalization. Excluding criteria were prosthetic heart valves, carotid stenosis >50% and poor window for TCD monitoring. Results: number of patients who had history of receiving SK were significantly more common in case group in comparison to control group. OR 2.4 CI(1.1-5.2 The frequency was more prevalent in anterolateral MI in comparison to inferior MI.OR=3.3 CI(1.4-7.4. Ejection fraction has no significant effect on frequency of microembolism. OR 0.5 CI(0.2-1.3.Hypokinesia is also a risk factor for increasing risk of microembolism. OR 4.5 CI(1.4.13.8 Discussion: frequency of microembolism has been increased in patients with history of streptokinase or in the type of Anterolateral MI or wall motion abnormality, so we should be careful for risk of microembolism in this groups.

  12. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Directory of Open Access Journals (Sweden)

    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  13. Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema

    Directory of Open Access Journals (Sweden)

    Budi Yuli Setianto

    2017-04-01

    Full Text Available Current guidelines for the management of patients with acute coronary syndromes (ACSs focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI or non-ST-elevation acute myocardial infarction (NSTEMI/unstable angina (UA. Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the ‘sine qua non’ for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.

  14. Mortality after acute myocardial infarction according to income and education

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Rasmussen, Søren; Gislason, Gunnar H

    2006-01-01

    OBJECTIVE: To study how income and educational level influence mortality after acute myocardial infarction (AMI). DESIGN AND SETTING: Prospective analysis using individual level linkage of registries in Denmark. PARTICIPANTS: All patients 30-74 years old hospitalised for the first time with AMI...... in Denmark in 1995-2002. MAIN OUTCOME MEASURES: Relative risk (RR) of 30 day mortality and long term mortality (31 days until 31 December 2003) associated with income (adjusted for education) or educational level (adjusted for income) and further adjusted for sex, age, civil status, and comorbidity. RESULTS...... of 30 day mortality and long term mortality among younger patients with low compared with high income was 1.54 (95% confidence interval 1.36 to 1.79) and 1.65 (1.45 to 1.85), respectively. The RR of 30 day and long term mortality among younger patients with low compared with high education was 1.24 (1...

  15. Recurrent Acute Myocardial Infarction in Patients with Immune Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Fengyi Shen

    2014-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP, also known as idiopathic thrombocytopenic purpura, is an acquired immune-mediated disease of adults and children characterized by a transient or persistent decrease of platelets and, depending upon the degree of thrombocytopenia, an increased risk of bleeding. The use of standard treatments for acute myocardial infarction (AMI, such as antiplatelet agents and anticoagulants, pose serious problems in patients with ITP due to the potential higher risk of bleeding complications. There are no current guidelines available for management of ITP patients with AMI. In this brief review of the limited available literature, we discuss the proposed pathophysiological link between ITP and arterial thrombosis and the challenging medical and interventional treatment of these patients.

  16. Climate and environmental triggers of acute myocardial infarction.

    Science.gov (United States)

    Claeys, Marc J; Rajagopalan, Sanjay; Nawrot, Tim S; Brook, Robert D

    2017-04-01

    Over the past few decades, a growing body of epidemiological and clinical evidence has led to heightened concerns about the potential short- and long-term deleterious effects of the environment on cardiovascular health, including the risk for acute myocardial infarction (AMI). This review highlights the increased risk of AMI caused by exposure to air pollution and cold temperatures. These factors should be considered modifiable risk factors in the prevention of cardiovascular disease. The current body of knowledge about the biological mechanisms linking environmental changes to atherothrombotic events and the impact of climate change on cardiovascular health are discussed. Finally, recommendations for prevention and public policy are presented. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  17. Sleep impairment and prognosis of acute myocardial infarction

    DEFF Research Database (Denmark)

    Clark, Alice; Lange, Theis; Hallqvist, Johan

    2014-01-01

    STUDY OBJECTIVES: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case...... fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). DESIGN: Prospective cohort study. SETTING: The Stockholm Heart Epidemiology Program, Sweden. PARTICIPANTS: There were 2,246 first-time AMI cases. MEASUREMENTS AND RESULTS: SLEEP IMPAIRMENT WAS ASSESSED...... BY THE KAROLINA SLEEP QUESTIONNAIRE, WHICH COVERS VARIOUS INDICES OF IMPAIRED SLEEP: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national...

  18. Intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Uglietta, J.P.; Boyko, O.B.; O'Connor, C.M.; Aldrich, H.; Massey, E.W.; Heinz, E.R.

    1990-01-01

    This paper determines the incidence and types of intracranial hemorrhage (ICH) in 1,696 patients treated with thrombolytic therapy for acute myocardial infarction (AMI). Thirteen of 1,696 patients experienced ICH, and their nonenhanced brain CT scans were reviewed. Their mean age was 62 years (range, 53-74 years), and nine of 13 were male. Six patients received tissue plasminogen activator (tPA), four streptokinase, two urokinase, and one tPA and urokinase. The hemorrhages were classified according to CT location: intraparenchymal (IPH), subarachnoid (SAH), subdural (SDH), and intraventricular (IVH). The incidence of ICH was 0.76%. There were 31 hemorrhages in 13 patients. Twelve hemorrhages were IPH, 10 were SDH, seven were SAH, and two were IVH. Excluding IVH, 24 of 29 hemorrhages (83%) were supratentorial

  19. Raman spectroscopy of human saliva for acute myocardial infarction detection

    Science.gov (United States)

    Chen, Maowen; Chen, Yuanxiang; Wu, Shanshan; Huang, Wei; Lin, Jinyong; Weng, Guo-Xing; Chen, Rong

    2014-09-01

    Raman spectroscopy is a rapidly non-invasive technique with great potential for biomedical research. The aim of this study was to evaluate the feasibility of using Raman spectroscopy of human saliva for acute myocardial infarction (AMI) detection. Raman spectroscopy measurements were performed on two groups of saliva samples: one group from patients (n=30) with confirmed AMI and the other group from healthy controls (n=31). The diagnostic performance for differentiating AMI saliva from normal saliva was evaluated by multivariate statistical analysis. The combination of principal component analysis (PCA) and linear discriminate analysis (LDA) of the measured Raman spectra separated the spectral features of the two groups into two distinct clusters with little overlaps, rendering the sensitivity of 80.0% and specificity of 80.6%. The results from this exploratory study demonstrated that Raman spectroscopy of human saliva can serve as a potentially clinical tool for rapid AMI detection and screening.

  20. Diabetes mellitus and cardiogenic shock in acute myocardial infarction

    DEFF Research Database (Denmark)

    Lindholm, M G; Boesgaard, S; Torp-Pedersen, C

    2005-01-01

    AIMS: Cardiogenic shock is the leading cause of in-hospital mortality after acute myocardial infarction (MI). This study investigates the importance of age and preexisting diabetes mellitus on the incidence and prognosis of cardiogenic shock in a large group of consecutive patients with MI. METHODS...... nondiabetics and 10.6% among diabetics. Age, wall motion index, reinfarction, and the absence of thrombolytic treatment were significant independent predictors of mortality in patients with cardiogenic shock. Intriguingly, diabetes was not a significant predictor for short- and long-term mortality...... AND RESULTS: Baseline characteristics and in-hospital complications to the infarction were prospectively recorded in 6676 patients with MI. Ten-year mortality was collected. Diabetes was present in 10.8% of the total population. A total of 443 developed cardiogenic shock with an incidence of 6.2% among...

  1. Update on intravenous fibrinolytic therapy for acute myocardial infarction.

    Science.gov (United States)

    Wright, R S; Kopecky, S L; Reeder, G S

    2000-11-01

    Intravenous fibrinolytic therapy is used widely in the treatment of ST-elevation acute myocardial infarction. Advances in this therapeutic modality during the past 5 years include new third-generation fibrinolytic agents and creative strategies to enhance administration and efficacy of fibrinolytic therapy. Several of the new agents allow for single- or double-bolus injection. A number of ongoing large randomized trials are attempting to determine whether the combination of fibrinolytic therapy with low-molecular-weight heparin or a glycoprotein IIb/IIIa antagonist enhances coronary reperfusion and reduces mortality and late reocclusion. One large prospective trial is investigating the potential benefit of prehospital administration of fibrinolytic therapy. This article summarizes recent safety and efficacy data on fibrinolytic therapy, with particular emphasis on the new third-generation fibrin-specific agents; reviews the preliminary data on facilitated fibrinolysis; and discusses the rationale for prehospital administration of fibrinolytic therapy.

  2. Diagnosing and treating acute myocardial infarction in pregnancy.

    LENUS (Irish Health Repository)

    Merrigan, Orla

    2012-02-01

    Acute myocardial infarction (AMI) in pregnancy is a very rare occurrence. However, statistics indicate high mortality rates, with a maternal death rate at 20-37%. Nursing and medical care of AMI in pregnancy is a very complex issue. Risk factors such as stress, smoking, obesity, high cholesterol and family history of heart disease may increase the risk of AMI in pregnancy. There are a variety of challenges for the nurse caring for this patient, as the presenting signs and symptoms of AMI in pregnancy can mimic regular pregnancy symptoms and therefore may be misdiagnosed. There is limited nursing literature on this topic to guide and educate nurses. Recommendations need to be implemented across multiple nursing settings. There is a need for both national and international guidelines on care of this type of patient. There is also a need for policies to be in place and links within the hospital setting and the community.

  3. Frequency of dyslipidaemia in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zaman, Q.U.; Fazal, I.F.; Ali, A.; Satti, L.

    2012-01-01

    Objective: To study the frequency of dyslipidaemia in young patients aged between 20-40 years, with Acute Myocardial Infarction in our population. Study design: Descriptive study Place and duration of Study: Coronary Care Unit (CCU) of Armed Forces Institute of Cardiology (AFIC) National Institute of Heart Diseases (NIHD), Rawalpindi from December 2008 to May 2009. Subjects and Methods: One hundred patients of acute myocardial infarction (AMI) fulfilling the World Health Organization (WHO) diagnostic criteria of AMI, having ages between 20-40 years, were included in the study after full informed consent using non-probability consecutive sampling. Blood samples for serum lipid profile were taken after 12 hours fasting (within 24 hours of presentation), and analyzed in laboratory of AFIC. Individual patients' results were compiled with respect to age, gender, serum total cholesterol, serum triglycerides, serum low density lipoprotein (LDL) cholesterol, serum very low density lipoprotein (VLDL) cholesterol and serum high density lipoprotein (HDL) cholesterol. The data was entered in SPSS (version 11.0) and analyzed. Results: Of the 100 patients with AMI, 47 were found to have dyslipidaernia. Hypertriglyceridaernia was the most common lipid abnormality as it was found in 32 (68.1 %) patients; followed by raised serum VLDL, hypercholesterolemia, raised serum LDL and low serum HDL found in 25 (53.2%), 16 (34.0%), 4 (8.5%) and 2 (4.3%) patients respectively. Out of 47 patients with dyslipidaemia, 28 (59.6%) had more than one lipid abnormality. Conclusion: Frequency of dyslipidaemia in young patients with AMI in our population is high. (author)

  4. Apical Hypertrophic Cardiomyopathy Mimicking Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Lütfü Bekar

    2013-03-01

    Full Text Available Apical hypertrophic cardiomyopathy is a rare form of hypertrophic cardiomyopathy and it can be mistaken for coronary artery disease due to the symptoms and electrocardiography findings. In this report, we aimed to present a patient referred to our clinic with complaints of chest pain and electrocardiography findings who had been misdiagnosed as non-ST elevation acute coronary syndrome.

  5. Blood PGC-1α Concentration Predicts Myocardial Salvage and Ventricular Remodeling After ST-segment Elevation Acute Myocardial Infarction.

    Science.gov (United States)

    Fabregat-Andrés, Óscar; Ridocci-Soriano, Francisco; Estornell-Erill, Jordi; Corbí-Pascual, Miguel; Valle-Muñoz, Alfonso; Berenguer-Jofresa, Alberto; Barrabés, José A; Mata, Manuel; Monsalve, María

    2015-05-01

    Peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) is a metabolic regulator induced during ischemia that prevents cardiac remodeling in animal models. The activity of PGC-1α can be estimated in patients with ST-segment elevation acute myocardial infarction. The aim of the present study was to evaluate the value of blood PGC-1α levels in predicting the extent of necrosis and ventricular remodeling after infarction. In this prospective study of 31 patients with a first myocardial infarction in an anterior location and successful reperfusion, PGC-1α expression in peripheral blood on admission and at 72 hours was correlated with myocardial injury, ventricular volume, and systolic function at 6 months. Edema and myocardial necrosis were estimated using cardiac magnetic resonance imaging during the first week. At 6 months, infarct size and ventricular remodeling, defined as an increase > 10% of the left ventricular end-diastolic volume, was evaluated by follow-up magnetic resonance imaging. Myocardial salvage was defined as the difference between the edema and necrosis areas. Greater myocardial salvage was seen in patients with detectable PGC-1α levels at admission (mean [standard deviation (SD)], 18.3% [5.3%] vs 4.5% [3.9%]; P = .04). Induction of PGC-1α at 72 hours correlated with greater ventricular remodeling (change in left ventricular end-diastolic volume at 6 months, 29.7% [11.2%] vs 1.2% [5.8%]; P = .04). Baseline PGC-1α expression and an attenuated systemic response after acute myocardial infarction are associated with greater myocardial salvage and predict less ventricular remodeling. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Stem cell mobilization by granulocyte colony-stimulating factor for myocardial recovery after acute myocardial infarction: a meta-analysis

    DEFF Research Database (Denmark)

    Zohlnhofer, D.; Dibra, A.; Koppara, T.

    2008-01-01

    OBJECTIVES: The objective of this meta-analysis was to evaluate the effect of stem cell mobilization by granulocyte colony-stimulating factor (G-CSF) on myocardial regeneration on the basis of a synthesis of the data generated by randomized, controlled clinical trials of G-CSF after acute...

  7. Markers of Autolysis in Acute ST Elevation Myocardial Infarction – A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Prabindra Maharjan

    2015-06-01

    Conclusions: MVP, Lp (a, TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required. Keywords: acute coronary syndrome; infarct related artery; myocardial infarction.

  8. ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, P; Grande, P; Pedersen, F

    1990-01-01

    Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage was t...

  9. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    International Nuclear Information System (INIS)

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-01-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

  10. Predictors of left ventricle aneurism development in patients with acute anterior Q-wave myocardial infarction

    Directory of Open Access Journals (Sweden)

    V.D. Syvolap

    2013-08-01

    Full Text Available 67 patients with diagnosis: Q-wave myocardial infarction – were examined. Peculiarities of ECG and echocardiographic indexes were studied depending on the presence of left ventricle aneurism. Predictors of left ventricle aneurism formation were revealed in patients with acute Q-wave myocardial infarction.

  11. Predictors of left ventricle aneurism development in patients with acute anterior Q-wave myocardial infarction

    OpenAIRE

    V.D. Syvolap; S.M. Kyselov

    2013-01-01

    67 patients with diagnosis: Q-wave myocardial infarction – were examined. Peculiarities of ECG and echocardiographic indexes were studied depending on the presence of left ventricle aneurism. Predictors of left ventricle aneurism formation were revealed in patients with acute Q-wave myocardial infarction.

  12. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

    Directory of Open Access Journals (Sweden)

    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  13. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  14. Thrombolysis with rt-PA in acute myocardial infarction: no additional benefit of immediate PTCA

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); A. Betriu; M. Bokslag; D.P. de Bono (David); R.W. Brower (Ronald); J.J. Col (Jacques); F.C. Dougherty; R. von Essen; H. Lambertz; J. Lubsen (Jacob); B. Meier (Bernard); P.L. Michel; P. Raynaud (Philippe); W.R. Rutsch (Wolfgang); G.A. Sanz; W. Schmidt; P.W.J.C. Serruys (Patrick); C. Thery; R. Uebis; A. Vahanian (Alec); G.M. Willems (George); D. Wood; M. Verstraete (Marc); A.E.R. Arnold (Alfred); F.J.J. van de Werf (Frans)

    1988-01-01

    textabstractA randomised trial of 367 patients with acute myocardial infarction was performed to determine whether an invasive strategy combining thrombolysis with recombinant tissue-type plasminogen activator (rTPA), heparin, and acetylsalicylic acid, and immediate percutaneous transluminal

  15. Clinical observation of early rehabilitation nursing on the prognosis of patients with acute myocardial infarction effect

    Directory of Open Access Journals (Sweden)

    Song Zaiying

    2017-01-01

    Full Text Available To explore the effect of early rehabilitation nursing on the quality of life of patients with acute myocardial infarction. Methods 41 cases of patients with acute myocardial infarction were selected according to the diagnostic criteria of acute myocardial infarction, stable vital signs, and no obvious complications. On the basis of routine nursing care, the system of early rehabilitation nursing care, the development of daily rehabilitation nursing plan. The cardiac function, clinical symptoms, quality of life and average length of stay were observed in 41 patients. Results During hospitalization, 41 patients had no deaths and all patients clinical symptoms significantly reduced; length of hospital stay was significantly decreased; heart function recovered well; the quality of life of patients significantly improved. Conclusion Early rehabilitation nursing care for patients with acute myocardial infarction is conducive to improving the condition, shorten the hospital stay, can greatly improve the quality of life of patients, it is worthy of clinical promotion.

  16. HDL function is impaired in acute myocardial infarction independent of plasma HDL cholesterol levels

    NARCIS (Netherlands)

    Annema, Wijtske; Willemsen, Hendrik M.; de Boer, Jan Freark; Dikkers, Arne; van der Giet, Markus; Nieuwland, Wybe; Muller Kobold, Anna; van Pelt, L. Joost; Slart, Riemer H. J. A.; van der Horst, Iwan C. C.; Dullaart, Robin P. F.; Tio, Rene A.; Tietge, Uwe J. F.

    2016-01-01

    BACKGROUND: High-density lipoproteins (HDLs) protect against the development of atherosclerotic cardiovascular disease. HDL function represents an emerging concept in cardiovascular research. OBJECTIVE: This study investigated the association between HDL functionality and acute myocardial infarction

  17. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan J M; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Voskuil, M

    2017-01-01

    BACKGROUND: In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether

  18. Clinical implications of sleep disordered breathing in acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Doron Aronson

    Full Text Available Sleep disordered breathing (SDB, characterized by nightly intermittent hypoxia, is associated with multiple pathophysiologic alterations that may adversely affect patients with acute myocardial infarction (AMI. This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.We prospectively enrolled 180 AMI patients. SDB was defined as oxygen desaturation index (ODI >5 events/hour based on a Watch Pat-100 sleep study. Blood samples were obtained for high-sensitivity C-reactive protein (hs-CRP and markers of oxidative stress (lipid peroxides [PD] and serum paraoxonase-1 [PON-1] (arylesterase activity. Echocardiography was performed to evaluate cardiac dimensions and pulmonary artery systolic pressure.SDB was present in 116 (64% patients. Hs-CRP levels, PD and PON-1 were similar in patients with and without SDB. Echocardiography revealed higher left atrial dimension (4.1 ± 0.5 vs 3.8 ± 0.5 cm; P = 0.003 and a significant positive correlation between ODI and pulmonary artery systolic pressure (r = 0.41, P<0.0001. After a median follow up of 68 months, no significant differences were observed between the study groups with regard to clinical outcomes, including death, heart failure, myocardial infarction and unstable angina.There is a high prevalence of previously undiagnosed SDB among patients with AMI. SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure. SDB was not associated with adverse clinical outcomes.

  19. [Association between ABO blood group and acute myocardial infarction].

    Science.gov (United States)

    Hu, Xiaoying; Qiao, Shubin; Qiu, Hong; Ye, Shaodong; Feng, Lei; Song, Lei

    2015-09-01

    To explore the association between the ABO blood group and the risk of myocardial infarction in Chinese people. We retrospectively recruited 1 988 consecutive patients with acute myocardial infarction (AMI) and 1 856 non-coronary artery disease (non-CAD) subjects who hospitalized in our hospital between January 2013 and December 2013. The clinical features and ABO blood group were analyzed. Blood group distribution was A (27.1%, 539/1 988), B (34.4%, 684/1 988), AB (10.8%, 215/1 988), O (27.7%, 551/1 988) in patients with AMI and A (26.7%, 496/1 856), B(32.2%, 598/1 856), AB(10.8%, 200/1 856), O (30.4%, 564/1 856) in non-CAD group. The single factor analysis showed that blood group O tended to be more common in the non-CAD group than in AMI group (P = 0.06). After adjustment for common cardiovascular risk factors such as age, gender, hypertension, diabetes, smoking and serum cholesterol level, the A, B, and AB blood groups were associated with increased risk of AMI compared with O blood group, and the difference was significant with A blood group (OR = 1.229, 95% CI 1.019-1.482, P = 0.031) and B blood groups (OR = 1.214, 95% CI 1.017-1.449, P = 0.032). In addition, non-O blood group remained significantly associated with the increased risk of AMI than O blood group after logistic regression analysis (OR = 1.223, 95% CI 1.048-1.426, P = 0.01). Our results suggest that non-O blood group is associated with the increased risk of AMI.

  20. Avaliação das pressões sistólica, diastólica e pressão de pulso como fator de risco para doença aterosclerótica coronariana grave em mulheres com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST Evaluation of systolic, diastolic, and pulse pressure as risk factors for severe coronary arteriosclerotic disease in women with unstable angina non-ST-elevation acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    José Marconi Almeida de Sousa

    2004-05-01

    Full Text Available OBJETIVO: Avaliar se as pressões, medidas na raiz da aorta, são fatores de risco para doença aterosclerótica coronariana grave em mulheres com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST (AI/IAMSS. MÉTODO:As pressões, assim como os fatores de risco para doença arterial coronariana (DAC foram prospectivamente coletados de março/1993 a agosto/2001 em 593 mulheres com diagnóstico de AI/IAMSS submetidas à cinecoronariografia. Lesões coronarianas definidas como graves estenoses > 70%. RESULTADOS: Idade média de 59,2±11,2 anos, significantemente mais alta nas pacientes com DAC: 61,9 ± 10,8 anos vs 56.4 ± 10,8 anos; tabagismo, diabetes e climatério foram mais freqüentes nas pacientes com DAC. As médias das pressões sistólica e arterial média foram iguais nos dois grupos, entretanto as médias das pressões diastólicas do ventrículo esquerdo (17.6 ± 8.7 x 15.1 ± 8.1, p=0.001 e da pressão de pulso aórtica foram significantemente maiores nas pacientes com DAC (75.5 ± 22 x 70 ± 19, p=0.002, enquanto a média da pressão diastólica aórtica foi significantemente mais alta nas pacientes sem DAC (75.3 ± 17.5 x 79.8 ± 16, p=0.003. Na análise multivariada a pressão de pulso > 80 mmHg e pressão sistólica > 165 foram independentemente associadas a DAC com razão de chance de 2.12 e 2.09, p 80 mmHg e pressão sistólica > 165 mmHg determinaram risco duas vezes maior de lesão coronariana grave.OBJECTIVE: To evaluate pressures assessed at the aortic root as risk factors for severe atherosclerotic coronary heart disease in women with unstable angina/compatible clinical history associated with increase in cardiac enzymes (total CPK and CK-MB 2 times greater than the standard value used in the hospital, with the absence of new Q waves on the electrocardiogram (UA/NSTEMI. METHODS: Five hundred and ninety-three female patients with clinical diagnosis of UA/NSTEMI underwent cinecoronariography from March 1993 to August 2001, and the risk factors for CHD were studied. During examination the pressures, at the aortic root, and coronary obstructions were visually assessed by 2 interventional cardiologists, and those stenosis over 70% were considered severe. RESULTS: Eight-one per cent of the population was white and 18.3% was black. Mean age was 59.2±11.2 years, and it was significantly higher in patients with severe coronary lesions: 61.9 ± 10.8 years versus 56.4 ± 10.8 years; smoking, diabetes mellitus and climacteric were more frequent in patients with CHD. The average mean arterial pressure and mean systolic blood pressure was the same in both groups, however, average left ventricle diastolic pressure (17.6 ± 8.7 x 15.1 ± 8.1, p=0.001, and aortic pulse pressure were significantly greater in patients with CHD (75.5 ± 22 x 70 ± 19, p=0.002, while average aortic diastolic pressure was significantly greater in patients without CHD (79.8 ± 16 x 75.3 ± 17.5, p=0.003. In the multivariated analysis, pulse pressure > 80 mmHg and systolic blood pressure > 165 were independently associated with severe CHD with odds ratio of 2.12 and 2.09, p 80 mmHg and systolic blood pressure > 165 mmHG determined risk two times greater of severe coronary disease.

  1. Significant improvement in statin adherence and cholesterol levels after acute myocardial infarction

    DEFF Research Database (Denmark)

    Brogaard, Hilde Vaiva Tonstad; Køhn, Morten Ganderup; Berget, Oline Sofie

    2012-01-01

    Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time.......Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time....

  2. Gender differences in physical activity following acute myocardial infarction in adults: A prospective, observational study.

    Science.gov (United States)

    Minges, Karl E; Strait, Kelly M; Owen, Neville; Dunstan, David W; Camhi, Sarah M; Lichtman, Judith; Geda, Mary; Dreyer, Rachel P; Bueno, Héctor; Beltrame, John F; Curtis, Jeptha P; Krumholz, Harlan M

    2017-01-01

    Aims Despite the benefits of regular physical activity participation following acute myocardial infarction, little is known about gender differences in physical activity among patients after acute myocardial infarction. We described, by gender, physical activity trajectories pre- and post-acute myocardial infarction, and determined whether gender was independently associated with physical activity. Methods and results The Variation in Recovery: Role of Gender on Outcomes of Young AMI patients (VIRGO) study, conducted at 103 US, 24 Spanish, and three Australian hospitals, was designed, in part, to evaluate gender differences in lifestyle behaviors following acute myocardial infarction. We used baseline, one-month, and 12-month data collected from patients aged 18-55 years ( n = 3572). Patients were assigned to American Heart Association-defined levels of physical activity. A generalized estimating equation model was used to account for repeated measures within the same individual over time. Men were more active (≥150 min/wk moderate or ≥75 min/wk vigorous activity) than women at baseline (42% vs 34%), one month (45% vs 34%), and 12 months (48% vs 36%) (all p acute myocardial infarction to 12-months post-acute myocardial infarction (95% confidence interval: 1.21-1.55). Non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were also associated independently with being less active over time (all p acute myocardial infarction were less likely to meet physical activity recommendations than were men. By identifying factors associated with low levels of activity during acute myocardial infarction recovery, targeted interventions can be introduced prior to hospital discharge.

  3. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis

    OpenAIRE

    Angelini, A; Calzolari, V; Calabrese, F; Boffa, G; Maddalena, F; Chioin, R; Thiene, G

    2000-01-01

    OBJECTIVE—To test the hypothesis, using endomyocardial biopsies, that unexplained cases of apparent acute myocardial infarction were caused by myocarditis.
MATERIAL—Between 1992 and 1998, 12 patients were admitted to the coronary care unit with severe chest pain, ST segment elevation, increased serum creatine kinase and MB isoenzyme, and with wall motion abnormalities on echocardiogram highly suggestive of acute myocardial infarction. These patients were further investigated by endomyocardial...

  4. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rengin Çetin Güvenç

    2016-03-01

    Full Text Available Acute mitral regurgitation (MR is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

  5. Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs.

    Science.gov (United States)

    Zhu, Gang-jie; Sun, Li-na; Li, Xing-hai; Wang, Ning-fu; Wu, Hong-hai; Yuan, Chen-xing; Li, Qiao-qiao; Xu, Peng; Ren, Ya-qi; Mao, Bao-gen

    2015-09-01

    The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.

  6. [Myocardial infarction and acute coronary syndrome: definitions, classification, and diagnostic criteria].

    Science.gov (United States)

    Zaĭrat'iants, O V; Mishnev, O D; Kakturskiĭ, L V

    2014-01-01

    The review gives the definitions and classification of and diagnostic criteria for myocardial infarction and acute coronary syndrome in accordance with the "The third universal definition of myocardial infarction" adopted in 2012 (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, 2012). It also discusses the clinical and morphological comparisons of and the problems in the differential diagnosis of myocardial infarction as a nosological entity within coronary heart disease with other coronarogenic and non-coronarogenic necroses of the myocardium.

  7. Drug-eluting vs. bare-metal stents for treatment of acute myocardial infarction with renal insufficiency. Results from Korea Acute Myocardial Infarction Registry.

    Science.gov (United States)

    Bae, Eun Hui; Lim, Sang Yup; Choi, Young Hwan; Suh, Sang Heon; Cho, Kyung Hoon; Choi, Joon Seok; Kim, Chang Seong; Park, Jeong Woo; Ma, Seong Kwon; Jeong, Myung Ho; Kim, Soo Wan

    2011-01-01

    Patients with chronic kidney disease have had conflicting results between drug-eluting stents (DES) and bare-metal stents (BMS). The aim of the present study was to determine whether DES is preferable for the treatment of acute myocardial infarction (AMI) with renal insufficiency, and to elucidate the impact of diabetes mellitus (DM) on outcomes of each stent. As a part of the Korea Acute Myocardial Infarction Registry (KAMIR), 2,175 AMI patients with renal insufficiency (glomerular filtration rate renal insufficiency, DES implantation exhibits a favorable 1-year clinical outcome than BMS implantation, and subgroup analysis for diabetic subjects showed worse outcomes in the DM group with implanted DES.

  8. Importance of a history of hypertension for the prognosis after acute myocardial infarction--for the Bucindolol Evaluation in Acute myocardial infarction Trial (BEAT) study group

    DEFF Research Database (Denmark)

    Ali, Irma; Akman, Dilek; Bruun, Niels Eske

    2004-01-01

    BACKGROUND: Arterial hypertension is a major risk factor for cardiovascular events. The prognosis for hypertensive patients after acute myocardial infarction (MI) is uncertain because of the sparse and somewhat contradictionary data. HYPOTHESIS: Our study aimed to investigate the importance...... of hypertension to prognosis after an MI in patients receiving contemporary medical therapy. METHODS: We performed a retrospective study using a large register from the Bucindolol Evaluation in Acute myocardial infarction Trial (BEAT). The register comprised 3,326 patients admitted between June 1998 and August...

  9. Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN).

    Science.gov (United States)

    Reynolds, Kristi; Go, Alan S; Leong, Thomas K; Boudreau, Denise M; Cassidy-Bushrow, Andrea E; Fortmann, Stephen P; Goldberg, Robert J; Gurwitz, Jerry H; Magid, David J; Margolis, Karen L; McNeal, Catherine J; Newton, Katherine M; Novotny, Rachel; Quesenberry, Charles P; Rosamond, Wayne D; Smith, David H; VanWormer, Jeffrey J; Vupputuri, Suma; Waring, Stephen C; Williams, Marc S; Sidney, Stephen

    2017-03-01

    Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations. We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 US health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 US census data. Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction decreased an average 3.8%/y from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction decreased 8.7%/y from 104.3 in 2000 to 51.7 in 2008, whereas incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then decreased thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger decreases in ST-segment elevation myocardial infarction rates in women compared with men. As compared with 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women. Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation

  10. Pressure injuries in elderly with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Komici K

    2017-09-01

    Full Text Available Klara Komici,1 Dino F Vitale,2 Dario Leosco,1 Angela Mancini,1 Graziamaria Corbi,3 Leonardo Bencivenga,1 Alessandro Mezzani,4 Bruno Trimarco,5 Carmine Morisco,5 Nicola Ferrara,1,2 Giuseppe Rengo1,2 1Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; 2Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN, Telese Terme, Italy; 3Department of Medicine and Health Sciences, University of Molise Campobasso, Campobasso, Italy; 4Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy; 5Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy Objectives: To assess pressure injury (PI incidence among patients hospitalized for acute myocardial infarction (AMI in an intensive coronary care unit (ICCU and to detect the impact of specific risk factors on the development of PI in this clinical setting.Patients and methods: Prospective cohort study in ICCU setting. Patients admitted for AMI: patients mean age 67.5±11.5 years (n=165. Norton Scale, Mini Nutritional Assessment (MNA, demographic, clinical and biochemical data collected at the time of ICCU admission have been tested in a logistic model to assess the odds ratios (ORs of PI risk development. The jackknifed area under the receiver operating characteristic curve (AUC and the decision curve analysis have been employed to assess the additive predictive value of a factor.Results: Twenty-seven (16.3% patients developed PIs. An increased PI risk was associated with advanced age (OR =2.5 every 10-year increase; 95% CI =1.1–5.7, while probability of PI development was reduced in patients with higher left ventricular ejection fraction (LVEF (OR =0.4 every 5% increase; 95% CI =0.24–0.66, MNA score (OR =0.65 every unit change; 95% CI =0.44–0.95 and Norton Scale score

  11. A fast and effective method to assess myocardial hyperemia in acute myocarditis by magnetic resonance.

    Science.gov (United States)

    Perfetti, Matteo; Malatesta, Gelsomina; Alvarez, Irene; Liga, Riccardo; Barison, Andrea; Todiere, Giancarlo; Eletto, Nicoletta; De Caterina, Raffaele; Lombardi, Massimo; Aquaro, Giovanni Donato

    2014-03-01

    Current cardiac magnetic resonance (CMR) quantitative signs for the diagnosis of myocarditis include myocardial edema, fibrosis and myocardial hyperemia (Hyp). Methods for the assessment of Hyp are actually complex and time-consuming. To test a simple and fast method to assess Hyp, using contrast enhancement steady state free precession (ceSSFP) technique. CMR imaging at 1.5T was performed on 39 patients with diagnosis of acute myocarditis and in 20 healthy controls. Hyp was evaluated in systolic and diastolic frames (Hyp-SYS and Hyp-DIA) as areas of myocardial hyperintensity in ceSSFP images early after gadolinium injection. Myocardial edema was evaluated using T2-STIR images. Myocardial fibrosis was assessed in conventional late gadolinium enhancement (LGE) images. A value of ≤12.1 g of Hyp-DIA was obtained as cut-off of normality in healthy controls. Using this threshold, Hyp was detected in 30 patients (77 %) with myocarditis. LGE was detected in 36 patients (92 %), and myocardial edema in 38 (97 %) patients with myocarditis A linear relation was found between Hyp-DIA and the extent of myocardial edema (R(2) 0.48, 95 % CI 0.47-0.85, p method to assess myocardial hyperemia in patient with acute myocarditis. Compared with non-Hyp subjects, patients with Hyp had more signs of inflammation and myocardial damage.

