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Sample records for acute st elevation

  1. Inflammatory markers in ST-elevation acute myocardial infarction.

    Science.gov (United States)

    Seropian, Ignacio M; Sonnino, Chiara; Van Tassell, Benjamin W; Biasucci, Luigi M; Abbate, Antonio

    2016-08-01

    After acute myocardial infarction, ventricular remodeling is characterized by changes at the molecular, structural, geometrical and functional level that determine progression to heart failure. Inflammation plays a key role in wound healing and scar formation, affecting ventricular remodeling. Several, rather different, components of the inflammatory response were studied as biomarkers in ST-elevation acute myocardial infarction. Widely available and inexpensive tests, such as leukocyte count at admission, as well as more sophisticated immunoassays provide powerful predictors of adverse outcome in patients with ST-elevation acute myocardial infarction. We review the value of inflammatory markers in ST-elevation acute myocardial infarction and their association with ventricular remodeling, heart failure and sudden death. In conclusion, the use of these biomarkers may identify subjects at greater risk of adverse events and perhaps provide an insight into the mechanisms of disease progression.

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

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    A. L. Alyavi

    2016-01-01

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

  3. CLINICAL ASPECTS OF PATIENT SELECTION FOR CORONARY ANGIOGRAPHY IN NON-ST ELEVATION ACUTE CORONARY SYNDROME

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    K. A. Kireev

    2015-01-01

    Full Text Available Own clinical experience in the selection of patients with non-ST elevation acute coronary syndrome for coronary angiography based on clinical guidelines of the European Society of Cardiology (2011 is presented.

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

    DEFF Research Database (Denmark)

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita;

    2013-01-01

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

  5. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    DEFF Research Database (Denmark)

    Dankiewicz, J; Nielsen, N; Annborn, M;

    2015-01-01

    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required - ST......-segment deviation and/or T-wave inversion - in TC whereas in acute anterior STEMI, ECGs had to meet STEMI criteria. In the majority of these studies, patients of both genders were used even though TC predominantly occurs in women. The aim of this study is to see whether TC can be distinguished from acute anterior...... STEMI in a predominantly female study population where all patients meet STEMI-criteria. METHODS: Retrospective analysis of the ST-segment changes was done on the triage ECGs of 37 patients with TC (34 female) and was compared to the triage ECGs of 103 female patients with acute anterior STEMI...

  7. Management of non ST segment elevation acute coronary syndromes: A shift in the paradigm

    Institute of Scientific and Technical Information of China (English)

    Jean-Pierre Bassand

    2008-01-01

    @@ The new European guidelines on the management of non-ST segment elevation acute coronary syndromes (NSTE-ACS) were published in June 2007, two months before the American College of Cardiology-American Heart Association (ACC-AHA) guideline update on the same topic.1'2

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    Ticagrelor, when compared with clopidogrel, reduced the 12-month risk of vascular death/myocardial infarction and stroke in patients with ST-elevation acute coronary syndromes intended to undergo primary percutaneous coronary intervention in the PLATelet inhibition and patient Outcomes (PLATO) tr...

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

    OpenAIRE

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

    2013-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

  12. Transient ST-segment elevation in precordial leads by acute marginal branch occlusion during stent implantation.

    Science.gov (United States)

    Arzola, Leidimar Carballo; Esteban, Marcos T Rodríguez; Niebla, Javier García

    2016-01-01

    The isolated right ventricular infarction is a rare entity. Our case presented a selective occlusion of an acute marginal branch that supplies the right ventricular free wall with isolated ST elevation in precordial leads simulating an occlusion of the left anterior descending artery and without pseudonormalization in inferior due to the non-involvement of the main branch in the ischemic process. Our case clearly illustrates a rare differential diagnosis when a new ST segment elevation appears in earlier precordial leads in patients with symptoms of myocardial ischemia.

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

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2006-01-01

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

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

    OpenAIRE

    Markandeya Rao; Ravindra Kumar; Nanditha

    2015-01-01

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

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

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    Petrović Milovan

    2006-01-01

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

  16. Correlation of platelet count and acute ST-elevation in myocardial infarction.

    Science.gov (United States)

    Paul, G K; Sen, B; Bari, M A; Rahman, Z; Jamal, F; Bari, M S; Sazidur, S R

    2010-07-01

    The role of platelets in the pathogenesis of ST-elevation myocardial infarction (STEMI) has been substantiated by studies that demonstrated significant clinical benefits associated with antiplatelet therapy. Initial platelet counts in Acute Myocardial Infarction (AMI) may be a useful adjunct for identifying those patients who may or may not respond to fibrinolytic agents. Patient with acute STEMI has variable level of platelet count and with higher platelet count have poor in hospital outcome. There are many predictors of poor outcome in Acute Myocardial Infarction (AMI) like cardiac biomarkers (Troponin I, Troponin T and CK-MB), C-Reactive Protien (CRP) and WBC (White Blood Cell) counts. Platelet count on presentation of STEMI is one of them. Higher platelet count is associated with higher rate of adverse clinical outcome in ST-Elevation Myocardial Infarction (STEMI), like heart failure, arrhythmia, re-infarction & death. So, categorization of patient with STEMI on the basis of platelet counts may be helpful for risk stratification and management of these patients.

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

    Institute of Scientific and Technical Information of China (English)

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Ramazan Akdemir; Ekrem Yeter; (O)zlem Karakurt; Salih Orcan; Nihat Karakoyunlu; Mustafa Mucahit Balci; Levent Sa(g)nak; Hamit Ersoy; Mehmet Bulent Vatan; Harun Kilic

    2012-01-01

    Acute ST elevation myocarclial infarction has high mortality and morbidity rates.The majority of patients with this condition face erectile dysfunction in addition to other health problems,In this study,we aimed to investigate the effects of two different reperfusion strategies,primary angioplasty and thrombolytic therapy,on the prevalence of erectile dysfunction after acute myocardial infarction.Of the 71 patients matching the selection criteria,45 were treated with primary coronary angioplasty with stenting,and 26 were treated with thrombolytic agents.Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event.The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction.The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008).In conclusion,this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence,and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

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

    Directory of Open Access Journals (Sweden)

    C.S. Thejanandan Reddy

    2013-07-01

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

  1. Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation

    NARCIS (Netherlands)

    L.M. Dijksman; A. Hirsch; F. Windhausen; F.F. Asselman; J.G.P. Tijssen; M.G.W. Dijkgraaf; R.J. de Winter

    2009-01-01

    AIMS: The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    BACKGROUND: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay......). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. METHOD: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009...... for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. CONCLUSIONS: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2...

  3. Cardiac hemodynamics in men versus women during acute ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Dreyer, Rachel P; Beltrame, John F; Neil, Christopher; Air, Tracy; Tavella, Rosanna; Hoffmann, Bernadette; Pati, Purendra K; Di Fiore, David; Arstall, Margaret; Zeitz, Christopher

    2013-07-15

    Several biologic and clinical factors contribute to the increased 30-day mortality and re-infarction rate in women with ST-segment elevation myocardial infarction (STEMI). Sex differences in cardiac hemodynamic parameters such as pulmonary capillary wedge pressure (PCWP) have not been examined and might play an important role. The objectives of the present study were to examine whether female sex is an independent determinant of PCWP during acute STEMI and whether an elevated PCWP contributes to all-cause 30-day mortality and re-infarction in women. The clinical, angiographic, and hemodynamic features of 470 consecutive patients with STEMI (n = 135 women) undergoing emergency coronary angiography with right-side heart catheterization were evaluated with respect to sex. Women had an elevated PCWP (20 ± 8 vs 16 ± 7 mm Hg, p infarct size (β = 0.001, 95% CI 0.001 to 0.002, p ≤0.001) were independent predictors of an elevated PCWP. Female sex exerted a minor independent effect on 30-day mortality and re-infarction (odds ratio 2.36, 95% CI 1.25 to 4.46, p = 0.008). However, once PCWP was entered into the mediation model, sex was no longer significant, suggesting that the effect of sex on the post-STEMI outcomes is potentially mediated through PCWP (odds ratio 1.07, 95% CI 1.02 to 1.12, p = 0.011). In conclusion, during acute STEMI, women have greater left ventricular filling pressures compared with men, independent of age, hypertension, and infarct size. The biologic explanation for this difference requires additional investigation, although it does not appear to contribute to the increased 30-day mortality and re-infarction rate observed in women.

  4. Characteristics and prognostic importance of ST-segment elevation on Holter monitoring early after acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1995-01-01

    The correlation between episodes of ST-segment elevation on Holter monitoring, clinical characteristics, left ventricular function, exercise testing, and long-term prognosis was determined in 123 consecutive patients 55 +/- 8 years old (mean +/- SD) with a first acute myocardial infarction (AMI......). During 36 hours of Holter recording 11 +/- 5 days after AMI, 11 patients (9%) had 91 episodes of ST-segment elevation (group 1), whereas 112 patients had no such episodes (group 2). Most episodes of ST-segment elevation occurred in leads with pathologic Q waves or small, indistinct R waves. Large......) of follow-up, an association between episodes of ST-segment elevation on Holter monitoring and (1) cardiac death (Kaplan-Meier analysis; p

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

    Directory of Open Access Journals (Sweden)

    Markandeya Rao

    2015-12-01

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

  6. Pro-oxidant HDL predicts poor outcome in patients with ST-elevation acute coronary syndrome.

    Science.gov (United States)

    Distelmaier, Klaus; Schrutka, Lore; Seidl, Veronika; Winter, Max P; Wurm, Raphael; Mangold, Andreas; Perkmann, Thomas; Maurer, Gerald; Adlbrecht, Christopher; Lang, Irene M

    2015-07-01

    Oxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro-oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutaneous coronary intervention for STE-ACS. Patients were stratified as by a pro-oxidant serum HDL oxidant index (HOI≥ 1) or with an antioxidant serum HOI (HOL< 1) capacity. Multivariate regression analysis was used to relate HOI to survival. The median follow-up time was 23 months (IQR 14.4-40.0 months). Pro-oxidant HDL was observed in 44.1 % of STE-ACS patients and was independently associated with all-cause mortality with a hazard ratio of 3.30(95 %CI 1.50-7.27, p = 0.003). Mortality rates were higher in patients with baseline pro-oxidant HDL compared to patients with preserved HDL function at 30 days (11.9 % vs 2.2 %, p=0.002), and at 4 years (22.9 % vs 8.7 %, p=0.002). Elevated neutrophil counts were a strong and independent predictor for pro-oxidant HDL with an odds ratio per standard deviation of 1.50 (95 %CI 1.11-2.03, p=0.008), as was history of prior acute myocardial infarction, elevated triglycerides levels and reduced glomerular filtration rate. In conclusion, pro-oxidant HDL represents a strong and independent predictor of long-term as well as short-term all-cause mortality in STE-ACS patients. Elevated neutrophil counts predicted the presence of serum pro-oxidant HDL. The maintenance of HDL functions might be a promising therapeutic target in STE-ACS patients.

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

    Institute of Scientific and Technical Information of China (English)

    段晓霞

    2013-01-01

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

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

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    Tai-lian HONG

    2016-06-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevskiy

    2015-12-01

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

  11. Scavenger receptor A index and coronary thrombus in patients with acute ST elevation myocardial infarction.

    Science.gov (United States)

    Emura, Iwao; Usuda, Hiroyuki; Fujita, Toshio; Ebe, Katsuya; Nagai, Tsuneo

    2011-06-01

    To examine the relationship between the scavenger receptor A (SRA) index (the number of SRA+ cells observed in 10 high power fields of peripheral blood (PB) smear samples; normal upper limit <30) and coronary thrombus, 389 thrombi obtained from 393 patients with acute ST elevation myocardial infarction were examined. Thrombi were classified into platelets (PT), mixed (MT), fibrin-rich (FT) and organizing thrombi (OT); 387, 269, 57 and 29 cases were detected, respectively. Patients were divided into group A (PT only, 89 cases), B (containing MT and PT but not FT, 243 cases), and C (containing FT, 57 cases). SRA+ cells had infiltrated into all FT cases and 147 of the 269 MT, but no PT. At hospitalization, the SRA index exceeded 30 in 276 patients. PT was observed in 274 cases, and MT and FT (residual mural thrombus; RMT) observed in 230. Infarct-related coronary artery was thought to be totally and rapidly occluded by PT that had formed as a result of severe stenosis due to extrusion of plaque content or growth of RMT. An abnormal increase of SRA+ cells is considered to be a useful finding to detecting the presence of PT and, probably, RMT.

  12. Methylphenidatinduceret ST-elevations-myokardieinfarkt

    DEFF Research Database (Denmark)

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

    2012-01-01

    Adult attention deficit and hyperkinetic disorder (ADHD) is increasingly diagnosed and treated with methylphenidate. We present the case of an 20 year-old man, who was diagnosed with ADHD and suffered a ST elevation acute myocardial infarction due to coronary vasospasm related to an overdose...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张大鹏

    2014-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  16. Sudden cardiac death after acute ST elevation myocardial infarction: insight from a developing country

    Science.gov (United States)

    Rao, Hygriv B; Sastry, B K S; Korabathina, Radhika; Raju, Krishnam P

    2012-01-01

    Background There is no data concerning sudden cardiac death (SCD) following acute ST elevation myocardial infarction (STEMI) in India. We assessed the incidence and factors influencing SCD following STEMI. Methods Patients with STEMI admitted in our hospital from 2006 to 2009 were prospectively entered into a database. In the period 2010–2011, patients or their kin were periodically contacted and administered a questionnaire to ascertain their survival, and mode of death if applicable. Results Study population comprised of 929 patients with STEMI (mean age 55±17 years) having a mean follow-up of 41±16 months. The total number of deaths was 159, of which 78 were SCD (mean age 62.2±10 years). The cumulative incidence of total deaths and SCD at 1 month, 1, 2, 3 years and at conclusion of the study was 10.1%, 13.2%, 14.6%, 15.8%, 17.3% and 4.9%, 6.5%, 8.0%, 8.9% and 9.7%, respectively. The temporal distribution of SCD was 53.9% at first month, 19.2% at 1 month to 1 year, 15.4% in 1–2 years, 7.6% in 2–3 years and 3.8% beyond 3 years. Comparison between SCD and survivor cohorts by multivariate analysis showed five variables were found to be associated with SCD (age p=0.0163, female gender p=0.0042, severe LV dysfunction p=0.0292, absence of both reperfusion and revascularisation p=0.0373 and lack of compliance with medications p <0.0001). Conclusions SCD following STEMI accounts for about half of the total deaths. It involves younger population and most of these occur within the first month. This data has relevance in prioritising healthcare strategies in India. PMID:27326036

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-01-15

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

  18. Acute management of unstable angina and non-ST segment elevation myocardial infarction.

    Science.gov (United States)

    Silva, Fernando Morita Fernandes; Pesaro, Antonio Eduardo Pereira; Franken, Marcelo; Wajngarten, Mauricio

    2015-01-01

    Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high. PMID:26466065

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Alok; Deshpande; Yochai; Birnbaum

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    S. Rafla

    2016-07-01

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

  2. Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Ersbøll, Mads; Køber, Lars;

    2016-01-01

    OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF....... Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression......, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002). CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion...

  3. 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;

    2016-01-01

    patients to either acute or subacute CAG (i.e. 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...... randomized to subacute CAG it was two days. Time from randomization to initial revascularization was 1.3 h versus 2.4 days, and the median hospital stay was 4.0 days versus 4.5 days. Among patients randomized to subacute CAG, 17% crossed over to acute CAG and 5% developed STEMI before catheterization......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...

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

    Directory of Open Access Journals (Sweden)

    Ivanović Miloš

    2013-01-01

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

  5. Age-dependent differences in diabetes and acute hyperglycemia between men and women with ST-elevation myocardial infarction: a cohort study

    NARCIS (Netherlands)

    Otten, A.M.; Ottervanger, J.P.; Timmer, J.R.; Hof, A.W. van 't; Dambrink, J.H.; Gosselink, A.M.; Hoorntje, J.C.A.; Suryapranata, H.; Maas, A.H.E.M.

    2013-01-01

    BACKGROUND: Both acute hyperglycemia as diabetes results in an impaired prognosis in ST-elevation myocardial infarction (STEMI) patients. It is unknown whether there is a different prevalence of diabetes and acute hyperglycemia in men and women within age-groups. METHODS: Between 2004 and 2010, 4640

  6. PHARMACOTHERAPY ANALYSIS OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN HOSPITALS OF VARIOUS TYPES

    Directory of Open Access Journals (Sweden)

    R. M. Magdeev

    2011-01-01

    Full Text Available Aim. To evaluate pharmacotherapy of ST-elevation myocardial infarction (STEMI in cardiology departments of Saratov hospitals of various types. Material and methods. The retrospective pharmacoepidemiological study was carried out with involved of 424 hospital charts of STEMI patients, discharged during the year from the cardiology department of Saratov municipal hospital (MH; n=216 and emergency cardiology department of Saratov clinical hospital (CH; n=208. Results. The real practice in the audited hospitals are not fully consistent with current guidelines for the STEMI patients management. The relationship between guidelines compliance and hospital type is clearly seen. Doctors in MH in comparison with them in CH more often prescribed respiratory analeptics (13.4% vs 5.3% , respectively, metabolic drugs (63.4% vs 37.5%, respectively and rarer used beta-blockers (50% vs 88.9%, respectively and thrombolytic therapy (3.7% vs 51%, respectively. In MH dipyridamole was used in 9.6% of patients as an alternative to the acetylsalicylic acid, and clopidogrel was not prescribed. At the same hospital clotting time was determined for monitoring of heparin therapy. Statins were rare used in both hospitals (26% in MH vs 40% in CH. Conclusion. The real clinical practice of STEMI patients management in Saratov hospitals are not completely consistent with current clinical guidelines. There are differences in STEMI patients therapy depending on hospital type.

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

    Science.gov (United States)

    Dauerman, Harold L; Sobel, Burton E

    2012-08-01

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

  8. EPC mobilization after erythropoietin treatment in acute ST-elevation myocardial infarction: the REVEAL EPC substudy

    Science.gov (United States)

    Povsic, Thomas J.; Najjar, Samer S.; Prather, Kristi; Zhou, Jiying; Adams, Stacie D.; Zavodni, Katherine L.; Kelly, Francine; Melton, Laura G.; Hasselblad, Vic; Heitner, John F.; Raman, Subha V.; Barsness, Gregory W.; Patel, Manesh R.; Kim, Raymond J.; Lakatta, Edward G.; Harrington, Robert A.; Rao, Sunil V.

    2014-01-01

    Erythropoietin (EPO) was hypothesized to mitigate reperfusion injury, in part via mobilization of endothelial progenitor cells (EPCs). The REVEAL trial found no reduction in infarct size with a single dose of EPO (60,000 U) in patients with ST-segment elevation myocardial infarction. In a substudy, we aimed to determine the feasibility of cryopreserving and centrally analyzing EPC levels to assess the relationship between EPC numbers, EPO administration, and infarct size. As a prespecified substudy, mononuclear cells were locally cryopreserved before as well as 24 and 48–72 h after primary percutaneous coronary intervention. EPC samples were collected in 163 of 222 enrolled patients. At least one sample was obtained from 125 patients, and all three time points were available in 83 patients. There were no significant differences in the absolute EPC numbers over time or between EPO- and placebo-treated patients; however, there was a trend toward a greater increase in EPC levels from 24 to 48–72 h postintervention in patients receiving ≥30,000 U of EPO (P = 0.099 for CD133+ cells, 0.049 for CD34+ cells, 0.099 for ALDHbr cells). EPC numbers at baseline were inversely related to infarct size (P = 0.03 for CD133+ cells, 0.006 for CD34+ cells). Local whole cell cryopreservation and central EPC analysis in the context of a multicenter randomized trial is feasible but challenging. High-dose (≥30,000 U) EPO may mobilize EPCs at 48–72 h, and baseline EPC levels may be inversely associated with infarct size. PMID:23700090

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

    Science.gov (United States)

    Lindow, Thomas; Pahlm, Olle; Nikus, Kjell

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

  11. Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Fernando Bassan

    2016-01-01

    Full Text Available Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS. Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225 and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p 72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002, BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001 and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049 were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    姚怡

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张优

    2014-01-01

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

  16. Cystatin C for enhancement of risk stratification in non-ST elevation acute coronary syndrome patients with an increased troponin T.

    NARCIS (Netherlands)

    Windhausen, F.; Hirsch, A.; Fischer, J.; Zee, P.M. van der; Sanders, G.T.; Straalen, J.P. van; Cornel, J.H.; Tijssen, J.G.P.; Verheugt, F.W.A.; Winter, R.J. de

    2009-01-01

    BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective in

  17. Cystatin C for Enhancement of Risk Stratification in Non-ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

    NARCIS (Netherlands)

    F. Windhausen; A. Hirsch; J. Fischer; P.M. van der Zee; G.T. Sanders; J.P. van Straalen; J.H. Cornel; J.G.P. Tijssen; F.W.A. Verheugt; R.J. de Winter

    2009-01-01

    BACKGROUND: We assessed the value of cystatin C for improvement of risk stratification in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective in

  18. A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome : results of the ELISA-2 trial

    NARCIS (Netherlands)

    Rasoul, S; Ottervanger, JP; de Boer, MJ; Miedema, K; Hoorntje, JCA; Gosselink, M; Zijlstra, F; Suryapranata, H; van 't Hof, AWJ; Dambrink, Jan Hendrik Everwijn

    2006-01-01

    Aims To compare dual vs. triple antiplatelet pre-treatment in patients with non-ST-elevation acute coronary syndrome (NSTE ACS) who were planned for early catheterization. Methods and results A total of 328 consecutive patients with NSTE ACS were included and were randomized to pre-treatment with du

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

    NARCIS (Netherlands)

    T. Bauer (Timm); H. Möllmann (Helge); F. Weidinger (Franz); U. Zeymer (Uwe); R. Seabra-Gomes (Ricardo); F.R. Eberli (Franz Robert); P.W.J.C. Serruys (Patrick); A. Vahanian (Alec); S. Silber (Sigmund); W. Wijns (William); M. Hochadel (Matthias); H.M. Nef (Holger); C.W. Hamm (Christian); J. Marco (Jean); A.K. Gitt (Anselm)

    2010-01-01

    textabstractBackground: The most recent ESC guidelines for percutaneous coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa inhibitors (GPI) in high risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known about th

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-06-15

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

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

    International Nuclear Information System (INIS)

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

  3. 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.

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    Science.gov (United States)

    Hajizadeh, Reza; Ghaffari, Samad; Salehi, Rezvanieh; Mazani, Sarvin; Aghavali, Sharmin

    2016-01-01

    Introduction: Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment. The aim of this study was to evaluate the effect of on admission serum UA level on the mortality and morbidity of patients admitted with STEMI. Methods: A number of 608 patients with STEMI were enrolled in this study from December 21, 2012 until February 19, 2014. Patients were followed for 20 months. Male to female ratio was 2.53, and the mean age of patients was 62.6±13.4. The relationship between the level of UA and patients’ mortality and morbidity, left ventricular ejection fraction (LVEF), atrial and ventricular arrhythmia was analyzed. Results: Patients with high serum UA level had higher Killip class after STEMI (P=0.001). Mean LVEF was measured to be 39.5±9.6 in normal UA group and 34.6±11.6 in high UA group (P=0.001). In comparison with normal UA group, high UA group had significantly higher cTnI (2.68±0.09 vs 4.09±0.42, respectively, P=0.001), increased blood pressure (P=0.009), and higher atrial fibrillation (AF) occurrence (P=0.03), but no association was seen between ventricular tachycardia and serum UA level. Short term and midterm mortality were not different in two groups (P=0.44 and 0.31, respectively). Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI) was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF. PMID:27489597

  7. ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?

    Institute of Scientific and Technical Information of China (English)

    SONG Guang-yuan; YANG Yue-jin; XU Bo; LI Jian-jun; GAO Run-lin; QIAO Shu-bin; YUAN Jin-qing; TANG Yi-da; YOU Shi-jie; PEI Han-jun; ZHAO Zhen-yan; WANG Xi-mei; WU Yong-jian

    2009-01-01

    Background ST-elevated acute myocardial infarction (STEAMI) happening in the first month post percutaneous coronary intervention (PCI) is almost related to acute thrombosis or subacute thrombosis in-stents. This study aimed to investigate the possible causes of myocardial infarction one month later. Methods Patients who had a history of successful PCI, and received coronary angiography or re-PCI due to STEAMI were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and acute results of last PCI were recorded. If the AMI-related lesion was localized in-stents or at the edge of stents (distance apart from the edge <5 mm), it was defined to be late thrombosis; otherwise as a new-lesion induced AMI. Results One hundred and ninety-two patients aged 40-79 years were included in this study. New lesions, as the cause of STEAMI, were found in 144 patients (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). Almost all newly built thromboses were found at the sites of previous insignificant lesions (diameter stenosis <50%). There was a significant difference in the average time from previous PCI to AMI ((30.1+12.4) vs (20.3+11.9) months) between the two groups. Diabetes mellitus (DM) and drug-eluting stent (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted Logistic regression (hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.1-10.9 and 5.3, 95% CI 1.1-26.5). Conclusions STEAMIs happening 1 month after PCI are more likely to develop from previous insignificant lesion rupture than from late thrombosis in-stents. Moreover, DM and DES are associated with the high incidence of latethrombosis, which may indicate that intensive antiplatelet therapy should be considered in patients with diabetes.

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

    Directory of Open Access Journals (Sweden)

    Vibeke N. Ritschel

    2014-01-01

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

  9. 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...

  10. The Biochemical Aspects of a Non-ST-Segment Elevation Acute Coronary Syndrome

    NARCIS (Netherlands)

    Riezebos, R.K.; Verheugt, F.W.A.; Laarman, G.J.; Tijssen, J.G.P.

    2012-01-01

    The clinical course of an acute coronary syndrome can vary from relatively benign to potentially fatal. The biomarkers of myocardial necrosis relate to the amount of myocardial damage and are closely linked to a patient's prognosis. They are measured to help guide management decisions. Recent intere

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    叶明

    2014-01-01

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

  13. No beneficial effects of coronary thrombectomy on left ventricular systolic and diastolic function in patients with acute S-T elevation myocardial infarction: a randomized clinical trial

    DEFF Research Database (Denmark)

    Andersen, Niels Holmark; Karlsen, Finn Michael; Gerdes, Christian;

    2007-01-01

    OBJECTIVE: We sought to evaluate the effect of acute coronary thrombectomy, as adjunctive treatment to primary percutaneous coronary intervention, on the systolic and diastolic left ventricular function, in patients with acute S-T elevation myocardial infarction. METHODS: In a prospective...... randomized study, patients with acute S-T elevation myocardial infarction were randomized to treatment with primary percutaneous coronary intervention with or without thrombectomy. Outcome measures were left ventricular volumes and ejection fraction in addition to systolic long-axis function, estimated from...... the tissue Doppler systolic velocities of the mitral ring. Diastolic function was assessed by mitral inflow and diastolic velocities of the mitral ring movement. RESULTS: Of the 215 patients included, 172 patients (80%) had a 30-day follow-up. There were no significant differences in ejection fraction...

  14. Enoxaparin injection for the treatment of high-risk patients with non-ST elevation acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Caroline Schmidt-Lucke

    2007-05-01

    Full Text Available Caroline Schmidt-Lucke, Heinz-Peter SchultheissCharité Medical University Berlin, Campus Benjamin Franklin, Dept. of Cardiology and Pulmology, GermanyAbstract: Non-ST elevation acute coronary syndrome (NSTE-ACS refers to a cardiovascular disorder characterized by intracoronary thrombus formation on a disrupted atherosclerotic plaque with partial or transient occlusion. Generation of thrombin resulting from exposure of collagen leads to activation of platelets and conversion of fibrinogen to fibrin, thus forming a platelet-rich thrombus. The main therapeutic objective is to protect the patient from thrombotic complications, independent of the choice of antithrombotic agents. The management of NSTE myocardial infarction (MI is constantly evolving. For primarily conservative strategy, enoxaparin has been proven superior to unfractioned heparin (UFH. With early invasive strategy providing better clinical outcome compared with conservative strategy, the effectiveness of enoxaparin in reducing death and MI rates is now being reconsidered in the era of poly-pharmacotherapy, early percutaneous coronary interventions and drug eluting stents. Bleeding complications can be minimized by avoiding cross-over from UFH to enoxaparin or vice versa, or by reducing the dosage of enoxaparin. We review the studies of enoxaparin and discuss its current role in the contemporary treatment of NSTE-ACS.Keywords: low-molecular weight heparin, NSTEMI, treatment

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

    KAUST Repository

    Ammirati, Enrico

    2013-05-09

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

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

    Directory of Open Access Journals (Sweden)

    Hai DONG

    2016-06-01

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

  17. A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Chun-Peng MA; Xiao WANG; Qing-Sheng WANG; Xiao-Li LIU; Xiao-Nan HE; Shao-Ping NIE

    2016-01-01

    ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

  18. Long-term Prognosis of Patients with Acute non-ST-segment Elevation Myocardial Infarction undergoing Different Treatment Strategies

    Directory of Open Access Journals (Sweden)

    Bo Zhang

    2015-01-01

    Full Text Available Background: In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI and characterized the patients selected for an invasive approach. Methods: A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy (586 patients and invasive strategy (390 patients group. Unified follow-up questionnaire was performed by telephone contact (cut-off date was November, 2013. The long-term clinical events were analyzed and related to the different treatment strategies. Results: The median follow-up time was 29 months. Mortality was 28.7% (n = 168 in the conservative group and 2.1% (n = 8 in the invasive management at long-term clinical follow-up. The secondary endpoint (the composite endpoint was 59.0% (n = 346 in the conservative group and 30.3% (n = 118 in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management (adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]: 3.796-16.006, P < 0.001, and the similar result was also seen in the secondary endpoint (adjusted RR = 2.102; 95% CI: 1.694-2.610, P < 0.001. In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score (TRS, log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients (TRS 3-7. Conclusions: An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones (TRS 3-7.

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

    OpenAIRE

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

    2013-01-01

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

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Atla Bhagya Lakshmi

    2011-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    OpenAIRE

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

    2010-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Reza Hajizadeh

    2016-06-01

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

  8. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Høfsten, Dan Eik; Kelbæk, Henning; Helqvist, Steffen;

    2015-01-01

    BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring...... in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain. STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies...... in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end...

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

    OpenAIRE

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Wong Dennis TL

    2011-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  12. Acute Coronary Syndrome and ST Segment Monitoring.

    Science.gov (United States)

    Carey, Mary G

    2016-09-01

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

  13. Prevalence and prognostic implications of ST-segment deviations from ambulatory Holter monitoring after ST-segment elevation myocardial infarction treated with either fibrinolysis or primary percutaneous coronary intervention (a Danish Trial in Acute Myocardial Infarction-2 Substudy)

    DEFF Research Database (Denmark)

    Idorn, Lars; Høfsten, Dan Eik; Wachtell, Kristian;

    2007-01-01

    Ambulatory Holter monitoring has been shown to be useful in stratifying cardiovascular risk after acute myocardial infarction. However, it remains unclear whether ST-segment deviations might predict clinical outcomes in a population treated with primary percutaneous coronary intervention (PCI......) compared with thrombolysis. Holter monitoring was initiated at discharge from ST-segment elevation myocardial infarction in 958 patients followed for 2,773 patient-years, randomized to immediate revascularization with either fibrinolysis (n=474) or PCI (n=484). The primary end point was all-cause mortality...