  12. Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development

    DEFF Research Database (Denmark)

    Lindholm, M G; Køber, L; Boesgaard, S

    2003-01-01

    incidence, outcome and prognostic significance of cardiogenic shock in 6676 consecutive patients with acute myocardial infarction. METHODS AND RESULTS: Demographic and clinical data including the presence of cardiogenic shock were prospectively collected in 6676 non-invasively managed patients...... or late shock development (>80%) (Ppatients without cardiogenic shock but with post-infarction heart failure. CONCLUSIONS: In this nationwide prospectively collected registry, non-invasively managed consecutive myocardial infarct......AIMS: Cardiogenic shock accounts for the majority of deaths following acute myocardial infarction. The majority of outcome data on this issue are, however, derived from single hospitals, referral centers or selected patients in randomized studies. The purpose of this study was to investigate...

  13. Approaches to Improving Cardiac Structure and Function During and After an Acute Myocardial Infarction: Acute and Chronic Phases.

    Science.gov (United States)

    Kloner, Robert A; Dai, Wangde; Hale, Sharon L; Shi, Jianru

    2016-07-01

    While progress has been made in improving survival following myocardial infarction, this injury remains a major source of mortality and morbidity despite modern reperfusion therapy. While one approach has been to develop therapies to reduce lethal myocardial cell reperfusion injury, this concept has not translated to the clinics, and several recent negative clinical trials raise the question of whether reperfusion injury is important in humans undergoing reperfusion for acute ST segment elevation myocardial infarction. Therapy aimed at reducing myocardial cell death while the myocytes are still ischemic is more likely to further reduce myocardial infarct size. Developing new therapies to further reduce left ventricular remodeling after the acute event is another approach to preserving structure and function of the heart after infarction. Such therapy may include chronic administration of pharmacologic agents and/or therapies developed from the field of regenerative cardiology, including cellular or non-cellular materials such as extracellular matrix. The optimal therapy will be to administer agents that both reduce myocardial infarct size in the acute phase of infarction as well as reduce adverse left ventricular remodeling during the chronic or healing phase of myocardial infarction. Such a dual approach will help optimize the preservation of both cardiac structure and function. © The Author(s) 2015.

  14. Risk factors in young patients of acute myocardial infarction

    International Nuclear Information System (INIS)

    Faisal, A.W.; Khan, R.A.A.T.; Ayub, M.; Husnain, S.S.

    2011-01-01

    Background: Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of first Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. Methods: We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Results: Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Conclusion: Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us. (author)

  15. Accuracy in ED Triage for Symptoms of Acute Myocardial Infarction.

    Science.gov (United States)

    Sanders, Susan F; DeVon, Holli A

    2016-07-01

    More than 6 million people present to emergency departments across the United States annually with symptoms of acute myocardial infarction (AMI). Of the 1 million patients with AMI, 350,000 die during the acute phase. Accurate ED triage can reduce mortality and morbidity, yet accuracy rates are low. In this study we explored the relationship between patient and nurse characteristics and accuracy of triage in patients with symptoms of AMI. This retrospective, descriptive study used patient data from electronic medical records. The sample of 286 patients was primarily white, with a mean age of 61.44 years (standard deviation [SD], ±13.02), and no history of heart disease. The sample of triage nurses was primarily white and female, with a mean age of 45.46 years (SD, ±11.72) and 18 years of nursing experience. Nineteen percent of the nurses reported having earned a bachelor's degree. Emergency nurse triage accuracy was 54%. Patient race and presence of chest pain were significant predictors of accuracy. Emergency nurse age was a significant predictor of accuracy in triage, but years of experience in nursing was not a significant predictor. Of the 9 variables investigated, only patient race, symptom presentation, and emergency nurse age were significant predictors of triage accuracy. Inconsistency in triage decisions may be due to other conditions not yet explored, such as critical thinking skills and executive functions. This study adds to the body of evidence regarding ED triage of patients with symptoms of AMI. However, further exploration into decisions at triage is warranted to improve accuracy, expedite care, and improve outcomes. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  16. Medication adherence among persons with post-acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rapin Polsook

    2016-12-01

    Full Text Available This study was to test a model explaining the influence of financial status, education, social support, symptom severity, barriers, knowledge, depression, and self-efficacy on medication adherence among persons with post-acute myocardial infarction. The use of multi-stage cluster sampling method involved 348 patients from 9 regional hospitals in Thailand. The results revealed the hypothesized model fit to the empirical data and explained 20% of the variance of medication adherence (χ2 = 5.87, df = 5, p < .43, Chi-square/df = 0.97, GIF = 0.99, RMSEA = 0.065, AGFI = 0.97. Depression was the most influential factor affecting medication adherence, and had a negative direct effect (-.40, p < .05, followed by self-efficacy and barriers (.17 and .10, p < .05, respectively. These findings suggest that nurses should understand that depression, barrier, and selfefficacy are important factors to be considerate to improve medication adherence and improve the quality of life of Thai postmyocardial infarction patients.

  17. Treatment-seeking decisions of women with acute myocardial infarction.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia

    2005-01-01

    Women who experience symptoms of an acute myocardial infarction (MI) are less likely than men to seek medical attention after the onset of initial symptoms. The purpose of this study was to facilitate a better understanding of the treatment-seeking decisions of women who seek emergency evaluation for symptoms suggestive of MI. A qualitative, semi-structured, feminist, post structuralist interview approach was used to explore the treatment-seeking decisions of ten women hospitalized for a MI. The oral descriptions were tape-recorded, transcribed verbatim, and analyzed using the Morse and Field method. Content analysis revealed ten important issues that influenced women's treatment-seeking decisions: associating symptoms with non-cardiac causes, minimizing symptoms, experiencing non-classic symptoms, mass media portrayal, male family member experience, knowledge deficit, family insistence, experiencing increased pain, experiencing difficulty breathing, and having expectations different from realities. Based on their language and subjectivity, participants revealed the power of the meaning of heart disease on treatment-seeking decisions.

  18. Air Pollution and Hospitalization for Acute Myocardial Infarction in China.

    Science.gov (United States)

    Liu, Hui; Tian, Yaohua; Xiang, Xiao; Sun, Kexin; Juan, Juan; Song, Jing; Cao, Yaying; Xu, Beibei; Hu, Yonghua

    2017-09-01

    There is growing interest in the association between ambient air pollution and acute myocardial infarction (AMI). The objective of this study was to explore the association in 14 Chinese cities using a time-stratified case-crossover design. We identified 80,787 hospital admissions for AMI between January 1, 2014 and December 31, 2015 from electronic hospitalization summary reports. Conditional logistic regression was used to estimate the percent changes with 95% confidence intervals (CIs) in AMI admissions in relation to an interquartile range increase in ambient air pollutant concentrations. All analyzed air pollutants, with the exception of ozone, were positively associated with daily AMI admissions on lag2 and lag3 days. An interquartile range increase in particulate matter China, or even in other developing countries, to report the short-term effects of air pollution on AMI morbidity. Our findings contribute to the limited scientific data on the effects of ambient air pollution on AMI in developing countries. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Proinsulin and insulin profile in acute myocardial infarction

    International Nuclear Information System (INIS)

    Mowar, S.N.; Pal, S.K.; Chhetri, M.K.; Ghosh, K.K.

    1979-01-01

    Proinsulin and insulin in 104 and glucagon in 10 cases were estimated by radioimmunoassay (RIA) technique in uncomplicated cases of acute myocardial infarction (A.M.I.), matched against 44 and 5 controls respectively. Patients were divided into group A and B based on oral glucose tolerance test (G.T.T.) done on the following morning after admission. Group A comprised of 65 and group B comprised of 49 patients with normal and abnormal G.T.T. respectively. The tests were repeated prior to discharge from the hospital at the end of 6th week. The initial values of insulin and glucagon were found to be significantly raised in both the groups but came down to normal in group A whereas they remained unchanged in group B in the follow up study. Proinsulin values in group A were not significantly changed both in initial and follow up study. In group B proinsulin values were found to be significantly low both initially and in the follow up study. G.T.T. in group B remained abnormal even at the end of the 6th week. (author)

  20. IS OPIUM ADDICTION A RISK FACTOR FOR ACUTE MYOCARDIAL INFARCTION?

    Directory of Open Access Journals (Sweden)

    "S. M. Sadr Bafghi

    2005-06-01

    Full Text Available There is a misconception among our people that opioids may prevent or have ameliorating effects in the occurrence of cardiovascular diseases. In this study we evaluated 556 consecutive male patients hospitalized due to acute myocardial infarction (MI in city of Yazd, from May 2000 to October 2001 and compared the characteristics of opium addicts to non opium users. Prevalence of opium addiction in MI patients was 19% in comparison with 2-2.8% in general population. There were not any differences in prevalence of traditional risk factors between opium users and non-users. Overall, in-hospital mortality was 18.6 percent among opium users and 6.2 percent among non-opium users (unadjusted odd ratio, 1.3; 95% confidence interval, 0.7 to 2.7, P = 0.2. After adjustment for the differences in the baseline features (age and other risk factors, odds ratio increased to 2.2 (95 percent confidence interval, 0.9 to 5.1. It seems that opium addiction may work as a risk factor in cardiovascular disease.

  1. Biorhythm theory does not predict admission for acute myocardial infarction.

    Science.gov (United States)

    Joncas, Sébastien X; Carrier, Nathalie; Nguyen, Michel; Farand, Paul

    2011-02-01

    Temporal variations in the incidence of acute myocardial infarction (AMI) have been described. However, AMI occurrence and biorhythm theory, which proposes the existence of three endogenous independent infradian cycles and AMI occurrence, has not been well studied. The purpose of this study is to determine whether specific days in the biorhythm cycles are related to AMI incidence. Patients (40-85 years old) admitted for AMI at the Sherbrooke University Hospital Center, 1993-2008 were subjects of this study. Potential vulnerable days and performance days of the biorhythm cycles were calculated using birth and admission dates from the warehouse database. Observed AMI frequencies were compared to those expected using χ² tests. There were 11,395 admissions for AMI. No relation was noted between single, double, or triple critical or noncritical days and AMI (χ² = 3.78; p > 0.05). Observed and expected AMI frequencies for maximal and minimal performance days were similar (χ² = 15.06; p > 0.05). We found no evidence for a possible relationship between the date of AMI and critical maximum and minimum performance days of an individual's physical, emotional, or intellectual biorhythm cycles. We conclude that biorhythm theory does not predict admission for AMI.

  2. Solar Activity, Different Geomagnetic Activity Levels and Acute Myocardial Infarction

    Science.gov (United States)

    Dimitrova, Svetla; Jordanova, Malina; Stoilova, Irina; Taseva, Tatiana; Maslarov, Dimitar

    Results on revealing a possible relationship between solar activity (SA) and geomagnetic activity (GMA) and acute myocardial infarction (AMI) morbidity are presented. Studies were based on medical data covering the period from 1.12.1995 to 31.12.2004 and concerned daily distribution of patients with AMI diagnose (in total 1192 cases) from Sofia region on the day of admission at the hospital. Analysis of variance (ANOVA) was applied to check the significance of GMA intensity effect and the type of geomagnetic storms, those caused by Magnetic Clouds (MC) and by High Speed Solar Wind Streams (HSSWS), on AMI morbidity. Relevant correlation coefficients were calculated. Results revealed statistically significant positive correlation between considered GMA indices and AMI. ANOVA revealed that AMI number was signifi- cantly increased from the day before (-1st) till the day after (+1st) geomagnetic storms with different intensities. Geomagnetic storms caused by MC were related to significant increase of AMI number in comparison with the storms caused by HSSWS. There was a trend for such different effects even on -1st and +1st day.

  3. Understanding prehospital delay behavior in acute myocardial infarction in women.

    Science.gov (United States)

    Waller, Cynthia G

    2006-12-01

    Studies demonstrate that acute myocardial infarction (AMI) mortality can be reduced if reperfusion therapy is initiated within 1 hour of AMI symptom onset. However, a considerable number of men and women arrive at the emergency department outside of the time frame for thrombolytic and angioplasty effectiveness. This is especially true for women who have been shown to delay longer than men due to their prehospital decision-making process utilized. With a mean total delay time greater than 4 hours, the time interval from symptom onset to transport activation to the hospital consumes the majority of the prehospital phase of emergency cardiac care. The health belief model, self-regulation model, theory of reasoned action, and theory of planned behavior have all been used to describe the prehospital decision-making process of both men and women with an AMI and the variables that impact that process. These models have identified the importance of symptom attribution to cardiac-related causes as a target variable for research and interventions related to care-seeking behavior.

  4. Clinical Application of Heart Rate Variability after Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Heikki Veli Huikuri

    2012-02-01

    Full Text Available AbstractHeart rate (HR variability has been extensively studied in patients surviving an acute myocardial infarction (AMI. The majority of studies have shown that patients with reduced or abnormal HR variability/turbulence have an increased risk of mortality within few years after an AMI. Various measures of HR dynamics, such as time-domain, spectral, and non-linear measures of HR variability, as well as HR turbulence, have been used in risk stratification of post-AMI patients. The prognostic power of various measures, except of those reflecting rapid R-R interval oscillations, has been almost identical, albeit some non-linear HR variability measures, such as short-term fractal scaling exponent, and HR turbulence, have provided somewhat better prognostic information than the others. Abnormal HR variability predicts both sudden and non-sudden cardiac death after AMI. Because of remodeling of the arrhythmia substrate after AMI, early measurement of HR variability to identify those at high risk should likely be repeated later in order to assess the risk of fatal arrhythmia events. Future randomized trials using HR variability/turbulence as one of the pre-defined inclusion criteria will show whether routine measurement of HR variability/turbulence will become a routine clinical tool for risk stratification of post-AMI patients.

  5. Acute myocardial infarction spurred by myopericarditis in a young female patient: Coxsackie B2 to blame.

    Science.gov (United States)

    Liapounova, Natalia A; Mouquet, Frédéric; Ennezat, Pierre V

    2011-02-01

    Myocardial virus infection may mimic but also trigger acute myocardial infarction.The present paper reports an exceedingly rare presentation of an acute myocardial infarction in a very young female associated with Coxsackie B2 virus infection. A 17-year-old woman with no prior medical history presented to the Cardiac Intensive Care unit with chest pain, ST segment elevation and increased cardiac troponin with pericardial effusion one week after experiencing febrile viral gastroenteritis. Given the age and health of the patient, myocarditis was initially presumed. Coronary angiography and cardiac magnetic resonance imaging studies, however, demonstrated an acute posterior myocardial infarction related to a right coronary artery thrombosis. Serological studies disclosed a concurrent Coxsackie B2 virus infection. The patient made a successful recovery with subsequent minor left ventricular dysfunction at long-term follow-up. Coxsackie B2 myocarditis might have triggered a coronary artery spasm and subsequent thrombosis.

  6. Risk Stratification and Effects of Pharmacotherapy in Patients with Acute Myocardial Infarction (AMI) based on data from Pilot AMI Registry

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tomečková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Hubač, J.; Charalampidi, K.; Jánský, P.

    2007-01-01

    Roč. 30 (2007), s. 367-367 ISSN 1420-4096. [Central European Meeting on Hypertension and Cardiovascular Disease Prevention. 11.10.2007-13.10.2007, Kraków] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  7. Geographic variation in the treatment of acute myocardial infarction in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial

    DEFF Research Database (Denmark)

    Reed, Shelby D; McMurray, John J V; Velazquez, Eric J

    2006-01-01

    BACKGROUND: The VALIANT trial compared the efficacy and safety of captopril, valsartan, and their combination in patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction (MI). By examining this international trial population of high-risk patients...

  8. Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial

    DEFF Research Database (Denmark)

    Aguilar, David; Solomon, Scott D; Køber, Lars

    2004-01-01

    BACKGROUND: A prior diagnosis of diabetes mellitus is associated with adverse outcomes after acute myocardial infarction (MI), but the risk associated with a new diagnosis of diabetes in this setting has not been well defined. METHODS AND RESULTS: We assessed the risk of death and major cardiovas...

  9. EVALUATION OF SERUM ALBUMIN LEVELS IN ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Shilpa

    2015-10-01

    Full Text Available BACKGROUND : Acute myocardial infarction (AMI is one of the major causes of mortality and morbidity in the world. Serum albumin levels are inversely related with age, smoking, blood pressure and obesity. It is not clear whether low serum albumin level is a nonspecific , prognostic variable, a marker of subclinical disease, or whether it is a part of causal mechanism leading to death due to cardiovascular disease. Some studies have reported an inverse association between serum albumin and cardiovascular mortality but oth ers have not . 1 The association between serum albumin and cardiovascular mortality remains controversial. This study was done to evaluate the serum albumin levels in patients with ST segment elevation Myocardial infarction (STEMI over a period of three days from the date of admission and whether the changes had any relationship with the prognosis of the patient. AIM: to associate changes in serum albumin levels in AMI patients over a period of three days i.e., day zero - at the time of admission, day+1 - the following day(12 to 30hrs after collecting first sample, day +2(32 to 54 hrs after collecting first sample with the clinical prognosis of the patient. SETTINGS AND DESIGN : Prospective follow up study in patents admitted with AMI in a tertiary care hospital. METHODS: 30 pati ents admitted with STEMI were included in the study and serum albumin levels were estimated in them on admission and for two days thereafter. Statistical analysis used. The data was analysed using SPSS 15.0, STATA 8.0, MEDLAC 9.0.1, And SYSTAT 11 softwares. Repeated measures analysis of variance and student t test was used to find the significance in changes of serum albumin levels and prognosis of the patient on different days. RESULTS AND CONCLUSION: This study found that there was fall in serum albumin le vels in patients with AMI in the course of three days compared with the day of admission and it was significantly associated with bad prognosis.

  10. Financial stress and outcomes after acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Sachin J Shah

    Full Text Available Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI.We used prospective registry evaluating myocardial infarction: Event and Recovery (PREMIER data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL, assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care.Among 2344 AMI patients, 1241 (52.9% reported no financial stress, 735 (31.4% reported low financial stress, and 368 (15.7% reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference -3.24, 95% Confidence Interval [CI]: -4.82, -1.66, mental health (SF-12 MCS mean difference: -2.44, 95% CI: -3.83, -1.05, disease-specific QoL (SAQ QoL mean difference: -6.99, 95% CI: -9.59, -4.40, and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32 at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86, 4-year mortality was no different.High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.

  11. Usefulness of rest-redistribution on thallium myocardial scintigraphy in patients with acute myocardial infarction by SPECT

    International Nuclear Information System (INIS)

    Tahara, Yorio; Taya, Makoto; Sasaki, Akira; Nishimura, Tooru; Shimoyama, Katsuya; Mizuno, Haruyoshi; Ono, Akifumi; Okada, Michio; Ishikawa, Kyozo

    1990-01-01

    The purpose of this study was to clarify the clinical significance of rest-redistribution in myocardial scintigraphy (SPECT) in acute myocardial infarction (AMI). 30 patients with AMI within one week after the onset of attack were studied. SPECT images were obtained 10 min and 3hrs after injection of 201 Tl. Bull's eye images and unfolded map images were prepared. A 201 Tl uptake was studied at the infarct and non-infarct sites. Exercise SPECT and radionuclide angiography were performed in all patients one month after the onset of AMI, and the findings were compared with clinical and coronary angiographic (CAG) findings. Redistribution of Tl at rest was observed at the infarct sites in 9 of the 30 patients. Redistribution at rest was observed at the non-infarct sites in 8 patients. Redistribution at rest was observed during exercise SPECT one month after the onset of AMI in patients with redistribution at rest in the acute phase. In patients with redistribution at rest at the infarct site, left ventricular ejection fraction (EF) improved one month after the onset of AMI (ΔEF>5%), but it decreased slightly during exercise. Wall motion at the infarct site was not much impaired in patients who showed redistribution at rest at the infarct site. Angina pectoris and recurrence of myocardial infarction were observed more frequently on SPECT, but no characteristic findings were obtained on CAG in those with redistribution at rest. In conclusion, cardiac function and wall motion at the infarct site are better preserved in patients with redistribution of Tl at rest on SPECT in the acute stage of myocardial infarction, as compared with patients having fixed defects, but the EF decrease slightly during exercise and the frequency of post-infarction angina is greater in those patients. Resting SPECT in AMI is considered to provide useful information for predicting cardiac function and the clinical course following myocardial infarction. (author)

  12. Body mass index and myocardium at risk in patients with acute coronary syndrome.

    Science.gov (United States)

    Arrebola-Moreno, A L; Marfil-Alvarez, R; Catena, A; García-Retamero, R; Arrebola, J P; Melgares-Moreno, R; Ramirez-Hernández, J A; Kaski, J C

    2014-04-01

    Whilst traditional studies have shown that obese individuals are at a higher risk of cardiovascular events compared to lean subjects, recent studies in patients with acute myocardial infarction (AMI) have suggested that obesity may exert protective effects (the "obesity paradox"). We sought to assess the relationship between body mass index (BMI) and the BARI score (BARIsc), a validated tool used to assess myocardium at risk, in patients with acute coronary syndrome. Participants were 116 consecutive patients (mean age, 60.6 years; 97 men) with AMI (68 ST elevated myocardial infarction, STEMI; 48 non-ST elevated myocardial infarction, NSTEMI). Demographics, BMI, risk factors, biochemistry data, left ventricular function, angiographic data and the BARIsc were assessed in every patient. Multiple linear regression analyses showed that BMI significantly correlated with BARIsc; β=.23, p<0.02. This was found only in the overweight/obese patients, β=.27, p<0.01, but not in patients with normal BMIs, β=0.08, p=0.71. An increased body weight is associated with an increased area of myocardium at risk in patients with ACS. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. 5-Year Clinical Outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) Trial A Randomized Comparison of an Early Invasive Versus Selective Invasive Management in Patients With Non-ST-Elevation Acute Coronary Syndrome

    NARCIS (Netherlands)

    Damman, Peter; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; de Winter, Robbert J.

    2010-01-01

    OBJECTIVES: We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. BACKGROUND: Long-term outcomes may be relevant to decide treatment strategy for patients

  14. Impact of an Early Invasive Strategy versus Conservative Strategy for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome in Patients with Chronic Kidney Disease: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Catriona Shaw

    Full Text Available Clinical practice guidelines support an early invasive approach after NSTE-ACS in patients with chronic kidney disease (CKD. There is no direct randomised controlled trial evidence in the CKD population, and whether the benefit of an early invasive approach is maintained across the spectrum of severity of CKD remains controversial.We conducted a systematic review to evaluate the association between an early invasive approach and all-cause mortality in patients with CKD. We searched MEDLINE and EMBASE (1990-May 2015 and article reference lists. Data describing study design, participants, invasive management strategies, renal function, all-cause mortality and risk of bias were extracted.3,861 potentially relevant studies were identified. Ten studies, representing data on 147,908 individuals with NSTE-ACS met the inclusion criteria. Qualitative heterogeneity in the definitions of early invasive approach, comparison groups and renal dysfunction existed. Meta-analysis of the RCT derived and observational data were generally supportive of an early invasive approach in CKD (RR0.76 (95% CI 0.49-1.17 and RR0.50 (95%CI 0.42-0.59 respectively. Meta-analysis of the observational studies demonstrated a large degree of heterogeneity (I2 79% driven in part by study size and heterogeneity across various kidney function levels.The observational data support that an early invasive approach after NSTE-ACS confers a survival benefit in those with early-moderate CKD. Local opportunities for quality improvement should be sought. Those with severe CKD and the dialysis population are high risk and under-studied. Novel and inclusive approaches for CKD and dialysis patients in cardiovascular clinical trials are needed.

  15. Acute myocardial infarction in sub-Saharan Africa: the need for data.

    Directory of Open Access Journals (Sweden)

    Julian T Hertz

    Full Text Available BACKGROUND: Trends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this systematic review was to describe the prevalence of acute myocardial infarction in sub-Saharan Africa. METHODS: We searched PubMed, EMBASE, Global Health Archive, CINAHL, and Web of Science, and conducted reference and citation analyses. Inclusion criteria were: observational studies, studies that reported incidence or prevalence of acute myocardial infarction, studies conducted in sub-Saharan Africa, and studies that defined acute myocardial infarction by EKG changes or elevation of cardiac biomarkers. Studies conducted prior to 1992 were excluded. Two independent reviewers analyzed titles and abstracts, full-texts, and references and citations. These reviewers also performed quality assessment and data extraction. Quality assessment was conducted with a validated scale for observational studies. FINDINGS: Of 2292 records retrieved, seven studies met all inclusion criteria. These studies included a total of 92,378 participants from highly heterogeneous study populations in five different countries. Methodological quality assessment demonstrated scores ranging from 3 to 7 points (on an 8-point scale. Prevalence of acute myocardial infarction ranged from 0.1 to 10.4% among the included studies. INTERPRETATION: There is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. Well-designed registries and surveillance studies that capture the broad and diverse population with acute myocardial infarction in sub-Saharan Africa using common diagnostic criteria are critical in order to guide prevention and treatment strategies. REGISTRATION: Registered in International Prospective Register of Systematic Reviews (PROSPERO Database #CRD42012003161.

  16. Endogenous C1-inhibitor production and expression in the heart after acute myocardial infarction.

    Science.gov (United States)

    Emmens, Reindert W; Baylan, Umit; Juffermans, Lynda J M; Karia, Rashmi V; Ylstra, Bauke; Wouters, Diana; Zeerleder, Sacha; Simsek, Suat; van Ham, Marieke; Niessen, Hans W M; Krijnen, Paul A J

    2016-01-01

    Complement activation contributes significantly to inflammation-related damage in the heart after acute myocardial infarction. Knowledge on factors that regulate postinfraction complement activation is incomplete however. In this study, we investigated whether endogenous C1-inhibitor, a well-known inhibitor of complement activation, is expressed in the heart after acute myocardial infarction. C1-inhibitor and complement activation products C3d and C4d were analyzed immunohistochemically in the hearts of patients who died at different time intervals after acute myocardial infarction (n=28) and of control patients (n=8). To determine putative local C1-inhibitor production, cardiac transcript levels of the C1-inhibitor-encoding gene serping1 were determined in rats after induction of acute myocardial infarction (microarray). Additionally, C1-inhibitor expression was analyzed (fluorescence microscopy) in human endothelial cells and rat cardiomyoblasts in vitro. C1-inhibitor was found predominantly in and on jeopardized cardiomyocytes in necrotic infarct cores between 12h and 5days old. C1-inhibitor protein expression coincided in time and colocalized with C3d and C4d. In the rat heart, serping1 transcript levels were increased from 2h up until 7days after acute myocardial infarction. Both endothelial cells and cardiomyoblasts showed increased intracellular expression of C1-inhibitor in response to ischemia in vitro (n=4). These observations suggest that endogenous C1-inhibitor is likely involved in the regulation of complement activity in the myocardium following acute myocardial infarction. Observations in rat and in vitro suggest that C1-inhibitor is produced locally in the heart after acute myocardial infarction. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Trends in the risk of early and late-onset heart failure as an adverse outcome of acute myocardial infarction

    DEFF Research Database (Denmark)

    Sulo, Gerhard; Igland, Jannicke; Nygård, Ottar

    2017-01-01

    Aims Heart failure is a serious complication of acute myocardial infarction, leading to a poor prognosis. We explored trends in the risk of heart failure among patients hospitalised with an incident acute myocardial infarction in Norway during 2001-2009. Methods and results A total of 69,372 pati......Aims Heart failure is a serious complication of acute myocardial infarction, leading to a poor prognosis. We explored trends in the risk of heart failure among patients hospitalised with an incident acute myocardial infarction in Norway during 2001-2009. Methods and results A total of 69...

  18. Using machine learning techniques to differentiate acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Sougand Setareh

    2015-02-01

    Full Text Available Backgroud: Acute coronary syndrome (ACS is an unstable and dynamic process that includes unstable angina, ST elevation myocardial infarction, and non-ST elevation myocardial infarction. Despite recent technological advances in early diognosis of ACS, differentiating between different types of coronary diseases in the early hours of admission is controversial. The present study was aimed to accurately differentiate between various coronary events, using machine learning techniques. Such methods, as a subset of artificial intelligence, include algorithms that allow computers to learn and play a major role in treatment decisions. Methods: 1902 patients diagnosed with ACS and admitted to hospital were selected according to Euro Heart Survey on ACS. Patients were classified based on decision tree J48. Bagging aggregation algorithms was implemented to increase the efficiency of algorithm. Results: The performance of classifiers was estimated and compared based on their accuracy computed from confusion matrix. The accuracy rates of decision tree and bagging algorithm were calculated to be 91.74% and 92.53%, respectively. Conclusion: The proposed methods used in this study proved to have the ability to identify various ACS. In addition, using matrix of confusion, an acceptable number of subjects with acute coronary syndrome were identified in each class.

  19. Geomagnetic Storms and Acute Myocardial Infarctions Morbidity in Middle Latitudes

    Science.gov (United States)

    Dimitrova, S.; Babayev, E. S.; Mustafa, F. R.; Stoilova, I.; Taseva, T.; Georgieva, K.

    2009-12-01

    Results of collaborative studies on revealing a possible relationship between solar activity (SA) and geomagnetic activity (GMA) and pre-hospital acute myocardial infarction (AMI) morbidity are presented. Studies were based on medical data from Bulgaria and Azerbaijan. Bulgarian data, covering the period from 01.12.1995 to 31.12.2004, concerned daily distribution of number of patients with AMI diagnose (in total 1192 cases) from Sofia Region on the day of admission at the hospital. Azerbaijani data contained 4479 pre-hospital AMI incidence cases for the period 01.01.2003-31.12.2005 and were collected from 21 emergency and first medical aid stations in Grand Baku Area (including Absheron Economical Region with several millions of inhabitants). Data were "cleaned" as much as possible from social and other factors and were subjected to medical and mathematical/statistical analysis. Medical analysis showed reliability of the used data. Method of ANalysis Of VAriance (ANOVA) was applied to check the significance of GMA intensity effect and the type of geomagnetic storms - those caused by magnetic clouds (MC) and by high speed solar wind streams (HSSWS) - on AMI incidences. Relevant correlation coefficients were calculated. Results were outlined for both considered data. Results obtained for the Sofia data showed statistically significant positive correlation between considered GMA indices and AMI occurrence. ANOVA revealed that AMI incidence number was significantly increased from the day before till the day after geomagnetic storms with different intensities. Geomagnetic storms caused by MC were related to significant increase of AMI number in comparison with the storms caused by HSSWS. There was a trend for such different effects even on -1st and +1st day for the period 1995-2004. Results obtained for the Baku data revealed trends similar to those obtained for Sofia data. AMI morbidity increment was observed on the days with higher GMA intensity and after these days

  20. Allogeneic adipose stem cell therapy in acute myocardial infarction.

    Science.gov (United States)

    Rigol, Montserrat; Solanes, Núria; Roura, Santiago; Roqué, Mercè; Novensà, Laura; Dantas, Ana Paula; Martorell, Jaume; Sitges, Marta; Ramírez, José; Bayés-Genís, Antoni; Heras, Magda

    2014-01-01

    Stem cell therapy offers a promising approach to reduce the long-term mortality rate associated with heart failure after acute myocardial infarction (AMI). To date, in vivo translational studies have not yet fully studied the immune response to allogeneic adipose tissue-derived mesenchymal stem cells (ATMSCs). We analysed the immune response and the histological and functional effects of allogeneic ATMSCs in a porcine model of reperfused AMI and determine the effect of administration timing. Pigs that survived AMI (24/26) received intracoronary administration of culture medium after reperfusion (n = 6), ATMSCs after reperfusion (n = 6), culture medium 7 days after AMI (n = 6) or ATMSCs 7 days after AMI (n = 6). At 3-week follow-up, cardiac function, alloantibodies and histological analysis were evaluated. Administration of ATMSCs after reperfusion and 7 days after AMI resulted in similar rates of cell engraftment; some of those cells expressed endothelial, smooth muscle and cardiomyogenic cell lineage markers. Delivery of ATMSCs after reperfusion compared with that performed at 7 days was more effective in increasing: vascular density (249 ± 64 vs. 161 ± 37 vessels/mm2; P < 0.01), T lymphocytes (1 ± 0.4 vs. 0.4 ± 0.3% of area CD3(+) ; P < 0.05) and expression of vascular endothelial growth factor (VEGF; 32 ± 7% vs. 20 ± 4% of area VEGF(+) ; P < 0.01). Allogeneic ATMSC-based therapy did not change ejection fraction but generated alloantibodies. The present study is the first to demonstrate that allogeneic ATMSCs elicit an immune response and, when administered immediately after reperfusion, are more effective in increasing VEGF expression and neovascularization. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

  1. Association between divorce and risks for acute myocardial infarction.

    Science.gov (United States)

    Dupre, Matthew E; George, Linda K; Liu, Guangya; Peterson, Eric D

    2015-05-01

    Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults. We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (Pdivorce (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30-2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage. © 2015 American Heart Association, Inc.