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  20. Nível de NT-proBNP em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST NT-proBNP levels in patients with non-ST-segment elevation acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Luiz Ricardo A. Castro

    2011-12-01

    Full Text Available FUNDAMENTO: A síndrome coronariana aguda (SCA sem supradesnivelamento do segmento ST (SCASEST está associada ao supradesnivelamento do peptídeo natriurético tipo B (BNP e aos marcadores de necrose miocárdica, embora se desconheça a correlação dessa síndrome ao escore de trombólise no infarto do miocárdio (TIMI e à função ventricular esquerda. OBJETIVO: Avaliar a correlação entre os níveis do fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP e os marcadores de necrose miocárdica (creatinofosfoquinase fração músculo-cérebro CK-MB e troponina I, bem como entre o escore de risco TIMI e a fração de ejeção do ventrículo esquerdo (FEVE nos pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST. MÉTODOS: Oitenta e sete pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST foram divididos em dois grupos: 37 (42,5% com angina instável e 50 (57,5% com infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST. RESULTADOS: A fração de ejeção do ventrículo esquerdo superior a 40% foi encontrada em 86,2% do total da amostra. Os níveis séricos de NT-proBNP foram maiores em pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST, em comparação àqueles com angina instável (pBACKGROUND: Non-ST-segment elevation acute coronary syndrome is associated with elevation of brain natriuretic peptide and markers of myocardial necrosis, although its relationship with the TIMI score and left ventricular function are largely unknown. OBJECTIVE: To evaluate the correlation between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP and markers of myocardial necrosis [creatine phosphokinase muscle-brain fraction (CK-MB and troponin I], TIMI risk score and left ventricular ejection fraction in patients with non-ST-segment elevation acute coronary syndrome. METHODS: Eighty-seven patients with non-ST-segment elevation acute

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

    Science.gov (United States)

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

    1997-06-15

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  3. Safety and efficacy of dalteparin in percutaneous coronary intervention in Chinese patients with non-ST-elevation acute coronary artery syndromes: comparison with unfractionated heparin

    Institute of Scientific and Technical Information of China (English)

    Xing Ke; Haichu Yu; Qixin Wang

    2009-01-01

    Objective To prospectively evaluate the safety and therapeutic efficacy ofdalteparin in patients with high risk non-ST-elevation acute coronary syndromes (ACS) during percutaneous coronary intervention (PCI). Methods Atotal of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin (UFH) group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/ kg intravenous bolus ofdalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mgjust before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminai coronary angioplasty (PTCA). Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in dalteparin group were measured. The average anti-Xa activity was (0.83±0.26) U/ml at 15 minutes after intravenous injection of dalteparin and anti-Xa>0.5U/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group (2.3% vs 9. 2%, P < 0.05); none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection of dalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus ofdalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI

  4. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement.

    Science.gov (United States)

    Ellahham Md, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience.

  5. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement

    Science.gov (United States)

    Ellahham, MD, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J. Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience. PMID:26734321

  6. Acute intraventricular thrombosis of an impella LP 5.0 device in an ST-elevated myocardial infarction complicated by cardiogenic shock.

    Science.gov (United States)

    Ranc, Sylvain; Sibellas, Franck; Green, Lisa

    2013-01-01

    A 58-year-old male patient, suffering from an acute anterior ST-elevated myocardial infarction, developed cardiogenic shock, despite an optimal revascularization and hemodynamic support through the use of an intra-aortic balloon pump and inotropic pharmacological agents. Additional support was provided by a left ventricular assistance device Impella LP 5.0 (Abiomed, Europe GmbH). Device failure occurred 27 hours after implantation due to an acute thrombosis of the Impella inflow portion. This major adverse event might have occurred due to an inflammatory status in the cardiogenic shock context, a pre-existing intraventricular thrombus that could have been sucked up inside the Impella, and/or a subtherapeutic anticoagulation. There are very few data regarding this type of complication. Further studies are therefore needed to assess the frequency of such a complication and the means to avoid it.

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

    Directory of Open Access Journals (Sweden)

    Ekarat Rattarittamrong

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Oliver Koeth

    2010-01-01

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

  9. ST-elevations-myokardieinfarkt efter terapeutisk adrenalininjektion

    DEFF Research Database (Denmark)

    Rømhild Davidsen, Jesper; Lambrechtsen, Jess; Egstrup, Kenneth

    2006-01-01

    A case of acute myocardial infarction (AMI) following accidental iatrogenic overdose by adrenaline injection is described in a male aged 55 years. This patient was given 1 mg of adrenaline due to anaphylactic symptoms. Afterwards he presented with angina pectoris, dyspnoea and ST-segment elevation...... in the ECG. Plasma TnT and CK-MB were raised. A coronary angiography revealed a 66% stenosis of RCA. This patient had an asymptomatic RCA stenosis that probably became symptomatic due to coronary artery spasm related to adrenaline injection and thereby presented symptoms and signs of AMI....

  10. ST Elevation Myocardial Infarction in the elderly

    Institute of Scientific and Technical Information of China (English)

    Marcelo Franken; Amit Nussbacher; Alberto Liberman; Mauricio Wajngarten

    2012-01-01

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

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

    Science.gov (United States)

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

    2006-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

    Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P<0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.

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

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    van Dijk Arie PJ

    2008-12-01

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

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

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    Grossman P Michael

    2010-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

    刘晓宇

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-07-15

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

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

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    Ali Abbasi

    2011-05-01

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

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

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    Manish Ruhela

    2014-06-01

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

  19. Change in Growth Differentiation Factor 15, but Not C-Reactive Protein, Independently Predicts Major Cardiac Events in Patients with Non-ST Elevation Acute Coronary Syndrome

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    Alberto Dominguez-Rodriguez

    2014-01-01

    Full Text Available Among the numerous emerging biomarkers, high-sensitivity C-reactive protein (hsCRP and growth-differentiation factor-15 (GDF-15 have received widespread interest, with their potential role as predictors of cardiovascular risk. The concentrations of inflammatory biomarkers, however, are influenced, among others, by physiological variations, which are the natural, within-individual variation occurring over time. The aims of our study are: (a to describe the changes in hsCRP and GDF-15 levels over a period of time and after an episode of non-ST-segment elevation acute coronary syndrome (NSTE-ACS and (b to examine whether the rate of change in hsCRP and GDF-15 after the acute event is associated with long-term major cardiovascular adverse events (MACE. Two hundred and Fifty five NSTE-ACS patients were included in the study. We measured hsCRP and GDF-15 concentrations, at admission and again 36 months after admission (end of the follow-up period. The present study shows that the change of hsCRP levels, measured after 36 months, does not predict MACE in NSTEACS-patients. However, the level of GDF-15 measured, after 36 months, was a stronger predictor of MACE, in comparison to the acute unstable phase.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    OBJECTIVES: Our goal was to compare the safety and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, with clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). BACKGROUND: AZD6140 achieves higher mean levels of p...

  1. Diverging associations of an intended early invasive strategy compared with actual revascularization, and outcome in patients with non-ST-segment elevation acute coronary syndrome: the problem of treatment selection bias

    NARCIS (Netherlands)

    A. Hirsch; F. Windhausen; J.G.P. Tijssen; A.J.M. Oude Ophuis; W.J. van der Giessen; P.M. van der Zee; J.H. Cornel; F.W.A. Verheugt; R.J. de Winter

    2009-01-01

    In several observational studies, revascularization is associated with substantial reduction in mortality in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS). This has strengthened the belief that routine early angiography would lead to a reduction in mortality. We investiga

  2. Diverging associations of an intended early invasive strategy compared with actual revascularization, and outcome in patients with non-ST-segment elevation acute coronary syndrome: the problem of treatment selection bias.

    NARCIS (Netherlands)

    Hirsch, A.; Windhausen, F.; Tijssen, J.G.P.; Oude Ophuis, A.J.M.; Giessen, W.J. van der; Zee, P.M. van der; Cornel, J.H.; Verheugt, F.W.A.; Winter, R.J. de

    2009-01-01

    AIMS: In several observational studies, revascularization is associated with substantial reduction in mortality in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS). This has strengthened the belief that routine early angiography would lead to a reduction in mortality. We inv

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Matej Samoš

    2016-01-01

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

  7. Hyperglycemia, acute insulin resistance, and renal dysfunction in the early phase of ST-elevation myocardial infarction without previously known diabetes: impact on long-term prognosis.

    Science.gov (United States)

    Lazzeri, Chiara; Valente, Serafina; Chiostri, Marco; Attanà, Paola; Mattesini, Alessio; Nesti, Martina; Gensini, Gian Franco

    2014-11-01

    We evaluated the relationship between admission renal function (as assessed by estimated glomerular filtration rate (eGFR)), hyperglycemia, and acute insulin resistance, indicated by the homeostatic model assessment (HOMA) index, and their impact on long-term prognosis in 825 consecutive patients with ST-elevation myocardial infarction (STEMI) without previously known diabetes who underwent primary percutaneous coronary intervention (PCI). Admission eGFR showed a significant indirect correlation with admission glycemia (Spearman's ρ -0.23, P renal function and glucose values and acute insulin resistance in the early phase of STEMI was detectable, since a significant, indirect correlation between eGFR, insulin values, and glycemia was observed. Patients with renal dysfunction (eGFR renal function (eGFR ≥60 ml/min/1.73 m(2)). The prognostic role of glucose values for 1-year mortality was confined to patients with eGFR ≥60 ml/min/m(2), who represent the large part of our population and are thought to be at lower risk. In these patients, an independent relationship between 1-year mortality and glucose values was detectable not only for admission glycemia but also for glucose values measured at discharge.

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

    Science.gov (United States)

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

    2016-09-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dan BAO

    2015-06-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

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    Kim Young

    2012-03-01

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

  14. Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: Are we complying with practice guidelines?

    Directory of Open Access Journals (Sweden)

    Benjamin W. Wachira

    2014-09-01

    Conclusion: Whereas the majority of STEMI patients are evaluated within 10 min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients.

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Thomas Pilgrim

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

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

    Institute of Scientific and Technical Information of China (English)

    付艳东; 高海春; 刘丽

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ostojić Marina M.

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Roislien Jo

    2010-12-01

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

  20. Induction of PGC-1α expression can be detected in blood samples of patients with ST-segment elevation acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Óscar Fabregat-Andrés

    Full Text Available Following acute myocardial infarction (MI, cardiomyocyte survival depends on its mitochondrial oxidative capacity. Cell death is normally followed by activation of the immune system. Peroxisome proliferator activated receptor γ-coactivator 1α (PGC-1α is a transcriptional coactivator and a master regulator of cardiac oxidative metabolism. PGC-1α is induced by hypoxia and facilitates the recovery of the contractile capacity of the cardiac muscle following an artery ligation procedure. We hypothesized that PGC-1α activity could serve as a good molecular marker of cardiac recovery after a coronary event. The objective of the present study was to monitor the levels of PGC-1α following an ST-segment elevation acute myocardial infarction (STEMI episode in blood samples of the affected patients. Analysis of blood mononuclear cells from human patients following an STEMI showed that PGC-1α expression was increased and the level of induction correlated with the infarct size. Infarct size was determined by LGE-CMR (late gadolinium enhancement on cardiac magnetic resonance, used to estimate the percentage of necrotic area. Cardiac markers, maximum creatine kinase (CK-MB and Troponin I (TnI levels, left ventricular ejection function (LVEF and regional wall motion abnormalities (RWMA as determined by echocardiography were also used to monitor cardiac injury. We also found that PGC-1α is present and active in mouse lymphocytes where its expression is induced upon activation and can be detected in the nuclear fraction of blood samples. These results support the notion that induction of PGC-1α expression can be part of the recovery response to an STEMI and could serve as a prognosis factor of cardiac recovery.

  1. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

  2. Use and outcome of thrombus aspiration in patients with primary PCI for acute ST-elevation myocardial infarction: results from the multinational Euro Heart Survey PCI Registry.

    Science.gov (United States)

    Weipert, Kay F; Bauer, Timm; Nef, Holger M; Möllmann, Helge; Hochadel, Matthias; Marco, Jean; Weidinger, Franz; Zeymer, Uwe; Gitt, Anselm K; Hamm, Christian W

    2016-09-01

    The clinical benefit of thrombus aspiration (TA) in patients presenting with acute ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI) is not well defined. Furthermore, there is a large variation in the use of TA in real-world registries. Between 2005 and 2008, a total of 7146 consecutive patients with acute STEMI undergoing primary PCI were prospectively enrolled into the PCI Registry of the Euro Heart Survey Programme. For the present analysis, patients treated additionally with TA (n = 897, 12.6 %) were compared with those without TA (n = 6249, 87.4 %). Patients with hemodynamic instability at initial presentation (15.1 vs. 11.0 %; p < 0.001) and resuscitation prior to PCI (10.4 vs. 7.4 %; p = 0.002) were more frequently treated with TA. TIMI flow grade 0/1 before PCI was more often found among those with TA (73.5 vs. 58.6 %; p < 0.001). After adjustment for confounding factors in the propensity score analysis, TA was not associated with improved in-hospital survival (risk difference -1.1 %, 95 % confidence interval -2.7 to 0.6 %). In this European real-world registry, the rate of TA use was low. Hemodynamically unstable patients were more likely to be treated with TA. Consistent with the results of the TASTE study and the TOTAL trial, TA was not associated with a significant reduction in short-term mortality.

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

    Directory of Open Access Journals (Sweden)

    Zohair Al Aseri

    2011-01-01

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

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

    KAUST Repository

    Ammirati, Enrico

    2012-08-29

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

  5. Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; ZHANG Rui-yan; SHEN Jie; ZHANG Jian-sheng; HU Jian; YANG Zheng-kun; ZHANG Xian; ZHENG Ai-fang; SHEN Wei-feng

    2008-01-01

    Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era.This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset.Among them,86 patients had a serum creatinine level >115 μmol/L on admission (RD group),and the remaining 533 patients had normal renal function (non-RD group).The primary endpoint was 30-day major adverse cardiac events (MACE,including death,non-fatal reinfarction,and target vessel revascularization),and the secondary endpoint was subacute stent thrombosis.Results Patients in the RD group were older than those in the non-RD group.There are more female patients in the RD group and they had a history of hypertension,myocardial infarction and revascularization.The occurrence rates of Killip class ≥2 (29.1% vs 18.6%,P=0.02) and multi-vessel (62.8% vs 44.5%,P=0.001) and triple vessel disease (32.6% vs 18.2%,P=0.002),in-hospital mortality (9.3% vs 3.8%,P=0.03),and MACE rate during hospitalization (17.4% vs 7.7%,P=0.006) were higher in the RD group than those in the non-RD group.At a 30-day clinical follow-up,the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%,P=0.0003).Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group,respectively (P=0.15).Multivariate analysis revealed that the serum creatinine level≥115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18,P<0.001).Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up,the short-term prognosis of

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sarno Giovanna

    2007-12-01

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

  8. MECANISMOS ELECTROFISIOLÓGICOS DE LA ELEVACIÓN DEL SEGMENTO ST DURANTE EL INFARTO AGUDO DE MIOCARDIO. HIPÓTESIS ACTUAL / Electrophysiological mechanisms of the st segment elevation during acute myocardial infarction. Current hypothesis

    Directory of Open Access Journals (Sweden)

    Raimundo Carmona Puerta

    2010-12-01

    Full Text Available Resumen El origen de la elevación del segmento ST elevado durante el infarto agudo de miocardio (IMA ha sido motivo de controversia. Con el avance de la electrofisiología cardíaca básica, hoy puede suponerse con alto grado de fiabilidad, las bases iónicas que generan la modificación del electrocardiograma clínico. A partir de una heterogeneidad eléctrica que existe en condiciones normales la isquemia miocárdica aguda, induce a una exacerbación de este comportamiento fisiológico y crea gradientes eléctricos transmurales significativos, que producen vectores potentes de corriente desde el endocardio al epicardio. Una respuesta diferente desde el punto de vista electrofisiológico, ante tal estímulo anormal, crea el sustrato funcional para tal discrepancia eléctrica a través del espesor de las paredes cardíacas. / Abstract The origin of the ST segment elevation during acute myocardial infarction (AMI has been the object of controversy. The advances in basic cardiac electrophysiology has made possible to assume, with a high degree of reliability, the ionic bases that generate the clinical electrocardiogram change. Starting from an electrical heterogeneity that exists in normal conditions, the acute myocardic ischemia induces an exacerbation of this physiological behavior and creates significant transmural electric gradients, which produces powerful electrical current vectors from the endocardium to the epicardium. A different response from the electrophysiological point of view, in the presence of such abnormal stimuli, creates a functional substratum for such an electric discrepancy through the thickness of the cardiac walls.

  9. Multiple Biomarkers at Admission Significantly Improve the Prediction of Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

    NARCIS (Netherlands)

    P. Damman; M.A.M. Beijk; W.J. Kuijt; N.J.W. Verouden; N. van Geloven; J.P.S. Henriques; J. Baan; M.M. Vis; M. Meuwissen; J.P. van Straalen; J. Fischer; K.T. Koch; J.J. Piek; J.G.P. Tijssen; R.J. de Winter

    2011-01-01

    We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Few data exist on the prognostic value of combined biomarkers. We used data from 1,034 STEMI patients undergoing p

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王云飞; 华琦; 李静

    2013-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

  13. Inhibitory Effect of Clopidogrel on Release of Soluble CD40 Ligand by ADP-activated Platelet in Patients With Non-ST-segment elevation Acute Coronary Syndromes

    Institute of Scientific and Technical Information of China (English)

    Wei Wei; Chufan Luo; Zhimin Du

    2008-01-01

    Objectives To investigate the inhibitory effect of clopidogrel on release of soluble CD40 ligand (sCD40L) by ADP-activated platelet in patients with non-ST-segment elevation acute coronary syndromes(NSTEACS).Methods Forty-two patients with NSTEACS were treated with clopidogrel for 6~8 days.In order to obtain platelet rich plasma (PRP) samples,the venous blood was drawn before and after treatment,respectively.The platelets were activated by adenosine diphosphate (ADP),thus releasing sCD4OL,sCD40L levels were determined by enzyme-linked immunosorbent assay (ELISA) at different time of the reaction.Results Plasma sCD40L concentration before treatment was (0.199±0.155 ) ng/mL,and (0.190±0.176) ng/mL after treatment (P>0.05).Before treatment the PRP sCD40L level at 20-minute of platelet activation was (4.34±2.51 )ng/mL,and decreased to (2.79±1.93 ) ng/mL after treatment (P<0.001).The corresponding level at 40-minute of platelet activation was (5.29±3.13 ) ng/mL before treatment and (2.87±1.59 ) ng/mL after treatment(P<0.001 ).Conclusions Short-term clopidogrel administration might inhibit the release of sCD40L by ADP-activated platelet in patients with NSTEACS,suggesting that,in addition to its antiplatelet potency,clopidogrel may still have an anti-inflammatory effect.

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

    Science.gov (United States)

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

    2016-01-01

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

  15. Relation of Stature to Outcomes in Korean Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction (from the INTERSTELLAR Registry).

    Science.gov (United States)

    Moon, Jeonggeun; Suh, Jon; Oh, Pyung Chun; Lee, Kyounghoon; Park, Hyun Woo; Jang, Ho-Jun; Kim, Tae-Hoon; Park, Sang-Don; Kwon, Sung Woo; Kang, Woong Chol

    2016-07-15

    Although epidemiologic studies have shown the impact of height on occurrence and/or prognosis of cardiovascular diseases, the underlying mechanism is unclear. In addition, the relation in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains unknown. We sought to assess the influence of height on outcomes of patients with acute STEMI undergoing primary PCI and to provide a pathophysiological explanation. All 1,490 patients with STEMI undergoing primary PCI were analyzed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned hospitalization for heart failure (HF). Patients were divided into (1) MACCE (+) versus MACCE (-) and (2) first- to third-tertile groups according to height. MACCE (+) group was shorter than MACCE (-) group (164 ± 8 vs 166 ± 8 cm, p = 0.012). Prognostic impact of short stature was significant in older (≥70 years) male patients even after adjusting for co-morbidities (hazard ratio 0.951, 95% confidence interval 0.912 to 0.991, p = 0.017). The first-tertile group showed the worst MACCE-free survival (p = 0.035), and most cases of MACCE were HF (n, 17 [3%] vs 6 [1%] vs 2 [0%], p = 0.004). On post-PCI echocardiography, left atrial volume and early diastolic mitral velocity to early diastolic mitral annulus velocity ratio showed an inverse relation with height (p <0.001 for all) despite similar left ventricular ejection fraction. In conclusion, short stature is associated with occurrence of HF after primary PCI for STEMI, and its influence is prominent in aged male patients presumably for its correlation with diastolic dysfunction.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  19. Suboptimal medical care of patients with ST-Elevation Myocardial Infarction and Renal Insufficiency: results from the Korea acute Myocardial Infarction Registry

    Directory of Open Access Journals (Sweden)

    Choi Joon

    2012-09-01

    Full Text Available Abstract Background The clinical outcomes of ST-segment elevation myocardial infarction (STEMI are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR. Methods This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6% who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages. Results Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE inhibitor/angiotensin-receptor blocker (ARB, or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy. Conclusions Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.

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

    Directory of Open Access Journals (Sweden)

    James Gunton

    2016-08-01

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

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

    Science.gov (United States)

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

    2008-01-15

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dorokhova O.V.

    2014-12-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Matthew A Silva

    2006-03-01

    Full Text Available Matthew A Silva1, Jennifer L Donovan1,3, Pritesh J Gandhi2, Gregory A Volturo31Massachusetts College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Worcester, MA, USA; 2Alexion Pharmaceuticals, Inc., Cheshire, CT, USA; 3UMass Memorial Medical Center, Department of Emergency Medicine, Worcester, MA, USAAbstract: The role of glycoprotein (Gp IIb/IIIa receptor antagonists remains controversial and these agents are infrequently utilized during non-ST-segment elevation acute coronary syndromes (NSTE-ACS despite American Heart Association/American College of Cardiology guidelines. Despite recommendations, the NRMI-4 (National Registry of Myocardial Infarction 4 and CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines? registries observed that only 25%–32% of eligible patients received early Gp IIb/IIIa therapy, despite a 6.3% absolute mortality reduction in NRMI-4 and a 2% absolute mortality reduction in CRUSADE. A pooled analysis of Gp IIb/IIIa data from these registries suggest a major reduction in mortality (Odds Ratio = 0.43, 95% Confidence Index 0.25–0.74, p = 0.002 with early Gp IIb/IIIa therapy, yet clinicians fail to utilize this option in NSTE-ACS. The evidence-based approach to NSTEACS involves aspirin, clopidogrel, low-molecular weight heparins, or unfractionated heparin in concert with Gp IIb/IIIa receptor antagonists, however, newer percutaneous coronary intervention (PCI-based trials challenge current recommendations. Novel strategies emerging in NSTE-ACS include omitting Gp IIb/IIIa inhibitors altogether or using Gp IIb/IIIa inhibitors with higher doses of clopidogrel in selected patients. The ISAR-REACT (Intracoronary stenting and antithrombotic regimen–Rapid early action for coronary treatment and ISAR-SWEET (ISAR–Is abciximab a superior way to eliminate elevated thrombotic risk in diabetics trials question the value

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

    Institute of Scientific and Technical Information of China (English)

    Liu Yangchun; Su Qiang; Li Lang

    2014-01-01

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

  8. 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...... with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. Results: HTPR...

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

    Science.gov (United States)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  11. 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 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...

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

    Directory of Open Access Journals (Sweden)

    Priscilla Abraham Chandran

    2014-01-01

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

  13. Impact of different clinical pathways on outcomes of patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the RAPID-AMI study

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; ZHANG Rui-yan; QIU Jian-ping; JIN Hui-gen; ZHANG Jun-feng; WANG Xiao-long; JIANG Li; LIAO Min-lei; HU Jian; DING Feng-hua; ZHANG Jian-sheng; SHEN Wei-feng

    2009-01-01

    Background Current guidelines support primary percutaneous coronary intervention (primary PCI) as the first treatment of choice (as opposed to thrombolytic therapy) for patients with acute ST-segment elevation myocardial infarction (STEMI) especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI.Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory (rapid group), and 275 patients were admitted to the coronary care unit (CCU) or cardiac ward first, and then transferred to the catheterization laboratory (non-rapid group). Primary endpoint was door-to-balloon (D28) time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events (MACE) including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein Ⅱb/Ⅲa receptor inhibitors before angiography (84.0% and 77.1, P=0.042) and had TIMI 3 flow in the culprit vessel at initial angiogram (17.1% and 9.2%, P=0.007) in the non-rapid group. The D2B time was shortened ((108±44) minutes and (138±31) minutes, P <0.0001), and number of patients with D2B time <90 minutes was greater (22.6% and 10.9%, P <0.0001) in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality (4.1% and 5.8%) and cumulative

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  16. Investigation of the effect of Interleukin-1 receptor antagonist (IL-1ra on markers of inflammation in non-ST elevation acute coronary syndromes (The MRC-ILA-HEART Study

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    Flather Marcus D

    2008-02-01

    Full Text Available Abstract Background Acute Coronary Syndromes account for 15% of deaths in the UK, and patients remain at significant risk of re-admission for future complications and death. Pathologically the underlying process of atherosclerosis is driven by inflammatory mechanisms, which are activated in ACS patients. Previous studies have investigated the role of inflammatory markers in this process, including interleukin 1 (IL-1 and C Reactive Protein (CRP. Pre-clinical studies indicate that IL-1 may be a primary driver of ACS and that the naturally occurring interleukin-1 receptor antagonist (IL-1ra may inhibit the atherosclerotic process. This study will investigate the effects of IL-1ra on inflammatory markers in man. Methods/design Three centres in the UK are planning to recruit 186 Non-ST elevation myocardial infarction patients to receive either interleukin-1 receptor antagonist (Anakinra or matching placebo. Patients will receive a daily subcutaneous injection of either study drug or placebo over a 14 day period. The primary outcome is area under the curve of high sensitivity C-Reactive Protein (CRP over the first 7 days. Discussion The MRC-ILA-HEART Study is a proof of concept clinical trial investigating the effects of IL-1ra upon markers of inflammation in patients with Non-ST elevation myocardial infarction. It is hoped this will provide new and exciting information in relation to an "anti-inflammatory" strategy for patients with acute coronary syndrome. Trial registration ISRCTN89369318

  17. 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

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    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

  18. Determinantes prognósticos em pacientes com síndrome coronariana aguda sem elevação do segmento ST Prognostic factors in patients with acute coronary syndrome without ST segment elevation

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    Jessica Carolina Matos D'Almeida Santos

    2013-05-01

    Full Text Available FUNDAMENTO: Em pacientes com Síndromes Coronarianas Agudas (SCA sem Supradesnivelamento do Segmento ST (SST, sugere-se que uma série de marcadores (células inflamatórias, hiperglicemia e função renal é capaz de identificar indivíduos com maior risco para eventos cardiovasculares. OBJETIVO: Avaliar o impacto desses parâmetros laboratoriais em desfechos intra-hospitalares de pacientes com SCA sem SST. MÉTODOS: Foram avaliados prospectivamente 195 pacientes admitidos consecutivamente com SCA sem SST. Foram registrados dados clínicos, demográficos e laboratoriais ao longo do período de internação no hospital, em relação à ocorrência ou não de eventos combinados. RESULTADOS: A idade média foi de 67 ± 12 anos, e 52% eram homens. Na análise da área sob a curva ROC, somente a razão neutrófilo/linfócito (AUC: 70%, IC95%: 56%-82%, p = 0,006 e a creatinina (AUC: 62%, IC95%: 50%-80%, p = 0,03 discriminaram aqueles pacientes com SCA sem SST que apresentaram algum desfecho. Os pacientes que sofreram algum evento adverso durante a internação apresentaram menores contagens de linfócitos (1502 ± 731 / mm³ vs. 2020 ± 862 / mm³; p = 0,002, menores taxas de filtração glomerular (51 ± 27 mL/min vs. 77±34 mL/min; p BACKGROUND: In patients with acute coronary syndromes (ACS without ST segment elevation (SSE, it is suggested that a series of markers (inflammatory cells, hyperglycemia and renal function can identify individuals with increased risk for cardiovascular events. OBJECTIVE: To evaluate the impact of these laboratory parameters on intra-hospital outcomes of patients with ACS with no SSE. METHODS: We prospectively evaluated 195 patients consecutively admitted with ACS with no SSE. Demographic and clinical laboratory data were recorded during the course of the hospitalization period in relation to the occurrence of combined events. RESULTS: Mean age was 67 ± 12 years, and 52% were men. In analyzing the area under the ROC

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-15

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

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

    OpenAIRE

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

    Jayroe, Jason B; Spodick, David H; Nikus, Kjell;

    2008-01-01

    Guidelines recommend that patients with suggestive symptoms of myocardial ischemia and ST-segment elevation (STE) in > or =2 adjacent electrocardiographic leads should receive immediate reperfusion therapy. Novel strategies aimed to reduce door-to-balloon time, such as prehospital wireless electr...

  2. Utilizations and Perceptions of Emergency Medical Services by Patients with ST-Segments Elevation Acute Myocardial Infarction in Abu Dhabi: A Multicenter Study

    Science.gov (United States)

    Callachan, Edward Lance; Alsheikh-Ali, Alawi A.; Nair, Satish Chandrasekhar; Bruijns, Stevan; Wallis, Lee A.

    2016-01-01

    Background: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. Objectives: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. Methods: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi. Semi-structured interviews were conducted with patients to assess the rationale for choosing their prehospital mode of transport and their knowledge of EMS services. Results: Of 587 patients with STEMI (age 51 ± 11 years, male 95%), only 15% presented through EMS, and the remainder came via private transport. Over half of the participants (55%) stated that they did not know the telephone number for EMS. The most common reasons stated for not using EMS were that private transport was quicker (40%) or easier (11%). A small percentage of participants (7%) did not use EMS because they did not think their symptoms were cardiac-related or warranted an EMS call. Stated reasons for not using EMS did not significantly differ by age, gender, or primary language of the patients. Conclusions: EMS care for STEMI is grossly underutilized in Abu Dhabi. Patient knowledge and perceptions may contribute to underutilization, and public education efforts are needed to raise their perception and knowledge of EMS. PMID:27512532

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

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    Loïc Bière

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

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

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    Posnenkova О.М.

    2014-09-01

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

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

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    Jose F. Chavez

    2015-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  7. Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention

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    Azadeh

    2014-01-01

    Full Text Available Background: Myocardial blush grade (MBG, thrombolysis in myocardial infarction (TIMI and corrected TIMI frame count (cT F C are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI undergoing primary percutaneous coronary intervention (pPCI. Materials and Methods: A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3. Results: The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3 was positively associated with a history of nitrate intake (P = 0.03 and history of calcium channel blocker (CCB intake (P = 0.005. Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames (r = −0.32, P = 0.001. Conclusions: Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.

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

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    Hadadi Laszlo

    2015-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李英

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ivo Casagranda

    2013-10-01

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

  12. Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing irolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registr

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; LIAO Min-lei; HU Jian; SHEN Wei-feng; QIU Jian-ping; ZHANG Rui-yan; LI Yi-gang; HE Ben; JIN Hui-gen; ZHANG Jun-feng; WANG Xiao-long; JIANG Li

    2010-01-01

    Background Randomized, controlled trials have demonstrated the superiority of sirolimus-eluting stent (SES) implantation during primary percutaneous coronary intervention (PCI), as opposed to bare-metal stents, in patients with ST-elevation myocardial infarction (STEMI). This study aimed to test the hypothesis that clinical benefits of SES treatment were independent of gender in this setting.Methods A total of 2042 patients with STEMI undergoing SES-based primary PCI were prospectively enrolled into Shanghai Acute Coronary Event (SACE) registry (1574 men and 468 women). Baseline demographics, angiographic and PCI features, and in-hospital and 30-day major adverse cardiac events (MACE) were analyzed as a function of gender. Results Compared with men, women were older and more frequently had hypertension, diabetes, and hypercholesterolemia. Use of platelet glycoprotein IIb/IIIa receptor inhibitor (GPI, 65.5% vs. 62.2%, P=0.10) and procedural success rate (95.0% vs. 94.2%, P=0.52) were similar in both genders. In-hospital death and MACE occurred in 3.8% and 7.6%, and 4.5% and 8.1% in the male and female patients, respectively (all P >0.05). At 30-day follow-up, survival (94.3% vs. 93.8%, P=0.66) and MACE-free survival (90.2% vs. 89.3%, P=0.52) did not significantly differ between men and women. After adjustment for differences in patient demographics, angiographic and proceduralfeatures, there were no significant difference in either in-hospital (OR=0.77, 95%C/ of 0.48 to 1.22, P=0.30) or 30-day mortality (OR=1.28, 95%C/ of 0.73 to 2.23, P=0.38) between women and men.Conclusion Despite more advanced age and clustering of risk factors in women, female patients with STEMI treated by SES-based primary PCI had similar in-hospital and short-term clinical outcomes as their male counterparts.

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

    NARCIS (Netherlands)

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

    1991-01-01

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

  14. Troponin elevation in conditions other than acute coronary syndromes

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    Tanindi A

    2011-09-01

    Full Text Available Asli Tanindi, Mustafa CemriGazi University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyAbstract: Acute coronary syndromes comprise a large spectrum of clinical conditions ranging from unstable angina pectoris to acute ST-elevation myocardial infarction. Chest pain is usually the major symptom of atherosclerotic heart disease; however, it may be challenging to diagnose correctly, especially in the emergency department, because of the ambiguous way that pain is characterized by some patients. Cardiac troponins are sensitive and specific biomarkers used in the diagnosis of myocardial infarction that are released into the bloodstream when cardiac myocytes are damaged by acute ischemia or any other mechanism. They are the cornerstone for the diagnosis, risk assessment, prognosis, and determination of antithrombotic and revascularization strategies. However, troponin elevation indicates the presence, not the mechanism, of myocardial injury. There are many clinical conditions other than myocardial infarction that cause troponin elevation; thus, the physician should be aware of the wide spectrum of disease states that may result in troponin elevation and have a clear understanding of the related pathophysiology to effectively make a differential diagnosis. This review focuses on causes of troponin elevation other than acute coronary syndromes.Keywords: cardiac troponin, troponin elevation without acute coronary syndrome, differential diagnosis

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

    DEFF Research Database (Denmark)

    Fox, Keith A A; Bassand, Jean-Pierre; Mehta, Shamir R;

    2007-01-01

    BACKGROUND: A recent randomized, controlled trial, the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS 5) trial, reported that major bleeding was 2-fold less frequent with fondaparinux than with enoxaparin in acute coronary syndromes (ACS). Renal dysfunction increases t...

  16. Silent ST segment elevation myocardial infarction with multi-segmental renal infarction: an unusual presentation.

    Science.gov (United States)

    Chang, Hung-Yu; Yang, Yung-Nien

    2011-01-01

    A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography. Silent ST segment elevation myocardial infarction was noted on 12-lead electrocardiogram. Emergent coronary angiography revealed large thrombus burdens with complete occlusion at the left anterior descending artery ostium, which may be the embolic origin. Silent ST segment elevation myocardial infarction with acute flank pain and multiple segmental renal infarction is an unusual presentation. High vigilance may prevent delay of the "golden hour" to treat acute myocardial infarction.

  17. An unusual cause of ST elevation myocardial infarction (STEMI).

    Science.gov (United States)

    Monem, Mohammed; Rampat, Rajiv

    2014-09-22

    A 67-year-old Caucasian woman presented to clinic with a 2-month history of worsening shortness of breath on exertion and a single episode of chest pain 1 week before. Her ECG in clinic showed ST elevation inferiorly and she was admitted from clinic for further investigations as inpatient. She was initiated on the acute coronary syndrome protocol and underwent emergency left heart catheterisation on the day of admission. The coronary angiogram revealed large aneurysmal dilations in the right coronary artery and left main stem. A ventriculogram showed poor left ventricular (LV) systolic function in line with subsequent transthoracic echocardiogram, which revealed her to have an left ventricular ejection-fraction (LVEF) of approximately 20%. It was agreed with the cardiothoracic surgeons to treat the aneurysms non-operatively and start low-molecular weight heparin. Furthermore the underlying biventricular impairment was treated with ACE-inhibitors, β-blockers and diuretic therapy (loop and potassium-sparing). The strategy was to prevent further thrombus formation with the aneurysmal vessels and to achieve this the patient was initiated on lifelong warfarin. Other medical risk factors were optimised and patient started on statin medication. The aneurysm was monitored with serial CTs with a view to reconsider surgical intervention if any evidence of dilation. This case highlights an unusual cause of ST elevation myocardial infarction.

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

    Science.gov (United States)

    Tubaro, Marco; Sonia Petronio, Anna

    2009-10-01

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

  19. 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

    Full Text Available FUNDAMENTO: O eletrocardiograma (ECG de admissão tem um grande impacto no diagnóstico e tratamento de síndromes coronarianas agudas (SCA sem supradesnivelamento do segmento ST. OBJETIVO: Avaliar o impacto do ECG de admissão no prognóstico da SCA sem supradesnivelamento de ST. População: estudo prospectivo, contínuo, observacional, de 802 pacientes com SCA sem supradesnivelamento de ST de um único centro. MÉTODOS: Os pacientes foram divididos em 2 grupos: A (n=538 - ECG Anormal e B (n=264 - ECG Normal. ECG Normal era sinônimo de ritmo sinusal sem alterações isquêmicas agudas. Um seguimento clínico de um ano foi realizado tendo como alvo todas as causas de mortalidade e a taxa de eventos cardíacos adversos maiores (MACE. RESULTADOS: Os pacientes do Grupo A eram mais velhos (68,7±11,7 vs. 63,4±12,7 anos, pFUNDAMENTO: El electrocardiograma (ECG de ingreso tiene un gran impacto en el diagnóstico y tratamiento de síndromes coronarios agudos (SCA sin supradesnivel del segmento ST. OBJETIVO: Evaluar el impacto del ECG de ingreso en el pronóstico del SCA sin supradesnivel de ST. MÉTODOS: Población: estudio prospectivo, continuo, observacional, de 802 pacientes con SCA sin supradesnivel de ST de un único centro. Los pacientes se dividieron en 2 grupos: A (n=538 - ECG Anormal y B (n=264 - ECG Normal. ECG Normal era sinónimo de ritmo sinusal sin alteraciones isquémicas agudas. Se realizó un seguimiento clínico de un año teniendo como objetivo todas las causas de mortalidad y la tasa de eventos cardíacos adversos mayores (MACE. RESULTADOS: Los pacientes del Grupo A eran más viejos (68,7±11,7 vs 63,4±12,7 años, pBACKGROUND: Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS. OBJECTIVE: To assess the impact of the admission ECG on prognosis over non-ST ACS. Population: prospective, continuous, observational study of 802 non-ST ACS patients from a single center

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

    LENUS (Irish Health Repository)

    Manola, Sime

    2012-01-31

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Elizabete Silva dos Santos

    2009-10-01

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

  3. The Risk Factors of Cardiogenic Shock after Acute ST-elevation Myocardial Infarction%急性ST段抬高型心肌梗死并发心源性休克的相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    廖祁伟; 光雪峰; 景舒南; 李汝红; 赖碁; 付娟娟

    2013-01-01

    目的 探讨急性ST段抬高型心肌梗死患者并发心源性休克的危险因素.方法 以2010年1月至2011年1月期间住院治疗的185急性ST段抬高型心肌梗死患者为研究对象,以是否并发心源性休克为分组标准,对2组患者进行病例对照研究,通过多因素Logistic回归分析筛选出可能引起心源性休克的危险因素.结果 通过回归分析,进入回归方程的因素有血压(OR=6.314)、C-TnI (OR=12.932)、BNP (OR=3.523)、广泛前壁心肌梗死(OR=17.241)、冠脉多支血管病变(OR=5.039)、前降支病变(OR=9.955)、左室射血分数(OR=10.022)、室性心律失常(OR=7.513),差异有统计学意义(P>0.05).结论 血压、心率、心肌酶(CK-MB)、心肌标志物(C-TnI)、BNP、左心室射血分数、广泛前壁心肌梗死、前降支病变、多支血管病变、糖尿病史、房颤、左束支阻滞、室性心律失常是急性ST段抬高型心肌梗死患者并发心源性休克的危险因素,急性ST段抬高型心肌梗死患者并发心源性休克治疗关键在于尽早对导致心源性休克的危险因素进行评估,早期采取干预治疗.%Objective To analye the risk factors of cardiogenic shock after ST-elevation myocardial infaction Methods 185 patients with acute ST-elevation myocardial infarction during 2010.1.-2011.1 were divided into two groups: group with or without cardiogenic shock. Basic characteristics of each case were record by case control study and variate logistic regression analysis was used to find out the risk factors of cardiogenic shock. Results The regression analysis showed that the factors in the regression equation were Blood Pressure (OR =6.314) , CTnI (OR =12.932), BNP (OR =3.523) , extensive anterior myocardial infarction (OR = 17.241), multi-vessel coronary disease (OR=5.039) , anterior descending branch involvement (OR =9.955) , left ventricular ejection fraction (OR=10.022) and ventricular arrhythmia (OR=7.513). Conclusions Blood Pressure

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

    OpenAIRE

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

    2015-01-01

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

  5. Acute ST-segment elevation myocardial infarction in a young patient with essential thrombocythemia: a case with long-term follow-up report

    OpenAIRE

    Bhat T; Ahmed M; Baydoun H; Ghandour Z; Bhat A; McCord D

    2014-01-01

    Tariq Bhat,1 Mohammed Ahmed,2 Hassan Baydoun,2 Zahraa Ghandour,3 Alina Bhat,2 Donald McCord11Division of Cardiology, 2Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA; 3Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LebanonAbstract: Essential thrombocythemia (ET) is a neoplastic proliferation of mature myeloid cells – in particular, megakaryocytes – leading to persistently elevated platelet count....

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Mostafa Dastani

    2016-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Ruben N Eppinga

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

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Efficacy of pre-hospital use of glycoprotein IIb/IIIa inhibitors in ST-segment elevation myocardial infarction before mechanical reperfusion in a rapid-transfer network (from the Acute Myocardial Infarction Registry of Brittany).

    Science.gov (United States)

    Auffret, Vincent; Oger, Emmanuel; Leurent, Guillaume; Filippi, Emmanuelle; Coudert, Isabelle; Hacot, Jean Philippe; Castellant, Philippe; Rialan, Antoine; Delaunay, Régis; Rouault, Gilles; Druelles, Philippe; Boulanger, Bertrand; Treuil, Josiane; Avez, Bertrand; Bedossa, Marc; Boulmier, Dominique; Le Guellec, Marielle; Le Breton, Hervé

    2014-07-15

    Previous studies investigating prehospital use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-segment elevation myocardial infarction reached conflicting conclusions. The benefit of this strategy in addition to in-ambulance loading of dual-antiplatelet therapy remains controversial. The aim of this study was to analyze data from a prospective registry of patients with ST-segment elevation myocardial infarctions admitted 2 hours after symptom onset, of whom only 12.7% reached the primary end point. There was no significant difference between groups in the rate of in-hospital major adverse cardiac events. In conclusion, prehospital GPI use in patients with ST-segment elevation myocardial infarctions<12 hours after symptom onset scheduled for PPCI neither improved pre-PPCI infarct-related artery patency nor reduced in-hospital major adverse cardiac events.

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

    Directory of Open Access Journals (Sweden)

    Ragnhild Helseth

    2014-01-01

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

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

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    Eline Bredal Furenes

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    hours after symptom onset. Patients were randomized to double-blind treatment with G-CSF (10 microg/kg of body weight) or placebo for 6 days. The primary end point was change in systolic wall thickening from baseline to 6 months determined by cardiac magnetic resonance imaging (MRI). An independent core...... of subcutaneous G-CSF injections on left ventricular function in patients with ST-elevation myocardial infarction. METHODS AND RESULTS: Seventy-eight patients (62 men; average age, 56 years) with ST-elevation myocardial infarction were included after successful primary percutaneous coronary stent intervention

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

    OpenAIRE

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

    2013-01-01

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

  15. 急性ST段抬高型心肌梗死患者生活质量观察分析%Quality of life of patients with acute ST segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    韩瑞梅; 高方明

    2011-01-01

    Objective: To evaluate quality of life of patients with acute ST segment elevation myocardial infarction (STEMI) by Seattle angina questionnaire (SAQ) and explore factors that affect quality of life of patients. Methods: A total of 178 acute STEMI patients visited in our hospital and showed symptoms of angina pectoris one month ago were enrolled. All patients underwent emergency percutaneous coronary intervention (PCI) .Patients were divided into mild, moderate and severe group according to coronary severity scores (CSS) by coronary angiography. The difference in quality of life among the three groups was compared and their correlations were analyzed. Results: In scores of physical limitation of SAQ, severe group was significantly lower than those of mild and moderate groups [ (72±22. 8) scores vs. (80±l5. 6) scores vs. (78±18. 8) scores, P<0. 01] . Physical limitation in SAQ of patients with angina were affected by age, gender and CSS scores (F<0. 01 all). Conclusion; Age, gender and severity of coronary artery disease are factors influence on quality of life in patients with acute ST segment elevation myocardial infarction.%目的:采用心绞痛问卷(SAQ)对急性ST段抬高型心肌梗死(STEMI)患者生活质量进行评估,探讨影响患者生活质量的因素.方法:以在我院就诊且在就诊前1个月自觉有心绞痛症状的急性STEMI患者178例为研究对象,所有患者均进行急诊冠状动脉介入治疗(PCI)术,根据冠状动脉病变积分(CSS)评分分为轻度、中度和重度病变组,比较不同组患者生活质量差异及进行相关分析.结果:冠脉重度病变组SAQ活动受限程度评分明显低于轻度和中度组分别为[(72±22.8)分比(80±15.6)分比(78±18.8)分,P<0.O1].对于SAQ活动受限程度的影响因素为年龄、性别和CSS评分(P均<0.001).结论:年龄、性别、冠脉病变程度等是影响急性ST段抬高型心肌梗死患者生活质量的因素.

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

    Directory of Open Access Journals (Sweden)

    A. ALYAHYA

    2016-07-01

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

  17. Arterial healing following primary PCI using the Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS) versus the durable polymer everolimus-eluting metallic stent (XIENCE) in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Onuma, Yoshinobu; Brugaletta, Salvatore;

    2015-01-01

    AIMS: The Absorb bioresorbable vascular scaffold (Absorb BVS) provides similar clinical outcomes compared with a durable polymer-based everolimus-eluting metallic stent (EES) in stable coronary artery disease patients. ST-elevation myocardial infarction (STEMI) lesions have been associated...

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

    OpenAIRE

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

    2012-01-01

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

  19. [An unusual case of transient ST-segment elevation during hypertensive crisis in a patient with left ventricular hypertrophy].

    Science.gov (United States)

    Cappelletti, Alberto; Maggio, Silvia; Maranta, Francesco; Mazzavillani, Monica; Margonato, Alberto; Camici, Paolo G

    2012-10-01

    We report the case of a 73-year-old patient with severe left ventricular hypertrophy presenting with acute ST-segment elevation mimicking acute myocardial infarction on ECG during a hypertensive crisis. Unexpectedly, emergency coronary angiography showed no evidence of coronary thrombosis or spasm. Electrocardiographic alterations gradually resolved after lowering blood pressure.

  20. Relation between ST segment elevation during dobutamine stress test and myocardial viability after a recent myocardial infarction

    NARCIS (Netherlands)

    A. Elhendy (Abdou); M. El-Refaee; P.M. Fioretti (Paolo); G.M. El-Said; J.H. Cornel (Jan); P.R. Nierop; J.J. Bax (Jeroen); A. Sciarra; M.M. Ibrahim; J.R.T.C. Roelandt (Jos); M.L. Geleijnse (Marcel); R.T. van Domburg (Ron)

    1997-01-01

    textabstractOBJECTIVE: To assess the relation between ST segment elevation during the dobutamine stress test and late improvement of function after acute Q wave myocardial infarction. PATIENTS AND DESIGN: 70 patients were studied a mean (SD) 8 (3) days after acute myoca

  1. St. Thomas and St. John, U.S. Virgin Islands Coastal Digital Elevation Model

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 1/3 arc-second St. Thomas and St. John, U.S. Virgin Islands Coastal Digital Elevation Model will be used to support NOAA's tsunami forecast system and for...

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

    Directory of Open Access Journals (Sweden)

    Raimundo Carmona Puerta

    2010-09-01

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

  3. Comparative study of coronary artery lesions characteristics in myocardial infarction patients with or without acute ST segment elevation%急性ST段抬高型心肌梗死与非ST段抬高型心肌梗死冠状动脉病变特点的对比

    Institute of Scientific and Technical Information of China (English)

    郭胜

    2013-01-01

    目的 探讨急性ST段抬高型心肌梗死(STEMI)与非ST段抬高型心肌梗死(NSTEMI)患者的冠状动脉病变特点,为临床治疗提供参考.方法 随机选择2008年1月至2012年1月在南阳医学高等专科学校第一附属医院治疗的194例心肌梗死患者,根据心电图结果将其分成两组,ST段抬高组98例,非ST段抬高组96例.对两组患者均进行冠状动脉造影,对比研究两组患者冠状动脉造影的结果,总结两组患者冠状动脉病变的特点.结果 ST段抬高组单支病变比例(41.98%)明显高于非ST段抬高组(21.88%),差异有统计学意义(P<0.01);而ST段抬高组患者的三支病变比例(27.55%)明显低于非ST段抬高组(64.58%),差异有统计学意义(P<0.01);ST段抬高组的室壁瘤形成率(42.86%)明显高于非ST段抬高组(11.46%),差异有统计学意义(P<0.01).结论 ST段抬高型心肌梗死与非ST段抬高型心肌梗死冠状动脉的病变各有特点,在临床上要根据其发病特点进行治疗,提高治疗成功率.%Objective To investigate the characteristics of coronary artery lesions in patients with acute ST segment elevation myocardial infarction(STEMI) and non ST segment elevation myocardial infarction (NSTEMI),and provide references for clinical treatment.Methods One hundred and ninetyfour patients with myocardial infarction from January 2008 to January 2012 in the first affiliated hospital of Nanyang medical college were divided into two groups according to the electrocardiogram results,98 cases in ST-elevation group and 96 cases in non ST-elevation group.Patients in the two groups all received coronary artery angiography,then the coronary artery imaging result was combared and the coronary artery lesion characteristics between the two groups were summarized.Results Single lesion scale in ST-elevation group(41.98%) was obviously higher than that in non ST-elevation group(21.88%),the difference was statistical significant(P <0

  4. An Investigation into the Treatment of Acute ST Segment Elevated Myocardial Infarction with Early and Selective PCI after Thrombolysis with Urokinase and Recanalization%尿激酶溶栓再通后早期与择期 PCI 术治疗急性 ST 段抬高型心肌梗死的研究

    Institute of Scientific and Technical Information of China (English)

    吴坤生

    2015-01-01

    Objective:To study the treatment of acute ST segment elevated myocardial infarction with early and selective PCI after thrombolysis with urokinase and recanalization .Methods:Select 90 patients with acute ST segment elevated myocardial infarction received in cardiology department in some hospital during the period from .and randomly divided them into control group and intervention group (n =45).the patients in both group received thrombolysis with urokinase,the intervention group underwent PCI 6 hours later after they had thrombolysis had been recanalized ,the control group had selective PCI in 10 days after they had thrombolysis had been recanalized.observe the occurrence rate of MACE during their stay ,and compare the recovery patients'cardic function and their walking distance with 6min 1 week and 6 months later after they had PCI .Results:(1 )the total incidence of MACE of intervention group is lower than that of the control group,the difference is statistically significant (P 0.05 );6 months later after PCI,in intervention group ,the index values of cardiac function,including left ventricular end-systolic dimension,left ventricular end-diastolic dimension and LVEF and walking distance in 6 min were superior to that of the control group,the differences were statistically significant (P 0.05);PCI 术后6月,干预组患者的心功能指标值(左室收缩末内径、舒张末内径、左室射血分数)及6min 步行距离均优于对照组,差异具有统计学意义(P <0.01)。结论:急性 ST 段抬高型心肌梗死溶栓后早期行 PCI 术治疗,能有效改善患者术后心功能指标恢复,降低不良事件的发生率。

  5. 非ST段抬高型急性心肌梗死与ST段抬高型急性心肌梗死的临床特征比较%Comparison on Clinical Characteristics of Non ST Segment Elevation Acute Myocardial Infarction and ST Segment Elevation Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    刘长纲

    2012-01-01

      目的对比非 ST 段抬高型急性心肌梗死(NSTEMI)与 ST 段抬高型急性心肌梗死(STEMI)的临床特征.方法于我院心内科收治的急性心肌梗死患者中随机选取 ST 段抬高型和非 ST 段抬高型各60例,对两组患者的基本情况和实验室检测数据进行对比.结果 STEMI 组中吸烟、持续性胸痛及并发心律失常的患者明显较 NSTEMI 组多;NSTEMI 组患者年龄、女性比例和糖尿病并发率均明显高于 STEMI 组;STEMI 组血肌酸激酶、肌酸激酶同工酶、肌钙蛋白Ⅰ水平均明显高于 NSTEMI 组;造影显示冠脉单支病变 NSTEMI 组明显较少,而三支病变则多于 STEMI 组;冠脉狭窄程度≤90%的患者 NSTEMI 组较多,而狭窄>90%者 STEMI 组更多;以上差异均具有统计学意义,P 90% of group STEMI was more. The difference above all had statistical significance, P<0.05. Conclusions The age of patients in group NSTEMI are older, prefer to women, and angiography reveals the extent of coronary lesions is low. But the proportion of basic TIMI grade 3 flow and collateral circulation is high.

  6. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

    OpenAIRE

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-01-01

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion (“ACS” lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and ...

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

    Directory of Open Access Journals (Sweden)

    D. A. Kuzhel

    2015-09-01

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

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

    OpenAIRE

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

    2013-01-01

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

  9. 冠状动脉造影正常的急性ST段抬高型心肌梗死临床分析%Clinical analysis on acute ST-segment elevation myocardial infarction in patients with normal coronary angiography

    Institute of Scientific and Technical Information of China (English)

    赵荣诚; 于靖; 颜利求; 王钢; 韩立宪

    2012-01-01

    Objective To investigate the morbidity, the clinical characteristics and follow-up outcomes of acute ST-segment elevation myocardial infarction ( STEMI) with normal coronary angiography (CAG). Methods The clinical characteristics and results of CAG and some correlated risk factors of 648 patients with STEMI enrolled from March 2006 to October 2010 and during the follow up were analysed. Results The patients with STEMI and normal CAG accounted for 56/ 648 ( 8. 6% ) , most of whom were young patients and smokers. Most patients had strenuous exertional working, and free of angina pectoris, hypertension, diabetes mellitus and hyperlipidemia ( P <0. 01 ). The clinical follow-up was completed for 51 patients and during the follow-up period, no acute myocardial infarction or cardiogenic death occurred. Conclusions STEMI might happen in patients with normal coronary arteries. The coronary spasm or acute thrombosis and auto-thromobolysis on the basis of coronary endothelium lesion may occur in them. The follow-up shows some patients have recurrent angina even though they continue the use of statins and calcium antagonists.%目的 研究在急性ST段抬高型心肌梗死(STEMI)患者中冠状动脉(冠脉)造影正常的发生率、临床特点和随访结果.方法 选择2006年3月至2010年10月间收住沧州市中心医院的648例STEMI患者,分析其临床和冠脉造影结果,相关的冠心病危险因素和随访结果.结果 648例STEMI患者中有56例冠脉造影正常,占8.6%.该组患者中年龄较轻、大量吸烟者居多,多无心绞痛、糖尿病、高血压及高脂血症等病史,且多有情绪激动、过度劳累等明确诱因.完成随访的51例患者中,随访期间无患者发生急性心肌梗死或心原性死亡.结论 STEMI可以发生于冠脉造影正常的患者中,冠脉内皮受损继而引起冠脉痉挛或急性血栓形成并血栓自溶是其主要的发病机制;随访发现部分患者既使口服他汀类及钙拮抗剂

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

    Institute of Scientific and Technical Information of China (English)

    舒政; 邓小飞; 张家美; 葛琛瑾; 孟文斌

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Xin Lu

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

  12. Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry.

    Directory of Open Access Journals (Sweden)

    Sang-Don Park

    Full Text Available Besides contrast-induced acute kidney injury(CI-AKI, adscititious vital organ damage such as hypoxic liver injury(HLI may affect the survival in patients with ST-elevation myocardial infarction (STEMI. We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI.A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded.Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both.Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421..

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

    Directory of Open Access Journals (Sweden)

    D. B. Nemick

    2015-12-01

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

  14. rt-PA 溶栓治疗 ST 段抬高性急性心肌梗死的临床研究%Plasminogen activator Clinical study of thrombolytic therapy for acute ST elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    张艳凯; 徐志鑫; 程光茂; 郑小丽; 祝芳; 姬新颖

    2015-01-01

    Objective To observe the efficacy and safety of recombinant human tissue type plasminogen activator ( rt‐PA)in the thrombolytic therapy for patients with acute myocardial infarction . Methods The subject for this project was 123 cases of patients with acute myocardial infarction who were hospitalized in the Department of Emergency and EICU of Kaifeng Central Hospital from Aug 2012 to Jan 2014 . They were diagnosed in outpatient and emergency with age range from 42 to 75 years old . They were divided into 2 groups based on protocol of treatment which were medicinal conservative treatment plus thrombolytic therapy ( group A ) and medicinal conservative treatment only ( group B ) respectively . The dynamic evolution of life signs of each group was recorded . Percutaneous transluminal coronary angiography was performed after one week of onset in order to investigate the feature of coronary artery pathogenesis and compare the rate of complication on the 4th week after onet , the prognosis and mortality after admission of two groups .Results The rate of coronary recanalization of group A was higher than that of group B under the coronary angiography after treatment . The rate of complication of group A was lower than that of group B . Severe adverse events such as arrhythmia , myocardial re infarction , cardiac dysfunction were occurred in 30 days in both groups , with a rate of 11 .94% and 26 .79% respectively . The mortality of group A (10 .45% ) was less than that of group B ( 25 .00% ) at 4 weeks after admission .Conclusion The thrombolytic therapy by rt‐PA should be applied as earlier as possible to patients with acute myocardial infarction within 6 hours after onset . This therapy was more advantageous than medicinal conservative treatment only which could save dying myocardium in time and decrease the incidence rate of complication like malignant arrhythmia . The patients in group A had better results of heart function recovery , index like Ejection fraction

  15. 急诊冠状动脉介入疗法对急性 ST 段抬高型心肌梗死患者左心室功能的影响%Study on the Effect of Emergency Coronary Artery Interventional on Left Ventricular Function of Patients with Acute ST Segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    杜英; 兰军; 陈杰民; 蔡振明; 董家龙

    2015-01-01

    Objective:To investigate the effect of emergency coronary artery interventional on left ventricular function in patients with acute ST segment elevation myocardial infarction .Methods:70 cases of acute ST segment elevation my‐ocardial infarction in our hospital ,35 cases with emergency coronary artery interventional therapy were divided into ex‐perience group ,while the other 35 cases with selective PCI were divided into control group .The left ventricular systol‐ic and diastolic function was evaluated by ultrasonic Beckoning graph ,while the overall cardiac function was evaluated by 6min walk test of two groups .Results:The results of this study show that the left ventricular systolic and diastolic function by ultrasonic Beckoning graph of the experience group were significantly better than the control group (P<0.05);while the 6min walk test results showed that the heart function of patients in the experimental group was signif‐icantly better than the control group (P<0 .05) .Conclusion:Emergency coronary artery interventional can improve car‐diac function in patients with acute ST segment elevation myocardial infarction ,and improve the patients quality of life , it is worthy of further clinical promotion .%目的:探讨急诊冠状动脉介入疗法对急性ST段抬高型心肌梗死患者左心室功能的影响。方法:选取我院收治的急性S T段抬高患者70例,将接受急性冠状动脉介入治疗的35例患者纳入实验组,同时将接受择期冠状动脉介入治疗的35例患者纳入对照组。采用超声心动图检查以评价两组患者的左心室收缩与舒张功能,同时采用6min步行实验以评价患者总体心功能。结果:通过超声心动图结果显示,实验组患者左室收缩与舒张功能均显著优于对照组(P<0.05);同时通过6min步行实验结果发现实验组患者的心功能也显著优于对照组(P<0.05)。结论:急诊冠状动脉介入治疗能有效改

  16. Risk factor for acute ST-segment elevation myocardial infarction in young adults%年轻患者发生急性ST段抬高型心肌梗死的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李东宝; 陈文明; 华琦; 刘志

    2012-01-01

    AIM: To analyze the risk factors of acute ST-segment elevation myocardial infarction (STEMI) in young adults with acute myocardial infarction (AMI). METHODS: A cohort of 1137 consecutive STEMI patients admitted to our hospitals from April 1995 to May 2005 were divided into three groups according to ages; 21- to 40-year-old group (n = 55) , 41- to 60-year-old group (n =364) and 61- to 90-year-old group (n =718). Data on clinical cardiovascular risk factors, demographic features and angiographic findings were gathered and analyzed. RESULTS: Only 4. 84% of the hospitalized STEMI patients over the 10-year period were < 40 years of age. Young adults were found to be predominantly male and most had a smoking and alcohol history (P <0. 01). Diabetes and hypertension were less prevalent in the group of young adults. Analysis of lipid profiles showed comparatively higher total cholesterol, low-density lipoprotein, high-density lipoprotein and triglyceride values in the young age group (P < 0. 01). Angiography showed a high propensity toward single-vessel involvement in the young adult group (P <0. 01). In-hospital and 5-year all-cause deaths in the young age group were lower than those in older adults (P<0. 01). CONCLUSION: The risk factor profile and angiographic involvement differ considerably between the high-risk young population and older adults. However, the short- and long-term prognosis in young adults is more favorable.%目的:分析急性ST段抬高型心肌梗死(STEMI)患者中年轻患者的临床特点.方法:连续入选1995年4月~ 2005年5月入院的1 137名STEMI患者,根据年龄分为3组:21 ~40岁(n=55)、41~60岁(n =364)以及61 ~90岁(n=718),收集其心血管危险因素、人口统计学特点以及血管影像学结果并进行分析.结果:连续10年内入住本院的STEMI患者只有4.84%的患者年龄小于40岁,这些患者男性居多,多具有吸烟史、饮酒史(P<0.01);糖尿病和高血压病在年轻患者中相对较

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

    Institute of Scientific and Technical Information of China (English)

    夏树涛; 赵施竹

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Pilar Portero Pérez

    2012-07-01

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

  19. Visual functional changes during acute elevation of intraocular pressure

    Institute of Scientific and Technical Information of China (English)

    Tian-De SHOU

    2006-01-01

    Glaucoma is closely related to elevation of intraocular pressure (IOP). Many studies have done on the effect of chronic elevation of IOP on the retina and optic nerve, but less attention was paid to the effect of acute elevated IOP. Here we briefly review experimental studies on functional changes of the visual system from the retina to the visual cortex under acute elevated IOP condition, which is similar to that of acute primary angle-closure glaucoma.