  2. Handheld echocardiography during hospitalization for acute myocardial infarction.

    Science.gov (United States)

    Cullen, Michael W; Geske, Jeffrey B; Anavekar, Nandan S; Askew, J Wells; Lewis, Bradley R; Oh, Jae K

    2017-11-01

    Handheld echocardiography (HHE) is concordant with standard transthoracic echocardiography (TTE) in a variety of settings but has not been thoroughly compared to traditional TTE in patients with acute myocardial infarction (AMI). Completed by experienced operators, HHE provides accurate diagnostic capabilities compared with standard TTE in AMI patients. This study prospectively enrolled patients admitted to the coronary care unit with AMI. Experienced sonographers performed HHE with a V-scan. All patients underwent clinical TTE. Each HHE was interpreted by 2 experts blinded to standard TTE. Agreement was assessed with κ statistics and concordance correlation coefficients. Analysis included 82 patients (mean age, 66 years; 74% male). On standard TTE, mean left ventricular (LV) ejection fraction was 46%. Correlation coefficients between HHE and TTE were 0.75 (95% confidence interval: 0.66 to 0.82) for LV ejection fraction and 0.69 (95% confidence interval: 0.58 to 0.77) for wall motion score index. The κ statistics ranged from 0.47 to 0.56 for LV enlargement, 0.55 to 0.79 for mitral regurgitation, and 0.44 to 0.57 for inferior vena cava dilatation. The κ statistics were highest for the anterior (0.81) and septal (0.71) apex and lowest for the mid inferolateral (0.36) and basal inferoseptal (0.36) walls. In patients with AMI, HHE and standard TTE demonstrate good correlation for LV function and wall motion. Agreement was less robust for structural abnormalities and specific wall segments. In experienced hands, HHE can provide a focused assessment of LV function in patients hospitalized with AMI; however, HHE should not substitute for comprehensive TTE. © 2017 Wiley Periodicals, Inc.

  3. The Relationship Between Latent Tuberculosis Infection and Acute Myocardial Infarction.

    Science.gov (United States)

    Huaman, Moises A; Ticona, Eduardo; Miranda, Gustavo; Kryscio, Richard J; Mugruza, Raquel; Aranda, Ernesto; Rondan, Paola L; Henson, David; Ticona, Cesar; Sterling, Timothy R; Fichtenbaum, Carl J; Garvy, Beth A

    2018-03-05

    Tuberculosis has been associated with an increased risk of cardiovascular disease (CVD), including acute myocardial infarction (AMI). We investigated whether latent tuberculosis infection (LTBI) is associated with AMI. We conducted a case-control study in 2 large national public hospital networks in Lima, Peru, between July 2015 and March 2017. Case patients were patients with a first time diagnosis of type 1 (spontaneous) AMI. Controls were patients without a history of AMI. We excluded patients with known human immunodeficiency virus infection, tuberculosis disease, or prior LTBI treatment. We used the QuantiFERON-TB Gold In-Tube assay to identify LTBI. We used logistic regression modeling to estimate the odds ratio (OR) of LTBI in AMI case patients versus non-AMI controls. We enrolled 105 AMI case patients and 110 non-AMI controls during the study period. Overall, the median age was 62 years (interquartile range, 56-70 years); 69% of patients were male; 64% had hypertension, 40% dyslipidemia, and 39% diabetes mellitus; 30% used tobacco; and 24% were obese. AMI case patients were more likely than controls to be male (80% vs 59%; P tobacco users (41% vs 20%; P tobacco use, obesity, and family history of coronary artery disease, LTBI remained independently associated with AMI (adjusted OR, 1.90; 95% CI, 1.05-3.45). LTBI was independently associated with AMI. Our results suggest a potentially important role of LTBI in CVD. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  4. Estimation of myocardial viability and clinical significance of reverse redistribution in resting technetium-99m sestamibi myocardial single photon emission computed tomography in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Itagane, Hiroshi; Otsuka, Masato; Suto, Yayoi; Kajiwara, Kenji; Naruko, Takahiko; Tojo, Osamu; Okumachi, Fukumaru; Haze, Kazuo; Yamagishi, Hiroyuki.

    1997-01-01

    The clinical significance of reverse redistribution of Tc-99m sestamibi (MIBI) was investigated in 36 patients with acute myocardial infarction and angiographically confirmed single-vessel disease, but without previous infarction using resting MIBI myocardial SPECT and exercise-reinjection Tl-201 (Tl) myocardial SPECT. MIBI myocardial SPECT was performed 90 min and 300 min after injection of MIBI 370 MBq at rest. Four hours after exercise Tl imaging was completed, reinjection imaging was obtained. Wall motion abnormalities on left ventriculograms were analyzed at the onset of infarction and 1 month later. The severity scores on the MIBI early image, MIBI delayed image and Tl reinjection image were 98±18, 170±22 and 90±18, respectively. The reverse redistribution of MIBI was marked in acute infarction. A significant correlation of severity score was found between the MIBI early image and Tl reinjection image. In 18 patients with significant stenosis of an infarct-related artery, there was a significant correlation between the degree of reverse redistribution and that of Tl redistribution. A good correlation was found between the severity score on the MIBI early image and wall motion abnormality at 1 month after infarction. There was a significant correlation between the degree of reverse redistribution and wall motion improvement. Despite stenosis of the infarct-related artery, the wall motion abnormality was less in 22 patients with marked reverse redistribution than the other 14 patients. (K.H.)

  5. Nitroglycerine induced acute myocardial infarction in a patient with myocardial bridging

    DEFF Research Database (Denmark)

    Rujic, Dragana; Nielsen, Mette Lundgren; Veien, Karsten Tange

    2014-01-01

    Muscle overlying an intramyocardial segment of a coronary artery is termed a myocardial bridge. The intramyocardial segment, the tunneled artery, is compressed during systole. The condition is generally benign but may occasionally cause myocardial ischemia, infarction, arrhythmia, or sudden cardiac...... death. We present a case regarding a 52-year-old man with exercise-induced angina who was diagnosed with a myocardial bridge overlying the left anterior descending artery. He was initially treated with beta-blockers and later received coronary bypass graft surgery....

  6. Resveratrol activates endogenous cardiac stem cells and improves myocardial regeneration following acute myocardial infarction.

    Science.gov (United States)

    Ling, Lin; Gu, Shaohua; Cheng, Yan

    2017-03-01

    Stem cell antigen-1-positive (Sca-1+) cardiac stem cells (CSCs) therapy for myocardial regeneration following acute myocardial infarction (AMI) is limited by insufficient cell viability and a high rate of apoptosis, due to the poor regional microenvironment. Resveratrol, which is a compound extracted from red wine, has been reported to protect myocardial tissue post‑AMI by increasing the expression of angiogenic and chemotactic factors. The present study aimed to investigate the effects of resveratrol on Sca‑1+ CSCs, and to optimize Sca‑1+ CSCs therapy for myocardial regeneration post‑AMI. C57/BL6 mice (age, 6 weeks) were divided into two groups, which received intragastric administration of PBS or 2.5 mg/kg.d resveratrol. The endogenous expression of Sca‑1+ CSCs in the heart was assessed on day 7. Furthermore, C57/BL6 mice underwent left anterior descending coronary artery ligation for the construction of an AMI model, and received an injection of 1x106 CSCs into the peri‑ischemic area (n=8/group). Mice received intragastric administration of PBS or resveratrol (2.5 mg/kg.d) for 4 weeks after cell transplantation. Echocardiography was used to evaluate cardiac function 4 weeks after cell transplantation. Capillary density and cardiomyocyte apoptosis in the peri‑ischemic myocardium were assessed by cluster of differentiation 31 immunofluorescent staining and terminal deoxynucleotidyl transferase‑mediated dUTP nick end labeling assay, respectively. Western blot analysis was conducted to detect the protein expression levels of vascular endothelial growth factor (VEGF) and stromal cell‑derived factor (SDF)‑1α in the myocardium. Treatment with resveratrol increased the number of endogenous Sca‑1+ CSCs in heart tissue after 7 days (PBS vs. Res, 1.85±0.41/field vs. 3.14±0.26/field, P<0.05). Furthermore, intragastric administration of resveratrol significantly increased left ventricle (LV) function 4 weeks after AMI, as determined by an

  7. Discrepancy between myocardial perfusion and fatty acid metabolism following acute myocardial infarction for evaluating the dysfunctional viable myocardium.

    Science.gov (United States)

    Biswas, Shankar K; Sarai, Masayoshi; Toyama, Hiroshi; Hishida, Hitoshi; Ozaki, Yukio

    2012-01-01

    Following acute myocardial infarction (AMI) the area of myocardial perfusion and metabolism mismatch is designated as dysfunctional viable myocardium. (123)I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) is clinically very useful for evaluating myocardial fatty acid metabolism, and (99)mTc-Tetrofosmin (TF) is a widely used tracer for myocardial perfusion. This study was designed to evaluate the degree of discrepancy between BMIPP and TF at the subacute state of AMI. Fifty-two patients (aged 59 ± 10 years; mean 46 years) with AMI were enrolled, and all of them underwent percutaneous coronary intervention (PCI). Patients were classified according to ST-T change and PCI timing. (123)I-beta-methyl iodophenyl pentadecanoic acid and TF cardiac scintigraphy were performed on 7 ± 3.5 days of admission using a dual headed gamma camera. Perfusion and fatty acid metabolism defect were scored on a 17 segments model. The mean BMIPP defect score on early and delayed images were 16.67 ± 10.19 and 16.25 ± 10.40, respectively. The mean TF defect score was 10 ± 7.69. Defect score of BMIPP was significantly higher than that of the TF (P TF), and 5 (10%) patients showed matched defect (BMIPP = TF). Mismatched defect score (MMDS) was significantly higher in patients with ST-segment elevation myocardial infarction (STEMI) than that of non-ST-segment elevation myocardial infarction (NSTEMI) (P < 0.041; 95% CI 0.11-5.19). At the subacute state of AMI, most of the patients showed perfusion-metabolism mismatch, which represents the dysfunctional viable myocardium, and patients with STEMI showed higher mismatch. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  8. Radioimmunoassay determination of factor 4 platelets (PF4) in acute myocardial infarction patients

    International Nuclear Information System (INIS)

    Leon Herrejon, Ma. de L.; Graef S, A.; Altamirano B, P.; Ramos C, M.A.

    1985-01-01

    From a pathological standpoint an increase in the Factor 4 platelet has been observed in various abnormal states including myocardial infarction, diabetes mellitus, diffuse intravascular coagulation and renal insufficiency among others. Eighty subjects were studied at rest: 40 normal and under no medication, and 40 myocardial infarction patients in the acute phase and with added pathology. All were under the same therapeutic regimen. Results obtained between both groups were statistically significant with a P > 0.01. (author)

  9. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

    OpenAIRE

    Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

    2016-01-01

    Cardiovascular disease is the largest cause of mortality worldwide, and stress is a significant contributor to the development of cardiovascular disease. The relationship between acute and chronic stress and cardiovascular disease is well-evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury. Conversely, chronic stress is arrythmogenic and incr...

  10. Rationale and design of the Affordability and Real-world Antiplatelet Treatment Effectiveness after Myocardial Infarction Study (ARTEMIS): A multicenter, cluster-randomized trial of P2Y12 receptor inhibitor copayment reduction after myocardial infarction.

    Science.gov (United States)

    Doll, Jacob A; Wang, Tracy Y; Choudhry, Niteesh K; Cannon, Christopher P; Cohen, David J; Fonarow, Gregg C; Henry, Timothy D; Bhandary, Durgesh D; Khan, Naeem; Davidson-Ray, Linda D; Anstrom, Kevin; Peterson, Eric D

    2016-07-01

    The use of oral P2Y12 receptor inhibitors after acute myocardial infarction (MI) can reduce risks of subsequent major adverse cardiovascular events (composite of all-cause death, recurrent MI, and stroke), yet medication persistence is suboptimal. Although copayment cost has been implicated as a factor influencing medication persistence, it remains unclear whether reducing or eliminating these costs can improve medication persistence and/or downstream clinical outcomes. ARTEMIS is a multicenter, cluster-randomized clinical trial designed to examine whether eliminating patient copayment for P2Y12 receptor inhibitor therapy affects medication persistence and clinical outcomes. We will enroll approximately 11,000 patients hospitalized for acute ST-elevation and non-ST-elevation MI at 300 hospitals. Choice and duration of treatment with a P2Y12 receptor inhibitor will be determined by the treating physician. Hospitals randomized to the copayment intervention will provide vouchers to cover patients' copayments for their P2Y12 receptor inhibitor for up to 1 year after discharge. The coprimary end points are 1-year P2Y12 receptor inhibitor persistence and major adverse cardiovascular events. Secondary end points include choice of P2Y12 receptor inhibitor, patient-reported outcomes, and postdischarge cost of care. ARTEMIS will be the largest randomized assessment of a medication copayment reduction intervention on medication persistence, clinical outcomes, treatment selection, and cost of care after acute MI. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development

    DEFF Research Database (Denmark)

    Lindholm, M G; Køber, L; Boesgaard, S

    2003-01-01

    incidence, outcome and prognostic significance of cardiogenic shock in 6676 consecutive patients with acute myocardial infarction. METHODS AND RESULTS: Demographic and clinical data including the presence of cardiogenic shock were prospectively collected in 6676 non-invasively managed patients...... with myocardial infarction consecutively admitted to 27 different hospitals during a 2-year period. Six-year mortality data were collected in 99.9% of the population. Cardiogenic shock developed in 444 patients (6.7%). In 59% of these patients cardiogenic shock developed within 48 h, 11% developed shock during...... or late shock development (>80%) (Pcollected registry, non-invasively managed consecutive myocardial infarct...

  12. Detection of active left ventricular thrombosis during acute myocardial infarction using indium-111 platelet scintigraphy

    International Nuclear Information System (INIS)

    Ezekowitz, M.D.; Kellerman, D.J.; Smith, E.O.; Streitz, T.M.

    1984-01-01

    Platelet scintigraphy with radioactive indium-111 may be used both to identify and to reflect the activity of thrombin in vivo in man. Forty-one patients with acute myocardial infarction were studied for active left ventricular thrombosis by platelet scintigraphy and followed until in-hospital death, discharge, or same-admission cardiac surgery for evidence of systemic embolization. Group 1 (n . 29) had transmural myocardial infarctions, of which 21 were anterior and eight were inferior. Group 2 (n . 12) had subendocardial myocardial infarctions. Those with subendocardial and transmural inferior myocardial infarctions had neither left ventricular thrombosis nor emboli. Ten (48 percent) of 21 with anterior transmural myocardial infarctions had left ventricular thrombosis by platelet scintigraphy. Three with and one without such thrombosis by scintigraphy had acute neurologic episodes. In the group with anterior myocardial infarctions, seven of ten patients with and four of 11 without left ventricular thrombosis received heparin subcutaneously. We conclude that platelet scintigraphy may be used to monitor antiplatelet and anticoagulant therapy in patients with anterior transmural myocardial infarctions who are at risk for left ventricular thrombosis and systemic embolization

  13. Magnetic Resonance Imaging of Myocardial Strain After Acute ST-Segment-Elevation Myocardial Infarction: A Systematic Review.

    Science.gov (United States)

    Mangion, Kenneth; McComb, Christie; Auger, Daniel A; Epstein, Frederick H; Berry, Colin

    2017-08-01

    The purpose of this systematic review is to provide a clinically relevant, disease-based perspective on myocardial strain imaging in patients with acute myocardial infarction or stable ischemic heart disease. Cardiac magnetic resonance imaging uniquely integrates myocardial function with pathology. Therefore, this review focuses on strain imaging with cardiac magnetic resonance. We have specifically considered the relationships between left ventricular (LV) strain, infarct pathologies, and their associations with prognosis. A comprehensive literature review was conducted in accordance with the PRISMA guidelines. Publications were identified that (1) described the relationship between strain and infarct pathologies, (2) assessed the relationship between strain and subsequent LV outcomes, and (3) assessed the relationship between strain and health outcomes. In patients with acute myocardial infarction, circumferential strain predicts the recovery of LV systolic function in the longer term. The prognostic value of longitudinal strain is less certain. Strain differentiates between infarcted versus noninfarcted myocardium, even in patients with stable ischemic heart disease with preserved LV ejection fraction. Strain recovery is impaired in infarcted segments with intramyocardial hemorrhage or microvascular obstruction. There are practical limitations to measuring strain with cardiac magnetic resonance in the acute setting, and knowledge gaps, including the lack of data showing incremental value in clinical practice. Critically, studies of cardiac magnetic resonance strain imaging in patients with ischemic heart disease have been limited by sample size and design. Strain imaging has potential as a tool to assess for early or subclinical changes in LV function, and strain is now being included as a surrogate measure of outcome in therapeutic trials. © 2017 American Heart Association, Inc.

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

    DEFF Research Database (Denmark)

    Mickley, H; Nielsen, J R; Berning, J

    1998-01-01

    Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121...... consecutive male patients 7 Holter recordings. Considerable variability was found within and between patients...

  15. Correlation of symptom depression levels with mean platelet volume rate on patients of acute coronary syndrome

    Science.gov (United States)

    Hasugian, L.; Hanum, H.; Hanida, W.; Safri, Z.

    2018-03-01

    Patients with Depression and the acute coronary syndrome (ACS) is rarely detected, although in some studies say that depression can worsen cardiovascularly and increase mortality. From research, Canan F et al found that increasing levels of Mean platelet volume (MPV) as a risk factor for atherosclerosis and MPV was higher in patients with depression compared with patients without depression. In this study used observational methods of measurement of cross-sectional data. Research began in November 2015 - May 2016 against General Hospital inpatients H. Adam Malik Medan. There are 64 patients with a diagnosis of ACS were given quieter Beck Depression Inventory (BDI), then calculated a score of BDI patients and MPV levels were seen when they first entered the hospital before being given treatment. Patients answered quieter on days 3-7 after diagnosis ACS. ACS Patients were divided into 3 groups: acute myocardial infarction with ST elevation, acute myocardial infarction with non-ST elevation and unstable angina pectoris. The level of depression is grouped into not depression, mild depression, moderate depression and severe depression. Statistically significant with p-valuevalue 0.000003.

  16. [Acute coronary syndromes in Latin America: lessons from the ACCESS registry].

    Science.gov (United States)

    Martínez-Sánchez, Carlos; Jerjes-Sánchez, Carlos; Nicolau, José Carlos; Bazzino, Oscar; Antepara, Norka; Mármol, Ricardo

    2016-01-01

    Evidence of the clinical characteristics, treatment and outcomes among Latin American (LA) patients with acute coronary syndromes (ACS) is scarce. ACCESS, international prospective multicenter registry to evaluate risk stratification, management and outcomes in ACS (unstable angina or non-ST elevation myocardial infarction [UA/NSTEMI] or ST elevation myocardial infarction [STEMI]) in developing countries. Primary endpoint: all-cause death at 1 year; all-cause mortality within 30 days was also recorded, Patients with acute ischemic symptoms within 24 hours of symptoms onset and electrocardiographic evidence of ischemia were enrolled. Coronary artery disease was proved by positive invasive or non-invasive tests. Between 2007 and 2008, 4436 patients with ACS (2562 UA/NSTEMI and 2374 STEMI) from eight LA countries. On admission, acute symptoms were identified in 79 % and 90%, respectively. Both groups had a long delay from symptom onset to hospital arrival. Low access to pharmacological (29%) and mechanical reperfusion (32%) were observed. At admission, rates of evidence-based treatment were low in all groups. The most common in-hospital complications were heart failure (10% UA/NSTEMI and 20% STEMI) and recurrent ischemia (8% and 11%). Mortality at 30 days was 2% and 8% at 1 year. ACCESS registry provides contemporary information of patients with ACS in LA and their hospital management and subsequent clinical outcomes.

  17. Myocardium and microvessel endothelium apoptosis at day 7 following reperfused acute myocardial infarction.

    Science.gov (United States)

    Kang, Sheng; Yang, Yue-jin; Wu, Yi-ling; Chen, Yu-tong; Li, Li; Tian, Yi

    2010-01-01

    This study was to investigate the salvaged myocardial and microvascular endothelial cells apoptosis at the first week of reperfused acute myocardial infarction (AMI). Sixteen mini swines (20-30 kg) were randomly assigned to the sham-operated group and the AMI group. The acute myocardial infarction and reperfusion model was created, and pathologic myocardial tissue was collected at day 7 following left anterior descending coronary artery reperfusion, and detected by transmission electron microscope, in situ cell apoptosis detection (TUNEL method), Real-time Quantitative Polymerase Chain Reaction and Western blot. In the AMI group, the infarcted area showed the myolysis, fibroblast and injuried endothelial cells under transmission electron microscope. The infarcted area had higher apoptotic index of microvascular endothelial cells than the marginal area, the normal area, and the sham-operated area (all Pinfarcted area were higher than those in the marginal area, the normal area, and the sham-operated area (all Pinfarcted and marginal areas compared with the normal area and the sham-operated area. The overexpressions of Fas and Bax or the low expression of Bcl-2 in the infarcted and marginal heart tissue may play an important role in the acceleration of myocardial and endothelial apoptosis at 7th day following reperfused acute myocardial infarction. Copyright 2009 Elsevier Inc. All rights reserved.

  18. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M J Pekka

    2010-01-01

    Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction...... (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction....

  19. Sildenafil and diastolic dysfunction after acute myocardial infarction trial

    DEFF Research Database (Denmark)

    Andersen, Mads J; Gustafsson, Finn; Hassager, Christian

    2013-01-01

    Diastolic dysfunction following myocardial infarction is an important predictor of outcome, irrespective of left ventricular systolic function. Previous studies suggest that phosphordiesterase-5 inhibition has a favorable effect on the myocardium as well as on the pulmonary and systemic vasculature....

  20. A Case of Myopericarditis Mimicking Acute Myocardial Infarction in Childhood

    Directory of Open Access Journals (Sweden)

    Rahmi Özdemir

    2015-11-01

    Full Text Available Myopericarditis is an inflammatory disease of the both myocardial and pericardial tissues, and resulting from different etiologies. Viral agents such as coxsackie virus type B, adenovirus, and echovirus are the most common leading cause of this disease and it usually occurs following viral upper respiratory tract infections. Although there are different clinical features according to ages groups, some common findings such as tachycardia incompatible with fever, deeply heared heart sounds, and heart failure can be seen. Clinical findings often mimics a myocardial infarction. Diagnosis of this disease is made by the evaluation of the clinical condition, electrocardiography, echocardiography and elevation of the cardiac enzymes. Because it is mortality, discrimination of myopericarditis from myocardial infarction is very important. Herein, we report a 13 year-old-girl with the diagnosis of myopericarditis presenting with chest pain, electrocardiographic changes mimicking myocardial infarction and elevated cardiac enzymes and also aimed to emphasize the importance of accurate diagnosis of this disease.

  1. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Mehta, Laxmi S; Beckie, Theresa M; DeVon, Holli A; Grines, Cindy L; Krumholz, Harlan M; Johnson, Michelle N; Lindley, Kathryn J; Vaccarino, Viola; Wang, Tracy Y; Watson, Karol E; Wenger, Nanette K

    2016-03-01

    Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction. © 2016 American Heart Association, Inc.

  2. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents.

    Science.gov (United States)

    Eisenmann, Eric D; Rorabaugh, Boyd R; Zoladz, Phillip R

    2016-01-01

    Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions.

  3. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

    Science.gov (United States)

    Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

    2016-01-01

    Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia–reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions. PMID:27199778

  4. Creatine kinase radioimmunoassay and isoenzyme electrophoresis compared in the diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Homburger, H.A.; Jacob, G.L.

    1980-01-01

    We compared, in 116 patients, the relative usefulness of results of tests for creatine kinase B-isoenzymes, as measured by radioimmunoassay, and the MB isoenzyme, as measured by electrophoresis, in diagnosis of acute myocardial infarction. The radioimmunoassay was specific for isoenzymes of creatine kinase containing the B subunit. All patients with acute transmural infarcts had positive test results by both techniques, but concentrations of B-isoenzymes were more frequently above normal than were MB bands in the case of patients with acute subendocardial infarcts and in the case of all patients with acute myocardial infarcts from whom sera were collected more than 24 h after onset of chest pain. Concentrations of B-isoenzymes also were increased, even when MB bands were not electrophoretically detectable in specimens from several patients without documented acute myocardial infarcts. These abnormal results presumably were caused by increased concentrations of the BB isoenzyme in serum. Accordingly, an increased concentration of B-isoenzymes had less diagnostic specificity and predictive value for acute myocardial infarction than did a detectable MB band. Results of isoenzyme electrophoresis were more reliable for establishing this diagnosis, but the results of radioimmunoassay were more reliable for excluding it in patients with chest pain as the primary symptom

  5. Quality of health information on acute myocardial infarction and stroke in the world wide web.

    Science.gov (United States)

    Bastos, Ana; Paiva, Dagmara; Azevedo, Ana

    2014-01-01

    The quality of health information in the Internet may be low. This is a concerning issue in cardiovascular diseases which warrant patient self-management. We aimed to assess the quality of Portuguese websites as a source of health information on acute myocardial infarction and stroke. We used the search terms 'enfarte miocardio' and 'acidente vascular cerebral' (Portuguese terms for myocardial infarction and stroke) on Google(®), on April 5th and 7th 2011, respectively, using Internet Explorer(®). The first 200 URL retrieved in each search were independently visited and Portuguese websites in Portuguese language were selected. We analysed and classified 121 websites for structural characteristics, information coverage and accuracy of the web pages with items defined a priori, trustworthiness in general according to the Health on the Net Foundation and regarding treatments using the DISCERN instrument (48 websites). Websites were most frequently commercial (49.5%), not exclusively dedicated to acute myocardial infarction/ stroke (94.2%), and with information on medical facts (59.5%), using images, video or animation (60.3%). Websites' trustworthiness was low. None of the websites displayed the Health on the Net Foundation seal. Acute myocardial infarction/ stroke websites differed in information coverage but the accuracy of the information was acceptable, although often incomplete. The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable. Trustworthiness was low, impairing users' capability of identifying potentially more reliable content.

  6. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age artery disease offers some protection from protection....

  7. Lipid Testing and Statin Dosing After Acute Myocardial Infarction.

    Science.gov (United States)

    Wang, William T; Hellkamp, Anne; Doll, Jacob A; Thomas, Laine; Navar, Ann Marie; Fonarow, Gregg C; Julien, Howard M; Peterson, Eric D; Wang, Tracy Y

    2018-01-25

    The 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend high-intensity statins for patients after myocardial infarction (MI) rather than treating to a low-density lipoprotein cholesterol goal, as the previous ATP III (Adult Treatment Panel third report) guidelines had advised. To evaluate the frequency of postdischarge lipid testing and high-intensity statin use among MI patients discharged on a statin during the ATP III guidelines era, we linked ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry data to Medicare claims for 11 046 MI patients aged ≥65 years who were discharged alive on a statin from 347 hospitals (2007-2009). Multivariable regression was used to evaluate the association between lipid testing and 1-year high-intensity statin use. Only 21% of MI patients were discharged on a high-intensity statin. By 90 days after MI, 44% of patients discharged on a statin underwent lipid testing (43% on low- or moderate-intensity statins and 49% on high-intensity statins; P =0.001). Follow-up lipid testing rates were 47% among patients with in-hospital low-density lipoprotein cholesterol ≥100 mg/dL and 47% among newly prescribed statin recipients. By 1 year, only 14% of patients were on high-intensity statins. Only 4% of patients discharged on low- or moderate-dose statin were uptitrated to high intensity; postdischarge lipid testing was associated with a slightly higher likelihood of high-intensity statin use by 1 year (5.4% versus 2.9%, adjusted odds ratio: 1.92; 95% confidence interval, 1.52-2.41). Previous guidelines recommended low-density lipoprotein cholesterol goal-directed statin therapy, but lipid testing and high-intensity statin use were infrequent after MI. The American College of Cardiology/American Heart Association guidelines may promote more intensive cardiovascular risk reduction by eliminating treatment dependence on lipid testing. © 2018 The Authors. Published on

  8. Evaluation of the sickness rate for acute myocardial infarction

    International Nuclear Information System (INIS)

    Semenova, Y. V.; Litvinenko, T. M.; Takhanov, R. M.; Karpov, A. B.

    2004-01-01

    Cardiovascular diseases seem to be the main cause of people's death in industrial developed countries. That is why the active study of factors and conditions affecting the sickness and death rate for this group of diseases is being continued at present. Apart from the well-known risk factors, there is a group of technogenic factors the contribution of which to genesis of the examined group of diseases is not clear enough and requires a detailed study. One of such factors appears to be ionizing radiaiton, especially in case of a prolonged effect with the so-called small doses. The sickness rate due to acute myocardial infarction (AMI) in the period 1999-2001 has been studied in the closed population ZATO Seversk. To conduct examinations there was created the towns AMI register to be a structural component of the regional medico-dosimetric register (RMDR) of the Siberian Group of Chemical Enterprises (SGCE) personnel and population of ZATO Seversk. Information on coronary disasters among adult population above 20 is being collected according to the program AMI Register created by WHO in 1968 with our additional results of modern methods of examining patients with ischemic heart disease and prospective observation. The analysis of data obtained testifies to the tendency towards the sickness rate increase in the period under study both among residents of the town (2,011-2,014-2,238 per 1000 people in 1999, 2000 and 2001, respectively) and among SGCE workers (4,354-4,572-5,006 per 1000) that corresponds to general tendencies of AMI sickness rate on the territory of Russian Federation. it is noted that in the group of workers at the main production the AMI sickness rate exceeds similar indices by the plant as a whole (6,205-7, 176-6,518 per 1000). Great prevalence of this AMI form among workers of a large industrial enterprise can be conditioned by a predominance of male contingent high emotional mental load (shift work on complex technological equipment with

  9. Thrombus composition in sudden cardiac death from acute myocardial infarction.

    Science.gov (United States)

    Silvain, Johanne; Collet, Jean-Philippe; Guedeney, Paul; Varenne, Olivier; Nagaswami, Chandrasekaran; Maupain, Carole; Empana, Jean-Philippe; Boulanger, Chantal; Tafflet, Muriel; Manzo-Silberman, Stephane; Kerneis, Mathieu; Brugier, Delphine; Vignolles, Nicolas; Weisel, John W; Jouven, Xavier; Montalescot, Gilles; Spaulding, Christian

    2017-04-01

    It was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI). The TIDE (Thrombus and Inflammation in sudden DEath) study included patients with angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo-aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method using scanning electron microscopy. We compared the composition of the thrombi responsible for the coronary occlusion between the two groups and evaluated factors influencing its composition. We included 121 patients and found that thrombus composition was not different between the SCD group (n=23) and the STEMI group (n=98) regarding content of fibrin fibers (60.3±18.4% vs. 62.4±18.4% respectively, p=0.68), platelets (16.3±19.2% vs. 15.616.7±%, p=0.76), erythrocytes (14.6±12.5% vs. 13±12.1%, p=0.73) and leukocytes (0.6±0.9% vs. 0.8±1.5%, p=0.93). Thrombus composition did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8±18.5% vs. 71.9±10.1%, p=0.0008) and a higher platelet content (19.2±19.1% vs. 7.9±5.7% p=0.014) in early presenters (6h of ischemic time). Composition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in MI. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. SPR detection of cardiac troponin T for acute myocardial infarction.