  20. Short-term prognostic impact of hyponatremia on the patients with acute ST-elevation myocardial infarction%低钠血症与急性 ST 段抬高型心肌梗死患者近期预后相关性

    Institute of Scientific and Technical Information of China (English)

    王丽; 赵洛沙; 李海禹; 杨帆; 杨科; 张真真

    2016-01-01

    目的:探讨低钠血症与急性 ST 段抬高型心肌梗死(STEMI)患者近期预后的相关性。方法选取2014年3月至2015年5月至郑州大学第一附属医院心血管内科收治的急性 ST 段抬高型心肌梗死患者223例,测定患者入院时、入院后48 h、入院后72 h 血清钠离子浓度,低钠血症定义为血清钠离子浓度<135 mmol/ L,根据患者血钠浓度将所有入选患者分为血钠正常组、入院时低钠血症组、入院后72 h 内发生低钠血症组,观察患者入院30 d 内心源性休克、死亡、急性肾功能衰竭、室壁瘤形成及室间隔穿孔等不良事件发生率,并进行相关性及回归分析。结果与血钠正常组相比,低钠血症组患者病死率较高(P <0.01),更易合并心源性休克(P <0.01)、急性肾功能衰竭(P <0.01)、室壁瘤形成(P =0.005)等不良事件;30 d 的病死率与低钠血症的严重性呈正相关(与血钠正常组相比,血钠水平130~134 mmol/ L 死亡风险 OR 值2.0(95% CI:1.1~3.4;P =0.006),血钠水平<130 mmol/ L死亡风险 OR 值3.3(95% CI:1.4~7.7;P =0.003)。结论入院时或入院早期发生低钠血症是急性 ST 段抬高型心肌梗死患者近期病死率的独立危险因素,且预后与低钠血症严重性呈正相关。%Objective To investigate the correlation between hyponatremia and short-term prog-nostic impact of acute ST-elevation myocardial infarction. Methods Two hundred and twenty-three con-secutive patients with actute ST-elevation myocardial infarction from March 2014 to May 2015 were select-ed. Plasma sodium concentrations were obtained at 24,48,72 hours. Hyponatremia defined as a plasma sodium level <135 mmol/ L. According to the plama soudium level,patients were divided into three groups (normal sodium level,hyponatremia on admission,hyponatremia within 72 hours). Results Compared with normal sodium level group,the fatality of

  1. Predictors of short term mortality in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock%急性心肌梗死合并心原性休克死亡危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘尧; 杨艳敏; 朱俊; 谭慧琼; 梁岩; 刘力生; 丽英

    2010-01-01

    目的 探讨ST段抬高的急性心肌梗死合并心原性休克(cardiogenic shock,CS)患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄(68.5±10.3)岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%(322例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.46,95%GI:1.18~1.81)、前壁梗死(OR=2.01,95%CI:1.29~3.11)、入院基线血糖>7.8 mmol/L(OR=2.17,95%CI:1.26~3.73)、血钠<130 mmoL/L(OR=2.21,95%CI:1.21~4.04)、左心室射血分数(LVEF)<40%或重度左心功能障碍(LVD)(OR=3.78,95%CI:2.28~6.27)、未紧急血运重建(OR=3.53,95%CI:1.20~10.41)和使用利尿剂(OR=1.90,95%CI:1.21~2.97)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81(95%CI:0.77~0.86)和0.80(95%CI:0.75~0.84).结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.%Objective To explore the indepedent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction(STEMI)complicated by cardiogenic shock (CS). Methods We analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI)and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables. Results The overall 30-day mortality of STEMI

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

    2016-01-25

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

  4. Akut koronarangiografi er indiceret ved ST-elevation efter hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Bro-Jeppesen, John; Møller, Jacob Eifer;

    2013-01-01

    be offered to patients with a high likelihood of thrombotic coronary lesions, i.e. patients with ST-segment elevation in electrocardiogram (ECG) following resuscitation. This article suggests a triage and referral based on electronic transmission of ECG and teleconference with specialized centres in all......Guidelines suggest that acute coronary angiography (CAG) is considered in patients resuscitated from out-of-hospital cardiac arrest with presumed cardiac aetiology. Since specialized post-resuscitation care, including therapeutic hypothermia, has proved beneficial in randomized studies, CAG should...

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

    OpenAIRE

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Panina A.V.

    2013-12-01

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

  7. Optimize the treatment strategy in patients with acute ST-segment elevation myocardial infarction%优化急性ST段抬高型心肌梗死急诊救治流程

    Institute of Scientific and Technical Information of China (English)

    刘晓宇; 楚英杰; 秦历杰; 赵文利; 贺文奇; 许文克; 杨蕾; 董淑娟; 李兵

    2015-01-01

    目的 对STEMI患者救治流程进行优化改进,分析其对缩短医院延迟时间,提高门囊时间达标率的作用.方法 通过分析传统的STEMI流程对医院延迟的影响,对STEMI救治流程进行以下优化改进:(1)由急诊科医师直接启动导管室;(2)导管室值班人员电话单标注距医院时间;(3)启动导管室后立即转运患者至导管室.记录STEMI患者门囊时间构成,具体为5个时间段:(1)入急诊至完成首份心电图;(2)完成心电图至启动导管室;(3)启动导管室至手术开始;(4)手术开始至球囊扩张时间;(5)入急诊至球囊扩张时间.对比2008年5月至2012年12月间112例采用传统救治流程的STEMI患者与2013年1月至2014年12月间126例施行优化流程患者,分析其各时间段的构成变化.结果 (1)优化流程后的门囊时间与传统流程比较明显缩短[(82.68±16.35) min vs.(120.87±22.57) min,P<0.01];90 min达标率也由12.5%升高至61.1%;(2)从完成心电图到启动导管室时间由传统流程组(38.86±7.59) min减至优化流程组(13.75±5.56) min,P<0.01;(3)从启动导管室到手术开始时间由(44.37±7.56) min缩短至(30.39±4.94) min,P<0.01;(4)在优化流程中,手术开始至球囊扩张时间也较传统明显缩短[(34.83±5.97) minvs.(31.33±6.50) min,P<0.05].结论 通过优化STEMI急诊救治流程,特别是缩短急诊室和导管窒的反应时间,明显改善医院延迟,使门囊时间控制在90 min以内.%Objective To optimize the treatment strategy in patients with acute ST-segment elevation myocardial infaretion (STEMI) in order to shorten the system delay,achieving the goal door-to-balloon (DTB) as soon as possible.Methods After the analysis of the influence on system delay of conventional treatment process,the following algorithm taken to optimize the treatment process in STEMI patients was carried out:(1) emergency department physician had the activation of the catheterization laboratory and the STEMI

  8. Comparação entre troponina I cardíaca e CK-MB massa em síndrome coronariana aguda sem supra de ST Comparación entre troponina i cardíaca y ck-mb masa en síndrome coronario agudo sin supradesnivel de ST Comparison between cardiac troponin I and CK-MB mass in acute coronary syndrome without st elevation

    Directory of Open Access Journals (Sweden)

    Elizabete Silva dos Santos

    2011-03-01

    Full Text Available FUNDAMENTO: Há incertezas do valor prognóstico comparativo entre troponina I cardíaca (cTnI e CK-MB em síndrome coronariana aguda (SCA. OBJETIVO: Comparar o valor prognóstico entre a cTnI e a CK-MB massa em pacientes com SCA sem supradesnível do segmento ST. MÉTODOS: Foram analisados 1.027 pacientes, de modo prospectivo, em um centro terciário de cardiologia. Combinações dos biomarcadores foram examinadas: cTnI normal, CK-MB massa normal (65,5%; cTnI normal, CK-MB massa elevada (3,9%; cTnI elevada, CK-MB massa normal (8,8%; cTnI elevada, CK-MB massa elevada (20,7%. Análise multivariada de variáveis clínicas, eletrocardiográficas e laboratoriais determinou o valor prognóstico independente dos biomarcadores para o evento de morte ou (reinfarto em 30 dias. RESULTADOS: Pacientes com pelo menos um biomarcador elevado foram mais idosos (p = 0,02 e do sexo masculino (p FUNDAMENTO: Hay dudas sobre el valor pronóstico comparativo entre troponina I cardíaca (cTnI y CK-MB en síndrome coronario agudo (SCA. OBJETIVO: Comparar el valor pronóstico entre la cTnI y la CK-MB masa en pacientes con SCA sin supradesnivel del segmento ST. MÉTODOS: Fueron analizados 1.027 pacientes, de modo prospectivo, en un centro terciario de cardiología. Combinaciones de los biomarcadores fueron examinadas: cTnI normal, CK-MB masa normal (65,5%; cTnI normal, CK-MB masa elevada (3,9%; cTnI elevada, CK-MB masa normal (8,8%; cTnI elevada, CK-MB masa elevada (20,7%. Análisis multivariado de variables clínicas, electrocardiográficas y de laboratorio determinó el valor pronóstico independiente de los biomarcadores para el evento de muerte o (reinfarto en 30 días. RESULTADOS: Pacientes con por lo menos un biomarcador elevado eron más añosos (p = 0,02 y del sexo masculino (p BACKGROUND: There is uncertainty as to the comparative prognostic value between cardiac troponin I (cTnI and CK-MB in acute coronary syndrome (ACS. OBJECTIVE: To compare the prognostic

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    LI Jian-ping; HUO Yong

    2010-01-01

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

  11. Impact of cardiac care variation on ST-elevation myocardial infarction outcomes in Malaysia.

    Science.gov (United States)

    Selvarajah, Sharmini; Fong, Alan Y Y; Selvaraj, Gunavathy; Haniff, Jamaiyah; Hairi, Noran N; Bulgiba, Awang; Bots, Michiel L

    2013-05-01

    Developing countries face challenges in providing the best reperfusion strategy for patients with ST-segment elevation myocardial infarction because of limited resources. This causes wide variation in the provision of cardiac care. The aim of this study was to assess the impact of variation in cardiac care provision and reperfusion strategies on patient outcomes in Malaysia. Data from a prospective national registry of acute coronary syndromes were used. Thirty-day all-cause mortality in 4,562 patients with ST-segment elevation myocardial infarctions was assessed by (1) cardiac care provision (specialist vs nonspecialist centers), and (2) primary reperfusion therapy (thrombolysis or primary percutaneous coronary intervention [P-PCI]). All patients were risk adjusted by Thrombolysis In Myocardial Infarction (TIMI) risk score. Thrombolytic therapy was administered to 75% of patients with ST-segment elevation myocardial infarctions (12% prehospital and 63% in-hospital fibrinolytics), 7.6% underwent P-PCI, and the remainder received conservative management. In-hospital acute reperfusion therapy was administered to 68% and 73% of patients at specialist and nonspecialist cardiac care facilities, respectively. Timely reperfusion was low, at 24% versus 31%, respectively, for in-hospital fibrinolysis and 28% for P-PCI. Specialist centers had statistically significantly higher use of evidence-based treatments. The adjusted 30-day mortality rates for in-hospital fibrinolytics and P-PCI were 7% (95% confidence interval 5% to 9%) and 7% (95% confidence interval 3% to 11%), respectively (p = 0.75). In conclusion, variation in cardiac care provision and reperfusion strategy did not adversely affect patient outcomes. However, to further improve cardiac care, increased use of evidence-based resources, improvement in the quality of P-PCI care, and reduction in door-to-reperfusion times should be achieved.

  12. Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Timmer, Jorik R.; Hoekstra, Miriam; Nijsten, Maarten W. N.; van der Horst, Iwan C. C.; Ottervanger, Jan Paul; Slingerland, Robbert J.; Dambrink, Jan-Henk E.; Bilo, Henk J. G.; Zijlstra, Felix; van't Hof, Arnoud W. J.

    2011-01-01

    Background-In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is unce

  13. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

    Science.gov (United States)

    Brkovic, Voin; Dobric, Milan; Beleslin, Branko; Giga, Vojislav; Vukcevic, Vladan; Stojkovic, Sinisa; Stankovic, Goran; Nedeljkovic, Milan A; Orlic, Dejan; Tomasevic, Miloje; Stepanovic, Jelena; Ostojic, Miodrag

    2013-08-01

    This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE--composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  15. Uric acid in the early risk stratification of ST-elevation myocardial infarction.

    Science.gov (United States)

    Lazzeri, Chiara; Valente, Serafina; Chiostri, Marco; Picariello, Claudio; Gensini, Gian Franco

    2012-02-01

    Controversy still exists about uric acid as a potential prognostic risk factor for outcomes in patients with acute myocardial infarction. We prospectively assessed, in 856 patients with ST-elevation myocardial infarction (STMI) consecutively admitted to our Intensive Cardiac Care Unit after primary percutaneous coronary intervention (PCI) whether uric acid (UA) levels are associated with in-hospital mortality and complications. Killip classes III-IV were more frequent in the 3° UA tertile that was associated with the highest values of peak Tn I (p = 0.005), NT-proBNP (p pre-existing risk factors to the degree of myocardial ischemia (as indicated by Killip class, ejection fraction) and to the acute metabolic response (as inferred by glucose levels). Hyperuricemia is not independently associated with early mortality when adjusted for renal function and the degree of myocardial damage.

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

    Institute of Scientific and Technical Information of China (English)

    夏经钢; 曲杨; 胡少东; 许骥; 尹春琳; 徐东

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gosselink AT Marcel

    2007-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Omar Mousa

    2013-11-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ignasi Barba

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

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

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2008-01-01

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

  2. 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

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

    Institute of Scientific and Technical Information of China (English)

    徐莉(综述); 马依彤(审校)

    2015-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    2007-01-01

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

  6. ST-segment elevation during general anesthesia for non-cardiac surgery: a case of takotsubo

    Directory of Open Access Journals (Sweden)

    Leticia Bôa-Hora Rodrigues

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES: Takotsubo cardiomyopathy, also known as broken heart syndrome is a stress-induced cardiomyopathy, which can be interpreted as an acute coronary syndrome as it progresses with suggestive electrocardiographic changes. The purpose of this article is to show the importance of proper monitoring during surgery, as well as the presence of an interdisciplinary team to diagnose the syndrome.CASE REPORT: Male patient, 66 years old, with diagnosis of gastric carcinoma, scheduled for diagnostic laparoscopy and possible gastrectomy. In the intraoperative period during laparoscopy, the patient always remained hemodynamically stable, but after conversion to open surgery he presented with ST segment elevation in DII. ECG during surgery was performed and confirmed ST-segment elevation in the inferior wall. The cardiology team was contacted and indicated the emergency catheterization. As the surgery had not yet begun irreversible steps, we opted for the laparotomy closure, and the patient was immediately taken to the hemodynamic room where catheterization was performed showing no coronary injury. The patient was taken to the hospital room where an echocardiogram was performed and showed slight to moderate systolic dysfunction, with akinesia of the mid-apical segments, suggestive of apical ballooning of the left ventricle. Faced with such echocardiographic finding and in the absence of coronary injury, the patient was diagnosed with intraoperative Takotsubo syndrome.CONCLUSION: Because the patient was properly monitored, the early detection of ST-segment elevation was possible. The presence of an interdisciplinary team favored the syndrome early diagnosis, so the patient was again submitted to safely intervention, with the necessary security measures taken for an uneventful new surgical intervention.

  7. 肾功能不全对急性 ST 段抬高型心肌梗死患者住院期间预后的影响%Impact of Renal Insufficiency of Patients with Acute ST segment Elevation Myocardial Infarction on Prognosis in Duration of Hospital Stay

    Institute of Scientific and Technical Information of China (English)

    夏雪; 郑再星; 朱千里; 黄伟剑

    2015-01-01

    的重要危险因素。%Objective To characterize clinical features of acute ST segment elevation myocardial infarction (STEMI) patients with re-nal insufficiency (RI) and to explore impact of renal insufficiency (RI) on adverse outcomes of STEMI patients in hospital .Methods A retrospective study was conducted among 950 patients who were hospitalized with acute STEMI in the first hospitalization of Wen -zhou Medical University from March 2007 to March 2012 .Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated Modification of Diet in Renal Disease equation .The patients were divided into three groups according to eGFR , normal renal function (eGFR ≥ 90ml・min - 1・1 .73m - 2 ) ,mild RI (60ml・min - 1・1 .73m - 2 ≤ eGFR < 90ml・min - 1・1 .73m - 2 ) and moderate or severe RI (eGFR < 60ml・min - 1・1 .73m - 2) .The clinical features and hospital adverse outcomes were analyzed .Results Among the 950 STEMI patients ,444 (46 .74% ) patients had normal renal function ,351 (36 .95% ) patients had mild RI ,155 (16 . 32% ) patients had moderate or severe RI ,RI patients were more likely to be elderly ,female ,non drinker and non smokers ,and they were more likely to have a past history of hypertension ,diabetes ,hyperlipemia and cerebral infarction and to have complication of a -trial fibrillation and II/III degree atrioventricular block( P < 0 .05) .In addition ,RI patients were significantly more likely to have three vessel disease and more likely to have severe stenosis in left main ,right coronary artery and left circumflex artery ,but RI pa-tients received primary percutaneous coronary intervention less frequently than those with normal renal function (P< 0 .05) .Multivari-ate logistic regression analysis indicated that moderate or severe RI remained an independent predictor for cardiogenic shock (OR = 4 . 13 ,95% CI :1 .52 11 .22) and heart failure (OR = 2 .25 ,95% CI :1 .36 3 .71) for STEMI patients .Mild RI (OR = 2 .20 ,95% CI :1 . 27 6 .70) and

  8. QRS-ST-T triangulation with repolarization shortening as a precursor of sustained ventricular tachycardia during acute myocardial ischemia.

    Science.gov (United States)

    Batchvarov, Velislav N; Behr, Elijah R

    2015-04-01

    We present segments from a 24-hour 12-lead digital Holter recording in a 48-year-old man demonstrating transient ST elevations in the inferior leads that triggered sustained ventricular tachycardia/ventricular fibrillation (VT/VF) requiring cardioversion. The onset of VT was preceded by a gradual increase in the ST with marked QRS broadening that lacked distinction between the end of the QRS and the beginning of the ST (QRS-ST-T "triangulation"), and shortening of the QT interval not caused by an increased heart rate. This is a relatively rare documentation of the mechanisms immediately triggering sustained ventricular arrhythmias during acute myocardial ischemia obtained with 12-lead ECG.

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  10. Transient elevation of ST-segment due to pneumothorax and pneumopericardium

    Directory of Open Access Journals (Sweden)

    Rodrigo Martins Brandão

    2013-03-01

    Full Text Available ST-segment elevation, observed in the critically ill patients, almost always raises the suspicion of ischemic heart disease. However, nonischemic myocardial and non-myocardial problems in these patients may also lead to ST-segment elevation. Pneumothorax and pneumopericardium have been rarely reported as a cause of transient ST-segment elevation. The authors report the case of a patient admitted to the emergency care unit because of a respiratory failure requiring mechanical ventilatory support. As the patient showed signs of clinical deterioration, a pneumothorax was clinically diagnosed. Chest radiography after thorax drainage also disclosed a pneumopericardium. The 12-lead electrocardiogram recorded before the thoracic drainage revealed an ST-segment elevation, which normalized after the surgical procedure. Ischemic myocardial biomarkers were negative. The authors call attention to the right-sided pneumothorax associated with pneumopericardium as an unusual cause of ST-segment elevation.

  11. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Rajayer, Salil; Gurung, Vikash; Tam, Eric; Morante, Joaquin; Shamian, Ben; Malik, Ryan

    2016-01-01

    Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest. PMID:27609717

  12. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

    Directory of Open Access Journals (Sweden)

    Jose Orsini

    2016-09-01

    Full Text Available Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest.

  13. Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption.

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Rajayer, Salil; Gurung, Vikash; Tam, Eric; Morante, Joaquin; Shamian, Ben; Malik, Ryan

    2016-01-01

    Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest. PMID:27609717

  14. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction.

    Science.gov (United States)

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-06-26

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion ("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

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

    Institute of Scientific and Technical Information of China (English)

    王立军; 王晓军; 蔡卫东; 崔连群

    2002-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    于富军; 傅向华; 卫亚丽; 李寿霖; 肖蕴陟; 丁超; 赵战勇

    2004-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the Glycometabolic Intervention as Adjunct toPrimary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial)

    NARCIS (Netherlands)

    Gorter, Thomas M; Lexis, Chris P H; Hummel, Yoran M; Lipsic, Erik; Nijveldt, Robin; Willems, Tineke P; van der Horst, Iwan C C; van der Harst, Pim; van Melle, Joost P; van Veldhuisen, Dirk J

    2016-01-01

    Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce

  20. The prognosis prediction value of serum corin in patients with non-ST-elevation acute coronary syndrome%血清Corin水平对非ST段抬高急性冠脉综合征预后的意义

    Institute of Scientific and Technical Information of China (English)

    王占银

    2015-01-01

    AIM: To investigate the level of serine protease corin and its role in prognosis prediction in patients with acute coronary syndrome ( ACS) . METHODS:A total of 255 subjects were included in this study, including 152 ACS patients who underwent percutaneous coronary intervention and 103 control subjects. The serum corin level of all these subjects were measured by enzyme⁃linked immunoabsorbent assay. RESULTS:The corin level was significantly lower in ACS patients than in the controls ( 798 ± 288 pg/mL vs 1165 ± 613 pg/mL, P<0. 05 ) . A significantly lower corin level was also observed in ACS patients who developed major adverse cardovascular events ( MACE) than those who did not experience major adverse cardiovascular events (698.16±233.67 pg/mL vs 952.1±297.81 pg/mL, P<0.05). Using a multiple logistic regression model, corin level was a predictor of post⁃ACS MACE (P<0.05). CONCLUSION: The serum corin levels of patients with non⁃ST⁃elevation ACS and those who encountered major adverse cardiovascular events decreased significantly. In ACS patients, corin, as a novel biomaker, could be used either alone or in combination with other biomarkers for cardiovascular risk stratification assessment and outcome prediction.%目的:明确丝氨酸蛋白酶Corin在急性冠脉综合征患者中的水平变化及其作为预后标志物的临床意义.方法:本研究共纳入2010-12/2014-12受试对象255名,其中进行经皮冠脉介入( PCI)的非ST抬高急性冠脉综合征患者152名,对照健康体检人员103名.采用酶联免疫吸附法( ELISA)对丝氨酸蛋白酶 Corin 的水平进行检测.结果:丝氨酸蛋白酶Corin在急性冠脉综合征患者中的水平要显著低于对照组患者(798±288 pg/mL vs 1165±613 pg/mL,P<0.05).丝氨酸蛋白酶Corin在发生主要心血管事件的急性冠脉综合征患者中的水平要显著低于未发生急性冠脉综合征的患者(698.16± ;233.67

  1. Routine upstream versus selective down stream use of tirofiban in non-ST elevation myocardial infarction patients scheduled for early invasive therapy; a randomized comparison

    NARCIS (Netherlands)

    Rasoul, Saman; Ottervanger, Jan Paul; de Boer, Menko Jan; Dambrink, Jan Henk E.; Suryapranata, Harry; Hoorntje, Jan C. A.; Gosselink, A. T. Marcel; van 't Hof, Arnoud W. J.

    2007-01-01

    Despite their proven beneficial effects and inclusion in the guidelines, glycoprotein (GP) IIb/IIIA blockers are underused in daily practice in patients with non ST-segment elevation acute coronary syndrome (NSTE ACS). This study combines the data from two randomized controlled trials, comparing rou

  2. Influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction%女性急性心肌梗死静脉溶栓后ST段再抬高对预后的影响

    Institute of Scientific and Technical Information of China (English)

    张宏伟; 许虹; 李元红; 及心

    2012-01-01

    Objective To investigate the influence of delayed ST-segment re-elevation on prognosis after successful intravenous thrombolysis in female patients with acute myocardial infarction ( AMI ). Methods The female AMI patients ( n = 106 ) with successful intravenous thrombolysis within 6 hours after disease onset were selected and divided into group of ST-segment re-elevation ( re-elevation group,n = 38 ) and group without ST-segment re-elevation ( control group, re = 68 ) according to whether there was ST-segment elevation 12 hours after successful intravenous thrombolysis. The peak value and peak time of creatine kinase-MB ( CK-MB ) were monitored in two groups. In one week,two weeks,one month,three months and six months after intravenous thrombolysis,the changes of ECG,dynamic ECG and echocardiography were re-examined. Within six months,6-minute walk test was reviewed every month. All the above indexes were compared between two groups. Results In re-elevation group, age, proportion of complicated hypertension , diabetes, hyperlipidemia and obesity, and peak value of CK-MB were all significantly higher than those in control group ( all P <0. 05 ). The degree of shift forward in peak time of CK-MB was lower in re-elevation group than that in control group ( P < 0. 05 ). The incidence and mortality of malignant arrhythmia, heart failure and ventricular an-eurysm were significantly higher in re-elevation group than those in control group ( P < 0.05 ). The values of left ventricular ejection fraction ( LVEF ) and 6-minute walk test were lower in re-elevation group than those in control group ( P <0. 05 ). Conclusion The incidence and mortality of malignant arrhythmia, heart failure and ventricular aneurysm are higher in female AMI patients with delayed ST-segment re-elevation after successful intravenous thrombolysis and the prognosis is poor.%目的 探讨女性急性心肌梗死(AMI)静脉溶栓成功后ST段延迟性再抬高对预后的影响.方法 入选发病6 h

  3. St. Croix, U.S. Virgin Islands Coastal Digital Elevation Model

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 1/3 arc-second St. Croix, U.S. Virgin Islands Coastal Digital Elevation Model will be used to support NOAA's tsunami forecast system and for tsunami inundation...

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lukasz Lewicki

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Shahrooz Yazdani

    2012-06-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that provides hig...... ACS is the largest randomized clinical trial to date focusing exclusively on medically managed NSTE ACS patients and will provide important information regarding the optimal approach to oral antiplatelet therapy for this high-risk, understudied population....... higher and less variable levels of platelet inhibition than clopidogrel-has demonstrated benefit when used to treat ACS patients undergoing percutaneous coronary intervention. However, the optimal approach to antiplatelet therapy for high-risk, medically managed NSTE ACS patients remains uncertain...... revascularization procedures for their index event. Patients will be randomly allocated to prasugrel + aspirin versus clopidogrel + aspirin for a median duration of 18 months. A reduction in the maintenance dose of prasugrel for elderly patients (age >or=75 years) and those with body weight or=75 years). TRILOGY...

  10. Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Raio Luigi

    2010-06-01

    Full Text Available Abstract Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.

  11. Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature.

    Science.gov (United States)

    Arampatzis, Spyridon; Stefanidis, Ioannis; Lakiopoulos, Vassilios; Raio, Luigi; Surbek, Daniel; Mohaupt, Markus G

    2010-06-17

    Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.

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

    Science.gov (United States)

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

    2016-09-01

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

  13. The value of a new type of green channel that shortening the delay of before emergency intervention for patients with acute ST segment elevation myocardial infarction%新型绿色通道缩短急性ST段抬高型心肌梗死急诊介入术前延迟的价值

    Institute of Scientific and Technical Information of China (English)

    唐聚花; 李莉

    2015-01-01

    Objective:To investigate the important value of the new green channel that shortening the delay of before the emergency percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:261 with STEMI were selected,patients with PCI from the emergency room to the catheter room directly,as a new type of green channel model (referred to as the new model),a total of 125 cases,patients with direct PCI from the emergency room to the CCU and then to the catheter room line for the control group,as the traditional green channel model(referred to as the traditional mode), a total of 136 cases.We count the door-to-balloon time(DTB),door-to-diagnosis(DTD),diagnosis-to-lab(DTL),lab-to-balloon dilatation(LTB) of the two groups,observed whether there are differences.Results:The DTB and DTL were significantly shortened of the new model(P<0.05).Conclusion:The new green channel can shorten the time of hospital admission to PCI for patients with ST elevation myocardial infarction.%目的:探讨新型绿色通道对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠脉介入术前延迟的重要价值。方法:收治STEMI患者261例,由急诊室→导管室直接行经皮冠脉介入术(PCI)者,定为新型绿色通道模式(简称新型模式),共125例,对照组由急诊室→CCU→导管室行直接 PCI 者,定为传统绿色通道模式(简称传统模式),共136例,统计两组患者入门→球囊扩张时间(DTB),入门→确诊时间(DTD),确诊→导管室时间(DTL),导管室→球囊扩张时间(LTB),观察是否有差异。结果:新型模式DTB、DTL明显缩短(P<0.05)。结论:新型绿色通道能缩短ST抬高型心肌梗死患者入院至PCI的时间。

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

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Manish Pradhan; Shuxian Zhou; Juan Lei; Zesheng Liu

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-15

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

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

    International Nuclear Information System (INIS)

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

  18. 老年女性急性ST段抬高心肌梗死患者临床及冠状动脉造影特点分析%Analysis of clinical and coronary angiography of old women with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    刘志; 华琦; 谭静

    2012-01-01

    目的 探讨老年女性急性ST段抬高心肌梗死患者临床及冠状动脉造影特点.方法 选择经急诊PCI诊治的年龄>60岁女性急性ST段抬高心肌梗死患者90例为老年女性组;另收集同期年龄匹配的男性急性ST段抬高心肌梗死患者190例为老年男性组,对比老年女性ST段抬高心肌梗死患者的临床及冠状动脉造影特点.结果老年女性组吸烟史及糖尿病患病率明显低于老年男性组,LDL-C、高敏C反应蛋白、白细胞介素6水平明显高于老年男性组,差异有统计学意义(P<0.05,P<0.01);老年女性组平均发病年龄明显高于老年男性组,3支病变比例明显低于老年男性组,差异有统计学意义(P<0.05,P<0.01).结论女性心肌梗死发病年龄较晚,3支病变比例低;肥胖、LDLC升高及炎性反应是女性心肌梗死的重要危险因素.%Objective To study the clinical characteristics and coronary angiography of old women patients with acute ST-segment elevation myocardial infarction. Method 90 female patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary PCI treatment were selected(age>60 years). During the same period, 190 male patients with acute STEMI were collected as a control (age > 60 years). The clinical and angiographic characteristics of female STEMI patients were analysed. Results The proportion of old female patients suffering from smoking and diabetes were significantly lower than that of male patients, while LDL-C and inflammatory response were significantly higher than that in the old male group;the mean age of female patients group was elder than that in male patients group(F

  19. 术前负荷剂量国产氯吡格雷在急性ST段抬高型心肌梗死介入治疗中的疗效观察%The effect observation of preoperative loading dose of domestic clopidogrel in PCI of acute ST-segment elevation myocardial infarction interventional

    Institute of Scientific and Technical Information of China (English)

    贺铿; 石刚; 赵勇; 叶君明

    2013-01-01

    Objective To compare the therapeutic effects and safety of domestic clopidogrel and import clopidogrel on PCI in acute ST-segment elevation myocardial infarction(STEMI) patients. Methods 120 patients with acute STEMI were randomly divided into domestic clopidogrel group(58 cases) and imported clopidogrel group(62 cases). Before PCI the two groups were respectively given loading dose of domestic or import clopidogrel 600mg;after PCI they were respectively given 75mg every day for nine months. Major clinical cardiovascular events, bleeding events and adverse reaction were observed in the two groups. Results There were no signiifcant difference in cardiovascular events (P>0.05), adverse reaction (P>0.05), bleeding events (P>0.05) between domestic clopidogrel group and import clopidogrel group. Conclusion Domestic clopidogrel is as safe and effective as import clopidogrel in PCI of acute STEMI. Domestic clopidogrel was more beneift for patients than import clopidogrel in price, so domestic clopidogrel was more suitable for wide application in China.%目的:比较国产氯吡格雷与进口氯吡格雷在急性ST段抬高型心肌梗死介入治疗中的疗效及安全性。方法120例急性ST段抬高型心肌梗死患者,随机分为两组,国产氯吡格雷组:58例;进口氯吡格雷组:62例。均在经皮冠状动脉介入治疗(PCI)术前口服负荷剂量600 mg/次、术后75 mg/d。分别观察两组PCI基本特征,9个月的主要临床心血管事件及出血事件、药物不良反应的发生情况。结果国产氯吡格雷组在心血管事件与出血、药物不良反应与进口氯吡格雷组差异无显著性(P>0.05)。结论国产氯吡格雷与进口氯吡格雷在急性ST段抬高型心肌梗死PCI治疗同样安全、有效,但国产氯吡格雷经济效益较进口氯吡格雷高,更适合在我国广泛应用。

  20. Att befinna sig i stödåtgärder : Tre elevers upplevelser av särskilt stöd i matematik

    OpenAIRE

    Grödevik, Anna

    2011-01-01

    Elevers upplevelser av att befinna sig i stödåtgärder är antagligen av stort intresse för de lärare som undervisar elever med allmänna eller specifika matematiksvårigheter. Hur beskriver då några elever själva sina upplevelser av stödåtgärder? Syftet med denna studie är att få större kunskap om och ökad förståelse för hur stödåtgärder i matematik upplevs av de elever som fått särskilt stöd under en längre period. För att kunna ta del av några elevers upplevelser av stödåtgärder valde jag att ...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kirsi Alestalo

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

  3. THE BNP CHANGES AND LEFT VENTRICLE RECONSTITUTION OF ACUTE NON-ST ELEVATED MYOCARDIAL INFARCTION PATIENTS WITH DIFFERENT TREATMENT METHODS%急性非ST段抬高心肌梗死患者不同治疗方式BNP变化及左心室重构分析

    Institute of Scientific and Technical Information of China (English)

    朱凌凌

    2012-01-01

    Objective To investigate the changes of the B - type natriuretic peptide ( BNP ) and left ventricle reconstitution in acute non - ST elevated myocardial infarction patients with different therapy . Methods A total of 104 cases of primary acute non - ST elevated myocardial infarction patients from February 2010 to August 2011 were selected. According to different treatments, the subjects were randomly divided into two groups: Percutaneous coronary artery intervention ( PCI ) treatment group ( n =54 ) and conservative drug treatment group ( n = 50 ). The changes of BNP, left ventricular end systolic volume( LVESV ) and left ventricular end - diastolic volume( LVEDV ) on admission and 4 weeks after infarction onset were observed. Results On admission, the BNP level had no difference between PCI treatment group and conservative medical treatment group ( P > 0. 05 ), but there were significant difference 4 weeks after infarction onset between the two groups ( P < 0. 05 ). LVESV and LVEDV had no significant difference between two groups at admission and 4 weeks after infarction onset. Conclusion Excluding the effect of the heart function, after different therapy, the average BNP level was significantly lower in PCI treatment group than that of conservative medicine therapy group. After a followed - up of four weeks,the index of left ventricle reconstitution had no statistical difference between the two groups.%目的 探讨急性非ST段抬高心肌梗死患者不同治疗方式B型尿钠肽(B-type natriuretic peptide,BNP)的变化及左心室重构情况.方法 选择2010年2月-2011年8月初发急性心肌梗死患者104例,根据不同的治疗方式分为经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗组54例和药物非手术治疗组50例,观察入院时及发病后4周BNP、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)和左心室收缩末期容积(left ventricular end systolic volume

  4. Systematic evaluation of effects of domestic tirofiban for interventional therapy in Chinese patients with acute ST - segment elevation myocardial infarction%国产替罗非班对中国人群急性ST段抬高型心肌梗死介入治疗系统评价

    Institute of Scientific and Technical Information of China (English)

    张勇; 唐海沁; 李瑾

    2012-01-01

    Objective; To evaluate efficacy and safety of domestic tirofiban for interventional therapy of acute ST -segment elevation myocardial infarction (STEMI). Methods: Randomized controlled trials on interventional therapy of myocardial infarction with domestic tirofiban up to Jun 2011 were collected from Cochrane Controlled Trial Register (CCTR), Pubmed, Embase, Wanfang database, China national knowledge infrastructure (CNKI), Chinese bio-medical (CBM) literature database and VIP database (VIP). A total of 21 studies were enrolled, including 2 332 patients, in which tirofiban group contained 1 149 cases, routine therapy group contained 1 183 cases. Rev-Man 5. 0 software was used for Meta analysis. Results: (1) Therapeutic effects of tirofiban on STEMI were significantly better than those of control group [OR = 2. 47, 95%CI (1.81, 3.37), P<0. 00001]; (2) Incidence of cardiovascular events of composite end point within 24h, after 30 d during admission in tirofiban group was significantly lower than that of control group [OR = 0. 24, 95%CI (0. 16, 0. 35), OR = 0. 22, 95%CI (0. 15, 0. 32) , P< 0. 00001 all]; (3) Incidence rate of bleeding in tirofiban group was significantly higher than that of control group [OR=1.77, 95%CI (1.30, 2.43), P = 0.0003], but there were no severe bleeding and thrombopenia. Conclusion: Existing clinical studies indicate that domestic tirofiban has significant therapeutic effects on interventional therapy of acute ST - segment elevation myocardial infarction in Chinese population and incidence rates of adverse reactions are low.%目的:评价国产替罗非班在治疗急性ST段抬高心肌梗死介入治疗中的有效性及安全性.方法:计算机检索至2011年6月Cochrane图书馆临床对照试验资料库(CCTR)、Pubmed、Embase、万方数据库、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集国产替罗非班治疗心肌梗死介入治疗的

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

    Institute of Scientific and Technical Information of China (English)

    王书鹏; 秦历杰

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ker James

    2009-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王静

    2015-01-01

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

  8. Clinical characteristics,treatments and outcome of diabetic patients with non-ST elevation acute coronary syndromes in China%糖尿病合并非ST段抬高急性冠状动脉综合征患者的临床特点、治疗及远期预后

    Institute of Scientific and Technical Information of China (English)

    于丽天; 谭慧琼; 朱俊; 章晏; 李建冬; 刘力生; 代表急性冠状埃及综合征登记研究中国协作组

    2011-01-01

    Objective To observe the clinical characteristics,treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes(NSTEACS).Methods Consecutive patients admitted with NSTEACS from 38 centers in north China were enrolled.Medical histories,clinical characteristics,treatments and outcomes were evaluated and follow-up was made at 6,12,and 24 months 'after their initial hospital admission.Cumulative event rates were compared between diabetic and nondiabetic patients.Results There were 420 diabetic patients out of 2294 NSTEACS patients(18.3%).Diabetic patients were older[(64.9±6.7)years vs.(62.3±8.6)years,P100次/min是非ST段抬高ACS患者2年死亡的危险因素.结论 合并糖尿病的非ST段抬高ACS患者住院期间和2年死亡、慢性心力衰竭和联合终点事件发牛率明显高于非糖尿病者.糖尿病是非ST段抬高ACS患者2年死亡的独立危险因素.我国非ST段抬高ACS患者住院期间抗血小板治疗和早期介入检杳和治疗有待加强.有必要进行更有针对性的大规模临床研究,以提高糖尿病并发ACS的治疗水平,改善该人群的预后.

  9. Comparação da coronariografia de mulheres diabéticas e não-diabéticas com síndrome coronariana aguda sem supradesnivelamento de ST Comparison of coronary angiography findings in diabetic and non-diabetic women with non-ST-segment-elevation acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    José Marconi Almeida de Sousa

    2006-02-01

    Full Text Available OBJETIVO: Comparar o padrão hemodinâmico, angiográfico e a morfologia da lesão aterosclerótica em diabéticas e não-diabéticas com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST (AI/IAMSS. MÉTODOS: Dois hemodinamicistas determinaram a presença de lesão aterosclerótica grave, definida como > 70%, a morfologia da placa, de acordo com a classificação da American Heart Association, a presença de circulação colateral e as pressões ventriculares e aórticas. A fração de ejeção foi calculada pela angiografia ou pelo ecocardiograma. RESULTADOS: Em oito anos e meio, foram realizados 645 coronariografias em mulheres com AI/IAMSS. Foram analisadas 593 pacientes (215 diabéticas - 36%. Este grupo diferiu das não-diabéticas nos seguintes aspectos: idade mais alta (61 ± 10,6 x 58,1 ± 11,4, prevalência maior de mulheres pós-menopausa e menor prevalência de tabagismo. Lesão grave em três vasos foi significativamente mais freqüente nas pacientes diabéticas (28% x 10%, assim como vasos totalmente ocluídos: 51 (23% x 54 (14.3%, p OBJECTIVE: Compare hemodynamic and angiographic patterns, as well as atherosclerotic lesion morphology, in diabetic and non-diabetic females with unstable angina or non-ST-segment-elevation myocardial infarction (UA/NSTEMI. METHODS: Two interventional cardiologists determined the presence of severe atherosclerotic lesion, defined as those > 70%; plaque morphology, according to the American Heart Association classification; collateral circulation; plus ventricular and aortic pressures. Ejection fraction was calculated by angiography or echocardiography. RESULTS: During eight and a half years, 645 coronary angiographies were performed in women with UA/NSTEMI. In the present study, 593 female patients were assessed (215 diabetic - 36%. This group differed from the non-diabetic in the following aspects: older age (61 ± 10.6 x 58.1 ± 11.4, higher prevalence of

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

    Directory of Open Access Journals (Sweden)

    HamidReza Sanati

    2015-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

    魏庆民; 周彬; 王晓纲; 樊延明; 王爱平; 刘翠华

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李雪

    2016-01-01

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

  13. St. Thomas and St. John, U.S. Virgin Islands Coastal Digital Elevation Model

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA's National Geophysical Data Center (NGDC) is building high-resolution digital elevation models (DEMs) for select U.S. coastal regions. These integrated...

  14. Níveis séricos de interleucina-6 (IL-6, interleucina-18 (IL-18 e proteína C reativa (PCR na síndrome coronariana aguda sem supradesnivelamento do ST em pacientes com diabete tipo 2 Serum levels of interleukin-6 (Il-6, interleukin-18 (Il-18 and C-reactive protein (CRP in patients with type-2 diabetes and acute coronary syndrome without ST-segment elevation

    Directory of Open Access Journals (Sweden)

    José Roberto Matos Souza

    2008-02-01

    type-2 diabetes, atherosclerosis is related to a larger number of events such as myocardial infarction and death, when compared with patients without diabetes. OBJECTIVE: To evaluate the inflammatory response in patients with diabetes and acute events of coronary instability. METHODS: Two groups of patients were primarily selected. The first group was comprised of diabetic outpatients with stable angina (D-CCS and presence of coronary artery disease on coronary angiography (n=36. The second group was comprised of diabetic patients seen in the emergency room with acute coronary syndrome (D-ACS without ST-segment elevation (n=38. Non-diabetic patients with ACS (n=22 and CCS (n=16 comprised the control group. Serum levels of CRP, IL-6 and IL-18 were determined using nephelometry (CRP and ELISA (IL-6 and IL-18 techniques. RESULTS: Higher serum IL-6 levels were found in diabetic or non-diabetic patients with ACS than in the group with CCS. On the other hand, diabetic patients with ACS had higher CRP levels in comparison with the other groups. Serum IL-18 levels were not significantly different among the patients studied. CONCLUSION: our findings suggest a more intense inflammatory activity in patients with coronary instability. This inflammatory activity, as measured by CRP, seems to be even more intense in diabetic patients.

  15. ELEVATED LEVELS OF SOLUBLE ST2 PROTEIN IN DENGUE VIRUS INFECTED PATIENTS

    Science.gov (United States)

    Becerra, Aniuska; Warke, Rajas V.; de Bosch, Norma; Rothman, Alan L.; Bosch, Irene

    2008-01-01

    Levels of the soluble form of the interleukin-1 receptor like 1 protein (IL-1RL-1 / ST2) are elevated in the serum of patients with diseases characterized by an inflammatory response. The objective of this study was to determine the concentration of soluble ST2 (sST2) in dengue infected patients during the course of the disease. Twenty four patients with confirmed dengue infection, classified as dengue fever, and eleven patients with other febrile illness (OFI) were evaluated. Levels of sST2 in serum and laboratory variables usually altered during dengue infections were measured. Dengue infected patients had higher serum sST2 levels than OFI at the end of the febrile stage and at defervescence (p=0.0088 and p=0.0004 respectively). Patients with secondary dengue infections had higher serum sST2 levels compared with patients with primary dengue infections (p=0.047 at last day of fever and p=0.030 at defervescence). Furthermore, in dengue infected patients, we found a significant negative correlation of sST2 with platelet and WBC counts, and positive correlation with thrombin time and transaminases activity. We suggest that sST2 could be a potential marker of dengue infection, could be associated with severity or could play a role in the immune response in secondary dengue virus infection. PMID:18226917

  16. Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction

    NARCIS (Netherlands)

    Timmer, [No Value; Ottervanger, JP; de Boer, MJ; Hoorntje, JCA; Gosselink, ATM; Suryapranata, H; Zijlstra, F; van't Hof, AWJ; Dambrink, Jan Hendrik Everwijn

    2005-01-01

    OBJECTIVES This study was designed to investigate whether elevated glucose is associated with impaired Thrombolysis In Myocardial Infarction (TIMI) flow before primary percutaneous coronary intervention (PCI). BACKGROUND Reperfusion before primary PCI in patients with ST-segment elevation myocardial

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

    OpenAIRE

    V. A. Sulimov

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    YAN Hong-bing

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gamma Reto

    2011-08-01

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

  2. 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.

  3. Clinic outcome of ticagrelor in treatment of patients with acute ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention%替格瑞洛在急性ST段抬高型心肌梗死急诊PCI中应用的疗效观察

    Institute of Scientific and Technical Information of China (English)

    郭瑞威; 杨丽霞; 齐峰; 陈长征

    2014-01-01

    目的 观察替格瑞洛在急性ST段抬高型心肌梗死急诊经皮冠脉介入治疗(PCI)患者中的应用,分析其临床疗效.方法 行急诊冠脉介入治疗的急性心肌梗死62例患者,分为氯吡格雷组和替格瑞洛组,对比两组基线资料、PCI后即刻冠脉造影评价根据心肌梗死溶栓(TIMI)血流分级,30 d心血管不良事件和出血情况.结果 氯吡格雷组和替格瑞洛组年龄、性别及高血压病史率差异无统计学意义(P>0.05).替格瑞洛组术后即可恢复TIMI 3级血流率显著高于氯吡格雷组(96.7% vs 87.5%,P<0.05),30 d再发心绞痛率低于氯吡格雷组(3.3% vs 12.5%,P<0.05);两组患者30 d内全因死亡率差异无统计学意义(P>0.05),但轻微出血发生率替格瑞洛组高于氯吡格雷组(13.3% vs3.1%,P<0.05).结论 替格瑞洛可以显著改善急性心肌梗死患者的临床症状和预后,但在国人中有增加出血风险的趋势.%Objectives To investigate clinic outcome of ticagrelor in treatment of patients with acute ST-segment elevation my ocardial infarction receiving primary percutaneous coronary intervention.Methods Sixty-two consecutive patients with ST segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PCI) were included in this study.The clinic characteristics,thrombolysis in myocardial infarction (TIMI) refuse after PCI,clinical outcomes after 30 d of patients were compared between patients who were treated with ticagrelor (group A 30 cases) and clopidogrel (group B 32 cases).Results There was no difference in the age,proportion of women,hypertension,and diabetics (P > 0.05).TIMI 3 refuse after PCI were significantly higher in group A than group B (96.7% vs 87.5%,P < 0.05).The 30 d re-angina pectoris was lower in group A than group B (3.3% vs 12.5%,P <0.05).However,tiny bleeding of group A was higher than group B (13.3% vs 3.1%,P <0.05).Conclusions

  4. 不同时间使用替罗非班对急性ST段抬高型心肌梗死行急诊冠脉介入治疗患者的疗效比较%Effect of using tirofiban at different time on patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    郑扣龙; 卢辉和; 盛臻强; 黎叶飞

    2015-01-01

    Objective: To investiga te whether an early use of tirofiban could exert any impact on myocardial perfusion in patients with acute ST-elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(PPCI). Methods: A total of 98 patients with STEMI were included, who were planned to be performed PPCI and had no contraindications for tirofiban. Fifty patients were randomized to receive tirofiban early in the emergency ward (preoperation group, 15.00 μg/kg of bolus tirofiban was intravenous administrated as early as possible, followed by a maintenance infusion 0.10μg·kg-1·min-1 for 48 hours) and 48 patients were administrated in the catheter lab(intraoperation group, 15.00 μg/kg of bolus tirofiban was intravenous injected after the wire has crossed the lesion , followed by a maintenance infusion 0.10μg·kg/min-1 for 48 hours). The thrombolysis in myocardial infarction(TIMI) grade after PPCI, corrected TIMI frame count(cTFC) after PPCI, ST elevation resolution in 90 min after the procedure,left ventricular ejection fraction(LVEF) at 1 week and bleeding events were compared between the two groups. Major adverse cardiac events(MACEs) were also recorded in hospital and during 1 months’follow-up. Results: Baseline clinical characteristics were similar between the two groups(P>0.05). The TIMI 3 flow rate were significantly higher in preoperation group than that in intraoperation group, while the cTFC was obviously lower(P0 . 05 ) . Conclusions: Although TIMI grade 3 flows trended to be higher in the patients who received early Tirofiban in the emergency ward, the difference did not constitute statistical significance and possible benefits, therefore, require further clarification.%目的:比较不同时间使用替罗非班对急性 ST 段抬高型心肌梗死(ST-elevation myocardial infarction, STEMI)行急诊冠脉介入治疗(primary percutaneous coronary intervention, PPCI)患者的效果。方法:将98例入选的拟行PPCI

  5. Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.

    OpenAIRE

    Roe, Matthew; Mahaffey, Kenneth; Kilaru, Rakhi; Akkerhuis, Martijn; Simoons, Maarten; Harrington, Robert Alex; Tardiff, Barbara; Granger, Christopher; Ohman, Magnus; Moliterno, David; Lincoff, Michael; Califf, Robert; Topol, Eric; Werf, Frans; Alexander, John

    2004-01-01

    textabstractAIM: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). METHODS AND RESULTS: Peak CK-MB ratios (peak CK-MB level/upper limit of normal [ULN]) after PCI were analysed in 6164 patients with NSTE ACS from four randomized trials who underwent in-hospital PCI. We excluded 696 patients with elevated CK or CK-MB levels

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

    OpenAIRE

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

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sharmini Selvarajah

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-15

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

  9. Are There Ethnic Inequalities in Revascularisation Procedure Rate after an ST-Elevation Myocardial Infarction?

    Science.gov (United States)

    van Oeffelen, Aloysia A. M.; Rittersma, Saskia; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    Background Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI) between first generation ethnic minority groups (henceforth, migrants) and ethnic Dutch. Methods All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands. Ethnic Dutch and migrants from Suriname (Hindustani Surinamese and non-Hindustani Surinamese), Morocco, and Turkey were included (n = 1,765). Multivariable Cox proportional hazards regression analyses were used to identify ethnic inequalities in revascularisation rate (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) after a STEMI event. Results On average, 73.2% of STEMI events were followed by a revascularisation procedure. After adjustment for confounders (age, sex, degree of urbanization) no significant differences in revascularisation rate were found between the ethnic Dutch population and Hindustani Surinamese (HR: 1.04; 0.85–1.27), non-Hindustani Surinamese (HR: 0.98; 0.63–1.51), Moroccan (HR: 0.94; 0.77–1.14), and Turkish migrants (HR: 1.04; 0.88–1.24). Additional adjustment for comorbidity and neighborhood income did not change our findings. Conclusion Our study suggests no ethnic inequalities in revascularisation rate after a STEMI event. This finding is in agreement with the universally accessible health care system in the Netherlands. PMID:26368504

  10. Are There Ethnic Inequalities in Revascularisation Procedure Rate after an ST-Elevation Myocardial Infarction?

    Directory of Open Access Journals (Sweden)

    Aloysia A M van Oeffelen

    Full Text Available Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI between first generation ethnic minority groups (henceforth, migrants and ethnic Dutch.All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands. Ethnic Dutch and migrants from Suriname (Hindustani Surinamese and non-Hindustani Surinamese, Morocco, and Turkey were included (n = 1,765. Multivariable Cox proportional hazards regression analyses were used to identify ethnic inequalities in revascularisation rate (percutaneous coronary intervention (PCI and coronary artery bypass grafting (CABG after a STEMI event.On average, 73.2% of STEMI events were followed by a revascularisation procedure. After adjustment for confounders (age, sex, degree of urbanization no significant differences in revascularisation rate were found between the ethnic Dutch population and Hindustani Surinamese (HR: 1.04; 0.85-1.27, non-Hindustani Surinamese (HR: 0.98; 0.63-1.51, Moroccan (HR: 0.94; 0.77-1.14, and Turkish migrants (HR: 1.04; 0.88-1.24. Additional adjustment for comorbidity and neighborhood income did not change our findings.Our study suggests no ethnic inequalities in revascularisation rate after a STEMI event. This finding is in agreement with the universally accessible health care system in the Netherlands.

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

    Science.gov (United States)

    Zughaft, David; Harnek, Jan

    2014-08-01

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

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

    Institute of Scientific and Technical Information of China (English)

    覃秀川; 王春梅; 索旻; 穆希娟; 文勃

    2013-01-01

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

  13. Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway : rationale and design

    NARCIS (Netherlands)

    Ishak, Maycel; Ali, Danish; Fokkert, Marion J; Slingerland, Robbert J; Dikkeschei, Bert; Tolsma, Rudolf T; Lichtveld, Rob A; Bruins, Wendy; Boomars, René; Bruheim, Kim; van Eenennaam, Fred; Timmers, Leo; Voskuil, Michiel; Doevendans, Pieter A; Mosterd, Arend; Hoes, Arno W; ten Berg, Jurriën M; van 't Hof, Arnoud W J

    2015-01-01

    BACKGROUND: For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  15. 急性ST段抬高心肌梗死患者肾功能不全的发生率和预后价值%Incidence and prognostic value of renal insufficiency in patients with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    曾汇庆; 郑海生

    2010-01-01

    目的 评估急性ST段抬高心肌梗死(STEMI)患者肾功能不全的发生率及其预后价值.方法 采用改良的简化肾脏病改良饮食(MDRD)方程估算.肾小球滤过率(GFR),以GFR133 μmol/L判断肾功能不全,则其漏诊率为42.6%(40/94).伴肾功能不全的STEMI患者年龄较大,陈旧性心肌梗死、血脂异常患病率高,Killip分级较高,入院时尿素氮(BUN)、Cr水平较高.用Logistic回归分析筛选出年龄、肾功能不全、未再灌注治疗是STEMI患者住院期间死亡的危险因素.伴肾功能不全的STEMI患者院内死亡的相对危险度为2.411(95%可信区间为1.249~4.656).结论 STEMI患者肾功能不全的发生率高,并且是STEMI患者住院期间死亡的危险因素.%Objective To evaluate the incidence and prognostic value of renal insufficiency in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The glomerular filtration rate(GFR)was estimated with the modified abbreviated modification of diet in renal disease (MDRD)study equation.Renal insufficiency was defined as GFR133 μmol/L,renal insufficiency was unrecognized in 40 cases(42.6%)of them.The renal insufficiency was associated with elder,old myocardial infarction,dyslipidemia,higher Killip-grade,and higher level of blood urea nitrogen(BUN)and Cr.By the Logistic regression analysis,renal insufficiency and no reperfusion was the risk factor of in-hospital mortality.The mortality relative risk between the STEMI patients with renal insufficiency and those without renal insufficiency was2.411(95% confidence interval:1.249-4.656).Conclusion The incidence of renal insufficiency is higher in the patients with STEMI,and it is an independent predictor for in-hospital mortality.

  16. 性别对急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗预后的影响%Influence of sex on the prognosis of acute ST elevated myocardial infarction after primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    艾辉; 朱小玲; 颜红兵; 高海; 李南; 王健; 张晓江; 李世英

    2008-01-01

    Objective To study the influence of sex on the prognosis in acute ST elevated myocardial in- farction(STEMI)patients after primary percutaneous coronary intervention(PCI).Methods :The risk factors, coronary angiography and prognosis in 478 males and 101 females with STEMl were compared.Results:Mortality of STEMI was significantly different in different age groups(P<0.01).The attack of the STEMI in women was 10 vears later than that of men(P<0.01),especially in those women whose age was over 71 years oId.The complica- tion ratio of hypertension and type 2 mellitus diabetes was higher in female patients than that in male(P<0.01). More multi-vessel lesions were found in female patients than those in male(P<0.01).The incidence of in-hospital mortality,pseudoaneurysm,haematoma Was significantly higher in females than in males(P<0.05.P<0.01).Con- clusions The in-hospital mortalitv and puncture complications in STEMI female patients treated with primary PCI are higher than male patients.%目的 探讨性别对急性ST段抬高心肌梗死(STEMI)直接经皮冠状动脉介入(PCI)治疗预后的影响.方法 分析比较478例男性和101例女性急性ST段抬高心肌梗死患者的危险因素、冠状动脉造影特点和预后情况.结果 不同年龄段STEMI发病率的性别差异有统计学意叉(P<0.01),女性发病较男性晚10年以上,≥71岁女性发病率升高更明显;女性多合并原发性高血压、2型糖尿病,且2型糖尿病明显高于男性(P<0.01);女性多支病变明显高于男性(P<0.01).女性院内病死率、假性动脉瘤/血肿发生率明显高于男性(P<0.05,P<0.01).结论 直接PCI治疗STEMI女性患者的住院病死率及穿刺血管并发症发生率较男性高.

  17. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J; van Hellemond, Irene E G;

    2014-01-01

    in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich...... (12 patients) of the combined Aldrich and Selvester score. In conclusion, the ECG estimated MaR was stable between the earliest recording time and initiation of reperfusion treatment only in a subgroup of the patients with STEMI. The findings of this study may suggest heterogeneity in regards...

  18. Significance of Early ST-segment Changes in patients After Emergent percutaneous Coronary Intervention on patients With Acute ST-elevation Myocardial Infarction%急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后早期ST段变化的意义

    Institute of Scientific and Technical Information of China (English)

    张景昆; 赵运涛; 吴涛; 王斌; 张宗河

    2015-01-01

    Objective To explore the significance of early ST -segment changes in STEMI patients after emergent percutaneous coronary intervention( PCI) . Methods The study enrolled 48 STEMI patients who underwent emergent PCI in Peking University Aerospace School of Clinical Medicine from April 2011 to April 2013. According to ST -segment resolution within 60 minutes after PCI,the subjects were divided into resolution group( ST - segment resolution≥50%)and non -resolution group(ST-segment resolution0. 05)in LVEF and the number of segments with abnormal wall motion. The echocardiography before discharge showed that the resolution group was higher( P0. 05). The resolution group was lower(P0. 05 ) in the incidence rates of angina. The resolution group was lower than non-resolution group in the total incidence rates of malignant arrhythmia,heart failure,angina following myocardial infarction,major adverse cardiovascular events and composite cardiovascular events(χ2 =32. 643,30. 643, 33. 296,4. 023,30. 468;P = 0. 001 ). Conclusion The STEMI patients with early ST - segment resolution have lower incidence of total cardiovascular events,by which the short-term prognosis of STEMI patients can be well predicted,and the early ST-segment resolution usually occur within 30 minutes after PCI. And the finding may provide reference for further clinical research.%目的:探讨急性ST段抬高型心肌梗死( STEMI)患者行急诊经皮冠状动脉介入( PCI)术后早期ST段变化的临床意义。方法2011年4月—2013年4月选取在北京大学航天临床医学院住院行急诊 PCI术的48例急性STEMI患者。根据PCI术后60 min内ST段回落情况将患者分为回落组( ST段回落≥50%)和非回落组( ST段回落0.05)。出院前心脏超声示:回落组患者LVEF高于非回落组,EDV低于非回落组( P0.05)。回落组患者心律失常事件发生率、心力衰竭事件发生率、主要不良心脏事件( MACE)发生

  19. Comparison of Triggering and Nontriggering Factors in ST-Segment Elevation Myocardial Infarction and Extent of Coronary Arterial Narrowing.

    Science.gov (United States)

    Ben-Shoshan, Jeremy; Segman-Rosenstveig, Yafit; Arbel, Yaron; Chorin, Ehud; Barkagan, Michael; Rozenbaum, Zach; Granot, Yoav; Finkelstein, Ariel; Banai, Shmuel; Keren, Gad; Shacham, Yacov

    2016-04-15

    Various physical, emotional, and extrinsic triggers have been attributed to acute coronary syndrome. Whether a correlation can be drawn between identifiable ischemic triggers and the nature of coronary artery disease (CAD) still remains unclear. In the present study, we evaluated the correlation between triggered versus nontriggered ischemic symptoms and the extent of CAD in patients with ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective, single-center observational study including 1,345 consecutive patients with STEMI, treated with primary percutaneous coronary intervention. Acute physical and emotional triggers were identified in patients' historical data. Independent predictors of multivessel CAD were determined using a logistic regression model. A potential trigger was identified in 37% of patients. Physical exertion was found to be the most dominant trigger (65%) followed by psychological stress (16%) and acute illness (12%). Patients with nontriggered STEMI tended to be older and more likely to have co-morbidities. Patients with nontriggered STEMI showed a higher rate of multivessel CAD (73% vs 30%, p <0.001). In a multivariate regression model, nontriggered symptoms emerged as an independent predictor of multivessel CAD (odds ratio 8.33, 95% CI 5.74 to 12.5, p = 0.001). No specific trigger was found to predict independently the extent of CAD. In conclusion, symptoms onset without a recognizable trigger is associated with multivessel CAD in STEMI. Further studies will be required to elucidate the putative mechanisms underlying ischemic triggering.