    Science.gov (United States)

    Pawula, Maria; Altintas, Zeynep; Tothill, Ibtisam E

    2016-01-01

    A surface plasmon resonance (SPR) sensor developed for the rapid, sensitive and specific detection of cardiac troponin T (cTnT) in serum samples is reported in this work. An extensive optimisation of assay parameters was conducted to achieve optimal detection strategy. Both direct and sandwich immunoassay formats were investigated and optimised. The response obtained was enhanced further by the use of gold nanoparticles (AuNPs) conjugated to the anti-cTnT detection antibody. A regeneration method was developed to enable the reuse of the SPR sensor for multiple sample application. The SPR immunosensor showed good reproducibility for cTnT detection in the concentration range of 25-1000 ng mL(-1) and 5-400 ng mL(-1) for the direct and sandwich assays in buffer, respectively. The linear regression analysis was performed and R(2) value was found as 0.99 for both assays. In order to optimise the sensor for serum analysis, nonspecific binding of serum proteins was reduced through the use of additives in the dilution buffer. To achieve greater sensitivity, the performance of the cTnT immunosensor sandwich assay in human serum was evaluated using non-modified and AuNP modified detector antibodies. A detection limit (LOD) for the immunosensor in 50% serum was assessed as 5 ng mL(-1) cTnT for the standard sandwich assay and 0.5 ng mL(-1) cTnT when using AuNP conjugated detector antibodies with a linear dynamic range of 0.5-40 ng mL(-1). The dissociation constant was found as 3.28 × 10(-9) M using Langmuir binding model which indicates high affinity between cTnT and its antibody. The proposed SPR immunosensor has a promising potential to be developed for point-of-care testing for the early diagnosis of acute myocardial infarction (AMI). This method can also be used for the rapid detection of biomarkers in central nervous system diseases. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Occlusive acute myocardial infarct on 16 multidetector-row helical CT: an experimental study in rabbits

    International Nuclear Information System (INIS)

    Lee, Jeong Kyong; Kim, Yoo Kyung; Lee, Sun Wha; Cho, Min Sun; Choe, Yeon Hyeon

    2006-01-01

    We wanted to evaluate the findings and diagnostic accuracy of MDCT for diagnosing occlusive acute myocardial infarction rabbits. Myocardial infarction was induced in 14 rabbits. MDCT was performed in the early and delay phases at 1 minute and 6 minutes, respectively, after intravenous contrast injection. The rabbits were sacrificed after scanning. The cardiac specimens were sliced and then stained with triphenyltetrazolium chloride (TTC). The agreement in the transmural extent of infarction between the MDCT scans and the TTC-stained specimens were analyzed by using kappa values. Acute myocardial infarction was found in 9 of 14 rabbits on the TTC-stained specimens and MDCT. The infarcted myocardium was demonstrated as a low-attenuation area on the early phase and as a central low-attenuation area with rim-like enhancement along the endocardial and pericardial sides of the myocardial wall on the delay phase. There was excellent agreement in the scores of the transmural extent of myocardial infarction between the TTC-stained specimens and the early phase scan (kappa value = 0.882, ρ 0.000), and there was fair to good agreement between the TTC-stained specimens and the delay phase scan (kappa value = 0.439, ρ = 0.000). Microscopic examination of the cardiac specimens revealed necrosis of myocardial cells in the central portion and granulation tissue along the endocardial and pericardial sides of the necrotic myocardium. 16 slice MDCT scan was useful for the diagnosis of acute myocardial infarction. The early phase scan was more accurate than the delay phase scan for evaluating the transmural extent of myocardial infarction. Histopathologic examination suggested that the low-attenuation area on the delay phase might correspond to necrotic myocardium and the enhanced might correspond to granulation tissue

  12. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis

    DEFF Research Database (Denmark)

    Berning, J; Rokkedal Nielsen, J; Launbjerg, J

    1992-01-01

    Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculog......Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide...

  13. The effect of streptokinase on chest pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Sørensen, H T; Rasmussen, S E

    1991-01-01

    Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76......, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain....

  14. EFFECTS OF COMBINATION THERAPY ON PLATELET COUNT IN PATIENTS OF MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Sadaf Ahmed

    2014-12-01

    Full Text Available Aspirin and clopidogrel are usually used individually to prevent adverse cardiovascular events and stroke. They are used in stabilizing the blood pressure in patients of myocardial infarction while combination therapy of aspirin and Clopidogrel (dual anti-platelet therapy is used for preventing adverse cardiovascular events in myocardial infarction patients. A cross-sectional observational study is conducted through a structured questionnaire from 110 patients of K.I.H.D (Karachi Institute of Heart Disease hospital, Karachi, Pakistan. Indoor/admitted patients with diagnosis of acute coronary syndrome (ACS, non-ST elevation myocardial infarction (NSTE-MI, ST elevation myocardial infarction (STE-MI, supra ventricular tachycardia (SVT were included along with those with previous or current onset of angina pectoris or heart attack. Information from the test reports of these patients was included in the data. Patients without proper test reports were excluded from the study. Combination therapy duration is considered as key tool for evaluation. Out of 100 patients (after exclusion criteria applied almost 18% patients were using the combination therapy for 10 to 25 years while 52% of patients were using the combination therapy for 1 to 10 years. Platelet count of 88% patients was found to be in between 1,50,000–3,50,000/µl. Remaining patients had less than 1,50,000 µl to more than 3,50,000 to 4,50,000 µl. Most frequently reported side effects were chest pain, respiratory issues, headache and depression. On the basis of our data analysis it is concluded that long duration dual anti-platelet therapy will not harm platelet count in human blood but it can create drug dependency in patients. Hypertension is not completely cured with this therapy but can help in stabilizing blood pressure.

  15. Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Barbirato, Gustavo Borges; Azevedo, Jader Cunha de; Felix, Renata Christian Martins; Correa, Patricia Lavatori; Volschan, Andre; Viegas, Monica; Pimenta, Lucia; Dohmann, Hans Fernando Rocha; Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco

    2009-01-01

    Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. Objective: To evaluate the operating characteristics of 99m Tc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of cute myocardial infarction. Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and non diagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial infarction (MI) were not excluded (24 patients). Troponin I concentrations were determined at admission and 6 hours later. Nuclear physicians performed a blind analysis of the images, and myocardial infarction was confirmed whenever troponin I level increase was three times that of the control. Results: Resting perfusion image was abnormal in all 6 patients with MI. Only 1 patient had a normal image and increased troponin levels. Fifty-five patients had positive images without MI, and 46 patients had normal images and troponin levels. The prevalence of the disease was 6.5%. The sensitivity and specificity of the resting images during an episode of chest pain to diagnose MI was 85.7% and 45.5%, respectively. The negative predictive value was 97.7%. Conclusion: Patients undergoing chest pain protocol with SPECT showed an excellent negative predictive value to exclude diagnosis of myocardial infarction. These results suggest that resting perfusion image is an important tool at the chest pain unit. (author)

  16. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Gimelli, Alessia; Masci, Pier Giorgio; Pasanisi, Emilio Maria; Lombardi, Massimo [Fondazione CNR/Regione Toscana, Pisa (Italy); Liga, Riccardo; Grigoratos, Chrysanthos [University Hospital of Pisa, Pisa (Italy); Marzullo, Paolo [Fondazione CNR/Regione Toscana, Pisa (Italy); Institute of Clinical Physiology, CNR, Pisa (Italy)

    2014-09-15

    To assess the relationships between myocardial structure and function on cardiac magnetic resonance (CMR) imaging and sympathetic tone on {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy early after myocardial infarction (MI). Ten patients underwent {sup 123}I-MIBG and {sup 99m}Tc-tetrofosmin rest cadmium zinc telluride scintigraphy 4 ± 1 days after MI. The segmental left ventricular (LV) relative radiotracer uptake of both {sup 99m}Tc-tetrofosmin and early {sup 123}I-MIBG was calculated. The day after scintigraphy, on CMR imaging, the extent of ischaemia-related oedema and of myocardial fibrosis (late gadolinium enhancement, LGE) was assessed. Accordingly, the extent of oedema and LGE was evaluated for each segment and segmental wall thickening determined. Based on LGE distribution, LV segments were categorized as ''infarcted'' (56 segments), ''adjacent'' (66 segments) or ''remote'' (48 segments). Infarcted segments showed a more depressed systolic wall thickening and greater extent of oedema than adjacent segments (p < 0.001) and remote segments (p < 0.001). Interestingly, while uptake of {sup 99m}Tc-tetrofosmin was significantly depressed only in infarcted segments (p < 0.001 vs. both adjacent and remote segments), uptake of {sup 123}I-MIBG was impaired not only in infarcted segments (p < 0.001 vs. remote) but also in adjacent segments (p = 0.024 vs. remote segments). At the regional level, after correction for {sup 99m}Tc-tetrofosmin and LGE distribution, segmental {sup 123}I-MIBG uptake (p < 0.001) remained an independent predictor of ischaemia-related oedema. After acute MI the regional impairment of sympathetic tone extends beyond the area of altered myocardial perfusion and is associated with myocardial oedema. (orig.)

  17. Myocardial Hemorrhage After Acute Reperfused ST-Segment–Elevation Myocardial Infarction

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, M. Mitchell; Davie, Andrew; Mahrous, Ahmed; Mordi, Ify; Rauhalammi, Samuli; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Ford, Ian; Oldroyd, Keith G.

    2016-01-01

    Background— The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results— We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (Phemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:26763281

  18. Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review

    Directory of Open Access Journals (Sweden)

    Leila Abid

    2011-02-01

    Full Text Available Acute myocardial infarction (AMI is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man, admitted in our acute care unit for acute myocardial infarction (AMI. A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high level of CRP. Anticardiolipine was present in the 2 cases. However, anti B2 glycoprotein I antibodies were detected in only one case. Emergency percutaneous transluminal coronary angioplasty (PTCA with direct stenting had been performed successfully only in the first case, and the follow-up was uncomplicated. Thereafter, long-term oral anticoagulant appeared to be effective. The last patient was admitted because of peripheral acute ischemia of legs. Standard electrocardiogram showed signs of previous silent anteroseptal wall myocardial infarction confirmed by echocardiography. The latter revealed an apical thrombus and a very low left ventricular ejection fraction. Amputation of the right leg was necessary because of consultation occurred too late. However, he died four weeks later. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of this complication

  19. Evaluate the early changes of myocardial fibers in rhesus monkey during sub-acute stage of myocardial infarction using diffusion tensor magnetic resonance imaging.

    Science.gov (United States)

    Wang, Yuqing; Cai, Wei; Wang, Lei; Xia, Rui

    2016-05-01

    The deterioration of cardiac mechanical function starts from the micro-alterations in the myocardial fibers after myocardial infarction (MI) due to the heart beats derived from the systole and diastole of the myocardial fibers. So, we want to evaluate quantitatively the early changes of myocardial fibers in rhesus monkey during sub-acute MI stage. Three fixed hearts with infarction after left anterior descending coronary artery ligation for 7days and eight age-matched intact controls were scanned by ex-vivo diffusion tensor magnetic resonance imaging (DT-MRI) to measure apparent diffusion coefficient (ADC), fractional anisotropy (FA) and helix angle (HA). In comparison with healthy controls, FA and transmural range of HA in MI regions showed a significant reduction whereas ADC showed a significant increment (pmyocardial fibers shifted further to left-handed helix around the infarcted and adjacent myocardium but shifted further to right-handed helix in remote myocardium. HA is sensitive to evaluate quantitatively the early changes of myocardial fibers in sub-acute MI rhesus monkeys. The myocardial fibers in normal monkeys are similar to those in normal humans, suggesting that early changes of myocardial fibers in sub-acute MI monkeys can contribute to more accurately understand those in patients suffering sub-acute MI. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The incomplete bucindolol evaluation in acute myocardial infarction Trial (BEAT)

    DEFF Research Database (Denmark)

    Torp-Pedersen, Christian; Køber, Lars; Ball, Stephen

    2002-01-01

    The aim of this study was to evaluate the efficacy of adding the beta-blocker bucindolol to standard therapy shortly after a myocardial infarction in a high-risk population with reduced left ventricular function. METHODS: The study was planned to include 2000 patients with an enzyme confirmed...... myocardial infarction and severely reduced left ventricular function determined by echocardiography (corresponding to ejection fraction ... of bucindolol 0.88 (95% confidence limits 0.5-1.5; P=0.6). There were 9/4 (bucindolol/placebo, P=0.16) heart failure events and 5/17 (P=0.01) reinfarctions in the bucindolol/placebo groups. CONCLUSION: Due to early closure it is unknown whether bucindolol changes mortality in high-risk post myocardial infarct...

  1. Effects of Chronic and Acute Zinc Supplementation on Myocardial Ischemia-Reperfusion Injury in Rats.

    Science.gov (United States)

    Ozyıldırım, Serhan; Baltaci, Abdulkerim Kasim; Sahna, Engin; Mogulkoc, Rasim

    2017-07-01

    The present study aims to explore the effects of chronic and acute zinc sulfate supplementation on myocardial ischemia-reperfusion injury in rats. The study registered 50 adult male rats which were divided into five groups in equal numbers as follows: group 1, normal control; group 2, sham; group 3, myocardial ischemia reperfusion (My/IR): the group which was fed on a normal diet and in which myocardial I/R was induced; group 4, myocardial ischemia reperfusion + chronic zinc: (5 mg/kg i.p. zinc sulfate for 15 days); and group 5, myocardial ischemia reperfusion + acute zinc: the group which was administered 15 mg/kg i.p. zinc sulfate an hour before the operation and in which myocardial I/R was induced. The collected blood and cardiac tissue samples were analyzed using spectrophotometric method to determine levels of MDA, as an indicator of tissue injury, and GSH, as an indicator of antioxidant activity. The highest plasma and heart tissue MDA levels were measured in group 3 (p zinc administration and markedly by chronic zinc supplementation.

  2. Abrupt opium discontinuation has no significant triggering effect on acute myocardial infarction.

    Science.gov (United States)

    Masoomi, Mohammad; Zare, Jahangir; Nasri, Hamidreza; Mirzazadeh, Ali; Sheikhvatan, Mehrdad

    2011-04-01

    A deleterious effect of withdrawal symptoms due to abrupt discontinuation of opium on the cardiovascular system is one of the recent interesting topics in the cardiovascular field. The current study hypothesized that the withdrawal syndrome due to discontinuing opium might be an important trigger for the appearance of acute myocardial infarction. Eighty-one opium-addicted individuals who were candidates for cardiovascular clinical evaluation and consecutively hospitalized in the coronary care unit (CCU) ward of Shafa Hospital in Kerman between January and July 2009 were included in the study and categorized in the case group, including patients experiencing withdrawal symptoms within 6-12 h after the reduced or discontinued use of opium according to the Diagnostic and Statistical Manual of Mental Disorders-revised IV version (DSM-IV-R) criteria for opium dependence and withdrawal, and the control group, without opium withdrawal symptoms. The appearance of acute myocardial infarction was compared between the two groups using multivariable regression models. Acute myocardial infarction occurred in 50.0% of those with withdrawal symptoms and in 45.1% of patients without evidence of opium withdrawal (P = 0.669). Multivariable analysis showed that opium withdrawal symptoms were not a trigger for acute myocardial infarction adjusting for demographic characteristics, marital status, education level and common coronary artery disease risk profiles [odds ratio (OR) = 0.920, 95% confidence interval (CI) = 0.350-2.419, P = 0.866]. Also, daily dose of opium before reducing or discontinuing use did not predict the appearance of myocardial infarction in the presence of confounder variables (OR = 0.975, 95% CI = 0.832-1.143, P = 0.755). Withdrawal syndrome due to abrupt discontinuation of opium does not have a triggering role for appearance of acute myocardial infarction.

  3. Effectiveness of selective intracoronary thrombolysis in acute myocardial infarction

    International Nuclear Information System (INIS)

    Yamaguchi, Hiroshi; Nosaka, Hideyuki; Saitoh, Taroh

    1984-01-01

    Protective effects of percutaneous transluminal coronary recanalization (PTCR) on the myocardium were investigated by creatine phospho kinase levels, regional left ventricular wall motion in chronic stage and 201 Tl myocardial single photon emission computed tomography. Recanalization of the occlusive coronary artery at the early stage of myocardial infarction was effective for the protection of the myocardium and heart functions. This effect depended largely on the degree of occlusion at the time of the first imaging, the final degree of occlusion after recanalization, and the time required for the recanalization. Cases in which percutaneous transluminal coronary angiography was performed following PTCR are also presented and examined. (Namekawa, K.)

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    -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...... injuries following pPCI. Owing to its relatively non-toxic profile, melatonin is an easily implementable drug in the clinical setting, and melatonin has the potential to reduce morbidity in patients with AMI. FUNDING: This study received no financial support from the industry. TRIAL REGISTRATION: www...

  5. [Clinical demonstrations: Heart rupture in acute myocardial infarct. Infectious endocarditis. Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Nager, F

    1984-12-08

    This clinical demonstration includes three topics of clinical cardiology: myocardial rupture in acute myocardial infarction, infective endocarditis, and WPW-syndrome with paroxysmal supraventricular tachycardia. In the first part three cases with septal perforation or papillary muscle rupture are demonstrated. Our experience with myocardial rupture (free wall, septum, papillary muscle) during the last six years is summarized with special reference to the significance and the differential diagnosis of systolic regurgitant murmurs after myocardial infarction. Special features of acute mitral incompetence (papillary muscle dysfunction) in myocardial infarction are outlined and diagnostic guidelines for differentiation between septal perforation and papillary muscle rupture are discussed. In the second part two patients with aortic (e.g. mitral) valve rupture in the course of infective endocarditis are presented. The synoptic comparison of these two patients is related to the results of our own clinical studies on the changing pattern of infective endocarditis (epidemiologically, clinically) during the last three decades. The clinical picture of acute aortic valve rupture is outlined and the bedside signs indicating catastrophic complications of infective endocarditis are summarized. In the third part the odyssey of a patient with WPW-syndrome and consecutive paroxysmal supraventricular tachycardia is described. Progress in electrophysiological analysis of the re-entry circles in preexcitation syndromes is outlined.

  6. Effect of decellularized tissue powders on a rat model of acute myocardial infarction.

    Science.gov (United States)

    Tabuchi, Masaki; Negishi, Jun; Yamashita, Akitatsu; Higami, Tetsuya; Kishida, Akio; Funamoto, Seiichi

    2015-11-01

    Many research groups are currently investigating new treatment modalities for myocardial infarction. Numerous aspects need to be considered for the clinical application of these therapies, such as low cell integration and engraftment rates of cell injection techniques. Decellularized tissues are considered good materials for promoting regeneration of traumatic tissues. The properties of the decellularized tissues are sustained after processing to powder form. In this study, we examined the use of decellularized tissue powder in a rat model of acute myocardial infarction. The decellularized tissue powders, especially liver powder, promoted cell integration and neovascularization both in vitro and in vivo. Decellularized liver powder induced neovascularization in the infarct area, resulting in the suppression of myocardial necrosis. The results of this study suggest that decellularized liver powder has good potential for application as a blood supply material for the treatment of myocardial infarction. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Does the electrocardiographic presence of Q waves influence the survival of patients with acute myocardial infarction?

    DEFF Research Database (Denmark)

    Abdulla, J; Brendorp, B; Torp-Pedersen, C

    2001-01-01

    , electrocardiographic diagnosis of Q wave and non-Q wave myocardial infarction, echocardiographic estimation of left ventricular systolic function determined as wall motion index, infarct complications, and survival were documented. The factors influencing the postmyocardial infarction outcome of these patients were......AIMS: To compare the outcome of short- and long-term survival of patients with Q wave vs non-Q wave myocardial infarction. METHODS: A total of 6676 patients with acute myocardial infarction were enrolled on the TRAndolapril Cardiac Evaluation (TRACE) register between 1990 and 1992. Medical history.......9-1.1)]. The result was the same in univariate and multivariate analyses. Subgroup analysis defined by age, sex, wall motion index, presence of congestive heart failure, diabetes mellitus, arterial hypertension, subsequent myocardial infarctions and use of thrombolytic therapy did not disclose importance of Q waves...

  8. Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction

    DEFF Research Database (Denmark)

    Hamshere, Stephen; Jones, A Daniel; Pellaton, Cyril

    2016-01-01

    Background: AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ...

  9. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Science.gov (United States)

    Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

    2013-01-01

    Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

  10. Detection of experimental acute myocardial infarction in dogs with electron beam CT

    International Nuclear Information System (INIS)

    Zhang Minguang; Song Zhijian; Shen Tianzhen; Zuo Huansen; Feng Xiaoyuan; Chen Xingrong

    1999-01-01

    Objective: The value and limitation of discovering the site, shape, density and size of acute myocardial infarction with enhanced volume scans of electron beam computed tomography (EBCT) in experimental dogs were assessed. Methods: The anterior descending and circumflex branches of the left coronary artery were ligated and infarction in the wall of left ventricle was created in six dogs. Enhancement volume scan was made with a EBCT scanner at 1.5, 6, 12, and 20 hour after the ligation and CT sectional images of dog heart were obtained. After finishing the scanning, the dogs were then scarified, and the samples were sent for electron and optic microscopes for pathologic examination. The morphologic findings of myocardial ischemia and infarction in CT images were carefully analysed. The CT numbers and the ratios of left ventricular myocardial and luminal CT number (M/L) in the myocardial ischemic and infarcted areas and normal areas were calculated. Results: The typical myocardial infarction in areas ligated were confirmed by ECG and pathology 20 hours after ligation. The site and shape of acute myocardial infarction were clearly shown on the EBCT images. The density of the ischemia and infarction area was significantly lower than that of the normal myocardium (P < 0.001). M/Ls of the low density areas and normal areas were 13.2% and 32.9%, respectively. The difference was significant (P < 0.001). Conclusions: With adequate scanning technique, the site shape, density and size of acute myocardial ischemia and infarction can be accurately assessed by EBCT

  11. Challenges in secondary prevention after acute myocardial infarction

    DEFF Research Database (Denmark)

    Piepoli, Massimo F; Corrà, Ugo; Dendale, Paul

    2017-01-01

    Worldwide, each year more than 7 million people experience myocardial infarction, in which one-year mortality rates are now in the range of 10%, but vary with patient characteristics. The consequences are even more dramatic: among patients who survive, 20% suffer a second cardiovascular event in ...

  12. Challenges in secondary prevention after acute myocardial infarction

    DEFF Research Database (Denmark)

    Piepoli, Massimo F; Corrà, Ugo; Dendale, Paul

    2016-01-01

    Worldwide, each year more than 7 million people experience myocardial infarction, in which one-year mortality rates are now in the range of 10%, but vary with patient characteristics. The consequences are even more dramatic: among patients who survive, 20% suffer a second cardiovascular event in ...

  13. Lipoprotein lipase gene variants: Association with acute myocardial ...

    African Journals Online (AJOL)

    Background: Studies showed that lipid metabolism disorders are significant risk factors for myocardial infarction and coronary artery disease (CAD). Therefore, genes involved in lipid and lipoprotein metabolism pathways such as lipoprotein lipase (LPL), are proper candidates for susceptibility to CAD. Aim: To investigate the ...

  14. Cardiovascular adaptations to exercise training after uncomplicated acute myocardial infarction.

    Science.gov (United States)

    Motohiro, Masayuki; Yuasa, Fumio; Hattori, Toshihiko; Sumimoto, Tsutomu; Takeuchi, Masaharu; Kaida, Mutsuhito; Jikuhara, Toshimitsu; Hikosaka, Makoto; Sugiura, Tetsuro; Iwasaka, Toshiji

    2005-09-01

    This study examined the cardiovascular adaptations of an exercise training program and evaluated the role of peripheral vasodilator capacity in contributing to these adaptations after myocardial infarction. A total of 44 consecutive patients with uncomplicated myocardial infarction underwent 3 wks of exercise training. Controls (n = 12) with comparable myocardial infarction were selected from our database and were restricted to a program with minimal activity. All patients performed cardiopulmonary exercise testing with hemodynamic measurements. Forearm and calf reactive hyperemic flow were measured by venous occlusive plethysmography as indices of peripheral vasodilator capacity. Despite no change in arteriovenous oxygen difference at peak exercise after training, training resulted in significant increases in oxygen consumption, cardiac output, and stroke volume and a significant decrease in systemic vascular resistance at peak exercise (overall, P training (P training had a positive correlation with increases in peak cardiac output, stroke volume, and oxygen consumption after training and an inverse correlation with peak systemic vascular resistance. Exercise training improved exercise tolerance by improving hemodynamic responses to exercise after myocardial infarction. This improved exercise performance was linked to a training-induced increase in calf vasodilator capacity.

  15. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.

    1991-01-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction

  16. The value of radionuclide angiography for risk assessment of patients following acute myocardial infarction

    International Nuclear Information System (INIS)

    Morris, K.G.

    1985-01-01

    Radionuclide angiography (RNA) is an accurate noninvasive method for the evaluation of left ventricular function at rest and exercise. Both the change in ejection fraction from rest to exercise and the exercise ejection fraction correlate with the severity of coronary artery disease and are more sensitive than ST-segment changes for detecting abnormalities due to exercise-induced myocardial ischemia. The amount of left ventricular dysfunction produced acutely by myocardial ischemia appears to vary linearly with the severity of ischemia produced. Thus rest and exercise RNA provide information noninvasively regarding both the severity of left ventricular dysfunction and the amount of potentially ischemic myocardium, two of the three major pathophysiologic mechanisms related to prognosis. It is reasonable to hypothesize that rest and exercise RNA may provide useful prognostic information concerning subsequent mortality and morbidity in survivors of acute myocardial infarction

  17. A case of transient left ventricular apical ballooning. A condition simulating an acute myocardial infarction.

    Science.gov (United States)

    Morandi, Fabrizio; Bartesaghi, Giorgio; Romano, Melania; Albonico, Patrizia; Provasoli, Stefano; Salerno-Uriarte, Jorge A

    2004-10-01

    Transient left ventricular apical ballooning, sometimes associated with intraventricular pressure gradient, is a condition simulating an acute myocardial infarction and may occur in patients presenting with chest pain, electrocardiographic changes and minimal myocardial enzyme release typically without coronary angiographic stenosis. It was originally described in the Japanese population and is often associated with cerebrovascular accidents, surgical procedures and emotional and physical stress. We report the case of a 65-year-old woman presenting with chest pain typical of myocardial ischemia, dyspnea, electrocardiographic abnormalities and signs of hemodynamic instability, occurring after a severe emotional stress. Echocardiography and contrast ventriculography showed normokinesis confined to the basal segments of the left ventricle, with a markedly decreased ejection fraction. Scintigraphy was suggestive of a large perfusion defect. The electrocardiographic abnormalities and dyskinesis persisted for many hours. Coronary angiography, performed in the acute phase, was completely normal. Five months later, the functional and electrocardiographic abnormalities had totally disappeared.

  18. Acute myocardial infarction: estimation of at-risk and salvaged myocardium at myocardial perfusion SPECT 1 month after infarction.

    Science.gov (United States)

    Romero-Farina, Guillermo; Aguadé-Bruix, Santiago; Candell-Riera, Jaume; Pizzi, M Nazarena; Pineda, Victor; Figueras, Jaume; Cuberas, Gemma; de León, Gustavo; Castell-Conesa, Joan; García-Dorado, David

    2013-11-01

    To estimate at-risk and salvaged myocardium by using gated single photon emission computed tomography (SPECT) myocardial perfusion imaging after acute myocardial infarction (AMI). The study was approved by the hospital's Ethical Committee on Clinical Trials (trial register number, PR(HG)36/2000), and all patients gave informed consent. Forty patients (mean age, 61.78 years; eight women) with a first AMI underwent two gated SPECT examinations--one before percutaneous coronary intervention (PCI) and one 4-5 weeks after PCI. Myocardium at risk was estimated by assessing the perfusion defect at the first gated SPECT examination, and salvaged myocardium was estimated by assessing the risk area minus necrosis at the second examination. Myocardium at risk was estimated by determining the discordance between the areas of left ventricular (LV) wall motion and perfusion at the second examination. Concordance between tests was analyzed by means of linear regression analysis, the Pearson correlation, the intraclass correlation coefficient, and Bland-Altman analysis. An improvement in perfusion, wall motion, wall thickening, and LV ejection fraction (P Myocardial perfusion gated SPECT performed 1 month after early PCI in a first AMI provides potentially useful information on at-risk and salvaged myocardium. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122324/-/DC1. RSNA, 2013

  19. Acute heart failure in patients admitted to the emergency department with acute myocardial infarction.

    Science.gov (United States)

    Krzysztofik, Justyna M; Sokolski, Mateusz; Kosowski, Michał; Zimoch, Wojciech; Lis, Adrian; Klepuszewski, Maciej; Kasperczak, Michał; Proniak, Marcin; Reczuch, Krzysztof; Banasiak, Waldemar; Jankowska, Ewa A; Ponikowski, Piotr

    2017-01-01

    Acute heart failure (AHF), occurring as a complication of ongoing acute myocardial infarction (AMI), is a common predictor of worse clinical outcome. Much less is known about the unique subpopulation of patients who present these two life-threatening conditions in the emergency department (ED). The aim of the study was to establish the prevalence of coexistence of AHF with AMI in the ED, to identify clinical factors associated with the higher prevalence of AHF at very early onset of AMI, and to assess the prognostic impact of the presence of AHF with AMI. A prospective study of 289 consecutive patients (mean age: 68 ± 11 years, 61% men) admitted to our institution (via the ED) with the diagnosis of AMI between May and October 2012 and followed-up for 2.5 years. Acute heart failure was diagnosed in 13% of patients in the ED. In multivariable analysis, female sex, chronic obstruc-tive pulmonary disease, and chronic kidney disease significantly increased the risk of developing AHF together with AMI (all p < 0.05). Patients with AHF were hospitalised for longer (9.2 ± 6.1 vs. 6.3 ± 4.5 days, p < 0.001), had higher in-hospital cardiovascular mortality (8% vs. 0%, p < 0.001), and all-cause (34% vs. 15%, p = 0.004) and cardiovascular mortality (26% vs. 9%, p = 0.002) during long-term follow-up. Despite good logistic- and evidence-based treatment, AHF is present in one in eight patients with AMI at the time of admission to the ED. Particularly poor outcomes characterise critically ill patients; therefore, great effort should be undertaken to improve their care.

  20. The impact of the Danish smoking ban on hospital admissions for acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, Tabita Maria; Møller, Lisbeth; Jørgensen, Torben

    2014-01-01

    Background: Exposure to secondhand smoke is associated with an increased risk of acute myocardial infarction (AMI). The positive impact of a smoking ban on AMI hospitalization rates has been demonstrated both inside and outside Europe. A national smoking ban (SB) was implemented in Denmark on 15...

  1. Depressive symptoms in younger women and men with acute myocardial infarction : Insights from the VIRGO Study

    NARCIS (Netherlands)

    Smolderen, Kim G.; Strait, Kelly M.; Dreyer, Rachel P.; D'Onofrio, Gail; Zhou, Shengfan; Lichtman, Judith H.; Geda, Mary; Bueno, Hector; Beltrame, John; Safdar, Basmah; Krumholz, Harlan M.; Spertus, John A.

    2015-01-01

    Background Depression was recently recognized as a risk factor for adverse medical outcomes in patients with acute myocardial infarction (AMI). The degree to which depression is present among younger patients with an AMI, the patient profile associated with being a young AMI patient with depressive

  2. The aminoterminal propeptide of type III procollagen provides new information on prognosis after acute myocardial infarction

    DEFF Research Database (Denmark)

    Høst, N B; Jensen, L T; Bendixen, P M

    1995-01-01

    The aim of the study was to examine sequential changes in serum levels of the aminoterminal propeptide of type III procollagen (S-PIIINP) after acute myocardial infarction (AMI), and to assess the value of S-PIIINP as a predictor of outcome. The study group comprised 74 patients with AMI, and 24 ...

  3. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon

    2014-01-01

    BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI...

  4. Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction

    DEFF Research Database (Denmark)

    Svendsen, J H; Madsen, J K; Saunamäki, K I

    1992-01-01

    Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis follo...

  5. Glucose Variability and Mortality in Patients Hospitalized With Acute Myocardial Infarction

    NARCIS (Netherlands)

    Lipska, Kasia J.; Venkitachalam, Lakshmi; Gosch, Kensey; Kovatchev, Boris; van den Berghe, Greet; Meyfroidt, Geert; Jones, Philip G.; Inzucchi, Silvio E.; Spertus, John A.; DeVries, J. Hans; Kosiborod, Mikhail

    2012-01-01

    Background-Mean blood glucose (BG) during acute myocardial infarction (AMI) is an important predictor of inpatient mortality but does not capture glucose variability (GV), which has been shown to be independently associated with mortality in critically ill patients. Whether GV is associated with

  6. Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ayşe Saatçı Yaşar

    2010-09-01

    Full Text Available Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001. On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome.

  7. Prognosis of late versus early ventricular fibrillation in acute myocardial infarction

    DEFF Research Database (Denmark)

    Jensen, G V; Torp-Pedersen, C; Køber, L

    1990-01-01

    To determine the prognosis of late ventricular fibrillation (VF) after acute myocardial infarction (AMI), the length of the monitoring period after AMI was extended. All patients in this series were continuously monitored in a coronary care unit to ensure observation of all VF within 18 days of AMI...

  8. Impact of obesity on long-term prognosis following acute myocardial infarction

    DEFF Research Database (Denmark)

    Kragelund, Charlotte; Hassager, Christian; Hildebrandt, Per

    2005-01-01

    .01)]. Increasing WHR in women showed a trend of increased mortality, although this was not significant [adjusted RR=1.13 (0.95-1.34, p=0.2)]. CONCLUSION: In patients with acute myocardial infarction overall obesity as assessed by body mass index is inversely related to mortality. However, abdominal obesity appears...

  9. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); E.J. Topol (Eric); R.M. Califf (Robert); F.J.J. van de Werf (Frans); P.W. Armstrong (Paul); P.E. Aylward (Philip Edmund); G.I. Barbash; E.R. Bates (Eric); A. Betriu; J.H. Chesebro (James); J.J. Col (Jacques); D.P. de Bono (David); J.M. Gore (Joel); A.D. Guerci (Alan); J.R. Hampton (John)

    1993-01-01

    textabstractBACKGROUND: The relative efficacy of streptokinase and tissue plasminogen activator and the roles of intravenous as compared with subcutaneous heparin as adjunctive therapy in acute myocardial infarction are unresolved questions. The current trial was designed to compare new, aggressive

  10. Exclusion of acute myocardial infarction. The value of measuring creatine kinase slope

    NARCIS (Netherlands)

    Bakker, A. J.; Koelemay, M. J.; van Vlies, B.; Gorgels, J. P.; Smits, R.; Tijssen, J. G.; Haagen, F. D.

    1995-01-01

    For the exclusion (and diagnosis) of acute myocardial infarction, we studied timed sequential (slope) measurements of creatine kinase and creatine kinase-MB catalytic activity concentration, creatine kinase-MB mass concentration, troponin T and myoglobin, using data from 242 patients consecutively

  11. Prognostic implications of acute myocardial infarct scintigraphy with /sup 99m/Tc-pyrophosphate

    International Nuclear Information System (INIS)

    Holman, B.L.; Chisholm, R.J.; Braunwald, E.