  20. Effect on Inflammatory Factors between Ticagrelor and Clopidogrel after Emergency PCI about Patients with Acute ST-segment Elevation Myocardial Infarction%替格瑞洛与氯吡格雷对急性STEMI患者急诊PCI术后炎症因子的影响

    Institute of Scientific and Technical Information of China (English)

    张阳阳; 陈魁

    2014-01-01

    To compare the effect on inflammatory factors between ticagrelor and clopidogrel after emergency PCI about patients with acute ST-segment elevation myocardial infarction (STEMI) ,we divide 176 cases of acute STEMI patients who were undergone emergency PCI into ticagrelor group (group A) 58 cases ,conventional clopidogrel group (group B) 58cases and strenghed clopidogrel group (group C) 60 patients .Inflammatory cytokines such as C-reactive protein (CRP) , interleukin-6 (IL-6) ,myeloperoxidase (MPO) and soluble CD40 (sCD40L) were measured before surgery and 12 hours ,7 days ,1 month ,3months ,6months after surgery ,compared the statistics of inflammatory factors at different time .The results showed the inflammatory factors levels of enhanced clopidogrel and ticagrelor group degrades more than conventional clopidogrel group (P 0 .05 ) , but there was no statistical significance . Thus the effect on inflammatory factors of ticagrelor is stronger than conventional clopidogrel ,but near to strenghed clopidogrel .%为比较替格瑞洛与氯吡格雷对急性 ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)术后炎症因子的影响,将176例急性STEMI且行急诊PCI术的患者分为替格瑞洛组(A组)58例、氯吡格雷常规组(B组)58例、氯吡格雷强化组(C组)60例,分别测定术前、术后12小时、术后7天、术后1个月、术后3个月、6个月时炎症因子C-反应蛋白(CRP)、白细胞介素-6(IL-6)、髓过氧物酶(MPO)、可溶性CD40受体(sCD40L)的含量,比较3组患者各炎症因子在不同时间点有无统计学差异。结果显示C组和A组较B组明显降低(P<0.05),有统计学意义,而A组较C组稍降低(P>0.05),但两者无统计学意义。由此可见,替格瑞洛的抗炎作用较常规剂量氯吡格雷作用明显增强,和强化剂量氯吡格雷作用相仿。

  1. Analysis of clinical characteristics and coronary artery disease characteristics in young patients with acute ST-elevation myocardial infarction%青年急性 ST段抬高型心肌梗死的临床特点及冠状动脉病变特征分析

    Institute of Scientific and Technical Information of China (English)

    王玲; 张志; 刘紫东; 高航

    2014-01-01

    Objective:To analyze clinical characteristics and coronary artery disease characteristics in young patients with acute ST-elevation myocardial infarction ( STEMI) . Methods:112 patients with first-episode STEMI were selected and divided into young group (43 cases, 18-44 years old) and elderly group (69 cases, over than 60 years old). The main risk factors, clinical characteris-tics and coronary artery disease characteristics of the two groups were analyzed and compared. Results:The abdominal obesity, smok-ing history, drinking history, family history of premature coronary heart disease and dyslipidemia degree of young group were higher than those of elderly group (P<0. 05). Male was dominated in young group. Compared with the elderly patients, the causative factors of excessive fatigue, mood disorders, over eating and drinking were more frequently found among the young patients (P<0. 05). The young patients showed a higher incidence of the anterior descending branch lesion (P<0. 05), and their one-vessel disease rates were obviously higher than those of elderly patients (P<0. 05). Conclusions:The abdominal obesity, smoking, drinking, family history of premature coronary heart disease and dyslipidemia are the major risk factors for the young patients with acute STEMI. The causative factors of excessive fatigue, mood disorders, over eating and drinking are more frequently found among the young patients. Coronary ar-teriography shows that the young patients show the higher incidence of one-vessel disease, mainly involving the proximal anterior de-scending branch, and the lesions are in the low-risk group.%目的:探讨青年急性ST段抬高型心肌梗死( STEMI)的临床特点以及冠状动脉病变特征。方法:选择首次发病的STEMI患者112例,按年龄分青年组43例(年龄18~44岁)、老年组69例(年龄≥60岁),对两组患者间的主要危险因素,临床特点和冠状动脉病变特征进行对比分析。结果:青年组患者腹型肥

  2. 急性ST段抬高心肌梗死患者应用急救医疗服务的影响因素%Factors Related to Use of Emergency Medical Services in Patients with Acute ST Segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    王璟; 郭金成

    2009-01-01

    Objective To explore the choice of transportation mode to hospital in patients experiencing acute ST elevation myocardial infarction(STEMI)and ascertain the factors that may influence the use of Emergency Medical Service(EMS)in patients with acute STEMI.Methods 412 consective patients confirmed STEMI from Febury 2006 to January 2009 were divided into two groups based on the use of EMS:EMS group and self-transportation group.A questionnaire developed to assess demographic characteristics,Clinical factors and psychological factors.Paients were interviewed within 72 hours of admission to 2 hospitals.Results EMS was used in 26.90% of patients with STEMI,actors associated with EMS in a univariate analysis were history of coronary artery disease hospitalization,nausea,vomiting,dizziness,collapse,sudden onset,progressive symptoms,"waited and see","worried about to bother others",times of contacting physician before arrived at study hospital,thinking it was a cardiac origin disease.In a multivariate analysis,contact physician(0.49,0.33~0.73),nausea (2.57,1.58~4.19),collapse(5.49,2.05~14.70),progressive symptoms(1.98,1.19~3.29),"waited and see" (0.55,0.34~0.89)and contributed symptoms to cardiac disease(2.37,1.44~3.91).Conclusion Only one fourth of patients with STEMI were transported to the hospital by EMS,they view the EMS as an option for transportation to hospital only if they feel really sick.For that reason,it needs to be made well known to the public that EMS are not only a mode of transport,but also provide diagnostics and treatment.%目的 探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者到达医院时交通工具的选择类型及影响患者选择急救医疗服务(emergency medical service,EMS)的因素.方法 我院住院并确诊的412例STEMI患者,根据是否应用EMS到医院分为两组:EMS组和自我转运组.对比分析两组患者应用急救医疗服务的情况.结果 有26.90%的患者应

  3. The influence of different dose of statins on postoperative renal function in patients with acute non-ST segment elevation myocardial infarction%不同剂量他汀对急性非ST段抬高心肌梗死患者介入术后肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    段娜; 侯爱洁; 李占全

    2015-01-01

    Objective To evaluate the influence of different dose of statins on postoperative renal function in patients with acute non-ST segment elevation myocardial infarction. Methods 116 patients diagnosed as acute non-ST segment elevation myocardial infarction in our hospital heart center from December 2010 to November 2010 were selected,and all patients were agreed to undergo interventional examination and treatment.116 patients were randomly divided into 20 mg normal dose group and 40 mg strengthened dose group.All patients were given with atorvastatin calcium tablet oral before going to sleep.After three days of standard drug therapy,they were undergone interventional examination and treatment.All patients wre drew blood on preoperative and postoperative 24 hours,48 hours for the test of creatinine (SCr),urea nitrogen (BUN),cystatinC (Cys C) and C-reactive protein (CRP).According to the test results calculated the endogenous creatinine clearance (CCr). Results Compared with strengthened dose group,the Cys C level of the normal dose group at postoperative 24 hours was hihger (P<0.05),CCr was lower (P<0.05).Compared with preoperative level,Cys C level of normal dose group at postoperative 24 hours was higher (P<0.05). Conclusion Interventional examination and treatment with the contrast medium can lead to glomerular filtration function damage.The larger dose of statins can more effectively improve the kidney function.Application of 40 mg atorvastatin can be more effective prevented the happening of the CI-AKI than 20 mg atorvastatin.%目的:评价不同剂量阿托伐他汀对急性非ST段抬高心肌梗死患者介入术后肾功能的影响。方法选取2010年12月~2013年11月本院心脏中心明确诊断为急性非ST段抬高心肌梗死,并同意行介入检查及治疗的患者共116例,将其随机分为20 mg常规剂量组及40 mg强化剂量组,所有患者均睡前给予阿托伐他汀钙片口服,在给予药物规范化治疗3 d后行介入检查及

  4. 磁导航系统在急性冠状动脉综合征介入治疗中的初步应用研究%Clinical study on the invasive treatment in patients with non-ST-elevation acute coronary syndromes guided by the magnetic navigation system

    Institute of Scientific and Technical Information of China (English)

    王晖; 杨吉猛; 李春坚; 王连生; 朱铁兵; 杨志健; 曹克将

    2012-01-01

    Objective:To investigate the efficacy and safety of magnetic navigation system in patients with non-ST-elevation acute coronary syndromes(NSTE-ACS). Methods; Total 37 consecutive patients with NSTE-ACS were assigned to undergo magnetic guide-wire navigation PCI (MPCI). Time to cross lesion,fluoroscopy time,contrast usage to cross lesion and procedure-related complication were recorded and analyzed. Results; Of the 37 culprit lesions in MPCI,36 were crossed successfully giving a success rate of 97.3%. The average stenosis of the target lesions was (88.07 ± 8.33)% ,mean length was (27.08 ± 8.98) mm. The procedure and the fluoroscopy time to cross the lesion in the magnetic PCI were (82.0 ± 67.9) s and(62.6 ± 57.6) s,respectively. The contrast medium used to cross lesion were (6.3 ± 4.6) ml. The failed lesion was a subtotal stenosis combined with severe calcification. No magnetic navigation system associated complications or major adverse cardiac events were observed in MPCI. Conclusion; It is feasible and safe to use the magnetic navigation system as a tool for treatment in patients with NSTE-ACS.%目的:探讨磁导航系统在非ST抬高型急性冠脉综合征(non-ST-elevation acute coronary syndromes,NSTE-ACS)介入治疗中应用的可行性和安全性.方法:连续选择接受磁导航辅助介入治疗的中-高危NSTE-ACS患者37例,分别记录靶病变特征、导丝通过病变的时间、X线暴露时间、造影剂用量和相关并发症.用STATA9.2软件进行数据分析.结果:磁导航引导治疗靶病变37处,其中A/B1型病变7处、B2型病变17处、C型病变13处.术前靶病变平均狭窄程度和长度分别为(88.07±8.33)%和(27.08±8.98) mm.在磁导航指引下,磁导丝顺利通过36处靶病变,病变通过率为97.3%;失败1例,磁导丝未能通过1处次全闭塞伴严重钙化病变.磁导丝通过靶病变的平均时间为(82.0±67.9)s,其中A/B1、B2、C型病变的通过时间分别为(34.7±4.5)s、(61.0±14

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Tödt, Tim

    2012-01-01

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

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

    OpenAIRE

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

    2001-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  10. Myocardial infarction, ST-elevation and non-ST-elevation myocardial infarction and modelled daily pollution concentrations: a case-crossover analysis of MINAP data

    Science.gov (United States)

    Butland, Barbara K; Atkinson, Richard W; Milojevic, Ai; Heal, Mathew R; Doherty, Ruth M; Armstrong, Ben G; MacKenzie, Ian A; Vieno, Massimo; Lin, Chun; Wilkinson, Paul

    2016-01-01

    Objectives To investigate associations between daily concentrations of air pollution and myocardial infarction (MI), ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). Methods Modelled daily ground-level gaseous, total and speciated particulate pollutant concentrations and ground-level daily mean temperature, all at 5 km×5 km horizontal resolution, were linked to 202 550 STEMI and 322 198 NSTEMI events recorded on the England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. The study period was 2003–2010. A case-crossover design was used, stratified by year, month and day of the week. Data were analysed using conditional logistic regression, with pollutants modelled as unconstrained distributed lags 0–2 days. Results are presented as percentage change in risk per 10 µg/m3 increase in the pollutant relevant metric, having adjusted for daily mean temperature, public holidays, weekly influenza consultation rates and a sine-cosine annual cycle. Results There was no evidence of an association between MI or STEMI and any of O3, NO2, PM2.5, PM10 or selected PM2.5 components (sulfate and elemental carbon). For NSTEMI, there was a positive association with daily maximum 1-hour NO2 (0.27% (95% CI 0.01% to 0.54%)), which persisted following adjustment for O3 and adjustment for PM2.5. The association appeared to be confined to the midland and southern regions of England and Wales. Conclusions The study found no evidence of an association between the modelled pollutants (including components) investigated and STEMI but did find some evidence of a positive association between NO2 and NSTEMI. Confirmation of this association in other studies is required. PMID:27621827

  11. Effect of Coronary Thrombectomy in Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Suzuki, Makoto; Sumiyoshi, Tetsuya; Miyachi, Hideki; Yamashita, Jun; Yamasaki, Masao; Miyauchi, Katsumi; Yamamoto, Takeshi; Nagao, Ken; Tomoike, Hitonobu; Takayama, Morimasa

    2015-06-15

    Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEMI (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEMI (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal

  12. Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Najjar, Samer S.; Rao, Sunil V.; Melloni, Chiara; Raman, Subha V.; Povsic, Thomas J.; Melton, Laura; Barsness, Gregory W.; Prather, Kristi; Heitner, John F.; Kilaru, Rakhi; Gruberg, Luis; Hasselblad, Vic; Greenbaum, Adam B.; Patel, Manesh; Kim, Raymond J.; Talan, Mark; Ferrucci, Luigi; Longo, Dan L.; Lakatta, Edward G.; Harrington, Robert A.

    2012-01-01

    Context Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. Objective To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting, and Patients Prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single-dose (60,000 units of epoetin alfa) efficacy phase involving 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. Intervention Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. Main Outcome Measure Infarct size, expressed as a percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging 2–6 days after study medication administration. Results In the efficacy cohort (n=138), infarct size did not differ between groups at either 2–6 days (15.8±10.3 vs. 15.0±10.0, P=.666) or 12±2 weeks (10.6±8.6 vs. 10.4±7.6, P=.886). Left ventricular ejection fraction also did not differ between groups at either the early (48.2±9.1 vs. 48.9±8.7, P=.671) or late (52.5±9.3 vs. 52.0±8.8, P=.760) timepoints. In pre-specified analyses of patients aged ≥70 years (n=21), mean infarct size within the first week was larger in the epoetin alfa arm than in the placebo group (19.9±9.9 vs.11.7±7.2, P=.026). Patients who received epoetin alfa had a higher incidence of the composite endpoint of death, myocardial infarction, stroke, or stent thrombosis (4.0% vs. 0.0%, P=.042), and a higher incidence of serious adverse events (20.0% vs. 10.3%, P=.052). Conclusions In STEMI patients successfully reperfused with primary or rescue PCI, a single intravenous bolus of epoetin alfa did not reduce infarct size and was

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  14. 非ST段抬高型急性冠状动脉综合征患者血清胱抑素C与SYNTAX评分的相关性研究%Relationship between serum cystatin C level and SYNTAX score in patients with non-ST segment elevation acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    王林; 袁国裕; 陈国雄; 陈士良

    2016-01-01

    Objective To evaluate the relationship between serum cystatin C level and the severity of coronary lesion in patients with non- ST segment elevation acute coronary syndrome (NSTE- ACS). Methods 202 patients with NSTE- ACS underwent coronary angiography (CAG) and were divided into unstable angina pectoris (UAP) group(n=124) and non- ST segment elevation myocardial infarction (NSTEMI) group (n=78). 54 persons with negative result of CAG served as control group. According to SYNTAX score, NSTE- ACS patients were divided into low- risk group(1~22scores, n=69), intermediate- risk group (23~32scores, n=92) and high- risk group (>32scores, n=41). Serum cystatin C was measured before CAG and compared between groups. The relation between serum cystatin C and SYNTAX score was determined. Results The serum cystatin C level was significantly higher in UAP group and NSTEMI group than in control group, and significantly higher in the intermediate- and high- risk groups than in the low- risk group. The Pearson correlation analysis showed that SYNTAX score was positively correlated to serum cystatin C level (r=0.78, P32 (P<0.01, P<0.05). Conclusion The level of serum cystatin C may be used to predict SYNTAX score in patients with NSTE- ACS.%目的:探讨非ST段抬高型急性冠状动脉综合征(NSTE- ACS)患者血清胱抑素C(CysC)水平与冠状动脉病变严重程度的关系。方法选择行冠状动脉造影的NSTE- ACS患者202例,分为不稳定性心绞痛(UAP组)124例,非ST段抬高型心肌梗死(NSTEMI组)78例,54例冠状动脉造影阴性的患者为对照组。将NSTE- ACS患者根据冠状动脉造影结果分为(SYNTAX)评分低分组(1~22分)69例、中分组(23~32分)92例、高分组(>32分)41例。所有患者冠状动脉造影前均检测血清CysC,比较各组的CysC水平并分析CysC与SYNTAX评分的相关性。结果 UAP组、NSTEMI组患者CysC[(1.26±0.38)、(1.38±0.55)mg/L]高于对照组[(0

  15. The comparison of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute ST elevated myocardial infarction%替格瑞洛与氯吡格雷用于急性ST段抬高心肌梗死急诊介入治疗的疗效比较

    Institute of Scientific and Technical Information of China (English)

    毛幼林; 黄琼; 陈俭; 张宇

    2015-01-01

    Objective To compare the effects of ticagrelor and clopidogrel on patients undergoing percutane-ous coronary intervention(PCI)with acute ST elevated myocardial infarction (STEMI).Methods 120 patients with STEMI received PCI within 12h of symptom onset in our hospital were randomly divided into clopidogrel treated group (n=60)and ticagrelor treated group (n=60).Serum was collected before surgery and 36 hours after PCI for ALT, Cr,CK-MB,and MA.Cardiac ultrasound was examined,too.All patients were followed 6 months post-PCI for main adverse cardiovascular and cerebrovascular events (MACCE)and medicine side effect.Results No significantly difference was noted in baseline between the two groups.The level of CK-MB and MA in the ticagrelor treated group [CK-MB(56.5 ±8.3)U/L,MA (45.9 ±6.4)mm[and clopidogrel treated group[CK-MB(74.3 ±9.6)U/L,MA (35.6 ±7.3)mm]were significant difference (CK-MB,P=0.043;MA,P=0.038).The MACCE of patients in ticagrelor treated group were significantly lower than patients in clopidogrel treated group during post-PCI 6 months follow-up(The ratio of angina in ticagrelor group was 1.7%,while in clopidogrel group was 6.7%,P=0.042). Conclusion Ticagrelor is more effective in suppress the function of platelet,decrease MACCE in patients with STE-MI undergoing PCI.%目的:比较替格瑞洛与氯吡格雷在急性心肌梗死(STEMI)接受急诊冠脉介入治疗(PCI)患者中的疗效和安全性。方法选择在发病后12 h内行急诊PCI患者120例,随机分为氯吡格雷组和替格瑞洛组,观察并比较两组术后36 h的肝肾功能、肌酸激酶同工酶(CK-MB)、左室功能、血小板抑制率,随访6个月内主要不良心脑事件(MACCE)及药物不良反应发生率。结果替格瑞洛组术后36h 的 CK -MB 水平(56.5±8.3)U/L、血小板抑制率(45.9±6.4)mm,明显优于氯吡格雷组的(74.3±9.6)U/L 与(35.6±7.3)mm、(P=0.043、0.038),在6个

  16. Sensitivity and specificity of strain imaging in evaluating myocardial viability among patients with ST-segment elevation acute myocardial infarction%应变显像评价ST段抬高急性心肌梗死患者存活心肌的敏感性与特异性

    Institute of Scientific and Technical Information of China (English)

    阮雯; 舒先红; 石洪成; 潘翠珍; 周易; 陈灏珠

    2008-01-01

    .③The sensitivity and specificity of systolic strain(Set)to predict myocardial viability after AMl were 81% and 66% respectively at the optimal cut-off value of-60%.④Set was moderately concordant with SPECT scoring(Kappa=0.40)and the agreement between the two methods was 77%(199/260).Conclusions In ST-elevation AMI,SI and RR-201 Tl-SPECT appears equivalent in predicting segmental recovery after reperfusion,and SI could be a convenient and low-cost alternative for the non-invasive evaluation of myocardial viability.

  17. Clinical Characteristics and Coronary Angiographic Features of Young Patients with Acute ST-Elevation Myocardial Infarctions%青年急性ST段抬高性心肌梗死患者的临床特点及冠状动脉病变特点研究

    Institute of Scientific and Technical Information of China (English)

    陈莉; 李宪伦; 秦延莉; 周颖; 刘晓飞; 王勇; 曾玉杰; 柯元南

    2011-01-01

    Objective To analyze the clinical characteristics and coronary angiographic features of young patients with acute ST - elevation myocardial infarction ( STEMI ) . Methods Totally 389 consecutive patients with STEMI were enrolled from Jan. 2005 to Dec. 2010. Baseline clinical characteristics, coronary angiographic data and outcomes in young patients ( <45 years ) were compared with those in elder patients ( 60 ~ 80 years ) . Results Young patients with STEMI were predominantly males. In comparison with the aged patients, smoking and obesity were significant risk factors in young patients. Single vessel lesions were common and affected the left anterior descending artery mostly among young patients. Young patients experienced shorter hospital stay and less major adverse cardiovascular events ( MACE ) during hospitalization ( P < 0. 05 ) . Conclusion Smoking and obesity are the most important risk factors in young patients with STEMI. Young patients are more likely to have single vessel lesions. Young patients tend to develop less MACE during hospital stay.%目的 分析青年急性ST段抬高性心肌梗死患者的临床特征和冠状动脉病变特点.方法 将2005年1月-2010年12月我院收治的389例急性ST段抬高性心肌梗死患者按照年龄分为青年组(<45岁)和老年组(60~80岁),比较两组患者的基本临床特征、冠状动脉造影结果及预后.结果 与老年患者比较,青年急性ST段抬高性心肌梗死患者中男性占绝大多数,危险因素中以吸烟和肥胖为著.冠状动脉造影检查发现单支病变多见,多累及左前降支.青年患者平均住院天数明显少于老年患者,住院期间主要心血管不良事件的发生率均明显低于老年患者,差异均有统计学意义(P<0.05).结论 吸烟和肥胖是青年急性ST段抬高性心肌梗死患者最重要的危险因素.青年患者冠状动脉病变多为单支病变,住院期间主要心血管不良事件较老年患者少.

  18. 不同年龄ST段抬高型心肌梗死患者的临床及冠状动脉造影特点研究%Clinical and coronary angiographic characteristics of acute ST-segment elevation myocardial infarction in patients of different ages

    Institute of Scientific and Technical Information of China (English)

    陈启; 陈韬; 朱荔; 李文文; 刘宇; 陈亮; 马丽萍; 赵仙先

    2015-01-01

    目的:分析不同年龄急性ST段抬高型心肌梗死(STEMI)患者临床和冠状动脉造影特点。方法回顾分析在本院住院的STEMI患者的电子病历资料,比较青年组、中年组和老年组的危险因素、临床特点、实验室指标、心电图、冠状动脉造影结果及预后。结果共1354例STEMI患者,其中青年组68例,中年组413例,老年组873例。青年组男性患者、吸烟、冠心病家族史、Kil ipⅠ级所占比例以及甘油三酯和血小板水平较老年组患者高,而高血压、室性心动过速/心室颤动、新发心房颤动, Kil ip IV级较老年组低,差异均有统计学意义(P<0.05),青年组冠状动脉造影“正常”和单支病变所占比例较中年组和老年组高,而后壁心肌梗死和三支病变较低(均P<0.05)。青年组死亡、心肌再梗死和再次PCI的发生率低于中年组及老年组患者(均P<0.05)。结论急性STEMI的危险因素、临床情况、冠状动脉造影特点及预后青年与中年和老年患者有较大不同,应针对这些特点进行治疗。%Objective To analyze clinical and coronary angiographic features of ST- segment elevation myocardial infarction (STEMI) in patients of different ages. Methods The electric medical records of inpatients with STEMI from January 2007 to December 2013 in our hospital were reviewed. The risk factors,clincial characteristics, lab parameters, ECG, coronary angiography and prognosis were compared among young, middle- aged and elderly patients. Results 1354 inpatients with SETMI were enrolled. Of them, 68 cases were in young group, 413 cases in middle- aged group, and 873 cases in elderly group. Male, smoker, family history of coronary artery disease, Kil ip I, triglyceride and platelet count were significantly higher, while hypertension, ventricular tachycardia/fibril ation, new atrial fibrillation and Kil ip IV were lower in young group than elderly group (al P<0

  19. 急性大面积ST段抬高型心肌梗死患者早期床旁应用主动脉内气囊反搏术预后观察%Observation on the prognosis of early application of bedside intra-aortic balloon pump counterpulsation in patients with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李志娟; 李春燕; 董平栓; 杨旭明; 刘威; 王可; 李治国; 赵玉伟; 靳国青; 李转珍

    2012-01-01

    目的:研究急性大面积ST段抬高型心肌梗死(STEMI)患者在择期经皮冠状动脉介入治疗(PCI)前尽早床旁应用主动脉内气囊反搏术(IABP)对预后的观察.方法:选取发病12 ~72 h的STEMI患者150例,随机分为2组,IABP组72例,对照组78例,2组均给予规范的药物治疗,IABP组同时床旁应用IABP.2组均于发病10~14d行冠脉造影,必要时行PCI术,评价梗死相关血管PCI术前及术后冠脉血流,术后4周心功能、IABP主要不良心脏事件的发生情况.结果:2组患者PCI术前TIMI血流、PCI术后4周主要不良心脏事件的发生率、左心室射血分数(LVEF)均有显著性差异(P<0.05).结论:对于急性大面积STEMI患者择期行PCI,尽早床旁应用IABP能改善梗死相关血管的TIMI血流,改善心功能,减少主要不良心脏事件的发生率,临床应用安全可行.%Objective: To evaluate the effect of early application of intra-aortic balloon pump counterpulsation (IABP) on prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) before elective percutaneous coronary interventional (PCI). Methods; One hundred and fifty patients with STEMI were randomly divided into two groups: 72 patients in IABP group and 78 in control group. All patients in IABP group receiving bedside IABP support treatment while patients in control group do not. All patients were performed PCI after 10 to 14 days. The blood flow rate of infart related coronary vessel was observed before and after PCI. The major adverse cardiac events ( MACE) and heart function at 4 weeks were studied. Results; In IABP group, blood flow rate of related coronary vessel, the occurance of MACE at 4 weeks, left ventricle ejection fraction (LVEF) were significant different in two groups (P < 0. 05). Conclusions; Early application of IABP for patients with STEMI before elective PCI is safe and effective, which can reduce the incidence of MACE, and improve heart function.

  20. rPA联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的疗效%Effects of rPA combined with reduced glutathione hormone on acute ST segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李永东; 董春花

    2012-01-01

    Objective: To observe therapeutic effects and safety of recombinant human tissue type plasminogen activator (rPA) combined with reduced glutathione hormone (GSH) on patients with acute ST elevation myocardial infarction (STEMI). Methods: A total of 80 acute STEMI cases were randomly and equally divided into routine thrombolysis group and GSH group (received GSH based on routine thrombolysis). Plasma levels of cTnT, CK-MB and activity of superoxide dismutase (SOD) were measured before and 24h after treatment. On one month after treatment, LVEDd, LVESd and LVEF were measured; incidence rates of adverse cardiovascular events (MACE) were detected. Results: (1) Compared with before treatment, plasma levels of CK-MB, cTnT and SOD significantly increased after treatment in both groups (P<0. 01 all), but compared with routine thrombolysis group the levels of CK-MB, cTnT were less, and SOD was more in GSH group (P<0. 05 all); (2) Compared with routine thrombolysis group, there were significantly decreased in LVEDd [ (55. 01 ± 3. 56) mm vs. (51. 58 ± 2. 97) mm], LVESd [ (47. 34 ± 4. 83) mm vs. (42. 95 ± 4. 58) mm] , and significantly increased in LVEF [ (54. 76 + 4. 73) % vs. (61. 21 ± 6. 38)%] in GSH group, P<0. 05 all; 3. Compared with routine thrombolysis group, there were significantly decreased in incidence rate of angina pectoris after myocardial infarction (35. 0% vs. 22. 5%), recurrence rate of myocardial infarction (22. 5% vs. 5. 0%) and incidence rate of severe arrhythmias (37. 5% vs. 17. 5%) in GSH group, P<0. 05 all. Conclusion: rPA combined with GSH can significantly decrease MACE after coronary artery recanalization in patients with acute STEMI. GSH can exert protective effects on impaired myocardium after ischemia- reperf usion.%目的:观察重组人组织型纤溶酶原激活剂(rPA)联合还原型谷胱甘肽(GSH)治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性.方法:80例急性STEMI患者被随机均分为常规

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

    Institute of Scientific and Technical Information of China (English)

    李京宴; 玛依拉·吾甫尔; 时学昆; 陈凤辉; 程祖亨

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  3. Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Eitel, Ingo; Galasso, Gennaro;

    2015-01-01

    BACKGROUND: Although intracoronary abciximab failed to improve prognosis compared with intravenous route in unselected ST-segment elevation myocardial infarction (STEMI) patients, little is known about the role of intracoronary abciximab in diabetic patients. OBJECTIVES: To evaluate the efficacy ...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  8. Age-related differences in glucose abnormalities in women with ST-elevation myocardial infarction submitted to percutaneous coronary intervention: a single-center experience.

    Science.gov (United States)

    Lazzeri, Chiara; Gensini, Gian Franco; D'Alfonso, Maria Grazia; Chiostri, Marco; Attanà, Paola; Valente, Serafina

    2015-05-01

    No datum is so far available on the relation between age and the acute glucose response to stress in women with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).We evaluated the age-related differences in the acute glucose response in 373 STEMI women submitted to PCI. The oldest women, when compared to the other age subgroups, showed the higher admission and peak glycemia (P acute glucose response to myocardial injury since older women showed the higher admission glucose values and the poorer in-hospital glucose control, in the lack of differences of insulin-resistance incidence. Glucose values were independent predictors of in-hospital mortality, but were not related to long-term survival.

  9. Elevated expression of steroidogenesis pathway genes; CYP17, GATA6 and StAR in prenatally androgenized rats.

    Science.gov (United States)

    Jahromi, Marziyeh Salehi; Tehrani, Fahimeh Ramezani; Noroozzadeh, Mahsa; Zarkesh, Maryam; Ghasemi, Asghar; Zadeh-Vakili, Azita

    2016-11-15

    It is believed that excess androgen exposure of the fetus, via altered gene expression, causes hyperandrogenism a key feature of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate expression of Cytochrome P450-17 (CYP17), GATA-binding protein (GAGT6) and Steroidogenic acute regulatory protein (StAR), genes of adult female rats prenatally exposed to androgen excess, closely reflect endocrine and ovarian disturbances of PCOS in women, by comparing them during different phases of estrus cycle with those of non-treated rats. Both the adult prenatally testosterone exposed and control rats (n=23, each) were divided into four groups based on their observed vaginal smear (proestrus, estrus, metestrus and diestrus) and the relative expression of CYP17, GATA6 and StAR genes was measured in ovarian theca cells using Cyber-green Real-Time PCR. Serum sex steroid hormones and gonadotropins levels were measured using the ELISA method; a comparison of these two groups showed that there was an overall increase in the studied genes (CYP17; 2.39 fold change, 95% CI: 1.23-3.55; P<0.05, GATA6; 2.08 fold change, 95% CI: 1.62-2.55; P<0.0001, and StAR; 1.4 fold change, 95% CI: 1.02-1.78; P<0.05), despite variations in different phases with maximum elevation for all genes in diestrus. The changes observed may impair the normal development of ovaries that mediate the programming of adult PCOS.

  10. Steroidogenic Acute Regulatory Protein (StAR: Evidence of Gonadotropin-Induced Steroidogenesis in Alzheimer Disease

    Directory of Open Access Journals (Sweden)

    Webber Kate M

    2006-10-01

    Full Text Available Abstract Background Alzheimer disease (AD is clinically characterized by progressive memory loss, impairments in behavior, language and visual-spatial skills and ultimately, death. Epidemiological data reporting the predisposition of women to AD has led to a number of lines of evidence suggesting that age-related changes in hormones of the hypothalamic-pituitary-gonadal (HPG axis following reproductive senescence, may contribute to the etiology of AD. Recent studies from our group and others have reported not only increases in circulating gonadotropins, namely luteinizing hormone (LH in individuals with AD compared with control individuals, but also significant elevations of LH in vulnerable neuronal populations in individuals with AD compared to control cases as well as the highest density of gonadotropin receptors in the brain are found within the hippocampus, a region devastated in AD. However, while LH is higher in AD patients, the downstream consequences of this are incompletely understood. To begin to examine this issue, here, we examined the expression levels of steroidogenic acute regulatory (StAR protein, which regulates the first key event in steroidogenesis, namely, the transport of cholesterol into the mitochondria, and is regulated by LH through the cyclic AMP second messenger pathway, in AD and control brain tissue. Results Our data revealed that StAR protein was markedly increased in both the cytoplasm of hippocampal pyramidal neurons as well as in the cytoplasm of other non-neuronal cell types from AD brains when compared with age-matched controls. Importantly, and suggestive of a direct mechanistic link, StAR protein expression in AD brains colocalized with LH receptor expression. Conclusion Therefore, our findings suggest that LH is not only able to bind to its receptor and induce potentially pathogenic signaling in AD, but also that steroidogenic pathways regulated by LH may play a role in AD.

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

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Toklu, Bora; Wetterslev, Jørn

    2015-01-01

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

  12. State of the art contemporary treatment of patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Mehran, Roxana

    2014-01-01

    OBJECTIVE: To review the presentation, diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increase accessibility of primary percutaneous coronary intervention (PCI......). DATA SOURCES: Data were obtained from English publications on STEMI treatment. No formal systematic review was conducted, but an effort was made to be comprehensive. STUDY SELECTION: Studies were selected if they contained data relevant to the topic. Preferably, data from clinical randomized trials...

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

    Science.gov (United States)

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

    2014-08-01

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

  14. Multi-embolic ST-elevation myocardial infarction secondary to aortic valve endocarditis.

    Science.gov (United States)

    Rischin, Adam P; Carrillo, Philip; Layland, Jamie

    2015-01-01

    We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction.

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

    Institute of Scientific and Technical Information of China (English)

    白莹; 梁岩; 谭慧琼; 乔树宾; 张峻; 杨艳敏; 章晏; 朱俊

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes...... to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial...

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

    DEFF Research Database (Denmark)

    Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per;

    2010-01-01

    In patients with ST-segment elevation myocardial infarction treated with fibrinolytics, electrocardiogram-derived measures of ST-segment recovery guide therapy decisions and predict infarct size. The comprehension of these relationships in patients undergoing mechanical reperfusion is limited. We...... studied 144 patients treated with primary percutaneous coronary intervention. We aimed to define the association between infarct size as determined by cardiac magnetic resonance imaging and different metrics of ST-segment recovery. Electrocardiograms were assessed at baseline and 90 minutes after primary...... percutaneous coronary intervention. Three methods for calculating and categorizing ST-segment recovery were used: (1) summed ST-segment deviation (STD) resolution analyzed in 3 categories (> or = 70%, > or = 30% to or = 2 mm). Infarct size and ejection fraction were assessed at 4 months by cardiac magnetic...

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

    Institute of Scientific and Technical Information of China (English)

    段雯婷

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bensujin

    2014-05-01

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

  20. 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.

  1. 麒麟心痛舒对非ST段抬高型急性冠脉综合征合并消化道出血患者的疗效观察%An observation on therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes accompanied by gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    李景君; 孙红娟; 陶愈婷; 王国蕾; 黄积存; 李亮; 苏会钦

    2014-01-01

    Objective To observe the therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes(NSTE-ACS)accompanied by gastrointestinal bleeding (GIB). Methods A prospective randomized controlled trial was conducted. A total of 67 hospitalized patients in Cardiovascular Department of Qionghai City Hospital of Traditional Chinese Medicine were divided into therapy group(35 cases)and control group(32 cases). Both groups were given conventional medical treatment(except anti-coagulative agent). In the therapy group,the patients received Qilin Xintongshu pill(the ingredients consisting of panax pseudo-ginsen,dragon's blood,immature orange fruit,etc.)oral administration,once 5 mg and 3 times a day,while in the control group,the patients accepted clopidogrel orally,once 75 g and once a day,the therapeutic course in both groups being 30 days. The major cardiovascular events(such as death,a newly-happened myocardial infarction(MI),MI secondary,obstinately ischemia)and incidence of massive hemorrhage of gastrointestinal tract were compared between the two groups,and the adverse events were observed. Results After treatment,the incidence of cardiovascular events and massive hemorrhage of gastrointestinal tract in the therapy group were decreased significantly compared to those in the control group 〔incidence of cardiovascular events:8.57%(3/35)vs. 28.13%(9/32), incidence of massive hemorrhage of gastrointestinal tract:2.86%(1/35)vs. 21.88%(7/32),both P<0.05〕. Adverse events were not observed in both groups,and the examinations of blood,urine,liver and renal functions were of no abnormalities before and after treatment. Conclusion Qilin Xintongshu pill can effectively reduce the incidences of cardiovascular events and massive hemorrhage of gastrointestinal tract in patients with NSTE-ACS accompanied by GIB in the therapeutic course of 30 days,therefore this traditional Chinese herbal medicine is an ideal agent for

  2. Effect of stress hyperglycemia on long-term prognosis of patients with ST segment elevation acute myocardial infarction%应激性高血糖对急性ST段抬高型心肌梗死患者远期预后的影响

    Institute of Scientific and Technical Information of China (English)

    李青檀; 王冬梅; 汝磊生; 孙家安; 彭育红

    2013-01-01

    目的:探讨急性ST段抬高型心肌梗死(STEMI)患者发生应激性高血糖的相关危险因素,并评估应激性高血糖对STEMI患者远期预后的影响。方法白求恩国际和平医院2009年8月至2010年4月92例初次发生STEMI的非糖尿病住院患者,根据入院后测定的空腹血糖或随机血糖分A组(应激性高血糖组)41例和B组(血糖正常组)51例。平均随访1.5年。结果应激性高血糖的发生率是44.6%(41/92)。A和B组间经logistic回归分析提示女性(OR=8.952,P=0.013)、心功能Killip分级越高(OR=3.530,P=0.048)、肌酸激酶同工酶(CK-MB)峰值越高(OR=9.408,P<0.001)均是应激性高血糖发生的相关危险因素。Cox回归对A和B组患者1~2年内发生的死亡风险进行分析,提示应激性高血糖是远期死亡(RR 1.532,95%CI 1.004~2.337,P=0.048)的独立预测因子。高甘油三酯血症患者远期死亡风险是正常者1.557倍(P=0.041)。结论女性、Killip分级、CK-MB增高是应激性高血糖发生的相关危险因素。应激性高血糖可能是STEMI患者远期预后不良的独立预测因子和危险因素。高甘油三酯血症可能加重患者的死亡风险。%Objective To evaluate the predictors of stress hyperglycemia in patients with ST segment elevation acute myocardial infarction (STEMI) and the effect of stress hyperglycemia on the long-term prognosis of these patients. Methods A total of 92 patients who had no diabetes but sufferred from STEMI for the first time admitted in our hospital from August 2009 to April 2010 were enrolled in this study. The patients were divided into stress hyperglycemia group (n=41) and normal blood glucose group (n=51) according to the results of fasting blood glucose or random blood glucose after admission. The patients were followed up for 1.5 years on average. Results The prevalence of stress hyperglycemia was 44.6% (41/92). Logistic

  3. Reasons for failed electrocardiographic identification of the infarct-related artery in patients with ST-elevation acute myocardial infarction%体表心电图错误判断或无法判断梗死相关动脉的原因分析

    Institute of Scientific and Technical Information of China (English)

    张晓江; 颜红兵; 郑斌; 宋莉; 王健; 迟云鹏

    2010-01-01

    目的 将体表心电图(ECG)预测的梗死相关动脉(IRA)与冠状动脉造影结果 进行对比分析,以了解判断错误的原因和可能机制.方法 搜集2004年10月至2009年7月就诊的急性ST段抬高心肌梗死(STEMI)患者,入选发病时间≤12 h并且术前有≥2份18导联ECG,排除既往有陈旧性心肌梗死、冠状动脉旁路移植术后、起搏器置入术后或ECG显示有左束支传导阻滞的患者.所有患者入院后都在2 h内施行了急诊冠状动脉造影.采用最常用的ECG标准判断IRA,并与冠状动脉造影结果 进行对比分析.结果 入选STEMI患者1024例,其中854例能够通过ECG判断IRA,96例判断错误,74例无法判断.判断错误和无法判断的170例患者中有76例(44.7%)IRA为左回旋支,66例(38.8%)为右冠状动脉,20例(11.8%)为左前降支,7例(4.1%)为中间支,1例(0.6%)为左主干;27例(15.9%)合并双支病变,47例(27.6%)合并三支病变;8例(4.7%)合并早期复极综合征;6例(3.5%)患者冠状动脉造影提示小分支闭塞.结论 侧支循环影响ECG对IRA的判断.ECG无法判断IRA时最常见于左回旋支病变.解剖变异、早期复极综合征或小分支闭塞也会影响IRA的判断.%Objective The infarct-related artery (IRA) could not always be identified by electrocardiogram (ECG). In the present study, we attempted to explore the reason for failed IRA identification by ECG based on the comparison between ECG records and coronary angiographic findings. Methods All 18-lead ECG records were compared with respective angiographic findings in 1024 consecutive patients with ST elevation myocardial infarction (STEMI) between October 2004 and July 2009.More than two continous18-1ead ECG records were performed within 12 hours of the symptom onset in all patients. Patients with previous myocardial infarction, coronary artery bypass surgery, pacemaker implantation or ECG evidence of left bundle branch block and angiography was performed more than 12 hours

  4. GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估%The Predictive Value for Long-term Prognosis of GRACE Score and SYNTAX Score in Patients With Non-ST Elevation Acute Coronary Syndrome

    Institute of Scientific and Technical Information of China (English)

    张韶辉; 蔺跃栋; 刘立新; 魏广和; 王铁成; 王建军; 安毅; 杨国良; 陈安勇; 郭莹

    2015-01-01

    目的:明确GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征(NSTE-ACS)远期预后的评估价值。  方法:回顾性分析2009-01至2014-01住院诊断为NSTE-ACS的患者共784例,其中单纯药物治疗组410例,支架组325例,CABG组49例。计算患者的GRACE评分和SYNTAX评分,按照评分分为低、中、高危三组。GRACE评分和SYNTAX评分的关系采用Pearson相关分析;生存分析采用Kaplan-Meier法;用Cox比例风险模型进行单因素及多因素分析。计算受试者工作特征(ROC)曲线下面积比较预测方法的优劣性。  结果:研究完成随访784例,随访中位时间为47.7个月。Pearson相关分析显示,GRACE评分和SYNTAX评分存在较弱的正相关(r=0.40,P0.05)。Cox回归和ROC分析显示,GRACE评分和SYNTAX评分对NSTE-ACS的长期预后评估均有重要价值。将GRACE评分、SYNTAX评分及GRACE和SYNTAX联合评分进行ROC曲线分析后发现,三者对NSTE-ACS患者远期MACE风险均有良好的预测价值,但三者的95%可信区间明显重叠,预测价值的差异无统计学意义。  结论:GRACE评分和SYNTAX评分存在相关性,二者对NSTE-ACS的远期预后评估均有重要价值,预测价值无明显差异,即使两者联合也并不提高预测价值。利用GRACE评分对NSTE-ACS患者的远期预后进行低、中、高危分层是适宜的。%Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The

  5. Effect of percutaneous coronary intervention on prognosis of acute ST-segment elevation myocardial infarction in the elderly%介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

    Institute of Scientific and Technical Information of China (English)

    李春华; 丁振江; 王虹; 赵洁; 郝志敏

    2010-01-01

    目的 探讨介入治疗对老年急性ST段抬高性心肌梗死(STEMI)预后的影响. 方法 回顾性分析1998年6月至2008年6月我院心内科住院的STEMI患者1318例,其中老年人338例(25.6%),连续入选符合标准的老年STEMI 316例为研究对象,依据是否行冠状动脉介入治疗(PCI)分两组:PCI组136例(43.0%)和保守治疗组180例(57.0%).收集研究对象的临床资料,并随访2年评价患者预后. 结果 两组患者年龄、性别、高血压、糖尿病、血脂异常、吸烟饮酒史、家族史等比较差异均无统计学意义(P>0.05).两组患者前壁STEMI、心功能Killip Ⅲ~Ⅳ级、静脉溶栓及恶性室性心律失常例数等比较,差异均无统计学意义(P>0.05).随访患者急性心肌梗死二级预防:多数患者戒烟限酒、控制饮食、减轻体质量、坚持运动等,较规律服用预防心室重塑、抗血小板、抗动脉粥样硬化等药物:血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、阿司匹林、β受体阻滞剂、他汀类药物,两组间比较差异无统计学意义(均P>0.05).2年随访发生再梗死、心功能Ⅲ~Ⅳ级住院人数和1个月病死率比较,保守治疗组均高于PCI组(分别为17.2%与2.2%,OR=9.224,95%CI=2.756~30.876;31.1%与8.1%,OR=5.132,95%CI=2.568~10.257;8.3%与1.5%,OR=6.091,95%CI=1.369~27.105,均P<0.01).老年STEMI的1年、2年病死率比较,保守治疗组明显高于PCI组(分别为21.1%与2.2%,OR=11.864,95%CI=3.577~39.349;32.2%与4.41%,OR=10.301,95%CI=4.289~24.736,P<0.01). 结论 PCI可减少老年STEMI发生再梗死、心功能Ⅲ~Ⅳ级住院和1个月病死率,尤其是可明显减少1年、2年病死率.因此,早期PCI可明显改善老年STEMI患者预后.%Objective To investigate the effect of percutaneous eoronary intervention (PCI) on the prognosis of acute ST-segment elevation myocardial infarction (ASTEMI) in the elderly.Methods The 1318 ASTEMI patients in our hospital from June

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

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

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

  7. The impact of elevated serum creatinine on the prognosis of acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李帮清

    2006-01-01

    Objective To evaluate the clinical features and outcomes in patients suffering from acute myocardial infarction combined with elevated serum creatinine. Methods We enrolled 340 consecutive patients suffering from acute myocardial infarction admitted into our hospital from 2003.2.1 -2004.8.31. The patients were divided into the following 2 groups, 269 patients in a group with normal serum creatinine and 71 patients in a group with elevated serum creatinine, according to the normal limit of

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Miranda C Kramer

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

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

    Science.gov (United States)

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

    2016-09-01

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

  11. Systematic use of transradial PCI in patients with ST-segment elevation myocardial infarction: a call to "arms".

    Science.gov (United States)

    Eleid, Mackram F; Rihal, Charanjit S; Gulati, Rajiv; Bell, Malcolm R

    2013-11-01

    A growing body of evidence now supports the use of transradial percutaneous intervention (TRI) as the preferred access site for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Historically, TRI has been avoided in the STEMI population due to concerns over longer procedure time, longer door-to-device time, higher crossover rates, and the experience level required with TRI compared with transfemoral access. However, in recent years, recognition of the impact of periprocedural bleeding on mortality in patients with acute coronary syndromes has garnered interest in the utility of TRI as an established method to reduce bleeding. Registry data, meta-analyses, and randomized control trials all similarly demonstrate that TRI is associated with reduced periprocedural bleeding and lower mortality compared with transfemoral access in the STEMI population. Additional benefits of TRI include enhanced patient comfort, reduced hospital length of stay, and reduced cost. Despite the evidence, trends in use of TRI in the United States have shown a slow adoption rate as a result of multiple barriers in clinical practice and doubts about the mechanism and causal relationship of mortality reduction with TRI. We summarize the current evidence and propose a call to action to foster training of TRI in cardiovascular fellowship programs and post-fellowship courses, and for more widespread implementation of TRI in STEMI patients. PMID:24262613

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

    Directory of Open Access Journals (Sweden)

    Marina Mustilli

    2012-06-01

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

  13. Residual Myocardial Iron Following Intramyocardial Hemorrhage During the Convalescent Phase of Reperfused ST-Segment–Elevation Myocardial Infarction and Adverse Left Ventricular Remodeling

    Science.gov (United States)

    Bulluck, Heerajnarain; Rosmini, Stefania; Abdel-Gadir, Amna; White, Steven K.; Bhuva, Anish N.; Treibel, Thomas A.; Fontana, Marianna; Ramlall, Manish; Hamarneh, Ashraf; Sirker, Alex; Herrey, Anna S.; Manisty, Charlotte; Yellon, Derek M.; Kellman, Peter; Moon, James C.

    2016-01-01

    Background— The presence of intramyocardial hemorrhage (IMH) in ST-segment–elevation myocardial infarction patients reperfused by primary percutaneous coronary intervention has been associated with residual myocardial iron at follow-up, and its impact on adverse left ventricular (LV) remodeling is incompletely understood and is investigated here. Methods and Results— Forty-eight ST-segment–elevation myocardial infarction patients underwent cardiovascular magnetic resonance at 4±2 days post primary percutaneous coronary intervention, of whom 40 had a follow-up scan at 5±2 months. Native T1, T2, and T2* maps were acquired. Eight out of 40 (20%) patients developed adverse LV remodeling. A subset of 28 patients had matching T2* maps, of which 15/28 patients (54%) had IMH. Eighteen of 28 (64%) patients had microvascular obstruction on the acute scan, of whom 15/18 (83%) patients had microvascular obstruction with IMH. On the follow-up scan, 13/15 patients (87%) had evidence of residual iron within the infarct zone. Patients with residual iron had higher T2 in the infarct zone surrounding the residual iron when compared with those without. In patients with adverse LV remodeling, T2 in the infarct zone surrounding the residual iron was also higher than in those without (60 [54–64] ms versus 53 [51–56] ms; P=0.025). Acute myocardial infarct size, extent of microvascular obstruction, and IMH correlated with the change in LV end-diastolic volume (Pearson’s rho of 0.64, 0.59, and 0.66, respectively; P=0.18 and 0.62, respectively, for correlation coefficient comparison) and performed equally well on receiver operating characteristic curve for predicting adverse LV remodeling (area under the curve: 0.99, 0.94, and 0.95, respectively; P=0.19 for receiver operating characteristic curve comparison). Conclusions— The majority of ST-segment–elevation myocardial infarction patients with IMH had residual myocardial iron at follow-up. This was associated with

  14. Parvovirus B19-Induced Constellation of Acute Renal Failure, Elevated Aminotransferases and Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Iain W McAuley

    1997-01-01

    Full Text Available This report details a case of acute renal failure and elevated aminotransferases with subsequent development of congestive heart failure in a patient with history of exposure to parvovirus B19 and serological evidence of acute infection with this agent. This constellation of organ involvement has not been previously reported in the literature.

  15. Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    LIU Yu; CHI Yong-hui; LI Qiang; ZHANG Da-peng; WU Xiao-qing; SUN Hao; GUO Zong-sheng; WANG Le-feng; YANG Xin-chun; GE Yong-gui; WANG Hong-shi; XU Li; LI Wei-ming; NI Zhu-hua; XIA Kun

    2008-01-01

    Background The clinical outcome of percutaneous coronary intervention (PCI) is poorer in women than that in men.This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled.The male group consisted of 143 men aged >55 years,and a female group included 116 women without age limitation.Procedural success was defined as residual stenosis 2 and without death,emergency bypass surgery or disabling cerebral events during the hospitalization.The rate of major adverse cardiac events (MACE),including death,nonfatal myocardial infarction and target vessel revascularization during follow-up,was recorded.Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts.The prevalence of angiographic 3-vessel disease was higher in the female group,but the procedural success rate was comparable between the two groups (94.4% vs 92.2%).The occurrence rate of MACE did not differ during the hospitalization (4.2% vs 6.0%,P=0.50),but was significantly higher in the female group during follow-up (mean (16.0±11.2) months) than that in the male group (5.4% vs 0.7%,P=0.02).Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders,female patients with acute STEMI still have a worse prognosis during the long-term follow-up.

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  17. Long-term antithrombotic pharmacotherapy following ST-elevation myocardial infarction.

    Science.gov (United States)

    Buccheri, Sergio; Capodanno, Davide

    2016-06-01

    The selection and optimal duration of pharmacological agents to counteract thrombotic processes activated in patients with ST-elevation myocardial infarction (STEMI) still remain a debated issue in current clinical practice. Recently published trials have highlighted the potential benefits of dual-antiplatelet therapy (DAPT) extended beyond the currently recommended 12-months term. Anticoagulation with non-vitamin K oral anticoagulants in addition to DAPT has also been explored. Importantly, benefits of prolonged antithrombotic management strategies could be offset by harms following bleeding complications, therefore careful assessment of a patient benefit-risk profile must be used to drive individualized medical decisions. Appraising current available evidence is useful to inform clinical practice and to optimize the pharmacological management of patients with STEMI. Accordingly, we provide an overview of the literature focusing on long-term antithrombotic management strategies in patients with a recent or prior myocardial infarction, with a primary focus on STEMI. PMID:26934659

  18. Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the "risk region" during acute anterior or inferior myocardial infarction.

    Science.gov (United States)

    Vervaat, F E; Bouwmeester, S; van Hellemond, I E G; Wagner, G S; Gorgels, A P M

    2014-01-01

    The myocardial area at risk (MaR) is an important aspect in acute ST-elevation myocardial infarction (STEMI). It represents the myocardium at the onset of the STEMI that is ischemic and could become infarcted if no reperfusion occurs. The MaR, therefore, has clinical value because it gives an indication of the amount of myocardium that could potentially be salvaged by rapid reperfusion therapy. The most validated method for measuring the MaR is (99m)Tc-sestamibi SPECT, but this technique is not easily applied in the clinical setting. Another method that can be used for measuring the MaR is the standard ECG-based scoring system, Aldrich ST score, which is more easily applied. This ECG-based scoring system can be used to estimate the extent of acute ischemia for anterior or inferior left ventricular locations, by considering quantitative changes in the ST-segment. Deviations in the ST-segment baseline that occur following an acute coronary occlusion represent the ischemic changes in the transmurally ischemic myocardium. In most instances however, the ECG is not available at the very first moments of STEMI and as times passes the ischemic myocardium becomes necrotic with regression of the ST-segment deviation along with progressive changes of the QRS complex. Thus over the time course of the acute event, the Aldrich ST score would be expected to progressively underestimate the MaR, as was seen in studies with SPECT as gold standard; anterior STEMI (r=0.21, p=0.32) and inferior STEMI (r=0.17, p=0.36). Another standard ECG-based scoring system is the Selvester QRS score, which can be used to estimate the final infarct size by considering the quantitative changes in the QRS complex. Therefore, additional consideration of the Selvester QRS score in the acute phase could potentially provide the "component" of infarcted myocardium that is missing when the Aldrich ST score alone is used to determine the MaR in the acute phase, as was seen in studies with SPECT as gold

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

    Science.gov (United States)

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

    2016-07-01

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

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

    OpenAIRE

    Eroğlu M et al.

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Eroğlu M et al.

    2011-02-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

  4. Markedly elevated plasma D-dimer and the prevalence of acute pulmonary embolus

    Directory of Open Access Journals (Sweden)

    Andrew W. Bowman

    2011-11-01

    Full Text Available Objective. To evaluate if increasingly elevated levels of plasma D-dimer are associated with higher prevalence of acute pulmonaryembolus (PE. Patients and Methods. A retrospective study wasconducted evaluating all PE protocol CT examinations performed inlow-to-intermediate risk emergency department and hospitalized patients during 2007. All PE protocol CT reports were reviewed for thepresence or absence of acute PE. Th e charts of all of these subjectswere then reviewed for quantitative plasma D-dimer values, measuredin mg/ml Fibrinogen Equivalent Units, drawn within one day prior tothe CT exam. Th e prevalence of acute PE at different D-dimer threshold results was then evaluated using D-dimer groups as follows: < 1.0 mg/ml, ≥ 1.0 but < 2.0 mg/ml, ≥ 2.0 but < 4.0 mg/ml, and ≥ 4.0 mg/ml. Results. 943 PE protocol CT exams were reviewed. 410 subjectshad D-dimer values drawn before their CT exams; 30 (7.3% of thesewere positive for acute PE. As D-dimer values became increasingly elevated, the prevalence of acute PE increased accordingly. In particular, D-dimer elevation ≥4.0 mg/ml was almost 94% specific for acute PE by CT criteria. Conclusion. Increased elevation of plasma D-dimer is associated with increased prevalence of acute PE in low-to-intermediate risk patients.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  6. The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion.

    Science.gov (United States)

    Nimmermark, Magnus O; Wang, John J; Maynard, Charles; Cohen, Mauricio; Gilcrist, Ian; Heitner, John; Hudson, Michael; Palmeri, Sebastian; Wagner, Galen S; Pahlm, Olle

    2011-01-01

    The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.

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

    Institute of Scientific and Technical Information of China (English)

    简芳

    2012-01-01

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

  8. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    OpenAIRE

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

    2011-01-01

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

  9. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Is ST elevation in aVR a sure sign of left main coronary artery stenosis?

    Science.gov (United States)

    Morris, Niall; Body, Richard

    2016-01-01

    A shortcut review was carried out to establish whether ST elevation in aVR accurately identifies acute myocardial infarction caused by left main coronary artery stenosis. 141 unique papers were found in Medline, EMBASE, Cochrane Database of Systematic Reviews, ACP Journal Club and the Database of Abstracts of Reviews of Effects using the reported searches. Of these, 12 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that ST elevation in aVR can identify high-risk patients for early intensive investigation, particularly when found alongside widespread ST depression. It has insufficient utility to identify patients who require immediate revascularisation. PMID:26699191

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张宇晨

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    myocardial infarction; however, its prognostic significance may be limited to patients treated with fibrinolysis. METHODS: In the DANAMI-2 (DANish trial in Acute Myocardial Infarction-2) substudy, including 1,421 patients, the ST-segment elevation at baseline, pre-intervention, 90 min, and 4 h was assessed...

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

    Science.gov (United States)

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

    2005-04-01

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

  17. Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients.

    Science.gov (United States)

    Juliard, Jean-Michel; Golmard, Jean Louis; Himbert, Dominique; Feldman, Laurent J; Delorme, Laurent; Ducrocq, Gregory; Descoutures, Fleur; Sorbets, Emmanuel; Garbarz, Eric; Boudvillain, Olivier; Aubry, Pierre; Vahanian, Alec; Steg, Philippe Gabriel

    2013-06-15

    There is intense interest in examining hospital mortality in relation to gender in ST-segment elevation myocardial infarction. The aim of the present study was to determine whether gender influences outcomes in men and women treated with the same patency-oriented reperfusion strategy. The influence of gender on hospital mortality was tested using multivariate analysis and local regression. The influence of age was tested as a continuous and as a categorical variable. In the overall population of 2,600 consecutive patients, gender was not correlated with hospital mortality except in the subgroup of women aged ≥65 years. The risk for death increased linearly in logit scale for men. Up to the age of 65 years, the risk also increased linearly in women but thereafter increased faster than in men. Testing age as a categorical variable, hospital mortality was higher in women than in men aged ≥75 years but was similar between the genders in the younger age categories. In conclusion, despite following an equal patency-oriented management strategy in men and women with ST-segment elevation myocardial infarctions, the risk for hospital death increased linearly with age but with an interaction between age and gender such that older women had an independent increase in hospital mortality. Longer time to presentation and worse baseline characteristics probably contributed to determine a high-risk subset but reinforce the need to apply, as recommended in the international guidelines in the management of patients with ST-segment elevation myocardial infarctions, the same strategy of acute reperfusion in men and women.

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  19. Firebird sirolimus eluting stent versus bare mental stent in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    GAO Hai; YAN Hong-bing; ZHU Xiao-ling; LI Nan; AI Hui; WANG Jian; LI Shi-ying; YANG Duo

    2007-01-01

    Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction (STEMI). We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent (Firebird stent) and bare metal stent (BMS).Methods Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss (LLL) at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events (MACE) at 6 months.Results During one year period, 156 patients were randomized into the Firebird stent group (101 patients with an average age of 57.8 years) or the BMS group (55 patients with 59.7 years on average). Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up,mortality, target vessel revascularization (TVR) and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group (P<0.05). Subacute thrombosis occurred in 1 patient in both groups,respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group.Conclusion Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.

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

    Science.gov (United States)

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

    2016-07-01

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

  1. Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Kolte, Dhaval; Khera, Sahil; Dabhadkar, Kaustubh C; Agarwal, Shikhar; Aronow, Wilbert S; Timmermans, Robert; Jain, Diwakar; Cooper, Howard A; Frishman, William H; Menon, Venu; Bhatt, Deepak L; Abbott, J Dawn; Fonarow, Gregg C; Panza, Julio A

    2016-01-01

    Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  3. Clinical significance of serum triglyceride elevation at early stage of acute biliary pancreatitis

    OpenAIRE

    Cheng, Long; Luo, Zhulin; Xiang, Ke; Ren, Jiandong; Huang, Zhu; Tang, Lijun; Tian, Fuzhou

    2015-01-01

    Background Pancreatitis induced by hypertriglyceridemia (HTG) has gained much attention. However, very limited numbers of studies have focused on the clinical significance of TG elevation in non-HTG induced pancreatitis, such as acute biliary pancreatitis (ABP). This study aimed to study the clinical significances of triglyceride (TG) elevation in patients with ABP. Methods We retrospectively analyzed a total of 426 ABP cases in our research center. According to the highest TG level within 72...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

  7. Timeliness of Inter-Facility Transfer for Emergency Department Patients with ST-Elevation Myocardial Infarction

    Science.gov (United States)

    Ward, Michael J.; Kripalani, Sunil; Storrow, Alan B.; Liu, Dandan; Speroff, Theodore; Matheny, Michael; Thomassee, Eric J.; Vogus, Timothy J.; Munoz, Daniel; Scott, Carol; Fredi, Joseph L.; Dittus, Robert S.

    2015-01-01

    Objectives Most U.S. hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion and referring EDs are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. Methods We retrospectively analyzed a secondary dataset used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in-door-out [DIDO] interval), time periods that comprised DIDO (door-to-EKG, EKG-to-PCI activation, and PCI activation-to-exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). Results We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (IQR 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was comprised of: door-to-EKG 5 minutes (IQR 2,11), EKG-to-PCI activation 18 minutes (IQR 7,37), and PCI activation-to-exit 44 minutes (IQR 34,56). DIDO accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability=1.37) of these intervals. Conclusions In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision-making and transportation coordination following PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI. PMID:25618768

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  9. 经桡动脉单根 Ikari 指引导管行急诊冠状动脉造影及PCI的评价%A Single Ikari Guiding Catheter for Transradial Coronary Angiography and Intervention in Patients with Acute ST Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    沈剑耀; 王翔; 任品芳; 张志诚

    2013-01-01

    目的探讨急性ST段抬高患者经桡动脉应用单根Ikari指引导管直接行冠状动脉造影及冠状动脉介入(PCI)治疗的可行性和安全性。方法收集急性ST段抬高心肌梗死行急诊经桡动脉PCI治疗的患者,其中使用单根Ikari指引导管者56例(Ikari组),使用左右冠状动脉共用造影导管者63例(对照组)。比较两组患者导管-造影时间、造影时间、D2B时间、C2B时间、操作时间、透视时间。结果两组穿刺置管成功率均为100.0%,导管-造影时间、造影时间无明显差异(均P>0.05)。Ikari组患者造影剂用量、D2B时间、C2B时间、操作时间和透视时间小于对照组(P<0.01或0.05)。结论急性ST段抬高心肌梗死应用单根Ikari指引导管行急诊冠状动脉造影和PCI是安全可行的,能明显减少D2B时间、C2B时间、操作时间和透视时间及造影剂用量。%Objective To investigate the feasibility and safety of using a single Ikari guiding catheter for transradial coronary angiography(CAG) and percutaneous coronary intervention(PCI) in patients with ST elevation myocardial infarc-tion (STEMI). Methods Patients with STEMI underwent emergent CAG and primary PCI via a single Ikari guiding catheter (Ikari group, n=56) or underwent CAG via Tiger catheter and primary PCI via guiding catheters (control group, n=63). Catheterization- to- angiography time,angiographic time, door- to- balloon (DTB) time, cathlab door- to- bal oon (CTB) time, procedure time and fluoroscopy time were analyzed. Results Radial artery cannulation was successful in al patients. There was no significant difference between two groups in catheterization- to- angiography time and angio-graphic time(P>0.05). Contrast consumption, DTB time, CTB time, procedure time and fluoroscopy time were significantly lower in Ikari group than in control group (P<0.01 or 0.05). Conclusion A single Ikari guiding catheter is feasible and safe for CAG and

  10. 非梗死相关血管慢性完全闭塞对行急诊介入治疗的ST段抬高型心肌梗死患者预后的影响%Prognostic Impact of Chronic Total Occlusion on Non-infarct-related Artery in Patients of Acute ST-elevation Myocardial Infarction With Emergent Primary Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    张慧平; 艾虎; 李辉; 赵迎; 唐国栋; 郑耐心; 孙福成

    2016-01-01

    Objective: To study the prognostic impact of chronic total occlusion (CTO) on non-infarct-related artery (non-IRA) in patients of acute ST-elevation myocardial infarction (STEMI) with emergent primary percutaneous coronary intervention (PCI). Methods: In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups:non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death. Results: ①There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group (40.0%vs 20.0%, P=0.049) and (68.0%vs 36.3%, P=0.003);LVEF in CTO group was lower than non-CTO group (40.0 ± 20.1%vs 51.3 ± 15.3%, P Conclusion: Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.%目的:分析非梗死相关血管慢性完全闭塞(CTO)对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者预后的影响。  方法:选择2010-01至2011-06连续在我院确诊急性STEMI并行早期直接PCI治疗的185例患者,分为非梗死相关血管无CTO组(无CTO组)和非梗死相关血管合并CTO组(CTO组),共150例患者完成了1年随访,主要终点为1年时因心绞痛、再次心肌梗死(MI)、心力衰竭而住院或再次血运重建以及心血管死亡。  结果:(1)无CTO组160例(86.5%),CTO组25例(13.5%),CTO组患者糖尿病及冠状动脉三支血管病变的比例均显著高于无CTO组(40.0%vs 20.0%,P=0.049;68.0%vs 36.3%,P=0.003);CTO组左心室射血分数显著低于无CTO组[(40.0±20.1)%vs(51.3±15.3)%,P  结论:非梗死相关血管存在CTO并接受直接PCI的急性STEMI患者多

  11. Effect of PPCI at different time on the prognosis of patients with ST segment elevation myocardial infarction

    OpenAIRE

    Xue-yao FENG; Liu, Li; Jing-tao ZHAO; Song, Hong-Yong; Bei ZHAO; LIU, PEI-LIN; LIU, LI-FENG; Ying-qi LIU; Mao, Shuai; Zhou, Li; Hui-hui XIA; Tie-shan GAO; Shou-li WANG

    2016-01-01

    Objective  To analyze the influence of emergency direct percutaneous coronary intervention (PPCI) at different times on the prognosis of patients with ST segment elevation myocardial infarction (STEMI). Methods  The clinical data of two hundred twenty-three consecutive STEMI patients who were admitted to 306 Hospital of PLA from July 2011 to May 2014 receiving emergency PPCI within 12 hours of symptom onset were retrospectively studied. The patients were divided into three groups according to...