    1978-01-01

    The predictive value of myocardial scintigraphy with /sup 99m/Tc-pyrophosphate was studied in 100 patients admitted to the coronary care unit with suspected acute myocardial infarction. None of the 21 patients with normal scintigrams had acute myocardial infarction by other criteria. Fifty-five percent of patients with diffuse uptake (pattern B), 73% of patients with focal uptake (pattern C) and all patients with intense focal uptake (pattern D) and massive uptake (pattern E) had acute infarction. The complication rate in the hospital and after discharge (mean followup: 6.1 months) for patients with pattern E was 88% compared to 42% for D, 30% for C, 36% for B and 10% for patients with normal scintigrams (A). For patients with acute infarction with patterns C, D, and E, the complication rate rose with increasing size of the myocardial uptake of /sup 99m/Tc-pyrophosphate. In addition to its diagnostic potential, scintigraphy provides prognostic information which is useful for patient triage and for therapeutic decisions early in the evolution of the infarct

  12. Lay Public's Knowledge and Decisions in Response to Symptoms of Acute Myocardial Infarction

    Science.gov (United States)

    Cytryn, Kayla N.; Yoskowitz, Nicole A.; Cimino, James J.; Patel, Vimla L.

    2009-01-01

    Despite public health initiatives targeting rapid action in response to symptoms of myocardial infarction (MI), people continue to delay in going to a hospital when experiencing these symptoms due to lack of recognition as cardiac-related. The objective of this research was to characterize lay individuals' knowledge of symptoms of acute myocardial…

  13. Mortality and Revascularization following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

    Science.gov (United States)

    Abrams, Thad E.; Vaughan-Sarrazin, Mary; Kaboli, Peter J.

    2010-01-01

    Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified…

  14. Lipid Profile levels on the second day of Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    The main objective of this study is to note the changes that occur in the lipid profile levels following an acute myocardial ischemic attack and also correlate the changes in the lipid profile levels to the ischemic markers (Cardiac troponin-I and AST). The study included two groups; the first group consisted of 50 patients who ...

  15. Relationship between left ventricular longitudinal deformation and clinical heart failure during admission for acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2012-01-01

    Heart failure (HF) complicating acute myocardial infarction (MI) is an ominous prognostic sign frequently caused by left ventricular (LV) systolic dysfunction. However, many patients develop HF despite preserved LV ejection fractions. The aim of this study was to test the hypothesis that LV longi...

  16. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Tebbe, Ulrich; Wöhrle, Jochen; Pachinger, Otmar; Busch, Clemens; Pfeiffer, Nathalie; Neumer, Alexander; Ouarrak, Taoufik; Reimer, Thomas; Lober, Christiane; Clemmensen, Peter; Follath, Ferenc; Wegscheider, Karl; Zeitouni, M.; Overtchouk, P.; Guedeney, P.; Hage, G.; Hauguel-Moreau, N. N.; Eitel, Ingo; Weinschenk, Sabrina; Borggrefe, Martin; Neumann, Franz-Josef; Ferenc, Miroslaw; Olbrich, Hans-Gerd; Hopf, Hans-Bernd; Kastrati, Adnan; de Waha, Antoinette; Schunkert, Heribert; Richardt, Gert; Schwarz, Bettina; Abdel-Wahab, Mohamed; Toelg, Ralph; Geist, Volker; Bahnsen-Maaß, Monika; Hennersdorf, Marcus; Graf, Jochen; Riemann, Urs; Scharpf, Dominik; Empen, Klaus; Busch, Mathias C.; Werdan, Karl; Nuding, Sebastian; Hambrecht, Rainer; Fiehn, Eduard; Gitt, Anselm K.; Mark, Bernd; Winkler, Ralph; Lauer, Bernward; Möbius-Winkler, Sven; Schulze, Christian; Minden, Hans-Heinrich; Braun-Dullaeus, Rüdiger C.; Schmeißer, Alexander; Strasser, Ruth H.; Ebner, Bernd; Ertl, Georg; Mudra, Harald; Hug, Martin; Endemann, Dierk; Hamm, Christian; Walther, Claudia; Liebetrau, Christoph; Menck, Niels; Mehilli, Julinda; Orban, Martin; Hausleiter, Jörg; Massberg, Steffen; Prondzinsky, Roland; Gielen, Stephan; Gawaz, Meinrad; Pauschinger, Matthias; Ademaj, Fadil; Bode, Christoph; Nickenig, Georg; Fichtlscherer, Stephan; Zeiher, Andreas; Viertel, Achim; Kelm, Malte; Jung, Christian; Sydow, Carsten; Karakas, Mahir; Rudolph, Volker; Baldus, Stephan; Jacobshagen, Claudius; Hasenfuß, Gerd; Pfeiffer, Dietrich; Buchter, Björn; Hügl, Burkhard; Nef, Holger; Dörr, Oliver; Reinig, Karsten; Kuck, Karl Heinz; Ghanem, Alexander; Katus, Hugo; Gori, Tommaso; Münzel, Thomas; Schnupp, Steffen; Brachmann, Johannes; Ferrari, Markus; Achenbach, Stephan; Carrié, Didier; Henry, Patrick; Manzo-Silberman, Stephane; Ledermann, Bertrand; Cayla, Guillaume; Bonnet, Jean-Louis; Windecker, Stefan; Frenk, André; Jeger, Raban; Eeckhout, Eric; Henriques, Jose P.; van Geuns, Robert-Jan; Voskuil, Michiel; Bax, M.; van der Harst, Pim; Serpytis, Rokas; Jarasuniene, Dalia; Lang, Irene Marthe; Pichler, Philipp; Weidinger, Franz; Zaruba, Marc-Michael; Dudek, Darius; Depukat, Rafal; Witkowski, Adam; Milewski, Krzysztof; Prokopczuk, Janusz; Gąsior, Mariusz; Gorycki, Bogdan; Ochała, Andrzej; Piatti, Luigi; Galvani, Marcello; Bossi, Irene; Emilia, Reggio; Pignatelli, Gianluca; Greenwood, John; Lockie, Tim; Mamas, Mamas

    2017-01-01

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be

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

    NARCIS (Netherlands)

    Vervaat, Fabienne E.; Christensen, Thomas E.; Smeijers, Loes; Holmvang, Lene; Hasbak, Philip; Szabo, Balazs M.; Widdershoven, J.W. M. G.; Wagner, Galen S.; Bang, Lia E.; Gorgels, Anton P. M.

    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

  18. Influence of acute glycaemic level on measures of myocardial infarction in non-diabetic pigs.

    Science.gov (United States)

    Diemar, Sarah S; Sejling, Anne-Sophie; Iversen, Kasper K; Engstrøm, Thomas; Honge, Jesper L; Tønder, Niels; Vejlstrup, Niels; Idorn, Manja; Ekström, Kathrine; Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger; Dalsgaard, Morten

    2015-01-01

    Patients with diabetes are at increased risk of experiencing myocardial infarction. The influence of the prevailing plasma glucose level on infarction and mortality after acute ischaemia is however unknown. The aim was to study the effect of the acute plasma glucose level on the myocardial infarction size in a closed-chest pig model. 38 non-diabetic pigs were randomised to hypoglycaemic (1.8-2.2 mmol/l; n = 15), normoglycaemic (5-7 mmol/l; n = 12) or hyperglycaemic glucose clamping (22-23 mmol/l; n = 11). After 30 min within glucose target myocardial infarction was induced for 30 min followed by reperfusion for 120 min. Hereafter the heart was double-stained to delineate infarction from viable tissue within the area at risk. Mean infarction size was 201 ± 35 mm(2) (mean ± SEM) in the hypoglycaemic group, 154 ± 40 mm(2) in the normoglycaemic group and 134 ± 40 mm(2) in the hyperglycaemic group, with no differences in infarction size, infarct/area at risk ratio or troponin T levels between the groups. There was no difference in incidence of ventricular fibrillation or mortality between the groups. No statistically significant associations were observed between the acute glycaemic level and measures of myocardial infarction, rates of ventricular fibrillation and subsequent premature death in the setting of acute ischaemia and reperfusion.

  19. Increased Expression of Visfatin in Monocytes and Macrophages in Male Acute Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Cheng-An Chiu

    2012-01-01

    Full Text Available We demonstrated that visfatin expressed in monocytes and neutrophils and increased their reactivity in male acute ST-segment elevation myocardial infarction patients. Furthermore, visfatin was strongly appeared in lipid rich coronary rupture plaques and macrophages. These results suggest another explanation about leukocytes mediated visfatin that may play a pathogenesis role in coronary vulnerable plaques rupture.

  20. Statin use after acute myocardial infarction: a nationwide study in Denmark

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Gislason, Gunnar H; Abildstrom, Steen Z

    2005-01-01

    AIMS: To study outpatient statin use after first acute myocardial infarction (AMI) in Denmark between 1995 and 2002 and to determine the predictors of statin use. METHODS: This is a nationwide population-based study using administrative registries. Patients with first AMI between 1995 and 2002 ol...

  1. Value of serum tenascin-C in patients with acute myocardial infarction

    African Journals Online (AJOL)

    Rania Gaber

    2015-10-09

    Oct 9, 2015 ... Value of serum tenascin-C in patients with acute myocardial infarction. Rania Gaber a,. *, Wesam Salah Ibrahim b. , Hanaa El-sayed Nofal b. ,. Dina Shafik Mahran c a Department of Cardiology, Faculty of Medicine, Tanta University, Egypt b Department of Clinical Pathology, Faculty of Medicine, Tanta ...

  2. Acute myocardial infarction incidence and hospital mortality : routinely collected national data versus linkage of national registers

    NARCIS (Netherlands)

    Koek, Huberdina L.; Kardaun, Jan W. P. F.; Gevers, Evelien; de Bruin, Agnes; Grobbee, Diederick E.; Bots, Michiel L.; Reitsma, J.

    2007-01-01

    Background and Objective To compare levels of and trends in incidence and hospital mortality of first acute myocardial infarction (AMI) based on routinely collected hospital morbidity data and on linked registers. Cases taken from routine hospital data are a mix of patients with recurrent and first

  3. Acute Myocardial Infarction in a Young Adult Male Associated with the use of Smokeless Tobacco (Sweka).

    Science.gov (United States)

    Ali, Waleed Muhsin; Al-Aqeedi, Rafid Fayadh; Gehani, Aa

    2011-10-01

    Dipping smokeless tobacco (ST) is used worldwide. We report a case of acute myocardial infarction in a young patient, who consumed smokeless tobacco (Sweka) for over one year. ST may be as harmful as smoking and carries adverse cardiac complications. A prompt call for restriction and prohibition is advised and its alternative use to quit smoking must be abandoned.

  4. Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients?

    Science.gov (United States)

    Condén, Emelie; Rosenblad, Andreas; Wagner, Philippe; Leppert, Jerzy; Ekselius, Lisa; Åslund, Cecilia

    2017-03-01

    Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.

  5. Myocardial Production of Plasminogen Activator Inhibitor-1 is Associated with Coronary Endothelial and Ventricular Dysfunction after Acute Myocardial Infarction.

    Science.gov (United States)

    Shimizu, Takuya; Uematsu, Manabu; Yoshizaki, Toru; Obata, Jun-Ei; Nakamura, Takamitsu; Fujioka, Daisuke; Watanabe, Kazuhiro; Watanabe, Yosuke; Kugiyama, Kiyotaka

    2016-05-02

    Although plasminogen activator inhibitor-1 (PAI-1) is abundantly expressed in infarcted myocardium, the pathogenic role of myocardial PAI-1 remains unknown. This study examined whether PAI-1 in the infarcted lesion contributes to coronary endothelial dysfunction and left ventricular (LV) dysfunction in patients with acute myocardial infarction (AMI). Plasma levels of PAI-1 activity and tissue-plasminogen activator (tPA) antigen were measured 2 weeks and 6 months after MI by ELISA in plasma obtained from the aortic root (AO) and anterior interventricular vein (AIV) in 28 patients with a first AMI due to occlusion of the left anterior descending coronary artery (LAD). Coronary blood flow responses in LAD to intracoronary infusion of acetylcholine (ACh) and left ventriculography were measured at the same time points: 2 weeks and 6 months after MI. The trans-myocardial gradient of PAI-1 from AO to AIV, reflecting production/release of PAI-1 in the infarcted lesion, was inversely correlated with the coronary blood flow response to ACh 6 months after MI (r=-0.43, p=0.02) and with the percentage change in LV regional motion in the LAD territory from 2 weeks to 6 months after MI (r=-0.38, p=0.04). The trans-myocardial gradient of tPA level showed no significant correlations. PAI-1 produced in the infarcted myocardium and released into the coronary circulation is associated with endothelial dysfunction in resistance vessels of the infarct-related coronary arteries and with progressive dysfunction of the infarcted region of the left ventricle in AMI survivors.

  6. Prognostic significance of transient myocardial ischaemia after first acute myocardial infarction: five year follow up study

    DEFF Research Database (Denmark)

    Mickley, H; Nielsen, J R; Berning, J

    1995-01-01

    , and echocardiography in patients with documented ischaemic heart disease. DESIGN: Prospective study. SETTING: Cardiology department of a teaching hospital. PATIENTS: 123 consecutive men aged under 70 who were able to perform predischarge maximal exercise testing. INTERVENTIONS: Echocardiography two days before...... discharge (left ventricular ejection fraction), maximal bicycle ergometric testing one day before discharge (ST segment depression, angina, blood pressure, heart rate), and ambulatory ST segment monitoring (transient myocardial ischaemia) started at hospital discharge a mean of 11 (SD 5) days after...

  7. Circadian Variation In The Onset Of Acute Myocardial Infarction In Diabetics.

    Science.gov (United States)

    Kumar, Suresh; Kumar, Naresh; Kumar, Haresh; Niazi, Rizwan Ahmed; Rashid, Muhammad Farhan

    2018-01-01

    It has been shown in previous studies there is circadian variation in the onset of acute myocardial infarction. The objective of this study was to evaluate the relation of circadian variation in onset of Acute Myocardial infarction in Diabetic subjects. This study was conducted at the Services Institute of Medical Sciences Lahore and Punjab Institute of Cardiology from January 2015 to February 2016. Hundred diabetic and 100 Non-diabetic patients with Myocardial infarction were included in the study. Among diabetics those were included in the study that had diabetes for ≥5 years. The time of onset of symptoms to determine the circadian rhythm was noted. In order to determine the frequency of acute myocardial infarction associated with circadian rhythm, 24 hours of the day were divided into four equal sections of 6 hours each. We noted time of onset of acute MI. Thereafter, patients were bracketed in their respective six-hour time periods. These six-hour periods were 0-6, 6:01-12, 12:01-18, and 18:01-24 hours. In this study patients' mean age was 59.16±13.81. Forty-two (71.2%) non-diabetic patients had acute myocardial infarction (AMI) during 6:00-12:00 hours whereas 17 (28.8%) diabetic patients presented with AMI during this time. Incidence of AMI is significantly increased in the morning 6:01-12:00 hours in non-diabetics. However, diabetic subjects did not show significant increased incidence of AMI during this time rather there was increased incidence of AMI during 0-6:00 hours.

  8. Predictors of pre-hospital delay in Hong Kong Chinese patients with acute myocardial infarction.

    Science.gov (United States)

    Li, Polly Wc; Yu, Doris Sf

    2018-01-01

    The pre-hospital delay to seek care remains the most significant barrier for effective management of acute myocardial infarction. Many of the previous studies mainly took place in Western countries. Few data are available about the care-seeking behavior of Hong Kong Chinese. The purpose of this study was to identify the predictors of pre-hospital delay in care seeking among Hong Kong Chinese patients with acute myocardial infarction. Adult Chinese patients ( n=301) with a confirmed diagnosis of acute myocardial infarction were recruited from the cardiac units of three regional hospitals in Hong Kong. Various socio-demographic, clinical, symptom presentation characteristics and patient perceptual factors were considered as potential predictors. Multivariate analysis was conducted to identify the independent predictors with pre-hospital delay in care-seeking among acute myocardial infarction patients. Perceived barriers to care seeking constituted the most significant predictor for longer pre-hospital delay in acute myocardial infarction patients. Female gender was also significant in predicting longer delay, whereas a greater extent of symptom congruence and a greater extent of typical symptom presentation were significantly associated with a shorter delay. The final model accounted for 49.6% of the variance in pre-hospital delay as a whole. The most prominent predictors of pre-hospital delay are modifiable in nature, including the perceived barriers to care seeking and symptom congruence. Other sociodemographic and clinical factors also influence patients' decision. Although these are non-modifiable, our findings provide important insight for educating high-risk individuals.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    reperfusion. The endogenous hormone, melatonin, works as an antioxidant and could potentially minimise the ischaemia-reperfusion injury. Given intracoronarily, it enables melatonin to work directly at the site of reperfusion. We wish to test if melatonin, as an antioxidant, can minimise the reperfusion injury......-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...... injuries following pPCI. Owing to its relatively non-toxic profile, melatonin is an easily implementable drug in the clinical setting, and melatonin has the potential to reduce morbidity in patients with AMI. FUNDING: This study received no financial support from the industry. TRIAL REGISTRATION: www...

  10. Acute Myocardial Infarction following Naltrexone Consumption; a Case Report

    Directory of Open Access Journals (Sweden)

    Bita Dadpour

    2017-01-01

    Full Text Available Cardiovascular effects of opioid withdrawal have long been studied. It was reported that patients with underlying ischemic heart disease and atherosclerotic vessels may be complicated by a sudden physical and emotional stress due to withdrawal syndrome. But some other believes sudden increase in catecholamine level as a sympathetic overflow might effect on heart with and without underlying ischemia. In the current study, a patient on methadone maintenance therapy (MMT who experienced myocardial infarction (MI after taking naltrexone was described.

  11. Central sympathetic activation and arrhythmogenesis during acute myocardial infarction: modulating effects of endothelin-B receptors

    Directory of Open Access Journals (Sweden)

    Theofilos M Kolettis

    2015-02-01

    Full Text Available Sympathetic activation during acute myocardial infarction is an important arrhythmogenic mechanism, but the role of central autonomic inputs and their modulating factors remain unclear. Using the in vivo rat-model, we examined the effects of clonidine, a centrally-acting sympatholytic agent, in the presence or absence of myocardial endothelin-B (ETB receptors. We studied wild-type (n=20 and ETB-deficient rats (n=20 after permanent coronary ligation, with or without pretreatment with clonidine. Cardiac rhythm was continuously recorded for 24 hours by implantable telemetry devices, coupled by the assessment of autonomic and heart failure indices. Sympathetic activation and arrhythmogenesis were more prominent in ETB-deficient rats during the early phase post-ligation. Clonidine improved these outcomes throughout the observation period in ETB-deficient rats, but only during the delayed phase in wild-type rats. However, this benefit was counterbalanced by atrioventricular conduction abnormalities and by higher incidence of heart failure, the latter particularly evident in ETB-deficient rats. Myocardial ETB-receptors attenuate the arrhythmogenic effects of central sympathetic activation during acute myocardial infarction. ETB-receptor deficiency potentiates the sympatholytic effects of clonidine and aggravates heart failure. The interaction between endothelin and sympathetic responses during myocardial ischemia/infarction and its impact on arrhythmogenesis and left ventricular dysfunction merit further investigation.

  12. Akt-dependent Girdin phosphorylation regulates repair processes after acute myocardial infarction.

    Science.gov (United States)

    Hayano, Shinji; Takefuji, Mikito; Maeda, Kengo; Noda, Tomonori; Ichimiya, Hitoshi; Kobayashi, Koichi; Enomoto, Atsushi; Asai, Naoya; Takahashi, Masahide; Murohara, Toyoaki

    2015-11-01

    Myocardial infarction is a leading cause of death, and cardiac rupture following myocardial infarction leads to extremely poor prognostic feature. A large body of evidence suggests that Akt is involved in several cardiac diseases. We previously reported that Akt-mediated Girdin phosphorylation is essential for angiogenesis and neointima formation. The role of Girdin expression and phosphorylation in myocardial infarction, however, is not understood. Therefore, we employed Girdin-deficient mice and Girdin S1416A knock-in (Girdin(SA/SA)) mice, replacing the Akt phosphorylation site with alanine, to address this question. We found that Girdin was expressed and phosphorylated in cardiac fibroblasts in vitro and that its phosphorylation was crucial for the proliferation and migration of cardiac fibroblasts. In vivo, Girdin was localized in non-cardiomyocyte interstitial cells and phosphorylated in α-smooth muscle actin-positive cells, which are likely to be cardiac myofibroblasts. In an acute myocardial infarction model, Girdin(SA/SA) suppressed the accumulation and proliferation of cardiac myofibroblasts in the infarcted area. Furthermore, lower collagen deposition in Girdin(SA/SA) mice impaired cardiac repair and resulted in increased mortality attributed to cardiac rupture. These findings suggest an important role of Girdin phosphorylation at serine 1416 in cardiac repair after acute myocardial infarction and provide insights into the complex mechanism of cardiac rupture through the Akt/Girdin-mediated regulation of cardiac myofibroblasts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: incidence, predictors, and outcomes

    NARCIS (Netherlands)

    H.D. White (Harvey); R.A. Harrington (Robert Alex); R.J. Simes (John); E.J. Topol (Eric); D.J. Moliterno (David); C.B. Granger (Christopher); Y. Huang (Yao); K.L. Lee (Kerry); R.M. Califf (Robert); M.L. Simoons (Maarten); P.W. Armstrong (Paul); F.J.J. van de Werf (Frans); S.M. Al-Khatib (Sana)

    2002-01-01

    textabstractBACKGROUND: The prognosis of ventricular arrhythmias among patients with non-ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients. METHODS AND RESULTS: We

  14. Assessment of viability of acute myocardial infarction using MRI and gadolinium DTPA

    International Nuclear Information System (INIS)

    Toyama, Takuji; Nishimura, Tsunehiko; Yamada, Naoaki

    1993-01-01

    To evaluate the myocardial viability using gated MRI and gadolinium-DTPA enhancement, we compared with Tl-201 exercise myocardial scintigraphy (Ex-Tl) and two-dimensional echocardiography (UCG) in 22 patients with acute myocardial infarction (AMI). These patients were divided into three groups. In group A (8 patients), thallium redistribution (RD) was found at infarcted region. In group B (6 patients), RD was not found at infarcted region, but wall motion by UCG was normal or hypokinesis at infarcted region. In group C (8 patients), RD was not found at infarcted region, and wall motion by UCG was akinesis or dyskinesis at infarcted region. MRI was performed at one week, two weeks, one month and three months from the onset of AMI. We evaluated signal intensity (SI), extent of Gd-E and wall thinning at short axial image of T 1 weighted image. Ex-T l was performed at one month after AMI to evaluate presence of RD and extent of perfusion defect on delayed SPECT image. In addition, UCG was performed within one month after AMI to evaluate regional wall motion at infarcted region. In most cases of groups A and B Gd-E>PD was found. Decrease of Gd-E area was found in group A, but early disappearance of Gd-E within three months was not different among three groups. This study indicated that Gd-E>PD and decrease of Gd-E area reflected myocardial viability at infarcted region to some extent, but SI of Gd-E and early disappearance of Gd-E did not reflect myocardial viability. Gd-E was slightly useful for detecting the myocardial viability of acute myocardial infarction. (author)

  15. Acute myocardial infarction caused by left atrial myxoma: Role of intracoronary catheter aspiration.

    Science.gov (United States)

    Al-Fakhouri, Ahmad; Janjua, Muhammad; DeGregori, Michele

    2017-01-01

    Acute ST-segment elevation myocardial infarction (STEMI) caused by left atrial myxoma is very rare. Catheter-based approaches or thrombolytic therapy are mostly the first step in the management of STEMI with less time delay. We report a case of acute anterior/lateral STEMI caused by a left atrial myxoma. The patient was successfully treated by intracoronary aspiration with an Export aspiration catheter, with excellent distal coronary flow. Intracoronary catheter aspiration in acute myocardial infarction caused by a left atrial myxoma may help to salvage the infarcting myocardium with less time delay. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Technetium-99m pyrophosphate myocardial scintigraphy in the diagnosis of acute rheumatic carditis

    International Nuclear Information System (INIS)

    Malhotra, A.; Radhakrishnan, S.; Reddy, K.S.; Gopinath, P.G.; Bhatia, M.L.

    1989-01-01

    Rheumatic fever (RF) and rheumatic heart disease (RHD) are major health problems in India. The most difficult decision to make in such a setting is whether a patient of acute rheumatic fever has acute rheumatic carditis or not. Physical signs such as a new cardiac murmur, cardiac enlargement, congestive cardiac failure although quoted as pointers to carditis are non-specific specially if the attack is superimposed on pre-existing RHD. Any investigation which will provide an answer to this problem would be very welcome. sup(99m)Tc pyrophosphate (Tc PYP) is a very sensitive indicator of myocardial necrosis in acute myocardial infarction. A study to determine the usefulness of this technique in diagnosis of rheumatic carditis in patients with unequivocal clinical evidence of myocarditis was undertaken. Results are reported. (author). 14 refs

  17. Triggers of acute myocardial infarction: a neglected piece of the puzzle.

    Science.gov (United States)

    Colombo, Alessandro; Proietti, Riccardo; Culić, Viktor; Lipovetzky, Nestor; Viecca, Maurizio; Danna, Paolo

    2014-01-01

    The existence of specific risk factors for the development of coronary heart disease, both chronic and acute, has been extensively investigated and is well understood by cardiology professionals. Diabetes, hypertension, hypercholesterolemia, psychological patterns and smoking are assumed to interact in a complex way with individual heritable predisposition, thus determining the long-term probability of coronary disease. However, the possibility that defined circumstances and activities may act as immediate triggers of acute coronary syndromes, particularly acute myocardial infarction, has not been given comparable attention in clinical research. For example, the recently issued 2012 European guidelines on cardiovascular disease prevention completely overlook the topic of triggers and their possible prevention. This review presents a picture of the most reliable evidence regarding the triggering of myocardial infarction and contributes to further investigation in the field.

  18. Long-term mortality in patients with diabetes mellitus type 2 after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2014-01-01

    Full Text Available Introduction. Myocardial infarction is the most common cause of death in patients with diabetes, and several studies have shown that people with diabetes have twice the risk of dying from a heart attack compared to non diabetics. Objective. The aim of this study was to determine the mortality of patients that have survived acute myocardial infarction, in population of patients with diabetes mellitus and without diabetes. Method. The study included 135 patients recovered from myocardial infarction, of whom 51 (37.8% had type 2 diabetes mellitus, and 84 (62.2% were without diabetes, mean age 55,4±9,6 years. All patients underwent a complete cardiac and hemodynamic testing, cardiac catheterization with selective coronary angiography, and in most patients the aortocoronary bypass revascularization or percutaneous coronary intervention. Start of follow-up was the date of acute myocardial infarction. The study included only patients who survived at least one month after acute myocardial infarction. All patients with diabetes and without diabetes were monitored for an average of 84 months, i.e. 7 years. Results. The average age of patients with diabetes and myocardial infarction was 57.1±8.7 years, and of patients with myocardial infarction without diabetes 54.5 ± 9.6 years (t=1.62; p>0.05. Among patients with diabetes 14 (27.5% were women and 37 (72.5% were men, and in non-diabetics 15 (17.9% were women and 69 (82.1% were men (χ2=1.66; p>0.05. In the follow-up period died 15 (29.4% patients with diabetes, and 7 (8.3% patients without diabetes. Mortality in patients with diabetes and myocardial infarction was significantly higher than the mortality of patients with myocardial infarction without diabetes (χ2=11.2; p0.05. In the group of 27 patients who were treated with insulin, died five (18.5% and in the group of 24 patients on oral therapy died 10 (41.7%. There was no significant difference in mortality in patients with diabetes treated with

  19. Evaluation of Anthropometric Indices of Patients with Left Ventricle Dysfunction Fallowing First Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Rasoul Azarfarin

    2012-02-01

    Full Text Available Introduction: In the current study, we evaluated the effect of anthropometric indices on ejection fraction following first acute anterior myocardial infarction. Methods: In an analytic-cross sectional study, 50 patients with acute anterior myocardial infarction and abnormal anthropometric indices (Body Mass Index (BMI ≥ 30, Waist Hip Ratio (WHR ≥ 1 and ≥ 0.85 in males and females respectively and Waist Circumference (WC ≥ 102 cm and ≥ 88 cm in males and females respectively were recruited as case group and 50 patients with acute anterior myocardial infarction and normal anthropometric indices as control group. Subsequently, the relation between anthropometric indices and left ventricle dysfunction was evaluated and compared between two groups. Results: 77 peopleof the studied patients were male and 23 female with the mean age of 59± 1.2 years and an age range of 32-90 years. To evaluate the left ventricle function, the mean ejection fraction of the patients was measured as 34.3± 7.2 % and 44.8± 6.3% in patients withabnormal anthropometric indices and patients with normal anthropometric indices respectively (P= 0.0001. Calculation of the correlation coefficient between ejection fraction and BMI, WHR and WC in males and females revealed a moderate reverse (r=-0.521 tor=-0.691 and statistically significant (P= 0.0001 relations which was of more strength in females. Conclusion: Anthropometric indices including BMI and waist circumference influence cardiac function following myocardial infarction.

  20. Acute myocardial infarction and pulmonary tuberculosis in a young female patient: a case report

    Science.gov (United States)

    Bakalli, Aurora; Osmani, Behxhet; Kamberi, Lulzim; Pllana, Ejup

    2008-01-01

    Introduction Tuberculous coronaritis is known to be a very rare phenomenon, although Mycobacterium tuberculosis, as some other infectious agents, may also act in the coronary vessels by activating the inflammatory mechanism of atherosclerosis. The association between active pulmonary tuberculosis and acute myocardial infarction has not been reported for around three and a half decades. Case presentation We presented here a case of a young, 30 year old, Caucasian woman who presented to Emergency Ward with severe chest pain, ECG and enzyme profile typical for acute myocardial infarction. Chest X-ray displayed high intensity shades in the left lung field, which after additional laboratory tests were shown to be due to active pulmonary tuberculosis. Conclusion As the patient did not have any other known coronary artery disease risk factors, we held responsible Mycobacterium tuberculosis for occurrence of acute myocardial infarction in this young female patient. We believe that the presentation of this rare case of myocardial infarction in a patient with active pulmonary tuberculosis should encourage researchers to investigate the potential role of Mycobacterium tuberculosis in pathogenesis of coronary heart disease. PMID:18928530

  1. Acute myocardial infarct imaging with indium-111-labeled monoclonal antimyosin Fab

    International Nuclear Information System (INIS)

    Khaw, B.A.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Johns, J.A.; Kanke, M.; Barlai-Kovach, M.; Strauss, H.W.; Haber, E.

    1987-01-01

    Indium-111 monoclonal antimyosin Fab scintigraphy was used to detect myocardial necrosis in 52 of 54 patients (96.3%) with acute myocardial infarction. Infarcts were visualized when coronary arteries were persistently occluded (n = 10), became patent after thrombolysis (n = 33), or became patent after spontaneous reperfusion (n = 7). Posteroinferolateral visualizations were obtained in two patients with clinical and enzymatic evidence of infarction but normal electrocardiograms. Of the two patients in whom no infarcts were visualized, one had an anterior myocardial infarct. This patient underwent successful thrombolytic therapy, with attendant minimization of creatine kinase release. The other patient had a small, nonreperfused inferior myocardial infarct. Five patients with a history of remote infarction and acute necrosis showed antimyosin uptake only in regions concordant with the acute episodes of infarction, and radiolabeled antimyosin Fab localized in neither old infarcts nor normal, noninfarcted myocardium. Antimyosin Fab scintigraphy, thus, appears to be a highly specific means of delineating necrotic myocardium, at least in this limited and selected group of patients

  2. Implantation of stem cells in the treatment of acute myocardial infarction

    International Nuclear Information System (INIS)

    Obregon Santos, Angel; Wilford de Leon, Mario; Aroche Aportela, Ronald; Isla Garcia, Rosa; Conde Cerdeira, Hector; Vila Garcia, Elena

    2007-01-01

    A lot of investigations demonstrate the possibility of regeneration of the cardiomiocity from stem cells. A longitudinal, prospective, observational study was conducted in patients with acute myocardial infarction in CIMEQ'S hospital since January 2004 up to January 2007 with the purpose to evaluate the security and efficacy of the intracoronary transfer of autologous bone-marrow-cells during acute myocardial infarction. Patients within seven days of the onset of symptoms of a first ST-segment elevation myocardial infarction, and between 18 and 70 years old. The patients are evaluated previous to apply the procedure and 6 months for clinic, electrocardiography, echocardiography, ergometry and coronariography. The drug eluting stent is placed on the culprit lesion and the bone marrow is stimulated with granulocyte colony-stimulating factor (G-CSF). The mononuclear's cells which are obtained have been implanted using the intracoronary way. The implantation by means of the intracoronary way of stem cells, after of stimulation of bone marrow during acute myocardial infarction demonstrated to be an effective and safety procedure

  3. Development of Right Ventricular Dysfunction in Acute Myocardial Infarction and Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    L. I. Sergeyeva

    2007-01-01

    Full Text Available Objective: to evaluate the structural and functional state of the right cardiac cavities in acute left ventricular myocardial infarction and in progressive chronic heart failure (CHF in patients with coronary heart disease.Materials and methods. 20 patients with acute myocardial infarction and 48 with postinfarct cardiosclerosis with NYHA functional classes I to IV CHF were examined. The structural and functional state of the right heart was evaluated in progressive left ventricular systolic and diastolic dysfunction by echocardiography.Results. In the acute period of infarction, remodeling processes occur in the left ventricle, with normal postload values, volumetric indices and right ventricular contractility are in the normal range. There is right cardiac dilatation at the early stage of left ventricular systolic and diastolic dysfunction in postinfarct remodeling and evolving CHF, normal pulmonary arterial and right atrial pressures. With a significant reduction in left ventricular contractility and its pronounced filling impairment, increases in post- and preload for the right ventricle occur with a just considerable change in its structural and functional state.Conclusion. In impaired myocardial relaxation in the presence of CHF, remodeling of the right cardiac cavities takes place without the influence of a hemodynamic factor. There is a close relationship of remodeling of both ventricles from the very early CHF stages, which suggests that there are common pathogenetic mechanisms responsible for the development of myocardial dysfunction. 