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    1994-01-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    琚保军

    2013-01-01

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

  16. Predictors of delayed pre-hospital presentation among patients with ST-segment elevation myocardial infarction

    Science.gov (United States)

    Albrahim, Mohammed; Ahmed, Amjad M.; Alwakeel, Abdulrahman; Hijji, Faisal; Al-Mallah, Mouaz H.

    2016-01-01

    Background: Early treatment of ST elevation myocardial infarction (STEMI) is essential to improve survival of these patients. However, not all patients present early enough to receive optimal treatment especially in third world countries. Social factors affecting early vs. late treatment have not been studied, particularly in the Middle East. Thus, the aim of this study was to determine the social factors associated with delayed presentation of STEMI patients. Methods: All patients with STEMI presenting to King Abdulaziz Cardiac Center (KACC) between October 2013 and July 2014 were approached. After obtaining consent, patients were interviewed regarding their psychosocial circumstances using a standardized questionnaire. Their medical charts were also reviewed for further clinical data. Patients were divided according to their symptom-to-door time into early ( ≤ 6h) and late (>6h) presentation and group comparisons were conducted. Results: A total of 79 patients were enrolled, of which 24 patients (30%) presented late. Patients with increased symptom-to-door time had higher prevalence of diabetes (40% vs. 79.2%, p = 0.001), hypertension (43.6% vs. 70.8%, p = 0.023), and dyslipidemia (23.6% vs. 54.2%, p = 0.009). Most of the late presenters did not undergo primary coronary intervention (72.7% vs. 47.8%, P = 0.034) and had less prior information about myocardial infarction (43.6% vs. 25%, P = 0.023). Late presenters were more often illiterates and lived most often far away from the hospital. Using multivariate logistic regression; dyslipidemia was the only independent predictor for the late hospital presentation for STEMI patients. Conclusion: One third of patients with STEMI present more than six hours after symptom onset; these patients have a higher prevalence of coronary risk factors and less information about STEMI. Programs should be designed to educate patients and the general public about the symptoms of STEMI and the necessary action to be

  17. ST segment elevation in lead aVR during exercise testing is associated with LAD stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Neill, Johanne; Harbinson, Mark [Royal Victoria Hospital, Regional Medical Cardiology Centre, Belfast (United Kingdom); Queens University, Belfast (United Kingdom); Shannon, Heather J.; Morton, Amanda; Muir, Alison R.; Adgey, Jennifer A. [Royal Victoria Hospital, Regional Medical Cardiology Centre, Belfast (United Kingdom)

    2007-03-15

    To evaluate, in patients with chest pain, the diagnostic value of ST elevation (STE) in lead aVR during stress testing prior to {sup 99m} Tc-sestamibi scanning correlating ischaemic territory with angiographic findings. Consecutive patients attending for {sup 99m} Tc-sestamibi myocardial perfusion imaging (MPI) completed a treadmill protocol. Peak exercise ECGs were coded. STE {>=}0.05 mV in lead aVR was considered significant. Gated perfusion images and findings at angiography were assessed. STE in lead aVR occurred in 25% (138/557) of the patients. More patients with STE in aVR had a reversible defect on imaging compared with those who had no STE in aVR (41%, 56/138 vs 27%, 114/419, p=0.003). Defects indicating a left anterior descending artery (LAD) culprit lesion were more common in the STE in aVR group (20%, 27/138 vs 9%, 39/419, p=0.001). There was a trend towards coronary artery stenosis (>70%) in a double vessel distribution involving the LAD in those patients who had STE in aVR compared with those who did not (22%, 8/37 vs 5%, 4/77, p=0.06). Logistic regression analysis demonstrated that STE in aVR (OR 1.36, p=0.233) is not an independent predictor of inducible abnormality when adjusted for STD >0.1 mV (OR 1.69, p=0.026). However, using anterior wall defect as an end-point, STE in aVR (OR 2.77, p=0.008) was a predictor even after adjustment for STD (OR 1.43, p=0.281). STE in lead aVR during exercise does not diagnose more inducible abnormalities than STD alone. However, unlike STD, which is not predictive of a territory of ischaemia, STE in aVR may indicate an anterior wall defect. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Knudsen Lars

    2012-10-01

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

  19. Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

    Directory of Open Access Journals (Sweden)

    Shuji Akimoto

    2016-08-01

    Full Text Available Serum carbohydrate antigen 19-9 (CA 19-9, a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET-computed tomography (CT findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3 without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

  20. Prospective multi-center study of female patients with ST-elevation myocardial infarction in Liaoning province, China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Bo; LI Yu-ze; SHI Jing-pu; QI Guo-xian; JIANG Da-ming; ZHOU Xu-chen; LIU Jun; ZHANG Wei; SUN Yu-jiao; REN Li-na; ZHANG Zhi-hong; GAO Yuan

    2012-01-01

    Background In cardiology,it is controversial whether gender influences prognosis after acute myocardial infarction (MI).We examined the 30-day and 1-year prognosis for female patients with ST-elevation myocardial infarction (STEMI)in Liaoning province,and we analyzed factors that influenced these outcomes.Methods This was a prospective,multicenter,observational study in which patient data were collected by questionnaire at the time of diagnosis and at approximately 30 days and 1 year later by telephone inquiries.Patients were diagnosed with STEMI between June 1,2009 and June 1,2010 at any of the 20 hospitals that gave treatment representative of current STEMI treatment in Liaoning Province.Unified follow-up questionnaire was used to visit the STEMI patients.Results We analyzed data from a total of 1429 consecutive patients with STEMI in Liaoning province.Female patients were older (70.0 vs.60.3,P <0.001) and were less likely to receive emergency reperfusion therapy than male ones (39.2% vs.58.0%,P <0.001).Female gender was associated with higher unadjusted 30-day mortality rates (HR=2.118,95%C/:1.572-2.854,P <0.001) and higher unadjusted 1-year mortality rates (HR=2.174,95%C/:1.659-2.848,P <0.001).Multivariate Cox regression analysis showed that female gender was not an independent predictor of 30-day mortality rates (HR=1.273,95%C/:0.929-1.745,P=0.133) nor of 1-year mortality rates (HR=1.112,95%C/:0.831-1.487,P=0.475).Conclusions Women with STEMI appear to be at increased risk of 30-day and 1-year mortality compared with male STEMI patients,but this difference may be explained by older age and less frequent receipt of reperfusion therapy among the women.

  1. [Role of the SYNTAX score in assessing the outcomes of percutaneous interventions in patients with ST segment elevation myocardial infarction].

    Science.gov (United States)

    Tarasov, R S; Ganyukov, V I; Barbarash, O L; Barbarash, L S

    2016-01-01

    Based on the findings of a single-centre study of 327 patients presenting with ST segment elevation myocardial infarction (STEMI) subjected to primary percutaneous coronary intervention (PCI) we examined the prognostic role of severity of atherosclerotic multivascular lesion (ML) of the coronary bed. The patients were subdivided into three groups depending on the quantitative index assessing severity of coronary atherosclerosis in points with the help of the SYNTAX scale. Group One was composed of 207 patients with the SYNTAX score≤22 points (moderate lesion), Group Two comprised 89 patients with severe coronary atherosclerosis and the SYNTAX equalling 23-32 points, whereas 31 patients were included into Group Three with extremely severe lesion and the SYNTAX score>32 points. During 30 days and 12 months of follow up we assessed the effect of severity of coronary atherosclerosis on the outcomes of myocardial revascularization. The end points of the study were such unfavourable cardiovascular events as death, recurrent myocardial infarction (MI), secondary unplanned revascularization (SUR) of coronary arteries and in-stent thrombosis (IST). We obtained the findings suggesting that severity of the lesion of the coronary bed according to the SYNTAX scale>23 is associated with a decrease in the global myocardial contractility, increased incidence of postinfarction cardiosclerosis (PICS) and more pronounced manifestation of acute left ventricular insufficiency as compared to patients with moderately pronounced coronary atherosclerosis (SYNTAXSYNTAX score was evidenced both at the stage of the 30-day and 12-month period of follow up, which manifested itself in a considerable increase of frequency of fatal outcomes, in-stent thrombosis and the composite end point amongst patients with severity of the coronary bed lesion by the SYNTAX score>23 points. Thus, the SYNTAX scale developed and adapted for optimal choice of the method of revascularization in patients with

  2. Polyvascular Disease and Long-term Cardiovascular Outcomes in Older Patients with Non–ST-segment Elevation Myocardial Infarction

    Science.gov (United States)

    Subherwal, Sumeet; Bhatt, Deepak L.; Li, Shuang; Tracy Y., Wang; Thomas, Laine; Alexander, Karen P.; Patel, Manesh R.; Ohman, E. Magnus; Gibler, W. Brian; Peterson, Eric D.; Roe, Matthew T.

    2013-01-01

    Background The impact of polyvascular disease (peripheral arterial disease [PAD] and/or cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction (MI) has not been well studied. Methods Non–ST-elevation MI (NSTEMI) patients aged ≥65 years from the CRUSADE registry who survived to hospital discharge were linked to longitudinal data from the Centers for Medicare and Medicaid Services (n=34,205). All patients were presumed to have coronary artery disease (CAD) and were classified into 4 groups: 10.7% had prior CVD (CAD+CVD group); 11.5% had prior PAD (CAD+PAD); 3.1% had prior PAD and CVD (CAD+PAD+CVD); and 74.7% had no polyvascular disease (CAD alone). Cox proportional hazard modeling was used to examine the hazard of long-term mortality and the composite of death, readmission for MI, or readmission for stroke (median follow-up 35 months, IQR 17–49) among the 4 groups. Results Compared with the CAD-alone group, patients with polyvascular disease had a greater comorbidity burden, were less likely to undergo revascularization, and less often received recommended discharge interventions. Three-year mortality rates increased with a greater number of arterial beds involved: 33% for CAD alone, 49% for CAD+PAD, 52% for CAD+CVD, and 59% for CAD+PAD+CVD. Relative to the CAD-alone group, patients with all 3 arterial beds involved had the highest risk of long-term mortality (adjusted HR [95% CI]: 1.49 [1.38–1.61], with a lower risk for those with CAD+CVD, 1.38 [1.31–1.44], and those with CAD+PAD, 1.29 [1.23–1.35]). Similarly, the adjusted risk of long-term composite ischemic events was highest among the CAD+PAD+CVD group. Conclusions Older NSTEMI patients with polyvascular disease have substantially higher long-term risk, such that the 3-year mortality rate is >50%. Future studies targeting greater adherance to secondary prevention strategies and novel therapies are needed to help reduce long

  3. A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Samai, Alyana A.; Boehme, Amelia K.; Shaban, Amir; George, Alexander J.; Dowell, Lauren; Monlezun, Dominique J.; Leissinger, Cindy; Schluter, Laurie; El Khoury, Ramy; Martin-Schild, Sheryl

    2016-01-01

    Background and Purpose Elevated levels of coagulation factor VIII (FVIII) may persist independent of the acute-phase response; however, this relationship has not been investigated relative to acute ischemic stroke (AIS). We examined the frequency and predictors of persistently elevated FVIII in AIS patients. Methods AIS patients admitted between July 2008 and May 2014 with elevated baseline FVIII levels and repeat FVIII levels drawn for more than 7 days postdischarge were included. The patients were dichotomized by repeat FVIII level for univariate analysis at 150% and 200% activity thresholds. An adjusted model was developed to predict the likelihood of persistently elevated FVIII levels. Results Among 1616 AIS cases, 98 patients with elevated baseline FVIII had repeat FVIII levels. Persistent FVIII elevation was found in more than 75% of patients. At the 150% threshold, the prediction score ranged from 0 to 7 and included black race, female sex, prior stroke, hyperlipidemia, smoking, baseline FVIII > 200%, and baseline von Willebrand factor (vWF) level greater than 200%. At the 200% threshold, the prediction score ranged from 0–5 and included female sex, prior stroke, diabetes mellitus, baseline FVIII level greater 200%, and baseline vWF level greater than 200%. For each 1-point increase in score, the odds of persistent FVIII at both the 150% threshold (odds ratio [OR] = 10.4, 95% confidence interval [CI] 1.63–66.9, P = .0134) and 200% threshold (OR = 10.2, 95% CI 1.82–57.5, P = .0083) increased 10 times. Conclusion Because an elevated FVIII level confers increased stroke risk, our model for anticipating a persistently elevated FVIII level may identify patients at high risk for recurrent stroke. FVIII may be a target for secondary stroke prevention. PMID:26777556

  4. Increased rate of stent thrombosis and target lesion revascularization after filter protection in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: 15-month follow-up of the DEDICATION (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Kaltoft, Anne; Kelbaek, Henning; Kløvgaard, Lene;

    2010-01-01

    The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).......The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI)....

  5. Safety and efficacy of hybrid platform design sirolimus eluting stent system in percutaneous coronary intervention in ST elevation myocardial infarction patients at 1 year after treatment

    Directory of Open Access Journals (Sweden)

    Louie Fisher

    2016-10-01

    Conclusions: In contemporary practice of percutaneous coronary intervention in ST Elevation Myocardial Infarction, Genxsync stent was associated with low risks of stent thrombosis and MACE. [Int J Res Med Sci 2016; 4(10.000: 4458-4464

  6. Effect of high loading dose of clopidogrel plus tirofiban on percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome%高负荷氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合征经皮冠状动脉介入治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    齐丽平

    2012-01-01

    目的 探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST段抬高型急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的作用及安全性.方法 152例拟行PCI术的高危非ST段抬高型ACS患者,术前口服氯吡格雷600 mg+替罗非班0.4 μg/(kg·min)静脉注射30 min,继以0.1μg/(kg·min)持续静脉泵入至术后36h者72例为观察组,术前仅口服氯吡格雷600 mg者80例为对照组,观察PCI术后TIMI血流分级、心肌灌注、30 d内主要不良心血管事件和出血并发症发生率.结果 PCI术后观察组患者心肌灌注分级TMPG 2级以上发生率(87.5%)高于对照组(72.5%)(P<0.05),观察组校正TIMI计帧数(24.70±6.60)小于对照组(27.33±6.42)(P<0.05);2组PCI术后病变血管血流TIMI 3级发生率比较差异无统计学意义(P>0.05);观察组30 d主要不良心血管事件发生率(9.7%)低于对照组(23.8%)(P<0.05),2组出血事件发生率比较差异无统计学意义(P>0.05).结论 PCI术前静脉应用替罗非班联合高负荷剂量氯吡格雷,可改善ACS患者PCI术后心肌灌注、减少30 d内主要心血管事件发生率,且不增加出血风险.%Objective To evaluate the effect and safety of high loading dose of clopidogrel plus tirofiban on percutaneous coronary intervention (PCI) m patients with high-risk non-S I -segment elevation acute coronary syndrome (ACS). Methods A total of 152 patients with high-risk non-ST-segment elevation ACS who needed percutaneous coronary intervention were divided into experimental group (n = 72) and control group (n = 80). The experimental group received oral administration of clopidogrel 600 rag plus tirofiban intravenous injection of 0. 4 μg/(kg · min) for 30 minutes before operation, and followed by continuous tirofiban intravenous injection of 0. 1 μg/(kg · mini by 36 hours after opration. The control group received oral administration

  7. Association between Periodontal Disease and Elevated C-reactive Protein in Acute Myocardial Infarction Patients

    OpenAIRE

    G. Radafshar; B. Shad; M. Mirfeizi

    2006-01-01

    Statement of problem: Periodontal disease (PD) has been linked to adverse cardiovascular events by unknown mechanisms. C-reactive protein (CRP) is a prognostic marker for cardiovascular disease, with reported elevated serum levels during PD.Purpose: The aim of the present study was to evaluate the association between PD and higher CRP levels in the serum of acute myocardial infarction (AMI) patients.Materials and Methods: In this cross-sectional study, periodontal examinations and CRP serum l...

  8. An unusual case of ST-segment elevation myocardial infarction following a late bare-metal stent fracture in a native coronary artery: a case report

    Directory of Open Access Journals (Sweden)

    Minardi Giovanni

    2009-11-01

    Full Text Available Abstract Introduction A bare-metal stent fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome is a rare clinical event that, to the best of our knowledge, has previously not been reported. A stent fracture is a rare complication arising from percutaneous coronary intervention. Case presentation We present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation. Conclusion A coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction in a native coronary artery. It was diagnosed angiographically and treated early and effectively.

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

    OpenAIRE

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  11. Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Risgaard, Bjarke; Fosbol, Emil L;

    2015-01-01

    We aimed to assess the risk factors and outcome of ventricular fibrillation (VF) before and duringprimary percutaneous coronary intervention (PPCI) in patients with ST-segment elevationmyocardial infarction. From 1999 to 2012, we consecutively enrolled 5,373 patients withST-segment elevation myoc...

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

    Science.gov (United States)

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

    2012-01-01

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

  13. Are there Ethnic inequalities in revascularisation procedure rate after an ST-elevation myocardial infarction?

    NARCIS (Netherlands)

    Van Oeffelen, Aloysia A M; Rittersma, Saskia; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    Background: Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisatio

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

    Directory of Open Access Journals (Sweden)

    Taillon Heather

    2009-07-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Hoang Pham; James Nguyen; Liang Ge; Thach Nguyen

    2006-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  17. Acute nitric oxide synthase inhibition and endothelin-1-dependent arterial pressure elevation

    Directory of Open Access Journals (Sweden)

    Robert eRapoport

    2014-04-01

    Full Text Available Key evidence that endogenous nitric oxide (NO inhibits the continuous, endothelin (ET-1-mediated drive to elevate arterial pressure includes demonstrations that ET-1 mediates a significant component of the pressure elevated by acute exposure to NO synthase (NOS inhibitors. This review examines the characteristics of this pressure elevation in order to elucidate potential mechanisms associated with the negative regulation of ET-1 by NO and, thereby, provide potential insight into the vascular pathophysiology underlying NO dysregulation. We surmise that the magnitude of the ET-1-dependent component of the NOS inhibitor-elevated pressure is 1 independent of underlying arterial pressure and other pressor pathways activated by the NOS inhibitors and 2 dependent on relatively higher NOS inhibitor dose, release of stored and de novo synthesized ET-1, and ETA receptor-mediated increased vascular resistance. Major implications of these conclusions include: 1 the marked variation of the ET-1-dependent component, i.e., from 0-100% of the pressure elevation, reflects the NO-ET-1 regulatory pathway. Thus, NOS inhibitor-mediated, ET-1-dependent pressure elevation in vascular pathophysiologies is an indicator of the level of compromised/enhanced function of this pathway; 2 NO is a more potent inhibitor of ET-1-mediated elevated arterial pressure than other pressor pathways, due in part to inhibition of intravascular pressure-independent release of ET-1. Thus, the ET-1-dependent component of pressure elevation in vascular pathophysiologies associated with NO dysregulation is of greater magnitude at higher levels of compromised NO.

  18. St. Croix, U.S. Virgin Islands Coastal Digital Elevation Model

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA's National Geophysical Data Center (NGDC) is building high-resolution digital elevation models (DEMs) for select U.S. coastal regions. These integrated...

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

    Directory of Open Access Journals (Sweden)

    Jacopo Gianetti

    2013-01-01

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

  20. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction.

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    Siamak Abdi

    2015-03-01

    Full Text Available Serum troponin elevation, characteristic of ischemic myocardial injury, has been observed in some acute ischemic stroke (AIS patients. Its cause and significance are still controversial. The purpose of this study is to find determinants of troponin elevation and its relationship with stroke severity and location.Between January 2013 and August 2013, 114 consecutive AIS patients confirmed by diffusion-weighted magnetic resonance imaging were recruited in this study. Serum troponin T level was measured as part of routine laboratory testing on admission. Ten lead standard electrocardiogram (ECG was performed and stoke severity was assessed based on National Institutes of Health Stroke Scale (NIHSS.Troponin T was elevated in 20 (17.6% of 114 patients. Patients with elevated troponin were more likely to have higher age, higher serum creatinine and ischemic ECG changes. Troponin levels were higher in patients with more severe stroke measured by NIHSS [7.96 (6.49-9.78 vs. 13.59 (10.28-18.00]. There was no association between troponin and locations of stroke and atrial fibrillation. There were 6 (5% patients with elevated troponin in the presence of normal creatinine and ECG.Stroke severity, not its location, was associated with higher troponin levels. Abnormal troponin levels are more likely, but not exclusively, to be due to cardiac and renal causes than cerebral ones.

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

    Science.gov (United States)

    Paech, Christian; Gebauer, Roman Antonin

    2014-01-01

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

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

    Science.gov (United States)

    Paech, Christian; Gebauer, Roman Antonin

    2014-01-01

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

  3. Outcome of the HORIZONS-AMI trial: bivalirudin enhances long-term survival in patients with ST-elevation myocardial infarction undergoing angioplasty

    Directory of Open Access Journals (Sweden)

    Feldman DN

    2012-02-01

    Full Text Available Ashish Shah, Dmitriy N FeldmanGreenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USAAbstract: Cardiovascular disease is the leading cause of death in the US. For patients with ST-elevation myocardial infarction (STEMI, urgent reperfusion of the culprit arterial occlusion, often achieved via primary percutaneous coronary intervention (PCI, reduces post-MI mortality and other major adverse cardiovascular events (MACE. Adjunctive antithrombotic and antiplatelet therapies are used during PCI to reduce MACE rates. Currently, a variety of antithrombotic options are available for peri-procedural use. The most commonly used agents include unfractionated heparin or low molecular weight heparin ± glycoprotein IIb/IIIa inhibitors (GPI. These agents reduce the rates of peri-procedural ischemic and thrombotic events, though these benefits come at the cost of an increase in bleeding complications. Bivalirudin is a direct thrombin inhibitor with a short half-life and linear pharmacokinetics, which results in predictable serum concentrations and anticoagulant effect. Bivalirudin has emerged as an efficacious and safe alternative to heparin plus GP IIb/IIIa inhibitors in both stable coronary artery disease and acute coronary syndrome patients. In the HORIZONS-AMI trial, monotherapy with bivalirudin was compared with the combination of heparin and a GPI in a large population of patients with STEMI who underwent primary PCI. Bivalirudin treatment was associated with improved event-free survival at 30 days and reduced rates of major bleeding. Based on the results of the trial, the American College of Cardiology/American Heart Association and European Society of Cardiology guidelines have incorporated recommendations for bivalirudin use in the setting of STEMI. Recently, 3-year follow-up data from the HORIZONS-AMI cohort were published, demonstrating sustained benefits in patients treated with bivalirudin

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

    Institute of Scientific and Technical Information of China (English)

    Lin Yuan; Shao-Ping Nie

    2016-01-01

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

  5. Comparative effects of percutaneous coronary intervention for infarct-related artery only or for both infarct-and non-infarct-related arteries in patients with ST-elevation myocardial infarction and multi-vessel disease

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; WANG Bin; WANG Xiao-zeng; LI Yi; WANG Shou-li; JING Quan-min; WANG Geng; MA Ying-yan; LUAN Bo

    2008-01-01

    Background Rapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI),but strategy for treatment of non-IRA lesions in this setting remains unclear.This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.Methods A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing≥70%) undergoing primary PCI were included.Of them,149 patients underwent primary PCI for IRA only (group 1),and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2).Drug-eluting stents (DESs) were deployed in more than 90% of the patients.Results The two groups did not differ with respect to baseline clinical and angiographic characteristics.No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%,P>0.05) and target lesion revascularization (8.1% vs 7.6%,P>0.05) between the two groups.However,patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%,P<0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56±0.22 vs 0.63±0.25,P <0.05).Conclusion With the use of DESs,complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

  6. Acute effects of fine particulate air pollution on ST segment height: A longitudinal study

    Directory of Open Access Journals (Sweden)

    Wu Rongling

    2010-11-01

    Full Text Available Abstract Background The mechanisms for the relationship between particulate air pollution and cardiac disease are not fully understood. Air pollution-induced myocardial ischemia is one of the potentially important mechanisms. Methods We investigate the acute effects and the time course of fine particulate pollution (PM2.5 on myocardium ischemic injury as assessed by ST-segment height in a community-based sample of 106 healthy non-smokers. Twenty-four hour beat-to-beat electrocardiogram (ECG data were obtained using a high resolution 12-lead Holter ECG system. After visually identifying and removing all the artifacts and arrhythmic beats, we calculated beat-to-beat ST-height from ten leads (inferior leads II, III, and aVF; anterior leads V3 and V4; septal leads V1 and V2; lateral leads I, V5, and V6,. Individual-level 24-hour real-time PM2.5 concentration was obtained by a continuous personal PM2.5 monitor. We then calculated, on a 30-minute basis, the corresponding time-of-the-day specific average exposure to PM2.5 for each participant. Distributed lag models under a linear mixed-effects models framework were used to assess the regression coefficients between 30-minute PM2.5 and ST-height measures from each lead; i.e., one lag indicates a 30-minute separation between the exposure and outcome. Results The mean (SD age was 56 (7.6 years, with 41% male and 74% white. The mean (SD PM2.5 exposure was 14 (22 μg/m3. All inferior leads (II, III, and aVF and two out of three lateral leads (I and V6, showed a significant association between higher PM2.5 levels and higher ST-height. Most of the adverse effects occurred within two hours after PM2.5 exposure. The multivariable adjusted regression coefficients β (95% CI of the cumulative effect due to a 10 μg/m3 increase in Lag 0-4 PM2.5 on ST-I, II, III, aVF and ST-V6 were 0.29 (0.01-0.56 μV, 0.79 (0.20-1.39 μV, 0.52 (0.01-1.05 μV, 0.65 (0.11-1.19 μV, and 0.58 (0.07-1.09 μV, respectively, with all p

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kanka David

    2007-09-01

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

  9. Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease.

    Directory of Open Access Journals (Sweden)

    Dongfeng Zhang

    Full Text Available BACKGROUND: The best strategy for ST-segment elevation myocardial infarction (STEMI patients with multivessel disease (MVD, who underwent primary percutaneous coronary intervention (PCI in the acute phase, is not well established. OBJECTIVES: Our goal was to conduct a meta-analysis comparing culprit vessel only percutaneous coronary intervention (culprit PCI with multivessel percutaneous coronary intervention (MV-PCI for treatment of patients with STEMI and MVD. METHODS: Pubmed, Elsevier, Embase, and China National Knowledge Infrastructure (CNKI databases were systematically searched for randomized and nonrandomized studies comparing culprit PCI and MV-PCI strategies during the index procedure. A meta-analysis was performed using Review Manager 5.1 (Cochrane Center, Denmark. RESULTS: Four randomized and fourteen nonrandomized studies involving 39,390 patients were included. MV-PCI strategy is associated with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002, long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001, and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03 compared with culprit PCI strategy, while it reduced the incidence of revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001. CONCLUSIONS: This meta-analysis supports current guidelines which indicate that the non-culprit vessel should not be treated during the index procedure.

  10. Progressed Multivessel Spontaneous Coronary Artery Dissection That Naturally Healed in a Male Patient with Non-ST Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Tatsuo Haraki

    2016-01-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare condition that may have a serious outcome because of acute coronary syndrome. The condition especially affects young women. We evaluated a middle-aged male patient with a non-ST segment elevation myocardial infarction caused by multivessel SCAD. The SCAD had occurred in the distal right coronary artery (RCA, the mid left anterior descending artery (LAD, and the distal LAD at the same time. His culprit lesion was in the distal RCA, but the SCAD had progressed more proximally within the RCA 12 days later with no clinical symptoms. We treated the mid LAD with implantation of a drug-eluting stent on admission and the SCAD had not progressed 12 days later. Moreover, the SCAD in the distal RCA and distal LAD healed spontaneously 12 days later. He had no recurrent attack, and all SCAD lesions of the RCA and LAD had completely healed 6 months later. Given that SCAD appears in various forms over the clinical course, a strategy of intervention needs careful consideration.

  11. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien;

    2015-01-01

    BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin...... with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively (p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST......-segment resolution either before or after the index procedure. CONCLUSIONS: Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies....

  12. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune H;

    2016-01-01

    BACKGROUND: Global longitudinal systolic strain (GLS) has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI). The aim of this study was to evaluate the prognostic value of regional longitudinal...... myocardial deformation in comparison to GLS, conventional echocardiography and clinical information. METHOD: In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All...... patients were examined by tissue Doppler imaging (TDI) and two-dimensional strain echocardiography (2DSE). RESULTS: During a median-follow-up of 5.3 (IQR 2.5-6.1) years the primary endpoint (death, heart failure or a new MI) was reached by 145 (38.9%) patients. After adjustment for significant confounders...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  14. Letter regarding article "Primary coronary angioplasty for ST-°©‐Elevation Myocardial Infarction in Qatar: First nationwide program"

    Directory of Open Access Journals (Sweden)

    Mohamed Badreldin Elshazly

    2012-03-01

    Full Text Available Dear Editor: In their article “Primary Coronary Angioplasty for ST-Elevation Myocardial Infarction (STEMI in Qatar: First Nationwide Program”, Gehani et al. developed an impressive plan to implement primary percutaneous coronary intervention (PCI for the first time in Qatar [1]. As a graduate of Weill Cornell Medical College in Qatar, I have witnessed immense improvement in the Qatari healthcare system over the past few years. From building the new state of the art Heart Hospital to developing the first unified nationwide primary PCI program in the world, there is no doubt that Qatar has made an immense leap towards implementing world-class cardiovascular healthcare in the Middle East.

  15. Stent Thrombosis is the Primary Cause of ST-Segment Elevation Myocardial Infarction following Coronary Stent Implantation

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Galløe, Anders M; Thuesen, Leif;

    2014-01-01

    Background: The widespread use of coronary stents has exposed a growing population to the risk of stent thrombosis, but the importance in terms of risk of ST-segment elevation myocardial infarctions (STEMIs) remains unclear. Methods: We studied five years follow-up data for 2,098 all-comer patients...... treated with coronary stents in the randomized SORT OUT II trial (mean age 63.6 yrs. 74.8% men). Patients who following stent implantation were readmitted with STEMI were included and each patient was categorized ranging from definite-to ruled-out stent thrombosis according to the Academic Research...... Consortium definitions. Multivariate logistic regression was performed on selected covariates to assess odds ratios (ORs) for definite stent thrombosis. Results: 85 patients (4.1%), mean age 62.7 years, 77.1% men, were admitted with a total of 96 STEMIs, of whom 60 (62.5%) had definite stent thrombosis...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  17. Pre-infarction angina and outcomes in non-ST-segment elevation myocardial infarction: data from the RICO survey.

    Directory of Open Access Journals (Sweden)

    Luc Lorgis

    Full Text Available BACKGROUND: The presence of pre-infarction angina (PIA has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI. However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs, heart failure and 30-day mortality were collected. Among the 1541 patients included in the study, 693 (45% patients presented PIA. PIA was associated with a lower creatine kinase peak, as a reflection of infarct size (231(109-520 vs. 322(148-844 IU/L, p<0.001 when compared with the group without PIA. Patients with PIA developed fewer VAs, by 3 fold (1.6% vs. 4.0%, p = 0.008 and heart failure (18.0% vs. 22.4%, p = 0.040 during the hospital stay. Overall, there was a decrease in early CV events by 26% in patients with PIA (19.2% vs. 25.9%, p = 0.002. By multivariate analysis, PIA remained independently associated with less VAs. CONCLUSION: From this large contemporary prospective study, our work showed that PIA is very frequent in patients admitted for a first NSTEMI, and is associated with a better prognosis, including reduced infarct size and in hospital VAs. Accordingly, protecting the myocardium by ischemic or pharmacological conditioning not only in STEMI, but in all type of MI merits further attention.

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

    Directory of Open Access Journals (Sweden)

    Lei Zhang

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王树碧

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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