  4. Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment-Elevation Myocardial Infarction.

    Science.gov (United States)

    Khan, Jamal N; Nazir, Sheraz A; Singh, Anvesha; Shetye, Abhishek; Lai, Florence Y; Peebles, Charles; Wong, Joyce; Greenwood, John P; McCann, Gerry P

    2016-06-01

    Late gadolinium-enhanced cardiovascular magnetic resonance imaging overestimates infarct size and underestimates recovery of dysfunctional segments acutely post ST-segment-elevation myocardial infarction. We assessed whether cardiovascular magnetic resonance imaging-derived segmental myocardial strain and markers of myocardial injury could improve the accuracy of late gadolinium-enhancement in predicting functional recovery after ST-segment-elevation myocardial infarction. A total of 164 ST-segment-elevation myocardial infarction patients underwent acute (median 3 days) and follow-up (median 9.4 months) cardiovascular magnetic resonance imaging. Wall-motion scoring, feature tracking-derived circumferential strain (Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular obstruction, intramyocardial hemorrhage, and salvage index (MSI) were assessed in 2624 segments. We used logistic regression analysis to identify markers that predict segmental recovery. At acute CMR 32% of segments were dysfunctional, and at follow-up CMR 19% were dysfunctional. Segmental function at acute imaging and odds ratio (OR) for functional recovery decreased with increasing SEE, although 33% of dysfunctional segments with SEE 76% to 100% improved. SEE was a strong predictor of functional improvement and normalization (area under the curve [AUC], 0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI, 0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI, 0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization). Its predictive accuracy for improvement, as assessed by areas under the receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI, 0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95% CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI, 0

  5. Clinical and angiographic characteristics of young adult patients recovered from acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2015-01-01

    Full Text Available Introduction. Occurrence of acute myocardial infarction in young adults is a relatively rare. In majority of the studies, age of 45 years is used as cut-off line in definition of the young patients with coronary artery disease or myocardial infarction. Studies have shown that younger population aged less than 40 years represents only 2-8% of all patients with myocardial infarction. Objective. The aim of this study was to examine the specificities of clinical and angiographic characteristics of the patients recovered from acute myocardial infarction, younger than 45 years at the moment of attack, by comparing their clinical and angiographic characteristics with those of patients older than 65 years, who recovered from acute myocardial infarction. Method. The study included 78 patients recovered from acute myocardial infarction, 33 patients were younger than 45 years (40.7 ± 3.9 years, 25 (75.7% men and eight (24.2% female, and 45 patients were older than 65 years (68.2 ± 4.2 years, 32 (71.3% men and 13 women. Detailed history taking, physical examination, permanent ECG monitoring, laboratory analyses, X-ray examination, echocardiography and selective coronarography of all patients were performed. Results. Patients younger than 45 years had a significantly higher incidence of STEMI (p 0.05 Multivessel disease existed at 54.5% under the age of 45 and 77.8% older than 65 years (p0.05. The disease of left main coronary artery had 6.1% of patients younger than 45 and 22.2% of patients older than 65 years (p0.05 Were without significant coronary artery stenosis Comparing risk factors for coronary artery disease in patients younger than 45 years and older than 65 years, we find: hypertension in 48.5% vs. 88.9% (p0.05, diabetes mellitus in 21.2% vs. 55.5% (p 0.05, and stress in 18.2% vs. 2.2% (p <0.01. Conclusion. Patients with myocardial infarction younger than 45 years are predominantly male and have a significantly higher incidence of infarction

  6. Cardiovascular magnetic resonance imaging assessment of outcomes in acute myocardial infarction

    Science.gov (United States)

    Khan, Jamal N; McCann, Gerry P

    2017-01-01

    Cardiovascular magnetic resonance (CMR) imaging uniquely characterizes myocardial and microvascular injury in acute myocardial infarction (AMI), providing powerful surrogate markers of outcomes. The last 10 years have seen an exponential increase in AMI studies utilizing CMR based endpoints. This article provides a contemporary, comprehensive review of the powerful role of CMR imaging in the assessment of outcomes in AMI. The theory, assessment techniques, chronology, importance in predicting left ventricular function and remodelling, and prognostic value of each CMR surrogate marker is described in detail. Major studies illustrating the importance of the markers are summarized, providing an up to date review of the literature base in CMR imaging in AMI. PMID:28289525

  7. Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

    Science.gov (United States)

    Spacek, R; Widimský, P; Straka, Z; Jiresová, E; Dvorák, J; Polásek, R; Karel, I; Jirmár, R; Lisa, L; Budesínský, T; Málek, F; Stanka, P

    2002-02-01

    Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy. Copyright 2001 The European Society of Cardiology.

  8. Stent selection in patients with myocardial infarction: drug eluting, biodegradable polymers or bare metal stents?

    Science.gov (United States)

    Mieres, Juan; Rodríguez, Alfredo E

    2012-08-01

    Percutaneous coronary intervention (PCI) has been increasingly used in the last years during interventional procedures in patients with acute coronary syndromes (ACS) including ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In patients with either STEMI, NSTEMI, high risk ACS with EKG changes or cardiac enzymes rises; PCI with bare metal stent (BMS) implantation has been associated with a significant improvement in clinical outcome. Therefore, BMS implantation during primary PCI in STEMI has become a standard of practice. With the introduction of drug eluting stents (DESs) in this decade, the use of these new devices instead of BMSs in patients with STEMI has emerged as a rational PCI alternative in this particular subgroup of patients. In spite of the unquestionable benefits of DESs in terms of reduction of restenosis and TVR, specific concerns have arisen with regard to their long-term safety. High incidence of very late stent thrombosis has been described with these devices, and special attention should be paid in patients with unstable coronary lesions, in which plaque composition and remodeling may play a main role in their safety and long-term outcome. Intraluminal thrombus caused by plaque rupture is the most frequent mechanism of STEMI, in which the necrotic core and thin fibrous cap play a major role. In this context, the use of first DESs designs may be futile or even unsafe because delayed healing may further contribute to plaque instability. Adjunctive invasive imaging tools can improve stent deployment and safety outcome in these lesions with intravascular findings of plaque instability. Recently, other players such as new dedicated antithrombotic BMS designs, including selfexpanding stents or drug-eluting coated balloons, are exploring their potential indications in patients with ACS and myocardial infarction. This paper reports and discusses new stent devices and adjunctive pharmacologic agents. It

  9. Stepwise optimization of the procedure for assessment of circulating progenitor cells in patients with myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Yu-Xin Cui

    Full Text Available The number and functional activity of circulating progenitor cells (CPCs is altered in diabetic patients. Furthermore, reduced CPC count has been shown to independently predict cardiovascular events. Validation of CPCs as a biomarker for cardiovascular risk stratification requires rigorous methodology. Before a standard operation protocol (SOP can be designed for such a trial, a variety of technical issues have to be addressed fundamentally, which include the appropriate type of red blood cell lysis buffer, FMO or isotype controls to identify rare cell populations from background noise, optimal antibody dilutions and conditions of sample storage. We herein propose improvements in critical steps of CPC isolation, antigenic characterization and determination of functional competence for final application in a prospective investigation of CPCs as a biomarker of outcome following acute myocardial infarction.In this validation study, we refined the standard operating procedure (SOP for flow cytometry characterisation and functional analysis of CPCs from the first 18 patients of the Progenitor Cell Response after Myocardial Infarction Study (ProMIS. ProMIS aims to verify the prognostic value of CPCs in patients with either ST elevation or non-ST elevation myocardial infarction with or without diabetes mellitus, using cardiac magnetic resonance imaging (MRI for assessment of ventricular function as a primary endpoint. Results indicate crucial steps for SOP implementation, namely timely cell isolation after sampling, use of appropriate lysis buffer to separate blood cell types and minimize the acquisition events during flow cytometry, adoption of proper fluorophore combination and antibody titration for multiple antigenic detection and introduction of counting beads for precise quantification of functional CPC activity in migration assay.With systematic specification of factors influencing the enumeration of CPC by flow cytometry, the abundance and

  10. Temperature-corrected postmortem 3-T MR quantification of histopathological early acute and chronic myocardial infarction: a feasibility study.

    Science.gov (United States)

    Persson, Anders; Baeckmann, John; Berge, Johan; Jackowski, Christian; Warntjes, Marcel; Zech, Wolf-Dieter

    2018-03-01

    The goal of the present study was to evaluate if quantitative postmortem cardiac 3-T magnetic resonance (QPMCMR) T1 and T2 relaxation times and proton density values of histopathological early acute and chronic myocardial infarction differ to the quantitative values of non-pathologic myocardium and other histopathological age stages of myocardial infarction with regard to varying corpse temperatures. In 60 forensic corpses (25 female, 35 male), a cardiac 3-T MR quantification sequence was performed prior to autopsy and cardiac dissection. Core body temperature was assessed during MR examinations. Focal myocardial signal alterations in synthetically generated MR images were measured for their T1, T2, and proton density (PD) values. Locations of signal alteration measurements in PMCMR were targeted at heart dissection, and myocardial tissue specimens were taken for histologic examinations. Quantified signal alterations in QPMCMR were correlated to their according histologic age stage of myocardial infarction, and quantitative values were corrected for a temperature of 37 °C. In QPMCMR, 49 myocardial signal alterations were detected in 43 of 60 investigated hearts. Signal alterations were diagnosed histologically as early acute (n = 16), acute (n = 10), acute with hemorrhagic component (n = 9), subacute (n = 3), and chronic (n = 11) myocardial infarction. Statistical analysis revealed that based on their temperature-corrected quantitative T1, T2, and PD values, a significant difference between early acute, acute, and chronic myocardial infarction can be determined. It can be concluded that quantitative 3-T postmortem cardiac MR based on temperature-corrected T1, T2, and PD values may be feasible for pre-autopsy diagnosis of histopathological early acute, acute, and chronic myocardial infarction, which needs to be confirmed histologically.

  11. [Acute myocardial infarction in the postoperative period following pneumonectomy].

    Science.gov (United States)

    López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilariño, M J; Etxainz Alvarez, A; Alvarez Refojo, F

    2002-11-01

    A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided.

  12. Monocyte subset accumulation in the human heart following acute myocardial infarction and the role of the spleen as monocyte reservoir

    NARCIS (Netherlands)

    van der Laan, Anja M.; ter Horst, Ellis N.; Delewi, Ronak; Begieneman, Mark P. V.; Krijnen, Paul A. J.; Hirsch, Alexander; Lavaei, Mehrdad; Nahrendorf, Matthias; Horrevoets, Anton J.; Niessen, Hans W. M.; Piek, Jan J.

    2014-01-01

    Monocytes are critical mediators of healing following acute myocardial infarction (AMI), making them an interesting target to improve myocardial repair. The purpose of this study was a gain of insight into the source and recruitment of monocytes following AMI in humans. Post-mortem tissue specimens

  13. Acute left ventricular remodeling following myocardial infarction: coupling of regional healing with remote extracellular matrix expansion.

    Science.gov (United States)

    Chan, William; Duffy, Stephen J; White, David A; Gao, Xiao-Ming; Du, Xiao-Jun; Ellims, Andris H; Dart, Anthony M; Taylor, Andrew J

    2012-09-01

    This prospective study aimed to assess regional and temporal patterns of extracellular matrix (ECM) changes post-myocardial infarction (MI). A fundamental process in the development of ischemic left ventricular (LV) dysfunction is LV remodeling, characterized by structural and functional abnormalities throughout the myocardium including the noninfarcted (remote) myocardium and interstitium. Contrast-enhanced cardiac magnetic resonance (CMR) was performed on MI patients acutely (mean: 5 days post-MI, n = 25) and repeated subacutely (mean: 139 days post-MI, n = 21), and was also performed in a separate group of 15 patients with chronic MI (mean: 2,580 days post-MI, n = 15). Twenty volunteers without a history of MI acted as controls. CMR was used to evaluate LV morphology and function, with post-contrast T1 mapping to semiquantitatively assess changes in the ECM. Putative mediators of myocardial inflammation and fibrosis, including macrophage migration inhibitory factor (MIF), were also measured. Age, sex, and diabetic and hypertensive status did not differ between MI groups and controls. Compared with controls, patients early post-acute MI demonstrated reduced LV ejection fraction (50.25 ± 7.29% vs. 66.7 ± 6.2% [controls], p infarction early post-acute MI, compared with controls, demonstrated reduced systolic thickening (60 ± 5.0% vs. 106 ± 7.6%, p ≤ 0.0002), and lower post-contrast myocardial T1 times suggestive of ECM expansion (437 ± 113 ms vs. 549 ± 119 ms, p = 0.01). In a subgroup analysis between early post-acute MI and controls of similar age and sex, the remote sector post-contrast myocardial T1 times remained significantly shorter post-acute MI compared with controls (420 ± 121 ms vs. 529 ± 113 ms, p = 0.03). Serum levels of MIF inversely correlated with global myocardial T1 time in patients early post-acute MI (r = -0.6, p = 0.01), suggesting a coupling of regional healing with acute LV remodeling. Within a week of acute MI, the remote myocardium

  14. ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, P; Grande, P; Pedersen, F

    1990-01-01

    Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage...... was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously...... developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than...

  15. Haploinsufficiency of Hand1 improves mice survival after acute myocardial infarction through preventing cardiac rupture.

    Science.gov (United States)

    Lu, Shuangshuang; Du, Pan; Shan, Congjia; Wang, Yaohe; Ma, Changsheng; Dong, Jianzeng

    2016-09-30

    Previous studies have demonstrated a significantly lower level of Hand1 in ischemic cardiomyopathy than in normal heart tissue. The role of decreased Hand1 in myocardial infarction remains unclear. This study was designed to investigate the effects of haploinsufficiency of Hand1 on mouse heart after myocardial infarction. 8-10 weeks old male heterozygous Hand1-deficient (Hand1(+/-)) mice and wild-type littermates (control) were subjected to sham operation or ligation of the left anterior descending coronary artery to induce acute myocardial infarction (AMI). Hand1(+/-) mice have low incidence of left ventricular free wall rupture in the first week after operation than control mice. Then we found lower MMP9 activity and less cardiomyocytes apoptosis in Hand1(+/-) than in control mice. All of these contribute to the protection role of haploinsufficiency of Hand1 after AMI. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Acute myocardial infarction induced by concurrent use of adderall and alcohol in an adolescent.

    Science.gov (United States)

    Sharma, Jayendra; de Castro, Carlyle; Chatterjee, Partha; Pinto, Rohit

    2013-01-01

    Adderall (amphetamine, dextroamphetamine mixed salts), a widely prescribed stimulant for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, is considered safe with due precautions. Nonmedical use of Adderall is prevalent and rising in high school and college students. Use of prescribed Adderall without intention to overdose as a cause of myocardial infarction is extremely rare, and to our knowledge, only 3 cases have been reported in the pediatric literature. We report a case of acute myocardial infarction in an adolescent without cardiovascular risk factors who took the total prescribed daily dose of Adderall one time while consuming alcohol. The sporadic use of Adderall with alcohol creates a potentially dangerous situation with serious cardiovascular adverse effects. We should have a high degree of suspicion for children and adolescents on stimulant therapy who present with chest pain and an abnormal electrocardiogram in the pediatric emergency department, and there is a need to evaluate them for myocardial ischemia and infarction.

  17. Stretching exercises enhance vascular endothelial function and improve peripheral circulation in patients with acute myocardial infarction.

    Science.gov (United States)

    Hotta, Kazuki; Kamiya, Kentaro; Shimizu, Ryosuke; Yokoyama, Misako; Nakamura-Ogura, Misao; Tabata, Minoru; Kamekawa, Daisuke; Akiyama, Ayako; Kato, Michitaka; Noda, Chiharu; Matsunaga, Atsuhiko; Masuda, Takashi

    2013-01-01

    The purpose of this study was to clarify the acute effects of a single session of stretching exercises on vascular endothelial function and peripheral circulation in patients with acute myocardial infarction. This study evaluated 32 patients (mean age, 66 ± 9 years) who received phase I cardiac rehabilitation after acute myocardial infarction. Five types of stretching exercises were performed on the floor: wrist dorsiflexion, close-legged trunk flexion, open-legged trunk flexion, open-legged lateral trunk bending, and cross-legged trunk flexion. Each exercise entailed a 30-second stretching followed by a 30-second relaxation, and was repeated twice. Low- and high-frequency components (LF and HF) of heart rate variability (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz) were analyzed, and HF and LF/HF were used as indices of parasympathetic and sympathetic nervous activities, respectively. Reactive hyperemia peripheral arterial tonometry (RH-PAT) index was measured and used as a parameter for vascular endothelial function. Transcutaneous oxygen pressure (tcPO2) on the right foot and chest was also measured, and the Foot-tcPO2/Chest-tcPO2 ratio was used as a parameter for peripheral circulation. The HF, RH-PAT index, and Foot-tcPO2/Chest-tcPO2 ratio were significantly higher after the exercises than before (P after stretching exercises. These findings demonstrate that stretching exercises improve vascular endothelial function and peripheral circulation in patients with acute myocardial infarction.

  18. Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction.

    Science.gov (United States)

    Chapman, Andrew R; Anand, Atul; Boeddinghaus, Jasper; Ferry, Amy V; Sandeman, Dennis; Adamson, Philip D; Andrews, Jack; Tan, Stephanie; Cheng, Sheun F; D'Souza, Michelle; Orme, Kate; Strachan, Fiona E; Nestelberger, Thomas; Twerenbold, Raphael; Badertscher, Patrick; Reichlin, Tobias; Gray, Alasdair; Shah, Anoop S V; Mueller, Christian; Newby, David E; Mills, Nicholas L

    2017-04-25

    High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the optimal approach is uncertain. We compared the European Society of Cardiology rule-out pathway with a pathway that incorporates lower cardiac troponin concentrations to risk stratify patients. Patients with suspected acute coronary syndrome (n=1218) underwent high-sensitivity cardiac troponin I measurement at presentation and 3 and 6 or 12 hours. We compared the European Society of Cardiology pathway (Acute Coronary S yndrome) population (myocardial infarction or type 1 myocardial infarction or cardiac death at 30 days. We evaluated the primary outcome in prespecified subgroups stratified by age, sex, time of symptom onset, and known ischemic heart disease. The primary outcome occurred in 15.7% (191 of 1218) patients. In those less than the 99th centile at presentation, the European Society of Cardiology pathway ruled out myocardial infarction in 28.1% (342 of 1218) and 78.9% (961 of 1218) at presentation and 3 hours, respectively, missing 18 index and two 30-day events (negative predictive value, 97.9%; 95% confidence interval, 96.9-98.7). The High-STEACS pathway ruled out 40.7% (496 of 1218) and 74.2% (904 of 1218) at presentation and 3 hours, missing 2 index and two 30-day events (negative predictive value, 99.5%; 95% confidence interval, 99.0-99.9; P myocardial infarction in more patients at presentation and misses 5-fold fewer index myocardial infarctions than guideline-approved pathways based exclusively on the 99th centile. URL: http://clinicaltrials.gov. Unique identifier: NCT01852123. © 2016 The Authors.

  19. The association of microalbuminuria with mortality in patients with acute myocardial infarction. A ten-year follow-up study

    DEFF Research Database (Denmark)

    Taskiran, Mustafa; Iversen, Allan; Klausen, Klaus Peder

    2010-01-01

    Our study evaluates the long-term effect of microalbuminuria on mortality among patients with acute myocardial infarction. We followed 151 patients from 1996 to 2007 to investigate if microalbuminuria is a risk factor in coronary heart disease. All patients admitted with acute myocardial infarction...... with acute myocardial infarction is prognostic for increased long-term mortality. We recommend measurement of microalbuminuria to be included as a baseline risk factor in patients with acute myocardial infarction and in future trials in patients with coronary heart disease....... in 1996 were included. At baseline, we recorded urinary albumin/creatinine concentration ratio, body mass index, blood pressure, left ventricle ejection fraction by echocardiography, smoking status, medication, diabetes, age, and gender. Deaths were traced in 2007 by means of the Danish Personal...

  20. Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction

    DEFF Research Database (Denmark)

    van der Vlugt, Maureen J; van Domburg, Ron T; Pedersen, Susanne S.

    2005-01-01

    We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event....

  1. Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale.

    Science.gov (United States)

    Hayıroğlu, Mert İlker; Bozbeyoğlu, Emrah; Akyüz, Şükrü; Yıldırımtürk, Özlem; Bozbay, Mehmet; Bakhshaliyev, Nijad; Renda, Emir; Gök, Gülay; Eren, Mehmet; Pehlivanoğlu, Seçkin

    2015-07-01

    Acute myocardial infarction (MI) and pulmonary embolism canal one lead to life-threatening conditions such as sudden cardiac death and congestive heart failure. We discuss a case of a 74-year-old man presented to the emergency department with acute dyspnea and chest pain. Acute anterior MI and pulmonary embolism concomitantly were diagnosed. Primary percutaneous coronary intervention performed because of preliminary acute anterior MI diagnosis. Transthoracic echocardiography was performed to determine further complications caused by acute MI because patient had a continuous tachycardia and dyspnea although hemodynamically stable. Transthoracic echocardiography revealed a thrombus that was stuck into the patent foramen ovale with parts in right and left atria. Anticoagulation therapy was started; neither fibrinolytic therapy nor operation was performed because of low survey expectations of the patient's recently diagnosed primary disease stage IV lung cancer. Patient was discharged on his 20th day with oral anticoagulation and antiagregant therapy.

  2. Retrospective Evaluation of Two Fast-track Strategies to Rule Out Acute Coronary Syndrome in a Real-life Chest Pain Population

    DEFF Research Database (Denmark)

    Schønemann-Lund, Martin; Schoos, Mikkel Malby; Iversen, Kasper

    2015-01-01

    BACKGROUND: The European Society of Cardiology (ESC) guideline on non-ST-elevation acute coronary syndrome (N-STE ACS) proposed a new ACS rule-out protocol. OBJECTIVES: To evaluate this new tool, which uses diagnostic levels of high-sensitivity troponin T (hs-TnT; > 14 ng/L) in a slightly modified...

  3. Histamine deficiency exacerbates myocardial injury in acute myocardial infarction through impaired macrophage infiltration and increased cardiomyocyte apoptosis

    Science.gov (United States)

    Deng, Long; Hong, Tao; Lin, Jinyi; Ding, Suling; Huang, Zheyong; Chen, Jinmiao; Jia, Jianguo; Zou, Yunzeng; Wang, Timothy C.; Yang, Xiangdong; Ge, Junbo

    2015-01-01

    Histamine is a biogenic amine that is widely distributed and has multiple functions, but the role it plays in acute myocardial infarction (AMI) remains unclear. In this study, we investigated the origin and contribution of endogenous histamine to AMI. Histidine decarboxylase (HDC) is the unique enzyme responsible for histamine generation. Using HDC-EGFP bacterial artificial chromosome (BAC) transgenic mice in which EGFP expression is controlled by the HDC promoter, we identified HDC expression primarily in CD11b+Gr-1+ immature myeloid cells (IMCs) that markedly increase in the early stages of AMI. Deficiency of histamine in HDC knockout mice (HDC−/−) reduced cardiac function and exacerbated the injury of infarcted heart. Furthermore, administering either an H1 receptor antagonist (pyrilamine) or an H2 receptor antagonist (cimetidine) demonstrated a protective effect of histamine against myocardial injury. The results of in vivo and in vitro assays showed that histamine deficiency promotes the apoptosis of cardiomyocytes and inhibits macrophage infiltration. In conclusion, CD11b+Gr-1+ IMCs are the predominant HDC-expressing sites in AMI, and histamine plays a protective role in the process of AMI through inhibition of cardiomyocyte apoptosis and facilitation of macrophage infiltration. PMID:26278136

  4. Histamine deficiency exacerbates myocardial injury in acute myocardial infarction through impaired macrophage infiltration and increased cardiomyocyte apoptosis.

    Science.gov (United States)

    Deng, Long; Hong, Tao; Lin, Jinyi; Ding, Suling; Huang, Zheyong; Chen, Jinmiao; Jia, Jianguo; Zou, Yunzeng; Wang, Timothy C; Yang, Xiangdong; Ge, Junbo

    2015-08-17

    Histamine is a biogenic amine that is widely distributed and has multiple functions, but the role it plays in acute myocardial infarction (AMI) remains unclear. In this study, we investigated the origin and contribution of endogenous histamine to AMI. Histidine decarboxylase (HDC) is the unique enzyme responsible for histamine generation. Using HDC-EGFP bacterial artificial chromosome (BAC) transgenic mice in which EGFP expression is controlled by the HDC promoter, we identified HDC expression primarily in CD11b(+)Gr-1(+) immature myeloid cells (IMCs) that markedly increase in the early stages of AMI. Deficiency of histamine in HDC knockout mice (HDC(-/-)) reduced cardiac function and exacerbated the injury of infarcted heart. Furthermore, administering either an H1 receptor antagonist (pyrilamine) or an H2 receptor antagonist (cimetidine) demonstrated a protective effect of histamine against myocardial injury. The results of in vivo and in vitro assays showed that histamine deficiency promotes the apoptosis of cardiomyocytes and inhibits macrophage infiltration. In conclusion, CD11b(+)Gr-1(+) IMCs are the predominant HDC-expressing sites in AMI, and histamine plays a protective role in the process of AMI through inhibition of cardiomyocyte apoptosis and facilitation of macrophage infiltration.

  5. Time elapsed after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Ortiz-Pérez, José T; Lee, Daniel C; Bucciarelli-Ducci, Chiara; Tejedor, Paula; Bonow, Robert O; Wu, Edwin

    2015-05-30

    In acute myocardial infarction (MI), late Gadolinium enhancement (LGE) has been proposed to include the infarcted myocardium and area at risk. However, little information is available on the optimal timing after contrast injection to differentiate these 2 areas. Our aim was to determine in acute and chronic MI whether imaging time after contrast injection influences the LGE size that better predicts infarct size and functional recovery. Subjects were evaluated by cardiovascular magnetic resonance (CMR) the first week (n = 60) and 3 months (n = 47) after a percutaneously revascularized STEMI. Inversion-recovery single-shot (ss-IR) imaging was acquired at multiple time points following contrast administration and compared to segmented inversion-recovery (seg-IR) sequences. Inversion time was properly adjusted and images were blinded, randomized and measured for LGE volumes. In acute MI, LGE volume decreased over several minutes (p = 0.005) with the greatest volume occurring at 3 minutes and the smallest at 25 minutes post-contrast injection; however, LGE volume remained constant over time in chronic MI (p = 0.886). Depending on the imaging time, in acute phase, a change in the transmurality index was also observed. A transmural infarction (>75%) at 25 minutes better predicted the absence of improvement in the wall motion score index (WMSI), a higher increase in left ventricular volumes and a lower ejection fraction compared to 10 minutes. A change was observed in LGE volume in the minutes following contrast administration in acute but not in chronic MI. Infarct transmurality 25 minutes post-contrast injection better predicted infarct size and functional recovery at follow-up.

  6. The measurement of serum fibrinogen levels in patients with acute coronary syndrome

    International Nuclear Information System (INIS)

    Omran, Mohammad T.; Asadollahi, S.

    2007-01-01

    Serum fibrinogen level (SF) is thought to be one of the risk factors for coronary artery disease (CAD). The purpose of this study was to measure the SFL in patients with acute coronary syndrome (ACS). This study was performed in patients with ACS, admitted in Shahid Beheshti Hospital, Babol, Iran, from February 2005 to June 2006. Two hundred patients with ACS were divided into 4 groups: Group I - ST elevated myocardial infarction (STEMI); Group II - non-ST elevated myocardial infarction (NSTEMI), Group III - unstable angina (U/A) with ST-T change and Group IV: U/A without ST-T change. Each group includes 50 patients. Twenty-four hours after admission, the SFL was measured using chromatography methods. The data were collected and analyzed. The mean SFL per mg/dl in each group are Group I - 377.8+-28, Group II - 417.2+-26.8, Group III - 335.4+-19.8 and Group IV - 305.1+-13.8. The SFL in Group II was significantly higher in the other group (p=0.002). The SFL in Group II was higher than in Group III (p=0.02) and much higher than in Group IV (p=0.000). The SFL in Group III was more than in Group IV (p=0.018). The results show that SFL is an important marker in patients with ACS, with ST-T change. (author)

  7. Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

    Science.gov (United States)

    Neri, Margherita; Pascale, Natascha; Pomara, Cristoforo

    2017-01-01

    Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Reperfusion strategies are the current standard therapy for AMI. However, they may result in paradoxical cardiomyocyte dysfunction, known as ischemic reperfusion injury (IRI). Different forms of IRI are recognized, of which only the first two are reversible: reperfusion-induced arrhythmias, myocardial stunning, microvascular obstruction, and lethal myocardial reperfusion injury. Sudden death is the most common pattern for ischemia-induced lethal ventricular arrhythmias during AMI. The exact mechanisms of IRI are not fully known. Molecular, cellular, and tissue alterations such as cell death, inflammation, neurohumoral activation, and oxidative stress are considered to be of paramount importance in IRI. However, comprehension of the exact pathophysiological mechanisms remains a challenge for clinicians. Furthermore, myocardial IRI is a critical issue also for forensic pathologists since sudden death may occur despite timely reperfusion following AMI, that is one of the most frequently litigated areas of cardiology practice. In this paper we explore the literature regarding the pathophysiology of myocardial IRI, focusing on the possible role of the calpain system, oxidative-nitrosative stress, and matrix metalloproteinases and aiming to foster knowledge of IRI pathophysiology also in terms of medicolegal understanding of sudden deaths following AMI. PMID:28286377

  8. Serum uric acid level in hypertensive patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Burki, L.; Mehmood, A.

    2013-01-01

    To estimate serum uric acid level in hypertensive patients with acute myocardial infarction and hypertensive patients without myocardial infarction. Study Design Cross-sectional study. Setting Department of Medicine, Mayo Hospital, Lahore. Duration of study with dates Study was carried over a period of six months from 01-01-2007 to 30-06-2007. Subjects and methods Eighty hypertensive patients were included in the study out of which 40 patients with acute myocardial infarction were put in MI group and 40 patients without any history of myocardial infarction were labeled as non-MI group. Results Mean age of the patients in MI group and non-MI was found to be 50.0+-12.4 and 51.8+-10.1 years, respectively. Results of Serum uric acid level in MI group were 6.9+-1.0 mg/dl (0.407 +- 0.059 mmol/L ) and in non-MI group were 5.8+-1.5 mg/dl (0.342 +- 0.088 mmol/L) (p<0.001). (where 1 mmol/L = 16.78 mg/dl or 1 mg/dl = 0.059 mmol/L). Conclusion The present study proved that raised serum uric acid level can cause hypertension and further rise can lead to MI. (author)

  9. Early expression of angiogenesis factors in acute myocardial ischemia and infarction.

    Science.gov (United States)

    Lee, S H; Wolf, P L; Escudero, R; Deutsch, R; Jamieson, S W; Thistlethwaite, P A

    2000-03-02

    When the myocardium is deprived of blood, a process of ischemia, infarction, and myocardial remodeling is initiated. Hypoxia-inducible factor 1 (HIF-1) is a transcriptional activator of vascular endothelial growth factor (VEGF) and is critical for initiating early cellular responses to hypoxia. We investigated the temporal and spatial patterns of expression of the alpha subunit of HIF-1 (HIF-1alpha) and VEGF in specimens of human heart tissue to elucidate the early molecular responses to myocardial hypoxia. Ventricular-biopsy specimens from 37 patients undergoing coronary bypass surgery were collected. The specimens were examined by microscopy for evidence of ischemia, evolving infarction, or a normal histologic appearance. The specimens were also analyzed with the reverse-transcriptase polymerase chain reaction for HIF-1alpha and VEGF messenger RNA (mRNA) expression and by immunohistochemical analysis for the location of the HIF-1alpha and VEGF proteins. HIF-1alpha mRNA was detected in myocardial specimens with pathological evidence of acute ischemia (onset, response to myocardial ischemia or infarction. This response defines, at a molecular level, one of the first adaptations of human myocardium to a deprivation of blood. HIF-1alpha is a useful temporal marker of acutely jeopardized myocardium.

  10. Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market

    OpenAIRE

    Luciane Boreki Lucinda; Ana Claudia Merchan Giaxa Prosdócimo; Katherine Athayde Teixeira de Carvalho; Julio Cesar Francisco; Cristina Pellegrino Baena; Marcia Olandoski; Vivian Ferreira do Amaral; José Rocha Faria-Neto; Luiz César Guarita-Souza

    2015-01-01

    Introduction: Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. Objective: To identify the presence of stress and its phases in hospitalized an...

  11. Baicalin ameliorates isoproterenol-induced acute myocardial infarction through iNOS, inflammation and oxidative stress in rat.

    Science.gov (United States)

    Chen, Huaguo; Xu, Yongfu; Wang, Jianzhong; Zhao, Wei; Ruan, Huihui

    2015-01-01

    Baicalin belongs to glucuronic acid glycosides and after hydrolysis baicalein and glucuronic acid come into being. It has such effects as clearing heat and removing toxicity, anti-inflammation, choleresis, bringing high blood pressure down, diuresis, anti-allergic reaction and so on. In this study, we investigated whether baicalin ameliorates isoproterenol-induced acute myocardial infarction and its mechanism. Rat model of acute myocardial infarction was induced by isoproterenol. Casein kinase (CK), the MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), cardiac troponin T (cTnT) and infarct size measurement were used to measure the protective effect of baicalin on isoproterenol-induced acute myocardial infarction. iNOS protein expression in rat was analyzed using western blot analysis. Tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), malondialdehyde (MDA) and superoxide dismutase (SOD) and caspase-3 activation levels were explored using commercial ELISA kits. In the acute myocardial infarction experiment, baicalin effectively ameliorates the level of CK, CK-MB, LDH and cTnT, reduced infarct size in acute myocardial infarction rat model. Meanwhile, treatment with baicalin effectively decreased the iNOS protein expression, inflammatory factors and oxidative stresses in a rat model of acute myocardial infarction. However, baicalin emerged that anti-apoptosis activity and suppressed the activation of caspase-3 in a rat model of acute myocardial infarction. The data suggest that the protective effect of baicalin ameliorates isoproterenol-induced acute myocardial infarction through iNOS, inflammation and oxidative stress in rat.

  12. [Echocardiographic indices related with acute coronary anatomy in acute phase of myocardial infarction: our experience].

    Science.gov (United States)

    Belluzzi, Fabio; Ciocca, Anna; Grosso Di Palma, Lucia; Cattaneo, Mattia; Conti, Caterina; Magrini, Fabio

    2011-11-01

    Inferior acute myocardial infarction (IAMI) is often associated with right ventricle involvement (RVAMI). Echocardiogram (Echo) shows the ischemic involvement of the right ventricle with an initial dilatation (RVD) and segmental cinetic abnormalities (RVSCS). During RVAMI the normal convexity of the interatrial septum (IAS) toward right atrium is inverted (IASI). 53 patients with IAMI were studied with ECG, echo and hemodinamic monitoring by a Swan-Ganz catheter. Echo was early performed and patients were subdivided into three groups: 1. IAMI with RVSCS and/or RVD with IASI (12 patients); 2. IAMI with RVSCS and/or RVD without IASI (8 patients); 3. IAMI without VSCS, RVD IASI (33 patients). ECG showed RV involvement only in A and B groups (ST-T segment elevation more than 2 mm in V3 r - V5 r). Echo-Doppler showed no statistically differences between the two groups on RV protodiastolic pression; no hemodinamic differences between the two groups (p = n.s.); no statistically differences in central venous pressure, right ventricular pressure, cardiac output, wedge pressure. Complications (arrhytmias, heart failure, ipotension, pericarditis, 3rd A-V block) were so subdivided: group A: 6 patients (50%); group B: 2 patients (24%); group C: 4 patients (12%) with statistical significance (p41 % in group A (5 patients); 20 % in group B (2 patients); 6 % in group C (2 patients), with p<0.01 between all three groups. Echo after six months showed IASI only in two patients of group A. Patients with IASI revealed complications (residual angina, ventricular ipercinetic arrytmias). IASI in patients with IAMI and RVAMI seems to identify a group with higher risk in developing complications and with a more adverse prognosis.

  13. In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

    International Nuclear Information System (INIS)

    Masood, A.; Naqvi, M.A.; Jafar, S.S.

    2009-01-01

    Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p=0.001). TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI. (author)

  14. [Hemodynamics after prindolol and digitalis in acute myocardial infarction (author's transl)].

    Science.gov (United States)

    Bachour, G; Bender, F; Hochrein, H

    1976-03-05

    In 20 patients with acute myocardial infarction hemodynamic controls were performed after digitalisation and following i.v. injection of 0,4 mg of Prindolol. Circulatory changes were most pronounced 5-15 min after Prindolol injection and consisted of decrease in heart rate of 7%, mean arterial blood pressure of 6%, cardiac output of 10,5%, stroke volume index of 5,1% and left ventricular work of 18%. An increase of pulmonary wedge pressure of 17%, pulmonary pressure of 9%, mean right atrial pressure of 16% and peripheral arterial resistance of 6% were calculated. In 5 cases a favourable effect on extrasystoles and in 2 cases on sinus tachycardia were observed. Not infrequently, during the initial phase of acute myocardial infarction, a hyperadrenergic state may be noted. Prindolol may be indicated, when circulatory changes or arrhythmias are suspect to be the result of this hyperadrenergic stimulation. A simultaneous digitalisation may inhibit a more intensive cardiodepression.

  15. Improvement of exercise capacity and left ventricular diastolic function with metoprolol XL after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Egstrup, K

    2000-01-01

    BACKGROUND: Left ventricular (LV) diastolic function predicts and correlates with exercise capacity. Beta-blockers improve exercise capacity and LV diastolic function in patients with severe LV systolic dysfunction in dilated cardiomyopathy. However, information on the effect of metoprolol XL...... on exercise capacity in relation to LV diastolic function in patients with mild to moderate LV systolic dysfunction after acute myocardial infarction is limited. METHODS: In a randomized, double-blind, placebo-controlled study of 77 patients, a subgroup of 59 patients with mild to moderate LV systolic...... dysfunction after acute myocardial infarction were given metoprolol XL (n = 29) or placebo (n = 30). The effects of metoprolol XL on exercise capacity in relation to effects on LV diastolic filling were studied. Two-dimensional Doppler echocardiography and maximal symptom limited bicycle test were performed...

  16. Comparing levels of anxiety during bed and shower baths in patients with acute myocardial infarction.

    Science.gov (United States)

    Lopes, Juliana de Lima; Nogueira-Martins, Luiz Antonio; Gonçalves, Maria Aparecida Batistão; de Barros, Alba Lucia Bottura Leite

    2010-01-01

    This study compared the levels of anxiety presented by patients with acute myocardial infarction in bed and shower baths and the influence of antecedent variables: age, gender, medications, previous hospitalization and/or bed bath, patients' preference regarding the professional's gender, risk factors and anxiety-traits. This crossover study was conducted between February and August 2007 in coronary units. The sample was composed of 71 patients with acute myocardial infarction. The State-Trait Anxiety Inventory (STAI) was applied before the baths (bed and shower baths), immediately after the baths and twenty minutes after the second evaluation. Results revealed that patients were more anxious in the bed bath than in the shower in the three assessments (p <0.0001) and the only variable that interfered with state-anxiety was high blood pressure.

  17. Short and long term prognostic importance of regional dyskinesia versus akinesia in acute myocardial infarction

    DEFF Research Database (Denmark)

    Kjøller, E; Køber, L; Jørgensen, S

    2002-01-01

    the nine segment model, scoring 3 for hyperkinesia, 2 for normokinesia, 1 for hypokinesia, 0 for akinesia, and -1 for dyskinesia. Calculation of WMI either included information on dyskinesia or excluded this information by giving dyskinesia the same score as akinesia. MAIN OUTCOME MEASURES: Long term...... outcome (up to seven years) with respect to mortality. RESULTS: Dyskinesia occurred in 673 patients (10.8%). In multivariate analysis, WMI was an important prognostic factor, with a relative risk of 2.4 (95% confidence interval (CI), 2.2 to 2.7), while dyskinesia had no independent long term prognostic...... when WMI is estimated for prognostic purposes following acute myocardial infarction. DESIGN: Multicentre prospective study. PATIENTS: 6676 consecutive patients, screened one to six days after acute myocardial infarction in 27 Danish hospitals. INTERVENTIONS: WMI was measured in 6232 patients, applying...

  18. Hypertrophic Cardiomyopathy Mimicking Acute Anterior Myocardial Infarction Associated with Sudden Cardiac Death

    Directory of Open Access Journals (Sweden)

    Y. Daralammouri

    2012-01-01

    Full Text Available Hypertrophic cardiomyopathy is the most common genetic disease of the heart. We report a rare case of hypertrophic obstructive cardiomyopathy mimicking an acute anterior myocardial infarction associated with sudden cardiac death. The patient presented with acute ST elevation myocardial infarction and significant elevation of cardiac enzymes. Cardiac catheterization showed some atherosclerotic coronary artery disease, without significant stenosis. Echocardiography showed left ventricular hypertrophy with a left ventricular outflow tract obstruction; the pressure gradient at rest was 20 mmHg and became severe with the Valsalva maneuver (100 mmHg. There was no family history of sudden cardiac death. Six days later, the patient suffered a syncope on his way to magnetic resonance imaging. He was successfully resuscitated by ventricular fibrillation.

  19. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  20. [The Torino Network Project. Global management of acute myocardial infarction from the field to the hospital].

    Science.gov (United States)

    Casaccia, Michele; Sicuro, Marco; Scacciatella, Paolo

    2002-02-01

    A unidirectional clinical pathway for acute myocardial infarction from out-of-hospital setting to the coronary care unit and catheterization laboratory could lead to mortality reduction. The ongoing "Progetto Torino Network. Gestione globale dell'infarto miocardico acuto prime ore dal territorio all'ospedale" is based on this statement and described in the three-structural, diagnostic-therapeutical, multimedial issues. This project represents the historical evolution of our involvement in out-of-hospital cardiac emergency management.

  1. Validation of the Killip-Kimball Classification and Late Mortality after Acute Myocardial Infarction

    OpenAIRE

    Mello, Bruno Henrique Gallindo de; Oliveira, Gustavo Bernardes F.; Ramos, Rui Fernando; Lopes, Bernardo Baptista C.; Barros, Cecília Bitarães S.; Carvalho, Erick de Oliveira; Teixeira, Fabio Bellini P.; Arruda, Guilherme D'Andréa S.; Revelo, Maria Sol Calero; Piegas, Leopoldo Soares

    2014-01-01

    Background: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. Objective: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation...

  2. Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002

    DEFF Research Database (Denmark)

    Buch, P.; Rasmussen, S.; Gislason, Gunnar Hilmar

    2007-01-01

    OBJECTIVE: To investigate trends in case-fatality and prognostic impact from recurrent acute myocardial infarction (re-AMI) during 1985-2002. DESIGN: Retrospective cohort study using nationwide administrative data from Denmark. Settings: National registries on hospital admissions and causes of de...... to patients without reinfarction. CONCLUSION: Prognosis after AMI has improved substantially during the latest two decades and extends to patients with re-AMI....

  3. Recovery from Hospital-Acquired Anemia after Acute Myocardial Infarction and Effect on Outcomes

    OpenAIRE

    Salisbury, Adam C.; Kosiborod, Mikhail; Amin, Amit P.; Reid, Kimberly J.; Alexander, Karen P.; Spertus, John A.; Masoudi, Frederick A.

    2011-01-01

    New onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) is independently associated with poor outcomes. Patterns of recovery from HAA after AMI and their association with mortality and health status are unknown. In the prospective 24-center TRIUMPH registry, we identified 530 AMI patients with HAA (defined as normal hemoglobin at admission with development of anemia by discharge) who had repeat, protocol-driven hemoglobin measurement 1 month after discharge. The 1-m...

  4. Educational Level and Long-term Mortality in Patients With Acute Myocardial Infarction.

    Science.gov (United States)

    Consuegra-Sánchez, Luciano; Melgarejo-Moreno, Antonio; Galcerá-Tomás, José; Alonso-Fernández, Nuria; Díaz-Pastor, Ángela; Escudero-García, Germán; Jaulent-Huertas, Leticia; Vicente-Gilabert, Marta

    2015-11-01

    The value of socioeconomic status as a prognostic marker in acute myocardial infarction is controversial. The aim of this study was to evaluate the impact of educational level, as a marker of socioeconomic status, on the prognosis of long-term survival after acute myocardial infarction. We conducted a prospective, observational study of 5797 patients admitted to hospital with acute myocardial infarction. We studied long-term all-cause mortality (median 8.5 years) using adjusted regression models. We found that 73.1% of patients had primary school education (n=4240), 14.5% had secondary school education (including high school) (n=843), 7.0% was illiterate (n=407), and 5.3% had higher education (n=307). Patients with secondary school or higher education were significantly younger, more were male, and they had fewer risk factors and comorbidity. These patients arrived sooner at hospital and had less severe heart failure. During admission they received more reperfusion therapy and their crude mortality was lower. Their drug treatment in hospital and at discharge followed guideline recommendations more closely. On multivariate analysis, secondary school or higher education was an independent predictor and protective factor for long-term mortality (hazard ratio=0.85; 95% confidence interval, 0.74-0.98). Our study shows an inverse and independent relationship between educational level and long-term mortality in patients with acute myocardial infarction. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

    Science.gov (United States)

    Dreyer, Rachel P; Dharmarajan, Kumar; Hsieh, Angela F; Welsh, John; Qin, Li; Krumholz, Harlan M

    2017-05-01

    Women have an increased risk of rehospitalization in the immediate postdischarge period; however, few studies have determined how readmission risk dynamically changes on a day-to-day basis over the full year after hospitalization by sex and how these differences compare with the risk for mortality. We identified >3 000 000 hospitalizations of patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia and estimated sex differences in the daily risk of rehospitalization/death 1 year after discharge from a population of Medicare fee-for-service beneficiaries aged 65 years and older. We calculated the (1) time required for adjusted rehospitalization/mortality risks to decline 50% from maximum values after discharge, (2) time required for the adjusted readmission risk to approach plateau periods of minimal day-to-day change, and (3) extent to which adjusted risks are greater among recently hospitalized patients versus Medicare patients. We identified 1 392 289, 530 771, and 1 125 231 hospitalizations for heart failure, acute myocardial infarction, and pneumonia, respectively. The adjusted daily risk of rehospitalization varied by admitting condition (hazard rate ratio for women versus men, 1.10 for acute myocardial infarction; hazard rate ratio, 1.04 for heart failure; and hazard rate ratio, 0.98 for pneumonia). However, for all conditions, the adjusted daily risk of death was higher among men versus women (hazard rate ratio women versus with men, <1). For both sexes, there was a similar timing of peak daily risk, half daily risk, and reaching plateau. Although the association of sex with daily risk of rehospitalization varies across conditions, women are at highest risk after discharge for acute myocardial infarction. Future studies should focus on understanding the determinants of sex differences in rehospitalization risk among conditions. © 2017 American Heart Association, Inc.

  6. Acute myocardial infarction and pulmonary tuberculosis in a young female patient: a case report

    OpenAIRE

    Bakalli, Aurora; Osmani, Behxhet; Kamberi, Lulzim; Pllana, Ejup

    2008-01-01

    Introduction Tuberculous coronaritis is known to be a very rare phenomenon, although Mycobacterium tuberculosis, as some other infectious agents, may also act in the coronary vessels by activating the inflammatory mechanism of atherosclerosis. The association between active pulmonary tuberculosis and acute myocardial infarction has not been reported for around three and a half decades. Case presentation We presented here a case of a young, 30 year old, Caucasian woman who presented to Emergen...

  7. Differences in Therapeutic Approach and Clinical Outcome in Patients over 70 Years with Acute Myocardial Infarction

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, H.; Charalampidi, K.; Kadlečková, A.; Ryšavá, D.; Velimský, T.; Ballek, J.; Hubač, J.; Janský, P.

    2007-01-01

    Roč. 9, č. 3 (2007), s. 183-183 ISSN 1748-2941. [Intensive Cardiac Care International Meeting /5./. 14.10.2007-16.10.2007, Tel Aviv] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * age * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  8. Possible Reasons for Worse Clinical outcome in Women with Acute Myocardial Infarction

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, H.; Charalampidi, K.; Kadlečková, A.; Ryšavá, D.; Velimský, T.; Ballek, J.; Hubač, J.; Janský, P.

    2007-01-01

    Roč. 9, č. 3 (2007), s. 183-183 ISSN 1748-2941. [Intensive Cardiac Care International Meeting /5./. 14.10.2007-16.10.2007, Tel Aviv] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * gender * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  9. Myocardial scintigraphy with gallium-67 in the detection of cardiac acute rejection

    International Nuclear Information System (INIS)

    Meneguetti, J.C.

    1990-01-01

    In order to evaluate the myocardial scintigraphy with Gallium-67 potentiality in the detection of acute rejection phenomenon, 105 studies were performed in 20 patients after they had a heart transplantation. The scintigraphic images were obtained by a conventional camera-computer system. These images were acquired 48 hours after all the patients were given an intravenous injection of 111 MBq of Gallium-67 Citrate. The biopsies were done according to the Mason technique and the histological analysis followed the Billingham standards. (author)

  10. A Lethal But Treatable Complication: Free Wall Rupture After Acute Myocardial Infarction

    OpenAIRE

    Ülgen, Mehmet S; Öztürk, Önder; Kayrak, Mehmet; Soylu, Ahmet; Düzenli, M Akif; Koç, Fatih

    2015-01-01

    A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. ...

  11. Approach to chest pain and acute myocardial infarction

    African Journals Online (AJOL)

    March 2016, Vol. 106, No. 3. Chest pain is a common cause for attendance at emer gency and primary care consultation rooms. The life time prevalence accounts for 20 ..... Pancreatitis. Cholecystitis. Cholangitis. Biliary colic. Peptic ulcer disease. Pulmonary. Acute pulmonary embolism. Pulmonary hypertension. Pneumonia.

  12. Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kathleen Stergiopoulos

    2008-12-01

    Full Text Available Kathleen Stergiopoulos1, Joseph J Brennan2, Robin Mathews1, John F Setaro2, Smadar Kort11Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA; 2Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT, USAAbstract: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.Keywords: acute myocardial infarction, anabolic steroid use, polycythemia

  13. The nursing care of nausea and vomiting occurred in interventional treatment for acute myocardial infarction

    International Nuclear Information System (INIS)

    Meng Qing'na; Li Guoqing; Bai Xiaodong

    2011-01-01

    Objective: To investigate the effective nursing measures of nausea and vomiting occurred in percutaneous coronary intervention for acute myocardial infarction. Methods: During the period from Jan. 2010 to Feb. 2011, percutaneous coronary intervention was carried out in 109 patients with acute myocardial infarction. Among the 109 patients, 21 developed nausea, 83 developed vomiting one to three times and 5 developed projectile vomiting for 4-5 times. For these patients the nursing assessment was conducted, while proper psychological care, symptomatic nursing, psychosomatic relaxation, guidance for vomiting posture, vomiting nursing, balanced replenishment of fluid, etc. were carried out in order to ensure the accomplishment of percutaneous coronary intervention. Results: After the employment of nursing measures, no recurrence of vomiting was seen in 21 patients, the percutaneous coronary intervention was uninterruptedly completed in 83 patients, and in five patients with severe vomiting the procedure was eventually accomplished. Conclusion: The effective nursing care of nausea and vomiting plays an important auxiliary role in performing percutaneous coronary intervention for acute myocardial infarction. (authors)

  14. Risk Factors for Senile Corneal Arcus in Patients with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mirnaghi Moosavi

    2010-01-01

    Full Text Available Purpose: To investigate the association between senile corneal arcus and atherosclerosis risk factors in patients with recent acute myocardial infarction. Methods: In this cross sectional study, atherosclerosis risk factors including fasting blood sugar, total cholesterol and triglyceride levels were measured in 165 patients with recent (less than three months′ duration acute myocardial infarction. Slitlamp examination was performed to detect corneal arcus. Associations between senile corneal arcus and atherosclerosis risk factors were assessed. Results: Overall, 165 patients including 100 male and 65 female subjects with mean age of 62±10.3 years were evaluated. In 122 patients (74%, variable degrees of corneal arcus were observed. The presence of corneal arcus was significantly associated with age (P = 0.03 and high levels of total cholesterol (over 200 mg/dl, P < 0.01. After adjusting for age, arcus was not associated with sex (P = 0.10, hypertriglyceridemia (P = 0.09, fasting blood sugar (P = 0.06, or systemic hypertension (P = 0.08. Conclusion: Our study revealed that corneal arcus is associated with age and hypercholesterolemia in patients with recent acute myocardial infarction. No association was detected with sex, fasting blood sugar, hypertension, and hypertriglyceridemia.

  15. Quality of life after acute myocardial infarction: A comparison of diabetic versus non-diabetic acute myocardial infarction patients in Quebec acute care hospitals

    Science.gov (United States)

    Simpson, Ewurabena; Pilote, Louise

    2005-01-01

    Background Previous studies have evaluated the individual effects of acute myocardial infarction (AMI) and diabetes mellitus on health-related quality of life outcomes (QOL). Due to the rising incidence of these comorbid conditions, it is important to examine the synergistic impact of diabetes mellitus and AMI on QOL. Methods In this study, we assessed using several previously validated questionnaires the QOL and functional status of 96 diabetic patients and 491 non-diabetic patients admitted to Quebec hospital sites with AMI between 1997 and 1998. We also conducted multivariate analyses to ascertain whether diabetes mellitus was an independent determinant of SF-36 physical functioning (PCS) and mental health (MCS) component score QOL outcomes after AMI. Results Both patient groups had similar baseline clinical characteristics, but diabetic patients had slightly higher rates of cardiac risk factors compared to non-diabetics. Overall, QOL measures were similar between both patient groups at baseline, but diabetic patients reported poorer functional status than non-diabetic patients. Over the study period, there were significant differences between the QOL and functional status of diabetic and non-diabetic populations. By one year, diabetic patients reported poorer QOL outcomes than non-diabetic patients. However, diabetic patients showed greater improvements in their functional status, but were less likely to return to work compared to non-diabetic patients. In contrast with these findings, our multivariate analyses showed that diabetes mellitus was not an independent determinant of QOL and functional status. Conclusion Our study findings suggest that diabetes mellitus is not an independent determinant of QOL after AMI. PMID:16329755

  16. Quality of life after acute myocardial infarction: A comparison of diabetic versus non-diabetic acute myocardial infarction patients in Quebec acute care hospitals

    Directory of Open Access Journals (Sweden)

    Pilote Louise

    2005-12-01

    Full Text Available Abstract Background Previous studies have evaluated the individual effects of acute myocardial infarction (AMI and diabetes mellitus on health-related quality of life outcomes (QOL. Due to the rising incidence of these comorbid conditions, it is important to examine the synergistic impact of diabetes mellitus and AMI on QOL. Methods In this study, we assessed using several previously validated questionnaires the QOL and functional status of 96 diabetic patients and 491 non-diabetic patients admitted to Quebec hospital sites with AMI between 1997 and 1998. We also conducted multivariate analyses to ascertain whether diabetes mellitus was an independent determinant of SF-36 physical functioning (PCS and mental health (MCS component score QOL outcomes after AMI. Results Both patient groups had similar baseline clinical characteristics, but diabetic patients had slightly higher rates of cardiac risk factors compared to non-diabetics. Overall, QOL measures were similar between both patient groups at baseline, but diabetic patients reported poorer functional status than non-diabetic patients. Over the study period, there were significant differences between the QOL and functional status of diabetic and non-diabetic populations. By one year, diabetic patients reported poorer QOL outcomes than non-diabetic patients. However, diabetic patients showed greater improvements in their functional status, but were less likely to return to work compared to non-diabetic patients. In contrast with these findings, our multivariate analyses showed that diabetes mellitus was not an independent determinant of QOL and functional status. Conclusion Our study findings suggest that diabetes mellitus is not an independent determinant of QOL after AMI.

  17. Population-based register of acute myocardial infarction: manual of operations

    DEFF Research Database (Denmark)

    Madsen, Mette; Gudnason, Vilmundur; Pajak, Andrzej

    2007-01-01

    Cardiovascular disease is the leading cause of death and hospitalization in both sexes in nearly all countries of Europe. The main forms of cardiovascular disease are ischaemic heart disease and stroke. The magnitude of the problem contrasts with the shortage, weak quality and comparability of data...... Set) to build up comparable and reliable indicators (attack rate and case fatality) for the surveillance of acute myocardial infarction/acute coronary syndrome at population level.This manual of operations is intended for health professionals and policy makers and provides a standardized and simple...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    the antiplatelet effect of aspirin and clopidogrel and evaluate platelet turnover in the acute phase of STEMI compared to a stable phase 3 months later. In this observational follow-up study on 48 STEMI patients transferred for PPCI, loading doses of aspirin (300 mg) and clopidogrel (600 mg) were given orally......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...

  19. Low-Intensity Pulsed Ultrasound Enhances Angiogenesis and Ameliorates Left Ventricular Dysfunction in a Mouse Model of Acute Myocardial Infarction.

    Science.gov (United States)

    Shindo, Tomohiko; Ito, Kenta; Ogata, Tsuyoshi; Hatanaka, Kazuaki; Kurosawa, Ryo; Eguchi, Kumiko; Kagaya, Yuta; Hanawa, Kenichiro; Aizawa, Kentaro; Shiroto, Takashi; Kasukabe, Sachie; Miyata, Satoshi; Taki, Hirofumi; Hasegawa, Hideyuki; Kanai, Hiroshi; Shimokawa, Hiroaki

    2016-06-01

    Left ventricular (LV) remodeling after acute myocardial infarction still remains an important issue in cardiovascular medicine. We have recently demonstrated that low-intensity pulsed ultrasound (LIPUS) therapy improves myocardial ischemia in a pig model of chronic myocardial ischemia through enhanced myocardial angiogenesis. In the present study, we aimed to demonstrate whether LIPUS also ameliorates LV remodeling after acute myocardial infarction and if so, to elucidate the underlying molecular mechanisms involved in the beneficial effects of LIPUS. We examined the effects of LIPUS on LV remodeling in a mouse model of acute myocardial infarction, where the heart was treated with either LIPUS or no-LIPUS 3 times in the first week (days 1, 3, and 5). The LIPUS improved mortality and ameliorated post-myocardial infarction LV remodeling in mice. The LIPUS upregulated the expression of vascular endothelial growth factor, endothelial nitric oxide synthase, phosphorylated ERK, and phosphorylated Akt in the infarcted area early after acute myocardial infarction, leading to enhanced angiogenesis. Microarray analysis in cultured human endothelial cells showed that a total of 1050 genes, including those of the vascular endothelial growth factor signaling and focal adhesion pathways, were significantly altered by the LIPUS. Knockdown with small interfering RNA of either β1-integrin or caveolin-1, both of which are known to play key roles in mechanotransduction, suppressed the LIPUS-induced upregulation of vascular endothelial growth factor. Finally, in caveolin-1-deficient mice, the beneficial effects of LIPUS on mortality and post-myocardial infarction LV remodeling were absent. These results indicate that the LIPUS therapy ameliorates post-myocardial infarction LV remodeling in mice in vivo, for which mechanotransduction and its downstream pathways may be involved. © 2016 American Heart Association, Inc.

  20. CARDIOPROTECTIVE ROLES OF THE CHINESE MEDICINAL FORMULA BAO-XIN-TANG ON ACUTE MYOCARDIAL INFARCTION IN RATS.

    Science.gov (United States)

    Wang, Yang; Wang, Weihao; Peng, Weijun; Liu, Weiping; Cai, Weijun; Xia, Zian; Zhang, Honggeng; Xing, And Zhihua

    2017-01-01

    Bao-Xin-Tang (BXT) is a traditional Chinese medicinal formula used for the treatment of coronary heart disease and known to have favorable therapeutic benefits. The current study was designed to determine whether BXT has a cardioprotective role for acute myocardial infarction. The underlying mechanisms were also explored. The Sprague-Dawley rat model of acute myocardial infarction was established by occluding the left anterior descending branch of the coronary artery. After a 3-h ischemic period, we determined the myocardial infarction size, inflammatory components, and antioxidant activities. The data showed that BXT could reduce the infarction size and lower the levels of C-reactive protein, interleukin-6, and myeloperoxidase, and increase the activities of superoxide dismutase and the anti-inflammatory cytokine, interleukin-10. These results indicate that administration of BXT, following acute myocardial infarction, could reduce infarct size. The effects of BXT may be related to its anti-inflammatory and anti-oxidative properties.

  1. An experimental study on the acute myocardial infarction with CT perfusion scans

    International Nuclear Information System (INIS)

    Liu Yuanjian; Yan Weiqiang; Wang Chenglin; Liu Pengcheng; Feng Xiaoyuan; Shen Tianzhen; Chen Xingrong

    2004-01-01

    Objective: To determine the reliability of CT perfusion scans and its parameters of γ-variate curve in evaluating the acute myocardial infarction for clinical reference of diagnosis on coronary artery disease and myocardial infarction. Methods: Imatron C-150 electron beam CT (EBCT) were used to scan a hydrodynamic model which could mimic a change of contrast medium by intravenous injection in vivo. Then 6 adult canines were employed in the experiment with thoracic operation, and branches of the anterior descending and circumflex of left coronary arteries (LCA) were ligated so that myocardial infarction was made out. After intravenous administration of contrast medium, the hearts were scanned with perfusion EBCT and γ-variate curves were manifested. Some heterogeneities and differentiations between the normality and the infarctions were put forward when the parameters of all these curves were analyzed and statistically processed. Two myocardial infarctions were also verified by SPECT, and all the samples stained with TTC method were compared with those on the perfusion images. The pathological study with optical microscope and electron microscope were further carried on. Results: The ascending slopes of γ-variate curves were different in the perfusion quantity. The normal curve of canine myocardium showed a somewhat quick ascending pattern first, and then a gradual descending pattern successively, with the ascending time of about 10-13 s, ascending CT value of about 34-37 HU, and peak CT value of about 70-81 HU. Whereas the curve on myocardial infarction demonstrated a prolonged ascending time of about 19.9 s, diminished ascending CT value of only about 20 HU, and peak CT value of about 53.8 HU, which were significantly different from the normality (P<0.05). Conclusion: There are some differences in γ-variate curves between normal myocardium and myocardial infarction, which can be detected by CT perfusion scan. (authors)

  2. Acute humanin therapy attenuates myocardial ischemia and reperfusion injury in mice.

    Science.gov (United States)

    Muzumdar, Radhika H; Huffman, Derek M; Calvert, John W; Jha, Saurabh; Weinberg, Yoni; Cui, Lingguang; Nemkal, Anjana; Atzmon, Gil; Klein, Laura; Gundewar, Susheel; Ji, Sang Yong; Lavu, Madhav; Predmore, Benjamin L; Lefer, David J

    2010-10-01

    Humanin (HN), an endogenous antiapoptotic peptide, has previously been shown to protect against Alzheimer's disease and a variety of cellular insults. We evaluated the effects of a potent analog of HN (HNG) in an in vivo murine model of myocardial ischemia and reperfusion. Male C57BL6/J mice (8 to 10 week old) were subjected to 45 minutes of left coronary artery occlusion followed by a 24-hour reperfusion. HNG or vehicle was administered IP 1 hour prior or at the time of reperfusion. The extent of myocardial infarction per area-at-risk was evaluated at 24 hours using Evans Blue dye and 2-3-5-triphenyl tetrazolium chloride staining. Left ventricular function was evaluated at 1 week after ischemia using high-resolution, 2D echocardiography (VisualSonics Vevo 770). Myocardial cell signaling pathways and apoptotic markers were assessed at various time points (0 to 24 hours) following reperfusion. Cardiomyocyte survival and apoptosis in response to HNG were assessed in vitro. HNG reduced infarct size relative to the area-at-risk in a dose-dependent fashion, with a maximal reduction at the dose of 2 mg/kg. HNG therapy enhanced left ventricular ejection fraction and preserved postischemic left ventricular dimensions (end-diastolic and end-systolic), resulting in improved cardiac function. Treatment with HNG significantly increased phosphorylation of AMPK and phosphorylation of endothelial nitric oxide synthase in the heart and attenuated Bcl-2-associated X protein and B-cell lymphoma-2 levels following myocardial ischemia and reperfusion. HNG improved cardiomyocyte survival and decreased apoptosis in response to daunorubicin in vitro. These data show that HNG provides cardioprotection in a mouse model of myocardial ischemia and reperfusion potentially through activation of AMPK-endothelial nitric oxide synthase-mediated signaling and regulation of apoptotic factors. HNG may represent a novel agent for the treatment of acute myocardial infarction.

  3. Prior exercise training does not prevent acute cardiac alterations after myocardial infarction in female rats

    Directory of Open Access Journals (Sweden)

    Eduardo C. A. Veiga

    2011-01-01

    Full Text Available OBJECTIVE: This study aimed to investigate whether previous exercise training could prevent or attenuate acute cardiac alterations after myocardial infarction. METHODS: Female rats were submitted to swim training (1 h/day; 5 days/week or allowed to remain sedentary for 8 weeks. Afterwards, they were randomly assigned to left coronary artery occlusion or sham surgery. After this procedure, the rats remained sedentary for one week until euthanasia. Cardiac structural and functional analyses were performed using Doppler echocardiography. The rats that had a moderate or large infarct size were included in the evaluations. The data (mean + SEM were analyzed using a two-way ANOVA model followed byTukey's post-hoc test. RESULTS: After the surgery, no significant difference between the exercise and sedentary groups was observed in the left ventricular infarct sizes (34.58 + 3.04 vs. 37.59 + 3.07. In another group of rats evaluated with Evans blue 1 h after myocardial infarction, no siginificant difference in the area at risk was observed between the exercised and sedentary rats (49.73 + 1.52 vs. 45.48 + 3.49. The changes in the left ventricular fractional areas for the exercised and sedentary myocardial infarction groups (36 + 2% and 39 + 3%, respectively were smaller than those for the exercise sham surgery (ES, 67+1% and sedentary sham surgery (SS, 69 + 2% groups. The E/A was higher in the sedentary myocardial infarction (4.4 + 0.3 and exercised myocardial infarction (5.5 + 0.3 rats than in the SS (2.4 + 0.1 and ES (2.2 + 0.1 rats. CONCLUSION: Previous swim training of female rats does not attenuate systolic and diastolic function alterations after myocardial infarction induced by left coronary artery occlusion, suggesting that cardioprotection cannot be provided by exercise training in this experimental model.

  4. Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Claudia Caminha Escosteguy

    Full Text Available CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2. 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4. The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0. Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9 of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6; beta-blockers in 49.0% (95% CI 43.8 to 54.1; angiotensin-converting enzyme (ACE inhibitors in 63.3% (95% CI 58.2 to 68.1; nitrates in 82.0% (95% CI 82.4 to 89.6; heparin in 81.3% (95% CI 76.9 to 85.0; calcium antagonists in 30.5% (95% CI 26.0 to 35.4. There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and

  5. Hearts deficient in both Mfn1 and Mfn2 are protected against acute myocardial infarction.

    Science.gov (United States)

    Hall, A R; Burke, N; Dongworth, R K; Kalkhoran, S B; Dyson, A; Vicencio, J M; Dorn, G W; Yellon, D M; Hausenloy, D J

    2016-05-26

    Mitochondria alter their shape by undergoing cycles of fusion and fission. Changes in mitochondrial morphology impact on the cellular response to stress, and their interactions with other organelles such as the sarcoplasmic reticulum (SR). Inhibiting mitochondrial fission can protect the heart against acute ischemia/reperfusion (I/R) injury. However, the role of the mitochondrial fusion proteins, Mfn1 and Mfn2, in the response of the adult heart to acute I/R injury is not clear, and is investigated in this study. To determine the effect of combined Mfn1/Mfn2 ablation on the susceptibility to acute myocardial I/R injury, cardiac-specific ablation of both Mfn1 and Mfn2 (DKO) was initiated in mice aged 4-6 weeks, leading to knockout of both these proteins in 8-10-week-old animals. This resulted in fragmented mitochondria (electron microscopy), decreased mitochondrial respiratory function (respirometry), and impaired myocardial contractile function (echocardiography). In DKO mice subjected to in vivo regional myocardial ischemia (30 min) followed by 24 h reperfusion, myocardial infarct size (IS, expressed as a % of the area-at-risk) was reduced by 46% compared with wild-type (WT) hearts. In addition, mitochondria from DKO animals had decreased MPTP opening susceptibility (assessed by Ca(2+)-induced mitochondrial swelling), compared with WT hearts. Mfn2 is a key mediator of mitochondrial/SR tethering, and accordingly, the loss of Mfn2 in DKO hearts reduced the number of interactions measured between these organelles (quantified by proximal ligation assay), attenuated mitochondrial calcium overload (Rhod2 confocal microscopy), and decreased reactive oxygen species production (DCF confocal microscopy) in response to acute I/R injury. No differences in isolated mitochondrial ROS emissions (Amplex Red) were detected in response to Ca(2+) and Antimycin A, further implicating disruption of mitochondria/SR tethering as the protective mechanism. In summary, despite apparent

  6. Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats

    Energy Technology Data Exchange (ETDEWEB)

    Nunez, Wilson Ranu Ramirez; Ozaki, Michiko Regina; Vinagre, Adriana Mendes; Collares, Edgard Ferro; Almeida, Eros Antonio de, E-mail: erosaa@cardiol.br [Universidade Estadual de Campinas, Campinas, SP (Brazil)

    2015-02-15

    In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABA{sub B} receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABA{sub B} receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABA{sub B} receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.

  7. Selective Blockade of Periostin Exon 17 Preserves Cardiac Performance in Acute Myocardial Infarction.

    Science.gov (United States)

    Taniyama, Yoshiaki; Katsuragi, Naruto; Sanada, Fumihiro; Azuma, Junya; Iekushi, Kazuma; Koibuchi, Nobutaka; Okayama, Keita; Ikeda-Iwabu, Yuka; Muratsu, Jun; Otsu, Rei; Rakugi, Hiromi; Morishita, Ryuichi

    2016-02-01

    We previously reported that overexpression of full-length periostin, Pn-1, resulted in ventricular dilation with enhanced interstitial collagen deposition in a rat model. However, other reports have documented that the short-form splice variants Pn-2 (lacking exon 17) and Pn-4 (lacking exons 17 and 21) promoted cardiac repair by angiogenesis and prevented cardiac rupture after acute myocardial infarction. The apparently differing findings from those reports prompted us to use a neutralizing antibody to selectively inhibit Pn-1 by blockade of exon 17 in a rat acute myocardial infarction model. Administration of Pn neutralizing antibody resulted in a significant decrease in the infarcted and fibrotic areas of the myocardium, which prevented ventricular wall thinning and dilatation. The inhibition of fibrosis by Pn neutralizing antibody was associated with a significant decrease in gene expression of fibrotic markers, including collagen I, collagen III, and transforming growth factor-β1. Importantly, the number of α-smooth muscle actin-positive myofibroblasts was significantly reduced in the hearts of animals treated with Pn neutralizing antibody, whereas cardiomyocyte proliferation and angiogenesis were comparable in the IgG and neutralizing antibody groups. Moreover, the level of Pn-1 expression was significantly correlated with the severity of myocardial infarction. In addition, Pn-1, but not Pn-2 or Pn-4, inhibited fibroblast and myocyte attachment, which might account for the cell slippage observed during cardiac remodeling. Collectively, these results indicate that therapeutics that specifically inhibit Pn exon-17, via a neutralizing antibody or drug, without suppressing other periostin variants might offer a new class of medication for the treatment of acute myocardial infarction patients. © 2015 American Heart Association, Inc.

  8. [Association between biochemical markers and left ventricular dysfunction in the ST-elevation acute myocardial infarction].

    Science.gov (United States)

    de Abreu, Maximiliano; Mariani, Javier; Guridi, Cristian; González-Villa-Monte, Gabriel; Gastaldello, Natalio; Potito, Mauricio; Reyes, Graciela; Antonietti, Laura; Tajer, Carlos

    2014-01-01

    The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. With an observational and prospective design we included patients with less than 24h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P=.005), peak creatine-phosphokinase-MB (P=.01), leukocyte count (P=.001) and glucose (P=.033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P=.01) and peak creatine-phosphokinase-MB (P=.02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  9. Markers of Autolysis in Acute ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Maharjan, P; Manandhar, R; Xu, W; Ma, S; Han, W; Liu, Y; Zhou, Y; Rijal, Y; Sun, C; Yuan, Z

    2015-01-01

    The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary. We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease. MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01. MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.

  10. Different patients, different outcomes: A case-control study of spontaneous coronary artery dissection versus acute coronary syndrome.

    Science.gov (United States)

    Adams, Heath; Paratz, Elizabeth; Somaratne, Jithendra; Layland, Jamie; Burns, Andrew; Palmer, Sonny; MacIsaac, Andrew; Whitbourn, Robert

    2018-02-01

    There is progressive interest worldwide in spontaneous coronary artery dissection (SCAD). To identify a SCAD cohort and compare risk factors, presentation, and management outcomes compared to acute coronary syndrome (ACS) matched controls. Retrospective analysis was performed from 2000 to 2015. Clinical data included a neuropsychiatric history, with management and clinical outcomes assessed at 12 months. Patients were matched on a 1:3 case-control basis according to type of ACS. Twenty-two SCAD patients were matched to 66 controls by ACS type (ST-elevation myocardial infarction 45%, Non-ST-elevation myocardial infarction 41%, unstable angina 14%). The SCAD group were more likely female (77.3% vs 19.7%, P SCAD patients had a high prevalence of anxiety, depression or previous neuropsychiatric history (52.4% SCAD vs 1.5% ACS, P SCAD patients (13.6% SCAD vs 83.3% ACS, P SCAD vs 27.3% ACS P = NS). SCAD affects young females with a paucity of cardiovascular risk factors. The major risk factor for SCAD was a history of anxiety, depression, or neuropsychiatric illness. A conservative approach to SCAD revascularization led to similar MACCE when compared to ACS controls undergoing guideline revascularization at 12 months. © 2017, Wiley Periodicals, Inc.

  11. Timing of ischemic onset estimated from the electrocardiogram is better than historical timing for predicting outcome after reperfusion therapy for acute anterior myocardial infarction: a DANish trial in Acute Myocardial Infarction 2 (DANAMI-2) substudy

    DEFF Research Database (Denmark)

    Sejersten, Maria; Ripa, Rasmus S; Grande, Peer

    2007-01-01

    BACKGROUND: Acute treatment strategy and subsequently prognosis are influenced by the duration of ischemia in patients with ST-elevation acute myocardial infarction (AMI). However, timing of ischemia may be difficult to access by patient history (historical timing) alone. We hypothesized that an ...

  12. [Myocardial infarction related to sport. Acute clinical and coronary angiographic characteristics in 16 cases].

    Science.gov (United States)

    Halna du Fretay, X; Akoudad, H; Nejjari, M; Benamer, H

    2013-12-01

    Determination of clinical and angiographic characteristics of myocardial infarctions related to sport. Retrospective study of acute coronary syndromes with ST elevation related to sport treated with interventional cardiology from 2006 to 2013. Sixteen patients were included. They are mostly men (15/16), aged 24-65 years (over 35 years old in 13 cases) with few cardiovascular risk factors, most frequently heredity or smoking. Myocardial infarctions usually occur during the practice of sports (13/16), with serious rhythmic complications in three of the cases. On angiography, most patients have single vessel disease (12/16). Myocardial infarction related to sports affects a male population aged over 35 years old with few cardiovascular risk factors, most often single vessel disease, making the preventative screening uneasy. Other studies investigating larger populations, assessing previous clinical events (symptoms, results of stress tests), evaluating the impact of competition and integrating sudden deaths would improve the screening and the treatment of sport-related myocardial infarctions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  13. The relationship between coronary stenosis severity and compression type coronary artery movement in acute myocardial infarction.

    Science.gov (United States)

    Chan, Kim H; Chawantanpipat, Chirapan; Gattorna, Tim; Chantadansuwan, Thamarath; Kirby, Adrienne; Madden, Ann; Keech, Anthony; Ng, Martin K C

    2010-04-01

    Acute myocardial infarction is thought to occur at sites of minor coronary stenosis. Recent data challenge this and also propose a role for coronary artery movement (CAM) in plaque instability. We examined the relationship between coronary stenosis severity, CAM pattern, and infarct-related lesions (IRLs) in acute myocardial infarction. We investigated 203 consecutive patients with ST-segment elevation myocardial infarction after successful fibrinolysis. Quantitative coronary angiography, CAM pattern, and extent score (atheroma burden) analysis was performed for each coronary artery segment. The IRL stenosis was at least moderate (>50%) and severe (>70%) in 78% and 31% of patients, respectively. Culprit arteries were associated with higher atheroma extent scores (25.2 vs 21.6, P 70% vs Compression CAM was also strongly associated with culprit segments (OR 3.4, 95% CI 2.6-4.5, P compression CAM and stenosis severity were strongly correlated, with the likelihood of a coronary segment having compression CAM progressively increasing with worsening stenosis (OR 56.4, 95% CI 37.9-83.8, P 70% vs relationship between stenosis severity and IRLs. Our study also raises the hypothesis that compression CAM may accelerate atherosclerosis and predispose to plaque vulnerability. Copyright 2010 Mosby, Inc. All rights reserved.

  14. [Unilateral acute pulmonary edema and ischemic myocardial process: a case report].

    Science.gov (United States)

    Bentaleb, A; Tagu, P; Vascaut, L

    2008-08-01

    Unilateral acute pulmonary oedema (APO) is a rare radioclinical finding. It occurs secondary to multiple specific and rare pathological processes. Functional ischemic mitral regurgitation (FIMR) secondary to myocardial necrosis is one of the rare aetiologies involved in its pathogenesis. This concerns a 94-year-old male patient with a history of myocardial infarction who presented with a clinical picture of unilateral APO secondary to functional mitral regurgitation as a complication of myocardial necrosis. In addition to the clinical presentation and unilateral radiological findings, the diagnosis was based essentially on the electrocardiographic tracing, as well as changes in cardiac enzyme levels and transthoracic echocardiogram coupled with Doppler tissue imaging. This resulted after ruling out many differential diagnoses. Unilateral APO secondary to functional mitral regurgitation often presents diagnostic challenges and problems of initial management for the clinician. There are multiple aetiologies of acute unilateral pulmonary oedema, namely mechanical (re-expansion), lesional, vascular, bronchial obstructions, as well as iatrogenic causes, as is the case with some lung transplantations. As with all cases of APO, the treatment is based mainly on diuretics with high-flow oxygen therapy in association with an anticoagulant, which is usually effectively combined with a platelet aggregation inhibiting drug and sometimes with vasodilators and beta-blockers. Surgical treatment with valvuloplasty or valvular replacement appears to be the most effective means for preventing relapse.

  15. Four-year prognosis of 254 patients after acute myocardial infarction

    International Nuclear Information System (INIS)

    Nishimura, Tohru; Taya, Makoto; Sasaki, Akira; Shimoyama, Katsuya; Mizuno, Haruyoshi; Tahara, Yorio; Ono, Akifumi; Okada, Michio; Ishikawa, Kyozo

    1994-01-01

    The present study was undertaken to determine whether left ventricular diastolic function can be used as a measure for assessing prognosis of patients with acute myocardial infarction. The subjects were 254 patients who had Tc-99m gated blood pool scintigraphy within one month after the onset of myocardial infarction and could be followed up for the subsequent 4 years. The following indices for left ventricular diastolic function were calculated from the time activity curve of the left ventricle: time to peak filling, time to peak filling/t, peak filling rate, peak filling rate/t, 1/3 filling rate/t, and time per beat. On the basis of the morphology of the time activity curve and the primary differential curve, left ventricular diastolic function was visually assessed as normal (Group 0, n=30), slightly decreased (Group 1, n=98), moderately decreased (Group 2, n=81) and severely decreased (Group 3, n=45). The incidences of cardiac failure and cardiac death were remarkably increased when left ventricular ejection fraction (LVEF) was less than 30%. The incidence of cardiac failure tended to be increased in patients with severer diastolic function; it was remarkably high in Group 3. Cardiac failure was more often associated with more decreased diastolic function, even if LVEF was 40% or more. These findings suggest that left ventricular diastolic function may be helpful for assessing prognosis of acute myocardial infarction. (N.K.)

  16. Nobiletin attenuates adverse cardiac remodeling after acute myocardial infarction in rats via restoring autophagy flux.

    Science.gov (United States)

    Wu, Xiaoqian; Zheng, Dechong; Qin, Yuyan; Liu, Zumei; Zhang, Guiping; Zhu, Xiaoyan; Zeng, Lihuan; Liang, Zhenye

    2017-10-14

    Our previous study showed that autophagy flux was impaired with sustained heart ischemia, which exacerbated adverse cardiac remodeling after acute myocardial infarction (AMI). Here we investigated whether Nobiletin, a citrus polymethoxylated flavonoids, could restore the autophagy flux and improve cardiac prognosis after AMI. AMI was induced by ligating left anterior descending (LAD) coronary artery in rats. Nobiletin improved the post-infarct cardiac dysfunction significantly and attenuated adverse cardiac remodeling. Meanwhile, Nobiletin protected H9C2 cells against oxygen glucose deprivation (OGD) in vitro. The impaired autophagy flux due to ischemia was ameliorated after Nobiletin treatment by testing the autophagy substrate, LC3BⅡ and P62 protein level both in vivo and in vitro. GFP-mRFP-LC3 adenovirus transfection also supported that Nobiletin restored the impaired autophagy flux. Specifically, the autophagy flux inhibitor, chloroquine, but not 3 MA, alleviated Nobiletin-mediated protection against OGD. Notably, Nobiletin does not affect the activation of classical upstream autophagy signaling pathways. However, Nobiletin increased the lysosome acidation which also supported that Nobiletin accelerated autophagy flux. Taken together, our findings suggested that Nobiletin restored impaired autophagy flux and protected against acute myocardial infarction, suggesting a potential role of autophagy flux in Nobiletin-mediated myocardial protection. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Present treatment of acute myocardial infarction in patients over 75 years--data from the Berlin Myocardial Infarction Registry (BHIR).

    Science.gov (United States)

    Schuler, Jochen; Maier, Birga; Behrens, Steffen; Thimme, Walter

    2006-07-01

    Guidelines issued by European and German cardiology societies clearly define procedures for treatment of acute myocardial infarction (AMI). These guidelines, however, are based on clinical studies in which older patients are underrepresented. Older patients, on the other hand, represent a large and growing portion of the infarction population. It was our goal in the present paper to analyse the present treatment of AMI patients over 75 years of age in the city of Berlin, Germany, with data gained from the Berlin Myocardial Infarction Registry (BHIR). We prospectively collected data from 5079 patients (3311 men and 1768 women, mean age 65.6) with acute myocardial infarction who were treated in 25 hospitals in Berlin during the period 1999-2003. 1319 patients (25.9%) were older than 75 (mean age 82.5 years). Overall hospital mortality rate was 11.6%. In patients over 75, this rate was 23.9%; among the younger infarction population, it was 7.3%. In contrast to the younger AMI patients, the majority of those over 75 were female (62.5 vs 25.1% for the younger) and demonstrated a significantly higher frequency of all prognostically meaningful comorbidities (heart failure 14.4% vs. 3.5%; renal failure 11.5 vs 3.9%; diabetes 37.3 vs 24.3%). Clinical signs of severe infarction, moreover, were more common among the aged patients (pulmonary congestion 45.4 vs 19.7%; left bundle branch block 12.7 vs 3.6%). Pre-hospital time was prolonged (2.8 vs 2 h) and guideline-recommended therapy was applied significantly less frequently to AMI patients over 75 (reperfusion therapy 39.8 vs 71.7%, beta-blockers 62.8 vs 78.3%, statins 26.5 vs 45.5%). Multivariate analysis revealed the following factors to be independent predictors of hospital mortality in patients over 75: age (OR 1.05 per year), acute heart failure (OR 2.39), pre-hospital resuscitation (OR 10.6), cardiogenic shock (OR 2.73), pre-hospital delay >12 h (OR 1.68), and ST elevation in the first ECG (OR 2.09). Independent

  18. [Significance of acute-phase inflammatory reactants as an indicator of prognosis after acute myocardial infarction: which is the most useful predictor?].

    Science.gov (United States)

    Katayama, Toshiro; Nakashima, Hiroshi; Yonekura, Tsuyoshi; Honda, Yukiharu; Suzuki, Shin; Yano, Katsusuke

    2003-08-01

    To investigate the relationship between representative acute-phase inflammatory reactants [highly sensitive C-reactive protein (hsCRP), serum amyloid A protein (SAA) and interleukin-6 (IL-6)] and the severity of acute myocardial infarction and patient prognosis, and to identify the most useful predictor of the three. This study investigated 132 consecutive patients admitted within 8 hr of onset of first acute myocardial infarction and successfully reperfused with primary percutaneous coronary intervention. Acute-phase (= 24 hr from onset) blood samples were taken for evaluation of inflammatory reactants (hsCRP, SAA and IL-6), and peak creatine phosphokinase levels were measured every 4 hr after admission for 48 hr to assess myocardial infarction infarct size. Left ventriculography was performed in the chronic stage (20 +/- 9 days post-admission) to analyze left ventricular ejection fraction and regional wall motion, using Killip's classification to determine acute myocardial infarction severity. Logistic regression analysis was used to quantify the usefulness of the reactants as predictors of patient prognosis. Both hsCRP and SAA showed significant positive correlations with peak creatine phosphokinase. hsCRP and SAA showed significant inverse correlations with left ventricular ejection fraction and regional wall motion in the chronic stage. Multivariate analysis identified SAA as the best predictor of severe heart failure (Killip's classification III, IV). SAA was the best predictor of a major cardiac event (shock, cardiac death). These results suggest a strong correlation between acute-phase SAA and the clinical course of patient outcomes after acute myocardial infarction, such as cardiac function, heart failure and cardiac death. SAA may be the most useful acute-phase inflammatory reactant for predicting the prognosis after acute myocardial infarction.

  19. Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST-Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications.

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Ahmed, Nadeem; Rauhalammi, Samuli; Clerfond, Guillaume; Carberry, Jaclyn; Mordi, Ify; McEntegart, Margaret; Petrie, Mark C; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, M Mitchell; Mahrous, Ahmed; Welsh, Paul; Sattar, Naveed; Ford, Ian; Oldroyd, Keith G; Radjenovic, Aleksandra; Berry, Colin

    2016-02-23

    The time course and relationships of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction (STEMI) are uncertain. Patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [IQR] 0.0-5.6%), 7.0% (IQR 4.9-7.5%), and 4.1% (IQR 2.6-5.5%; Pmyocardial edema (percentage of left ventricular mass) in all patients (P=0.001) and for infarct zone edema (T2, in ms: 62.1 [SD 2.9], 64.4 [SD 4.9], 65.9 [SD 5.3]; Pmyocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [SD 4.6]; Pmyocardial hemorrhage (P=0.001) but not in patients without hemorrhage (P=0.377). The temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion. URL: https://clinicaltrials.gov/. Unique identifier: NCT02072850. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

    International Nuclear Information System (INIS)

    Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

    2006-01-01

    Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

  1. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

    DEFF Research Database (Denmark)

    McMurray, John; Solomon, Scott; Pieper, Karen

    2006-01-01

    failure, most treated with an ACE inhibitor). One of the main active controlled trials was confounded by a blood pressure difference between treatments. METHODS: We compared the effects of captopril, valsartan, and their combination on atherosclerotic events in 14,703 patients randomized in the Valsartan...... in Acute Myocardial Infarction Trial (VALIANT). RESULTS: The number of individuals adjudicated as having a fatal or non-fatal MI in the captopril group was 559 (total investigator reported events 798), 587 (796) in the valsartan group, and 554 (756) in the combination group; valsartan versus captopril, p...... = 0.651 (0.965); combination versus captopril, p = 0.187 (0.350). Overall, all atherosclerotic events examined occurred at a similar frequency in the captopril and valsartan groups. CONCLUSIONS: Angiotensin receptor blockers appear to be as effective as ACE inhibitors in reducing atherosclerotic...

  2. Functional engineered human cardiac patches prepared from nature's platform improve heart function after acute myocardial infarction.

    Science.gov (United States)

    Wang, Qingjie; Yang, Hui; Bai, Aobing; Jiang, Wei; Li, Xiuya; Wang, Xinhong; Mao, Yishen; Lu, Chao; Qian, Ruizhe; Guo, Feng; Ding, Tianling; Chen, Haiyan; Chen, Sifeng; Zhang, Jianyi; Liu, Chen; Sun, Ning

    2016-10-01

    With the advent of induced pluripotent stem cells and directed differentiation techniques, it is now feasible to derive individual-specific cardiac cells for human heart tissue engineering. Here we report the generation of functional engineered human cardiac patches using human induced pluripotent stem cells-derived cardiac cells and decellularized natural heart ECM as scaffolds. The engineered human cardiac patches can be tailored to any desired size and shape and exhibited normal contractile and electrical physiology in vitro. Further, when patching on the infarct area, these patches improved heart function of rats with acute myocardial infarction in vivo. These engineered human cardiac patches can be of great value for normal and disease-specific heart tissue engineering, drug screening, and meet the demands for individual-specific heart tissues for personalized regenerative therapy of myocardial damages in the future. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. MR study of acute myocardial infarction with injection of Gd-DOTA (Fifteen patients)

    International Nuclear Information System (INIS)

    Richoz, B.; Delcour, C.; Depelchin, P.; Lenaers, A.; Jacquemin, C.; Gusella, P.; Struyven, J.; Richoz, B.

    1990-01-01

    We studied 15 patients 4 to 8 days after myocardial infarction by using ECG gated MR before and after administration of 0.2 mmol/kg Gd-DOTA. The diagnosis in each patient was confirmed by electrocardiographic criteria, elevated levels of fractionated creatine kinase (CK) isoenzyme, thallium scintigraphy, ventriculography and coronarography. T1-weighted, spin-echo images, were obtained before and immediately after injection of Gd-DOTA and were repeated 15 min later. The site of infarction was visualized in 10 patients as an area of high signal intensity after the injection of Gd-DOTA. Contrast between normal and infarcted myocardium was greatest 15 min after injection. Three patients were excluded because of failure to acquire adequate MR studies. In 2 other patients, the infarct were not detected. Before injection of Gd-DOTA, only 2 infarcts were detected. These results suggest that Gd-DOTA can improve MR visualization and detection of acute myocardial infarction [fr

  4. [Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis].

    Science.gov (United States)

    Capilla-Geay, E; Poyet, R; Brocq, F X; Pons, F; Kerebel, S; Foucault, G; Jego, C; Cellarier, G R

    2016-05-01

    Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  5. Do you know them when you see them? Women's prodromal and acute symptoms of myocardial infarction.

    Science.gov (United States)

    McSweeney, J C; Cody, M; Crane, P B

    2001-04-01

    This study described women's prodromal and acute symptoms associated with myocardial infarction (MI) based on interviews with 76 women who had experienced an MI in the previous year. Sixty-eight women experienced prodromal symptoms including unusual fatigue (70%), shortness of breath (53%), and pain in the shoulder blade/upper back (47%). All women experienced acute symptoms including chest pain/discomfort (90%), unusual fatigue (59%), shortness of breath (59%), and shoulder blade/upper back discomfort (42%). Although women in this study reported numerous prodromal symptoms, none had received a new diagnosis of coronary heart disease (CHD) prior to MI. Practitioners must develop an awareness of and a more comprehensive approach to treating women at risk for CHD. Further research to elucidate prodromal and acute symptom clusters is needed to assist practitioners in early diagnosis of CHD in women.

  6. Transforming growth factor β receptor 1 is a new candidate prognostic biomarker after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Devaux Yvan

    2011-12-01

    Full Text Available Abstract Background Prediction of left ventricular (LV remodeling after acute myocardial infarction (MI is clinically important and would benefit from the discovery of new biomarkers. Methods Blood samples were obtained upon admission in patients with acute ST-elevation MI who underwent primary percutaneous coronary intervention. Messenger RNA was extracted from whole blood cells. LV function was evaluated by echocardiography at 4-months. Results In a test cohort of 32 MI patients, integrated analysis of microarrays with a network of protein-protein interactions identified subgroups of genes which predicted LV dysfunction (ejection fraction ≤ 40% with areas under the receiver operating characteristic curve (AUC above 0.80. Candidate genes included transforming growth factor beta receptor 1 (TGFBR1. In a validation cohort of 115 MI patients, TGBFR1 was up-regulated in patients with LV dysfunction (P Conclusions We identified TGFBR1 as a new candidate prognostic biomarker after acute MI.

  7. Acute Simultaneous Thrombotic Occlusion of Multiple Coronary Arteries in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Daei

    2017-05-01

    Full Text Available Introduction Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI, and has a high mortality rate. Case Presentation We report a case of myocardial infarction with cardiogenic shock, left bundle branch block, and multiple ST segment elevation on the electrocardiogram and thrombotic occlusion of the left circumflex, optus marginal, and left anterior descending arteries on emergency coronary angiography. Thrombus aspiration was performed at left circumflex, optus marginal, and left anterior descending arteries. Conclusions In patients with STEMI, multiple coronary thrombosis is unusual and associated with high patient mortality.

  8. The impact of winter cold weather on acute myocardial infarctions in Portugal

    International Nuclear Information System (INIS)

    Vasconcelos, João; Freire, Elisabete; Almendra, Ricardo

    2013-01-01

    Mortality due to cardiovascular diseases shows a seasonal trend that can be associated with cold weather. Portugal is the European country with the highest excess winter mortality, but nevertheless, the relationship between cold weather and health is yet to be assessed. The main aim of this study is to identify the contribution of cold weather to cardiovascular diseases within Portugal. Poisson regression analysis based on generalized additive models was applied to estimate the influence of a human-biometeorological index (PET) on daily hospitalizations for myocardial infarction. The main results revealed a negative effect of cold weather on acute myocardial infarctions in Portugal. For every degree fall in PET during winter, there was an increase of up to 2.2% (95% CI = 0.9%; 3.3%) in daily hospital admissions. This paper shows the need for public policies that will help minimize or, indeed, prevent exposure to cold. -- Highlights: ► We model the relationship between daily hospitalizations due to myocardial infarctions and cold weather in Portugal. ► We use Physiological Equivalent temperature (PET) as main explanatory variable. ► We adjust the models to confounding factors such as influenza and air pollution. ► Daily hospitalizations increased up to 2.2% per degree fall of PET during winter. ► Exposure to cold weather has a negative impact on human health in Portugal. -- There is an increase of up to 2.2% in daily hospitalizations due to acute myocardial infarctions per degree fall of thermal index during the winter months in Portugal

  9. Nationwide claims data validated for quality assessments in acute myocardial infarction in the Netherlands.

    Science.gov (United States)

    Eindhoven, D C; van Staveren, L N; van Erkelens, J A; Ikkersheim, D E; Cannegieter, S C; Umans, V A W M; Mosterd, A; van Wijngaarden, J; Schalij, M J; Borleffs, C J W

    2018-01-01

    Since health insurance is compulsory in the Netherlands, the centrally registered medical claims data might pose a unique opportunity to evaluate quality of (cardiac) care on a national level without additional collection of data. However, validation of these claims data has not yet been assessed. Retrospective cohort study. National claims data ('national registry') were compared with data collected by patient records reviews in four representative hospitals ('validation registry'). In both registries, we extracted the national diagnosis codes for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction of 2012 and 2013. Additionally, data on medication use at one year after acute myocardial infarction (AMI) was extracted from the Dutch pharmacy information systems and also validated by local patient records reviews. The data were compared at three stages: 1) validation of diagnosis and treatment coding; 2) validation of the hospital where follow-up has taken place; 3) validation of follow-up medical treatment after 365 days. In total, 3,980 patients ('national registry') and 4,014 patients ('validation registry') were compared at baseline. After one-year follow-up, 2,776 and 2,701 patients, respectively, were evaluated. Baseline characteristics, diagnosis and individual medication were comparable between the two registries. Of all 52,672 AMI patients in the Netherlands in 2012 and 2013, 81% used aspirin, 76% used P2Y12 inhibitors, 85% used statins, 82% used beta-blockers and 74% angiotensin converting enzyme inhibitors/angiotensin II antagonists. Optimal medical treatment was achieved in 49% of the patients with AMI. Nationwide routinely collected claims data in patients with an acute myocardial infarction are highly accurate. This offers an opportunity for use in quality assessments of cardiac care.

  10. Quantification of microvascular obstruction in acute myocardial infarction using cardiac MRI

    International Nuclear Information System (INIS)

    Nassenstein, Kai; Waltering, K.; Hollenhorst, M.; Schlosser, T.; Bruder, O.; Hunold, P.; Barkhausen, J.

    2009-01-01

    Purpose: Microvascular obstruction (MO) and the extent of infarction are important prognostic factors in acute myocardial infarction. Our study aimed to investigate the effect of the time interval between contrast administration and image acquisition on the quantification of microvascular obstruction and myocardial infarction. Materials and methods: 50 consecutive patients with acute myocardial infarction (40 male, mean age 58.1 ± 11.7 years) treated by percutaneous coronary revascularization resulting in a grade 3 flow according to the thrombolysis in myocardial infarction flow classification were examined on a 1.5 T MR scanner within the first 5 days after infarction. 2, 5, 10, and 20 minutes after I.V. administration of 0.2 mmol/kg per kg body weight of Gadodiamid (Omniscan trademark GE Healthcare Buchler, Germany), a single shot IR-SSFP sequence (TR 2.4 ms, TE 1.08 ms, TI l80-280 ms, FA50 ) covering the entire left ventricle was acquired. Areas of MO and myocardial infarction were measured for all times after contrast injection (p.i.). Results: MO was detected in 32 of 50 patients two minutes p.i., while 23 patients showed evidence of MO (p = 0.002) 20 min. p.i. In all patients with MO, the extent of MO decreased over time (7.4±9.0% of the LV myocardium 2 min. p.i. vs. 2.4±4.6% 20min. p.i. p<0.0001). The area of myocardial infarction increased from 13.9 ± 13.5%2min. p.i. to 18.6±14.2% l0min. p.i. (p < 0.0001), and then remained unchanged (18.7 ± 14.3% at 20 min. p = 0.57). Conclusion: Our study shows that the time delay between contrast media injection and image acquisition has a significant impact on the delimitable extent of MO and infarct size. (orig.)

  11. Evaluation of the differences of myocardial fibers between acute and chronic myocardial infarction: Application of diffusion tensor magnetic resonance imaging INA Rhesus monkey model

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yu Qing; Cai, Wei; Wang, Lei; Xia, Rui; Chen, Wei; Zheng, Jie [Dept. of Radiology, West China Hospital, Sichuan University, Sichuan (China); Gao, Fabao [Mallinckrodt Institute of Radiology, School of Medicine, Washington University, St. Louis (United States)

    201